Breaking the cycle of disease, debt and despair

Sita rests in the shade of her mango tree, relishing the cool air and heady fragrance. She can enjoy these little moments now.

Her compound has been swept spotless, the children’s clothes flutter on the washing line, the kaba toh (maize flour) is prepared for lunch.

What’s evident in Yalo village these days is what’s absent. The flies, the stench, the suffocating panic in Sita’s chest.

Five years ago, she was suicidal. She and her husband, Ankoma, were deep in debt. The meagre pay they earned harvesting cashews didn’t cover all the family’s trips to the health clinic a few miles away. Sometimes the nurses would give them a week’s grace to settle up. Sometimes, Sita managed to borrow from neighbours. But the bills stacked up.

The children were sick often. Diarrhoea can be fatal in remote rural communities in north-east Ivory Coast, so life was precarious.

‘We felt trapped,’ Sita says. ‘We didn’t want to live any more. We asked: What’s the point in living if you’re in debt to everyone?’

A humble hero

What changed everything for Sita and her family was something simple: a toilet.

Before, like everyone else in Yalo, they went to the toilet outdoors. Hence the flies, the smell, the diarrhoea, the vicious cycle of debt, disease, despair.

Our partner Medical Assistance Programme (MAP) taught Sita and Ankoma to dig a pit and construct a toilet enclosure. Almost overnight, the family’s health started to improve.

But this transformation took a significant investment of time, education and training. MAP’s team had first to convince Sita and her neighbours about the importance of clean water, proper toilets and good hygiene. Villagers had to understand why not having a toilet was trapping them in poor health and poverty.

MAP set up a new community water pump and a village committee to maintain it. But families built their own toilets and they’re immensely proud of them.

‘Now, thank God, our village is clean and doesn’t smell any more,’ says Sita. ‘My family is much healthier. I returned the money I owed, thanked my neighbours and I felt great. Now we have money to send our children to school.’

The bottom line

Building a simple pit latrine was the first practical step Sita and Ankoma took to set their life on a course out of poverty.

Now their finances are not haemorrhaging into the health clinic, they have saved enough to start building a new home. And now that everyone in Yalo is committed to keeping their village clean, the paths and communal areas are unrecognisable.

Toilets are a hugely cost-effective driver of development. According to World Health Organisation calculations, every £1 spent on sanitation has a return of £5.50, thanks to increased productivity and lower health care costs. The WHO estimates that a quarter of children’s deaths could be prevented by limiting ‘environmental risks’, including dirty water, poor sanitation and inadequate hygiene.

Yet, sanitation remains a neglected sector in international efforts to reach the Sustainable Development Goals. In Ivory Coast, still only ten per cent of people in rural areas have access to proper sanitation.

Where sanitation projects are taking place, they’re having a dramatic impact. So far, 90 villages – including Sita’s – have been declared ‘Open Defecation Free’ as a result of MAP’s work in Bounkani region. Their success is already self-replicating as neighbouring communities have started building toilets themselves, even before MAP has arrived.

For Sita, the economic benefits are clear. But there are other rewards too, less tangible but no less life-changing: privacy, dignity, hope and the fragrance of ripe mango… Priceless.