BAMENDA, CAMEROON – At a large compound in Bamenda, the capital of Cameroon’s Northwest region, a series of apartments houses more than 15 residents. Those residents share just one pit toilet.
Yvette points to the apartment that was hers in the compound until some months ago, when she moved out.
“All of us in the compound shared two bathrooms and one pit toilet that was almost full,” she says. “I got sick of the situation and had to move to a new compound where, though I still share the toilets with my neighbors, am a little satisfied that at least we have more than one toilet and it is modern.”
Besides the pressure of waiting in a queue to use the toilet in her old neighborhood, Yvette says that on rainy nights, it was very difficult to go to the toilet at all because it lacked a proper roof. So, many tenants would poop in plastic bags or pails and dispose of it in the morning, she says.
Yvette and her former neighbors are not alone in this sanitation dilemma. Open defecation is a common practice in Cameroon. Still, it is considered a shameful topic for young women to discuss, so Yvette requested her last name be withheld. Moreover, public defecation creates numerous health risks.
Thousands of residents of Bamenda and other cities in Cameroon don’t have access to toilets because of a lack of public and private facilities. The government has built some facilities, but it admits it’s not enough. A sanitation team strives to discourage residents from open defecation, the elimination of which is crucial in preventing outbreaks of cholera and other sanitation-related diseases. Meanwhile, nongovernmental organizations have initiated campaigns to improve sanitation facilities and practices.
Sanitation is a human right and key in disease prevention, according to the World Health Organization. WHO predicts that 2.7 billion people – about 40 percent of the world’s population – will be without access to basic sanitation by 2015 if current trends continue. Cholera outbreaks are a result of inadequate water supplies, sanitation, food safety and hygiene practices.
Less than half of Cameroon’s population has access to improved sanitation facilities, according to UNICEF’s latest statistics from 2008.
Musa Usman Ndamba is the president of Bamenda Traders and Economic Operators Union, an association of more than 1,000 small businesses in the city that advocate for labor rights and better working conditions. He says that public bathrooms are lacking here, estimating that there are 5,000 traders occupying 1,000 shops in the city’s main market – yet just a few toilets for them and their customers to use.
“These traders, plus the thousands of people who visit the market, are disposed to two urina[ls] and four toilets provided by the local council,” he says.
Traders and customers must pay 50 francs (10 cents) to use the toilet, he says. The number of toilets are few, and the maintenance is poor. During the rainy seasons, the toilets often flood. Because they are located near the stalls that sell food, this puts the traders and the public at high risk for disease. The risk is even greater for women, who must squat to use the toilets, because of their proximity to the waste.
Ndamba says his union has written to the council appealing for positive action to protect the health of the traders and the public.
Ndumu Vincent Nji, delegate from the federal government to the Bamenda City Council, acknowledges that most of the public toilet facilities in his town need maintenance and improvement. He says that during the past 30 years, the population of the town and the number of dwellings have increased.
“Sadly enough, this has not been matched with the provision of appropriate and modern toilet facilities,” he says.
Nji says his administration prioritizes sanitation and hygiene, carrying out daily cleaning exercises around the city. But, he says they are yet to fully deal with the issue of city dwellers defecating in the open or defecating in plastic bags and tossing them into gutters.
The government acknowledges that homes and businesses either have poorly constructed toilet facilities or none at all. Still, Nji says that users must also take responsibility for their actions. He says some citizens still defecate in the open, even when the government provides facilities for them to use. Others abuse these facilities by improperly using the toilets, forcing the next users to go outside.
“It’s very shocking what people will do in the environments where they live, forgetting that their health will be affected adversely,” Nji says.
He recognizes that when people don't see a problem, they don't push for solutions.
To press for a solution, the city council has a sanitation and hygiene department that supervises sanitation in the town and also educates the public on the dangers of open defecation.
Mathias Nouboussi, sanitation and hygiene officer for Bamenda, says that he and his team of four circle the town to check on the general sanitation conditions. When they find citizens violating the hygiene laws governing the city, Nouboussi says they educate them. If the people continue to violate the laws, the team gives out sanctions.
People who refuse to follow rules or defecate in unauthorized areas are liable to fines ranging from 5,000 francs ($10) to 10,000 francs ($20), according to the municipality code. Residences or businesses within the council area that do not dispose of excrement properly are liable to pay fines ranging from 5,000 francs ($10) to 100,000 francs ($200).
Eliminating open defecation is key to preventing cholera outbreaks and other sanitation-related diseases, according to health experts and organizations. Two years ago, Cameroon had its worst cholera outbreak in six years, according to WHO.
“As long as people continue to defecate in the open and neglect their personal hygiene, the threat of cholera will continue to loom around us,” says Dr. Julius Sama, in charge of cholera prevention and control in Cameroon’s Northwest region.
“This year, we have had three suspected cases in the Northwest region,” he says. “It turned out the patients were not suffering from cholera.”
But Sama cautions that when large numbers of people are defecating and urinating outdoors, it's extremely difficult to avoid ingesting human waste, either because it enters the food or water supplies or it’s spread by flies and dust.
Sama says that health units in the region are prepared to intervene in case of an outbreak. Besides the risk of a cholera outbreak, though, Sama says that open defecation and poor hygiene remains a big threat to the health of the population, and especially schoolchildren, who can contract intestinal worms.
In addition to government efforts, Plan International, an international development charity, is collaborating with the Centre for Low-Cost Water Supply and Sanitation, now Water Sanitation Africa, which develops and promotes innovative approaches to water, sanitation and hygiene. The duo is currently carrying out a hygiene and sanitation campaign as part of Plan’s one household, one latrine initiative in Cameroon, which strives to equip each home with its own toilet. The campaign employs a door-to-door method to raise awareness about sanitation and to improve knowledge of the importance of clean water and hand-washing to disease prevention.
Plan has built 48 new latrines in Bafut, a village on the outskirts of Bamenda. This increases the households in the village with a toilet to 71 percent and reduces open defecation there by 65 percent, according to Plan. This also minimizes the risk of a cholera outbreak in the village, which affected more than 200 people and resulted in eight deaths last year.
