06/17/2010 02:49 pm ET Updated May 25, 2011

The Sanitation Problem in Mentawai: Watch What You Eat

A provocative new technique called Community-led Total Sanitation (CLTS) is successfully challenging mainstream sanitation models through empowerment.

I first went to the remote Mentawai islands, off Indonesia's West Sumatran coast, in 1999 in pursuit of waves; waves groomed into surfing perfection from their stormy beginnings at the formidable Cape of Good Hope, in Africa. I ended up spontaneously running a clinic in a village that had never seen a doctor and where many children were left dying and suffering from preventable diseases. After a strident but short-lived resistance from my voice of self interest, SurfAid was born -- a nonprofit dedicated to improving the health, wellbeing and self-reliance of people living in remote locations connected to us by surfing.

The one observation that continually hammered at my Western sensitivities was the hygiene and sanitation practices of the people. SurfAid's baseline studies for the Mentawai showed that less than 10 percent of women washed their hands after changing their baby's dirty pants and community members were defecating everywhere, even squatting over their pig pens -- raising both pork meat and squadrons of disease-carrying flies. If we were to help these people and eradicate a leading cause of child mortality and morbidity, it would be essential to find a way to help them change their perceptions and behavior surrounding excrement.

Our human condition and mindset, with our love of the tangible and visible, often leads us astray from the path to greater cost-effective impact. Case in point: the current worldwide sanitation model is unfortunately still based on providing tantalizing and expensive subsidies to poor communities to cover the costs of building septic tank latrines, all too often without effective education on the need to clean and maintain the latrines. The result of our misplaced love: the UN sanitation Millennium Development Goal is lagging well behind its target with an estimated 2.6 billion people still using the outdoors as a bathroom, contributing to about 1.5 million preventable child deaths every year. Further, thousands of old filthy latrines are left abandoned and unused, diminishing the power of these disadvantaged populations to help themselves.

Multiple evidence-based studies have proven that well trained development practitioners who focus on the difficult but achievable process of behavior change and cultural norm shifting can reliably empower communities to dramatically improve their lives with little additional cost. Community-led Total Sanitation is one good example. This new "shame, empower and walk away" technique provocatively tells communities and their populations that their widespread diarrhea is directly caused by the daily consumption of each other's feces. With CLTS, communities are led on a 'walk of shame' to witness their unspoken collusion in continuing their mass open defecation practices in their own backyards. Adding to the emotion of shame is disgust from the "You are eating each other's shit" process where calculations are made of how many tons the village is producing every year and followed with powerful demonstrations of how they end up eating some of it.

A further, well defined set of triggering steps then gives clear instructions on how to build simple, safe pit latrines using their own resources and often communities themselves then ban open defecation and appoint children as the whistle blowers and law enforcers. People are increasingly taking control of their own lives, building latrines and hand washing with soap for the first time in their long histories without any money for materials that can now be used to train practitioners to scale up the process.

Oscar Wilde said about charity: "We are often told that the poor are grateful for charity. Some of them are, no doubt, but the best amongst the poor are never grateful. They are ungrateful, discontented, disobedient, and rebellious. They are quite right to be so."

CLTS demonstrates to all of us in this huge development/aid sector that the relative ease of the patronizing, hand-out charity model is long outdated and that we need to embrace the science that proves that the disadvantaged, when empowered with the right approach, are very capable of implementing change themselves. Now is the time for NGOs and their donors to seek, design and support scalable and sustainable models such as CLTS; models that tap and guide the "rebellious and the disobedient" energy into self-driven, lifesaving action. These populations deserve this respect.

Watch a video of the SurfAid CLTS triggering process in action.