A basic yet vital component in the tourism industry that can make or break the experience is when the tourist has to use the toilet.
Toilets need to be clean, hygienic, complete with various amenities and facilities, located conveniently, well-maintained, and using proper waste management systems.
The 15th World Toilet Summit and Expo was held in Kuching, Sarawak, in 2016, hosting more than 750 delegates from 11 countries.
“The conditions of a country’s public toilets can be used as a yardstick to measure its public health system,” said Dr Sim Kui Hian, Sarawak Minister of Local Government and Housing while officiating the Kuching City South Council Health Talk on Toilet Cleanliness and Maintenance in 2017.
How does Sarawak measure up? Come with me on a historical tour of the evolution of its rural toilets and sanitation!
In the late 1950s, my grandfather’s shophouse in Market Street, Kuching had a bucket toilet at the far corner of the kitchen at the back of the shop. There were high steps to a cement platform raised three feet off the ground.
Below the large hole in the platform was a metal bucket for faeces. The bucket had two handles. Early every morning, a man would come with his wooden yoke, carrying two clean buckets to replace the full ones.
He would slosh his way out across the length of the shop. Some shops would have holes in the wall at the back of the toilets, where the buckets could be less messily exchanged from outside.
Going to the toilet as a small child was quite scary, once we got too big for the tall potty outside our room. There was a great fear of falling through the hole, especially when it got dark and one depended on a dim torch or candle for light.
It was very smelly too. I remember helping myself to the rolled-leaf cigarettes that the shop used to sell. We kids used to smoke these in the toilet to reduce the stench!
Moving to the low-cost housing at the KMC flats (completed in 1957) was a blessing in many ways. The toilet was the flushing, squat type.
My first exposure to rural toilets was during my six months as a student volunteer in 1970 and 1971.
I remember doing a mobile clinic in a village with Sister Rose. In the middle of helping her screen the mothers in our host’s house, I suddenly had tummy cramps and needed the toilet. There was none in that house.
I was directed to go in the general direction of the jungle. As I rushed out and walked behind the houses looking for a private location, women were looking out of the kitchen windows, calling to me, “Kini wai?” (“Whither goes thou?” in the Iban language).
This ubiquitous polite greeting “Kini wai” is the reason natives say the outbound journey always takes longer than the return one. According to them, even the grass stops asking “Kini wai” when you return, because they already found out where you went.
I found a spot, finally, where I managed to clear my bowels. Just as I finished adjusting my sarong, I heard some rushing sounds in the bushes. The scavenging village pigs had picked up the scent and were rushing in to claim their lunch.
I must have run my fastest ever 50-metre dash, in a sarong.
Ten years later, as the medical officer of Health, I was visiting a coastal village with my health inspector and staff. We were meeting the tua kampung (headman) and his villagers for a preliminary feasibility survey of his village to plan the water supply options and sanitation improvements.
They were so hospitable. Every household insisted we sat down for drinks and kueh (homemade desserts).
In the night, the coconut water I had drunk all day, the generous servings of kampung delicacies, and my dinner had a major ‘disagreement’. Whispering to the lady of the house where we were staying the night, I asked where the tandas (toilet) was.
She pointed to a gap in the floorboards on the kitchen floor. Oh dear! With my male staff wandering around and preparing to sleep roughly in that same vicinity, I insisted on Plan B.
The hostess looked at me. They do have a tandas at the back, but was I really sure I wanted to walk out there alone at that time of the night? It was pitch black and quite a walk from the house. There was no electricity supply in that village. (P.S. A large torch with new batteries is an absolute must for all travellers in rural Sarawak).
The shed over their surface pit toilet had a very low attap roof — low even for my 5-feet height. I shone my torch very carefully around, making sure there were no reflections from the eyes of some snake or sleeping reptile. Better to be safe than sorry.
Such experiences made me a passionate campaigner and earned me the name ‘Lutur Jamban‘ (Dr Toilet). I assume they meant well and were not referring to my medical skills?
The Rural Health Improvement Scheme (RHIS) of the Sarawak Health Department is one of its least known, but with the biggest impact on diseases like worm infestation, dysentery, cholera, typhoid, and gastroenteritis (Heritage in Health, The Story Of Medical And Health Care Services In Sarawak, 2012).
In 1962, a pilot health study in Sarawak revealed that the disposal of human waste was done in nearby bushes, or through gaps in the floors of houses. The excreta dropped to the ground below, where scavenging animals did the final disposal.
Toilets were also built over rivers. Refuse and household waste were indiscriminately thrown and allowed to pile up, attracting flies and rodents.
Water for drinking and household use was from streams or water holes. Domestic animals ran loose, scavenging below the houses, turning the ground soggy. Wastewater from bathing and kitchen stagnated under and around the houses, becoming breeding grounds for mosquitoes.
A white paper was drafted to improve the sanitation of rural villages in Sarawak. In 1963, with the formation of Malaysia, RHIS was incorporated into the First Malaysia Plan.
A rural health training school was started in Tarat, Serian district. The technical training of rural health supervisors (RHS) included the motivation of villagers to build sanitary latrines, drains, and water supply systems, and to promote animal fencing, proper drainage, and the proper disposal of household refuse.
This advisory approach did not work well, until in 1967, the health department adopted the policy that before a free water system could be approved for construction, latrines, drains, general cleaning of village, fencing, and proper rubbish disposal must have been satisfactorily completed.
In the hilly interior, the RHS would help the villagers find suitable streams that could be dammed up for the gravity feed water system. The water in the dam would be piped to the longhouse by gravity. Unfortunately, as logging activities became widespread, such water sources have become contaminated or have dried up.
Houses in the coastal areas were provided with rainwater tanks, suitable roofing material, and roof gutters. Mechanical water pumps were provided to pump water from suitable rivers to communal tanks. Sanitary wells were also dug in some areas.
Up to 1987, 3,326 villages had benefited from the RHIS programme. 66 per cent of them had gravity feed, 19.3 per cent had rainwater tanks, 9.7 per cent had dug wells, 4 per cent had mechanical pumps, and 1 per cent had hydraulic rams.
The villagers helped to construct the water system by gotong-royong (volunteering free labour). In bigger villages, they would also help to install the cement incinerators for household waste disposal.
Villagers had to be shown how far to locate the pits of their toilets downstream to avoid contaminating their water sources. In the coastal areas where the high-water table or tide makes the digging of pits for the toilets impossible, metal or cement barrels were provided to trap the excreta from the pour flush toilets.
Initially, the squatting type toilet bowls (jitra bowl) were cast from cement at the division or headquarters. These were heavy and difficult to transport. They may crack on transit and were difficult to keep clean because of the rather rough surfaces.
Plastic toilet bowls, when available, quickly replaced this, which meant that the RHS could carry more in his boat or vehicle per trip.
The latrine bowls, outlet pipe, and cement (for the platform where the bowl is set) were provided free for each household. Each household had to dig and prepare the toilet pit of a prerequisite depth and size (estimated to last for 10 years of use). The villagers installed their own toilet with the RHS’s help.
Plastic squat toilets were easily flushed with a small pail of water and easy to keep clean. Almost every house would install them adjacent to the kitchen. In the longhouse, they would also install a visitor’s toilet outside the common ruai (corridor). Provided there is no problem with access to water, these toilets are a welcome amenity for travellers.
Initially, toilets would get blocked up (e.g., in the hospital), because the natives continued to use little sticks to clean themselves after opening their bowels, as they would in the bush!!
The RHIS was initially partially financed by Unicef, which provided materials and logistic support. The water supply systems were constructed with rural development funds from the Sarawak state government, until the Ministry of Health took over in 1971 under the Second Malaysia Plan.
From 1963 to 2005, 98.3 per cent of the rural population was provided with potable and safe water supplies. This included 2,820 gravity feeds built for 185,963 doors, benefiting a population of one million population. 96.5 per cent of villages had sanitary toilets. (Heritage in Health, The Story Of Medical And Health Care Services In Sarawak, 2012).
A study published by KB Liew in 2005 showed that from 1963 to 2002, water supply intervention contributed to a more-than-200-fold decrease in dysentery and a 60-fold decrease in enteric fever. Variations in reporting of viral hepatitis during that period made it difficult to detect a trend. Cholera was still endemic in 2002.
A survey done by Andrew Kiyu et al of 976 households in 41 villages covered by the RHIS in Sarawak was carried out in 1992 to determine the state of functioning and utilisation of rural water supplies and latrines.
The survey was carried out via inspections and interviews. About one-third of the systems were functioning well, one-third imperfectly, and the remainder were no longer functioning.
The coverage of households by water supply varied with the type of water supply, the overall coverage being 81.3 per cent. Usage varied with the type of water supply and access, the overall figure being 87.1 per cent, and the overall utilisation was 70.8 per cent.
56 per cent of the households had pour flush latrines.
Upon inspection, 91.3 per cent showed signs of recent use. Based on interviews, 90 per cent of women, 86.5 per cent of men, and 47.6 per cent of children below five will always use the latrine for defecation. The most common reason for not using the latrine among adults was the lack of water to flush the latrines, as well as not being home when the need arises.
Maintenance of installed water systems in rural areas is under the purview of local management, who may not have adequate resources to ensure the proper maintenance.
With regard to piped water, the percentage of piped water in rural areas of Peninsular Malaysia increased from 42 per cent to 96 per cent in 2020. However, Sabah and Sarawak lagged behind, with only 62 per cent in 2020.
As of November 2021, the current water supply coverage in Sarawak was 84.3 per cent, with 99 per cent in urban areas and 66.5 per cent in rural areas.
The Sarawak state government has allocated RM8.28 billion to implement 606 water supply development projects from 2017 to 2021. This Sarawak Water Supply Grid Masterplan will ensure that there will be 100 per cent water supply coverage by 2025.
The days of rushing to the bushes behind someone’s house for your urgent toilet needs are probably over in most parts of Sarawak except, perhaps in nomadic areas or on treks.
Shopping malls, airports, and air-conditioned eating places have greatly improved their toilet maintenance and aesthetics, although not quite reaching the Changi Airport gold standard yet.
If you wish to go back in time, you may go and visit our rural (and some urban) school toilets.
Flush toilets are difficult to maintain where plumbers are rare or costly. Parts tend to fall off, with so many users rushing during the limited break time, Water tanks take too long to refill, so users often do not wait to flush, even in urban schools.
How can we hope to raise the culture of keeping toilets clean among our people when the maintenance of toilets in so many schools are so neglected?
I would strongly recommend that in all schools, simple pails of water or a tap (that has water) are provided, so kids can at least pour and flush after use, while the tank refills (if ever) or if the lever is broken.
In rural schools, perhaps the lowly pour flush system could be installed, instead of five-star toilet fixtures that die prematurely from overuse and neglect. The nearest rural health supervisor would be very happy to assist in the gotong-royong.
Along our peaceful meandering rivers, you may still be able to use those overhanging toilets, and listen to the musical tinkling as your excreta drop to the river below. But please watch out for the kids downriver taking their baths, jumping up and down, and perhaps, brushing their teeth?
Dr Tan Poh Tin, proudly Sarawakian, is a paediatrician and public health specialist. She says: “Sarawak – to know you is to love you.”
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
