Three-fifths of Cambodians still practise open defecation, according to health experts, and as flood waters rise each year, people find themselves thrust into contact with a freshwater soup of fecal matter, bacteria and parasitic worms.
With the rainy season fast approaching, those conditions will once again leave populations increasingly vulnerable to infection and diarrhoeal diseases, which every year claim the lives of more than 2,300 children and thousands more adults.
Despite improvements in the past two decades, developers and experts agree that changing the culture of public hygiene remains an uphill battle.
However, a number of new hygiene-based technologies have entered the Cambodian market this season intent on improving rural and urban sanitation.
Satepheap Heng, acting chief of the Water, Sanitation and Hygiene, or WASH, program at UNICEF Cambodia, said via email that less than half of rural households have access to hand washing facilities, which are key to disease prevention.
One new product, however, seeks to change that. Launched earlier this week, Labobo is a plastic, low-flow sink, brightly decorated and marketed to children (at $30 a pop – though it is marked down to $15 in rural communities) with the hope that the “aesthetic appeal” will get kids excited about good hygiene and educate their parents by proxy.
“People in a typical rural households often already know about the importance of using a latrine and hand washing . . . but [there are] low levels of practice,” said Geoff Revell, regional program manager for WaterSHED, the hygiene development organisation working to introduce LaBobo to Cambodian homes.
Though Revell believes people need tools to bridge the gap between knowledge and adoption, government leadership is equally essential, he added.
“Commune and village leaders wield important influence among villagers,” he said, citing an initiative that increased latrine sales to 400 per cent after local leaders got involved.
In floating villages, bodies of water and shore land have historically served, and continue to serve, as cost-free latrines.
Particularly in regions along the Mekong river, in Kratie and Strung Treng provinces, a high rate of illness, malnutrition and delayed development is tied to water-borne contamination transmitted through faeces.
Water, according to Dr Michael Hsieh, a parasite investigator at the BRI Biomedical Research Institute in the United States, serves as the catalyst for parasitic infections, like schistosomiasis, that are nearly impossible to entirely eradicate.
In Kratie and Stung Treng, schistosomiasis worms are transmitted between snails living in the Mekong and mammalian skin, and the area has the highest rate of infection in the nation.
While 90 per cent of the population in the affected area received anti-parasitic medication in 2014, according to the Ministry of Health’s Communicable Disease Control Department, a single dose does little to combat re-infection.
Wetlands Work! has been trying to develop latrine technologies that villagers in such communities will embrace.
For the past four years, they have been developing floating toilets for Cambodia’s approximately 100,000 villagers in floating communities, with the help of Engineers Without Borders.
The organisation has spent the past seven months rolling out the HandyPod, which is affixed to the side of a floating home, and allows waste to be digested by the micro-nutrients of leafy green plants that consume and sanitise the waste as it is redistributed along the water’s surface.
“Many rural Cambodians are hesitant to adopt new behaviours, especially if there is a monetary cost to that change,” explained Wetland Works! founder Taber Hand.
“The challenge quickly becomes the development of people’s interest and demand to the point where they will actually pay for the sanitation treatment product,” he explained.
Like Labobo, the HandyPod retails for about $30. But the question of how to interest anyone in paying for something they have done for free their entire lives is at the root of every program targeting open defecation in Cambodia, said Hand.
“Improving sanitation in Cambodia, however, is mainly changing a mindset,” he added.
The actual practice of open defecation, and the mindset surrounding the practice, is as entrenched as the bacteria bred from poor sanitation, according to BRI’s Dr Hsieh.
“In many cases, you are fighting centuries – if not millennia – of a certain way of doing things,” he said. “But that doesn’t mean we shouldn’t do it.”
Without changing how people use the Mekong river, from washing to defecation, parasites and disease will continue to be rampant, he said.
“It all revolved around how water is used.”
ADDITIONAL REPORTING BY SARAH TAGUIAM