On the 29th August 2012 I attended an amazing ceremony where over 600 community members –girls and boys, men and women- in Kaguma sub-location in Tharaka South District gathered under trees, drummed, sang and danced to mark the end of open defecation in their community. It is the biggest ODF celebration I have ever attend -12 villages celebrating ODF at once is a big achievement. All together 398 households with a population of about 2500 are now living in an ODF environment. As they narrated their ODF journey I couldn’t help but ask why it had taken so long (4 years!!!) to produce an ODF village – the first CLTS training and triggering in this area took place in 2008.

• What did we not do well?
• What can we learn from Kaguma Sub-location now that they have shown that it is possible?
• How can we use such lessons to shape our CLTS engagements in other places that exhibit condition similar to Tharaka?

Unfavourable Conditions
First and foremost Tharaka District, does not meet the so called favourable conditions for CLTS Most parts of Tharaka exhibit unfavourable conditions for CLTS.

• The district is sparsely populated
• There are no obvious massive open defecation fields,
• The soil is rocky.
• The climate is quite hot and dry so the shit dries up a few minutes after hitting the ground. This makes it very difficult for CLTS facilitators to find appropriate specimen to evoke disgust during the triggering.
• Latrine coverage and use is fairly good in Tharaka – about 67%.

Our strategy in Eastern Province has always been to trigger in small towns where there is a huge concentration of people and evidence of mass open defecation.

False start
No doubt our start in 2008 had some shortcomings. I personally faulted it. First there was no adequate buy in from the district stakeholders. It was very much seen as a project by Plan. Stakeholders who participated thought they were doing Plan a favour. Perhaps the timing for the entry was wrong. Though the training was done, no meaningful action plans for the next steps emerged. The quality of the training, particularly on the practical side was wanting. Not all participants had an opportunity to practice triggering as only one village had been chosen for triggering.

Cholera Outbreak Opportunity
I know some people find it difficult to turn crisis into opportunity. But in CLTS, funerals and poor sanitation or hygiene related epidemics can present opportunities. On the 10th February 2009 the then Acting Program Unit wrote to the Country Management Team:

“I wish to inform you that there is a confirmed outbreak of Cholera in the adjacent districts of Tharaka South, Meru South and Mbeere. Of 27 cases screened by Monday 08.02.2009, 11 were positive. Today we have received reports that there is a new case confirmed in Kanyuru; one of the areas where we are working. We have discussed with MoH on areas we can support and we are releasing 100 liters of diesel for Contact training, Prophylaxis and Health education. We have also cautioned staff on preventive and control measures to take for personal protection and advised them to pass the same to the communities. We are closely monitoring the situation and will give you regular updates”.

I knew this was the moment. So how did I respond? A very short e-mail – it was only seven words: “And what became of CLTS in Tharaka?!”

Rekindling the CLTS Fire
 With the cholera outbreak, the CLTS fire in Tharaka was rekindled in 2010. As a colleague (Mutunga Nzoka) from Tharaka PU put it, stakeholders who were doubtful about CLTS were now willing to give it a chance as a long-term strategy to address cholera outbreaks. It was however, not until March 2011, that a hands on CLTS training for all water and sanitation actors in the district, the majority of whom were Public health officers/technicians, Plan staff and education officials, was done by Philip Otieno (the then CLTS Advisor) and Frank Marita (the then WASH Advisor). Triggering was targeted to only those villages that had been hit by the cholera outbreak. Coincidentally these happened to be the ones with the lowest latrine coverage and use, where the majority of people were defecating in the open.

Community action

After the triggering, the CLTS easily ignited in 2 villages who set July 2011 as target date for attaining ODF. Njiru and Iriani villages attained ODF status towards end of 2011, but the community members insisted that they would not hold celebrations until the other 10 villages in Kaguma Sub-Location attained ODF status. As one of the female natural leaders remarked, “We were not going to celebrate while our neighbours were still shitting in the open and making us eat their shit”. Following the triggering each village had formed a steering committee to follow-up and ensure attainment of ODF status. While some were not as enthusiastic, efforts of two female and one male natural leaders (who were in attendance during the celebrations) is to be noted. They took it upon themselves to work with the public health technicians and moved from village to village encourage their neighbours to end open defecation, build and use latrines, make tippy taps for hand washing. By mid-July there were claims from the community that the entire Kaguma Sub-Location was ODF.

ODF Verification Exercise
A verification exercise undertaken by MOPHs, Plan and other stakeholders in the district on 1st August 2012 confirmed that all 398 households in the 12 villages in Kaguma sub-locations were ODF. We had an opportunity to walk for 3 miles before the celebrations and sure enough every homestead we visited had either a newly constructed latrine or a rehabilitated one that was in use. We were also looking for signs of open defecation but we did not see any shit. All the homesteads had hand-washing facilities in the form of tippy-taps and were using ash to keep their latrines clean. It was, however, hard to verify if they use soap or ash to clean their hands after using the toilet.

ODF Benefits
Dignified shitting in Kiswahili is “Kunya kwa heshma”.The fact that people have privacy and safety while using the toilet is a major benefit. As one woman pointed out she has not had to take a children as regularly to the clinic as she used to. “I used to think someone has bewitched my children because I had to take my children to the hospital always, then I realized it was all because they were eating shit”, one lady remarked. “We have not had any other cholera outbreak since 2010”, remarked another. One of the folk music groups used a very strong analogy in their musical, equating open defecators to people in a deep sleep, who after CLTS triggering had woken up and now were taking action to save themselves from the negative effects of open defecation.

So what now?
It is not enough to count villages and sub-locations. Riding on the Ministry of Public Health and Sanitation Campaign for ODF Rural Kenya by 2013, Tharaka can work towards becoming the first ODF District in Eastern Province. Out of the 130,000 people only about 43,000 (approximately 7200 Households) do not have access to improved sanitation and are most likely defecating in the open. Inspired by the achievements in Kaguma sub-location and with the enthusiasm exhibited by natural and local leaders and the District Health management team, it should be possible to attain an ODF Tharaka, if systematic planning is done. I suggested that working towards ODF Tharaka was an achievable dream and that Plan was ready to work with MOPHS (in the lead), other stakeholders, natural and local leaders to develop and implement an ODF Road Map for the district. We left Tharaka re-energized and motivated to keep pressing on to end open defecation in Kenya and save the lives of many children who suffer and die from sanitation related diseases.