Anticipate Environmental-Based Diseases with Assistance in Building Family Toilets

The light began to fully illuminate Nusa Poring Village. The light showed a man coming down from the house with an anxious expression on his face walking towards the Mentatai River which was less than 100 meters from his house. His anxiety stemmed from the heartburn that was being held in his stomach and his goal was the latrine (overhung latrine) located in the river.

If someone wants to relieve themselves at the same time, they have to choose another place. Because the latrine that is used together actually has users. If you are too lazy to look for another latrine that is far from the latrine, a fallen tree in the river is also an option.

Moving to the afternoon after returning from work in the fields, the activities of bathing, washing clothes, washing dishes and defecating all come together in the latrine. Meanwhile, those who don't go to the fields do washing dishes and clothes during the day.

Regardless of the choice of time, there are similarities among the residents returning from the Mentatai River apart from bringing clothes, eating utensils and some body parts that are still wet. Namely, they carry water in 5 liter jerry cans for drinking and cooking needs in their respective homes.

Rita (35) and her husband also did the same thing in the afternoon. Her husband rode a motorbike from home, she and her child also headed to the latrine where the man had visited this morning. With cloth bags and a bucket filled with toiletries and several 5 liter jerry cans on her lap, Rita and her family definitely wanted to clean themselves in the river after work.

Approximately 15 minutes on the river, the motorbike that Rita and her husband and child were riding in passed by again. With jerry cans filled with Mentatai River water for his family's drinking needs.

Drinking from the same clean water source as where you carry out bathing, washing and toileting (MCK) activities carries the risk of contracting disease caused by bacteria in human feces such as Escherichia coli, Salmonella typhi, and others. That's what Rita experienced last April. He came to the ASRI Clinic and complained of feeling podih porut (stomach pain).

"When I checked, he said he had diarrhea because he drank unboiled water," he said. Juniardus Stepen, his 2 year old son also drank from the same water, and had diarrhea several months ago. Accompanied by fever and vomiting.

According to ASRI Clinic health data in Nusa Poring Village and Mawang Mentatai Village, sufferers of environmental-based diseases such as diarrhea and typhoid showed a significant increase in 2019 and early 2021. And are included in the list of 10 diseases most commonly treated by ASRI Clinics in these 2 villages .

Diarrhea like that experienced by Rita and her child cannot be considered just a stomach ache. Diarrhea dominates the cause of infant deaths in Indonesia. Not to mention the problem of stunting and chronic malnutrition in babies and children due to the intestine's lack of ability to absorb food nutrients.

Recognizing the importance of environmental-based disease prevention for people's quality of life, since 2008, the Ministry of Health has launched a Community-Based Total Sanitation (STBM) program and has strengthened it with Minister of Health Regulation (Permenkes) No. 3 of 2014. In it there are also steps so that people avoid environmental-based diseases due to poor sanitation. Such as not defecating in the open (BABS), washing hands with soap, processing household drinking water, processing household waste, and waste water treatment facilities. In the Sustainable Development Goals (SDGs) or Sustainable Development Goal point 6, there is an obligation to ensure the availability of sustainable management of clean water and adequate sanitation for all.

"Good sanitation can be supported by the presence of healthy toilets in every household. Toilets with standardized health disposal areas for feces can avoid bacterial contamination of feces into water sources," said ASRI-BBBR Clinic doctor, Dr. Meilia Nur Chrisandra.

ASRI, which promotes the idea of planetary health, believes that poor environmental health will also have an impact on the health of its people. In cases of diarrhea in the 2 supporting villages of the Bukit Baka Bukit Raya National Park, ASRI not only wants to answer community health problems using a curative approach, namely providing health services. But also preventive measures to overcome the cause of the problem.

After implementing a water filter distribution program to reduce the risk of consuming raw water contaminated with diarrhea-causing bacteria for the community in these 2 villages in December 2021, ASRI also wants to give the community access to healthy and adequate sanitation. To avoid their clean water not being directly polluted by dirt or feces.

"So in the context of solving this diarrhea problem, the preventative step is to build a family toilet for each household to create a healthy environment which is expected to support human health," said ASRI-BBBR Replication Program Manager, Thomas Wendorise Rakam.

The toilet assistance program, whose funding is supported by the Tropical Forest Conservation Act Kalimantan (TFCA Kalimantan), goes through various processes. Starting from raising public awareness of the importance of good sanitation and environmental health. Then it continued with data collection on houses that did not have toilets.

Initially, it was planned that only 150 families would receive toilet assistance. However, seeing the urgency of the community's need for toilets, recipients increased to 215 houses. To get around budget limitations, the cost-sharing principle was used in constructing this toilet. Where toilet recipients also contribute in providing building materials and septic tanks. Meanwhile, ASRI provides pipes, toilets, cement and other materials.

The more frequently diseases that originate from drinking water contaminated with bacteria appear, the awareness of the importance of good sanitation in society is increasing. Then a longing for a toilet arises which is hindered by financial capabilities. These conditions make the level of use of toilets high and make changes in people's behavior to no longer defecate in the river possible.

"So ASRI's assistance is actually assistance that cures their longing. That is what makes the community's sense of ownership of this toilet so strong," he said.

What Thomas said was in line with what Mulyadi (36 years), one of 23 recipients of toilet assistance in Mengkilau Hamlet, Nusa Poring Village, said. He is aware of the importance of toilets for health and has planned to build a toilet. However, limited funds to build a toilet in his house mean that Mulyadi and his family still carry out the habit of defecating, bathing and washing in the river.

"We have a plan to build a toilet. We just have to wait for more money to build it. Because if it's not built, we will be in trouble ourselves," he said.

Now that the toilet is finished, he never does toilet activities in the river again. Plus the water that flows to the toilet makes it easier. So that there is no longer any reason for him not to practice healthy sanitation.