Diguem marranades. Fa uns anys, sorprenentment, vaig haver d'anar al lavabo. En vaig trobar un, un de públic, hi vaig entrar i vaig fer el que havia fet tota la vida: fer les necessitats, tirar de la cadena i no pensar-hi més. Aquell dia, en canvi, per alguna raó em vaig preguntar: "On va tot això?" I així em vaig veure submergida en el món dels sanitaris. [Riures] I encara n'hi ha més... Sanitaris, lavabos i caca. I encara no n'he sortit. I això és perquè és un tema irritant, però interessant, malgrat tot.
Let's talk dirty. A few years ago, oddly enough, I needed the bathroom, and I found one, a public bathroom, and I went into the stall, and I prepared to do what I'd done most of my life: use the toilet, flush the toilet, forget about the toilet. And for some reason that day, instead, I asked myself a question, and it was, where does this stuff go? And with that question, I found myself plunged into the world of sanitation -- there's more coming -- (Laughter) — sanitation, toilets and poop, and I have yet to emerge. And that's because it's such an enraging, yet engaging place to be.
Tornant a aquell lavabo, no era especialment atractiu. No era pas com aquest de l'Organització Mundial dels Sanitaris. És l'altra OMS. [Riures] Però tenia porta amb pany, privacitat, aigua i sabó, i m'hi podia rentar les mans, i ho vaig fer, perquè les dones ho fem.
To go back to that toilet, it wasn't a particularly fancy toilet, it wasn't as nice as this one from the World Toilet Organization. That's the other WTO. (Laughter) But it had a lockable door, it had privacy, it had water, it had soap so I could wash my hands, and I did because I'm a woman, and we do that.
[Rialles] [Aplaudiments]
(Laughter) (Applause)
Llavors, quan m'ho vaig preguntar, em vaig adonar que havia viscut creient que tenir un lavabo així era un dret, quan, de fet, és un privilegi. 2.500 milions de persones al món no tenen lavabo. No tenen una galleda o una caixa. El 40% del món no té un lavabo decent. I han de fer el que fa aquest nen al costat de l'aeroport de Mumbai, defecar a l'aire lliure, o cagar a la intempèrie. I ho fa cada dia, i cada dia, probablement, aquest home passa de llarg, perquè veu el nen, però no el veu.
But that day, when I asked that question, I learned something, and that was that I'd grown up thinking that a toilet like that was my right, when in fact it's a privilege. 2.5 billion people worldwide have no adequate toilet. They don't have a bucket or a box. Forty percent of the world with no adequate toilet. And they have to do what this little boy is doing by the side of the Mumbai Airport expressway, which is called open defecation, or poo-pooing in the open. And he does that every day, and every day, probably, that guy in the picture walks on by, because he sees that little boy, but he doesn't see him.
I l'hauria de veure. Aquest és el problema, perquè tota la caca escampada porta passatgers. 50 malalties contagioses viatgen en la merda humana. Els ous, les larves, els paràsits, els bacteris, els virus, tots viatgen en un gram de femta humana. Com? Bé, aquest nen no s'ha rentat les mans i va descalç. Correrà cap a casa i contaminarà l'aigua potable i el menjar i el seu entorn amb les malalties que transporti en les partícules fecals dels dits i dels peus. En el món amb cadena i canonades en què nosaltres tenim la sort de viure, el símptoma més comú d'aquestes malalties, la diarrea, és una broma. Les caguetes, la diarrea explosiva, la pasterada... Alguns l'anomenem 'ventre de Delhi', com un llegat de l'imperi. Però si busqueu una foto d'arxiu de la diarrea en una agència fotogràfica important, trobareu aquesta foto. [Riures] Encara no sé per què va en biquini. Això és una altra imatge de la diarrea. Es diu Marie Saylee, té nou mesos. No la veieu perquè està enterrada sota l'herba d'un poblet de Libèria perquè va morir en tres dies de diarrea, de caguetes, d'una broma. I aquest és el seu pare. Però no estava sola perquè 4.000 nens més van morir de diarrea aquell dia, i cada dia. La diarrea és la segona causa de mortalitat infantil al món i us deuen dir que us preocupeu per coses com el VIH, la SIDA, la tuberculosi o el xarampió, però la diarrea mata més nens que aquestes malalties juntes. És una arma de destrucció massiva potent. I el cost per al món és immens: pèrdues de 200.000 milions d'euros cada any per sanitaris en males condicions. Mireu els llits del còlera d'Haití. Es parla del còlera, però no de la diarrea, que no obté gens d'atenció o finançament en comparació amb aquelles malalties.
But he should, because the problem with all that poop lying around is that poop carries passengers. Fifty communicable diseases like to travel in human shit. All those things, the eggs, the cysts, the bacteria, the viruses, all those can travel in one gram of human feces. How? Well, that little boy will not have washed his hands. He's barefoot. He'll run back into his house, and he will contaminate his drinking water and his food and his environment with whatever diseases he may be carrying by fecal particles that are on his fingers and feet. In what I call the flushed-and-plumbed world that most of us in this room are lucky to live in, the most common symptoms associated with those diseases, diarrhea, is now a bit of a joke. It's the runs, the Hershey squirts, the squits. Where I come from, we call it Delhi belly, as a legacy of empire. But if you search for a stock photo of diarrhea in a leading photo image agency, this is the picture that you come up with. (Laughter) Still not sure about the bikini. And here's another image of diarrhea. This is Marie Saylee, nine months old. You can't see her, because she's buried under that green grass in a little village in Liberia, because she died in three days from diarrhea -- the Hershey squirts, the runs, a joke. And that's her dad. But she wasn't alone that day, because 4,000 other children died of diarrhea, and they do every day. Diarrhea is the second biggest killer of children worldwide, and you've probably been asked to care about things like HIV/AIDS or T.B. or measles, but diarrhea kills more children than all those three things put together. It's a very potent weapon of mass destruction. And the cost to the world is immense: 260 billion dollars lost every year on the losses to poor sanitation. These are cholera beds in Haiti. You'll have heard of cholera, but we don't hear about diarrhea. It gets a fraction of the attention and funding given to any of those other diseases.
Però sabem com arreglar-ho. Ho sabem, perquè el s. XIX, uns meravellosos enginyers victorians van crear el clavegueram, el tractament d'aigües i el lavabo de cadena, i les malalties van caure en picat. La mortalitat infantil es va reduir més que mai en la història. El lavabo de cadena va ser escollit el millor avanç mèdic dels darrers 200 anys pels lectors del 'British Medical Journal', amb més vots que les pastilles, l'anestèsia, i la cirurgia. És un gran sistema d'eliminació de residus.
But we know how to fix this. We know, because in the mid-19th century, wonderful Victorian engineers installed systems of sewers and wastewater treatment and the flush toilet, and disease dropped dramatically. Child mortality dropped by the most it had ever dropped in history. The flush toilet was voted the best medical advance of the last 200 years by the readers of the British Medical Journal, and they were choosing over the Pill, anesthesia, and surgery. It's a wonderful waste disposal device.
I és tan bo! No fa pudor. El podem tenir a casa i oblidar-lo darrere d'una porta. Però també l'hem oblidat en les converses. No tenim una paraula neutra. 'Caca' no és gaire adequat. 'Merda' és ofensiu. 'Femta' és massa mèdic.
But I think that it's so good — it doesn't smell, we can put it in our house, we can lock it behind a door — and I think we've locked it out of conversation too. We don't have a neutral word for it. Poop's not particularly adequate. Shit offends people. Feces is too medical.
I l'he d'anomenar quan veig les dades i vull explicar què està passant. Sabem què fer amb la diarrea i els sanitaris, però si mireu els pressupostos dels països, en desenvolupament i desenvolupats, veureu que els números no quadren, perquè us espereu absurditats com ara que el Pakistan gasta 47 cops més en l'exèrcit que en aigua i sanitaris, tot i que 150.000 nens moren de diarrea al Pakistan cada any. Però mireu el ja minúscul pressupost per a aigua i sanitaris, i un 75-90% es destina al subministrament d'aigua neta, que és genial; ens fa falta. Ningú no rebutjarà l'aigua neta. Però la simple latrina, o el lavabo de cadena, redueixen les malalties el doble que distribuir aigua neta. Penseu-hi. Aquell nen que corria cap a casa pot tenir aigua neta i fresca, però té les mans brutes i contaminarà l'aigua.
Because I can't explain otherwise, when I look at the figures, what's going on. We know how to solve diarrhea and sanitation, but if you look at the budgets of countries, developing and developed, you'll think there's something wrong with the math, because you'll expect absurdities like Pakistan spending 47 times more on its military than it does on water and sanitation, even though 150,000 children die of diarrhea in Pakistan every year. But then you look at that already minuscule water and sanitation budget, and 75 to 90 percent of it will go on clean water supply, which is great; we all need water. No one's going to refuse clean water. But the humble latrine, or flush toilet, reduces disease by twice as much as just putting in clean water. Think about it. That little boy who's running back into his house, he may have a nice, clean fresh water supply, but he's got dirty hands that he's going to contaminate his water supply with.
I em reca que res dels residus humans es recicli com a recurs i com a potenciador del desenvolupament, perquè hi ha unes quantes coses que els lavabos i la caca poden fer per a nosaltres. Un lavabo pot fer tornar una noia a l'escola. El 25% de les noies a l'Índia deixen l'escola perquè no tenen sanitaris adequats. Seuen a classe al llarg del dia durant anys i anys aguantant-s'ho. Tots ho hem fet, però no cada dia. I quan arriben a la pubertat i els ve la regla, això ja és massa. I ho entenc. No les culpo. Així que si coneixeu un pedagog i li dieu "Puc millorar l'índex d'assistència a classe en un 25% amb una sola cosa", fareu un munt d'amics en l'educació.
And I think that the real waste of human waste is that we are wasting it as a resource and as an incredible trigger for development, because these are a few things that toilets and poop itself can do for us. So a toilet can put a girl back in school. Twenty-five percent of girls in India drop out of school because they have no adequate sanitation. They've been used to sitting through lessons for years and years holding it in. We've all done that, but they do it every day, and when they hit puberty and they start menstruating, it just gets too much. And I understand that. Who can blame them? So if you met an educationalist and said, "I can improve education attendance rates by 25 percent with just one simple thing," you'd make a lot of friends in education.
I aquí no s'acaben les possibilitats. La caca us pot cuinar el sopar. Conté nutrients. Nosaltres ingerim nutrients i n'excretem. No els aprofitem tots. A Rwanda, ara obtenen el 75% del combustible per cuinar a les presons del contingut dels intestins dels presos. Aquí teniu un grapat de reclusos de la presó de Butare. La majoria són genocides i remenen el contingut de les seves latrines, perquè si poseu caca en un ambient tancat, en un dipòsit, com passa a l'estómac, llavors, com passa a l'estómac, emet gasos i serveix per cuinar. I podeu pensar que és només bon karma el veure aquests homes remenant merda, però també és bona visió econòmica, perquè estalvien 765.000 d'euros l'any. Redueixen la desforestació i tenen una font de combustible inesgotable, infinita i de producció gratuita.
That's not the only thing it can do for you. Poop can cook your dinner. It's got nutrients in it. We ingest nutrients. We excrete nutrients as well. We don't keep them all. In Rwanda, they are now getting 75 percent of their cooking fuel in their prison system from the contents of prisoners' bowels. So these are a bunch of inmates in a prison in Butare. They're genocidal inmates, most of them, and they're stirring the contents of their own latrines, because if you put poop in a sealed environment, in a tank, pretty much like a stomach, then, pretty much like a stomach, it gives off gas, and you can cook with it. And you might think it's just good karma to see these guys stirring shit, but it's also good economic sense, because they're saving a million dollars a year. They're cutting down on deforestation, and they've found a fuel supply that is inexhaustible, infinite and free at the point of production.
I la caca no sols pot salvar la vida als pobres. Aquesta dona està a punt de rebre una dosi d'això marró de les xeringues, que és el que esteu pensant, però no del tot, perquè és una donació. Hi ha una nova sortida professional com a donant. És com el nou donant d'esperma. Aquesta dona té un bacteri anomenat 'Clostridium difficile', que és resistent a molts antibiòtics. L'ha tingut durant anys. Ara es posa una dosi de femta humana i l'índex de curació és d'un 94%. És sorprenent, però quasi ningú no s'ho fa encara. Potser és el factor 'ecs'. Però no passa res, perquè al Canadà han creat una femta artificial anomenada RePOOPulate.
It's not just in the poor world that poop can save lives. Here's a woman who's about to get a dose of the brown stuff in those syringes, which is what you think it is, except not quite, because it's actually donated. There is now a new career path called stool donor. It's like the new sperm donor. Because she has been suffering from a superbug called C. diff, and it's resistant to antibiotics in many cases. She's been suffering for years. She gets a dose of healthy human feces, and the cure rate for this procedure is 94 percent. It's astonishing, but hardly anyone is still doing it. Maybe it's the ick factor. That's okay, because there's a team of research scientists in Canada who have now created a stool sample, a fake stool sample which is called RePOOPulate.
Ara potser penseu: "Oh, la solució és simple, donem un lavabo a tothom." I aquí és on es posa interessant, perquè no és tan simple, perquè nosaltres tampoc no ho som. La part realment interessant i emocionant (la que ho fa atractiu) d'aquest món és entendre la psicologia humana. Hem d'entendre de programació a part de donar l'ordinador. S'ha observat en països en desenvolupament que els governs han proporcionat latrines gratuïtes i revisant-les uns anys més tard s'han trobat nous coberts per a cabres, temples o habitacions d'invitats i els seus amos les ignoraven del tot i defecaven a l'aire lliure.
So you'd be thinking by now, okay, the solution's simple, we give everyone a toilet. And this is where it gets really interesting, because it's not that simple, because we are not simple. So the really interesting, exciting work -- this is the engaging bit -- in sanitation is that we need to understand human psychology. We need to understand software as well as just giving someone hardware. They've found in many developing countries that governments have gone in and given out free latrines and gone back a few years later and found that they've got lots of new goat sheds or temples or spare rooms with their owners happily walking past them and going over to the open defecating ground.
Per això, la idea és manipular les emocions. S'ha fet durant dècades. Les empreses de sabó ho van fer a principis del s. XX. Venien el sabó com a saludable. Ningú no en comprava. El van vendre com a atractiu. Tothom en va comprar. A l'Índia ara hi ha una campanya que convenç les núvies joves que no es casin amb famílies sense lavabo. Li diuen "Sense cadena no hi ha nena." [Riures] I si creieu que el cartell és només propaganda, aquí teniu la Priyanka, de 23 anys. La vaig conèixer l'octubre a l'Índia. Es va criar en un entorn conservador. Va créixer en un zona rural i pobra de l'Índia. La van prometre als 14 i cap als 21 es va mudar amb la família política. Es va horroritzar en arribar i trobar que no tenien lavabo. Havia crescut amb una latrina. No era gran cosa, però era una latrina. I la primera nit que hi passava, a les 4 del matí la sogra la va llevar, li va dir que sortís i que ho fes en la foscor a la intempèrie. Estava espantada. Patia pels borratxos, per les serps i per les violacions. Tres dies després va fer una cosa impensable. Va marxar. I si sabeu res de l'Índia rural, sabreu que és un gest de valentia inimaginable. Però va fer més. Va agafar un lavabo i ara viatja pels pobles de l'Índia convencent les altres dones de fer el mateix. Jo ho anomeno 'contagi social', i és molt poderós i molt emocionant.
So the idea is to manipulate human emotion. It's been done for decades. The soap companies did it in the early 20th century. They tried selling soap as healthy. No one bought it. They tried selling it as sexy. Everyone bought it. In India now there's a campaign which persuades young brides not to marry into families that don't have a toilet. It's called "No Loo, No I Do." (Laughter) And in case you think that poster's just propaganda, here's Priyanka, 23 years old. I met her last October in India, and she grew up in a conservative environment. She grew up in a rural village in a poor area of India, and she was engaged at 14, and then at 21 or so, she moved into her in-law's house. And she was horrified to get there and find that they didn't have a toilet. She'd grown up with a latrine. It was no big deal, but it was a latrine. And the first night she was there, she was told that at 4 o'clock in the morning -- her mother-in-law got her up, told her to go outside and go and do it in the dark in the open. And she was scared. She was scared of drunks hanging around. She was scared of snakes. She was scared of rape. After three days, she did an unthinkable thing. She left. And if you know anything about rural India, you'll know that's an unspeakably courageous thing to do. But not just that. She got her toilet, and now she goes around all the other villages in India persuading other women to do the same thing. It's what I call social contagion, and it's really powerful and really exciting.
Una altra història, d'un altre poble de l'Índia a prop d'on viu la Priyanka, és la d'aquest poble, Lakara, que fa un any no tenia lavabos. Els nens morien de diarrea i del còlera. Uns visitants van usar trucs de canvi de conducta com posar un plat de menjar i un de merda per veure les mosques anar d'un a l'altre. Els que pensaven que el que feien no era repugnant van pensar "Ui". Es menjaven la merda dels veïns. Això és el que els va fer canviar de debò. La mare d'aquest nen va instal·lar una latrina en poques hores. Sempre havia usat el camp de plàtans, però va instal·lar la latrina en poques hores. No costa res i salvarà la vida d'aquest nen.
Another version of this, another village in India near where Priyanka lives is this village, called Lakara, and about a year ago, it had no toilets whatsoever. Kids were dying of diarrhea and cholera. Some visitors came, using various behavioral change tricks like putting out a plate of food and a plate of shit and watching the flies go one to the other. Somehow, people who'd been thinking that what they were doing was not disgusting at all suddenly thought, "Oops." Not only that, but they were ingesting their neighbors' shit. That's what really made them change their behavior. So this woman, this boy's mother installed this latrine in a few hours. Her entire life, she'd been using the banana field behind, but she installed the latrine in a few hours. It cost nothing. It's going to save that boy's life.
Per això, quan em desanimo per l'estat dels sanitaris, tot i que ara vivim un bon moment ja que tenim la Fundació Bill i Melinda Gates reinventant el lavabo, que és genial, i tenim el Matt Damon en vaga de ventre, que és genial per a la humanitat, però fatal per al seu còlon. Però hi ha coses que preocupen. És l'Objectiu de Desenvolupament del Mil·lenni més endarrerit. Va uns 50 anys endarrerit. No complirem l'objectiu de proporcionar sanitaris a aquest ritme. Per això, quan m'entristeixo penso en el Japó, perquè fa 70 anys usaven latrines a l'exterior i s'eixugaven amb pals, però ara tenen el que anomenen 'woshurettos', o 'washlets'. Tenen aixetes de bidet incorporades que els netegen automàticament i altres funcions diverses com un seient climatitzat i una tapa automàtica, anomenada "el salvamatrimonis". [Riures]
So when I get despondent about the state of sanitation, even though these are pretty exciting times because we've got the Bill and Melinda Gates Foundation reinventing the toilet, which is great, we've got Matt Damon going on bathroom strike, which is great for humanity, very bad for his colon. But there are things to worry about. It's the most off-track Millennium Development Goal. It's about 50 or so years off track. We're not going to meet targets, providing people with sanitation at this rate. So when I get sad about sanitation, I think of Japan, because Japan 70 years ago was a nation of people who used pit latrines and wiped with sticks, and now it's a nation of what are called Woshurettos, washlet toilets. They have in-built bidet nozzles for a lovely, hands-free cleaning experience, and they have various other features like a heated seat and an automatic lid-raising device which is known as the "marriage-saver." (Laughter)
Però el més important, el que han fet al Japó i que trobo tan edificant, és recuperar el lavabo de darrere de la porta. Se'n pot parlar. La gent va i actualitza el seu lavabo. En parlen. L'han sanejat. Espero que nosaltres també ho fem. No és difícil. Només hem de considerar aquest assumpte tan urgent i vergonyós com és. I no és només en el món pobre on les coses van malament. El nostre claveguerem fa pena. Les coses van malament aquí també. La solució és prou fàcil. Us faré la vida més fàcil avui i només haureu de fer una cosa, que és sortir, fer-vos sentir, parlar sobre el tabú, i dir marranades.
But most importantly, what they have done in Japan, which I find so inspirational, is they've brought the toilet out from behind the locked door. They've made it conversational. People go out and upgrade their toilet. They talk about it. They've sanitized it. I hope that we can do that. It's not a difficult thing to do. All we really need to do is look at this issue as the urgent, shameful issue that it is. And don't think that it's just in the poor world that things are wrong. Our sewers are crumbling. Things are going wrong here too. The solution to all of this is pretty easy. I'm going to make your lives easy this afternoon and just ask you to do one thing, and that's to go out, protest, speak about the unspeakable, and talk shit.
Gràcies.
Thank you.
[Aplaudiments]
(Applause)