Author: Rose George
Henry Holt and Company, 2008, 288 pp.

“I need the bathroom.”

Thus begins the introductory chapter to Rose George’s The Big Necessity, an offhand, anecdotal account of how people throughout the world deal with, or fail to deal with, their “shit.”

The fundamental premise of The Big Necessity is that inadequate sanitation is the world’s most pervasive and harmful social malady, primarily because cultural pressures and taboos prevent societies from openly and directly addressing it. George’s book begins with a chapter intended to mention the “unmentionable,” making the case that we need to be able to talk about shit before we can do anything about it. Her approach is intentionally frank to the point of challenging, in an attempt to break down the barriers—disgust, modesty, embarrassment—that prevent politicians, policymakers, and citizens from finding solutions to the shocking absence of basic sanitation throughout the developing world.

And shocking it is. George runs some basic numbers to provide context for the varied stories that will follow: 2.6 billion people, or roughly 40% of the world’s population, have no access to any type of toilet whatsoever—including even public toilets, outhouses or holes in the ground. Essentially, four in ten people on Earth defecate in the open. One result of this is that 2.2 million people, including 1.8 million children, die annually from diarrhea, most of which is caused by exposure to fecal pathogens. This number is higher than fatalities from AIDS, tuberculosis or malaria, and “dwarfs” the devastation caused by armed conflict. Yet, as George details through numerous specific examples, government investment in solving the problem is comparatively minute.

Following the introduction, The Big Necessity takes us on a whirlwind tour of sewage facilities, feces-ridden villages, and latrine purveyors across the globe. George spelunks through sewers in London, squats on high-tech toilets in Japan, drinks tea in rural Chinese kitchens powered by fecal biogas, and steps carefully between piles of shit in dozens of villages and slums in India, Bangladesh, South Africa, Tanzania and elsewhere. In a book filled with endless disturbing descriptions, several stories stand out. George describes the Dalits of India, for example: an entire caste of Indian society, numbering roughly a million people, whose sole function is to pick up human feces wherever it occurs and carry it to a dumping area, often by hand or in buckets balanced on the head. Though the practice is illegal, Dalits still exist, passing their duties from generation to generation; and for their efforts, they are treated as outcasts, “untouchables,” living in abject poverty and filth, deprived of basic human rights, and routinely abused by members of higher castes.

George offers first-hand accounts of these tragic conditions, but also of many individuals and organizations that are working to solve the problem, often one village at a time. And while many stories are inspiring—such as Jack Sim’s World Toilet Organization (WTO, an intentional shot at the World Trade Organization), which calls attention to the problem through annual conferences and other activities—George is always careful to characterize individual initiatives in the context of the enormity of the problem. Never does she leave us with the sense that we are winning the battle.

Though a journalist by trade, George writes in a casual, often droll first person, injecting her own experiences and reactions into the telling of each story. This approach is generally engaging, and often helps to draw us into the incomprehensibly squalid environments of her travels. Nevertheless, there are times when we get a little too much of the writer’s filtering: in one instance, when she is interviewing Jack Sim early in the morning, we get “I’m not at my best in the morning, so I switch on the recorder and switch off my brain.” Such self-indulgence occasionally distracts us from the real subject. Also annoying at times is George’s tendency to start paragraphs and chapters with non sequiturs that have no immediate context: Chapter 4 begins “It drips on her head most days, says Champaben, but in the monsoon season it’s worse.” We have to keep reading to find out who Champaben is and what is dripping on her head. (It’s feces, of course, and she’s a Dalit.) Such a device can be employed to create curiosity and intrigue, but becomes mildly tiresome after constant repetition over 237 pages of text.

Nevertheless, these are minor criticisms. Overall, The Big Necessity is a far-reaching, in-depth yet highly readable portrait of a vast and mind-boggling global crisis about which very few people in the developed world are aware. George’s research is first-hand, balanced, and extensive, and in spite of her highly personal tone, she passes no final judgments on any of her subjects, offers no policy recommendations, and decidedly eschews a Hollywood ending to her story. She concludes with the same plea argued in her introduction: “The first thing sanitation needs is a spotlight shining on it. It needs to be unshackled from shame.” The Big Necessity is a very good start.

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