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Column Embarrassing bowel problem? We’d really rather not hear about it
The media shapes our picture of global health threats, writes Glendora Meikle – and the unglamorous, smelly, downright deadly conditions are too often left out.

IF YOU’RE LIKE me, you probably don’t have your Google Alerts programmed to seek out articles with the word “poop” in them. If you did, you might have noticed that last month the Gates Foundation hosted a Reinvent the Toilet Fair. It is the latest in their efforts to increase awareness of the dangers of poor sanitation in developing regions. They aim to offer new solutions to the more than two billion people worldwide who lack access to a toilet, millions of whom succumb to diarrhoea-related deaths.

If you didn’t hear about the Toilet Fair via your typical news-consumption habits, it’s probably because this is a conversation that is traditionally met with some resistance. As a society, we’re generally not overly eager to delve into the delicate, messier realities of how something as mundane yet icky as human waste can be fatal, and what needs to be done about it. Simply put, members of the media – and the public – get squeamish about having to articulate the unseemly specificities that must necessarily accompany an article about poo. Or any disease with the word “rectal” in it. And especially any maladies involving … lady parts.

The zone of global health communication we’ve stumbled into could be classified as the Chasm of Unglamorous Ailments. Though we spend a tremendous amount of ink and column inches working to address health threats like malaria, HIV/AIDS and tuberculosis, there are certain conditions that fall through the cracks of public discourse. The explanation for our collective disinterest is that these illnesses are awkward, unpalatable, or just plain gross. They make us blush.

Deadly consequences

Anyone with a passing interest in media studies may have found themselves wondering why certain stories gain instant traction in the newsroom and others manage only to grab the interest of a blogger in Timbuktu. Logic tells us that every potential story needs a hook: some change to the status quo, threat to the local population, timely relevance, or other reason that the telling of the story should happen now as opposed to some other occasion. Otherwise, it wouldn’t technically be news, and editors would have a hard time justifying their motives.

For example, before the establishment of World Toilet Day (now held annually in November), what would spur a reporter to talk specifically about life-threatening diarrhoea? It’s not new – millions of people (children especially) have been dying from the dehydration caused by diarrhoea for centuries. Westerners aren’t faced with the same conditions (contaminated water, lack of toilet facilities), so it’s not organically something of note. It’s no more relevant today than it was a month ago; rather, it continues to affect populations from Bangladesh to Burkina Faso at steadily high rates, killing more children per year than AIDS, malaria and measles combined, according to a 2009 report by the World Health Organization (WHO).

We’re familiar with myriad health problems and social inequities that plague developing regions. The majority of them aren’t embarrassing for us to recount. It’s a lot less unsavoury to discuss the need for bed nets to protect against mosquito bites than to spell out the deadly consequences of distressed bowels. The problem with cherry-picking health issues is that it can inaccurately influence our perception of what most urgently needs attention. Without the media to help spread awareness, we will be tempted to direct assistance and foreign aid towards issues we believe to be the most widespread and menacing. If this perception is misinformed, huge swaths of suffering people will be ignored.

‘Nobody talks about it’

Let’s consider a concrete example of a condition that falls solidly into the public avoidance category. In March, I traveled to Ethiopia to tour the Hamlin Fistula Hospital in Addis Ababa. The vast majority of Westerners have never heard of obstetric fistula. It is a hole that develops between the vagina and bladder – and sometimes rectum – when a woman experiences tissue death due to prolonged, obstructed labour. In other words, in countries where access to medical facilities is severely limited and the expectant mothers are too young or too small (due to malnourishment), the baby gets stuck and can’t make its way through the pelvis.

A woman can suffer for days or even a week in this state, desperately trying to expel what at this point is a stillborn child. If she lives and can eventually manage to dislodge the baby from her body – sometimes pulling it piece by piece – she will find that she has developed a fistula, and cannot control the urine and/or faeces that now drips constantly down her legs.

As if the trauma of losing a child and becoming so mortifyingly incontinent weren’t enough, the overwhelming odour that now accompanies the woman at all times causes her community and her own family to cast her out. She will be banished from society, develop crippling side effects, and often contemplate suicide to end such a miserable existence.

More than two million women in sub-Saharan Africa and parts of Asia experience this horrific scenario. Two million. But nobody talks about it, because it requires defining a condition by using words like “vagina” and “urine leakage.” It is much safer to lump it under the umbrella of maternal health and move on.

This is bad. It perpetuates the stigma and allows the public to remain uneducated. As a result, up until a few years ago there was only one hospital on the entire African continent that was dedicated exclusively to fistula repair (a €250 surgery fixes it in 90 percent of cases). Most women don’t know a cure exists.

Worlds apart

Since it is long proven that we always need an anecdote to make a distant situation relatable, here’s mine: On the day I visited the fistula hospital in Addis, a dear friend delivered a baby of her own, half a world away in New York City. My friend is half Burmese and of small stature, and she ended up needing a C-section – the very surgery that eradicated fistula in the West a century ago. I couldn’t stop my mind from making the connection: if things were different and she’d been in rural Burma when she went into labour, would she have lived? Would her son? Would she have developed a fistula?

Sometimes our bodies betray us in ways that are unpleasant to discuss. We can’t let that dictate our response. We need to do better, and there’s hope that we are starting to find ways into the conversation. The Gates Foundation employs cheeky headlines (“You Don’t Know $h!t About $h!t”) to put readers at ease, and fundraising campaigns like Movember, which raises money for prostate cancer research, encourage participants to go as zany with their moustache-growing as possible (the men are sponsored in exchange for not shaving their upper lip for the month of November). Acknowledging tensions with a bit of humour can go a long way, and with cooperation between advocacy groups, media actors and the public, the hope is that every illness floundering in the Chasm of Unglamorous Ailments can find its niche.

From Bono to Angelina Jolie, there does exist an element of glamour in certain spheres of social responsibility and development aid. For the sake of those who lack that edge, we need to collectively nut up and push past the discomfort. Let’s find some space on the front page for lady parts and poop.

Glendora Meikle is completing her master’s degree in Media & International Conflict at UCD’s Clinton Institute. Her dissertation explores the silence surrounding obstetric fistula in the media, as compared with other global health issues. She has worked in communications and international affairs for several years, most recently at United Nations Headquarters in New York. Twitter: @gmeiks

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