We all need to flush

Diarrhoea kills more children than Aids or malaria. But clean water supplies are only part of the so

Diarrhoea. The runs. The squits. The “insert funny name here”. Diarrhoea is funny, right? Because diarrhoea is something that you get from a bad kebab or some dodgy prawns. Because it is curable; not fatal; benign. It can be all those things, but only if your surroundings are not continually contaminated with the faecal particles that probably gave you the diarrhoea in the first place. Four in ten people in the world (2.6 billion) live with no sanitation whatsoever. When there’s no good containment – a toilet, or a pit latrine will do – faecal particles will be tramped on by people’s feet and carried on their fingers into food and water, with horrible consequences. Diarrhoea is the second biggest killer of children under five in the world. It kills more children than HIV/Aids or malaria. A child dies of those banal squits every 15 seconds.

So it is good news that the World Health Organisation this month recommended that vaccines for rotavirus be standard for children in the developing world. Rotavirus does not cause all diarr­hoea, but it causes a lot of it. Instead of a single vaccine dose, however, harried nurses may have to give several, as diarrhoea makes it difficult for a child to retain anything. Diarrhoea is the reason you can have a malnourished child in a well-fed family. Because human faeces can carry 50 ­­­­com­municable diseases, they are an efficient weapon of mass destruction. Half of the hospital beds in sub-Saharan Africa are filled with people ­suffering from what are generally known as ­water-related diseases. Actually, they’re shit-­related diseases.
A couple of years ago, readers of the British Medical Journal voted the toilet the best medical advance of the past 200 years, over penicillin and the pill. They knew that before the flush toilet became the norm in the 19th century, one in two children in London died before the age of five. With toilets, sewers and hand-washing with soap, child mortality dropped dramatically. ­Today, we in the developed world take these things for granted. We do not give much thought to the women who must get up at 4am in darkness, trek to a nearby bush or field, and try to do their business risking rape and snakebites. It can be easy to ignore, even when you live among it.

I have met countless Indians, who live in a country where 700 million people have no choice but to do open defecation, who claim never to have seen anyone toileting in public. Yet visit any Indian – or Indonesian, or Vietnamese, or Malawian – village, and along the roads you will see men and women, elderly and young, squatting by the roadside, the women trying and failing to keep both their faces and backsides covered for modesty’s sake. “Before, they would have been jumping up at every passing car,” my Indian companion told me. “Now there’s too much traffic. They’d be up and down like a yo-yo.”

Open defecation, and its concomitant diseases, is not just unpleasant. It also costs the world a fortune. Last year, the World Bank calculated that poor sanitation cost Cambodia, Indonesia, the Philippines and Vietnam between 1.4 and 7.2 per cent of GDP (not to mention the girls who do not go to school because there is no private latrine; or the mothers who cannot work because they are trekking into the bushes for ­privacy). Yet sanitation is the most cost-effective disease prevention tool we have. The World Bank economist Guy Hutton has estimated that investing $1 in sanitation saves $7 in healthcare costs and labour days that aren’t lost. When Peru had a cholera outbreak in 1991, losses from tourism and agricultural revenue were three times greater than the total money spent on sanitation in the previous decade.

Yet, as Fatal Neglect, a recent report by WaterAid demonstrated, money continues to flow towards more fashionable diseases and causes. In Madagascar, for example, 0.1 per cent of the population has HIV/Aids, and UNAids found there were too few Aids deaths to estimate. Yet HIV/Aids receives five times more funding than sanitation, though diarrhoea kills 14,000 Madagascan children every year. Antiretroviral therapies, the most common prevention tool against Aids, costs $922 per Daly (Disability-Adjusted Life Year, a standard health-prevention unit of calculation). Sanitation and hygiene promotion costs $11 and $3 respectively. By any measure, sanitation is a bargain.

Sanitation activists do not just look wistfully at the money flowing into HIV/Aids. They also see funds gushing into clean water supplies, an easier cause to sell and publicise. Water and sanitation budgets are usually a pittance (often 0.1 per cent of GDP), and of that, 90 per cent goes on clean water supplies. I have lost count of how many celebrities have put their names to clean water charities, happily photographed in front of a bright, shiny new tap, preferably with a ­photogenic child nearby. A laudable cause, but a clean water supply reduces disease by 20 per cent, while a latrine can reduce it by 40 per cent.

In a slum not far from Calcutta, I met Sandya Barui. She was 60 (and looked 80), but had dug her own latrine pit and built her own superstructure from spare tin and banana leaves. Before that, she had had to do her business in the ban­ana fields behind her home, and it was “sinful”. Children would come and look at you as you squatted, she said. And she was spending 100 rupees ($2.50) a month on medicine, which was 100 rupees more than she had.

Then some visitors came to the slum and asked for a tour, and at the end they asked to see where people went for open defecation. Such shame! Then they asked people to estimate how many truck-loads of shit they were leaving in the open. It was a shock, Sandya said – as it was when people noticed that a plate of excrement had been brought to the meeting place and the flies were hopping merrily from the shit to the plate of chapattis next to it.

Children immediately ran off and began digging, but Sandya’s was one of the first proper ­lat­rines to be built. She spent 700 rupees on it, and thinks it is worth every paise. Diarrhoea rates in the area have dropped dramatically, and more children are going to school (studies have shown that latrines can increase school attendance, particularly among girls, by up to 20 per cent).

Sandya has done her sums. She knows that good sanitation adds up. If only the politicians holding the purse strings could figure it out too.

Rose George’s book “The Big Necessity: Adventures in the World of Human Waste” is published by Portobello Books (£12.99)

This article first appeared in the 29 June 2009 issue of the New Statesman, The Great Escape

Biteback and James Wharton
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“It was the most traumatic chapter of my life”: ex-soldier James Wharton on his chemsex addiction

One of the British Army’s first openly gay soldiers reveals how he became trapped in a weekend world of drug and sex parties.

“Five days disappeared.” James Wharton, a 30-year-old former soldier, recalls returning to his flat in south London at 11pm on a Sunday night in early March. He hadn’t eaten or slept since Wednesday. In the five intervening days, he had visited numerous different apartments, checked in and out of a hotel room, partied with dozens of people, had sex, and smoked crystal meth “religiously”.

One man he met during this five-day blur had been doing the same for double the time. “He won’t have been exaggerating,” Wharton tells me now. “He looked like he’d been up for ten days.”

On Monday, Wharton went straight to his GP. He had suffered a “massive relapse” while recovering from his addiction to chemsex: group sex parties enhanced by drugs.

“Crystal meth lets you really dig in, to use an Army term”

I meet Wharton on a very different Monday morning six months after that lost long weekend. Sipping a flat white in a sleek café workspace in Holborn, he’s a stroll away from his office in the city, where he works as a PR. He left the Army in 2013 after ten years, having left school and home at 16.


Wharton left school at 16 to join the Army. Photo: Biteback

With his stubble, white t-shirt and tortoise shell glasses, he now looks like any other young media professional. But he’s surfacing from two years in the chemsex world, where he disappeared to every weekend – sometimes for 72 hours straight.

Back then, this time on a Monday would have been “like a double-decker bus smashing through” his life – and that’s if he made it into work at all. Sometimes he’d still be partying into the early hours of a Tuesday morning. The drugs allow your body to go without sleep. “Crystal meth lets you really dig in, to use an Army expression,” Wharton says, wryly.


Wharton now works as a PR in London. Photo: James Wharton

Mainly experienced by gay and bisexual men, chemsex commonly involves snorting the stimulant mephodrone, taking “shots” (the euphoric drug GBL mixed with a soft drink), and smoking the amphetamine crystal meth.

These drugs make you “HnH” (high and horny) – a shorthand on dating apps that facilitate the scene. Ironically, they also inhibit erections, so Viagra is added to the mix. No one, sighs Wharton, orgasms. He describes it as a soulless and mechanical process. “Can you imagine having sex with somebody and then catching them texting at the same time?”

“This is the real consequence of Section 28”

Approximately 3,000 men who go to Soho’s 56 Dean Street sexual health clinic each month are using “chems”, though it’s hard to quantify how many people regularly have chemsex in the UK. Chemsex environments can be fun and controlled; they can also be unsafe and highly addictive.

Participants congregate in each other’s flats, chat, chill out, have sex and top up their drugs. GBL can only be taken in tiny doses without being fatal, so revellers set timers on their phones to space out the shots.

GBL is known as “the date rape drug”; it looks like water, and a small amount can wipe your memory. Like some of his peers, Wharton was raped while passed out from the drug. He had been asleep for six or so hours, and woke up to someone having sex with him. “That was the worst point, without a doubt – rock bottom,” he tells me. “[But] it didn’t stop me from returning to those activities again.”

There is a chemsex-related death every 12 days in London from usually accidental GBL overdoses; a problem that Wharton compares to the AIDS epidemic in a book he’s written about his experiences, Something for the Weekend.


Wharton has written a book about his experiences. Photo: Biteback

Wharton’s first encounter with the drug, at a gathering he was taken to by a date a couple of years ago, had him hooked.

“I loved it and I wanted more immediately,” he recalls. From then on, he would take it every weekend, and found doctors, teachers, lawyers, parliamentary researchers, journalists and city workers all doing the same thing. He describes regular participants as the “London gay elite”.

“Chemsex was the most traumatic chapter of my life” 

Topics of conversation “bounce from things like Lady Gaga’s current single to Donald Trump”, Wharton boggles. “You’d see people talking about the general election, to why is Britney Spears the worst diva of them all?”

Eventually, he found himself addicted to the whole chemsex culture. “It’s not one single person, it’s not one single drug, it’s just all of it,” he says.



Wharton was in the Household Cavalry alongside Prince Harry. Photos: Biteback and James Wharton

Wharton feels the stigma attached to chemsex is stopping people practising it safely, or being able to stop. He’s found a support network through gay community-led advice services, drop-ins and workshops. Not everyone has that access, or feels confident coming forward.

“This is the real consequence of Section 28,” says Wharton, who left school in 2003, the year this legislation against “promoting” homosexuality was repealed. “Who teaches gay men how to have sex? Because the birds and the bees chat your mum gives you is wholly irrelevant.”


Wharton was the first openly gay soldier to appear in the military in-house magazine. Photo courtesy of Biteback

Wharton only learned that condoms are needed in gay sex when he first went to a gay bar at 18. He was brought up in Wrexham, north Wales, by working-class parents, and described himself as a “somewhat geeky gay” prior to his chemsex days.

After four years together, he and his long-term partner had a civil partnership in 2010; they lived in a little cottage in Windsor with two dogs. Their break-up in 2014 launched him into London life as a single man.

As an openly gay soldier, Wharton was also an Army poster boy; he appeared in his uniform on the cover of gay magazine Attitude. He served in the Household Cavalry with Prince Harry, who once defended him from homophobic abuse, and spent seven months in Iraq.


In 2012, Wharton appeared with his then civil partner in Attitude magazine. Photo courtesy of Biteback

A large Union Jack shield tattoo covering his left bicep pokes out from his t-shirt – a physical reminder of his time at war on his now much leaner frame. He had it done the day he returned from Iraq.

Yet even including war, Wharton calls chemsex “the most traumatic chapter” of his life. “Iraq was absolutely Ronseal, it did exactly what it said on the tin,” he says. “It was going to be a bit shit, and then I was coming home. But with chemsex, you don’t know what’s going to happen next.

“When I did my divorce, I had support around me. When I did the Army, I had a lot of support. Chemsex was like a million miles an hour for 47 hours, then on the 48th hour it was me on my own, in the back of an Uber, thinking where did it all go wrong? And that’s traumatic.”

Something for the Weekend: Life in the Chemsex Underworld by James Wharton is published by Biteback.

Anoosh Chakelian is senior writer at the New Statesman.

This article first appeared in the 29 June 2009 issue of the New Statesman, The Great Escape