Improving safe sanitation for children with disabilities in Vanuatu

For the first time since childhood, Shirley, who was born with cerebral palsy, has access to safely managed sanitation. (photo: World Vision Vanuatu)

Fourteen-year-old Shirley was born with cerebral palsy and movement difficulties. Without access to a wheelchair or mobility device suitable for the rough terrain where she lives, Shirley moves by pulling herself along the ground.

Despite living close to an urban area, Shirley was unable to easily access or safely use the household's outdoor toilet, located around 250 metres from the family home. The often muddy and unlit path to the toilet is uneven, carpeted in sticks, grass, and fallen leaves. So, it was common for Shirley to get wet and muddy, and often have trouble avoiding obstacles at nighttime. Once inside the toilet, with no handrails to hold onto, Shirley used her unaffected hand to pull herself up to a seated position and hold onto the toilet seat. This meant she often came in contact with residual excreta.

This all changed recently though, when Shirley was given her own portable commode chair made from locally sourced, recycled materials, which she now has at her disposal 24 hours a day. Although simple, the commode chair has been life-changing for Shirley and her family. “I am happy about my new toilet,” she said. “This is the first time I have had a chair of my own at home." For the first time since childhood, Shirley has access to independent and safely managed sanitation.

As part of the Water for Women project, Laetem Dak Kona: Gender-equitable and disability accessible WASH in Vanuatu, and working in partnership with disability service provider, Vanuatu Society for People with Disability (VSPD), and people with disabilities, World Vision Vanuatu designed the assistive device to improve access to safe sanitation for people with disabilities and be suitable for most households. After successful trials, manufacture of the portable commode chair is now being scaled-up to reach more people.

Each portable commode chair is made by a local Vanuatu craftsperson to suit each individual's specific needs. For Shirley, her commode is at a height appropriate and manageable for her. It has sturdy armrests that enable her to independently pull herself up onto the seat from the ground, and it has anti-tip supports to ensure it doesn't fall forward as Shirley adjusts her position. It has a lid that converts the commode into a chair when not in use, which also traps odors, and means the chair can be used independently for other daily seated activities or bathing if required. Shirley now has the ability to use the toilet at her own convenience, with increased safety, hygiene and dignity.

Shirley’s story sounds extreme, but access to safely managed sanitation is an all too common challenge for children and people with disabilities living in Vanuatu, and for their carers.

Access to basic water and sanitation in the Pacific is lower than any other region of the world. In Vanuatu, it is estimated that just 34 percent of the population has access to basic sanitation, while a recent study by World Vision and partners found that more than 30 percent of people with disabilities come into contact with urine or faeces when they go to the toilet.

Carers also report experiencing increased back pain when needing to carry children to the toilet, and people with disabilities often not wanting to burden carers, and therefore delaying requests to go to the toilet until soiling themselves.

In peri-urban communities with overcrowding or limited space, or for people with significant mobility issues,  incontinence, or both, simply building a more accessible latrine close to home either isn't possible or wouldn't meet all their needs, particularly during wet season. So, the portable commode seat is proving an innovation solution for many people with disabilities and their carers.

VSPD mobility coordinator, James, said the availability of the locally made commodes is also making a significant and positive difference for people with disabilities and VSPD as an organisation. “Instead of having to wait for assistive devices to be donated to VSPD from overseas aid, we can source locally made products that are helpful and people want,” he explained.

“Sometimes donated devices take a long time to come and they don’t always fit the person or their needs.  These new commodes help us to provide assistance quickly and make sure it is the right fit for the person. This makes our job much more satisfying when we can provide something that really works to make a difference."

Water for Women is the Australian government's flagship WASH program and is being delivered as part of Australia's aid program over five years, from 2018 to 2022. Through Water for Women, Australia is investing AUD118.9m to deliver 33 water, sanitation and hygiene (WASH) projects and research initiatives, which aim to directly benefit 2.9 million people in 15 countries across South Asia, South East Asia and the Pacific.