nimboo pani: challenges and triumphs

there has been some complaint from some quarters that i have not recently provided any update about my life, reserving blog posts for slightly more wonky topics.

this post will be a small antidote.*

in delhi, one way of dealing with the energy-sapping heat is nimboo pani — literally “lemons water” but in actuality lemonade that is salty and possibly spicy/masala-ed in addition to sweet. (some people add mint but, of course, such frippery is not welcome in this household. i have only recently found a source for basil leaves, which is a far more sensible option.) in this salty way, nimboo pani approximates ORS and can help combat creeping dehydration, which seems to happen even if you are not noticeably sweating or doing anything at all.

i am curious as to why similarly salty lemonades did not catch-on in other hot places, for example, the southern US, which goes heavy on the sweet drinks in summer but, to my knowledge, doesn’t add salt (granted, the food may provide plenty, so things may balance out).

in any case, to celebrate having my flat nearly in order (yes, i know, people want pictures; patience is a virtue), i had a small open-house party at the beginning of july (HOT). i wanted to have nimboo pani on hand but was uncertain how to have ample drink prepared given the constraints of the refrigerator space and the need to have other drinks and food chilled as well.

one small triumph came in finding a shop that sold pre-squeezed lemon juice. nimboo (lemon) here are generally about golf- ball sized and the prospect of squeezing enough to quench thirst for 5+ hours was unappealing, no matter how many martha stewart points i would earn.

my first thought to dealing with the space issue was to make a lot of nimboo pani in advance and then freeze it. this seemed briefly promising until i thought about using salt to melt ice in the winter. this led to a string of probably unnecessarily dramatic texts to pop of the nature “I HAVE  A CHEMISTRY CRISIS.” it was agreed that freezing salty water would be difficult. (it was also likely, tacitly agreed that this was not a crisis.) (follow-up point, auto-correct suggested i might have meant “nimboo panic.” it does fit.)

the ice idea remained promising but how to dissolve all the ingredients on the spot? a friend (thanks, @urmy_shukla!) pointed out that sugar was particularly difficult to mix, given the temperature of the drink. simple syrup presented itself as a solution (ha!). so, in the end, i had frozen lemon cubes and frozen ice tea cubes (in hopes of nimboo pani palmers (go deacs) catching on, but must admit that brown ice has limited appeal, especially in a place where water quality and sanitation are such a serious concerns. perhaps green tea represents a future way forward.) so, people could drop lemon cubes into their glasses of water, which worked out well. i had bowls of rock salt, ground cumin, and ground ginger out so that people could salt and spice their drinks as per their own taste buds. and, i made plain and cardamom simple syrup, which veered slightly towards caramelized but seemed to be ok. this set-up was also good but there is at least one person in our midst who does not agree that drinks should be salty or spicy ever. i may have needed to add a little instruction on how sweet simple syrup is, as @sg402 discovered with VERY sweet nimboo pani.

anyway, party was a success, make-your-own nimboo pani seemed to be a success — so, the world’s problems are nearly solved. basil simple syrup will be pursued in the future.

please do be impressed that i smuggled two public health references into this post.


*a problem with blog-writing is that any word can be a rabbit hole. in typing “antidote,” i wondered if at any time “dote” was used to mean “poison,” in which case, antidote would be a sensible word. “dote” in the sense that we use it now, seems to be derived from the word for foolish. implies that dotum comes from the greek “to give,” so that antidote was “to give against.” there you go.



thank you. water, sanitation, infrastructure, cholera.

someone said something helpful here. about cholera. but not about a new vaccine, a new super-antibiotic, or engineering a new vector that can be lulled to sleep by harp music, along with plans for a helicopter drop of harps or new ways to subsidize harps.

whenever epidemics of cholera occur, the global public health community is energized. experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted… [but]

the best intervention for long-term cholera control and, for that matter, for the control of the great majority of diarrheal diseases is the strategy that eliminated epidemic cholera from the united states and northern europe long before either marketed antibiotics or effective vaccines existed. the development and maintenance of water and sewage treatment systems assured safe drinking water and safe disposal of sewage for all, keeping contaminated sewage out of water, foods, and the environment. the strategy not only eliminated cholera but also dramatically reduced mortality related to diarrheal diseases of all causes.

among others, culter’s articles on mortality determinants are worth reading.

how is a raven like a writing desk? (smartphones as sanitation metaphor)

i have raised my eyebrows once or twice here about some of the discussions on the ipad or smartphone of toilets and sanitation. now i have gotten through the @gatesfoundation challenge paper and have a few more things to say. i briefly summarize the three key topics of the paper in  terms of approaches to improving sanitation and then consider the extent to which a smartphone is a reasonable guide to a reinvented, universally appealing and affordable toilet.

first off all, the premise of the paper, in part, is that we have managed to meet the world drinking water MDG early, though i cannot find a clear explanation of how we did that. but, if we did, we have somehow found a way to bring water in without having it flow back out to carry away waste. are there any cool lessons we are supposed to have learned from successes in the provision of drinking water (despite the fact that gains are uneven, that they may not be sustained, etc) that can  be applied to sanitation or development efforts more broadly?

but the authors want to suggest that not having water to carry away waste is not a bad thing: not only is it the reality with which we have to deal for the foreseeable future (governments are not adequately setting up sewer systems, leaving TMNT homeless) and waste processing — but using large amounts of water to move waste to an energy-intensive plant may not be the soundest idea in general. the authors lay out three  main approaches to improving sanitation. first is the unfortunately acronym-ed* Community Led Total Sanitation (could we not have gone with CoLTS instead of CLTS?), which is about altering social norms around sanitation – open defecation in particular. communities strive to become open-defecation free communities (welcome to pleasantville! open-defecation free since 2008!). of course, behavior change depends on the maintenance of a viable alternative to open defecation – i.e. functional and pleasant toilet facilities. also, it is worth noting, as the authors do, that ‘open defecation’ can occur even when people use latrines; emptying the septic tank out in the open is the equivalent of just having gone in the open in the first place — meaning that open-defecation remains both an urban and a rural problem.

the second idea, which is linked to the third, is that toilets should be able to create useful products out of the waste, namely fertilizer and/or energy. linked to this idea of profit- or product-generation is the need to come up with better services for emptying latrines and processing ‘fecal sludge.’

the third idea also has to do with reconceptualizing the toilet – this is where the smartphone metaphor comes in. the idea (with prototyping currently funded by gates) is to come up with a cool toilet that not only will it be a reasonable technology for those currently without access to safe sanitation but it will become the new gold standard everywhere. because of it’s high water and energy use, the authors suggest, the water closet’s reign is – or should be – nearing an end.

i understand that the ‘smartphone of sanitation’ is nice because it is alliterative and rings of the birth-of-social-marketing-catchphrase, ‘why can’t we sell brotherhood like soap?’ it lets you talk about poop in the same way you discuss technology. the main point of the metaphor seems to be about toilets being designed and marketed as an aspirational item that, again, will become the new gold standard for everyone, as the authors say, “from sitters to squatters and washers to wipers” the world over.

it seems worth pausing to consider how toilets could be like smartphones. spoiler alert: i have not yet come up with a better metaphor, just starting the conversation.

first, what is currently the height of toilet technology? japanese toilets (further reading here.). these are presently the aspirational toilet, with a wide array of features and services — and it is probably aspirational in ways that a reinvented toilet would not be (since the new toilet designs are supposed to use less water and energy, assorted spraying and heating would seem to run counter to this).

how could a new toilet be like a smartphone? what works about this metaphor?

  • like the move away from landlines, the new toilets will be off-the-grid
  • it will be hard to remember how you ever lived without one & everyone will need/want one
  • the user scale will be at the individual or household level, rather than the community
  • the user interface and experience is emphasized — finally moving us to a conversation that we need to not only provide safe sanitation but pleasant sanitation that people will want to use (moving beyond it just being free of flies and unpleasant odors as criteria for satisfaction with sanitation)
  • an industry has grown up around the maintenance, transport, decoration, and so on, of smartphones
  • it may (?)  be able to overcome “issues of high cost, slow adoption, and limited benefits” that previous technologies have faced (suggesting that our present flush toilet model is the equivalent of fax machines and desktop computers and that we will leapfrog over it?)

but, part of why we buy smartphones are features that will likely never be captured in a toilet (perhaps my imagination is not sufficiently active) — and which we may not want to emulate.

  • part of the aspirational aspect of smartphones is that everyone is pulling theirs out all the time, so you get to see and be seen. they are a profoundly public and social technology.
  • there is an ever-proliferating pool of new apps and functions that smartphones can take on, making the phone constantly novel in some way.
  • smartphones can be tailored and customized in various ways
  • people can be bewildered by their phones (not me, of course) but the reinvented toilet is explicitly supposed to be “fool-proof” (echoes of birth control in the 1970s, anyone?)
  • if you run out of money or time to do maintenance (let’s say, topping up your phone with credit), it doesn’t become totally unusable — you can still receive calls & texts. but, if you forget to charge it, it doesn’t work
  • there is a constant desire to upgrade
  • they are constantly getting smaller

so, smartphones as the model for toilets work in some ways but not in all. even if we chat about the novelty of the japenese toilet on the first few trips to a fancy restaurant, in the end, toilets are fairly private and socially disconnected. and it is not clear that they need to be high-tech to be pleasant, safe, and useful. the ways in which we will make people want to invest in a new toilet will be quite different from the ways that smartphones have become desirable. though we may be able to harness nutrients and energy from waste in these reinvented toilets, there probably won’t be a constantly flow of new things that a toilet can do for us.

the comparison with smartphones may help us start the conversation about sanitation but it can’t completely guide us toward the toilet of the future. toilets may remain more like dishwashers and washing machines and vacuum cleaners, in which case, they may well need to be marketed towards moms – either to make their life easier or to help them care for their family better (whether or not you think that is an appropriate or fair marketing strategy for household appliances, it is certainly the strategy).  (happy belated mother’s day mom! i’ll get you a new toilet when they come out.)

remaining questions:

  • thoughts on must-have features for a new toilet, which may or may not have a smartphone parallel? 
  • also, if these are going to be the hip new toilet for everyone, how long do you think it will be before we BOGO toilet schemes pop up?
  • absent flushing toilets, how will dead goldfish get back to the sea?

*there really needs to be a business that checks acronyms and baby names/initials before anyone  makes final decisions on such things.

off-the-grid, profitable toilets? / why would you do things that way? (I)

i am pretty sure this is the beginning of a cool idea for improving water & sanitation, which is ever-so-critical for public health (still the #2 cause of under-5 mortality globally – though it’s not clear if these new toilets have potty-training options and what that actually means for the spread of disease…). skipping the toilet grid might be an example of a leap-frogging technology and the argument runs that if the waste could be made profitable (in addition to the initial unit), there would be incentive to maintain facilities.

the article reads:

the flush toilet… credited with adding a decade to our longevity… is an impractical luxury for about two- thirds of the world’s 7 billion people because it relies on connections to water and sewerage systems that must be built and maintained at great expense.

first, new designs are required for toilets that are hygienic, pleasant, and cheap to make and use, and that work without being connected to a grid. because such a facility would have to be periodically emptied, ideally excretions would be treated not as waste but either recycled on site or turned into profitable resources… the Gates Foundation requires that the overall cost of a future toilet, including maintenance, not exceed 5 cents per user per day… that would enable the private sector to step up production and distribution once practical new models have emerged. Cities would have to build a new generation of waste-processing centers, but the investment would quickly pay for itself… for gridless sanitation to be economical, commerce needs to flourish around the collection and treatment of excrement.

is the assumption that low- and middle-income states cannot or need not have responsibility for water & sanitation? water & sanitation seem like fairly classic examples of public goods and even of rights as citizens or humans, depending how you like your rights. what role can and should the state play if we move forward sans grid? does sanitation represent a natural monopoly or is it fair ground for competition? what role can/should the state play in regulation and/or provision of free or low-cost (or micro-financed) options for those who cannot pay — either as a public good for public health or as a right?

the main example of private water – if not sanitation – provision that comes to mind are the different water companies that provided water in John Snow’s day — allowing for a nice epidemiological experiment and the near-conclusion of an important disease transmission debate — but also for a lot of cholera. is there an example of scaled private sanitation provision that could provide a model for how the whole system – provision, collection, & maintenance, not just individual toilets (though, rock on, engineers) — might work?

fun fact! John Snow tested his anesthetics on himself, recording just before he passed out and first thing when he woke up. (see The Ghost Map)

rethinking the use of the word ‘simple’ in global health & development (III)

suvojit made some great points that turned into (what i think is) an interesting conversation. check it & think about what ‘best buys‘ in development really mean.

plus, generally check out suvo! we’re all better off since he decided to stop and blog every now and then.

toilets: the importance of ownership (also, really, the iPad of commodes?)

there are some cool ideas about local maintenance and ownership in the reported community-led total sanitation.

we shouldn’t be too hasty to overlook the ‘conceptual ownership’ aspect, though. It’s really important that there is responsibility delegated for taking care of a toilet or latrine. i have encountered plenty of toilets – and lines for toilets – in many places that make going outside the clearly superior alternative. any time i see an initiative for building a large number of new latrines or toilets (like this), i worry about that all-important maintenance component that turns the toilets into a permanent improvement.

among other experiences, an unregistered slum in bombay in which i did some research had only a few latrines, privately owned by households. The households charged money but did not maintain the latrines. It was clear why many people still preferred to use the ocean. and those who did wait for the latrine often faced a morning before-school rush that was daunting, often resulting in kids being late for school.

so, yes, there is a very important element of ownership related to aspirations and feeling good about your latrine and bad about the alternative. but don’t forget the cleaning-duty chore wheel and check-list.