An Affirmation of Dirt

A Quick Stop in Central America

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I went to Nicaragua during my time at OSU, through an organization called Project Nicaragua. We partnered with Noemi, a missionary doing amazing nutrition and agriculture work in a mountainous rural village called Rancho Grande, a welcoming community. It was the first troupe we’d ever sent to Rancho Grande and there were six of us. The three girls stayed at the home of the pastor in the main village. The three guys, on the other hand, stayed in the mud-floored schoolhouse in the mosquito net covered cots, a trek up a sludgy hill.

The trip to Rancho Grande, less significantly, coincided with a purchase I made: new shoes (the pointy Puma ones that only Usain Bolt could actually wear without looking ridiculous; I’m not Usain Bolt). As the honeymoon period of purchasing material things usually goes, these shoes seemed imbued with semi-magical qualities. I walked differently in them, stood differently, felt differently.

The honeymoon carried over into the airport as I flew from Miami to Managua. What the love affair hadn’t planned for, though, was monsoon season.

The first day, a torrential downpour left the floor of the schoolhouse flooded. There, we went into panic mode, desperately shifting our suitcases from the floor to the tables to prevent them from getting any muddier while trying to swat away Jurassic Park-sized insects. My shoes had gotten dirty; I patiently used our hand sanitizer (a precious resource, no less) on paper towels to wipe them clean, feeling at peace with myself. That sense of dirtiness was finally gone, and my hard work had paid off.

The second day, after we had taught English in the class, the kids in Noemi’s program, our students, began spontaneously playing soccer on the field right outside. I joined in, and we sloshed around in the mud, playing a messy style of soccer to equal the messy plain.

By the third day, I looked down at those same shoes, once shiny but now caked in a layer of mud, and stopped caring. This quiet and not insignificant event reflected a broader pattern of my relationship with dirt while I was in Rancho Grande. I got used to it. We all did. And I came to an insight that anyone who’s been on a long hike knows: a sense of cleanliness is relative, and can be transformed in a matter of days.

I didn’t realize how much that sense had been warped until I returned to Cleveland and ,while unpacking, I opened my suitcase in the family room. The rest of the family could smell the offensive odors from the kitchen.

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There are a lot of words to describe Calcutta, but “clean” is almost never one of them. Even relative to other cities in India and the ‘developing world’, Calcutta usually takes the trophy in terms of dirtiness. The city seems to be eternally engulfed by a fog of dust. Every surface is covered in grime, and the buildings are splotched with decay, colored with black muck that leaves a pristine state only to the imagination.

Dirt in Calcutta is not something over there but everywhere. It is weaved into the daily fabric of life. In the morning, I pass by the large fish market in Howrah next to a large dump, the scents burning my nostrils. I’ve seen far too many bright-yellow taxis leaving this market loaded up with bundles of naked fish to ever let a taxi driver put my suitcase in the trunk. As I pass by the dumps, I see men made of pure sinew and fiber shoveling trash into a rusty wheelbarrow. Openness is the presiding rule here: the garbage dumps are open, the sewers open, the nearby restaurant windows open, produce sold in the open, and the windows on the bus open. The result is a mingling without any separation at all. My daily ritual first thing upon returning home from work is to rigorously wash a layer of black soot from the bottom of my feet. The remnants of Calcutta streets are removed, the cost of wearing sandals expunged before I enter the pristine home.[1] The black soot, though, is an indicator of the all-encompassing cloud that lurks here. Another litmus test is wearing a white shirt (after a day of going through the city, white no longer).

Private spaces, in many places though, are spic and span. It provides a strange effect when you leave the sleek steel and glass Bose audio store or the mahogany shelves of Oxford bookstore to the dust swirls of Park Street. The street sweepers are engaged in the Sisyphean task of keeping the sidewalks in Calcutta clean. With their wooden brooms, they push the dirt and trash onto Park Street. The dust then gets reshuffled to the sidewalk after a few buses pass by, and the process is repeated ad infinitum. On Park Street, when I pop around the corner to grab a Kati roll (have I mentioned my love of Kati rolls?), I wonder how much of it is composed of unstated ingredients: dust, grime, and sweat (and also how much of these unstated ingredients add to the taste).

There’s an easy and natural response to such an environment. That response is disgust, enough disgust to drown in. The brown waters of the Hugli, (in which tens of thousands must bathe), the pollution (which delays my recovery from a cough for weeks[2]), the overcrowding and the resulting creation of pure human matter and odors: these are all things to be easily disgusted by. Dirt is ubiquitous, and nothing is pure.[3]

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Beyond Disgust

Dirt is matter out of place- Lord Chesterfield by way of anthropologist Mary Douglas (by way of fellow Calcutta fellow Liz Peyton)

Disgust, though, doesn’t last forever. It was an instinctive, gut-level response, but eventually I got used to it. I returned to that insight in Nicaragua. I began thinking about what this thing we call “dirt” was really anyway and what caused that initial emotional reaction. The more I thought about it, the more I understood that I had systematically divided up the world into arbitrary categories of clean and dirty. These were categories that were products of the environment I was raised in (one with plenty of antibacterial hand sanitizer, Febreze, and Tide-to-go available).

The dust swirls, the black muck, the trash strewn on the side of the road, I began to accept these previously jarring sights. I didn’t gag anymore while the bus passed the toxic dump-fish market duo. I stopped thinking of it as dirty at all, began living within the openness instead of rebuking it. I recognized how subjective the notion cleanliness seemed: what did the daily inhabitant of these streets see as dirty or clean? It definitely didn’t align with what I’d had as sensory expectations.

Dirtiness, historically speaking, has been used as a tool to subjugate and stigmatize. As the philosopher Martha Nussbaum states, “…certain disgust properties- sliminess, bad smell, stickiness, decay, foulness– have repeatedly and monotonously been associated with jews, women, homosexuals, untouchables, lower-class people– all of those are imagined as tainted by the dirt of the body.” It’s been tied to religion, class, and ethnicity. Dirtiness was created and then marketed wholesale for political purposes, to preserve social privilege.

In India, one doesn’t have to look any farther than the caste system, expressed not only in large injustices but the repeated, small offenses (ones that I’ve seen in the last month include separate dishes and divided areas for shoe removal). It reminds me of Rohinton Mistry’s novel A Fine Balance, in which two main characters, Om and Ishvar are members of the chamaar caste, a group that is relegated to the undesired and “dirty” profession of leather tanning (no other caste would touch the carcass). They escape their “birthright” profession for tailoring in the big city of Mumbai, but the wretched legacy of untouchability follows them there too.

Dirtiness has been tied to disease too, a potent way to socially isolate people. Isolation of carriers of infectious disease makes sense now that we know about how pathogens can be transmitted. Historically, though, it was used for nefarious and inhumane purposes without any evidence whatsoever (for example, Nazi separation of Jewish populations in Poland based on the fact that they were “natural carriers” of typhus). Beyond stigmatization, dirtiness was thought to cause disease period. The “miasma” theory held that cholera and other diseases were all caused by vapors in the air from general rottenness (malaria is Medieval Italian for bad air: mal, aria).

“Dirt is matter out of place.” Out of place. It’s something that was borne of a system, and what I expected to see in that system. And my experience hadn’t conditioned me to expect hordes of men lined up in the public park by the Victoria Memorial urinating. And it definitely hadn’t taught me to expect goat feces next to tailoring shops, like in the slum of Fakir Bagan. That’s why this felt dirty- it was out of place, my perspective of cleanliness was based on a systematic bias I had from every experience I’d had before. But that had changed from living in Calcutta; everything now held the potential of beauty, and everything was pure.

So, then, I overcame this initial emotional reaction of disgust said that “dirtiness” was all in my head and called it a day.[4]

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Treating the Loosies

But it wasn’t all in my head. My work at Calcutta Kids kept rudely interrupting me with the truth that some dirt makes us sick. A rude and vulgar fact: diarrhea kills 1.5 million kids under 5 a year, and there are billions of cases across the globe annually, upwards of 80% in South Asia and Africa (WHO Report, Diarrhoea 2009). It’s a devastating disease that stunts physically and mentally, and it’s a terrifying Grim Reaper especially in the developing world. All year, it’s a constant problem for the residents of the Fakir Bagan slum, but one that’s heightened during monsoon season.

So, what causes it? You can easily say E. coli, or Rotavirus, or Shigella, or V. cholerae, and you’d be right by any account (and any microbial plate). But isolating the specific pathogen only gives us a partial account; the real, ultimate cause (the cause that we can most directly take action on at Calcutta Kids) is something messier, something that popped my bubble of romanticism about dirtiness and brought me back to earth. That cause is fecal-oral transmission. The name, dear reader, explains itself.

Which leads me to the first real partial description what I’m doing here with Calcutta Kids. One of my main tasks over the next few months is helping to restart a Diarrhea Treatment Center. In October of last year, Calcutta Kids began transitioning all our activities into a new community center that’s now in the middle of the slum itself.  In the new center, we’re hoping to systematically tackle acute cases of diarrhea so that it not only provides the treatment but also prevents future cases. The treatment side is ridiculously simple and cheap: “oral rehydration therapy,” a fancy name for water with sugar and salt that rehydrates the child (that’s been called the most important advance of the 20th century, saving over 50 million lives) along with zinc tablets (which work, but interestingly nobody really knows how).

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Patients at Calcutta Kids’ diarrhea treatment center

The prevention aspect is harder: having dedicated health workers persuade mothers to use different hygiene and sanitation practices through face to face counseling, and change their behaviors more generally. Germ theory’s taught us a lot[5], but that understanding hasn’t trickled down to everyone. Essentially, we are trying to change the way they see dirtiness around them to align with where the harmful bacteria are, and by doing so help prevent illness and save lives. When you feel like your hands are “dirty,” that’s when you’ll wash your hands (a simple act that reduces diarrhea incidence by 40 percent!). Efforts like these, along with improved sanitation (reducing open sewers that overflow during monsoon, for example) and distribution of vaccines are the way that diarrhea (a killer of more than AIDS, malaria, and measles combined) will be stopped.

So, helping with the diarrhea treatment and hearing about my partner fellow Sriya’s work with behavior change communication modules made me stop my romanticization of all dirt. Not all matter is created equal. After all, some of that matter causes death and suffering if it ends up travelling along that messy highway of the fecal-oral route.

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All of this brought me back to one question that’s been batted around by philosophers and religious figures for a long time now, one that the way we treat dirt can inform: what’s the proper attitude towards the world as a whole, a world that’s full of suffering, pain, dirtiness and squalor, full of imperfection?

One way is to reject it, to be disgusted by it. This is the path that ascetics take, and also one that is expressly pessimistic and sometimes nihilistic (See: Schopenhauer, Arthur). Another is to accept it blindly with open arms, and let nature run its course (See: Toaism). I don’t think either of these is sufficient. The path I think we have to take has to do with affirmation and a trickier word: love.

Love is not idealization. Every true lover knows that…love means that you accept a person with all its failures, stupidities, ugly points, and nonetheless the person is absolute; everything that makes life worth living. This is perfection in imperfection itself. This is how we should love the world.- Slavoj Zizek in Examined Life

 

That love that Zizek talks about has to be tempered by a desire to change the faults we see around us, to make it better. That is the tough balance of being a good human being for me: to live in a city, a country, a world that is deeply flawed, to love it anyway, and to seek to change it for the better at the same time.

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[1] The slums are more constrained, extreme, and intermingled compared to the rest of the city. Walking there requires a constant dual attention: one upward, seeking to simultaneously avoid oncoming traffic, animals, and take in the colors and life around, and also one downward, to avoid stepping in something you don’t want to step in.

[2]  The sinuses are better antennae for smog than the eyes or nose. Nothing shows this effect better than a visit to somewhere with fresh mountain air. We visited two fellow fellows, JC and Arunima, working on a health project in Darjeeling (a hill station a night train and a jeep ride away from Calcutta). I’d been congested going into Darjeeling, but almost miraculously, a cup of famous Darjeeling tea and being in the warmth of our friends’ home cured me. Coming back to Calcutta, though, was painful on the eye to mouth region of my head.

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[3]  An interesting aside on where all this dirt goes anyway: I visited the East Kolkata Wetlands, a beautiful and serene place that is full of rice paddies and fish ponds minutes from the city. It also happens to be known as the “kidneys of Calcutta”; the wetlands serve as the single largest natural sewage system in the world- most of the city’s wastewater is sent out here to irrigate vegetable gardens. Biodiversity is plummeting there, and the city is quickly encroaching onto the wetlands.

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[4]  In one of my favorite books One Hundred Years of Solitude, there’s a passage about an orphan girl named Rebeca who comes to the small Columbian town of Macando, and is overtaken by a visceral need to eat dirt:

‘Rebecca got up in the middle of the night and ate handfuls of earth in the garden with a suicidal drive, weeping with pain and fury, chewing tender earthworms and chipping her teeth on snail shells… The first time she did it almost out of curiosity, sure that the bad taste would be the best cure for the temptation. And, in fact, she could not bear the earth in her mouth. But she persevered, overcome by the growing anxiety, and little by little she was getting back her ancestral appetite, the taste of primary minerals, the unbridled satisfaction of what was the original food. 

Eating dirt isn’t just a literary phenomenon though, it’s been observed in humans (and grizzly bears apparently), and it’s called geophagia. It’s often been diagnosed in medicine as a form of pica, where the patient eats substances that don’t give them nutrition. Interestingly, pregnant women and iron-deficient anemics have been observed with an insatiable appetite for dirt. Hippocrates (460 B.C.) wrote the first recorded account of geophagia (in a pregnant woman), but the exact mechanisms are still unknown. It’s been theorized that it’s an evolutionary mechanism for getting essential minerals when you’re deficient, like Calcium and Sodium, or that maybe it’s a detoxification system.

[5] 

We inherit every one of our genes, but we leave the womb without a single microbe. As we pass through our mother’s birth canal, we begin to attract entire colonies of bacteria. By the time a child can crawl, he has been blanketed by an enormous, unseen cloud of microorganisms—a hundred trillion or more. They are bacteria, mostly, but also viruses and fungi (including a variety of yeasts), and they come at us from all directions: other people, food, furniture, clothing, cars, buildings, trees, pets, even the air we breathe. They congregate in our digestive systems and our mouths, fill the space between our teeth, cover our skin, and line our throats. We are inhabited by as many as ten thousand bacterial species; these cells outnumber those which we consider our own by ten to one, and weigh, all told, about three pounds—the same as our brain.- “Germs Are Us” in The New Yorker

Born in Halifax, Nova Scotia, and raised in Cleveland, OH, Pranav has been involved with health policy, bioethics, and global health throughout his time at Ohio State. There, he helped found the third national chapter of Project Nicaragua and participated in multiple service trips to the rural mountain town of Rancho Grande for initiatives in nutrition, education, and agriculture. Pranav also helped found the Bioethics Society and participated in Yale's bioethics summer program, researching the ethics of GM crop usage in the developing world. He interned in Canadian Parliament for Dr. Carolyn Bennett, the Liberal Health Critic, working with the Health, Development, and Food and Agriculture profiles, co-organizing conferences, and writing nationally televised addresses. In addition, Pranav has traveled to India to investigating eye-care health networks in Andhra Pradesh and writing his Honors Thesis on the political context for health system reform in the state.

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4 thoughts on “An Affirmation of Dirt

  1. Pranav
    Fascinating reading. Great pictures .
    But wonder whether the men urinating in the Maidan where just extricating the dirt which was “out of place” in their body. They “cleaned” themselves by “dirtying” the Maidan. Piles of garbage right outside your clean living space is not uncommon. This understanding of being clean yourself while living with dirt on the immediate outside is I think part of accepting India. But that dirt on the immediate outside making your body unclean( through diarrhea or otherwise) is the lesson which needs to be taught .My question to Noah after my visit was whether the nutrition provided by Calcutta Kids was fighting an uphill if not losing battle against the dirty conditions outside.
    Sridar

    1. Sridar- thank you. It’s a great question. The honest truth, which Noah would probably agree with, is that the nutrition Calcutta Kids provides (the food itself) doesn’t really impact the root causes of chronic malnutrition (and isn’t meant to). It serves as an incentive for the mothers who have children who are severely malnourished to come to the clinic and participate in the program. Once they’re enrolled and participating, they can get messages and advice from health workers on how to change those root causes, for example: hygiene and sanitation, breastfeeding, what kind of foods they should be feeding their children themselves.

  2. Pranav, I consistently enjoy your writing. This post was such an incredible way of taking us on your personal journey in figuring out how to process something so simple — dirt — that nonetheless is accompanied by so many important social and cultural particularities, which you nicely outlined.

    I’ve also struggled with this “love or change” balance. I’ve sometimes wondered if I could ever make development work my life’s work. Activism and NGO-work often compels us to focus only on what needs to change, rather than what is already beautiful. Interestingly enough, I often come back to writing as a career that balances a prescriptive role — ‘this is the way the world should be’ — with a descriptive one — ‘this is the world as it is.’ You’re pretty damn good at it, too! Just a thought.

  3. Pranav, I don’t know how you continue to write such amazing narratives, blog after blog. You capture so may facets, but always string it together so beautifully!

    And wonderful message at the end 🙂

    Peace,
    Allison

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