CSO Contribution to Sanitation in Bhutan

The emergence of Bhutan's own national civil society organization (CSO) in the sanitation sector is a recent development. However, with their volunteers and activities at the grassroots levels, their contributions are significant in raising awareness, civic responsibility and influencing social changes. The decades of government efforts found a complementing partner in civil society to make it complete.

Following are some of the contributions made by the national CSOs in sanitation;

1. Policy Dialogue: CSOs contributed significantly to influencing, lobbying, drafting and reviewing national sanitation policies, guidelines, and roadmap. They are also a major player in creating awareness on sanitation issues and mobilizing volunteers to become a part of the solution. They are also responsible for highlighting the government's efforts and letting people do their part.

2. Proper management of public toilets: many public toilet facilities have become defunct without proper ownership or management. CSO volunteers conducted mass cleaning campaigns to make the facilities usable and handed them over to caretakers.

3. School Toilet Upgrade: students were using old toilets that are difficult to clean and maintain hygiene. With students using unsafe and dirty toilets, their behaviours are reflected in the way the Bhutanese perceive toilets. Realizing the influence of school toilets on overall national sanitation, CSO partnered with the Ministry of Education and development partners to upgrade over 2800 units of school toilets using smart methods and technologies. Over 400 school staff are trained to carry out maintenance work. 

4. Monastic School Toilet: to make toilet facilities in the monastic schools clean and safe for the monks and nuns, the old toilets were upgraded using the same method carried out in the schools. The monks are trained to maintain and manage the facilities hence.



5. Toilet for Persons with Disabilities (PwD) and Elderly: For people who cannot go to the toilet or use ordinary toilets due to disabilities, age or sickness, CSOs have taken various initiatives to either make toilets accessible or bring in innovative technologies to put toilets closer to the people. Small portable toilets were introduced as bedside toilets that are made available to people in various forms and models.

6. Emergency Toilets; During the pandemic, hundreds of duty stations were built along the borders and hundreds more outside the quarantine facilities. CSOs rose to the occasion and helped provide sanitation facilities for duty personnel across the country and for the displaced communities and schools. 

7. Rural Toilets: CSOs have worked with communities that are hard to reach and that are vulnerable to the impacts of climate change in improving their livelihood. Communities are empowered with economically viable activities and provided housing and sanitation that are resilient and in coherence with their environment. About 1000 rural families who could not afford sanitation facilities were supported by various CSOs. On top of that, CSOs have brought in technologies to upgrade hundreds of old rural toilets to speed up government efforts to achieve 100% ODF. 

8. Event Toilet: During events, the venues do not have sufficient toilet facilities. These events usually lead to massive public health issues. But CSOs have developed modern interventions to provide portable toilet facilities and safe temporary toilets to tackle the issue.

9. Professional Toilet Managers: There are no professional sanitation workers. We have been dependent on foreign workers to deal with the dirty job. CSOs have worked to create opportunities for the emergence of local professionals who are proud and skilled in doing the job. Over 200 Bhutanese cleaners are trained to manage toilets professionally. 




Note: The above write-up is a brief note prepared to be included in a national presentation to be made at SaniLearn Workshop in Sri Lanka. It includes the works of CSOs like Bhutan Toilet Org, Tarayana Foundation, Ability Bhutan Society, RSPN, Rotary Club of Thimphu, among others. I am sharing this to celebrate CSO's contributions to sanitation to reserve World Toilet Day.

And as the founder of Bhutan Toilet Org, I would like to thank UNICEF, Save the Children, WHO Bhutan, the Education Ministry, Helvetas Bhutan, the European Union, SARAYA, LIXIL, Dept of Tourism and friends from Japan who supported us in carrying out the above activities. I want to remember all those generous private donors for believing in us. Look how far we have come. Thank you so much. 

Today, we offer our solemn gratitude to His Majesty the King for the vision, direction and handholding from the beginning and throughout. We rededicate our commitment to take it to the end without any compromise.

How Dawa Founded Bhutan Stroke Foundation

Dawa Tshering heard of stroke for the first time when his 32 years young wife Rinchen Pelmo collapsed on the ground and was rushed to the hospital in June 2019. He knew she had issues with her blood pressure but he has never known the fatality of it until it struck. It caught him completely off guard. Rinchen was on life support in the ICU. Doctors didn't give him any false hope. They told him on the face to be prepared for the worst. 

Dawa Tshering and Rinchen Pelmo before their lives changed

His ignorance of stroke helped him shield against the harshness of reality. He didn't give up. His wife was in deep sleep for over a week. He has done rituals of every kind. He went to every influential friend he had around to get a referral to India. But he was told that there was no use taking her out. Gradually he began to realize how bad it was. He was told by everyone who knew the disease that she will not wake up. 

He went to a researcher friend seeking any information he could gather on stroke in Bhutan. He was given a handful, mostly articles and social media post by some Dr Tashi Tenzin. He managed to get connected to the doctor. Over the phone, he asked in desperation, "Doctor, tell me more about stroke."

Dr Tashi invited him over after hearing how earnestly he wanted to know more. He said, "You are the first person to have ever asked. Come over, let's have a chat."

Dr. Tashi Tenzin, the Guide
Photo Courtesy: Friends of Bhutan Association, Austria

By the third week, he managed to get his wife to blink her eyes in response when we ask her questions. On the 23rd day, he surprised everyone when he took her home and began the long ordeal of nursing her. Within the next few months, he left his job with Tarayana Foundation and dedicated fulltime on her. He was given the option to take a long leave if he wished but he opted to resign because he needed his provident fund to treat his wife. 

He regrettably recollects that despite free healthcare in Bhutan, he emptied his pocket on his wife's treatment; not on surgeries or medicines but on rituals. He went to every odd place any fool recommended and conducted every damn rimdro that came out. He shared that he could have treated her faster had he not desperately wasted his time and money on strange rituals. He declared that it was physiotherapy that put her back on her feet, which was absolutely free of cost. 

He would strap her to the car seat and drive her around knowing she would be so sick of staring at the ceiling all day long. He would carry her on his back like a child and go to all the places they would have gone if she were fine. He said going out helped both him and his wife. 

In less than a year, he succeeded in getting his wife, whom doctors feared won't wake up, out of her bed and make her walk on her own. She is still struggling to relearn everything, starting with speaking and eating. Knowing her love for farming, Dawa has helped setup her mushroom farm and vegetable garden. This has helped her wake up every morning with excitement and looking forward to the day.

Rinchen Watering Her Plants

Looking back at the experience he lived since his wife fell ill and watching her relearning how to do things, he felt that if he knew as much about the stroke he could have done anything to prevent that in his wife. His success at getting his wife walk on her feet is another experience, and now dealing with her disability and keeping her meaningfully occupied are things that he wanted to share with others. Having faced with so much at the prime age, Dawa says that the true battle was fought on two fronts; one with the illness and other with depression, and he hopes to be able to create much-needed awareness among the stroke patients and their families. 

Rinchen in her Mushroom Shed

Dr Tashi Tenzin with whom he had kept in constant touch shared with him how important it was for him to create a formal forum to share such stories to create awareness. As a doctor, he had said that he would love to do it but his hands are full within the four walls of the hospital. The doctor wanted Dawa to be the one to go beyond the hospital to reach out to the people. Thus, Bhutan Stroke Foundation was established. 

Personally for myself, having run to Bajo hospital carrying my mother inlaw in my arms and watch her dies a few days later in Thimphu hospital, and having watched the doctors pull the plug on my brother-in-law who was declared braindead, I have always felt the need for a stroke care organization. An organization that will create awareness to prevent stroke (before), help build efforts in timely treatment toward recovery (during) and create means for the patients to cope with life after stroke through meaningful engagements (after). 

Meeting Dawa Tshering in Punakha

When I met Dawa Tshering in Punakha, introducing his Foundation during the CSO retreat I felt like my prayers were being answered. As he spoke about his wife I couldn't see him well through my teary eyes, I knew he was destined to do this. Having hit the hardest, he has the motivation and determination to take this forward like no other. He says he wants to strive for stroke-free Bhutan, where no one has to suffer like his wife, like him and like his two children.

Every day, JDWNR Hospital alone is said to receives 2-3 stroke cases. Globally 17 million cases are reported annually, out of which 6 million dies and 5 million are left with a disability. 

Civil Society Organizations- Fragments of The King's Dream

The following article was written for The Bhutanese's special issues dedicated to the 10th Anniversary of His Majesty's reign. It was published on 9-12-2016. A week later on the 109th National Day in Trongsa 23 CSOs were awarded National Order of Merit (Gold). 

Read the same article below.

At the World Toilet Summit 2016 in Malaysia members of toilet associations of different countries took to stage and shared great stories about their works but one tragic twist in all their stories was the lack of support from the leadership of their countries. They were yet to convince their leaders on the significance of what they were doing. They were fighting to get their leaders’ attention to their cause.

I was to speak in the afternoon of the second day of the summit. By then people had heard enough toilet stories to have any more appetite. Attending the summit for the first time that was the best slot I could get. But I have enjoyed so much attention in two days just by being in gho. Even before I went to stage hundreds of people took pictures of me or with me. They called me Mr. Bhutan Toilet.

When I finally went to stage that lethargic afternoon I could see that I had all eyes because of my dress. I soon projected the photograph of His Majesty and me on the giant screens across the hall and told them stories of how I have the blessing of my king on what I do. When I told them that His Majesty the King gave me the title ‘Chablop’- The Toilet Teacher, I heard the loudest round of applause in that hall. That made me the only country representative at the summit who, with a little guilt of having to contradict with the rest in the house, spoke proudly about having the support of the King of his country.

When elsewhere in the world Civil Society Organizations fight for benefactions from their countries’ leadership here in Bhutan our leadership inspires people to take up social works. In 2015, during the Royal Bhutan Flower Exhibition in Paro His Majesty said, “Where we live must be clean, safe, organized and beautiful, for national pride, national integrity, and for our bright future. This too is Nation building.”

I was then experimenting with Bhutan Toilet Org as an online campaign but that royal message seemed to me like a personal command. I immediately began working on making toilets across the country ‘clean, safe, organized and beautiful’ and that was the beginning of this long journey I have started.

Who wouldn’t desire for an audience with His Majesty the King, but when His Majesty summoned me during Paro Tshechu I was least expecting it. I knew I didn’t deserve it yet. What I didn’t know was I was summoned to be blessed, to be inspired and to be guided for the long journey ahead of me.

I still have vivid memory of that auspicious moment. Dasho Zimpon made me wait on the bridge. I was the only person kept on the bridge and the next person I would see was His Majesty. I could see thousands of people on both ends of the bridge waiting to get a glimpse of His Majesty. I was frozen. I didn’t move an inch even though no one was watching.

Then came the moment, I couldn’t look up directly but I could make out from the radiance that His Majesty had come. I bowed down to pay my respect and froze back to stillness. His Majesty right away congratulated me on my team’s work during the Tshechu and told me to walk alongside him across the bridge.

I had crossed that bridge thousand times in my life but even in my most beautiful dream I haven’t seen myself walking with His Majesty the King and talking about the work I am so passionate about. I shared Bhutan Toilet Org’s Roadmap and the challenges faced in maintaining public toilets. His Majesty talked about the importance of behavioural change in making our efforts sustainable. The bridge seemed so short that day, at the other end of the bridge His Majesty stopped and shared stories of toilet issues in our country and how thing are in other countries. He blessed me with his guidance and assurance of royal support henceforth. Everything seemed so possible suddenly.

To make this priceless moment live with me forever His Majesty granted a Kupar with me with the permission to share it on social media. It was as if he knew I would need this to remain motivated each day and to influence people around me.

I couldn’t quite convince my mother to appreciate my new work after I left teaching until I sent her my picture with His Majesty. It worked magic with her. She finally began to accept and appreciate my work.

Few months later I received Royal Command to participate in the Royal Bhutan Flower Exhibition. It was only during the last Flower Exhibition that I was inspired work with toilets and now I was going to setup toilets at the event, it was too good to be true. It was granting the biggest platform to showcase ourselves and we took it up with challenge and with great pride.

During the closing ceremony of the exhibition His Majesty made special mention of Clean Bhutan, and Bhutan Toilet Org and it was then that I was granted the title ‘Chablop’. It suddenly made me feel like I was doing a prestigious job. Thereon, it made us glorify the act of cleaning toilets; it felt like an art. We never had a problem looking for volunteers to help us.

Just last month, during the Royal Highland Festival in Laya, I had the fortune of meeting His Majesty again and this time it was right next to the toilets we set up. The first question came as a compliment to our team, “How do you manage to keep the toilet odorless?” We were surprised that His Majesty knew about our knockdown toilets that were travelling places during events. For the King to know about every little effort you make was the highest reward we could ever dream of.

Later at the end of festival, during Civil Society Organizations’ audience with His Majesty I knew how he has been instrumental in the formation of every organization and how they were guided by his vision. It was like we were gifted fragments of his dream with his blessings.