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Comment by staticassertion | Hacker News Reader

The first or second chapter of Diffusion of Innovation covers a case where a health organization official tried to convince people to boil their water. No one did it. The concept of "germs" was so foreign to them, and their beliefs about water were already so ingrained. It was a complete failure.

It seems obvious to say "if you drink dirty water you will get sick" but you're assuming that people can make so many connections - what makes it dirty? What makes you sick? What is illness?

In many places there is no connection between 'germs' and illness because germs are not a concrete concept to them.

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This is a good point.

Though that as a kid, I was educated as to what happens when you drink unclean water or food made at the road side.

There were a lot of educational shows that aired on a channel named Doordarshan. That channel was free and you were able to watch it even without having a cable connection.

The educational/scientific shows aired around 10 AM to 12 PM the time after which most kids started school. So it would happen that I was getting ready for school and learning about all this shit; pun intended.

I never drank water from a shitty source ever again. Never left water in a bucket outside as it leads to creation of mosquitoes etc.

I must admit though, it is not enough. I also remember government officials coming to my grandfather's village where they educated about how mosquitoes are born in stationary water.

I think one of the best thing to do is, give some sort of a portable microscope to these officials, that can let people take the water they drink and observe the microscopic bacteria - or lack thereof - in their water. Even someone who is uneducated or does not know of scientific method will reason with what they see themselves.

Edit: Remove colloquial/useless words and grammar changes.

> Even someone who is uneducated or does not know of scientific method will reason with what they see themselves.

This is really the subject of the entire book - it's not this simple. There are many factors that are involved in someone accepting a truth that goes against what they already know.

Maybe it's easier for people (here) to understand to consider that it goes the other way just as well. Being educated on ways that food/drink can be contaminated also results in certain people getting truly physically nauseous if they consume food or drink that they believe could have been potentially contaminated. You probably know some people like this.

"mmm these pineapple chunks for the fridge taste tingly and slightly alcoholic, did you marinate them in sparkling booze or such?"

"probably just fermented a bit, they're five days old"

"hurrrrrrrrrrrrrrrrrrrrrrrrrrrk"

There's much more situations like this, food that fell on the ground, or un(der)cooked meat. People that have a firm basic understanding of how germs work, have some pretty irrational beliefs their ability to teleport to the insides of uncut raw-but-seared-on-the-outside muscle tissue. And many will remain queesy about it, even if you teach them.

My point is, you can lead a horse to water but you can't teach it to fish if it wants to keep warm for the rest of its life.

On one hand I think 'what the heck is wrong with these people' and on the other hand is the painting The Gross Clinic, which shows a complete disregard for the concept of hygiene during an operation, even though germs and their effects were discovered decades earlier.

http://www.philamuseum.org/collections/permanent/299524.html

You have indeed hit upon a good point.

I am reading many of the comments here with a lot amusement. Perfect marriages between the clueless and the patronizing. So many efforts have come and gone: (i)hey you 3rd world person here take this money build a proper toilet, (ii) hey Indian govt here's some aid for toilet for your people, (iii) hey my brother we built these toilets for you, now use them, (iv) govt gave us money to built them so we did it for you... and on and on in so many variations.

There is a strong urge to believe in the narrative: oh the poor souls if only they had access to the toilets that they have yearned for things would be all right. Lets build them for them, lets raise money etc. Yes its true for many people, but it is also very untrue for many.

Just as the a one size cancer cure is silly notion (because cancer is not a single thing) there is no such easy one dimensional cure here either. There is a lot of understanding that needs to take place before this is solved.

Some people break open toilets constructed for free, by the govt or a charity, in their house and sell of the bricks. Why ? because they think a toilet in the house makes it impure and dirty. No worries about that tied cow that shits with gay abandon inside that very house, that is clean holy godmother. Heck the current govt is getting social security cards for cows (I am not kidding). Some will fight tooth and nail for their habit of defecating in the open. They don't see a problem with that. Disease ? what disease, that's just bad karma.

Political parties play into this as well. Right now one party is big into "swachchh(clean) Bharat". A move sorely needed and something I strongly support. But when this same party was not in power, they were big into propaganda: toilets are a 'foreign influence', a 'theft of tradition'. Open defecation has been how it has been done and god almighty in the name of tradition and patriotism that's how it would be. Break free from your toilets if you are a patriot ... etc etc. resist rule by the Italian.

I don't think that maybe necessarily the case as these very people will boil milk before drinking it. It is basic practice in rural India to boil milk before consuming it even if it was straight from the cow. So I find it extremely odd that these very people couldn't connect the dots and make the same leap onto impurity of water.

There is a cultural/ religious myth in the sub-continent that fresh, fast-flowing water is always safe to drink. This might have contributed to the failure of this leap.

Before the massive overpopulation of the continent this was very likely true for all practical effects.

It's probably as simple that boiling water requires energy and is expensive.

People understand just fine what "illness" is. Every culture has a long tradition of medical practice since long before anyone knew what a germ was, and people in many civilizations (this isn't some eurocentric western-world thing) have known for hundreds or thousands of years to keep feces away from their food and water.

It seems obvious because it is obvious and has been, in India and practically everywhere else, for centuries.

What the parent described is probably due to other external factors (e.g. lack of choice, land restrictions or other things) that constrain behavior.

Edit for further clarity: it's unlikely these people are all "too stupid" to realize what they're doing is not healthy, but that there are other factors making it a (perceived) better choice than others (which may be perceived as worse).

Everyone understands that illness exists. Not everyone understands what it is, or why it occurs. This has nothing to do with stupidity.

>> In many places there is no connection between 'germs' and illness because germs are not a concrete concept to them.

> People understand just fine what "illness" is. Every culture has a long tradition of medical practice since long before anyone knew what a germ was, and people in many civilizations (this isn't some eurocentric western-world thing) have known for hundreds or thousands of years to keep feces away from their food and water.

The germ theory is relatively recent and was not readily accepted in Europe. And for that matter Europe was very late to adopt a theory of keeping faeces away from their food and water.

Traditional Brahmanism in India is extremely fastidious. Sadly by connecting the practices to caste they did not become widespread among others.

Your sense of obviousness is inconsistent with the investigations of history or sociology.

You have Indians invent small-pox vaccination techniques which clearly shows, at least to some level, an understanding and acceptance of the idea of "germs" albeit something more basic.

Furthermore trying to tie everything to caste related issues will cause more harm than good, as it is popular and easy to blame a simple demon the truth is often more nuanced.

> Furthermore trying to tie everything to caste related issues will cause more harm than good, as it is popular and easy to blame a simple demon the truth is often more nuanced.

How true that is, and I agonized over how to word the end of my comment to avoid overstating/ misstating / offending / hitting peoples' hot buttons (pro or con). However I think there's an essential truth somewhere in there, and I chose the word "fastidious" because it is more clear than incorrect (and emotionally laden) words like "better" / "cleaner" etc. In fact "fastidious" can even have some slightly negative implications.

But to be realistic: my Brahmin grandparents and great grandparents (born in 1800s!) & family all lived well into their 90s as long as they survived childhood. My anglo grandparents and great grandparents (also born in 1800s) were lucky to survive childhood and make it to their 50s, much less past that.

The note I was responding to claimed that Europeans had the germ theory and anyone who did something bad for their health was willfully ignorant and stupid.

That wasn't my note you were responding to, in that case. In fact it was the exact opposite in meaning to what you suggest.

> What the parent described is probably due to other external factors (e.g. lack of choice, land restrictions or other things) that constrain behavior.

It's also a cultural thing. Just the other day I was minding my own business on a relatively central street in the European Eastern capital where I live and all of a sudden I see a Roma lady, in her early 50s, reasonably well dressed, coming towards the lightning pole that was on my left side, taking her underwear down and urinating, literally in the middle of the sidewalk, in plain daylight. Before that she had been talking with some acquaintances of her just outside a court-yard, I presume that if she really wanted to she could have asked those people if she could use their toilet.

I can't help observing that it's very common for men to take a leak on the street, especially if they've been drinking. It's not the most sanitary habit but it's not especially harmful either, and I don't feel anything different about a woman squatting to take a leak either.

Public defecation, though, I have no hesitation about shaming someone for unless it's some sort of emergency.

Public urination is illegal in most places, you get a fine. I wouldn't call it common, I'd call it something that happens in alleyways, under cover of darkness, and only when the man in question is desperate and judgement impaired. In the city, at least. In the country everyone pees when they have to, gender whatever.

Most places?

In the UK it is, but my bladder/prostate totally gives up, and in that situation it's a choice between a public place or my trousers.

> have known for hundreds or thousands of years to keep feces away from their food and water

It wasn't that long ago that Chicago had to raise all their buildings a couple meters, to help keep feces away from the people. And in the next generation had to reverse the course of a river, to keep feces away from their drinking water.

So it's certainly not that ingrained, or not since so long ago, or, as most things in life, easier said than done.

That's a case for bending the truth.

Find out how to explain it in their existing culture. Curses, uncleanness, etc. There's probably SOMETHING responsible for misfortune, death, and disease.

Claim that there is a method which helps battle this, it involves purifying the water with a strong fire for this duration of an hour-glass. Once it is cooled it is, for a short time, safe to use.

This wouldn't work in the case I mentioned because they actually already had a very strict definition of when water should be hot and cold. If this were vague or unclear in their culture, you could lie and say "Oh yeah, because you believe X and Y, Z is true" - ignoring the ethical questions this brings up.

But in their case water being boiled was something you did when you were sick. This already had them boiling water for sick people, the sick would get better (to some extent confirming their belief), and they'd go back to cold dirty water.

This opens the door for unintended side effects and cargo-cult behaviour. Not recommended.

One interesting attempt at this was a health intervention in Cambodia. Rural villagers were having iron deficiencies. A cheap countermeasure was to put lumps of iron into boiling broths or water that people were going to drink, but it was hard to convince locals to actually follow through.

So, they made iron lumps in the shape of fish (a local good-luck symbol) and handed them out - increased compliance a lot.

http://www.bbc.com/news/health-32749629

Tell the truth, but dress it in marketing. Use the same tricks that advertisers use to sell damned near everything to damned near everyone.

Shitting in the river will make you sick, but it's also the low-class thing to do, it's unfashionable, it's unattractive to the opposite sex, it makes you look foolish. Toilets are respectable, they're modern, they're stylish, they're a status symbol. You don't have to invoke superstition to create a taboo.

If you want people to boil their water, just provide subsidised tea and let the addictive properties of caffeine do the work for you.

I am particularly hooked on this idea.Distributing free low concentrated sugar free tea :-) I remember a case study i read some years ago about the difference in drinking culture between india and china.The Chinese factory workers often have a 24 hour boiling pot of low concentrated green tea parked where they constantly consume small portions of during their day.AFI remember around 70% of water intake for them was via this medium. That could be an out of the box solution.:-)

Education is key, and I'd like to think the topic could be covered in a couple of sessions.

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