Hacking Hygiene: Designing around an invisible problem

Supposedly, knowledge is power and ignorance is bliss. But in the case of water hygiene, knowledge has lifesaving power and ignorance is deadly. That’s why WASH is the acronym used by professionals in the safe drinking water field: Water, Sanitation, and Hygiene.

The Power of Hygiene

To date, hygiene education has been the most essential part of providing safe water in developing countries. Successfully teaching the whole world’s population the basic behaviors including hand washing, use of toilets, treatment of diarrheal sickness, and water purification would win a Nobel Prize.

On the other hand, improving infrastructure, such as municipal drinking water and sewer systems, can and has improved health outcomes for households without hygiene education, but these changes are expensive, slow, and susceptible to failures. Both of our offices in Pittsburgh and New Delhi currently experience the pain of difficult-to-repair infrastructure in the form of lead and pathogenic contamination, respectively.

In theory, no one would suffer from waterborne pathogens if 100% of the world had proper hygiene education. Solar disinfection is free, unlimited, and comprehensive sterilization enabled by leaving clear water bottles in sunlight. In places without enough sunlight, a combination of boiling, chlorination, and physical media filtration can suit most everyone’s needs.

Here’s a noble effort towards winning that Nobel prize: a video making invisible cholera germs visible.

The Downfall of Hygiene

But we know how different the world is in theory vs. in practice. There are significant challenges to educating nearly everyone in the world on any subject, but hygiene is particularly difficult to teach for 4 reasons.

  1. It's invisible. Western scientists didn’t even agree on germ theory—the revolutionary idea that microscopic bugs make us sick—until the late 1800s. The idea originated in 1546, but it took more than 300 years to catch on particularly because initially, it sounds fantastical, magical, or unreal to someone who’s never heard it before.

    To a modern, uneducated adult in a remote part of the world, germ theory can still be just as hard or strange to comprehend. Most of us were simply lucky to be taught and shown germ theory from a young age. By now, we instinctively know to be careful sharing drinks or touching bodily fluids.
     
  2. The benefits seem too far off. Most likely, there’s something you could do today to avoid getting as many common colds this year. Perhaps it’s avoiding shaking hands or just washing your own hands more often. Maybe you could even stay at home when you’re feeling tired just in case your immune system is weakened. We don’t choose to further improve our behaviors simply because the costs don’t seem worthwhile and colds seem like an inevitable part of life, right? 

    Similarly, diarrheal disease is a part of life in many parts of the world, along with the deaths it causes. Losing a child before the age of 5 is disparagingly common; in Liberia, one out of every six children die due to diarrhea before the age of five. In these homes, diarrhea can feel inevitable and impossible to control, sapping the motivation from people whose lives are already very strained.
     
  3. It’s most difficult where and when it matters most. Right now, I’m in India where my pampered American immune system is being challenged by new, foreign, and prevalent pathogens. Even after I purify my water and overcook my food, these pathogens are in the water I use to wash my dishes, on the doorknobs of bathrooms and hallways, and on the produce I buy from the market. It takes significantly more work for me to stay healthy here because many people are not healthy and the majority of water is not purified here.

    Similarly, when people really need to stay healthy, it’s even harder to keep pathogens in check. If you’re immunocompromised and weak because of a disease such as HIV, you’re more susceptible. If you’re living paycheck to paycheck, you don’t have any free time to focus on learning and using hygienic behaviors, but if you get sick you’ll miss work!

    The epitome of this issue is shown by the cyclical nature of childhood diarrhea. Not only does it make children miss school, but severe childhood diarrhea is correlated with impaired cognitive development later in life, making hygiene education and poverty alleviation even more difficult.

     
  4. It requires changes to social behaviors. Think of a complete germaphobe who won’t shake hands or touch doorknobs. These people can become outcasts because they may avoid certain social environments, be terrified of public transit, or be grossed out by sharing food or drinks. This is just an example of how keeping different hygiene norms from your surrounding culture can be stressful or seem antisocial. 

    Even in business meetings here, I have to refuse kindly offered glasses of water if I’m not sure how the glass was washed or how the water has been treated. When I’m welcomed into someone’s home, I have to refuse half the food they give me (bread, uncooked vegetables, yogurt, warm-but-not-hot rice) and only eat the piping hot, cooked dishes.

    The first few people in any unhygienic situation who walk an extra kilometer to refuse open defecation, carry soap with them to wash their hands, or refuse to share in food made near flies will not necessarily be popular.

Amazing initiatives around the world are still working on hygiene education today, and often they use brilliant social engineering to spread information and change daily behaviors where it matters most. It’s a difficult but necessary endeavor.

But Rorus is a slightly impatient and very passionate group who wants to see improvements made right now. So we took the approach used by many of the most talented product designers in the world to add something to the world's WASH toolkit:


Rather than suggesting or creating a new behavior for households,
we design in parallel with behaviors that already exist.


For example, a computer mouse follows the common instinct to point and interact with visual cues, rather than use a command line to "talk to" and instruct a computer. And responsive touch screens are another design improvement because they more directly parallel to our instinct to touch and move real, physical items.

New behaviors can be slow or unlikely to catch on; just think about the many predictions that computers were unnecessary and had no place in common households, let alone in the hands of most of the world. For someone learning the basics of hygiene, it can be strange or counterintuitive to add smelly chemicals like Chlorine drops to water or to leave water bottles in the sun to make water clean. Some people think, “How could it possibly clean the water if it still tastes and looks the same or even worse?"

So we design our filters to fit with the most common understanding of water. Most people regardless of age understand the concept of a physical filter, such as running cloudy water through a cloth. We stick to this paradigm: dirty water in, clean water out. No timing, no measurements, and no strange chemicals.

We combine different technologies so that water comes out smelling, tasting, and looking cleaner, and that helps motivate use. You can see and experience the difference between before and after, making the invisible problem visible! Conveniently, these experiences translate across culture, language, and even distance and time. I don't need to be in Nigeria showing someone how to use a FilterPack. Any person using it is a correct example of how others should use it too.

We also focus on flow rate, duration, and quality so that people don’t get impatient and ignore the filters. We don't want "user error" to ever be an excuse for filters failing.

Our filters require less user education and are more delightful to use. That’s important for any product company, but it’s truly essential for hacking hygiene.