While Pakistan is struggling with devastating flood waters, neighboring Nepal is fighting a water problem of its own: Contamination by human feces. Open defecation is so widespread in Nepal that health groups are making it a priority to change how and where people relieve themselves.
But when you have to go, you have to go. And for many people in Nepal, that often means outdoors.
"They feel that to do the open defecation in the open space or in the open air, they feel it is very much comfortable for them in the rural parts of the country," said Roshah Raj Shrestha, who works with the U.N. Habitat in Kathmandu.
Nearly 60 percent of people in Nepal do not have toilets at home, according to Shresta. That means about 16 million people are defecating in the open.
"One thing is that they can't invest money for toilets and then they feel that open air defecation is quite good for them, so they don't care."
Should they care? Shrestha says yes - if you care about your health.
"Last year in two months of time, around 300 people died only because of the waterborne diseases and cholera," he said. "And one of the reasons in those areas, there was no toilets."
Many people in Nepal defecate in open fields or along riverbanks, contaminating both ground and surface water used for drinking and cooking. Diarrhea, intestinal worms and gastritis are rampant.
Development groups have tried for years to draw the connection between open defecation, poor health and low productivity. But posters and preaching do not always work. Shame, on the other hand, is proving highly effective.
Children are being recruited across the country to whistle at offenders, said Namaste Lal Shrestra from the United Nation's children agency in Nepal.
"When early in the morning, they go to the bank of the river or open place where people defecate. They go there and they whistle there. I mean they irritate the people who are open defecating" Lal Shrestra said.
The children travel to patrol the streets and riverbanks in groups to feel more confident. The subjects of the whistling? Not so confident.
"This is very interesting thing. People, they feel sad, but the thing is they have to feel they are doing the wrong things," said Lal Shrestra. "Some people react also but later they realize children are doing the good things."
Lal Shrestra said the children also plant flags in open-defecation areas, like marking fields booby-trapped with landmines.
"They want to show the people where people usually defecate and how much dirty in that areas," he said.
One group in Siddhipur village is using shock tactics by telling people they are eating two kilograms of feces a year from improperly washed hands or unsanitary water containers. Another organization in Darechowk, near Kurintar, is actually paying people to use toilets. Signs posted on the highway advertise "Take a Pee and Get One Rupee."
The investments are slowly paying off. Kabir Rajbhandari, the program manager of WaterAid in Nepal, said from January to June this year, more than 78 communities WaterAid works in have been declared free of open defecation. And more local governments are setting goals to wipe out public defication.
"I can not exactly say it is political," he said. "But because of the people's commitment and the pressure they're putting on the municipalities and some of the areas where there's been a public health disaster last year and this year."
But even if the people want to change, they do not always have the facilities to do so. Public toilets are often so mismanaged that they are too dirty and smelly to approach. And the country lacks sewers and sanitation systems, according to Rajbhandari.
"If you look at the capital of Nepal itself, the treatment efficiency is quite poor. We can find evidence of [contamination], which the government tries to say that is treated water," said Rajbhandari. "So in Kathmandu area there is no liability in terms of the water supply they are providing."
Rajbhandari said the Nepalese government has improved in the past two years by sketching out a national plan to tackle the problem and allocating a separate budget for sanitation.
But the political uncertainty that has plagued the country since Nepal's civil war ended in 2006 has also undermined those plans.
