THIMPHU - In the past three years, Passang Tshering and his team of over 1,000 volunteers have cleaned up more than 60 public toilets and built temporary bathrooms at a dozen events in Bhutan.
Passang decided to take matters into his own hands after spotting a huge gap in sanitation provision in the tiny Himalayan state, launching the Bhutan Toilet Organisation in 2014.
"Everybody seemed to complain about toilets everywhere, but there was no governing body to listen and find solutions," he told the Thomson Reuters Foundation.
The goal of Passang and his young team is to rid the country of the practice of open defecation. "It is not even seen as a problem," said the former computer teacher.
Traditionally, Bhutanese families built toilets on the first floor of their dwellings, with a pig sty underneath so that the human waste could serve as fodder.
People would use leaves, sticks and stones to clean up after themselves, while flushing was rare due to a lack of piped water.
Modern toilets have now become popular in cities and towns. But with the majority of Bhutanese people still living in remote hamlets, poor sanitation remains a major issue in large parts of the country.
Reports of typhoid cases due to water contamination are common during the monsoon that runs from May through September.
According to records from the health ministry, nearly 20,000 children under five are treated for diarrhoeal disease annually.
Other health problems exacerbated by a lack of sanitation and hygiene include skin infections, conjunctivitis, dengue and malaria.
However, in the past few years, deaths linked to diarrhoeal disease in young children have dropped significantly.
Bhutan managed to achieve a global goal to reduce the mortality rate of under-fives by two thirds between 1990 and 2015, partly thanks to improvements in drinking water and sanitation.
Still, experts say more progress is needed on raising public awareness and providing clean drinking water, reliable water supplies and proper sanitation facilities, especially in rural communities.
The government is working with UN agencies and international aid groups to educate villagers in how to pursue and maintain better health and hygiene.
Meanwhile, motivated individuals like Passang are changing mindsets too.
Since launching a "Clean Toilets for All" campaign online in November 2014, he has created a vibrant community of sanitation activists, including young student volunteers and civil servants.
The group plans to build toilet facilities along highways and upgrade existing public toilets, ensuring they are friendly to women and people with disabilities.
The volunteers also set up portable toilets at public events, and are lobbying for mandatory toilets in parks, low-income housing estates, construction sites, garages and bus stops.
"We used to openly defecate when I visited my village," recalled 15-year-old Tandin Zam, who is glad a toilet has now been built at her family home in Paro, some 70 km from the capital Thimphu where she lives.
Infectious diseases linked to water and sanitation account for almost 30 per cent of health problems in remote areas.
That is why the health ministry is backing a nationwide campaign to build toilets in every locality, funded by international organisations.
The proportion of Bhutan's population with access to improved sanitation now stands at 70 per cent, up from 58 per cent in 2010.
"My clean modern toilet is the best thing that has happened in my lifetime," said 72-year-old Jigme Choden of Thorshong Gonpa village in Mongar, one of Bhutan's fastest-developing districts.
Communities are supposed to maintain their own facilities, but illiteracy, the mountainous terrain and lack of water connectivity have often led to improper usage.
Jack Sim, founder of the World Toilet Organisation who visited Bhutan four years ago, said schools in the South Asian nation lacked adequate lavatories.
"The teachers had nice toilets but the facilities for the student were in a bad condition," he told the Thomson Reuters Foundation. "Bhutan needs to promote improvement in design of toilets and training for cleaners."
The government should also work with the private sector to install toilets at tourist sites, he added.
The Buddhist kingdom has a number of important festivals where thousands of locals and foreigners flock to ancient fortresses and monasteries - and the shortage of toilets at these locations has always been a concern.
Where there are toilets, they do not have enough staff to keep them clean, said Passang. But when bathrooms are modern and in good condition, people show more respect, he added.
"They contribute their share by flushing, and ensuring their footprints are not left behind on the tiles," he said.
"To make a complete change in the toilet habits of our people, we must give them great toilets." His organisation plans to train cleaners and assign people to man public toilets.
It has set up "Toilet Clubs" in around 10 colleges to manage sanitation facilities, while universities have decided to observe Oct. 8 as University Toilet Day each year.
The group is also keen to tackle issues relating to sewage and wastewater management, as well as the pollution of river and groundwater.
"We want to ensure that no sewer flows into the stream or river system, and we will also push for mandatory connections to the main sewer system," said Passang.