Were Guevara and Fanon correct? Did sanitation merely amount to a form of colonial or neocolonial social control? Was Guevara right to suggest that this was a particularly American phenomenon? While Fanon correctly noted that many postcolonial states appropriated these colonial projects upon independence, was it true that these reforms were then embraced by their citizens? Ruth Rogaski has noted that historians of modern biomedicine and public health “have faced two analytical paths: either it brings the desirable benefits of health and modernity … or it is a mode of social control, a coercive force, which, in creating modernity, limits the range of possible expressions of humanity.” There is no reason, Rogaski suggests, why it cannot be both. Health education and improved sanitation remain unquestionably positive development goals, but they can also become modes of social control and regulation. Public health systems give states enormous power to intervene in and regulate their citizens’ private lives. While many development projects enter the workplace, public health projects enter the home, and, in many postcolonial settings, public health systems allowed new states to build new citizens. In the name of extending health care into the countryside in ways that colonial states had never attempted, governments could create the kind of modern citizens they wanted by determining the way people should cook, eat, clean, dispose of waste, defecate, and reproduce. Such projects were as much about staking the state's claim on the population and establishing the writ, sovereignty, and legitimacy of the postcolonial state in rural areas, as they were about giving citizens a better standard of life. Thus, it is no surprise that in the years after independence, peasant populations sometimes accepted and sometimes resisted the postcolonial state's health interventions.
The Sanitary Hamlet Program in Vietnam, a joint South Vietnamese–U.S. effort, set out to improve rural health and serve the goals of counterinsurgency during the final years of the Vietnam War. The project focused on health education, clean water, and especially latrine construction. The program identified shortcomings in existing Vietnamese defecatory practices and targeted the peasantry—particularly women and refugees—for sanitary reform. The United States and South Vietnamese governments built thousands of toilets in the countryside and sought to educate ordinary Vietnamese in their use. The goal was to forge a new sanitary citizenship that might transform rural life and secure rural dwellers’ commitment to the state. Situating this project within a much larger sweep of American engagement in toilet-building at home and abroad highlights the continuities in American approaches to international development from the age of formal empire to the postcolonial era. These continuities appeared not only in rhetoric but also in on-the-ground practices and reveal the blurred lines between domestic and foreign development strategies.