Vann Sopheap, an ethnic Cambodian who lives in this small border town in Vietnam, prefers the outdoors to the bathroom. "It smells much nicer outside," he says. "The toilets are too dirty."
Villagers such as Vann are often reluctant to use latrines, a behavior that contributes to the prevalence of diarrheal diseases in Vietnam, which can sometimes become deadly, especially for children under-five.
According to the UN, some 10 million people in Vietnam continue to practice open defecation.
Each year more than 20,000 people die in the country because of a lack of clean water, poor sanitation and hygiene, the World Health Organization (WHO) reports.
Sanitation lags behind other MDGs
In the past two decades, speedy economic growth and efficient government policies have led to "considerable gains" in child health, Lotta Sylwander, the country representative for the UN Children's Fund (UNICEF), recently told government officials and international donors in the capital, Hanoi.
The country has achieved almost all the Millennium Development Goals (MDGs) "well ahead of schedule", making it a leader among many Asian countries, reveals a report published by UNICEF in September. But progress in sanitation has been slow.
In 2006, the latest year for which data is available, just over half of the rural population had access to "improved" sanitation facilities, as did 88 percent of the urban population, according to UNICEF.
Twenty million children, or 59 percent of all children in Vietnam, do not have access to proper sanitation. About 73 percent of schools have latrines, but fewer than half meet national standards. A lack of access to clean sanitation and hygiene causes about half of all communicable diseases in the country.
"Poverty can be one reason for this, but education and culture play very important roles as well," Thowai Zai, head of the UNICEF water and sanitation program, told IRIN.
Many people living in rural and remote mountainous areas consider open defecation to be cleaner, he said. In poor areas, especially in northern mountainous regions and the central highlands, people have much scarcer access to toilets, Zai added.
Others defecate in rivers and ponds, the same water sources they use for cooking, cleaning and bathing.
Some experts argue that NGOs need to more effectively educate villagers. "Villagers know it's no good to poop into the water," Jack Sim, founder of the World Toilet Organization, told IRIN from Singapore.
"The only thing needed is to reinforce that message, because old habits take time to change," he added.
Merely providing toilets does not guarantee local people will use them, experts say.
To encourage more efficient use of latrines and good hygiene, in 2009 the Ministry of Health introduced a program called community-led total sanitation (CLTS), in several poor provinces throughout the country, such as Dien Bien, Lao Cai, Kon Tum, Ninh Thuan, and An Giang.
Rather than NGOs subsidizing the construction of individual toilets for each household, the project attempts to mobilize communities to analyze their own sanitation problems and agree on their own solutions.
UNICEF hopes the villages can become "open-defecation-free."
Earlier this year, the Asian Development Bank (ADB) approved a US$45 million loan for a large water supply and sanitation project in six central Vietnamese provinces.
The loan will be used to improve toilets in schools, hospitals and homes. About 350,000 people will reap the benefits, according to the ADB, which hopes the project will be completed by 2016.