Engineers are exploring a new paradigm in wastewater treatment; focus is shifting to the recovery and reuse of energy, water, and nutrients. Ecological sanitation (EcoSan) technologies, which allow for this recovery and reuse, are an environmentally sound option for the future of sanitation. While the technology to achieve this goal of recovery and reuse exists, a limiting factor is user attitudes and perceptions. Social sciences, especially anthropology, can and should inform engineering projects to ensure socio-cultural sustainability. Since 2003, rural indigenous Ngäbe communities in Panama have been implementing ecological sanitation projects, mainly double vault urine diverting (DVUD) latrines known as composting latrines. With the help of governmental agencies and the Peace Corps, over 200 of these latrines have been built across the province of Bocas del Toro and the ñÖ Kribu region of the Comarca Ngäbe-Buglé. To this point, little monitoring and evaluation has taken place in these communities. Interviews and observations in 23 communities throughout this coastal region revealed that 70.6% of composting latrines constructed (n = 201) were completed and 71.8 % of the completed composting latrines (n = 142) are still in use. Based on observations, 65% of the latrines in use were determined to be used properly, which translates to the proper use of 45.8% of the completed latrines. To promote composting latrine adoption, social marketing and pilot latrine projects can be employed, and to improve the percentage of properly used composting latrines, education campaigns can be deployed as follow up. Utilizing suggestions made in recent literature as guidelines for the proper application of compost, analysis showed that new training messages have not reached the communities with older composting latrines. Informal interviews in 18 communities identified compost production, the lack of mosquitoes and flies, and the lack of odor as the most frequently mentioned advantages. With respect to the disadvantages, the inability to use water for anal cleansing was the most frequently mentioned disadvantage. In three communities, informal interviews and 124 surveys were used to characterize the perceptions of Ngäbes regarding feces and their use of composted human excrement as a soil amendment in agriculture. In general, the responses reflected perceptions that show no strong barrier to the operation and maintenance of composting latrines. Utilizing the Fisher's exact test and Kruskal-Wallis test, the community, sanitation classification, gender, primary occupation, and age all showed some level of association with the perceptions expressed in the survey responses. Filo Verde was more likely to respond with perceptions accepting of composting latrine use, while San San Puente was more likely to respond with "don't know" or with perceptions objecting to composting latrine use. At times, up to 37.9% of the respondents responded with negative perceptions; thus, evaluations of perceptions prior to the implementation stage are still beneficial. One discrepancy existed between the overall majority and the composting latrine user majority; 56.5% of the 124 respondents perceived the handling of human excrement as a great health risk, whereas 59.1% of the 22 composting latrine users did not. As expected, the composting latrine users responses represent the positive perceptions of feces and their reuse, but pit latrine owners were most likely to respond with perceptions contrary to those indicative of proper composting latrine behavior. Overall, males were more likely to agree with the perceptions related to composting latrine use. Regarding primary occupations, farmers consistently replied with more favorable perceptions of feces and their use as a soil amendment, while banana company workers showed more dissidence. Additionally, older participants gave responses reflecting favorable perceptions of composting latrines more than younger participants. Finally, education and household size do not have any statistically significant associations with the perceptions reflected in the survey responses.