- “This is a very close person to me,” Dismas, a sales officer in one of the country’s soft drinks company speaks of his co-worker. “I was taken aback with the act. From thereon, I decided to have the disinfectant spray with me all the time.”
Jake Dismas* gave up handshaking and sharing his working tools in the office after observing a colleague going out of the bathroom without having his hands washed. The 28-year-old Dismas described the act as “awkward.”
“This is a very close person to me,” Dismas, a sales officer in one of the country’s soft drinks company speaks of his co-worker. “I was taken aback with the act. From thereon, I decided to have the disinfectant spray with me all the time.”
Is it because Dismas had suffered anything from what he’s saying? “No, but as the old saying goes prevention is better than cure,” responds Dismas.
Not a lone case
If you thought that Dismas’s friend is a lone case, you might’ve gotten it wrong.
According to the Health Minister Ummy Mwalimu, only 35 per cent of Tanzanians do wash their hands after using the bathroom. What does this translate to our public health system? The minister responds:
“No wonder that almost 80 per cent of patients admitted to the country’s hospitals suffer from diseases which have something to do with poor cleanliness and sanitation issues,” noted Ms Mwalimu in a recent press conference.
The health implication
Dismas is doing what an environmental health expert from the Muhimbili University of Allied Sciences (Muhas) would exactly advice.
Dr Simon Mamuya, senior lecturer at Muhas attests that any person who will touch a particular place or object with their naked hands is more likely to be infected with bacteria only if the place or object was previously touched with dirty and infectious hands.
“And by disease, we don’t mean that a person should be sick as there are numerous diseases one may have inside them unconsciously,” offers Dr Mamuya, who also heads the Department of Environmental and Occupational Health at Muhas. “These people are known as reservoirs, that is, they have the disease and aren’t sick but they can transmit them to others.”
The implication of Dr Mamuya’s insight is that once a person is infected with any infectious dieses and touches a place with their insanitary hands, it’s more likely that another person who will touch the same place with disinfectant-free hands will take the bacteria and become infected with the disease.
A hand as a conveyer
But does a hand have any problem? A 2011 study report on ‘Bacterial hand contamination among Tanzanian mothers varies temporally and following household activities’ published in the journal of Tropical Medicine and International Health puts it this way: food handling, exiting the household premises and longer time since last handwashing with soap are positively associated with bacterial levels on hands.
Dr Mamuya, who appeared to co-author the study, highlights that in most cases, a hand is considered as a conveyer, meaning, it the key transmitter of diseases. Many people don’t know the best and proper way to wash their hands, he says from his experience from other studies he has co-authored.
Bunch of diseases
The diseases that can be transmitted through touching, according to Dr Kilawa Shindo, a medical doctor based on Kigoma Ujiji Hospital, can range from those caused by virus to bacterial. “These include, but not limited to, worms, tuberculosis, hepatitis, leprosy, scabies, fungal infection and other diarrhoeic related diseases.”
Even doctors, Dr Shindo shares, are required to wash their hands with sanitary soap after attending each patient. “Though in practice, this isn’t the case as you know the working environment of our hospitals,” adds Dr Shindo from Kigoma during a recent interview with Your Health. “Instead, we rub our hands with an anti-bacteria liquid [sanitiser] as an alternative.”
The spreading of a particular disease doesn’t need ‘a lot of hours’ to occur, even a second is enough to transmit a particular disease from one person to another, debunks Dr Mamuya.
“The spreading of any disease depends on something called viral infection, that is, how fast it can be transmitted. For example, if one will eat something infected with vibrio cholera-insects, which cause cholera-within a few moments, it can bring problems in one’s body like diarrhoea or vomiting,” he points out.
Dr Mamuya says there is a great need for people to cultivate the behaviour of washing hands. He says there are people who spread the bacteria in their hands thinking that they wash them away. Many people don’t use sanitary liquid in washing their hands, he offers.
“Even handshaking isn’t a good healthy behaviour. Can one be able to know where the hand had touched before they handshake it? Personally, I don’t prefer handshaking,” says Dr Mamuya.
Dr Mamuya advices that people should stop the behaviour of handshake. When touching something is unnecessary, people should restrain from touching them.
In expressing his view why most people do not have a culture of washing hands, despite being aware of its consequences, Dr Mamuya calls the problem “behavioural.”
He says everyone has his/her own upbringing and things that he/she deems casual as they have been with them since childhood. “Someone will tell you that ‘my father died at 99 and never washed his hands.” To change this behaviour, Dr Mamuya advices it would be a good idea that these people are built with the culture since their childhood.
“Once we stress this matter in a family level and in schools, it’ll go a great mile towards changing the persisting behaviour,” he says.
Ingredients for change
While Dr Mamuya calls for an emphasis at the family level, Dr Deodatus Kakoko, a senior lecturer in health psychology at the Behavioural Sciences Department at Muhas indicates that there are several reasons why people don’t wash their hands.
On one hand, he says, the reasons relate to an individual person but on the other, they relate on the supportive nature of the environment surrounding that person.
“Knowledge, skills and attitude is key to making someone adapts a particular behaviour. Through knowledge, a person will understand the benefits which come with washing hands, skill will teach them how to wash while attitude will make them perceive the act of washing hands as ‘a good and positive’ thing,” offers Dr Kakoko.
Dr Kakoko’s views concede with a 2011 study which found out that mothers in Dar es Salaam, the target of the study, were aware and knowledgeable of the risks of certain household practices and understood safer alternatives.
However, the study titled ‘Understanding Household Behavioural Risk Factors for Diarrhoeal Disease in Dar es Salaam: A Photovoice Community Assessment’ published in the Journal of Environmental and Public Health notes that the mothers were restricted by the perceived impracticality and financial constraints to make changes.
The ‘reminding’ factors
In workplaces, where everything is in place from safe and clean water to soap and other sanitary equipment, what’s needed is what Dr Kakoko calls ‘cue factors.’
“These are actually reminding factors, for example, in developed countries they have alarm which will ring once a person has not washed his/her hands.”
Alternatively, he urges, you can have a banner with a ‘disgraceful message’ reminding a person to wash their hands. These will trigger people to take actions, which is to wash their hands.
Another important factor in behaviour changing according to Dr Kakoko, is what they call ‘motivating factor’ which can provoke one to adapt a particular behaviour. This includes award or punishment.
“Moshi, Kilimanjaro for example, enacted a law based on that basis and anyone can see how far they have gone in the cleanliness issue. Simply because the law clearly stipulated the punishment,” he says.
Ms Mwalimu says that every year the government loses almost Sh300 billion due to poor hygiene.
It starts with you
In order to avoid this ‘unbearable loss’ to the government and prevent ourselves from any infection associated with poor hygiene, there is a dire need to stress the matter of personal hygiene.
This, experts say, involves washing our hands with sanitary soaps and apply disinfectant spray/liquid.
This, according to Dr Mamuya, and Dr Kakoko concurs, “It starts with you.”
*Not his real name