The Civility of Hand Washing
By Kofi Akosah-Sarpong

It is human, and wise, that hand washing and general sanitation campaigns are heightened Ghana-wide. It borders on morality, too. Across Ghana, the sanitation situation isn’t good. That makes it instructive that in Ghana’s Upper East Region 14 junior high and primary schools in the Kassena-Nankana West District were brought together in hand washing campaign. It sound naive but simple hand washing could save a lot of lives.

It is surprising that such simple public hygienic practices – washing hands before and after eating, washing hands after using the toilet, washing hands after holding dirty objects and other such sanitation practices have become a national problem, veering into serious health issue. In 2010, it should have been the other way round.

Such public civility should normally start from homes and schools, and then into the larger society. Schools, as part of their civic studies, are expected to teach appropriate hygienic and sanitation practices. And this should be reflected in the public domain. The measure of any society’s depth of health is seen in its public sanitary practices. You don’t have to be a public health expert to know this. It is simple, if people urinate or spite or defecate in public, then they have poor sanitary and hygienic upbringing.

You see this shameful health picture on landing in Kumasi, Accra, Cape Coast, or Takoradi. The visitor quickly realizes that hygienic and sanitation practices are poor to the extent of interpreting that the people aren’t healthy. In markets, beaches, traditional “chop bars” (restaurants), banks, internet cafes, road-side food sellers, among others, people move through ramble through with unwashed hands under the sweltering sun. The people might have either come from toilets or might have blown their noses and with wipe their hands with it or touched dirty objects without washing their hands. Either they ignorant of the implications of their unhealthy actions or they do not consider the health implications of their actions.

Recently, at Adabraka, suburb of Accra, where I was staying, across my apartment, I used see a khebab seller, a young man, blow his nose repeatedly beside the stove he is using to roast the meat. And without washing his hands, immediately touched the meat being roasted. In the scorching sun, sometimes, too, I used to see him wipe his face from his sweat with his bare hands, and without washing his hands, touched the meat being roasted. Almost everyday, I saw him do this. Despite all these unhygienic practices, the young man was selling the khebab to people, some of whom, I am very sure, might have seen his unhygienic practices. He was passing diseases to the public.

Globally, health experts say over 80 percent of diseases start from the hands. And if the hands aren’t cleaned and sanitized properly, diseases are transmitted into the larger society. The heavy incident of cholera and malaria that attack and kill most Ghanaians reveal the level of civility in public health practices. If you urinate or defecate in public and die from cholera then one’s civility is bad.

Like the Foundation for Grassroots Initiatives in Africa (FGIA), a non-governmental organization, that mounted the Upper East hand washing campaign, in Canada for the past years public health promotion by Public Health Agency of Canada has been advising people to wash their hands thoroughly in order to limit the spread of diseases. Across Canada, in banks, internet cafes, restaurants, offices, groceries, malls, convenience stores, libraries, shops, university halls, etc hand sanitizers are everywhere for the public to use. And Canadians are using them as part of their civic health duties.

My sense here is that whether you are Canadian or Ghanaian, we all human beings and at certain level we have to conduct ourselves in the same ways, as the import of the hand washing campaigns reveal. There is hand washing campaigns in Canada, the same is underway in Ghana’s Upper East. But more seriously is the fact that since health-care services are more inadequate in Ghana, Ghanaians should be more serious about the hand washing issues as a way of lessening the burden on the health-care system. The Adabraka khebab seller will help the Ghana health-care system if he can simply wash his hands any time he wipes his face with his hands or blows his nose with his hands.

At the web site of Public Health Agency of Canada, as part of its public health promotion, tips are giving about how to clean one’s hands. The campaigns have saturated the Canadian public so much so that, in some cases, if one forgets to wash his or her hands after using a public toilet (they call it washroom in Canada), another person who might happen to be around will remind the person to wash his or her hands. That isn’t rudeness, that’s part of civility.

The Canadian hand washing campaign became more pronounced during the flu outbreak recently. “Preventing the flu is everyone’s responsibility!,” charged Public Health Agency of Canada in its promo, using mass communication tools such as radio, public transport, e-health, television, flyers, newsletters, public bill boards, presentations, participatory communication, community organizations, etc to drum home the benefits of hand washing to one’s self and to the Canadian society.

In a simple public health promotion, Public Health Agency of Canada advises Canadians to wash their hands “several times a day with soap and warm water, especially: before meals; before feeding children, including breastfeeding; before and after preparing food; after using the toilet; after changing diapers or helping a child use the toilet; after blowing your nose, coughing or sneezing; after playing with shared toys; before and after visiting with people who are sick; and after handling animals or their waste.” It may sound basic but that’s why the power of the message lies.

This is despite the fact that public health in Canada is among the best in the world, if not the best. But while public health promotion anywhere may use the same mass communication tools like Canada, in Ghana, as the FGIA thoughtfully did in Upper East Region, should include traditional institutions, traditional rulers, traditional values, education institutions, drama and churches as part of its campaign. This is a reflection of the Ghanaian/African reality. FGIA’s inclusion of Ghana Health Services is laudable. But, like Canada, Ghana Health Services should take the lead, pro-actively, and work with non-governmental organizations. This is for fuller authority and sustainability of the hand washing campaigns.

In promoting hand washing as a way of preventing diseases, it is also reducing the health- care expenditure. Though hand washing exercises have the same positive health effects, in Ghana, unlike Canada, the implications are larger. There are cultural believe dimensions in Ghana. Hand washing and its added reduction of diseases will help push away the awful cultural believe that diseases are the work of evil spirits, the devil, demons, or witches and not poor hygienic and sanitation practices.

Simple hand washing will help rationalize Ghanaians in regard to evil spirits, the devil, demons, or witches and diseases. The diseases and ailments come from disturbing unhygienic and unsanitary practices. There is no evil spirits, the devil, demons, or witches involved. And Canadians have better health indicators than Ghanaians because of proper hygienic and sanitation practices and not because Ghanaians are under some sort of siege from evil spirits, the devil, demons, or witches.

And so when the evil spirits, the devil, demons, or witches are eliminated from the mindset of Ghanaians in relation to diseases and ailments, Ghanaians will come to the same conclusion as Canadians that “Hands spread an estimated 80 percent of common infectious diseases like the common cold and flu” and “…when you touch a doorknob that has the flu virus on it and then touch your mouth, you can get sick. But these disease-causing germs slide off easily with good hand washing technique.”

This is simply part of civilization. And the Foundation for Grassroots Initiatives in Africa has shown the lead. The Ghana Health Services in collaboration with the Ghanaian mass media (as part of its public service duties) should join the hand washing bandwagon, for higher utilitarian reasons. A simple jingle or bumper – “Please, wash your hands,” “Please, wash your hands,” “Please, wash your hands” – will swab away most diseases and ailments.

 

Kofi Akosah-sarpong, Canada, August 7, 2010