The fecal oral route, not a journey to read about over a meal time, not romantic like stories of the ancient silk route, and not spectacular like driving along the Amalfi Coast of Italy. But it is a route taken every day by pathogens affecting millions of children from very low-income families. It’s the route followed by germs that are passed when people defecate in the open. The fecal matter is touched and contaminates food and water that is then ingested by other people.

Every year more than 700,000 children die from diarrhea.  Millions more contract intestinal worms that cause poor health especially in school children.  Yet washing hands with soap (the optimal word is soap) can interrupt this route, place a roadblock stopping the transmission of infection.

My work is to fight intestinal worms in children, to offer a parasite- free childhood.  These worms are both vulnerable and resilient.  Individually they can be killed by a very simply administered dose of deworming medicine once a year.  But as a species, they are resilient because they survive in unhygienic environments and re-infect the same children within months. So we treat annually, children by the millions – to me a fantastic and valuable end in itself when I don’t have the resources to tackle the fecal oral route or the even wider geographical environment from which the disease caused by worms gets its name, geohelmithiasis.

But at the beginning of 2014, thanks to the Helmsley Charitable Trust, the END Fund had the opportunity to invest funds in a program to, in addition to treatment, provide hand washing facilities and tools to help clean the environment and dig pit latrines in 2,317 schools in three provinces in Angola. It seems a bit strange to try and communicate the excitement a development practitioner like me has when offered such an opportunity.

A few weeks ago I was in central Angola at rural school #46 outside the town of Caala to see one of the initiatives that is being implemented by our partner the MENTOR Initiative and the WASH coordinator Elena Catalan and her team. The director of the school welcomed me in the local language, which was translated into Portuguese for the benefit of other members of our small delegation and then into English for me.  It brought tears to my eyes when in the first few words of the local language I had never heard before, I heard “tippy tap.”

I was treated to a wonderful presentation by school children using a “tippy tap;” wetting their hands, lathering with soap, rinsing, air-drying, and then returning to class. In one of the skits the children performed, they were treating water with water purifier and showing their mums about the importance of handwashing before preparing meals and washing vegetables.

It’s still early days in the project.  Behavior change does not happen overnight.  How many follow-up visits will the project team have to make to see hand washing with soap really embedded in the children’s behavior?

It’s just one school and one I know I was probably shown the best example, but what a great example, more than one hour’s drive from the nearest town. And all generated by an equipped and motivated teacher, receptive children, and an interested community.

Pathogens do not need to enjoy freedom of travel along the fecal oral route. Hand washing with soap is an effective roadblock, it can save the lives of hundreds of thousands of children and offer many more millions better health.

I left feeling I had been welcomed among empowered school children even though there was not a single desk or chair in the two mudbrick classrooms. Only a blackboard in each and almost three hundred students who rotate between morning and afternoon classes. Worms are going to have to fight for survival at school #46.

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