Dr Lisa Ackerley, Professorial Fellow of RSPH, talks about the Lifebuoy “Help a child reach 5” campaign in Bangladesh and the importance of hand washing as a disease prevention measure.

Diarrhoea causes 4% of deaths globally, and there are around 4 billion cases of diarrhoea world-wide. Three to five million cases of respiratory diseases occur every year around the world, resulting in between 250,000-500,000 deaths. We know that globally every year 1.7m children die before their 5th birthdays from preventable infectious illnesses such as diarrhoea and pneumonia. The World Health Organisation says:

“Washing hands regularly with soap and water is one of the most simple, affordable and effective ways of preventing ill-health and saving lives” (2013).

I recently returned from the WONCA Conference in Dhaka, Bangladesh, where I helped promote the Lifebuoy “Help a child reach 5” campaign on hand washing. I am passionate that everyone should wash their hands regularly, and particularly at the right time – the Unilever School of 5 teaches children to wash their hands before breakfast, before lunch, before supper, after the toilet and before going to bed.

This is a very good start and is simple to remember. By instilling hygiene messages in children we can see the benefit later when they grow up and teach their own children. In addition, the project encourages children to teach their parents and all the family, thus cascading the message throughout the community.

This is the first campaign to be accredited by the RSPH, in recognition of Lifebuoy’s hygiene education efforts with respect to hand washing with soap as a disease-prevention measure in developing countries. Through my experience creating hand washing habits with soap among children in other developing countries, I have seen first hand how effective the campaign can be.

Last year, I carried out a mini programme when I visited an orphanage/school in Zambia that I support. With my teenage daughter Rose, we trained 446 children and their teachers, kitchen staff (very important) and even the administrators in hand washing. Unilever very kindly provided a bar of Lifebuoy soap for every child and enough for teachers and carers too as well as their materials and training pack.

Although we were not staying long enough to follow up the initial initiative, we passed the materials on to the teachers to continue to keep the message going. We also installed liquid soap dispensers at all wash basins (previously they had no soap) and we put up ‘now wash your hands’ notices everywhere. The metalwork skills students made cages for the dispensers so they would not get damaged. We raised funds, which were ring-fenced for soap and kitchen cleaning products so that the dispensers were kept full and the children have no excuse not to wash their hands. The children loved the concept and quickly learned the 5 key times to wash their hands.

In addition, using a special powder and an ultra-violet torch I demonstrated how invisible germs can be transferred from one person to the next and on to surfaces. Because people can’t see micro-organisms or germs, it is sometimes hard to discuss how germs can cause infection, and the importance of washing germs off our hands. Media campaigns using the glow in the dark powder can also be very effective to visually demonstrate the “journey of the germ.” I have found TV programmes love to see a seemingly  “clean” surface reveal dirty fingerprints under the ultra-violet light – it really makes people sit up and listen!

There are a number of ways the message can be supported in a range of settings. In schools, children should be encouraged to wash their hands when they get to school. My grandmother told me that in her childhood children had to line up to get their hands checked by the teacher before they could start the day. In the Zambian school I supported, the children have to line up and wash their hands in front of the prefect or teacher before being allowed into the dining hall.

In healthcare settings, doctors may want to display easy-to-read posters in the waiting room and the back of a toilet door is a great place to leave a poster! Everyone involved in health care in the community can drop hand washing into conversation easily at any opportunity, for example when talking about food preparation and clean-up, nappy-changing and dealing with a family member with an infectious disease. Healthcare workers should lead by example – make a show of washing their hands in front of the patient. Understandably, I get anxious when my doctor doesn’t!

One thing that is often significant to people who are unconvinced by the health benefits of hand washing is the economic cost of failing to wash your hands – if you are sick, you can’t work and that can cost a lot of money. Hand washing with soap costs so little, but the result is very powerful. As the WHO emphasises, proper hand washing with soap is one of the most simple, affordable and effective ways of preventing ill-health and this is a potent message on the individual level as well as the population level.

We need to get everyone to take responsibility for their health and the health of others through good hand washing with soap. We need to think “where have my hands been?” before we eat, prepare food, put in contact lenses, apply make-up, rub our eyes, dress a child’s scratched knee, or chew our nails.

Your life is in your hands – it’s a good motto to remember!