Claire McDonald, RSPH's Behaviour Change Advisor, reflects on her recent trip to Karachi to see Unilever/Lifebuoy’s hand washing campaign in action.

What I knew about Pakistan was limited to what I had seen on the news and read in the history books. Independent for 60 years, Pakistan is a young, ambitious and vibrant country and Karachi is a city that never seems to sleep – well, the estimated 23 million residents certainly don’t.

I was introduced to the Unilever Help a Child Reach Five programme in Pakistan; starting with a group of people normally overlooked by commercial organisations.

In Pakistan there are 18 million people with a learning disability – of whom 6.9 million have a visual impairment.  As life expectancy for this group is between 32 – 35 years of age, there lies a huge opportunity to improve health outcomes for those with visual impairments.

To see the approach in action we visited the Ida Rieu School for the Deaf and Blind, which educates children from across Pakistan. Lifebuoy have created Braille materials specifically to engage and inform the children at the school, which, alongside presentations, practical sessions and songs have helped the children develop behaviours that mean they are washing their hands 5 times a day. 

First stop was to meet children in the deaf school. We started with the primary age children who were all keen to show their skills in maths and letters, with broad welcoming smiles all round. This is one place where the fact I spoke no Urdu didn’t make a whole lot of difference.

At the school for the blind, Ammar from the Lifebuoy team asked the children to remind him when they should wash their hands, and as they demonstrated their skills, enthusiastically washing their hands, we both got rather wet!

They really wash their hands; no cursory shake of the hands under the water here. They use plenty of soap and make sure all the steps of hand-washing are followed. They were proud to know how to do it properly and when to do it. 

Day 2 started bright and early as we headed out in the morning traffic, heading for Rahim Charan, the village that Lifebuoy has adopted. This village has the highest maternal and neonatal death rate in the area, and we were going to open their new maternity clinic.

Karachi in the morning is another eye opening traffic experience – entire families heading off to school on motorbikes and scooters, the colourful buses full to the point that the seating on the roof is taken up, and one enterprising young man doing his homework on his father’s back as they bike through the traffic.

As we approached the village I noticed the welcoming crowd – oh my, this was going to be an experience. The film crew jumped out first, I covered my head and with a camera man walking backwards in front of me I walked into the village.

The welcome was overwhelming; the cheers, the clapping, young children throwing flowers in front of my feet and into my hair. Many of the women hugged me and grabbed my hands, they were obviously very grateful for the maternity clinic and the water pump they had received, they really valued what they had.

Next it was time to officially cut the ribbon to the maternity clinic. This done, the midwife took her place at her desk and with elders from the village we celebrated the clinic opening. The clinic was small and functional –but will make such a difference to the mothers in the village. Lifebuoy hand-washing materials adorned the walls and hand-washing will be a key part of what midwives will teach new mothers.

Next stop was to inaugurate the pump. It is situated in the yard in front of the school – the whole community gathered to watch some of the children wash their hands with soap.  Lifebuoy have provided the funding for the clinic and the pump and also provide materials for hand washing such as soap. Such is the poverty in the area that soap is a luxury this village is unable to afford.

Next we headed to the Poly Technical Institute Makli, Thatta where an afternoon of maternity presentations was to be made. I was honoured to be asked to present work cards and certificates for the new community midwives. Much has been done to challenge cultural differences that prevent women being educated and increase the number of midwives. Lifebuoy work in partnership here with JHPIEGO (affiliated with The Johns Hopkins University) and MCHIP (Maternal and Child Health Integrated Program) to increase the number of midwives in the Sindh area and their ability to teach hand-washing.

We finished the visit with a press conference, officially telling Pakistan about the accreditation from RSPH. Lifebuoy’s hand washing work around the world was the first campaign to receive RSPH’s Accreditation, and we continue to monitor their work against our assessment criteria, and their own target of saving lives through effective hand washing.

An hour or so back at the hotel and then I was at the airport once again. My 69 hours in Pakistan complete. Karachi is a wonderfully energetic and varied city, from the kites which fill the skies, the insane driving and the calm of the countryside. The disparity in lifestyles, the cool of the air-con to the full in the face heat of 39 degrees; every time you turned your head you saw something new and there was never a dull moment. I hope to return one day to Karachi…I’ve kept my rupees in case.