Let's get down to business

Recently, I drafted an article for a Peace Corps, Togo in-country publication, which is released for volunteers and Peace Corps staff – think college magazine or newspaper. As I was thinking about what to post for a blog entry, I realized that this may be information that I could share to further illustrate some of my work here. I edited it a bit as my audience is different – but the story remains the same.

The Battle for Clean Street Food: Environmental Impacts on the Sanitation of our Food and Conveying the Repercussions

When I first came to my village, I was impressed by the strategies employed by my work partner and his team regarding the sanitation of food throughout town. First, I learned that it was necessary that all vendors of food were certified. Certification entails training on nutritional hygiene and sanitation practices – prepare food in a sanitary location, wash hands when touching food, cover food, do not prepare food when sick, wash all dishes, use clean water etc. – and periodic retraining on these practices. If a vendor is found mis-practicing or without the certification card, which includes a head-shot of the vendor, the vendor is subject to a fine. Before the vendor can sell again, it is mandatory that the fine be paid. I also accompanied the hygiene and sanitation department on school visits during the first week of the fall semester. These visits included educational sessions for all vendors at schools and ensuring that all vendors were certified. My work partner presented about the importance of dish washing, clean water, food preparation, hand washing, and attempting to control the flood of students grabbing for food. After watching the regulations exercised throughout town, I was feeling confident that my street food was impeccably sanitary.

Top: local street food; bottom: local trash pile.

One day at the hygiene and sanitation office, I came across a notebook documenting the street food vendors in town. The notebook included the status of each vendor’s health as each vendor is tested for intestinal parasites upon becoming certified to sell food. I conducted a brief randomized sample and calculated the approximate percentage of street vendors with intestinal parasites within any given one month. Sixty percent of street food vendors in town have intestinal parasites within any one given month. Street food vendors who do not have intestinal parasites at the time of the test receive medication preventing against parasites.

The close monitoring of street food vendors across town, in schools, and in the market occurs for a reason – even in a town with accessible sanitary water, the struggle to obtain sanitary food is a harsh reality. Unhygienic and unsanitary environmental conditions impact the contents of our food. My work partner often informs me about inspections that he conducts throughout town. Although street vendors are certified and are therefore aware of sanitary food practices and the enforcement of these practices, street food stands are located immediately next to makeshift latrines, or large piles of trash. The street vendors may be taking precautions, and the agents of hygiene and sanitation may be accurately prescribing medication for the control of intestinal parasites; however, there are a few missing pieces to the equation of sanitary food.

When I ask agents of hygiene and sanitation about the major road blocks on this mission to behavior change they explain to me the challenge of conveying the gravity of sanitation to an audience that has an extremely minimal foundation of science. I don't see my intestinal parasites and worms. I see that fly, but I don't know that it's coming straight from the neighboring pile of excrement. I don't see the germs. In fact, that looks clean. In order for behavior to change, it is necessary to communicate the contamination of this seemingly clean environment and just how deeply that impacts one's health. This is where our work comes in, and this is where – if you ask me – the work gets fun.

To encourage individuals to wash their hands, we use oil or glitter to represent germs. Just like you need soap to wash off oil or glitter, you need soap to wash off germs. Thankfully, it is commonly understood that germs cause sickness. Now, how does one encourage one not to defecate in public? A community mapping activity that relies on a village-wide walk collecting samples of public excrement and showing not only the prevalence of public waste, but also the cycle of flies moving from your plate of lunch to that pile of you-know-what a few feet away. This visual, hands-on, community-centered activity conveys the message. The way that you shape your environment's sanitation can directly affect your health. Can you see it?

This community exercise to inspire behavior change related to public hygiene and sanitation practices is a brainchild of Kamal Kar, who is a public health worker. The exercise that I briefly mentioned is a strategy known as community-led total sanitation (CLTS). More on CLTS, or Kamal Kar, can easily be found through a search online. The training manual for CLTS workshops can be found online here: http://www.communityledtotalsanitation.org/resource/handbook-community-led-totalsanitation.