Water Wellness

Two weeks ago I built a hand-washing station outside my latrine in the village. Yes, I know, I’ve lived there for seven months, and the fact that I haven’t had a hand-washing station is both disgusting and appalling, especially since I work in the water and sanitation sector. I am ashamed to admit this, but I think this also makes for an interesting discussion: why did this take me so friggin’ long?

I’ve been pondering this for the past couple of weeks, and I think the factors that prevented, and eventually contributed to me washing my hands provide some interesting insights into how behaviour change really works. The fact that I should build a hand-washing station is something I’ve known for a long, long time. After numerous courses in waterborne disease, contamination, and biology, plus experience working in the water and sanitation sector, I am very well aware of the reasons why hand-washing is important. Clearly, this rational thinking just wasn’t enough.

There are other examples of things like this. Take flossing, for instance. I regularly floss now, but for years my dentist pleaded – to no avail – for me to slide that white strand between my molars daily. I knew it was something I should do, I knew it might cause problems later if I didn’t, yet that still wasn’t enough to get me to change. I’m sure there were others out there too.

What caused me to change hinges on much more than rational understanding. After some reflection, I think the points below were the biggest influencing factors:

The Case for Hand-washing

1. Sickness. I know I’m more likely to get sick if I don’t wash my hands. I won’t recount any graphic stories here, but, trust me; I have weathered some truly wretched moments that I never want to endure again.

2. Peer pressure. I am also terribly embarrassed to be working in the water and sanitation while not following good practices myself. The fact that I work almost exclusively with rural water supply and not sanitation makes me feel slightly less hypocritical – barely. Just by publishing this blog post, I’m surely opening myself to a flurry of hate mail and dirty looks from other colleagues in the sector.

3. Ease of construction. Hand-washing stations are brutally cheap and simple to make. If I can’t handle this, I should probably just burn my engineering degree and go home.

4. Affect on community. Beginning a practice of hand-washing would likely influence my host mother and sister to do the same. Other community members might follow as well, affecting the sanitation and health of many people beyond myself.

“Sopo”, Unicef’s hand washing mascot promotes good hygiene practices in Malawi.

The Factors Undermining Hand-washing

1. Pretty clean anyways. Although I didn’t wash immediately outside of the latrine, I would always wash my hands before meals and I occasionally dig out a bottle of hand sanitizer. I didn’t have a hand-washing station, but it seemed good enough.

2. Good health. Despite previous illnesses, my health has been near perfect for months. I haven’t been truly sick since I had malaria in April.

3. Distant peer pressure. Sure, colleagues give me a hard time about sanitation practices, but in the village not washing hands is the status quo. When I first arrived, I was in a period of cultural integration and I adopted the practices that everyone else was using. Once those behaviours became the norm, they became that much harder to change.

4. One more errand. Sometimes, I’m pretty lazy. After a 50 hour work week, once the weekend I have laundry to do, music to play with friends, interesting books to read, and dance bars to check out in town. It’s pretty easy to shuffle “build hand-washing station” to the bottom of the to-do list.

5. The weird white guy. As the only foreigner in the village, everything I do is conspicuous. I built a surf board in June (back when the lake had decent breakers) and no one knew quite what to make of it. After that, I tried to tone down the number of ways that I was “different” and hand-washing was just one more thing that would make me stick out.

The Tipping Point

It was tragedy that finally tipped the scales. My friend’s son passed away a few weeks ago and I was reminded of the high level of child mortality here in Malawi. Although the death was unrelated, diarrheal disease from contaminated water and poor sanitation is a leading killer of children. If something as simple as hand-washing could change this in any way, it was definitely something I should be doing.

I knew all of this before, but it took an event, something real, for me to really connect the dots and take action. It’s kind of like hearing from the dentist that you’re about to lose all of your teeth because you haven’t flossed.

Now I happily wash my hands daily, and my host mother and sister do as well. Although it took a long time to happen, in the end the change was a simple one to make. I just had to realize that there is more to creating behaviour change than simply knowing it is something one should do.