Taking Care of the Children: Hand Washing, Sanitation, Dental Hygiene and Spider Bites in Cygera, Rwanda
Jun 02 2010
June 2, 2010
by Beth O'Connell
East Tennessee State University: College of Public Health
Upon my arrival to the Cygera Faith and Hope Children’s Home I discussed the problems and what could be done about them with my preceptor, Elizabeth Nzakizwanimana, who the nurse for the children’s home, Ernest Batera, the administrator of the children’s home and the local church’s pastor, and John Mary Bemeyimana, the headmaster of the school.
Environmental Illnesses: Malaria and Spider-Bites
The immediate need presented to me was environment-related illnesses. Two children were recovering from malaria and several had spider bites. Spider bites can be dangerous if incurred from a poisonous spider. Malaria can be life threatening, and mosquitoes can spread other dangerous illnesses as well. Therefore, my first objective quickly became analyzing and addressing environmental hazards at the children’s home and adjacent school.
My environmental analysis revealed both broad problems and some more addressable problems. Those that I was able to address included the pest problems, which I tackled in several ways. First , we placed screen over the windows to avoid insects coming into the children’s bedrooms. Second, we sprayed a pesticide barrier around the homes and nearby school to detour insects. So that these interventions would be continued after I leave, I asked the home administrator to assist me. He helped me place the screens, dilute the pesticide concentrate appropriately, and helped spray it. Third, I placed fly traps in the homes, reducing the chance of fly-related food contamination, and conjunctivitis, which is often caused by flies. During my assessment, I questioned staff about the presence of lice and bed bugs. They denied their presence and said they were currently preventing these problems by washing bed linens regularly and keeping the children’s hair short. I explained the use of the lice treatment materials and gave to them for future use.
Sanitation is another environmental problem. There is a lack of a garbage system and the outhouses used at the children’s home were incredibly dirty. One of the caretakers explained that they scrubbed them out weekly, along with the floors of the homes. I provided scrub brushes I had brought with me and suggested that the outhouses be cleaned twice a week to avoid fecal-related infectious disease.
The entire community has no publicly provided means of garbage disposal; therefore, they simply throw it on the ground, or give it to children to play with. The children’s home has a small composting system, but the community as a whole does not. This problem is much greater than I can address during the time I will be here and requires government cooperation and funding.
Climate related problems include extremes in temperature with a vast difference between day and night. Some of the children and I have been sick with head and chest colds probably due to the cold nights. The local people call this illness “grape” and told me that I had it because I drank a cold Fanta (a soft drink soda) the day before I got sick! This explanation prompted me to educate them on the correct cause of colds and was to prevent them. Another climate related problem is lack of consistent rain fall. Like many equatorial locations, Cygera has a rainy season and a dry season. In order to manage water supply, the children’s home has two rain water storage tanks which collect from the two roofs. I have suggested to Hope 2.2.1. that purchasing more storage tanks would allow the home to use rain water only throughout the dry season, rather than resorting to using a local stream, which is highly contaminated. In the future, it would also be beneficial to install rain water collection at the school and any home that have metal roofs. The problem of unclean water will be addressed in the next update.
Hand Washing Campaign
I have also begun my hand washing campaign. I first taught the children at the Faith and Hope Children’s home as well as the caregivers and cooks. I did this by simply discussing the steps recommended by the Centers for Disease Control and Prevention with some minor changes for cultural effectiveness, such as singing “Jesus Loves Me” instead of “Happy Birthday” as the guide for how long it takes for an effective hand washing. I then prepared a handout and posted it on the hand washing station and also demonstrated the technique at a hand washing station outside of the homes.
Additional hygiene education involved a Coleman solar camp shower which is more effective in prevention of infectious diseases than their current use of a bucket of water. I am still persuading the adults that it is better to bathe this way for full coverage and with warm water. I have purchased soap for the home, because the soap they were using was actually for laundry. They used it because it was cheaper. I was given permission to teach hand washing and give soap and handouts to the congregation after church on Sunday. In this class, we discussed the proper way to wash hands and when we should wash our hands to prevent infection and disease. The people asked questions and showed interest. The outcome of the hand washing campaign will be determined by observation at the children’s home and school over the next nine weeks. Members of the church class will simply be asked in coming services if they have been washing their hands at appropriate times and with correct technique.
I have begun working on dental hygiene by providing the children with toothpaste, toothbrushes, and dental floss to aid in prevention of dental diseases. I also began the nutritional portion of my objectives. I created an excel spreadsheet for tracking the daily intake of the adults and children at the Faith and Hope Children’s Home and have documented all meals since my arrival.