Back to Basics

Have you ever had one of those “Oh Crap” moments when you realize something very bad or embarrassing is about to happen? Your heart starts pounding and your mind quickly flips through all possible scenarios only to find that they all end in complete shame, utter humiliation, extreme awkwardness.

I had one of these experiences recently while working in the capital of a Latin American country as part of my fellowship year. I was sitting in a meeting at the Ministry of Health where local officials were welcoming us and discussing a large overhaul of their health care system that our organization was going to fund. All of a sudden, I got an all-too-familiar feeling in my stomach. I tried to wish it away, but it became obvious that it was inevitable. I kept my calm, as this seemed to be a relatively manageable situation. I went through the steps in my head: excuse yourself from the meeting, wipe the sweat from your forehead and calm your breathing enough to ask the secretary “donde está el baño?,” walk there quickly, and do your thing.

My master plan went off without a hitch, I arrived to the bathroom, looked in the first stall and…no toilet paper. That’s fine, everything’s cool. I looked into the second (and last) stall. Oh Crap! No toilet paper either. My heart started racing, my mind kicked into high gear, desperately searching for a solution. I reached into my pocket and felt pure beauty. Several tissues. Crisis averted.

After I finished, I breathed a sigh of relief and walked to the sink to wash my hands, only to have those “Oh Crap” feelings rush back to me. No soap. I searched around in disbelief, but my eyes weren’t fooling me. I reached into my pocket again and found a wet wipe, which by some act of fate had traveled from a crawfish restaurant in Washington, DC, into my suitcase, and then into my pants pocket that morning. Second crisis averted.

I struggled to stay focused during the rest of the meeting as I thought about how ironic it was that we were discussing a $100 million project to implement a new financing model for health clinics, yet there was no hand soap or toilet paper in the Ministry of Health bathroom. Now, I want to be clear that the financing project will likely have a huge positive impact on the health of the people of this country, and there are a million reasons why there may not have been soap in the bathroom: perhaps the maintenance man or woman was on his/her way to resupply it, or maybe the soap and toilet paper had fallen victim to budget cuts. Either way, this incident reminded me of an important point.

Many people and institutions working in public health or public policy today are constantly searching for “innovative,” “sexy,” “ground-breaking” solutions to the most complex problems using state-of-the-art technology. New ideas are great, but it’s important not to forget about the proven interventions such as basic hygiene. In developing countries, researchers observed that 65-97% of people don’t wash their hands after going to the bathroom. In the US, 15% of adults don’t wash their hands. Not washing hands with soap and water after going to the bathroom increases the spread of diarrhea and respiratory infections, two of the leading causes of death for children worldwide. Most people, including in the developing world, have access to soap. Changing people’s behavior can be challenging, but education and media campaigns have been proven to be effective for getting people to wash their hands. As we continue to develop new ideas and technology to tackle complex public health problems, let’s not forget to dedicate just as much energy to the seemingly simple, “unsexy” problems. Around the world, two thousand children per day die of diarrheal diseases, many of which could have been prevented with proper handwashing. So whether you are a public health official or just someone who poops, remember to do your part to promote good hygiene.