Did you go in the bathroom?

Just seeing the classroom won't give you a
full picture of her education.

For me, one of the hardest parts of living in a developing country is the lack of clean bathrooms.  Especially when I go outside of Dhaka, I limit my fluid intake to avoid the need to use a smelly, dank toilet at a gas station or restaurant.

In any case, one place where I always make a point to visit the bathrooms is when I visit a school.  And not the teachers' bathrooms, which are separate.  I want to see where the students, especially the girls, have to go.  There's plenty of literature that shows that girls' attendance is linked to bathroom availability and quality, especially when they reach the age of menstruation.  And it's no wonder!  Imagine if your child had to come home from school every time he or she needed to pee.  It's more than a little humiliating.

Can you really teach people to wash their hands?

Occasionally I'll see in the American newspaper breaking stories about how rarely doctors wash their hands.  Or even the average American citizen.  Maybe getting people to wash their hands is actually much harder than one would think.

But Americans don't seem to suffer from diarrheal disease, typhoid, and all these other fecal-oral diseases that plague many developing countries.  Why not?

I'm convinced that Americans are essentially saved by two things: utensils and toilet paper.  Their hands have essentially been removed from both ends of the equation, which drastically reduces the opportunity for transmission and consumption.

Maybe the WASH folks are going about this the wrong way--why can't we start an advertising campaign to get people in places like Bangladesh to eat with a fork and a knife, and wipe with toilet paper?  Perhaps started with the wealthy so that this might be perceived as a "wealthy" behavior (and therefore something others aspire to)?

It's easy to get tunnel vision on the "best" outcomes, or the "ideal" outcomes, but it's important to keep looking for other approaches that we may have missed.  Sure, people should wash their hands.  And use condoms.  And wear their seat belts.  But unlike economists, we can't just assume rational behavior, especially when we've got a lot of evidence to the contrary.  So we also have to think about which behaviors are easier for people to pick up, even if the gains are marginal compared to "best" case.

The grossest thing I've ever seen

A community hand washing demonstration in a village in Habiganj.

Everyone knows that they are supposed to wash their hands.  And yet, many don't.  So many people still get sick sick from things that simple hand washing can prevent.

One of the techniques that our Water, Sanitation and Hygiene (WASH) program uses is a simple public demonstration.

A community educator gathers up a group of villagers and ask one person to come up to the front.  First the educator asks the volunteer to wash his/her hands just with water.  She pours water from a pitcher over their hands and catches all the water in a glass bowl.  Already anyone can see that the water is dirty.