What's Hygiene Got To Do With Hunger?

Action Against Hunger's extraordinary Staff Honoree of the Year explains

Daisy Nyaga is a Public Health Program Manager with Action Against Hunger in Kenya. She works with families to improve their health and prevent illnesses like malaria, dysentery, and cholera that kill millions of children every year and devastate families and entire communities. In recognition of her outstanding work on behalf of communities in distress, Daisy was honored with the Staff Honoree of the Year at the Action Against Hunger Annual Gala on November 18th. We sat down to talk about her work training families in good hygiene and sanitation practices in northeastern Kenya.

Why is promoting good health and hygiene practices so important? What does it have to do with hunger?

Surveys we’ve done in the North East Province of Kenya show that only 20 percent of the population has access to a latrine or has ever used one. As a matter of fact, going to the bathroom out in the open is a normal occurrence for everyone—women and men, old and young alike.

In Kenya, a third of all disease stems from these kinds of unsanitary living conditions. The good news is that taking simple steps literally saves lives—steps like using a latrine, washing hands, cooking with clean utensils, and drawing water from protected sources.

"The good news is that taking simple steps literally saves lives."

We also know that the fight against malnutrition can’t be won unless we also tackle underlying diseases like dysentery and cholera—diseases that are major contributing factors to malnutrition. That’s why public health promotion is so vital in preventing childhood deaths.

How do you go about promoting good practices?

A good deal of my work involves sitting with mothers and their children to talk about embarrassing subjects like breastfeeding and cleaning a baby’s bottom. Our primary targets are mothers of malnourished children because if children are malnourished, it’s very likely that there are problems at home related to sanitation and hygiene.

We train these mothers on different topics, from best breastfeeding practices, to immunizing their children, to preventing malaria and acute respiratory infections. After we discuss each topic, we all come up with an action plan for these mothers to implement in their homes. They then become models for other community members who look to them for guidance on how best to protect their families.

Take the example of a mosquito net. It’s a highly effective way to prevent malaria, but many families don’t know how to use nets or are even afraid to use them. After we discuss the importance of nets and teach mothers how to use them, we follow up with them to make sure they're implementing the action plan. Then, we organize community visits to these “model” homes to show other families how to use the nets.

Outbreaks of cholera are all too common in Kenya. How do you prevent them?

Cholera is one of the things we work on in northern Kenya because it’s directly related to malnutrition. Many of the children we lose are first malnourished and then fall ill with cholera, which is an illness that stems from unsanitary conditions and contaminated water. We promote hand-washing with soap, or, when there’s no soap available, with ash. We help families construct simple hand-washing stations called “tippy taps,” which are like mini water fountains made from buckets.

We promote safe water handling practices through water treatment. Water is treated at the source, but because we know that contamination can also happen at the household level, we work with families in their homes to make sure they’re treating their water before consuming it. We teach families how to boil water and build water filters made from basic materials like cement, sand, and gravel. Even though they’re simple, these filters are extremely effective in purifying drinking water.

"It’s gratifying to have a direct impact on people who are going through the kinds of things I went through when I was growing up."

Finally, we make sure that people have access to latrines by subsidizing household latrine construction. The family builds the latrine and invests in a portion of the materials. We supply the technical advice and the remaining materials, including a bag of cement, shared digging tools, and steel reinforcing bars. We also promote their use and maintenance because having a latrine is one thing, but using it is quite another.

How do you encourage people to use the latrines?

One way is to change the norms that are attached to latrine usage. People share latrines with other people, including their in-laws, so they don’t always want to use them. We teach them how to properly clean and maintain the latrines, because people will be much more likely to use a latrine if it’s sanitary. We work with families to figure out who will be responsible for cleaning the latrines and who will be using them.

What kind of impact have you had?

I have worked in Kenya for four years now, so it’s easy for me to see the result of our work. For example, in 2006, there were multiple cases of cholera in a number of communities in northeast Kenya. Last year, after Action Against Hunger came to these very same communities, there were no cholera outbreaks. Through the trainings and the programs we put in place, and by ensuring that people have access to latrines and improved practices at the household level, we are seeing real improvements. I’m really proud of this.

"Families tell me all the time about how they’ve benefited from our work."

Families tell me all the time about how they’ve benefited from our work. In Kenya, many communities depend on rainfall for their drinking water. They collect the rain in something called an earth-pan and then take the water from there for use in their homes. As you can imagine, the water is brown and often very contaminated. As I mentioned before, we give mothers a filter and teach them how to use it. One day, when we were going from house to house, we paid a visit to one particular family I still remember. The mother told me shyly that ever since she got the water filter, the babies’ stomachs were not making noises anymore. I distinctly remember her saying, “They were very noisy because they were getting sick from the water, but now they are quiet because they are happy.”

You grew up in Mandera, which is near many of the communities where you now work. What’s it like to do public health promotion work in a context that’s familiar to you?

Being familiar with the culture and the beliefs of the people makes it easier to do my work. I know what’s possible to accomplish, and they know that I understand them. People are more likely to see the benefit of our sanitation and hygiene promotion work because I can relate to them.

It’s also good to be home. It’s gratifying to have a direct impact on people who are going through the kinds of things I went through when I was growing up.

What motivates you every day to get up and do this work?

The children. Have you seen a malnourished child? You can count the bones. After two weeks of treatment for malnutrition in one of our Stabilization Centers, you can’t tell it’s the same child who was too weak to even smile before. In fact, one day I brought a severely malnourished child who couldn’t even cry to one of our Stabilization Centers. Within two days, he was running around. It’s unbelievable. But you know, it’s not enough to treat the symptoms of malnutrition. We have to ensure he doesn’t return to the same conditions that made him sick in the first place. That’s my job, and it’s extremely gratifying.