Picture this. It’s 1846 and a woman, clearly in the middle of labour, begs on her knees to doctors outside a Viennese hospital. But the woman isn’t trying to get into the clinic. She’s pleading not to be admitted. She knows that her chances of dying after childbirth in this particular clinic are high. She would rather give birth in the street.
Women were right to be terrified of Clinic Number One at the Vienna General Hospital; it was located next to the autopsy suite. Doctors would routinely carry out post mortems and then go on to examine the women in the labour ward. The high rates of puerperal fever that set in after childbirth in that clinic were put down to a miasma – or ‘bad air’.
Enter Hungarian doctor, Ignaz Semmelweis.
He saw how many women were dying and, not convinced by the miasma theory, questioned whether the fever was somehow transmitted by human to human contact. In a series of experiments, he encouraged doctors to wash their hands with chlorinated lime after dissecting dead bodies and before examining the women in labour. The results were astonishing – the death rate from puerperal fever dropped by 90%.
Problem solved? Sadly not.
Semmelweis’s findings were contrary to medical opinion at the time. Obstetrician Charles Meigs summed up the belief of the medical community: “Doctors are gentlemen, and a gentleman’s hands are clean.”
Semmelweis had challenged the established order and for that he would lose his job, his reputation and eventually be committed to a mental asylum where he would die in obscurity from sepsis, probably resulting from a beating by the asylum guards.
Only after ‘germ theory’ was fully established in the late 1800s was Semmelweis recognised for his achievements. He became known, posthumously, as the ‘saviour of mothers’, and nowadays the rejection of new evidence because it is contrary to established ideas is termed the ‘Semmelweis reflex’.
Fast forward 160 years and we see that Semmelweis’s messages are as pertinent now as they were back then.
Even today, an estimated one million mothers and babies die every year because of unhygienic conditions at childbirth. Lack of access to water, inadequate sanitation facilities and poor hygiene knowledge are still killing people every day.
This is why hygiene is central to WaterAid’s work.
We work with our partners to build waterpoints and install toilet blocks, but, unless we bring hygiene into the equation, the full benefits of this infrastructure would be missed. Something as straightforward as handwashing with soap can reduce the risk of diarrhoea by 50%. It’s a simple solution with enormous impact. Even better, it’s not expensive – hygiene promotion is the most cost-effective disease control intervention there is.
Promoting hygienic behaviour is difficult the world over because it involves changing habits and challenging traditional norms. People resist change – look what Semmelweis had to contend with. But when you don’t have enough water to drink and cook with, let alone use for washing, you are forced to make a choice between what is essential and what is not. So hygiene promotion has to go hand in hand with access to safe water and toilets.
WaterAid promotes hygiene in all of the countries where it works. The techniques vary from place to place but the principles are the same – we work closely with communities because they will find the best solutions and the best ways to promote lasting change.
There are endless possibilities for innovation.
In Madagascar, we have puppet shows in which six foot figures act out hygiene stories to huge crowds of children.
In Nigeria, we have a radio drama on water, sanitation and hygiene issues that is broadcast across the nation.
In Bangladesh, teachers play the blue hand game with children to show how germs are spread when hands aren’t washed.
In Zambia we promote menstrual hygiene management so that girls can stay in school when they have their periods.
In Uganda we have hygiene drama and dance groups.
The list goes on. But in every country there are committees, individuals or volunteers who are willing to spread the word about hygiene to their peers.
We have a lot to thank Ignaz Semmelweis and all the early hygiene pioneers for. It’s testament to their foresight and intuition that the hygiene messages we use today are the same as they were 160 years ago. Although there have been many developments in medical knowledge and practice, little is different in the world of germs. When we neglect simple hygiene practices, controllable diseases become serious threats.
WaterAid will continue to find innovative ways to promote hygiene and repeat those age-old messages. Together with access to safe water and sanitation, knowledge about good hygiene really is the first step out of poverty.
So thank you, Dr Semmelweis.