今年から10月15日（水）は「世界手洗いの日（Global Handwashing Day）」と決められました。
今年2008年は、国連衛生年（UN International Year of Sanitation）でもあり、衛生環境の改善に最も重要な方法のひとつとされている手洗いを奨励していこう、というもので、ユニセフ, CDC、UNAID、世界銀行などの国際機関、そしてユニリーバやP&Gといった民間企業がスポンサーとなっています。
ちょうどこの時期、西アフリカのギニアビサウではコレラが大規模に発生していて（現地は雨期にあたります）、その原因のひとつに、住民の間に手洗いをすることによって水を介して伝染病がうつると信じられているからではないかと言われています。
これは、水道や下水設備が整っている場所ではない地域で、手洗いはたらいに入った水を複数人で共有せざるをえず、考えられていることだと思います。
自分も現地駐在の時、友人宅に招かれたり外食をする時に、そこの家族と同じ水で手を洗って食事をした経験が何度もありますし、学校建設の支援プロジェクトでトイレを使った後の手荒い指導を活動内容に入れて取り組んできましたので、その背景はよく理解できます。
食事をする時、たらいに注がれた水と石鹸が回ってきて、その限られて水で手をぬらし、石鹸をつけ、石鹸の泡を取ります。当然、たらいの中には石鹸で濁った水が残ります。その同じ水をそこにいる人たちが順番に使っていくのです。
自分の場合は男性であり（ジェンダー的要素がまだまだ強い地域もあります）、友人宅に招かれている立場であったりするので、たらいに注がれた水を最初に使うように促されますが、その同じ水を使って最後の方に手洗いをするのは女性であったり、子どもであったりと社会的弱者になってしまうのです。
手洗いのように日常生活に根ざした習慣のようなものほど、行動変容を妨げる様々な社会文化的要因があります。
このように運動化して、国や地域の政治・政策の意思決定者や保健関係者に手洗い活動に取り組みやすい環境を作るのは大切なことだと思います。
Cholera Epidemic Not Yet Peaked 『UN Integrated Regional Information Networks』13 October 2008
The cholera epidemic is still out of control across Guinea-Bissau, with the number of cases doubling in the past three weeks, bringing the total number of people stricken to 10,476 as of 9 October.
There have been 312 new infections in the past two days, according to the UN Children's Fund (UNICEF), and 181 people have died from the disease.
"The epidemic is not under control. I don't want to be alarmist, but we haven't reached the peak and there are still new cases every day," Daniel Remartinez, emergency coordinator for Médecins Sans Frontières (MSF) Spain, told IRIN from the capital Bissau.
At 7,143, Bissau still has the highest number of cases, followed by Biombo in western Guinea-Bissau with 1,405 cases, and the Bijagos islands, 60km off the coast of the capital, with 441 infections - most of the Bijagos infections contracted in the past few weeks, according to Agostino Betunda, co-director of the Centre for Epidemiology in Bissau.
One in 10 people stricken by cholera are dying from it in the region of Quinara, which neighbours the capital, and one in nine in Bafata in central Guinea-Bissau, due in part to a lack of available treatment, according to Betunda.
MSF is providing treatment in hospitals and health clinics in Bissau, Oio and Biombo regions.
Source found
Epidemiologists in Bissau have traced the first case of cholera to an island in the southern region of Tombali.
"Our research points to Guinean fishermen living in encampments on the island of Campeane near the Guinean border," Betunda said, adding that he believes the source of the epidemic is related to recent cases of cholera in Guinea. About 40 cases were reported in Guinea in May, according to the World Health Organization (WHO).
"When there are cases in Guinea Conakry, often we have cases here," said Sylvana Nzirorera, UNICEF deputy representative in Guinea-Bissau.
"The epidemic in Guinea was contained very quickly because the government response was very organised," she said.
"There are no good sources of water on the island, so people cross the river to look for water. From there, it continued to proliferate throughout the region," the epidemiology centre's Betunda said.
Hygiene
Cholera is a recurring problem in Guinea-Bissau, particularly during the rainy months from June to October. A 2005 epidemic killed 400 people and infected over 25,000.
"We must look into the reasons why the country always has outbreaks. It is about lack of water infrastructure, but hygiene practices are also a major cause," said UNICEF's Nzirorera.
Nzirorera noted that under a third of Guinea-Bissauans believe that washing their hands will protect them from waterborne diseases like cholera. "This is a major problem," she said, "Even people who have water do not wash their hands systematically, and those that do, do not use soap."
UNICEF has put out radio announcements encouraging people to wash their hands regularly throughout the day. A UNICEF report investigating the causes of poor hygiene found that cultural practices play a role. "There is a saying [among some groups] that when a kid has dirty hands, he grows stronger," said Nzirorera.
The UNICEF report also found that stigma surrounding the disease contributes significantly to prevention efforts.
"Most people in villages think cholera is a shameful disease so they hide it," Nzirorera explains. "People are starting to link cholera with poor hygiene and they don't want to be seen as dirty."
Many people die at home or delay seeking treatment because they are ashamed to admit to the disease, she said.
End in sight
MSF's Remartinez said the number of infections is expected to peak in the coming weeks, though he said it will be months before the epidemic is over.
"It is difficult to say how many cases we will have at the end. But it will not be over with the end of the rainy season. It will last for some time - probably into November or December," he told IRIN.
Nzirorera was more optimistic. "The good news today is that Tombali region has not recorded any cases of cholera in the last four days," she said. "With the rains almost over, we could start seeing the end of the nightmare soon."
Ghana: Hand Washing With Soap Will Save More Lives 『Public Agenda (Accra)』10 October 2008
By Kwesi Yirenkyi Boateng
The saying that every nation relies on a pool of healthy citizenry to develop means that Ghanaians, as noted by Mrs. Mary Quaye, the Deputy Greater Accra Regional Director of Education, "need to be health conscious."
Speaking at a function to start activities for the 'Global Hand Washing Day' scheduled for 15th October, Mrs. Quaye advised both adults and children to wash their hands with soap especially after visiting the toilets, and just before eating.
According to a UNICEF publication on programmes for 2008 as a sanitation year; Water, Sanitation and Hygiene (WASH) in schools will focus on creating an effective and healthy environment for school pupils.
The Deputy Regional Education Director, said the School Health Coordinators in every district, and the School Base Health Coordinators are to supervise the implementation of the basic hygiene and hand washing with soap initiatives in all schools.
Pupils from Ministry of Health, Mamprobi Sempe 8, Association International, University of Ghana Basic and Services Junior High Schools were on hand and put up educative sketches and poetry recitals that echoed the message of hand washing with soap.
As an Ambassador of Sanitation, Ms. Eyiram Dotse, the first Runner up at this years' Ghana Most Beautiful, TV3 beauty pageant, stressed on the need to increase awareness on sanitation in the country. She announced that she would be touring all the 10 regions to campaign for greater awareness on sanitation.
Ms. Theodora Amoako-Adjei of the Community Water and Sanitation Agency, observed that "hygiene and gender issues are under reported," and called on the media as an agent of social change to increase a sustained awareness on the essence of hand washing with soap among Ghanaians.
Ms. Amoako-Adjei revealed that feacal-oral transmission of diseases was an unconscious act and therefore much care has to be taken after visiting the toilet. Recalling the prospects of awareness creation over the past years in the country, she said the 41 per cent of people recorded as using soap to wash their hands was encouraging but stressed that there was still room for improvement. She called on Ghanaians to join the campaign for proper sanitation.
The campaign for proper sanitation is being supported by World Bank, UNICEF, London School of Hygiene and Tropical Medicine (LSHTM).
