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close this bookWhere Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)
close this folderChapter 10: Staying Healthy
close this folderCleanliness
View the document(introduction...)
View the documentCleanliness in the community (sanitation)
View the documentCleanliness in the home
View the documentPersonal cleanliness
View the documentClean water
View the documentFood safety


¨ Different germs are spread in different ways. For example, tuberculosis (TB) germs are spread through the air. Lice and scabies are spread through clothes and bed covers.

Many illnesses are spread by germs that pass from one person to another. Here are some of the most common ways that germs are spread:

· by touching an infected person.


· through clothes, cloths, or bed covers.


· through the air. For example, when someone coughs, germs in small drops of spit (saliva) can spread to other people or objects.


· by eating contaminated food.


· through insect bites or animal bites.


Cleanliness in the community (sanitation), cleanliness in the home, and personal cleanliness are all important to prevent these sicknesses by stopping the spread of germs. For example:

1. A man infected with parasites has diarrhea outside.

2. A pig eats the man’s stool.

3. One of the man’s children plays with the pig and gets stool on himself.

4. Later, the child starts to cry and his mother comforts him and cleans his fingers with her skin. She also gets stool on her hands.

5. The mother prepares food for the family, forgetting to wash her hands first. She uses her soiled skirt to keep from burning her hands.

6. The family eats the food. Soon everyone has diarrhea.

What could have prevented the family’s illness?

If the family had used any of these precautions, the spread of illness could have been prevented:

· if the man had used a latrine or toilet.
· if the pig had not been allowed to run free.
· if the mother had not used her skirt to wipe the child’s hands and then touched the food.
· if the mother had washed her hands after touching her child and before preparing food.

Cleanliness in the community (sanitation)

Many common health problems are best solved in the community. When the community works together to improve sanitation, everybody benefits. For example:

Work together to develop a source of clean water for drinking and cooking. The source should be close enough to the community for people to get water easily.

To keep drinking and cooking water clean:

· do not let animals go near the water source. If necessary, build a fence to keep them out.
· do not bathe, or wash clothes, cooking pots, or eating utensils near the water source.
· do not pass stool or throw garbage (rubbish) near the water source.

Clean drinking water can help prevent diarrhea and parasites.

Get rid of garbage in a safe way. If possible, bury, compost, or burn garbage. If you bury it, make sure the pit is deep enough to keep animals and bugs away. If the garbage is above ground, fence off the dump and cover the garbage with dirt to reduce flies. Also, find safe ways to get rid of dangerous and toxic materials. For example, do not burn plastic near the house, because the fumes can be toxic, especially to children, old people, and sick people.

¨ Use composted food waste to fertilize your crops.

Drain standing water in washing areas, and in puddles, tires, and open containers. Malaria and dengue fever are spread by mosquitos, which breed in water that is not flowing. If possible, use mosquito nets when sleeping.

Organize your community to build latrines (see how to build a latrine).

How to build a latrine

1. Dig a pit about ° meter wide, 1° meters long, and 3 meters deep.
2. Cover the pit, leaving a hole about 20 by 30 centimeters.
3. Build a shelter and roof out of local building materials.


¨ For more information about building latrines, see Where There Is No Doctor.

¨ After using the latrine, throw a little lime, dirt, or ash in the hole to reduce the smell and keep flies away.

To be safe, a latrine should be at least 20 meters from all houses, wells, springs, rivers, or streams. If it must be anywhere near a place people go for water, be sure to put the latrine downstream.


Cleanliness in the home

Since family members are in close contact with each other, it is very easy to spread germs and illness to the whole family. A family will have less illness if they:

· wash cooking and eating pots and utensils with soap (or clean ash) and clean water after using them. If possible, let them dry in the sun.

· clean the living space often. Sweep and wash the floors, walls, and beneath furniture. Fill in cracks and holes in the floor or walls where roaches, bedbugs, and scorpions can hide.

· hang or spread bedding in the sun to kill parasites and bugs.

¨ Sunlight kills many germs that cause illness.


· do not spit on the floor. When you cough or sneeze, cover your mouth with your arm, or with a cloth or handkerchief. Then, if possible, wash your hands.

· get rid of body wastes in a safe way. Teach children to use a latrine or to bury their stools, or at least to go far away from the house or from where people get drinking water.

¨ If children or animals pass stool near the house, clean it up at once.


Personal cleanliness

It is best to wash with soap and clean water every day, if possible. Also:

· wash your hands before eating or preparing food, after passing urine or stool, and before and after caring for a baby or someone who is sick.

· wash the genitals every day with mild soap and water. But do not douche. The vagina cleans and protects itself by making a small amount of wetness or discharge. Douching washes away this protection and makes a woman more likely to get a vaginal infection.


· pass urine after having sex. This helps prevent infections of the urine system (but will not prevent pregnancy).

· wipe carefully after passing stool. Always wipe from front to back. Wiping forward can spread germs and worms into the urinary opening and vagina.


Protect your teeth

Taking good care of the teeth is important because:

· strong, healthy teeth are needed to chew and digest food well.

· painful cavities (holes in the teeth caused by decay) and sore gums can be prevented by good tooth care.

· decayed or rotten teeth caused by lack of cleanliness can lead to serious infections that may affect other parts of the body.

· people who do not care for their teeth are more likely to lose them when they get old.


Teeth should be cleaned carefully twice a day. This removes the germs that cause decay and tooth loss. Clean the surface of all front and back teeth, then clean between the teeth and under the gums. Use a soft brush, tooth stick, or finger wrapped with a piece of rough cloth. Toothpaste is good but not necessary. Salt, charcoal, or even plain, clean water will also work.

You can make a toothbrush to keep your teeth dean.

Clean water

Drinking water should be taken from the cleanest possible source. If the water is cloudy, let it settle and pour off the clear water. Then, before drinking, kill the harmful germs as described below. This is called purification.

Store the purified water in clean, covered containers. If the container has been used for storing cooking oil, wash it well with soap and hot water before storing clean water in it. Never store water in containers that have been used for chemicals, pesticides, or fuels. Wash water containers with soap and clean water at least once a week.

Store water in covered jars and keep your living space clean.

Here are some simple and inexpensive ways to purify your water:

Sunlight. Sunlight kills many harmful germs. To purify water using sunlight, fill clean, clear glass or plastic containers with water, and leave them outside from morning to late afternoon. Be sure to place the containers in an open space where they will be in the sun all day. (If drinking water is needed right away, putting the containers in the sun for 2 hours in the middle of the day should be enough for purification.)


To avoid getting germs in the water, choose a spot away from children, dust, and animals. If you want the water to cool before using, bring the containers inside overnight. Water can be stored for a day or two in the same container. Sunlight purification works best in warm climates.

Lemon juice sometimes kills cholera (but not other germs). Add 2 tablespoons lemon juice to a liter (1 quart) of water and let it sit for 30 minutes.


Boiling water for 5-10 minutes will kill most germs. Because boiling water uses so much fuel, use this method only if there is no other way to purify your water. If you want to kill all possible germs, you will have to boil the water for 20 minutes.


Food safety

Many common diseases of the intestines are spread through food. Sometimes people who harvest, handle, or prepare food pass germs from their hands into the food. Sometimes germs and molds in the air begin to grow in the food and it goes bad (spoils). This happens when food is not stored or cooked properly, or when it gets old.

¨ Washing your hands prevents the spread of disease. Keep a special dean rag for drying your hands. Wash it often and dry it in the sun.


Or dry your hands in the air by shaking the water off.

To prevent the spread of germs in food:

· wash your hands with soap and water before preparing food, before eating, and before feeding your children.

· wash or peel all fruits and vegetables that are eaten raw.

· do not let raw meat, poultry, or fish touch other food that is eaten raw. Always wash your hands, knife, and cutting board after cutting these meats.

· avoid coughing, spitting, and chewing things like gum or betel near food so your saliva does not get in the food.

· do not allow animals to lick dishes or utensils clean. If possible, keep animals out of the kitchen.

· throw food out when it spoils.

Here are some of the most common signs of spoiled foods:

· bad smell

· bad taste or a change in taste

· changed color (for example, if raw meat changes from red to brown)

· many bubbles on the top (for example, on the top of old stew or soup) along with a bad smell

· slime on the surface of meat or cooked foods

Cooked food

Cooking food kills germs. All meats, fish, and poultry should be well cooked. Nothing should look raw or have a raw color.

¨ In some communities there are special ways to prepare raw meat or fish that make them safe to eat.

If the food begins to cool, the germs quickly start to grow again. If the food is not eaten within 2 hours, reheat it until it is very hot. Liquids should be bubbling, and solids (like rice) should be steaming.


Food selection. Sometimes food is bad even before it is cooked or stored. Here are some things to look for when selecting food.

Fresh (raw) foods should be:

· fresh and in season.
· whole - not bruised, damaged, or eaten by insects.
· clean (not dirty).
· fresh smelling (especially fish, shellfish, and meat, which should not have a strong smell).

Processed (cooked or packaged) foods should be stored in:

· tins that look new (no rust, bulges, or dents).
· jars that have clean tops.
· bottles that are not chipped.
· packages that are whole, not torn.

Strong-smelling fish and bulging cans are signs that the food has spoiled.

Food storage

Whenever possible, eat freshly prepared food. If you store food, keep it covered to protect it from flies and other insects, and dust.

¨ Women in the community who know which local foods keep well and good ways to store them can teach others.

Food keeps best if it stays cool. The methods described below cool food using evaporation (the way that water disappears into the air). Put the food in shallow pans for more complete cooling.

Pottery cooler. This double-pot cooler is made of a small pot inside a large pot. The space between the pots is filled with water. Use a large pot and lid that have not been glazed (coated with a hard, smooth, baked-on covering) so that the water will evaporate through the pot. The small pot should be glazed on the inside to stop water from seeping into the stored foods.


Cupboard cooler. Put a wooden crate or box on its side, and then set it on bricks or stones to raise it off the floor Put a container of water on top of the crate and drape sackcloth or other coarse cloth over the bowl and around the crate. The cloth should not quite reach the floor. Dip the cloth in the water, so that the wetness spreads throughout the cloth. Place the food inside the crate. As the water in the cloth evaporates it will cool the food.This method works best if you can keep the cloth wet all the time.

Cover the entire crate when you make a cupboard cooler. The front is open here just so you can see inside.