Picture a typical working day of a low income, self employed urban ‘hotelier’, a member of the ‘hustler’ population. Wake up at 5 am and start making tea and chapatis at your roadside ‘hotel’ near a high-rise construction site. By 10 am your hotel is full of all sorts of customers from the construction site workers, matatu crews, college students to nearby office workers. The customers come in for a cup of tea and a snack. Everyone is in a hurry, no one washes their hands. In fact there is neither equipment nor water for washing hands.  This scenario plays out every day in urban areas be it in slums, low income neighbourhoods or the posh suburbs. 

On your way home after work, are you one of those busy, modern men and women who buy vegetables and ask to have them chopped up before you leave the grocery?  Have you ever eaten mahindi-choma or taken chai na chapati from these hotels? How fresh or well cooked was that food? Did you wash your hands? Have you ever wondered where the operators answer their calls of nature or where they wash their hands afterwards? Next time check to see how many have handkerchiefs and how clean they are, just in case they have flu.  How about that beer, nyama-choma and mutura you enjoy so much at your local? Take an interest to see how the glasses or that wooden chopping board is cleaned. Is there running water and soap – even an improvised jerrican with a tap? 

Examples of questionable personal and public hygiene practices around us abound. Some people urinate and defecate in the open; unhygienic hawkers of fruits, sugarcane and cooked food roam our roads and estates. A consequence of these behaviours is that diarrhoeal diseases repeatedly infect us. Many parts of Kenya are presently afflicted by disease outbreaks. 10 Kenyan counties and several cities big and small have in the last two months reported outbreaks of Cholera. I often observe behaviours which leave me thinking that perhaps out of public health ignorance or sheer ignominious grit, we urbanites often tempt fate far beyond comprehension. It is no wonder that these outbreaks frequently occur.

Urban dwellings are special places because unlike rural areas, people live and work in a small geographical space. This close proximity of living presents great opportunities for pooling resources for our common good but in turn requires intelligent approaches to issues in almost all spheres of our lives as individuals, families, communities and as a society. This is like a double-edged sword which gets bigger and sharper every day. By 2014 it was estimated that more than half of people worldwide lived in urban dwellings and this was projected to grow by 1.5% every year over the following 15 years. This growth estimate means that by the time our development blue-print, the Kenya Vision 2030 matures Nairobi with its present population of 3.5 million will have at least 4 million and all other Kenyan towns will be bigger than they are now. 

This large population concentrated in a small space with dearth of life-sustaining resources therefore means that we unwittingly share everything good or bad, natural or unnatural that our environment throws at us. In terms of our health we share the air, smells, water, noise and even germs with our all literally very close neighbours.  Infectious diseases therefore spread as fast as rumours and cures are as slow as the city peak hour traffic.  We therefore cannot afford care-free behaviours concerning our hygiene and sanitation because whatever we do affects us and many other people around us. Positive behaviour change among us is important and needs to start from awareness about how our individual and collective behaviours cause or prevent infectious diseases among us. Beyond awareness we need individual and collective will-power and public health leadership to provide the means to the desired change.

Cholera which is presently killing people in our cities as well as Para-Typhoid, Typhoid, Dysentery, Escherichia Coli and Rotavirus are common diarrhoeal diseases whose causative germs are transmitted from person to person through poor personal and environmental hygiene practices. Using toilets, eating fresh and well cooked food, boiling drinking water and washing hands with soap and clean running water before eating or after visiting the toilet prevents almost all diarrhoeal diseases. Such simple and cheap everyday behaviours which we often take for granted are all we need to prevent the many deaths from Cholera that we recently been hearing of in Kenya. What is more, Cholera and Typhoid are more preventable than others because they require a large number of germs before the disease develops in us. This means that by the time we develop them we have literally been deep in shit for a long time.  So before we blame the government or someone else for not doing enough to treat or prevent the diseases we often suffer from let us think about what we as individuals can do to protect ourselves and our loved ones from these diseases. The recent Ebola outbreak in West Africa for example, was controlled largely by simple individual positive behaviour. Good health is therefore much easier to achieve if each of us prevents ill-health and promotes good health through our good behaviour than when we wait to treat diseases. And it also costs very little this way, like just a walk to the nearby water point to wash your hands or lighting your stove to boil drinking water. To paraphrase what the late President John F Kennedy once said, “And so my fellow Kenyans, let us everyday ask not what our government or leaders can do for our health, but ask what we can each do for our public health.”

The author, Dr Amulundu is an infectious diseases and public health specialist and acting Dean of the School of Health Sciences South Eastern Kenya University.