Wash your hands, save lives!

They form an adorable and comical picture, these dozens of children, as they wait in line to use the toilet outside their kindergarten building. Their cheeks ablaze with red, some of them struggle to balance as they stand bundled in layer upon layer of clothing to protect against Mongolia's biting winter temperatures. Their teachers usher them in one at a time, the decrepit wooden frame of the outhouse covering little more than dirty slats above a long drop. The children skip handwashing upon their return indoors, some of them using wet tissue paper and hand sanitiser instead; with limited facilities and short class breaks, they are not afforded any other options.

When we realise the impact of this situation on the children's lives, suddenly the sight is not so amusing after all.

In an Ulaanbaatar school like the one described, 17 children fell ill will hepatitis A, mumps and dysentery during the last academic year. It is hard to believe that these diseases are still a reality in twenty-first century Mongolia. However, situations like this are all too common in both rural and urban areas.

When children don't wash their hands they are particularly susceptible to falling ill. Last year, there were 9,265 registered cases of infectious diseases, with 53% of them in the capital city. The causes are simple: a lack of hygiene habits, clean water and sanitation, which are the everyday reality in far too many schools and homes.

One of the schoolchildren to fall ill was 12 year old Tuugii, an intelligent and playful boy who contracted hepatitis A in early October, his seven year old sister following suit later the same day. Both children were hospitalised and treated for this infectious liver disease. Tuugii hated the daily injections and found his time in hospital extremely boring. Although hepatitis A can be deadly, Tuugii and his sister recovered and were discharged from hospital within two weeks.

All of this could have been prevented through regular handwashing with soap. Tuugii most likely caught the disease from handling the cedar nut snacks his mother sells to school children in the Autumn. These delicious tree nuts are held and crushed between the teeth, so when they are handled they act as a channel for disease-causing germs.

The lack of a handwashing habit is not the sole reason for the illnesses of Tuugii and his peers. His school attempts to accommodate approximately 2,000 children, with an average of 45 individuals per class. Although this is three times more than the institution's infrastructure can handle, this level of overcrowding has become common due to our rapid urban population growth rate. Tuugii's Bayanzurkh district school is connected to the city's water system, but not to the centralised drainage system. As a result, sewage must be pumped out on a daily basis at significant cost, sometimes causing the school to close all lavatories and handwashing facilities.

The state of affairs at the household level is no better. As migrants flock to urban centres in search of work and a better life, ger districts spread without urban planning. 48.4% of poor people have no access to improved sanitation facilities, whereas this figure is only 25% for non-poor people. As traditional gers do not by nature accommodate adequate washing facilities, outdoor makeshift restrooms are built. 97% of homes in ger districts dig deep holes for lavatories and pour their waste water onto the ground, leading to the slow pollution of the locality's underground water sources. Families must pay to use public showers, which themselves become unhygienic breeding grounds for the spread of disease.

There are critical moments during our daily routines when hands should be washed with soap, such as after using the toilet or before food preparation. Many Mongolians simply do not realise that one of the best ways to prevent disease is handwashing, and as a result many children come to school with unwashed faces and hands.  

In Mongolia, almost 500 children under the age of five die every year from diarrhea and acute respiratory illnesses, in addition to many more who become seriously ill. Many of these illnesses and deaths are preventable! Research shows that if handwashing with soap were widely practiced, diarrhea could be cut by almost 50 percent, and respiratory problems by nearly 25 percent.

Additionally, families should consider the economic advantages of sewing the simple act of handwashing into the fabric of their daily lives. This beautifully simple preventative measure would save on the cost of treating children's hygiene-related illnesses. Instead of spending on medical care, families can attack the root causes of disease, buying soap and installing improved facilities for a healthier environment.

The good news is that the small and innocuous action of washing hands with soap can dramatically improve the health of Mongolian families and even save lives! Let us take action today:

•    Children: Did you know that one trillion germs can live in one gram of human waste? Wash your hands with soap to kill germs and stay healthy and strong!
•    Parents and communities: Take a simple and affordable step towards improving the health of your family members by making handwashing a habit. A minor investment in soap and adequate hygiene facilities can save your children from distressing diseases and cut down on expensive medical bills.  
•    Government: If there is no water and sanitation infrastructure, there can be no hygiene. Improve urban planning and ensure that Mongolia's schools and homes have access to adequate water and sanitation facilities. Work with INGOs and NGOs like World Vision to spread hygiene messages to the general public. Together, this will transform the overall health of our nation and decrease health spending. With our skyrocketing GDP and rapid development as a nation, it is imperative that we do not allow a continuing disparity in living standards between the rich and the poor.

Dr. Narantuya Sanduijav is World Vision Mongolia's Water, Sanitation and Hygiene expert. Dr. Nara draws on her years of experience in the medical, health and environment sectors as she seeks to promote and develop healthy habits and surroundings for Mongolia's children and families. For more information please contact Dr. Nara at narantuya_sanduijav@wvi.org.

For more on Global Handwashing Day, visit www.globalhandwashing.org.