Hygiene refers to physical cleanliness, including personal matters such as regular bathing, washing hands, cutting nails, washing and changing clothes, and so on. It also includes keeping homes, workplaces, and even toilets clean and germ-free conditions that are considered as good qualities and habits in society. They need to be connected with required healthy manners (e.g. food habits, exercise, boosting immune system) at the forefront of the struggle against illness and disease such as the ongoing coronavirus (Covid-19).
The WHO and other health organizations have suggested that people maintain proper hygiene in the fight against the coronavirus pandemic. Related terms, such as lockdown, quarantine, social distancing, hand wash, face mask, and sanitizer became ubiquitous during the Covid-19 outbreak. However, these were not familiar to the people of many non-Western countries like Bangladesh; consequently, were often misunderstood or at least not understood in the same ways (Uddin, 2020a). Traditionally, people in Bangladesh are fond of cleanliness, but their notions of proper hygiene do not always accord with those of organizations like the WHO. Thus, even though Islam requires the washing of the hands, face, legs, head and other forms of cleanliness, it is worth exploring just how often this is done and the limits to it in relation to hygiene protocols during the time of coronavirus.
Hand washing is promoted as one of the most useful hygiene practices by international health programs. These programs did not invent hygiene. The earliest recorded evidence of the production of soap-like materials dates back to around 2800 BC in ancient Babylon (Frater, 2010). However, among the most Bangladeshi people, beliefs about hygiene and the ability to achieve it by way of hand washing, (or even conceptualizing hygiene in relation to the immune system), are not uniform. This is particularly true among those who live in the world’s most crowded slums and refugee camps (e.g. Rohingya refugee camps, with about one million people in several camps), who might desire hygiene in relation to hand cleanliness, but lack such daily essentials as water, let alone hand soap or sanitizer. Informal workers in cities and vulnerable people in rural areas face acute financial crisis to meet their daily basic needs, and they have fewer options for maintaining proper hygiene to prevent the spread of disease (Uddin, 2020b, Cooper, 2020). In practice globally, effective hand washing is not uniform, despite decades of public health advocacy on the part of international experts. Some estimates, such as the 2013 UNICEF survey (Cooper, 2020), find that only about 59.1 per cent of people practice hand washing with water and soap at critical times.
The lack of access to resources for soap-and-water-based hand washing produces critical sites for disease spread that go unchecked. For instance, Bangladeshis eat most of their meals with their hands but many do/can not wash their hands well with soap before taking foods anytime, anywhere. Those who participate in the preaching of Islam (i.e. tablighi jamaat), usually eat lunch/dinner seven-eight people together from one larger plate at a time. In the month of Ramadan, in addition to family arrangements, Muslim men sit together and break their fast by sharing food from one place or plate to enhance brotherhood (religious solidarity) while they are outside of home at that time, for example, at mosque. Similarly, in madrasas and schools, students often sit together and have their tiffin and lunches/dinners. This is before we consider the crowded housing situations at schools and for families.
Access to sanitary latrines is limited to roughly 50% of the population of Bangladesh (Akter, Ali and Dey, 2014). However, even among those with access to latrines, there is questionable sanitation in use of them. Those who live in the villages and crowded slums or refugee camps of Bangladesh enter the toilet with only one bodna (small water vessel) of water because more water is not available. While some of this water may be used to rinse one’s hands , many people are not in the habit of washing their hands with soap after defecation because soap is seldom available. Those who have soap often save it for bathing or cleaning clothes.
Scarcity of water is everywhere—both in urban and rural Bangladesh. While urban people largely use tap water, along with some tube-wells, many rural people use pond water for cooking, drinking, and bathing. Pond water is often contaminated with arsenic, micro-organisms and other impurities. As a result, water-borne diseases (e.g. diarrhea, influenza, malaria, and mumps) are prevalent in rural areas and slums. With limited clean water for drinking, it is not surprising that use of water for hand washing is considered of secondary importance. Even in urban settings such as in Chittagong city, the water supply is not necessarily clean or plentiful enough to use for extra hygiene. Water supplies are regularly interrupted by cut-offs.
On top of the limits to hygiene created by lack of access to water and soap or other cleaning products, Bangladeshis have the added problem of not being easily able to create social distance to mitigate the spread of infection. Bangladesh is a densely populated country, and people live in close contact with one another (e.g. camps, slums, buses, trains, and classrooms). In market and streets, it is difficult to move without touching or pushing others, and people accept this as normal. Physical distance is not easy to maintain when many people gather together in processions, meetings, strikes, etc. Handshaking in public and hugging in private are common and unlikely to be easily avoided, especially during Eid festivals or funerals, both of which have occurred during the time of COVID-19. Interruptions to these customs and others including cuddling children or reaching to touch the arm of a friend are unlikely to take place even though public health recommendations advise this.
Given the above stated Bangladeshi culture of hygiene, the following issues are conceivable as challenges toward maintaining required hygiene to prevent and slow down the spread of Covid-19.
Structural and institutional obstacles in maintaining required hygiene include:
- Lack of adequate facilities for running water for hand washing everywhere and lack of sufficient safe drinking water.
- For hand washing, water for 20 seconds is not available in most places.
- Soap, sanitizer and mask are luxuries for most of the people for whom basic food resources are a priority.
- Social distancing at home is impossible for most families both in rural and urban areas.
- Beyond few offices and institutions, most people have no access to hand sanitizers.
Given the challenges, culturally appropriate measures are needed to combat the spread of the coronavirus. While these issues do not affect all Bangladeshi people, noting that wealthy and urban resourced citizens can and often do follow hygiene protocols and that many urban educated students, teachers, and social workers work to spread information about hygiene in the fight against the deadly virus, the structural limitations to achieving these goals are important.
It is said that in Islam, ‘cleanliness is half of faith.’ Religious leaders (such as imam, mawlana) could guide their followers to also include messages about physical hygiene, including maintaining the required physical distance by suggesting that they avoid crowded religious prayers at mosques, for example (Uddin, 2020a). They are guiding their fellows to maintain required hygiene with limited success, as seen during the Eid prayer in late May (Bdnews24, 2020), but without resources that would make soap and water and uncrowded living situations available, these messages may not have much effect.
Anthropologists can play a role in not only noting how cultural beliefs and behaviors get in the way of hygiene, but also pointing to structural barriers to these goals.
Ala Uddin, PhD is a Professor in the Department of Anthropology, University of Chittagong, Bangladesh. (email: alactg@gmail.com). He conducted research works on diverse issues of the indigenous peoples in the Chittagong Hill Tracts, Bangladesh. Among other issues, he worked on: religious pluralism, street vending, health, migration, overseas migration of women workers, and forest management. Currently, he is conducting research among the Rohingya refugees in Bangladesh, and interested to work on the Covid-19 situation in Bangladesh.
- Acknowledgements: I am thankful to Professors Vincanne Adams, Alex M. Nading and other reviewers and editors at MAQ for guidance and feedback on the essay.
References
Akter, T., Ali, A.R. & Dey, N.C. (2014). Transition overtime in household latrine use in rural Bangladesh: a longitudinal cohort study. BMC Public Health 14. https://doi.org/10.1186/1471-2458-14-721
Bdnews24.com. (2020). “No hugs, no handshakes: Social distancing curtails Eid celebrations in Bangladesh,” May 25, 2020: https://bdnews24.com/bangladesh/2020/05/25/no-hugs-no-handshakes-social-distancing-curtails-eid-celebrations-in-bangladesh
Cooper, K. (2020). Fact Sheet: Handwashing with soap, critical in the fight against coronavirus, is ‘out of reach’ for billions. New York: New York. https://www.unicef.org/press-releases/fact-sheet-handwashing-soap-critical-fight-against-coronavirus-out-reach-billions
Frater, J. (2020). Ultimate Book of Bizarre Lists. Berkeley, CA: Ulysses Press.
Uddin, Ala. (2020a). “The Meaning of Lockdown in Bangladesh.” Anthropology News website, May 20, 2020. DOI: 10.1111/AN.1403
Uddin, Ala. (2020b). Local response to the global pandemic (COVID‐19) in Bangladesh. Social Anthropology (special section article). https://doi.org/10.1111/1469-8676.12888