Menstrual hygiene, Cholera and Space Travel

I heard through the grape vine that Nigeria is once again, nursing ambitions of sending some people (or unfortunate souls rather) into space. 

*Letting out an exaggerated sigh* 

Ladies and gentlemen, come closer; let me tell you two very compelling true stories.

On the 28th of May 2024, millions of girls and women like me celebrated World Menstrual Hygiene Day. This day which was created solely to promote good menstrual hygiene management at the global level, was initiated by the German-based NGO- WASH United in 2013 and observed for the first time in 2014.

This year, as part of its nationwide activities to mark the event, the Medical Women of Nigeria (MWAN) visited a few government girls’ secondary schools to deliver lectures on the importance of menstrual hygiene. The young girls welcomed us with their innocent smiles as we spoke to them in clear terms about the need to change their sanitary towels after every six hours and to clean themselves regularly. And because, we are all aware of the economic nuances in the country, the girls were introduced to the concept of reusable menstrual pads. 

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Now, reusable menstrual pads have been around for last few years. Cloth pads are made from layers of absorbent fabrics (such as cotton or hemp) which are worn during menstruation, post-birth bleeding or any other situation where it is necessary to absorb the flow of blood from the vagina, or to protect underwear from regular discharge of vaginal fluids. After use, they are washed, dried and then reused. The major advantage is that they are cost friendly as they can be washed and re-used thereby eliminating the need for continuous purchases of disposable pads. Additionally, reusable pads can be more comfortable and breathable, as they are often made with soft and natural materials. Also, they are more environmentally friendly since they do not have to be disposed of.

Cloth menstrual pads are washed with water and detergent and then dried on a clothesline. After washing, it is recommended that the pads are dried in a hygienic area under direct sunlight. Sunlight acts as a disinfectant and prevents microbial growth, which may happen if the pads are not completely dry.  

The reality in Nigeria is that one family can have up to six teenagers and women who are all menstruating and depending on the man of the house (their father) to buy sanitary pads for them. One pad now costs between N800 to N2000 depending on the brand and size. Also, depending on her flow, a girl can use up to 3 packets per period. That is N800 x 3 =N2400, per child per month. Six girls will amount to about N14,400 per month! 

While demonstrating to the young girls how to use the cloth pads require and telling them about regular washing and general maintenance, one particularly shy girl dared to raise her hand. I had been observing her seated at the back of the class, scribbling away in her notebook while paying rapt attention. I signalled for her to speak over the other obvious hands who had been repeatedly asking and answering questions. 

‘We have a neighbour who makes these cloth pads. She sells them to many women in our neighbourhood. At first, my mother thought we had found a solution as sanitary pads were becoming too expensive to buy. However, we have realised now that we need to fetch or buy more jerrycans of water when we are on our periods so that we can wash our cloth pads.’

‘You do not have access to water in your area?’

 It was a foolish question. Yet, I still had to ask.

‘Yes aunty. We have not had tap water for over five years. We fetch water from the community borehole and when there is no electricity (to pump the water), there is no water then. So, we have to buy from water vendors. A jerry can of water costs N250. We buy four every day; when we are on our periods (my sisters and I), we need to buy an additional two or more. Sometimes, we can’t afford it and so we tie the cloth pads in a plastic bag and wait until we can get water from the borehole to wash them.’

‘When all the cloth pads are dirty and you can’t afford to buy the disposable pads, what do you do then? I asked.

‘Sometimes, I use my old headscarves and wrappers. My younger siblings regularly scavenge refuse dumps for discarded clothes and rags. Other times, I beg my friends at school for the disposable pads’.

The lecture ended shortly after that. None of the doctors present had the guts to say anything more. How could we preach about menstrual hygiene when water scarcity is still an issue? 

This brings me to story number two.

Two days ago, the Lagos State Commissioner for Health, Akin Abayomi, after confirming the outbreak of cholera in the state, described the identified strain as “highly aggressive and contagious, with potential for widespread dissemination”. So far, Lagos has recorded 17 confirmed cases of cholera and 15 fatalities According to the commissioner, laboratory investigation has confirmed the strain to be cholera sub-type O-1, adding that the subtype is associated with more severe diseases.

In the mid-19th century, Soho in London had a serious problem with filth due to the large influx of people and a lack of proper sanitary services: the London sewer system had not reached Soho. Cowsheds, slaughterhouses and grease-boiling dens lined the streets and contributed animal droppings, rotting fluids and other contaminants to the primitive Soho sewer system. Many houses had pit latrines underneath their floorboards, which formed from the sewers and filth seeping in from the outside. Since the pit latrines were overrunning, the London government decided to dump the waste into the River Thames, contaminating the water supply. London had already suffered from a series of debilitating cholera outbreaks.

On 31st of August 1854, there was a major outbreak of cholera in Soho. Over the next three days, 127 people on or near Broad Street died. By 10 September, more than 500 people had died, and the mortality rate was 12.8 per thousand inhabitants in some parts of the city. By the end of the outbreak, 616 people had died.

John Snow, a physician and the father of modern epidemiology as we know it, spoke with several patients and residents and identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street) at Cambridge Street. Snow later used a dot map to illustrate the cluster of cholera cases around the pump. He also used statistics to illustrate the connection between the quality of the water source and cholera cases. He showed that homes supplied by the Southwark and Vauxhall Waterworks Company, which was taking water from sewage-polluted sections of the Thames, had a cholera rate fourteen times more than that of those supplied by Lambeth Waterworks Company, which obtained water from the upriver, cleaner Seething Wells. 

Researchers later discovered that this public water pump had been dug only 0.9 m away from an old pit latrine, which had begun to leak faecal bacteria. The cloth nappy of a baby, who had contracted cholera from another source, had been washed into this pit latrine. The broad street pump was disabled by removing its handle; however, the pump remains till date to symbolise the continuing challenges for advances in public health.

This happened in Soho in 1854. 

Just imagine the water scarcity/refuse disposal/sanitary situation in Lagos. How won’t we have cholera? When women are storing soiled pads for days in plastic bags and economising the small water they have for washing these pads, why won’t we have disease outbreak?

When basic hygiene is still a major dealbreaker, how is sending a person to space a priority?