Shot@Life Uganda Trip Blog: "The 4 F's" for World Pneumonia Day

Four boys at Railway Primary School in Kampala, Uganda enact a dramatic 

dialogue about sanitation using very emphatic hand gestures

"My friends, do you know about the four F's?" That was the opening line of a performance by four boys at a Ugandan school in the midst of the slums of Kampala. These were among the first words I ever heard African children say. One of the young men you see in the picture had eagerly volunteered and suggested he wanted to preform their "dialogue" for their American visitors. The rest of the script went something like this:

"No, we don't know about the four F's."
"What do you MEAN you don't know? Don't you know they are the ways that you can get sick?"
"No, tell me what they are."
"They are Feces, Flies, Food, and Fingers"
...and so on.

Here is a video of group of kids doing a recitation of the Four F's. You can hear my uncertain, nervous laughter at the end of the skit when they ask how the Four F's affect their lives and a child collapses to the ground. We weren't sure if the skit was done or not. It was unlike any school performance we'd ever seen to have it end with a child falling down to indicate death. But, ultimately, I love it. This is the intersection of global health and global education. (Wait a few seconds for them to speak in unison and the sound will be clearer)

The Four F's are an easy way that children (and adults!) can remember the most common ways that diseases - like pneumonia - are transmitted. Food that is cooked on dirty cookstoves and cookpots, flies that bite many hosts, feces holding germs that cling to unwashed hands, and fingers that touch eyes and mouths and noses and friends...these can all be deadly in communities of extreme poverty. I heard this theme over and over again as we toured classrooms and heard songs about good sanitation practices.

The songs are very fun and cute - some might even think them quaint - but they aren't just schoolyard games. The Four F's are talked about by fancy grown ups like pathology experts at universities and global health organizations. This is serious stuff. I saw another skit with a girl in the role of a mother with a cook pot being admonished for not cleaning because unclean food can carry disease, make her children sick, and maybe even cause them to die. You see children coming to their mother hungry. As she prepares to cook from a dirty pot, three others appear to tell her that she has not cleaned it properly or washed her hands while the hungry children literally bend their ears to listen in.

Who else talks about sanitation and pneumonia? How about U.S. Secretary of State Hilary Clinton and internationally-known actress Julia Roberts (a.k.a the Global Ambassador for the Alliance for Clean Cookstoves) on Huffington Post? Ms. Roberts said on World Pneumonia Day 2011, "Of the 2 million people killed each year from diseases caused by toxic smoke from dirty stoves and open cooking fires, about half are young children who die from acute lower respiratory infections, most commonly pneumonia." One year later, this is still of critical importance as pneumonia is the top killer disease of children under 5 years of age in Uganda and in the world. 

If you're like me - loving numbers, but not loving to read long paragraphs full of numbers - this infographic on pneumonia is my World Pneumonia Day gift to you.

I found it posted on the ACTION blog...where not-so-coincidentally you can find an ACTION blog from me about vaccinations in Uganda reaching hard-to-reach kids and the need for the pneumococcal virus vaccine there. 

So, now, my friends, you know about the four F's, too! I leave you with the cast of the cookpot skit mugging for the camera as all good primary school thespians do.