Document Sample

     A Health and Hygiene Activity Manual
               For Primary and
             Secondary Teachers

                  Produced by:
    The Voluntary Health Association of Sikkim

                  Supported by:
                   AND THE

                                                 Primary Level   
Editor: Jim Ratcliffe
Publisher: VHAS
Financial Support: AusAID

Much of the material in this handbook is based on the hard work of members of the Human Devel-
opment Foundation of Sikkim, specifically Mrs. Wendy Pulger, and Mrs. Veronika Boss. Without their
contributions, this manual would not have been possible.
Other material and images in this book have been adapted from publicly available sources. In par-
ticular, we would like to acknowledge the health and hygiene promotional materials prepared by

We would also like to thank HRDD, AusAID, and the GWSSP team including Mr. Pritam Kapur, Dr.
Sally Rynveld, Dr. Manoj Kumar Nath, Mr. Mahesh Kathi, and others.

Original illustrations are by Mr. Peter Lepcha.

Updated versions of this handbook may be downloaded from

      Your Heath Is in Your Hands!

The development of this Health and Hygiene Activity Book is a vital component of the Gangtok
Water Supply and Sanitation Project (GWSSP). The goal of this handbook is to offer teachers
a variety of lessons and activities that will encourage students to develop good hygiene
practices, to make connections between the health of the environment and the health of
their communities, and to spread this knowledge throughout their community.

The importance of imparting proper hygiene lessons to children cannot be overstated. In
schools, the pressure to perform well in core subject areas has forced hygiene to the sidelines.
Students are paying a price for this because total health of the child is essential to excel
in all aspects of school life.

This resource book seeks only to provide basic coverage of the key issues of health and
hygiene. It is envisioned as a supplement to the material that is provided in the textbooks
and in other classroom resources. The purpose of this handbook is to present health and
hygiene issues in a fun, engaging and relevant fashion.

Although this handbook is divided into primary and secondary levels, teachers at any level
should feel free to take lessons and ideas from any area of the handbook. The activities
described in this handbook are merely suggestions. Teachers should adapt the activities to
make them suitable for their classes.

Important adolescent health topics not addressed in this handbook include: first aid, drug
abuse, feminine hygiene, life skills, and managing stress and depression. These topics are
of vital importance, and it is expected that teachers and administrators can draw on other
resources to address these issues.

We welcome input and feedback from teachers and students who are using the materials, as
well as from the Health Department, HRDD, and any other stakeholders.

Thank you for your participation in this project, and we wish you and your children a happy
and healthy future!

                                                                               Dr. B. B. Rai
                                                                         Executive Director
                                                      Voluntary Health Association Of Sikkim

                                                                           Primary Level      
                            Your Health Is in Your Hands!

                                           Table of Contents

    Hygiene Curriculum Framework............................................................................5
    Four Myths of Health and Hygiene Education.................................................6
    What’s Your Message?............................................................................................7

    Lesson 1: Learning About Your Body.................................................................10
    Lesson 2: Taking Care of Your Eyes, Ears, Nose, and Teeth......................13
    Lesson 3: Germs and Diseases............................................................................18
    Lesson 4: Wash Your Hands!...............................................................................20
    Lesson 5: Using the Toilet...................................................................................26
    Lesson 6: Environmental Health.........................................................................28

    Lesson 1: Germ Theory and Hygiene.................................................................34
    Lesson 2: Taking Responsibility for Clean Toilets .......................................40
    Lesson 3: Learning About Common Diseases in Sikkim...............................42
    Lesson 4: Handling Food Safely.........................................................................50
    Lesson 5: Handling Water...................................................................................52
    Lesson 6: Health and the Environment.............................................................56

   Your Heath Is in Your Hands!
                         Hygiene Curriculum Framework

Hopefully, the introduction of a comprehensive hygiene curriculum in all schools in Sikkim
will help children become more conscious of their body and encourage them to take
responsibility for their own physical, mental, emotional and social health. This handbook
is a small effort toward that goal. It is divided into lessons for primary and secondary
students. Although time should be given exclusively to health education, teachers should
seek the opportunity to integrate health education into all subjects.

Below is a basic framework for health and hygiene education:

                             It is essential that younger students develop good health
                             and hygiene practices at an early age. If students develop
                             awareness and good habits early, these habits will become
                             second nature. It is expected that:

                               • Students learn the parts of the body, the organs,
                                 and the basic functions of each.

                               • Students learn about the causes of diseases and
                                 about the value of a simple but balanced diet.

                               • Students learn how to assess good and bad hygiene
                                 habits. Students should be able to identify how
                                 communicable diseases are caused by unhealthy
                                 and unhygienic conditions.

While students at the primary level should focus on learning
basic health and hygiene habits, students at the secondary
level should focus on why these habits are important.
Students should consider questions such as: What are the
causes of common diseases? What are the connections
between the environment and human health? In short, what
is the biological basis of health? However, it is even more
important that good habits are reinforced and strengthened
at the secondary level. It is expected that:

    • Students build on and strengthen good hygiene habits
      learned in the primary level.

    • Students learn common diseases in Sikkim (their cause,
       symptoms and treatment.)

    • Students learn about proper handling of food and water.

    • Students learn about connections between the state of the environment and
      human health.

                                                                      Primary Level     5
               Four Myths of Health and Hygiene Education

The way in which hygiene education used to be carried out
had very poor results. This was partly because it was founded
on a number of myths.

Myth No 1. People are empty vessels into which
new ideas can simply be poured
Hygiene Education rarely starts with what people already
know. Every society already has coherent explanations for
disease (which may or may not include microbes). If we try
to pour new wine into these already full vessels then, the new
wine will just spill over. The new ideas create confusion and
incomprehension. Some people even reject the new teachings
saying: “these doctors just don’t understand what makes my
child sick!”

Myth No 2. People learn germ theory in a few lessons
Everybody likes to learn, but how responsive would you be if you were worrying about a
sick child in a clinic waiting room? In addition, germs cannot be seen, but the results of
disease are obvious. Even in the best of circumstances, replacing old ideas about disease
with new ones is a long, slow process.

Myth No 3. New ideas replace old ideas
Most people hold a variety of ideas about the origins of disease in their heads at the same
time. Folk models of illness co-exist with medical models in all countries of the world, and
few people anywhere explain child diarrhoea by poor hygiene. Hygiene education often
just adds one more idea about disease without erasing the old ones.

                                                  Myth No 4. Knowing means
                                                  Even if we could convince large
                                                  populations that germs spread by poor
                                                  hygiene cause disease, would this
                                                  mean that people would change their
                                                  practices overnight? Though knowing
                                                  about disease may help, new practices
                                                  may be too difficult, too expensive, take
                                                  too much time, or be opposed by other
                                                  people. Fear of disease is not a constant
                                                  preoccupation and is often not a good
                                                  motivator of behaviour change.

                                                  It is the goal of health and hygiene
                                                  education to overcome these myths!

6     Your Heath Is in Your Hands!
                                    What’s Your Message?

Look at the lists of messages below. These are all common in hygiene education
programmes. But there are so many! And they are confusing. Two messages are normally
the maximum for effective communication.

         “wash hands with soap”                            “teach children to use
         “wash hands before eating”                        a toilet”
         “wash hands before feeding a                      “bury faeces”
         child”                                            “disinfect slabs and
         “wash hands after defecation”                     latrines”
         “wash hands after cleaning up
         a child”

          “cut fingernails”                           “cover food”
          “comb hair”                                 “use fly screens for food”
          “filter drinking water”                     “disinfect vegetables”
          “do not spit”                               “reheat food”
          “wear clean clothes”

         “burn rubbish”
                                                      “cover water containers”
         “bury rubbish”                               “boil drinking water”
         “transport rubbish to a                      “filter drinking water”
         dump”                                        “chlorinate drinking water”
         “separate rubbish”                           “use a dipper for water”
         “clean the jhoras”

So which two would you choose?
The only way to make a sensible choice is to know about how people get diarrhoea or
other diseases and to know what practices are common in your area. Then you and your
class can determine the most risky practices and the most effective interventions.

                                                                     Primary Level   7
8   Your Heath Is in Your Hands!
                   PRIMARY LEVEL

  “According to my research, laughter is the best medicine,
giggling is good for mild infections, chuckling works for minor
 cuts and bruises, and snickering only makes things worse.”

                                                       Primary Level   
                      Lesson 1: LEARNING ABOUT YOUR BODY

                       DISCUSSION: CAR PARTS, BODY PARTS

Objectives: Students will explore the parts of the body
and their functions.

Time: 15 minutes
Materials: None

Background: Its important that students have a basic familiarity with how the parts
of their body function as a system. Use the following discussion to help students begin
thinking about these issues.

    • We all know what a car looks like on the outside. But do you know what it looks
      like inside? Doesn’t a car look complicated?

     •     A car looks complicated because it
         is made up so many parts. When all
         the parts in a car work well together
         as a system, the passengers enjoy a
         smooth and safe ride.

     • Your body is much more amazing and
        complex than a car. It can do many
        things that a machine cannot do.
        What makes up your body and how
        does it function so amazingly?

     • Let’s look at what we can see, i.e.,
       the external parts of your body. The
       picture of a boy will help you identify
       and name the different parts of your

     • How many parts of the car can you
       compare to parts of your body?
       (Stomach: engine, heart: fuel pump,
       liver: fuel filter, bones: frame/chassis,
       skin: exterior, lungs: air filter and
       exhaust, vocal chords: horn, eyes
       and brain: driver.)

10       Your Heath Is in Your Hands!
                           PIN THE ORGAN ON THE BODY

Objectives: Students will review and discuss the functions
of the organs.

Time: 25 minutes
Materials: Chart paper, markers, cards

Draw the outline of a human body on a large piece of chart
paper. Leave out the organs. Draw these organs on separate
cards and label them. Then find a student volunteer. Hand a
card to the student and then blindfold him or her. Lead the
student towards the chart, and help the child turn around

Then ask the student to try to pin the organ in the right place. The rest of the class can
call out directions to help the volunteer. Other children also take turns until all parts are
pinned on. The finished picture can be quite comical! Discuss the chart and the correct
location of the organs. Discuss how each of the organs plays a vital role in maintaining a
person’s health.

                       WHERE ARE THE ORGANS LOCATED?

Objectives: Students will practice locating the organs and describing their functions.

Time: 20 minutes
Materials: Chart paper, markers

Ask students to work in pairs to trace the outline of their partner’s body on a large piece
of paper. If you do not have enough materials, have a volunteer trace an outline for the
class to see. Then ask the students to draw different organs and cut them out. Have the
students place the organs on the correct place in the body which they outlined. As they
place each of the organs, have students discuss the function and importance of each
organ. How do we keep each organ healthy?

                                                                        Primary Level      
                                          When temperatures drop and
Share the following poem with students,
                                          you feel chilly,
discuss the vocabulary terms and then
encourage them to write their own poem    Your suit’s got a trick, and its a
about an organ!                           dilly!
                                          It “arms” you with goosebumps
                                          that stiffen your hair,

 Birthday Suit Poem                       And trap a warming layer of air.

Let’s Salute Your Birthday Suit!
                                          Now if you still are in a dither,
Free to every newborn child
                                          Your muscles twitch and make you shiver!
comes a bag, and this bag is wild!
                                          That “shiver switch” turns on, you see,
It’s quite amazing and it’s true:
                                          And it produces energy!
It really can take care of you!

                                          You really should feel great just knowing
It holds your muscles bones and blood,
                                          That your epidermis is showing!
Without it, there could be a flood!
                                          That’s the outside of your skin,
It covers you just like a suit
                                          It keeps bad germs from getting in!
And keeps you warm from head to foot.

                                          It isn’t really very thick,
Most clothing fades when sun comes in,
                                          but helps keep you from getting sick!
But your suit produces melanin.
                                          The underpart is called the dermis,
It has a super nifty darkening action,
                                          And it’s alive! But please don’t “Squirmus”
To save you from a sun reaction.

                                          It holds your cells and glands,
Besides that there is a useful system
                                          Lets give our dermis a great big hand!
An auto-cooling mechanism!
When temperatures rises to 42
                                          Tear your suit? Did it get damaged?
Your Birthday Suit knows what to do!
                                          Well, fear not; your suit can manage!
                                          Don’t go out to buy a spare,
It makes your outside skin feel wet,
                                          Your Birthday Suit can self repair!
It works quite well - we call it sweat;
And when this sweat evaporates
                                          Your skin’s got grooves so you can wiggle;
It cools you off so you feel great!
                                          It’s sensitive to feel a tickle.
                                          It’s damp and dry and thin and hairy
Three million tiny sweaty glands
                                          Sound complex? It sure is! Very!
Are in your arms and legs and hands,
And lots of other places too,
                                          But it’s the best deal you can find,
Too many to count, Can you?
                                          So take care of your own; you can’t have mine!

     Your Heath Is in Your Hands!
                Lesson 2: Taking Care of Your Eyes, Ears,
                            Nose, and Teeth


Objectives: Students will discuss proper eye care and make a handbook about how to
care for their eyes.
                                                        Use the following activities about
Time: 20 minute discussion, and homework                ear, nose, teeth, and eye care as
Materials: Paper, markers                               you train students to use their
                                                        Personal Health Cards!
Your skull and eye socket are built to protect your eyes. But you must do your part in
taking care and protecting them too. “Pink Eye” (conjunctivitis) and trachoma (chronic
conjunctivitis) are common eye infections in Sikkim. They cause redness, pus and burning
in the eyes and are extremely contagious.

Remind students that if something gets in their eye they should not rub it. They should
blink several times to help remove the object with tears or wash it with clean water. In
case of eye infection, immediately see a doctor for treatment. If an eye infection is not
treated quickly, it may cause blindness. If you have frequent headaches or have difficulty
reading, visit an optometrist and get your eyes checked.
                               How to Care for Your Eyes
      •      Wash your face every morning in lukewarm water with soap, rinsing it
                   thoroughly and drying with a clean towel. Do the same at night.
      •      Use your own handkerchief, towel, or cajal. AND keep it clean!
      •      Keep flies away from your face and eyes.
      •      Protect your eyes with a shade, hat, or sunglasses on a sunny day.
             NEVER look directly at the sun.
      •      Read and study in a room that is well lit.
      •      Never throw dust, stones, or darts at other children.
      •      Eat plenty of green vegetables like palak, gundruk, methi and yellow
             fruits and vegetables like papaya, carrot and pharsi. They contain a lot
             of vitamin A that helps protect your eyes.
      •      Do not watch TV too closely. Stay at least 2 meters away.
      •      Take breaks when you are studying to rest your eyes. Practice
             exercises for your eyes.

After discussing this information, have students create a handbook or an “owner’s manual”
that shows the proper way to care for their eyes.

                                                                      Primary Level     
                                  YOGA FOR THE EYES

Move your eyes upwards as far as you can, and then downwards as far as you can. Repeat
four more times. Blink quickly a few times to relax the eye muscles.

Now do the same using points to your right and to your left, at eye level. Keep your raised
fingers or two pencils on each side as guides and adjust them so that you can see them
clearly when moving the eyes to the right and to the left, but without straining.
Keeping the fingers at eye level, and moving only the eyes, look to the right at your chosen
point, then to the left. Repeat four times. Blink several times, then close your eyes and

This exercise should not be done until three or four days after you have begun eye
exercises given here.
Slowly roll your eyes first clockwise, then counterclockwise as follows: Lower your eyes
and look at the floor, then slowly move the eyes to the left, higher and higher until you
see the ceiling. Now continue circling to the right, lower and lower down, until you see the
floor again. Do this slowly, making a full-vision circle. Blink, close your eyes and rest. Then
repeat the same action counterclockwise.
Do this five times then blink the eyes for at least five seconds.
When rolling the eyes, make as large a circle as possible, so that you feet a little strain as
you do the exercise. This stretches the eye muscles to the maximum extent, giving better

Next comes a changing-vision exercise. While doing it you alternately shift your vision
from close to distant points several times.
Take a pencil, or use your finger, and hold it under the tip of your nose. Then start moving
it away, without raising it, until you have fixed it at the closest possible distance where
you can see it clearly without any blur. Then raise your eyes a little, look straight into the
distance and there find a small point which you can also see very clearly.
Now look at the closer point-the pencil or your finger tip then shift to the farther point in
the distance. Repeat several times, blink, close your eyes and squeeze them tight.

Close your eyes as tightly as you possibly can. Really squeeze the eyes, so the eye muscles
contract. Hold this contraction for three seconds, and then let go quickly.
This exercise causes a deep relaxation of the eye muscles, and is especially beneficial
after the slight strain caused by the eye exercises. Blink the eyes a few times.

    Your Heath Is in Your Hands!

Objectives: Students will discuss proper ear and nose care and
demonstrate what they have learned in a creative way.

Time: 45 minutes
Materials: chart paper, markers

Discuss the information below and then have students make their
own poster, pamphlet, or fake TV commercial about their noses and

Common ear problems are hardened earwax, infection and foreign bodies entering the
outer ear. An ear infection should be treated early because it can be quite dangerous and
can lead to loss of hearing.

                                How to Care for Your Ears
      •       Clean your ears with warm water, soap and cloth each time you take a
              bath and dry them well afterwards.
      •       NEVER stick matchsticks or sharp objects
              into your ears and do not ask anyone else to
              do it for you. Cleaning the ear this way may
              push the earwax deeper or put a hole in your
              eardrum and damage it.
      •       You can loosen hardened wax by putting a few
              drops of vegetable oil in your ears.
      •       Protect your ears from insects, especially if you sleep on the floor.
      •       Avoid swimming in dirty ponds or streams.
      •       Avoid loud and sudden noises or constant exposure to loud music.
      •       If you suspect that you have an ear infection, see a doctor immediately.

Your nose is more than just an organ for smelling, it is a vital air filter for your lungs. The
hairs in your nose filter dust particles and warm the air before it enters the lungs.

                                          How to Care for Your Nose
                         •      Do not pick your nose as it may cause infection.
                         •      Blow gently to clean your nose and use a clean
                                handkerchief. Clean your handkerchief as often as you
                                clean your underwear!
                         •      If you have no handkerchief, wash your nose with water.
                         •      Turn your head and sneeze or cough into your shoulder
                                if you do not have a handkerchief.

                                                                         Primary Level      15
                                      A MODEL TOOTH

Objectives: Oral health is often overlooked
when discussing hygiene. In this activity,
students will explore tooth anatomy by making
a model.

Time: 30 minutes
Materials: Model making materials

Strong and healthy teeth are necessary to help
you chew your food. Teeth also add to the
beauty and expression of your face. Imagine
your face without teeth. It would be sunken
and hollow. Teeth also help you speak. Try
speaking without letting your tongue touch
your teeth!

One reason students neglect to care for their teeth is that they don’t realize that a tooth
is a living part of their body covered by a fragile protective coating of enamel. To help
students learn about their teeth, have them make a model of a tooth out of stiff cardboard
and encourage them to label the parts.

                        WATER-BOTTLE TOOTHBRUSHING

Objectives: Students will practice brushing teeth using a larger-than-life model!

Time: 20 minutes
Materials: Toothbrushes, shaving cream, empty plastic bottles

     1. Cut out the bottoms from several plastic water bottles. Then cut the bottoms
        of the bottles to look like a jaw with teeth. Spread shaving cream over the
        model teeth.
     2. Discuss proper toothbrushing methods and then let them practice on the
                                 How to Brush Your Teeth
        •     For the outside tooth surfaces, place the toothbrush at a 450 angle
              towards the gumline. Gently brush in small circular motions.
        •     For the inner tooth surfaces, use a back and forth motion.
        •     For the inside of the front teeth, hold the brush upright and brush
              using the tip of the toothbrush with gentle up and downstrokes.
        •     Also give your tongue a gentle brushing.

16     Your Heath Is in Your Hands!
                                    ACID ATTACK!!

Objectives: To show students how acids can eat away tooth enamel.
Time: 2 days
Materials: White vinegar, soda, chicken bones, eggs

Let the students feel the shell of an egg (raw or boiled) and compare it to the feel of a
tooth. Tell them that acids produced by bacteria in our mouth can eat away at tooth enamel
and cause cavities. Acidic drinks such as sodas can also damage teeth.

Then soak the egg and the chicken bones overnight in vinegar. Also place an egg overnight
in cola. (If you leave the bones in vinegar for a week, the bones will become so weak
that you can bend them easily!) The following day, discuss student observations. Bones
and eggs are like your teeth – they are rich in calcium and can be damaged by acids.
Students can use a toothbrush and toothpaste with fluoride to brush the stains from the
egg soaked in cola.

                         MAKE YOUR OWN TOOTHPASTE!

Objectives: In this activity, students will make
their own toothpaste using natural ingredients.
The purpose of this activity is for students to
develop responsibility for their own oral health.

Time: 15 minutes
Materials: 4 teaspoons baking soda,
1 teaspoon salt, 1 teaspoon flavoring such as
vanilla, elachi, or pudina
Optional: Neem, or meswak

Have students mix the materials together with
potable water to make a paste. Have them
experiment with different mixtures until they develop a mixture they like. Students can
store their toothpaste in a sealable container and keep it for use in school!

                                                                     Primary Level      17
                         Lesson 3: Germs and Diseases

                       DISCUSSION: GERMS AND DISEASE

Objectives: Students will discuss how most diseases are caused by tiny
microorganisms and learn that hand washing is the most effective way
to reduce the spread of diseases.

Time: 30 minutes
Materials: None

Have students discuss examples of good hygiene habits and unhealthy ones. What is one
common link in all good hygiene habits? (Students should answer that keeping our bodies
and our surroundings clean is the most important hygiene practice.)

This is a valid question that students may ask. After all, why should we believe that what
we can’t see will make us sick? A little more than a hundred years ago, people still didn’t
understand that sanitation reduces infections. While people knew about bacteria, they
did not understand their role in spreading disease. In some hospitals, people were more
likely to die from infections caused by unclean medical practices than they were to live!
It took the pioneering work of people like a British nurse named Florence Nightingale to
finally get surgeons to wash their hands and clean their instruments.

Tell students that the reason why we need to keep our bodies and our neighborhoods clean
is to get rid off the nasty critters called germs. These germs make you sick and weak and
prevent you from performing well in school or in sports. So you need to understand what
germs are and how they affect you.

              ALL ABOUT GERMS
              Germs are tiny organisms that cannot be seen without a microscope. Germs
             can be bacteria, viruses, fungi, or protozoa. Germs are so small and
             sneaky that they enter your body without being noticed. And once they are in
             your body they gobble up nutrients and energy from your body and produce
            toxins or wastes of their own. These toxins can cause symptoms of common
            infections like fevers, sniffles, rashes, coughing, vomiting and diarrhoea.

Bacteria are tiny single celled microorganisms that
get nutrients from their environment in order to live.     Did you know... bacteria
That environment could also be your body. Bacteria        are so small that about two
reproduce rapidly, producing poisonous waste products       and a half lakh can fit in
that cause diseases like sore throats, ear infections,    the stop at the end of this
and pneumonia. Streptococci are an example of bad                  sentence.
bacteria that cause us to have really sore throats.

But not all bacteria are bad. Some bacteria like the good E Coli live in our intestines and
help us break down food so nutrients can get to all parts of our bodies. Good bacteria like
acidophilus is found in yogurt.

18    Your Heath Is in Your Hands!
Viruses are simple protein structures that also cause disease. They are
much, much smaller than bacteria. When they enter your cells, they
reproduce by the millions, destroying cells in the process. Some examples
of diseases caused by viruses are hepatitis, measles and flu. Rhinovirus
is the leading cause of the common cold and respiratory tract infections
which result in headaches, chills, and a runny nose.

Fungi are multi celled plant-like organisms that obtain food by decomposing dead
organic matter or by existing as parasites on living organisms. Fungi thrive in damp, warm
environments. An example of infection caused by a fungus is athlete’s foot – an itchy
rash that teens and adults sometimes get between their toes.

                 Protozoa are one celled organisms like bacteria. Protozoa also like
                 moisture and often spread diseases through contaminated water. Some
                 protozoa cause intestinal infections that lead to diarrhea, nausea and
                 belly pain. Amoebic dysentery, and giardia are common forms of
                 diarrhoea caused by protozoans.

                 HOW ARE GERMS SPREAD?
Most germs are spread through water contaminated by human and animal faeces, in the
air by sneezes & coughs, through body fluids like sweat, saliva, and blood, or by flies and
other insects.

                                                       Did you know... viruses
                                                       are so small that about
                                                      twenty crore can fit in the
                                                        stop at the end of this


             So how do we get rid
             of germs and prevent
            diseases? Remember the
           two words germs fear most:
              “Soap and Water”!!!

                                                                      Primary Level     
                            Lesson 4: Wash Your Hands!

                                GERMS AND OUR HANDS

Objectives: In this demonstration, you show students how
easy it is to transfer bacteria from your hands to other parts
of your body.

Time: 10 minutes
Materials: Talcum powder

      1. Whiten your palm and fingers with the talcum powder just before the lesson.
         Tell the children that they will be having some special lessons to learn how to
         keep clean and healthy.

      2. While you are talking, act out some things which children often do e.g. rub
         your nose, scratch your face and arms etc., getting the powder streaked on
         your face and arms. This should arouse the children’s interest. After they notice
         the powder, offer to shake a student’s hand.

      3. Point out that the actions you did are common things that children do. Get the
         students to guess what would happen if the powder on your face and arms
         was harmful germs? (You would be spreading germs everywhere and others
         could get them.)

                                        PASS IT ON!

Objectives: In this fun activity, students will explore how clean hands can reduce the
spread of diseases.

Time: 30 minutes
Materials: Paper, pencils, scissors, and music

      1. Pass out a sheet of paper to each student. Have students cut the sheet of paper
         into 10 squares. Each student should write his or her name on the squares and
         fold each one so that the name cannot be seen.

      2. Start the music and ask the students to begin moving around the room.

      3. As soon as music stops, yell “FREEZE” and the children should stop moving.
         Students should then shake hands with as many of their neighbors as they can
         reach WITHOUT moving. When students shake hands, they should exchange
         a square of paper with their neighbors. At the same time students can strike
         up conversations with their neighbors, talk about things they like, what they
         like to do, etc.

20      Your Heath Is in Your Hands!
    4. Repeat this procedure several times.

    5. Finally, stop the game and tell students that two of their classmates are infected
       with a disease. Name the two students and then ask everyone to look at the
       pieces of paper they gathered in the game. Everyone who has an piece of
       paper from an infected student is also infected.

    1. What did the exchange of cards represent? (The exchange of cards represents
       normal social interaction. In the course of a day we have many interactions with
       different people. Some of them we don’t even see, because we use doorknobs
       they have touched, or eat off of plates they have cleaned.)

    2. Initiate discussion about the game by asking several questions: What if the
      squares were actually germs or disease? How do you fight germs when they
      can multiply so rapidly? How can we stop the spread of germs? How does
      good hand hygiene help?

                         NOTHING TO SNEEzE AT!!

                         Objectives: Students learn how infection spreads through coughs
                         and sneezes and how to prevent infections from spreading.

                         Time: 10 minutes
                         Materials: Spray bottle, paper

                         Tell students that some germs are perfectly adapted to spread
                         from one person to another by irritating our nasal passages
                         and making us sneeze. Show students a sheet of paper with a
                         face drawn on it. Put up the sheet and as you say “Ah-Choo” or
                         cough, press on the spray bottle. This shows how germs from
                         a sneeze can spread.

Spray each child’s hands with water. Explain that just as the water from the spray bottle
got onto their hands, germs can also get onto your hands.

Then ask the students to touch the desks and other surfaces in the classroom with their
wet hands. What happens to these surfaces? Students should conclude that if water can
get to these surfaces, then germs on your hands also get transferred to whatever we
may touch.

                                                                        Primary Level       
      1. Discuss other ways of that germs can enter your body.
         (Examples include cuts and consuming contaminated food
         or water).

      2. How can we prevent germs from entering our body?
         (By washing our hands frequently throughout the day,
         particularly before eating and after using the toilet.

Children should then be advised that they should not sneeze into
their hands, but use a handkerchief. This way the germs can be
washed away from the cloth instead of being transferred to their

                            HOW TO WASH YOUR HANDS

Objectives: In this activity, students will practice the essential life skill of hand washing
and then make posters showing how to properly wash your hands.

Time: 15 minutes
Materials: Water, soap, chart paper, markers and other art supplies

Hand washing is a lot like driving. Most people do it every day, but few people ever learned
how to do it properly. Despite this, everyone thinks that they know how to do it! If children
learn this vital skill at an early age, and if they understand the value of washing their
hands properly, it will continue to benefit them for the rest of their lives!

      1. Take students to a sink with soap and then review the 6 step hand washing
         poster shown on the next page.

      2. Have students pair up with a partner and practice washing their hands. Each
         partner should observe the other student and grade them on how well they
         performed each of the six hand washing steps.

      3. After students have finished washing their hands, challenge them to make a
         creative poster showing the correct procedure for washing your hands.

                           Did you know... most people don’t
                          soap their hands long enough. To help
                            students count the 15-20 seconds
                          needed to lather properly, have each
                          student choose a song they would like
                                 to sing during this step!

      Your Heath Is in Your Hands!
Primary Level   
                           WHEN TO WASH YOUR HANDS

Objectives: In this activity, students will play a game to explore all of
the different times when it is important to wash your hands. They will
then make a poster to reinforce what they learned!

Time: 30 minutes
Materials: Chart paper, markers and other art supplies

To remain healthy, you must not only know HOW to wash your hands, but WHEN to wash
your hands. Each time you go out to town, to school or to other public places you are
exposed to germs and diseases. Even your own home can be a source of contamination.
In fact, your own body can be a source of contamination if proper hygiene practices are
not followed.

Therefore, one of the easiest and most important steps for students to remain healthy is
to know when to wash their hands:

      1. Review the information about when to wash your hands listed below. Ask
         students to add to the list, if possible.

     2. Then play a game where each student acts out one of the things on the list
        (WITHOUT talking) and see if the other students can guess what it is! Allow
        the kids to have fun and move around during this game.

                                When to Wash Your Hands:
               •      Before eating food
               •      Before, during, and after preparing food
               •      After using the bathroom and toilet
               •      After changing diapers or cleaning a child’s bottom
               •      After handling money
               •      After handling trash
               •      After sneezing, coughing or blowing your nose
               •      Whenever hands come in contact with body fluids, such as
                      a runny nose, watery eyes, saliva, or blood
               •      After work or play
               •      After visiting the hospital and public places
               •      After touching any pets or animals
               •      More frequently when someone in the home is sick
               •      Before touching a wound
               •      When your hands are dirty

      Your Heath Is in Your Hands!
3. Then have students work in groups to illustrate all of the situations in which
   is it necessary to wash their hands. Have each group work on illustrating a
   different situation.

4. Have students add descriptions and labels to their posters. Specifically, have
   students explain why it is important to wash your hands in each situation. They
   will then share these posters with the rest of the school and the community
   to raise public awareness.

                              Song: Lower Primary

       (Sung to “Here we go round
       the mulberry bush”)
       This is the way I wash my
       hands, wash my hands, wash my
       This is the way I wash my
       hands, before I start to eat.
       This is the way I wash my
       hands, wash my hands, wash my
       This is the way I wash my
       hands, after I go to the toilet.
       This is the way I wash my hands, wash my hands, wash my hands,
       This is the way I wash my hands, after I touch my nose.
       This is the way I wash my hands, wash my hands, wash my hands,
       This is the way I wash my hands, after I play outside.
       This is the way I wash my hands, wash my hands, wash my hands,
       This is the way I wash my hands, after I go to town.
       This is the way I wash my hands, wash my hands, wash my hands,
       This is the way I wash my hands, after I play with pets.

                                                                  Primary Level      25
                             Lesson 5: Using the Toilet

                             DISCUSSION: TOILET RULES

Objectives: In this activity students will discuss how to use the toilet and keep it clean.
Then students will be challenged to develop catchy slogans to post in the toilet and remind
students and faculty of good habits!

Time: 30 minutes
Materials: Paper, markers and other art supplies

      1. Discuss student experiences of the toilet. What are the toilets like in your
         school? How can they be improved? What is it like to use a dirty toilet? What
         is it like to use a clean toilet? How can we keep the toilet (and ourselves)
         clean? As they grow older, have students become more aware of how to keep
         the toilet clean?

      2. Toilets are places where diseases have the greatest chances of spreading.
         Many germs are adapted to spread through human faecal matter. It is therefore
         extremely important that the toilet be kept clean and safe. How can you do
         this? Discuss the following points:

                            Toilet Rules (for people of any age)
        •      You must sit or squat properly over the pot so that your waste drops
               directly into the pot and not outside it.
        •      Wash your anus and behind with your left hand and pour water with
               your right hand. Wash thoroughly.
        •      Pour enough water into the pot to flush your waste into the hole.
        •      Be considerate and keep the mug, the pot and the toilet clean for your
        •      Boys urinating in the toilet must aim directly into the pot and not all over
               the floor and walls. When flushing, pour water into the pot and around
               the pot as well.
        •      Always wear shoes or chappels when you go into the toilet. Organisms
               like hookworm can enter the body through your bare feet.
        •      Do not throw solid materials like stones, sticks and sanitary pads into the
               pot as this will cause blockage and the toilet will not be usable.
        •      Be a part of the team to help clean and maintain the toilets.
        •      If your friends are not doing the right thing, explain to them the
               importance of keeping the toilet clean.
        •      Always close the tap after using it.
        •      MOST IMPORTANTLY: Wash your hands thoroughly in the sink with
               soap after you are done. Work up a good lather and wash the hands
               (front and back), the wrists, between the fingers and under the nails.
               Rinse thoroughly. If at all possible, do not touch the toilet doors or
               handles after washing.

26      Your Heath Is in Your Hands!
 3. If the toilets are not kept clean you will be carrying germs and diseases
    into your classroom and to your homes and thereby infecting your friends
    and family. But a dirty toilet doesn’t just spread disease, it is disgusting
    to use!

 4. Now that students have learned “the rules,” have students form groups and
    work on a catchy slogan to reinforce each rule. Then post the slogans in and
    around the toilet (if possible, cover the signs in plastic or laminate them.)
    Examples of catchy slogans are below:

                                    Bathroom Slogans
   •         If you sprinkle when you tinkle, be sweet and wipe the seat!
   •         If its brown, flush it down!
   •         Put your feet on the spot and you’ll hit the pot!
   •         Wear your shoes to the toilet, its our bathroom, don’t soil it!
   •         Students: Our aim is to keep this bathroom clean!

 1. Visit a toilet with the students and explain how to use it, how to keep it clean
    and how to keep themselves clean.

 2. Have students draw posters showing the proper and improper use of

 3. Have students write up a poster size code of conduct on the use of toilets.

        Pour a mug of water into    Put your feet on   Clean yourself with water
       the pan to make sure it is    the footrests.          from the mug.
          wet before using it.

                    Wash your hands              Leave the toilet clean.
                thoroughly with soap and

                                                                           Primary Level   27
                         Lesson 6: Environmental Health

                                      THE F-DIAGRAM

Objectives: In this activity, students will learn about the role our
local environment plays in the spread of disease, this information is
shown in the F-diagram.

Time: 20 minutes
Materials: Paper, pencil

Below is the f-diagram, which shows the different routes that the microbes that cause
diarrhoea take from faeces, through the environment, to a new person. For example,
microbes in faeces on the ground can be washed into a local stream (fluids) and are
drunk by another person. Or if a child does not wash his or her hands after using the
toilet, faeces can travel from fingers to foods, thereby infecting another person. This
person gets diarrhoea and spreads more microbes...

     1. Take some time to review the diagram with students, and make sure that
        they understand all of the connections shown. Why is it called the F-diagram?
        (Because it shows the 6 F’s that spread diarrhoea: fields, fingers, flies, fluids,
        foods, and faeces.)

     2. Have students make their own F-diagram that shows local examples from your
        area. Make sure that students can explain each part of the diagram. Post the
        diagrams in the school for other students to see.

28     Your Heath Is in Your Hands!
Discuss the following ways that students can reduce the spread of disease.

      •    The primary barrier is to use properly maintained toilets and to avoid
           defecation in open areas.

      •   Secondary barriers include washing your hands, and making sure that
          water and food is not contaminated.
      •   Fluids like water should be collected from a source that is free from
          contamination. It should be stored in a clean and hygienic covered
      •   Care should taken to ensure that food is cooked long enough to kill
          pathogens and is covered and not left open to flies
      •   Hands should be washed with soap and water before eating and after
          going to the toilet.

                                      Secondary Barrier
                                      Hygiene Practices

                                                                  Primary Level     
                               F-Diagram: See if students can label each picture and explain its significance
                                                           (image courtesy UNICEF)

Your Heath Is in Your Hands!
                                  IS IT BIODEGRADABLE?

Objectives: Students will classify common objects as biodegradable and non

Time: 30 minutes
Materials: Biodegradable and non-biodegradable items

Collect ten biodegradable and ten non biodegradable objects (see sample list below).
Have students form groups. Jumble the objects and arrange them on a tray. Cover the
tray with a cloth. Tell the groups that you will show them a collection of different items
for 30 seconds. After showing the items, cover the tray again with the cloth. Now, ask the
groups to list (on paper) the items that they remember seeing on the tray. The players
should then group the items into two categories biodegradable and non biodegradable.

After the students finish, ask each student group to explain how they have grouped the
items. Write the items under the heads ‘Biodegradable’ and ‘Non biodegradable’ on the
board for every one to see and discuss.
          	        Biodegradable              Non biodegradable
                   Banana skin                Styrofoam cup
                   Handkerchief               Plastic bag
                   Paper                      Empty fruit juice pack
                   Dry leaves                 Toothpaste tube
                   Dead insect                Broken plastic toy
                   Leather belt               Rexine bag
                   Flowers                    Plastic bangle
                   Wooden ladle               Plastic spoon
                   Potato                     Plastic pencil box
                   Rag doll                   Plastic doll

   1.    What do ‘biodegradable’ and ‘non biodegradable’ mean? (Biodegradable
      items break down into naturally-occurring components, and do not pollute an
      ecosystem. Non-biodegradable items, such as plastic, do not break down easily
      and pollute the environment.)

    2. How can we manage biodegradable and non biodegradable wastes? (We
      should         reduce the amount of non-biodegradable waste, and dispose of
      it properly. Biodegradable waste should also be disposed of properly.)

                                                                       Primary Level    
This is a good opportunity to get the school started on a campaign to separate waste at
the source. Have your class set up two bins, a blue one for non-biodegradable waste, and
a green one for biodegradeable waste. Have students practice separating their waste,
and then gradually they can educate the school. They can make posters, perform skits,
and organize awareness campaigns. It might take a while for other students and other
teachers to become familiar with this concept, but have patience, and pretty soon you will
be amazed at the amount of waste you are reducing!

   Your Heath Is in Your Hands!

“Surprise! We’re having health food!

                                       Primary Level   
                       Lesson 1: Germ Theory and Hygiene

                                PROVING GERM THEORY

Objectives: In this activity, students will reproduce the original experiment that proved that
microscopic germs exist everywhere, and that they contribute
to spoiling food and disease.

Time: 30 minutes and several days for observation
     • Tw o glass bott les wi t h airtight met al l ids
       (screw-top glass bottles will do)
     • Strained low salt chicken soup (chicken broth)
     • Glass or metal piping
     • A sterile piece of cotton

                                                                         Louis Pasteur
In the 1860s scientists debated fiercely about the origin of life. Many thought that life could
be spontaneously generated from a vital “life force” in the air. For example, when they saw
rotten meat begin to fill with maggots which then turned into flies, they assumed that the
maggots were spontaneously generated by the air. Because they could not see fly eggs,
or the bacteria that caused food to spoil, they assumed that these effects came from the
air. Although this sounds unbelievable, you may be surprised to learn that your students
have similar ideas. After all, you can’t see bacteria, why should we believe they exist?

These ideas were not disproven until a famous French scientist named Louis Pasteur
performed this experiment.

      1. Ask students how they could prove that bacteria exist without using a
         microscope. Discuss their answers, then explain that you are going to reproduce
         the famous experiment that proved that bacteria exist, even in the air!

      2. Explain each step to students as you go. Tell students that the chicken broth
         has all the nutrients that bacteria need to grow. In one glass bottle, the broth
         will be open to the air. The other glass bottle will also be open to the air, but
         it will have a special filter so that only air can enter.

      3. Punch a small hole in the lid of glass bottles to allow a short length of piping
         (3-5 cm) to poke through. Make this hole is as airtight as possible.

      4. Explain that all of the materials must be thoroughly sanitized for this experiment
         to work properly. If they are not sanitized, bacteria could be introduced from
         the equipment. Boil the chicken broth for 10 minutes to thoroughly kill any
         organisms in it. Also boil the glass jars, the lids and the piping in water for at
         least 10 minutes. Allow the water to cool.

      Your Heath Is in Your Hands!
 5. Wash your hands thoroughly with soap. (Explain why.) And then remove the
    bottles and the lids. Pour equal amounts of chicken broth in each bottle.

 6. Attach the lids. Seal the hole around the piping with the cotton.

 7. Plug the end of one pipe with cotton. Allow the other pipe to be open to the

 8. Have the students observe the chicken broth throughout the week and note
    any changes they see.

 1. What happened to the chicken broth in each bottle? (In the bottle that was
    open to the air, the broth became cloudy and bacterial colonies could be seen
    growing on its surface. In the bottle with the cotton filter, the broth remained

 2. Why is the broth in both bottles different? (Because the bottle that was open to
    the air allowed bacteria and other germs in the air to enter. These organisms
    multiplied in the chicken broth.)

 3. What was the purpose of the cotton filter? (The cotton filter allowed air to enter,
    but stopped most bacteria from entering. This proves that the changes in the
    broth happened because of bacteria in the air, not from the air itself.)

 4. What did this experiment prove? (That even though we can’t see bacteria,
    they exist everywhere- even in the air. Although things may look “clean” they
    can be contaminated by bacteria.)

                                                                     Primary Level
                                                                   Secondary Level        35
                       GIVE YOURSELF A HAND (SANITIzER!)

Objectives: Students will make their own hand
sanitizer gel in this activity.

Time: 15 minutes
Materials: Spirits (isopropyl alcohol), glycerin
(available at the chemist) Optional: Aloe vera gel
(ghew kumari)

      1. Place 1-2 teaspoons of alcohol and 2 teaspoons
         of glycerine to a bowl or bottle

      2. Add 1 cup of aloe vera gel (ghew kumari). If this is not available, add skin
         moisturizer or another substance to thicken the mixture.

      3. Shake or stir to mix.

      4. Store your hand sanitizer in a reused glass or plastic bottle. Keep it in your
         school bag, and use it right before you eat lunch!

      5. Encourage students to experiment with different mixtures. They can add
         different herbs with antibacterial properties and other herbs for fragrance. If
         students are ambitious, they can sell their hand sanitizers to raise money for
         an Eco-club!

      1. More alcohol speeds evaporation.

      2. Tea tree or neem oil is recommended due to their antibacterial properties.
        However, many other herbs have antibacterial properties, so feel free to
        experiment with others such as titeypati, elachi, clove, lavender, and lemon

36     Your Heath Is in Your Hands!
                             PROTECT THE POTATOES!

Objectives: In this activity, students will learn
that even though their hands look clean, they are
actually home to millions of germs. Students will
see how washing hands dramatically reduces the
amount of germs on them.

Time: 20 minutes for set-up, and 5 minutes
every day for a week
       • Raw potatoes
       • Knife
       • Plastic bags
       • Soap
       • Markers
       • Plastic gloves (available from a chemist)
       • Optional: Hand sanitizer gel made in previous activity.

Now that students have learned HOW and WHEN to wash their hands, they will do a fun
activity to learn WHY they need to wash their hands.

    1. Discuss how germs are invisible without the aid of a microscope. Talk about
       how millions of germs can be on our hands even though they look clean. Tell
       students that you are going to prove this in this experiment.

    2. Put on plastic gloves. Peel the potatoes, slice and wash them and place them
       on top of a clean plastic bag.

    3. Divide students into four groups. Group A is the control group. Group B will
       wash their hands with soap and water. Group C will rinse their hands but not
       wash them with soap, and Group D will not wash their hands at all.

    4. Have a member from Group A wear plastic gloves and place two potato slices
       in a sealable plastic bag. Have the group seal the bag securely with tape so
       that no air can get in, and then label the bag “Group A: Control Group” with
       a marker.

    5. Take Group B over to a sink and have each group member thoroughly wash
       their hands in water with soap. Time the group so that each group member
       washes their hands for at least 30 seconds. They should work up a thick lather,
       clean under their fingernails and rinse their hands thoroughly before drying
       their hands with a clean towel.

    6. Then have the members of Group B pass two potato slices around. They should
       hold the potatoes between their clasped palms. Make sure that each member
       of the group has had the chance to touch each potato piece.

                                                                   Secondary Level
                                                                      Primary Level      37
 7. Then have the group members place the potato pieces in a sealable plastic bag
    and label it “Group B: Washed Hands.” Have the group seal the bag with tape.

 8. Have Group C repeat this process, but have them rinse their hands without using
    soap and label their bag “Group C: Hands Washed Without Soap.”

 9. Have members of Group D repeat this process but they should not wash their
    hands at all. They should label their bag “Group D: Unwashed Hands.”

10. Students who made hand sanitizers in the previous activity can also test them.

11. Place the sealed bags in a warm, dark place. Have students observe the bags
    every day and note the changes they see. Students can record their results in a
    table similar to the one below:

        T able 1 : O bse r va t ions of Pot at o S lice s

                                    Day 1         Day 2     Day 3   Day 4   Day 5

        Gr oup A : Cont r ol

        Gr oup B: W ashe d

        Gr oup C: W ashe d
        wit h only W at e r

        Gr oup D: U nwashe d

12. Have students count the number of bacterial colonies or mold colonies that appear
    on each potato slice. Have each group make a drawing of their potato slice every

 1. Discuss what is observed in each bag and why. (The potato slices touched with
    unwashed hands should have the highest percentage of bacterial growth. Group
    A and Group B should have the lowest amount of growth.)

 2. What was the importance of the control group? (The potato slices in the control
    group can be compared to the potato slices in all the other groups to see what
    would happen if no one touched the potato slices and to determine if there was
    an error in the experiment.)

 1. Use a doll, some bowls, water, soap, and towels to show how to wash the face,
    ears, neck, hands, arms, underarms, legs, toes, feet, even the anus. Have students
    practice to demonstrate what they have learned.

 2. Discuss who in the community should pay extra careful attention to washing
    their hands: restaurant employees, hospital workers, doctors, dentists, teachers,
    garbage collectors, butchers, food vendors etc.

38   Your Heath Is in Your Hands!
                             OIL, SOIL, AND TROUBLE!

Objectives: In this activity, students will learn why soap is such an effective tool to clean
the human body.

Time: 15 minutes
Materials: A bowl, cooking oil, tissues or paper napkins, and liquid soap

The main reason that we need to clean our bodies so often is that our bodies produce
oils that trap dirt and bacteria on the skin. If our skin did not produce natural oils, our
skin would be a lot cleaner! However, these oils are essential to keeping our skin moist
and healthy.

    1. Pour about a tablespoon of cooking oil into a bowl. Tell the children to dip their
       finger in it and to describe how it feels. Have them wipe their fingers on a paper
       napkin. Ask them to observe the stains the oil leaves behind. Now ask them to
       rub another paper napkin on their scalps or foreheads. They will observe that
       they have their own natural oil.

    2. Now put some oil in a jar and add some water. Shake it well and see what
       happens. The oil should come to the top. Then add some soap and shake.
       The soap or liquid detergent should cause the oil to break down. That is why
       soap is such an effective cleaning agent- it breaks down the oil on your skin
       and releases the trapped dirt.


Objectives: In this activity, students will play a game of slides and ladders to reinforce
good health and hygiene habits they have learned.

Time: 45 minutes
Materials: Posterboard or chart paper, dice and game tokens

    1. Create a board of slides and ladders. This can be played on a large board for
       the entire class, which can be divided into two teams. Have students from each
       team take turns to play. You can use the suggestions in the boxed text of this
       handbook to make the slides of good habits and ladders of bad habits.

    2. A team member throws the dice and the team moves forward, square by square
       depending on the number.

    3. If a team lands below a ladder of good habits, the team can climb up. If the
       team lands on a slide of bad habits, the team has to slide downwards.

    4. At each slide or ladder, students must explain why a habit is good or bad. If
       they cannot, they must move back 10 squares.

    5. The team who travels all the way to the top wins.
                                                                    Secondary Level
                                                                       Primary Level        
               Lesson 2: Taking Responsibility for Clean Toilets

                                     ADOPT A TOILET!

Objectives: Students will keep the toilet cleaner if they are given a personal responsibility
to keep it clean.

Time: 20 minute discussion, ongoing maintenance throughout the year.
Materials: Paper, markers for a sign

      1. Have each class at your school “Adopt a Toilet” for the school year. Explain that
         the class will be responsible for keeping the toilet clean, making sure that the
         tap is not running, and maintaining it.

      2. Discuss their responsibilities, and develop a schedule for daily toilet inspection.
         Post an inspection and cleaning card inside the toilet and establish a rotating
         schedule for students to take this responsibility.

      3. Award prizes every month for the cleanest toilet. Have fun and be creative in
         establishing incentives for students to keep the toilets clean!

      Class VI Toilet Inspection and Cleaning: October
      Day                     Cleanliness of pot     Cleanliness of Mug      Taps closed?

      Monday 1st

      Tuesday 2nd

      Wednesday 3rd

      Thursday 4th

      Friday 5th

      Saturday 6th

      Monday 8th

      Tuesday 9th

      Wednesday 10th

      Thursday 11th

      Friday 12th

      Saturday 13th

40      Your Heath Is in Your Hands!

Objectives: Determining what your expectations are is often the first step to improving
your sanitation facilities. In this activity, students will work together with other members of
the school staff and the community to create a list of rights and responsibilities regarding
shared toilets.

Time: 20 minute discussion
Materials: Paper, markers for a sign

One reason that school bathrooms are often filthy and students disregard basic sanitation
is that the bathroom facilities at schools are often inadequate. For example, there are not
enough toilets, there is no running water and no place to wash. Trails to the bathroom
can be steep and treacherous, and students and teachers may not have enough time to
use the facilities properly.

    1. Discuss which, if any of these conditions apply at your school and then have your
       students work with other classes, teachers, administrators, and their parents
       to draw up a list of expectations they have for the toilets at your school. If
       students feel that they have an active role in these issues, they will take more
       responsibility for maintaining shared toilets.

    2. Then work as a class to figure out what resources are available to help improve
       the toilets at your school (donated materials, labor etc.) Set your sights on
       small, accomplishable tasks!

                    Sample Bathroom Declaration of Rights for
                     Students, Teachers, and Administrators

      •      Sufficient time should be allowed for the children to use the latrine.
      •      There should enough latrines for boys and girls. (Set a number!)
      •      If there are no water taps, water is stored in containers in the morning ,
             and refilled midday or when needed.
      •      Water taps do not leak.
      •      Each latrine should have a bucket, mug and a cleaning brush and should be
             cleaned every day with phenol.
      •      There should be an adequate handwashing basin with soap. Soap should
             always be there.
      •      There should be a bin for girls and women to dispose of sanitary pads.
      •      Toilets should have working doors.
      •      Toilets should have cross ventilation.
      •      The trail to the toilet should be safe, and should have steps or stepping

                                                                      Secondary Level
                               Lesson 3: Learning About
                              Common Diseases in Sikkim

                                 HEALTH IN THE NEWS

Objectives: In this activity, students will learn that illness and disease are not just a
personal problem, they affect society in many ways.

Time: Ongoing throughout the school year
Materials: Newspapers, magazines

      1. Collect newspapers and magazines over the course of a the school year. Every
         day, assign a different student to scan the news and see if there are any articles
         that relate to health and sanitation in Sikkim.

      2. Establish a bulletin board or other place where these articles can be posted.
         Then discuss the articles in class, and use them as the basis for research and

       • What health issues were in the news on this day and in past month?

        • Do health and sanitation issues change with the seasons?

        • What are three health topics recently in the news? Why do you
        think the publication chose to cover these issues instead of other
        health issues which could be in the news?

      Your Heath Is in Your Hands!

Objectives: Students will learn about common diseases and how to prevent them and
they will create a written report about disease risk in Sikkim.

Time: one class period, plus time for homework
Materials: None

Have students use this information to as a starting point for a written report.

Giardia: A protozoan that may cause long term
diarrhoea that ranges from mild to severe. Some people
say “rotten egg burp” is synonymous with giardia. This
is far from the truth as bacteria very often cause the
same kind of burp.

Amoebic Dysentery: A protozoan that can cause
malaise, lethargy, fever and diarrhoea. Can cause liver
problems as a complication.
Cryptosporidia: Is a common cause of diarrhoea
especially from April to September. It is not often seen
                                                         Giardia is spread by human and
in winter. The presenting symptom is tiredness out of animal faecal matter.
proportion to the amount of diarrhoea. Sickness may
go on for weeks or months if untreated.

How to prevent diarrhoea: The way to beat all of these nasty critters is to practice proper
hygiene: wash your hands at appropriate times, and use the toilet properly, remember
the F-Diagram!

                                   FOOD POISONING:
                                   Salmonella: Salmonella is one of the leading causes of
                                   bacterial diarrhoea and can cause death. It is associated
                                   with raw poultry, meat, and eggs. It may be found in food,
                                   water, soil, and faeces.

                                   E. coli and Staphylococcus: These are bacteria spread
                                   when faecal matter enters food-whether it is introduced by
                                   flies, dirty food or dirty hands.

                                   How to prevent them: The way to beat food poisoning
                                   is to follow this basic rule of food safety: Keep cold foods
                                   cold, and hot foods hot! Also be careful of market foods
                                   that are not covered!

Salmonella causes a particularly
serious form of food poisoning.
                                                                         Primary Level
Rhinovirus: Rhinovirus is the leading cause of the common cold and respiratory infections,
which results in headaches, chills and a runny nose. It is spread from person to person
and indirectly via contact with contaminated surfaces.

Influenza: The flu is a contagious respiratory illness caused by influenza viruses. It can
cause mild to severe illness, and at times can lead to death.

How to prevent them: Use a handkerchief, don’t spread a cold by coughing or sneezing
in open air. Clean your hands much more frequently than you would normally, and if
possible, stay home from school and rest until you are better.

Hepatitis Type A: Hepatitis A is a liver disease caused by the hepatitis A virus which is
found in unsafe water supplies.

How to prevent it: Good personal hygiene and proper sanitation can help prevent
hepatitis A.

Tuberculosis: Tuberculosis (TB) is a disease caused by bacteria that usually attack the
lungs. But TB can attack any part of the body such as the kidney, spine, and brain. If not
treated properly, TB can be fatal. TB is spread when a person with active TB disease of
the lungs or throat coughs or sneezes.

How to prevent it: Avoid exposure to TB patients. It is essential that people with TB
take ALL of their medicine because TB is still in a person’s body long after the symptoms

    Your Heath Is in Your Hands!

Objectives: Students will learn about intestinal worms and as a
class, you will develop an action plan to reduce the spread of worms
at your school.

Time: one class period
Materials: None

Like germs, worms can enter your body very easily and cause ill
health. It is also very easy for an infested person to spread worms.
Worm infestation is quite common in children in Sikkim. The most
common worms are threadworm, roundworm, and hookworm.                Hookworm mouth

                 What are the symptoms of worm infestation?
          •      Stomach pain off and on after eating food.
          •      Lack of appetite and poor digestion.
          •      The child can look weak, sick, and anemic.
          •      Sometimes a larger bunch of worms may block the intestinal
                 tract and cause total constipation, a swollen belly, and vomiting.
          •      Itching around the anal region.
          •      The child can show signs of restlessness, sleeplessness and

The presence of worm infestation is detected by examining the faeces. The eggs or worms
can be seen in the stool. Moving worms or eggs may also be seen around the anus, about
an hour after the child has gone to bed. By using a torch, worms should be visible to the
naked eye. Another useful way is to use sticky tape which is pressed against the child’s
anus. Worms like threadworms will appear as tiny white specs on the tape.

Worm infestation is a mild disease and can be treated by drugs. However, it is very important
that the child and the entire family, including household helpers, be treated all at the same
time. If not, any member of the family can be a cause of reinfestation.

 Roundworm                                    Whipworm

                                                                       Primary Level
                                                                     Secondary Level      45
Tapeworms are some of the most common
intestinal worms in Sikkim. People become
infected with tapeworms when they consume
beef or pork that is not handled or cooked
properly. It is very important that meat is handled
hygienically, and that it is cooked until the worm
cysts are destroyed. Review the tapeworm life
cycle shown below and discuss ways to reduce
tapeworm infestation.

A TAPEWORM LIFE CYCLE                                 Beef tapeworms can grow to the size of
                                                      8 m in your intestines!

       Humans consume meat                                     The tapeworm grows in the
       that is not cooked or                                   human’s intestines and the
         handled properly                                     tapeworm eggs are deposited
                                                                    in human feces.

       The tapeworms live
      in the animal’s flesh.
                                                        Cows or pigs consume
                                                             the eggs.
The girl shown here is eating a hamburger. What types of Sikkimese food are likely carriers of
hookworm? (beef and pork momos, chafaley, pork chowmein, thukpa, pork curry, etc.)

The beef tapeworm is a giant among the human parasites. A complete specimen may
grow to 8m in length - nearly the length of the digestive tract of an adult human! With
such a large body, these worms cause severe nutritional deficiencies in humans because
they absorb much of the nutrients in the food we consume.

The pork tapeworm is considered more dangerous because the cysts of the pork tapeworm
can live in the human body. These cycticerci may lodge in the brain, eye or muscle, causing
serious problems. Furthermore, if the body kills the parasites, calcium salts are laid down
in their place, creating tiny pebbles in the soft tissue.
46     Your Heath Is in Your Hands!
                        How can we prevent worm infestation?
    •      Wash vegetables and fruits before eating them raw. This is necessary
           because the soil where they have been grown could have been contaminated.
    •      Drinking water must be filtered and boiled, and care should be taken when
           handling food and water.
    •      A child should be cleaned properly after using the bathroom and the faeces
           disposed of properly.
    •      You must wash your hands after going to the toilet and before eating and
           touching food.
    •      Nails must be kept short and clean as the nails are places where the eggs of
           the worms reside.
    •      In case of itchy anus, apply appropriate medication and the child should be
           discouraged from scratching.
    •      Underwear should be changed frequently and bed linen kept clean.
    •      Avoid playing barefoot in the fields or near toilets as the eggs of worms
           like hookworm are able to enter the body through the feet. They get into
           the bloodstream and become adult worms.
    •      Regular deworming will help in preventing infestation.
    •      Develop a school action plan to reduce worms, and follow it every year!

Using the information above, work with your class to develop a school action plan to reduce
rates of worm infestation at your school. The action plan should include strategies to prevent
infestation, ways to detect when children have worms, and a deworming schedule. Be sure
to include parents and community members in your plan, and follow it every year!

                             One gram of faeces can contain:

                              SO ENEMY #1 IS FAECES!!

                                                                       Primary Level
                                                                      SecondaryLevel       47
                                          WHO AM I?

Students will play a game using deductive logic to identify and describe organisms and

Time: 30 minutes
Materials: Handwritten nametags for different disease-causing organisms and diseases,
Safety pins or tape

      1. Ask the students to secretly make nametags that identify a disease, or an
         organism that helps cause or spread a disease. (For example, “mosquito,”
         “dengue fever,” “pink eye,” “hookworm,” “a fly,” “an unsafe food vendor,” or
         “giardia.” Students can also illustrate their cards. They should not show their
         nametags to anyone else. When they have finished, students should pass the
         nametags to you. If students have trouble coming up with ideas, you can help
         by adding extra nametags.

      2.     Place all of the nametags in a bag, and ask the students to sit in a circle.

      3. Ask one student to volunteer. Fix a nametag on the back of the student so
        that the student cannot read it. The student could be a mosquito, tuberculosis,
        etc. Do not tell the student who he or she is.

      4. Now ask the student to go around the circle and have the other group members
         read the nametag SILENTLY.

      5. Then, the student with the nametag should ask questions to determine his or
         her identity. The others must answer questions WITH ONLY ‘yes’ or ‘no’. The
         student may only ask 10 questions, so he or she should choose questions very
         carefully. He or she should frame the questions based on the symptoms of a
         disease, or the characteristics of the disease-causing organism. For example,
         “Do I cause a fever?” “Do I bite people?” “Am I found in uncooked food? ”

      6. Give each student a chance to wear a mystery nametag and answer

      1. Discuss how students arrived at the answers. Did they ask questions like a
         doctor would? If so, how?

      2. How was this activity similar to how a doctor diagnoses a disease? (A doctor
         gradually narrows down the diagnosis by asking questions and making careful

      3. Why is it important to not only treat the symptoms of the disease, but also the
         cause of the disease? (If you only treat the symptoms, a person will continue
         to be infected by the disease-causing organism.)

48         Your Heath Is in Your Hands!
                              INTERVIEW A PATHOGEN

Students will play the roles of pathogens and reporters            What is a pathogen?
to explore how pathogens spread, and how they cause                It is a disease-causing
diseases.                                                                 organism.

Time: 45 minutes
Materials: Pencil, paper, research materials (if available)

    1. Have the class work together to come up with a list of diseases and pathogens
      that are common in Sikkim. Help the students add to their list.

    2. Have each student choose one pathogen to research and role-play. Students
       should then research to find out as much as possible about the pathogen they
       have chosen.

    3. Divide the class into pairs of students. One student will play the newspaper
      reporter, the other student will play the pathogen they have chosen.

    4. Provide guidelines for students’ questions, for example, each reporter should
       ask about the pathogen’s life cycle, how it spreads, the symptoms of the
       disease it causes, its food source, how it can be eradicated and any special
       adaptations it has to its environment. Students should also come up with their
       own questions.

    5. Have the student reporters spend 15 minutes interviewing their partner and
      writing down their responses. Then have students switch roles and interview
      their partners.

    6. Have students write a newspaper-style article about the pathogen that
      they interviewed. Ask students to include drawings and photographs in their
      newspaper article if possible.

    7. Post the finished newspaper articles in the classroom for all the students to see,
       and if possible, have students read their interviews aloud in class.

    1. How would you classify the pathogen you interviewed? Is it a major threat or
       a minor threat? (Answers will vary.)

    2. How can humans prevent the spread of the pathogen you interviewed?
      (Answers will vary.)

    3. Do you have any additional questions you would like to ask the pathogen you
       interviewed? (Answers will vary.)

                                                                       Primary Level
                       Lesson 4: Handling Food Safely

                           FOOD SAFETY CHECKLISTS

Objectives: In this activity, students will
explore common misconceptions about food
safety and then make a food safety checklist
to post in their kitchen at home.

Time: 30 minutes
Materials: None

Bacteria get in our food in many ways:
•      When people touch food or cooking equipment with dirty hands.
•      When a fly lands on food or cooking equipment.
•      When a pet touches food or cooking equipment.
•      When raw meat and cooked food come into contact.
•      When food is not cooked long enough.
•      When food is left out and not refrigerated.

Food: Bacteria multiply in raw meat, chicken,            Time/Temperature Factor:
fish, even cooked rice, meat curries, gravy,     The longer that food is in the danger zone, the more
sandwiches, raw milk, cheese, eggs and raw                        bacteria will grow.

vegetables, like salads.

Water: Most of your food has enough water
for bacteria to grow. It cannot grow in dry
foods, like milk powder and flour. But once
water is added to any dry food, bacteria start
to grow.

Warmth: Most bacteria like warm temperatures.
So between 5.5 and 63.5 degrees centigrade
is called the “danger zone.” The danger zone
is shown at right:

Time: If bacteria have the right conditions,
warmth, and plenty of food and water, then
the numbers of bacteria can double every 20
minutes. This means that in a matter of 6
hours, one bacterium could become 131,072

50   Your Heath Is in Your Hands!
Have students review and discuss the information below and then make a checklist to
post in their kitchen to remind everyone about how to prevent food poisoning.

As homework, have students use the information they learned in this activity to write a
mystery story in which some of the guests at a dinner become mysteriously sick. The
detective figures out that culprit is food poisoning!

                         Food Safety: A Kitchen Checklist

    • Wash your hands with soap before touching food or utensils.

    • Cover any cuts or sores with a waterproof band aid (now available at

    • Don’t cough or sneeze into food, don’t pick your nose, ears, or comb your hair
      in the kitchen or near food.

    •    Do not mix or store raw meat with other food that is ready to eat.

    •    Keep all kitchenware clean and stored in dry places.

    •    Wash the cutting board and knives after every use.

    • Do not use the same knife to cut meat and vegetables unless it is washed
      thoroughly with soap.

    •    Wash kitchen towels frequently and do not use the towel you use to wash
        dishes to dry your hands.

    • Always cover your food. Uncovered food attracts flies and flies carry many

    • Store meat, poultry, eggs, milk, cheese, and other perishables in the

    •    Refrigerate leftover foods immediately.

    •    Cook food thoroughly before serving.

    •    Keep hot food hot until you serve it.

    • Never keep perishable food at room temperature any longer than two hours
      (including time to prepare, serve, eat, and refrigerate leftovers).

    • Finally, if you want to kill the germs, heat your food to above 70°C for at least
      2 minutes. The hotter the food, the quicker the germs will die. Boiling and
      frying food kills most bacteria that cause food poisoning

    Finally, don’t eat food from street vendors who don’t practice these rules!

                                                                      Primary Level
                                                                    Secondary Level       51
                           Lesson 5: Handling Water

                          DISCUSSION: WATER SAFETY

Objectives: In this activity, students will discuss the basics of handling water

Time: 20 minutes
Materials: None

It is estimated that 80 percent of infectious diseases are waterborne, so it is essential
that students understand the importance of having safe drinking water.
      • Discuss with students where their water comes from. Does it come directly
        to their home, or is there a community water supply?

     • How do they store their water? Is it covered?

     • What are the differences between drinking water and other water?

     • How can you tell when water contains harmful pathogens? (You usually
       can’t.) Where do pathogens in water come from? (Usually from human and
       animal faeces that is improperly disposed of close to a water supply.)

     • Explain that drinking water must be filtered and boiled for at least 5 minutes
       for it to be safe.

                                IS IT BOILING YET?

Objectives: In many homes, water is heated, but never boiled properly. In this activity,
students will learn how to tell when water is boiled properly.

Time: 20 minutes
Materials: None

     1. Ask students to describe what happens as water is heated and begins to
        boil. (At first, bubbles form on the sides of the pot or kettle and wisps of
        steam appear. Then the bubbles get larger and travel to the top of the
        pot. You can hear a hiss as some water at the edges of the pot vaporizes
        and becomes steam. Then, finally, the water begins to boil: It is bubbling
        rapidly and mixing like the water in a swiftly flowing river.)

     2. Explain that this state is called a “rolling boil” and that water must be kept
        at a rolling boil for five minutes in order to kill harmful pathogens. Even if
        you keep water very hot (but not boiling) for the whole day, it will not kill
        some pathogens.

52   Your Heath Is in Your Hands!
                       WHICH WATER WOULD YOU DRINK?

To show that pollutants are not always obvious.
The students will learn that some contaminants
can be detected by sight, smell, or taste and that
others are not detectable except with sophisticated

Time: 40 minutes
       • Potable (drinkable) water
       • 6 clear, 2-liter bottles
       • Small cups numbered 1-6 for each
       • Paper and pencil
       • 2 blindfolds for each team
       • Salt
       • Food color
       • 3 edible but invisible flavorings such as vanilla, cardamom, and mint
  (pudina) extract

    1. Number the six bottles from 1–6 and fill them with drinkable water. Add a
      different contaminant (food coloring, flavorings, or salt) to each of the five
      water samples. Leave the sixth bottle unpolluted. Five bottles should now
       appear clear, one will be colored.

    2. Number enough small cups so that each team of students will have six
      cups. Partially fill the numbered cups with the corresponding “contaminated”

    1. Ask questions such as “What is pollution?” “Where does it come from?” “Are
       all contaminants from human activities or are some natural?” (Mud, algae or
       bacteria, iron, and salt are common sources of natural contaminants.) “Does
       pollution make water unsafe for all activities?” (Fishing, irrigation, swimming,
       washing and drinking are activities that require different levels of water

     2. Explain that they are going to do an experiment to identify which of the water
        samples is safe to drink. They are going to use three of their five senses.
        Review the five senses: sight, smell, taste, touch, and hearing.

     3. Organize the students into teams of four or five. Give each team 2 blindfolds
        and a paper and pencil. One blindfolded student will taste the samples and
        the other blindfolded student will smell the samples. One student will use their
        sense of sight and one student will record the results.

                                                                      Primary Level
                                                                     SecondaryLevel        53
      4. Tell students that when they observe each sample, they may only say YES or
         NO to indicate whether the sample is safe to drink. They may not say anything
         else or give nonverbal feedback (such as gagging or grimacing.) It is very
         important that students do not influence each other’s opinions.

      5. Have each team observe each sample and record their observations on a table
         similar to the one below:

 	            Sight          Smell                                  Taste

 Which glass of water would you drink based
 on your senses of sight, smell, and taste?

      6. After students have recorded their observations, remove the samples so that
         they cannot see them, and then allow students to remove their blindfolds.

      7. Ask the class which samples are safe to drink. Each team member will probably
         say that a different water sample is safe to drink. For example, all of the
         students that relied on their sense of taste should conclude that the sample
         with the food coloring was safe, because they couldn’t see it was colored. All
         team members should conclude that the uncontaminated sample is safe.

      8. Have the class guess what was in each sample and discuss their conclusions.
         Show students the samples and reveal what each contaminant was.

      1. Can you always see when water is polluted? Why can’t you rely on your sense
         of sight to determine when water is unsafe to drink? (No, you can’t always see
         when water is polluted. Water may be polluted with invisible chemicals or with
         bacteria or viruses that you cannot see.)

      2. Is visibly contaminated water unsafe for all uses? (No, we use different types
         of water for different purposes. Water that is safe for swimming, washing, or
         farming may not be safe for drinking.)

54      Your Heath Is in Your Hands!
3. What are the types and sources of water pollution? (The two main types of
  water pollution are biological and chemical. Biological pollutants can include
  bacteria, viruses, and protists. Major sources of biological pollutants include
  wastewater from homes and human waste. Major sources of chemical pollutants
  include fertilizer and pesticides from farms, and wastewater from homes.)

4. List three things that you can do to reduce water pollution. (Don’t litter; use less
   water; use chemicals carefully; recycle; dispose of household waste properly;
   don’t pour used motor oil along driveways; etc.)

                                    WATER QUIz:

1. What is polluted water? (Polluted water is water that contains organisms or
  chemicals that are harmful to life.)

2. List three water pollutants that we can see. (litter, sediment, algae or plants,

3. List three water pollutants that we can’t see. (Man-made chemicals, bacteria,

4. TRUE or FALSE All contaminants are harmful to humans. (FALSE)

5. TRUE or FALSE If water looks clear and pure it isn’t contaminated. (FALSE)

6. TRUE or FALSE Pollution we can’t see can’t hurt us. (FALSE)

7. TRUE or FALSE Some contaminants that aren’t toxic to humans may harm
   plants or other animals. (TRUE)

                                                                    Primary Level
                                                                   SecondaryLevel         55
                     Lesson 6: Health and the Environment

                          CREATING A PUBLIC HEALTH MAP

Objectives: In this activity students                      A Sample Community
will survey their neighborhood, or the                        Health Map:
area around the school to note health
and sanitation problems. Students will
then create a public health map of their

Time: 30 minutes
Materials: Pencil and paper, chart paper

Take students for a walk through an area
near your school. Ask them to carefully
observe the environment. Have them take
notes on activities and conditions that affect
the community’s health. These include: litter,
trash burning, water pollution, inadequate
toilets, landslides, etc. When students return
to class discuss the unhealthy practices and
situations they have observed, how do they
contribute to the spread of disease? Who is
responsible for these health risks, and how
can they be reduced?

Then ask the class to work together to make a public health map of their community that
shows areas that are public health problems.

Their maps should include the following points:

       •      Where is the community’s water source?
       •      Where are the toilets?
       •      Where are streams, rivers, lakes or springs?
       •      Where is trash disposed of?
       •      In which direction does the water flow?
       •      Where are most of the farm animals?
       •      Where is food grown?
       •      Where is your school?
       •      What areas pose threats to the community’s health?
       •      What are the major sources of soil, air, and water pollution?

The map should also include a key, an indication of scale, and compass directions.

After students finish making a map of the existing situation, have them make another
map that shows how they would like their community to be: How should environmental
and health threats be managed? Discuss how students can help the community meet
those goals.

56     Your Heath Is in Your Hands!
                       COMMUNITY SERVICE FOR PUBLIC
                       HEALTH AND THE ENVIRONMENT

Objectives: In this activity, students can work together as a
class to focus on a environmental or public health issue that
affects them.

Time: Ongoing
Materials: Materials will vary according to the project that
students choose

Have the class discuss public health or environmental issues
that concern them and then develop a public service program
to address this issue. Three ideas are below:

    • Litter pick-up in the schoolyard: Have students “get out there” and
      clean it up. This is a great stewardship activity that makes the students feel
      as if they are contributing to a cleaner community. (Warn students not to
      pick up glass, needles or any medical waste.) Discuss how to reduce litter in
      the schoolyard (this might include visiting other classes to talk to students
      about the litter).

    • “Adopt” an Area: As a class, find an area near your school to adopt and
      keep litter-free. This could be a park, a stretch of road, a jhora, a playground,
      or a local forest. Create a sign that says “This area has been adopted by
      Class VII of So and So School. Please help us keep it litter- free!” Have
      students measure and graph how much litter they found at the area at the
      beginning of their campaign. Did the clean-up campaign help reduce the
      amount of litter?

    • Health Communications: The class should be divided into four groups.
      Each group should focus on an important hygiene message that they
      want to communicate effectively. Groups can be very specific and focus
      on a community, or create a message for all of Sikkim. Groups may use
      any medium or language, and should use their imagination and creativity.
      Remind them that they must “market their message” so it must be attention-
      grabbing, but the content must be accurate. The groups can make their
      presentation in any form, e.g., speeches, essays, letters to the newspaper,
      drawings, slideshows, skits, etc. The presentations should be made to all
      groups for comment, changes, and improvements before they are taken
      to the community.

                                                                    Secondary Level
                                                                     Primary Level        57
                               PATHOGENS VS. PEOPLE

To help students learn about public health and about the role that environmental factors
play in the spread of disease. Student teams will play a game in which they assume the
roles of pathogens and hosts to explore the role of environmental stewardship, behavior,
and medicine in reducing the spread of disease. After playing the game, students will
develop an action plan to reduce the spread of disease in their community.

Time: one class period
      • posterboard
      • blank cards (approximately 60)
      • gamepieces (Each should be unique: 2 for human teams, 2 for pathogen
      • dice (1)

Review the terms pathogen and vector with students before beginning this game.
Pathogens are disease-causing organisms such as viruses, bacteria, and protists. Vectors
are organisms such as mosquitoes or environmental conditions such as stagnant water
that transmit disease to humans.

      1. Organize the class into four teams, two teams will be pathogens and two teams
         will be human hosts. Have both teams elect a representative to roll the dice
         and move their gamepiece. The teacher should record team points at end of
         each turn.

      2. Lay out the gameboard as illustrated at the end of this activity. The teams
        will move their game pieces from square to square during the game.
        For the Human teams, the objective of the game is to travel around the
        gameboard from Start to Finish without becoming infected by a pathogen.
        For    the Pathogen teams, the goal is to infect a Human team and prevent
        them from finishing the game.

      3. Create the Behavior cards, Vector cards, and Quiz cards as suggested at the
         end of this activity.

      1. Human teams begin the game with 15 health points. Pathogen teams begin
        the game with 10 Vector points. If a human team loses all of its Health points
        it will “die” and be removed from the game. If a Pathogen team loses all of its
        Vector points, it will be eradicated and removed from the game.

58      Your Heath Is in Your Hands!
    2. Both teams move around the gameboard by rolling the dice once each turn.
       Human teams may only move in a clockwise direction from Start to Finish.
       Pathogen teams may move in either direction.

    3. A Human team should move first. Afterwards, play should alternate between
       Pathogen and Human teams.

    4. A team will draw a card at the end of each turn. The Human team will
      draw a Behavior card and the Pathogen team will draw a Vector card. Each
      card describes an action that will result in a team either gaining or losing

    5. If at any time, a Pathogen team has more points than a Human team, the
      Pathogen team can challenge the Human team by jumping to the Human team’s
      square and challenging them with a quiz question. If the Human team answers
      the Quiz card correctly, there is no effect. But if the Human team answers the
      Quiz card incorrectly, they will become infected.

    6. An infected Human team has 4 chances to land on a medicine square by moving
       in either direction. They will lose two health points every turn until they are
       cured. If they do not land on a medicine square in four turns, they will die and
       be removed from the game. An infected team may not draw cards while it is
       infected. Landing on a rehydration square grants an infected Human team two
       extra turns before expiration.

    7. A healthy Human team can also become infected if it occupies the same square
       as an infected Human team.

    8. If a Human team uses more than three doses of medicine in the course of
      the game, the Pathogen team that last infected the Human team will become
      resistant. Resistant pathogens can move to any square occupied by a Human
      and challenge that team with three quiz cards. The challenged Human team
      must answer all of the quiz questions correctly or die and be removed from
      the game.

    9. Human teams can eradicate a Pathogen team by occupying squares on both
       sides of the Pathogen team’s gamepiece and challenging the Pathogen team
       to answer three Quiz questions. If the Pathogen team misses more than one
       question, they will be eradicated and removed from the game.

   10. Play ends when the first Human team successfully travels from Start to Finish,
      or if both Human teams are killed by Pathogens. If a Human team reaches the
      finish line and it is infected, it cannot win, and it must find medicine or die.

Have students use what they have learned in this game to create an action plan to educate
the community about the connections between the environment, behavior, and disease.
They can design posters or pamphlets for the school, or visit other classes to educate

                                                                     Secondary Level
                                                                      Primary Level       59
                                                            loose, they are
                                                            If the humans
                                                            human to a quiz.
                                                            challenge a
                                                            A Pathogen can

                                                                                            H ir

         t: 2                                                                             b u P
       ie in                                                                               a m o
      D ga nts                                                                              ck an llut
   od ans poi                                                                                 5 s        io
 Go um h                                                                                        sq mov n!
   H ealt                                                                                         u ar e
     h                                                                                                es
Medicine                                         Pathogens
                                                 Vs. People
                             Behavior               Quiz          Vector
                              Cards                 Cards         Cards

                                                                                                              Your Heath Is in Your Hands!

                                                            lands here they

                                                            correctly or be

                                                            must answer 

                                                            quiz questions
                                                            a Human team

          st s

                                                            Outbreak! If

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            Behavior Cards                              Vector Cards                                  Quiz Cards

You drink untreated water from a            A pathogen-carrying mosquito bites a        Describe two changes in the environment
contaminated source, lose  health points   human, gain 3 vector points                 that can lead to the spread of infectious

You eat food from a market stall that has   Food in the market is not covered to        Explain the term emerging virus.
a shield for flies, gain 2 health points    keep flies away, gain 2 vector points

You use a bathroom close to a water         Pork is cooked thoroughly to kill           How has the increased use of antibiotics
supply, lose  health points                parasites, lose  vector points             by humans led to antibiotic resistance in

After going to the bathroom you wash        Food in the market is covered to keep       What is the cross-species transfer of
your hands with water, but not with soap,   flies away, lose  vector points            disease?
lose  health points

Stagnant water has collected in your       Food is not cooked thoroughly to kill        Use the term vector correctly in a
neighborhood and mosquitoes flourish, lose pathogens, gain 3 vector points              sentence.
 health points

You walk barefoot in an area with farm      A pinworm has found a human host, gain      Use the term pathogen correctly in a
animals, lose  health points                vector points                             sentence.

People in your community go to the          Heavy rains occur and stagnant water        What type of animal is an intermediate
bathroom close to a river, lose  health    collects in empty containers, gain 3        host for cholera?
points                                      vector points

You are cut, but you do not clean the      Hitch a ride on a flying insect, gain 2      What type of animal is an intermediate
wound thoroughly or apply antiseptic, lose vector points                                host for yellow fever?
 health points

You drink water from a clean source, gain   Tables and surfaces where food is           How do stagnant bodies of water promote
 health points                             prepared are disinfected thoroughly,        the spread of malaria?
                                            lose  vector points

You do not your hands before a meal, lose   A village constructs a public toilet with   Which flying insect is responsible for
 health points                             a proper septic tank, lose  vector         spreading malaria?

You eat a meal that has been cooked         An untreated sewage spill leads to          What are the symptoms of cholera?
thoroughly, gain 3 health points            cholera outbreak, gain 3 vector points

You empty containers with stagnant          Global warming promotes the spread of       What is the importance of iodized salt?
water, stopping the spread of mosquitoes,   malaria, gain 2 vector points
gain 2 health points

You wear shoes when feeding farm            Outbreak! Challenge both Human teams        How does global warming promote the
animals, gain 2 health points               with 2 quiz questions                       spread of disease?

You are cut, but you clean the wound        A wound is not cleaned thoroughly, gain     What is the difference between a
thoroughly and apply antiseptic, gain 3     3 vector points.                            bacteria and a virus?
health points

Vaccination! You are immune to one          Someone sneezes and covers his or her       What happens when we do not wash the
challenge by a pathogen                     nose, lose 2 vector points.                 food before we eat?

After using the bathroom you wash your      A person drinks water and boils it first, Why is it important that we go to the
hands thoroughly with soap, gain 3 health   lose 2 vector points.                     bathroom in the proper place?

                                            Bathrooms are cleaned thoroughly every      What are two causes of diarroeha?
                                            week, lose 4 vector points.

                                            A person uses a bandage on a cut, lose 3    Name three local medicines.
                                            vector points.

                                                                                        Why is it important to take all of your
                                                                                        medicine when you have TB?

                                                                                        Is leprosy curable?

                                                                                                  Primary Level
                                                                                                 Secondary Level             61

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