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Thursday, June 5, 2003

MATTER OF COURSE

PREVENTION IN A TEAPOT?

National hygiene begins in the classroom


I always like to hear from readers, but it's especially nice when they provide ideas for my column. Several wrote in recently about severe acute respiratory syndrome.

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"I saw a piece on the news about Japan hoping it can avoid SARS because its citizens have such high standards of cleanliness," one reader in the U.S. wrote. "They said it's because personal hygiene is emphasized in Japanese schools. True?"

It's true, and I've wanted to write about hygiene education ever since I saw the health handouts my kids bring home from school. These handouts urge students to go to bed early, exercise regularly and wash their hands frequently. They also urge kids to gargle as soon as they get home.

Gargle? That struck me as just plain silly, although I know many Japanese believe gargling prevents colds. But in light of SARS, I figured it's time to stop giggling about gargling and take a serious look at how hygiene is taught in Japanese schools.

When we moved to Japan and enrolled our kids in the local elementary school, I was mightily impressed by the hand-washing facilities. In addition to sinks near the toilets, there are long sinks in the corridors on each floor of the school and even out in the schoolyard. The hand-washing stations are nothing fancy; just a row of eight cold-water taps, each with a bar of soap in a mesh bag.

Still, what an improvement over their school in the U.S. There, the teachers talked about the importance of hand-washing, but there was no follow-through or reinforcement. The bathrooms were too small for teachers to stand in there and make sure everyone washed. There was no opportunity for kids to wash their hands after recess, or even before eating lunch.

Here in Japan, students wash their hands several times a day. After bathroom breaks, everyone washes their hands together, out in the hall where teachers can supervise. Students wash up again before lunch, after science experiments and when they come in from recess. In most homes, kids are expected to wash their hands as soon as they come home. They might gargle, too.

In addition to hand-washing, schools teach kids to carry a handkerchief to dry their hands and a package of tissues to blow their nose. My third-grader, who came to Japan when he was young and trainable, won't go anywhere without a hankie in one pocket and tissues in the other.

This habit is reinforced by inspections. At our school, there's a weekly eisei shirabe (hygiene check). Students on the health committee come around and check if everyone has a handkerchief and tissues, and if fingernails are clipped short.

I appreciate that the schools foster good habits in my kids. If it weren't for the inspections, for example, I'd never get my boys to cut their nails. But the gargling? That struck me as a waste of time, and I decided to talk to the school nurse about it.

She's figured out that I only ask about things I find unusual, so when I asked about ugai (gargling), she opened her eyes wide in disbelief. "Don't tell me they don't gargle in American schools! It's very common at Japanese schools."

Indeed it is. I did a quick Web search and found dozens of schools that post information on their gargling programs. One school runs an All-School Gargling Campaign every year during flu season. At the end of recess, the school puts a Disney tune on the public address system and the kids march to the sinks for a group gargle. I can't help but wonder if they have developed a Pavlovian response. For the rest of their lives, when they hear Disney music, will they throw back their heads and make strangling noises in their throats?

I asked my son if he gargles. "The teachers don't make us, but they taught us about it. I gargle when I come in from recess." I asked why. "Because it prevents colds," he said in Japanese, which means it was something he heard at school. Then he added, in English, "And it gets my boogers out."

Ahem. Well, I can believe gargling helps with . . . shall we call it "debris removal?" But I was skeptical about the cold part of it. If gargling really prevents colds, I reasoned, how come I never heard of it before I came to Japan? Do the Japanese know something the rest of the world doesn't?

I checked the Web sites of major health organizations outside of Japan, including the U.S. Centers for Disease Control and Prevention, the American Lung Association and the National Institute of Allergy and Infectious Diseases. None of them recommended gargling to prevent colds. In fact, none even mentioned gargling, except to soothe a sore throat.

I also searched in PubMed, a major database that references 4,500 medical journals. The only hits I got were two articles from Japanese journals, which led me to Tadakatasu Shimamura, a professor of microbiology at Showa University School of Medicine, in Tokyo.

"It's a common belief in Japan that gargling prevents colds," he confirmed, "but the truth is that gargling with plain water does nothing but wash out the throat." I started to feel vindicated, but then Shimamura continued: "To prevent infection, you have to gargle with tea."

Tea? Shimamura explained that tea contains an anti-microbial agent called catechin that prevents some viruses from entering the body. In experiments conducted about 10 years ago, Shimamura found that gargling with black tea extract prevented influenza infection.

"But any brewed tea will work," he stressed. "The green tea that most Japanese drink at home is fine. It doesn't have to be particularly strong, and it needn't be warm."

Many schools, especially in tea-producing Shizuoka Prefecture, have kids gargle regularly with tea. One school documented that absences due to influenza dropped after students started gargling with tea at school.

I had to ask the question: Could gargling with tea prevent SARS? "There haven't been any experiments done on this, so I have no evidence," Shimamura replied. "But yes, I think it's possible."

Simple, inexpensive measures with a big impact. Hand-washing is one. Maybe gargling with tea will prove to be another. But surely the best investment we can make in public health is teaching good hygiene at school.

Alice Gordenker is a Tokyo-based writer. Her younger son goes to a Japanese public elementary school.


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