Teaching Kids FoodBorne Illness Prevention

Because children belong to the category of persons that are classified as high risk group when it comes to food-borne illness and they are more susceptible to food-borne illness and experience more severe consequences of food borne illness than adults, teaching them at an early age about food-borne illness is helpful in protecting them because when children become aware that food can be a source of illness it helps them make informed decisions on what to eat and what not to eat especially when they are alone or with their peers, away from the watchful eyes of adults.

Food-Borne Illness Prevention Initiative recently carried out a food borne illness awareness program for pupils of selected primary schools in Eket LGA. A total of 367 pupils from 6 primary schools were taught about food borne illness, what causes it, how to prevent it, and they were given food borne illness family awareness packs to take the message back home to their parents and families to help spread the awareness about food borne illness. The program was a success and the feedback from school authorities and parents were very positive. In this way FIPI aims to create the awareness that will contribute to reducing the public health burden of food borne illness in our society. Some photo shots of the program are below. Children interacting with FIPI volunteers and being taught hand washing techniques and basic food borne illness prevention steps.

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Surmounting Nigeria’s Food Borne Illness Problem.

Thinking about it, the food borne illness problem in Nigeria is not an insurmountable problem. All it needs to be surmounted is first and foremost an acknowledgement of its existence i.e that we have problem of food borne illness in this country and secondly a full commitment on the part of the government at all tiers (federal, state, local) to deploy resources required to deal with this matter.

When I consider the situation in the country as per food borne illness, many times I wonder and ponder “what is on the mind of the government concerning the public health burden of food borne illness in this country?”, “is the government even aware of the severity of the problem?”, “has the arm of government responsible for health matters in this country, the Federal Ministry of Health, taken any concrete steps in recent times (or should I say in living memory) in the direction of addressing the problem of food borne illness”, “what will it take for the government to upgrade food borne illness to the status of a public health issue that needs to be attended to like HIV/AIDS, Malaria, Tuberculosis”.

I know a National Food Safety Committee (NFSC) was set up two or three years ago but this committee has very little or nothing to do with solving the public health burden of food borne illness in the country, it’s terms of reference is largely focused on managing the process of ensuring Nigerian food products meet international safety standards for exports. So it’s more of an economic outfit than a health related body.

Even at that, one is yet to see any visible and tangible work that this enigmatic committee (I refer to it as an enigma because the names of the members of the committee or at the least the chairperson heading the committee are/is unknown in the public domain, no report or recommendation has been published by the committee since it’s inception, type “National Food Safety Committee of Nigeria” in any of the search engines and you will draw a blank or at most be  referred to some blogsites commenting about it being setup three years ago) has done. It truly has a lot of ground to cover if it truly wants to justify its creation.

It is also concerns me that when I check the websites of the Federal Ministry of Health, there is nothing about food borne illness in all its categories, the same applies to NAFDAC (National Agency for Food and Drug Administration and Control) although kudos needs to be given to the later for creating at least a level of public awareness about the fact that food can be dangerous to health. However the agency is more engaged in registering manufactured and finished food products and regulating their manufacturing process as well as combating fake and adulterated drugs and medicines in the country. When it comes to food from kitchens in hotels, restaurants, hospitals, boarding schools, prisons, cafeterias, hostels, fast food outlets etc. NAFDAC has no visibility.

I have heard of NACA (National Agency for the Control of Aids) and MAPS (Malaria Action Program for States), government agencies in this country that are visible to the public and in the media and with up-to-date and robust websites and calendar of activities addressing these two health issues. But concerning food borne illness in Nigeria, all we have is a worrying silence on the part of Federal, States, and Local Governments yet the casualty counts of food borne and water borne illness keeps mounting periodically in the country.

An example of a government with the will and commitment to deal with food borne illness is the United States. Three years ago President Obama signed into law the Food Safety Modernization Act which is aimed at minimizing food borne illness risks to the American consumer using a science and risk based approach.

I believe we need to have a similar level of government commitment in Nigeria to address the public health burden of food borne illness in this country.

To Eat Or Not To Eat?!?

To Eat Or Not To Eat?!?

To Eat Or Not To Eat?!?

I remember the first time I ate out at a fast food outlet. It was with my mum and brother at a place called Kingsway Rendezvous sometimes in the mid 1980s. At that time eating out hadn’t caught up as a favorite pastime, and the idea of fast food outlets was still in its infancy in Nigeria and limited to major cities like Lagos, Ibadan, & Port Harcourt.

But now almost 30 years afterwards, fast food outlets of various shades and grades litter the nation’s landscape. From the major players with franchises in almost every major city to the small town new entrants.

It appears many of these fast food outlets essentially pay very little thoughts to keeping a food safety/hygiene regimen and are more concerned on increasing the profit margin of the business. The idea of checking temperature of food, providing thermometers, using sanitizers, using color coded chopping boards, and even food handlers training and medical tests are viewed as overheads that can be conveniently avoided to push up the profit margin, particularly because there is no effective monitoring and enforcement body in the country. Very few local governments enforce their statutory duties of food business inspection for sanitation and hygiene compliance. The low pay and high turnover rate of fast food outlet workers doesn’t help either such that new staff are always needed to replace those that leave and training new staff again and again and again can be seen as unnecessary expenditure.

In other words there is always a food borne illness risk exposure every time one eats at these fast food outlets.

So how would one know where to eat or not to eat in order to minimize the risk of food-borne illness?

Eating from a recognized brand outlet is good guide. Or eating at an upscale outlet could tend to give an assurance of safe food. Or eating at an outlet with a track record of zero food-borne illness complaints. Or eating at an outlet with well designed and clean and well decorated sitting tables & chairs. All these are good guides, but they may let one down eventually cuz looks and appearance of the sitting areas and serving points doesn’t give a true picture of the state of where the food itself is prepared and track records have a way of failing unexpectedly.

One way that I typically determine if a fast food outlet or restaurant is ok for me to eat out is to “case the toilet” as in like to “case a joint”. That is to check out the state of the toilet facility of the food business. The state of the toilet in a food business facility is usually a reflection of the state of the kitchen where the food is coming from, which in many a cases is hidden away from the view of the customers.

A clean toilet with well stocked hand wash liquid soap, well fragranced, running water and a cleaning schedule posted on the wall of the toilet is indicative of a food business with good hygiene, cleanliness, and sanitation culture and values. And this you can be sure extends to the kitchen hygiene and sanitation.

However a toilet with broken door handle/knobs, exposed light bulbs, leaking hand wash tap, stained hand wash sink, broken toilet cover, empty soap dispenser, depleted toilet paper, no cover on the toilet WC, bad flushing handle, water puddle on the floor, cracked tiles and ceiling cover, and with no cleaning schedule visibly displayed is a red flag to me any day any time. I can bet you on your dollar that such a place will have a kitchen with poor hygiene and sanitation standards with high risk of food-borne illness.

Before you check out the menu at the serving line, check out the toilet first. This may spare you the trouble of frequent trips to your own toilet when you get back home!

To “case a joint” is an idiomatic expression which means: to check out the details to, and make speculations about, a home, car, store or other location by looking the place over. Source: http://www.urbandictionary.com

Know Thine Enemy & Know Thyself

Know Thyself & Know Thine Enemy

Sun Tzu

In the fight against food-borne illness, *Sun Tzu’s quote “know thine enemy and know thyself” is a good dictum to follow.

Why? Because in numerous kitchens (commercial kitchens, domestic kitchens in homes, and even communal village open-space kitchens) across the length and breadth of this country, the bugs that cause food-borne illness have been doing a lot of damage to the health and well-being of the public, and places considerable burden on the public health in Nigeria. Aided by ignorance of the populace, these pathogens seem to be having a field day. To turn the tide of this fight, folks need to know these germs, know how they infect, know the foods they are commonly associated with, know how they affect human health, and know how they can be curbed.

I have tried to profile five important food borne illness causative bugs in Nigeria in simple layman’s language as part of increasing awareness of these bugs, how they operate, and how they can be checkmated.

1. Vibrio Cholerae – Count for count, this food borne & water-borne bug has done more damage to public health in Nigeria than any other food borne illness bug.

To understand this check out my posts of 7th December and 22nd December titled 2013 Cholera Outbreak and Chronicling Cholera’s Carnage Parts 1 & 2 respectively.

Vibrio cholerae, the bug that causes cholera, is transmitted by consuming contaminated water or food washed or prepared with contaminated water or food prepared by a person sick with cholera.

Once the bug gets into the intestine of its victims it multiplies rapidly and secretes cholera toxin, it’s the toxin that does the damage by causing the intestine to release plenty of fluid that leads to its trademark symptoms; a sudden onset of watery stools and diarrhea. If not quickly treated the victims loose a lot of fluid from the body and die from dehydration. The suddenness of the watery stools and diarrhea is the characteristic of vibrio cholerae.

Hand-washing practices, properly boiling water before use, cooking food thoroughly, proper environment sanitation, use of latrines and toilets instead of open defecating are all ways of countering this bug.

2. Salmonella Spp – Salmonella bacterium is another major cause of food borne illness in Nigeria. The bug is transmitted by eating contaminated foods especially food of animal origin  i.e meat, poultry, eggs, milk. However fresh produce and vegetables have also been implicated in salmonella outbreaks. The bug gets into the food chain from infected livestock and animals where the livestock has been fed with salmonella contaminated animal feed. Fresh produce are contaminated when they are irrigated with sewage water containing salmonella or fertilized with animal manure of infected animals.

Food implicated in salmonella food borne illness in Nigeria are eggs (cracked eggs & eggs smeared with feaces), edible snails, roasted chicken sold by roadside vendors, improperly cooked chicken, local soft cheese “wara”, unpasteurized (raw) milk sold as fura-de-nunu, local sandwich and local salad. The salmonella bug was isolated in fillings from sandwiches that caused an outbreak of food borne illness in Ibadan that claimed about 20 lives some years ago.

In healthy adults the bugs needs to be consumed in large numbers to cause illness, but in the young and elderly a small dose is enough to cause trouble. Even though majority of the ingested bug gets destroyed in the stomach by gastric acid, the ones that survive and pass into the intestine and multiplies there resulting in the symptoms of diarrhea, fever, nausea, vomiting and stomach cramps usually between 12 – 72 hours after ingesting the bug. The illness may last 4-7 days. Serious forms of the illness can lead to fatality when the bugs spread from the intestines to the blood stream and then to other body organs especially in the young, elderly, or the sick.

Cooking food at temperatures at 75C for is sufficient to kill the bugs. Other means of preventing the bug from infecting is by avoiding cross contamination of the bug from raw food to other food i.e. not using same utensils (chopping boards, knives, work surface) for raw foods and ready to eat foods without thoroughly washing with soap and hot water, separating raw foods from ready to eat food in storage in fridge, ensuring proper cleanliness in the kitchen, and thorough washing and sanitizing fresh produce before eating.

3. Listeria monocytogenes – A contaminant found in Nigerian foods like smoked fish, kilishi (sun-dried & partially roasted seasoned meat slices), kununzaki (fermented sorghum drink), wara (local soft cheese popular in South West Nigeria), and unpasteurized (raw) milk sold as fura-de-nunu, Listeria monocytogenes, the bug that causes Listeriosis also referred to as L.Mono, is an uncanny food borne illness bug. Uncanny in the sense that unlike most food borne illness causing bugs, L.Mono can survive and even grow at temperature as low as 0C such that it multiplies even when food is refrigerated.

Naturally existing in soil, water and vegetation from where it gets into the food chain, L.Mono can be destroyed in food by proper cooking and pasteurizing. It’s symptoms are diarrhea, vomiting, nausea, fever, and muscle aches which may begin to manifest as short as few hours to as long as 3 months after ingestion (for the very severe type). Where you see the normal symptoms of food borne illness accompanied with aches at the knees and elbows as well as stiff neck, it’s probably L.Mono at work.

Healthy adults are rarely affected by L.Mono, it’s aged/elderly persons, pregnant women, newborns, and adults with weakened immune systems that are the groups mostly at risk of this bug. And of this group pregnant women are the highest number of its victims where the bug passes from the intestine into the blood and becomes blood borne affecting the fetus resulting in miscarriage or stillbirth.

Infection by L.mono can be prevented by cooking food thoroughly to safe temperatures, by washing and proper handling of food before eating, keeping kitchen environment clean, proper handwashing, separating raw food from ready to eat food, avoiding cross contamination, and avoid eating the high risks foods as listed above.

4. Staphylococcus aureus – This bug by itself is harmless and occurs naturally on skin, hair as well as nose and throats of humans and animals. However when it gets into food it rapidly multiplies and secretes very potent toxins into the food. The major source of contamination is from food handlers and food preparers.

Once it has multiplied and produced the toxins into the food, heating treatment or cooking of the food makes no difference anymore because the toxins are very heat stable and are not easily destroyed by heat. So cooking food that has been colonized by staph aureus may destroy the bugs themselves but the toxins survive and when the food is eaten the toxins cause the illness with symptoms of vomiting, diarrhea, nausea and stomach pains typically one to six hours after ingestion of the toxin and this may last between 24 – 48 hours before it subsides.

Staph aereus need time to multiply in food to the dangerous levels that are sufficient to cause illness. Leaving food unrefrigerated for a short period gives it the chance to do this.

Moi-Moi (bean pudding), Agidi (Fermented Corn Meal), Abacha (African Salad), Suya (Roasted Meat) and similar hand prepared meals are examples of Nigerian foods implicated in staph food borne illness.

Ways to prevent staph infection are avoiding time and temperature abuse of food, proper handwashing before food preparation, not allowing food handlers (and children’s nannies & caregivers) with open sores/boils/wounds/long fingernails/skin infections/nose & eye infection to prepare food, avoid coughing and sneezing unto food, eating food immediately after preparation, rapid chilling and cold storage of food to prevent multiplication of the bug in food.

5. Aspergillus flavus – Aspergillus flavus, unlike the previous four bugs above, is not a bacteria but a fungus found in food like maize, groundnuts, sorghum, groundnuts that produce poisonous toxin. This toxin can be very dangerous when ingested and cause aflatoxicosis. It has been reported to causes liver cancer, suppresses the immune system, and retards the growth and development of children.

Even though the toxin is invisible to the naked eye, the bugs can be discerned in crops by a characteristic mould green color.

Prevention of aflatoxicosis begins at the farm by treating the crops to kill the bugs and also during storage. Infected crops are usually destroyed to prevent human consumption. However some of these infected crops inevitably enters the food chain as Agidi, the peanut paste used to prepare Kilishi, Kuli-Kuli (local snack made from fermented groundnut), Yaji (the spice that accompanies Suya) and when livestock eat feed contaminated with Aspergillus flavus.

The toxins produced by the Aspergillus bug are not affected by routine cooking temperatures, but simple food preparation methods such as sorting, washing, crushing, and dehulling may reduce aflatoxin levels (Public Health Strategies for Preventing Aflatoxin Exposure 2005).

These five food borne illness pathogens, along with other such pathogens not profiled in this post, have collectively brought a huge burden on the public health system of this country.

*Sun Tzu was a Chinese general, military strategist, and author of The Art of War, an immensely influential ancient Chinese book on military strategy. (Source: http://www.wikiquote.org)

No Difference Between The Rich & The Poor

Consume food that is contaminated with germs, regardless of the status of the kitchen in which it was prepared, and you will be down with a bout of food-borne illness in a matter of time (hours, days, weeks depending on the germs involved), it’s as simple as that.

One universal truth about food-borne illness is that it doesn’t differentiate between the rich and the poor.

Whether you are living in the opulence of Asokoro in the Federal Capital Territory Abuja or in the squalor of the slums and shanties of Ajegunle in Lagos it makes no difference. Consume food that is contaminated with germs, regardless of the status of the kitchen in which it was prepared, and you will be down with a bout of food-borne illness in a matter of time (hours, days, weeks depending on the germs involved), it’s as simple as that.

However to effectively prevent foods-borne illness there is need to have some understanding of the dynamics of the germs that cause it.

These germs (permit me to use this term) need, amongst many other things, two very important requirements to thrive in food:

TIME & TEMPERATURE.

Temperature – germs that cause food-borne illness need the right temperature to germinate and multiply in food.
Time – they also need time to propagate (multiply) in food up to the levels capable of causing harm when consumed.

So two of the several ways of effectively “outflanking” these germs is to deny them the time they need to multiply to dangerous levels in the food and to deny them the right temperature that they need to be active. The flip side of the coin is that these bugs can be helped to do the damage they are known for by giving them enough time they need to propagate rapidly in the food and the right temperature they need to be actively metabolize in the food.

Food-borne illness causing germs are optimally active within the temperature range 4 Celsius – 60 Celsius (this temperature range is termed Danger Zone in food safety parlance) and they multiply rapidly in food within this temperature range. Outside this range the germs kind-of go to sleep at temperatures below 4 Celsius and they are essentially destroyed at temperatures above 60 Celsius (typically 76Celsius) or the spore forming ones sporulate and remain inactive until the temperature decreases to favourable levels.

To prevent food-borne illness, the temperature of food needs to be kept out of this range. Cold foods like salad needs to be kept chilled at less than 4 Celsius and hot food needs to be kept at temperature above 60 Celsius.

Example of an easy way to cause food-borne illness is to prepare salad by 8 A.M in the morning and leave it out on a shelf in the kitchen at room temperature 36 Celsius to be served at a party at 4 P.M later in the evening. In this way the bugs have the right temperature and enough time to multiply to dangerous levels in the salad. The proper thing to do would have been to prepare the salad not too far in advance to the time of the party (two hours before it’s required will be fine rather than six hours in advance) and to keep it refrigerated at temperature less than 4 Celsius instead of leaving it out on the kitchen shelf. In the event that the food has to be prepared well in advance, then the safest thing to do is hold the food at temperature outside of the danger zone for the time being until it’s consumed either by using a hot cupboard or food warmer or Bain Marie to hold hot cooked food and using the refrigerator for salads and fruits. In this way the germs are denied the right temperature to propagate even though the time is available for them to do so.

Many a food-borne illness outbreak at parties have resulted from time and temperature abuse of the food. That is preparing food to far in advance and not storing at safe temperatures.

Two of the rules of thumb in preventing food-borne illness is to KEEP HOT FOOD HOT & COLD FOOD COLD and COOK IT JUST BEFORE ITS NEEDED.

Food-Borne Illness On The Road

Food-borne illness and the symptoms that come with it, even in its mildest form, is a terrible experience to have. The uncontrollable urge to defecate, the turmoil in the tummy, the vomiting, the nausea and fever and chills, the weakness in the body and in many cases the inability to do anything productive (office work, business activity, school work are usually part of the casualties of a food-borne illness experience).

One of the worst scenarios to be hit by food-borne illness, particularly in this part of the world, is when traveling by road especially with public transport. Having food-borne illness when traveling by road in Nigeria can be very tricky. I know a man who openly confessed to me that he once had to quietly empty his bowels again and again on himself where he sat in a bus stuck in the middle of Lagos’ notorious traffic gridlock on his way to the airport to catch an early morning flight one Monday morning. He had tried to hold the urge on till he got to the airport but he couldn’t make it. He narrated how he had to disembark from the bus in front of a petrol station (gas station) halfway into the journey and shuffled towards the toilet facility where he managed to clean himself up and change into a new set of clothes from the packed clothes for his trip. He put this humiliating experience down to the Egusi soup he had for Sunday dinner, that was the last meal he had before the incident.

On interstate long distance trips, FBI (food-borne illness) can be a most unpleasant experience because many times the bus driver will not stop to allow a passenger to relief himself when driving in-between urban areas for security reasons. Truth is, a passenger having food-borne illness on such trips would elicit more of suspicion than sympathy from fellow passengers who will, in all probability, urge the bus driver on. Some luxurious buses now have onboard toilet facilities to cater for passengers needs, whereas many do not.

The assumptions I am portraying is where the FBI is mild. Where the symptoms of the illness are very severe and involves severe stomach cramps and, worse still, vomiting, then that’s bad news altogether for the passenger and other passengers onboard because the bug can be spread easily within the confined space of the vehicle.

Ironically located in most motor parks and bus stations are dodgy canteens and dubious roadside food sellers operating under the most unhygienic conditions where one can effortlessly pick up food-borne illness germs from patronizing them before proceeding on the trip.

The Christmas and New Year period in this country is usually accompanied with a lot of traveling from West to East, North to East, and North to West. Regardless of direction of travel, taking personal responsibility to protect oneself from food-borne illness before during and after the festivities should be paramount in everyone’s mind.

Celebrating The Year’s End With Care and Caution.

The end of each year is usually associated with lots of celebration and merriment. Christmas parties, New Year parties, Corporate End of Year Parties etc. But with the opportunity to celebrate comes the need for care and caution about what is being eaten.

About this time last December a company in Benin City, Nigeria chose to host the company end of year party and long service award with staff and their families in attendance.

Speeches were given, toasts were given, awards were given to outstanding staff and long serving staff, and retirees were recognized.

A reputable caterer (name withheld) in Benin City was contracted to provide food and drinks for the occasion and there was enough merriment and fun for everyone.

However hours after the party several staff and their family members were down with food-borne illness and with many being admitted to hospital for treatment.

What was meant to be a moment of celebration ended up to be terrifying moments of pain and discomfort. Fortunately there were no fatalities.

Quoting what was reported in the media:

“Staff participated at the occasion and ate the food irrespective of the type eaten some reacted later that day. Some reportedly had issues of recurring stool, while others experienced vomiting alongside the stool. It was obvious from the number of people involved that food poisoning could not be ruled out, though this has not been officially stated to be the case.”

What interested me from the entire episode was that the company management were quick to “suspect foul play” in the aftermath of the incident. That is to say rather than consider the food safety/food hygiene competency of the caterer and investigate if due diligence was carried out by the caterer to prevent an outbreak of food-borne illness, the company management began a witch-sniffing.

Perhaps the only foul play to be considered is inadequate time and temperature control of the food, poor HandWashing practices, insufficient sanitizing and disinfecting of utensils, using same utensils to prepare raw food and ready-to-eat food. Who knows.

As we gear up for this year’s end several parties and celebrations, we need to have it at the back of our minds that a food-borne bacteria may be lurking around the corner. When selecting caterers do not focus only on the kind of delicacies they can provide, or how reliable they are in getting the food ready on time before guests arrive…also ask about their food safety records and competency. Get your catering from a food safety assured source. So you can celebrate the season with peace of mind.

“Germs No Dey Kill Africans”

I once had a chat with a lady who works as a kitchen staff in an hotel here in Eket. In the course of our discussion about food safety practices & food-borne illness she told me, with a wide grin on her mouth, “oga, germs no dey kill Africans” (literally translated “boss, germs do not kill Africans”). I shot back at her “germs no dey do wetin?” (“germs do not do what?”), she replied with certitude “e no dey kill Africans now” (“it doesn’t kill Africans”). O dear, I thought…where did she get this hypothesis from? In my mind I couldn’t help thinking that observing proper food safety practices when preparing meals for customers would be the least of her worries if she really believes that germs don’t kill Africans. So I asked her if she had ever seen or heard of folks who fall ill or die as a result of eating contaminated food. She replied curtly “dat one fit happen…if dem put something for food for the person” (“it’s possible…if the food is poisoned by someone of malicious intent”). As far as she was concerned, food-borne illness can only occur where food is deliberately contaminated or poisoned. The opinion of this individual is actually an exception and not the rule, I haven’t come across anyone with such thoughts before and after my encounter with her. Nevertheless this false conception that the African race is immune to germs gave me a cause of concern, especially that it was coming from a food handler who ought to have been trained in basic food safety, and demonstrated how much work still needs to be done in educating the public about the danger of food-borne illness and as a matter of fact, other communicable diseases.

FIPI Conducts Food-Borne Illness Survey

Some months ago the Food-Borne Illness Prevention Initiative conducted a survey on food-borne illness risk perception and awareness at Ikot-Usekong, a semi-urban community in Eket LGA, using a mixture of face-to-face administered and self-administered questionnaires. Participants were selected using a non-probability convenience sampling strategy.

Findings from the survey showed that majority of the participants have a high risk perception of food-borne illness. It also emerged that most participants simply rely on cleanliness and good sanitation as the sole means of preventing food-borne illness. There seemed to be little or no knowledge about other food safety practices like separation of raw foods and ready-to-eat foods to prevent cross contamination, temperature control of food during storage, cooking food at right temperature and time to destroy pathogenic microflora, and so on and so forth.

What this implies is that a false sense of being secured from food-borne illness is assumed by the participants simply by maintaining good sanitation and cleanliness whereas as good as this practice is, in itself alone its unable to completely prevent food-borne illness from occurring.

This finding is consistent with similar social research work conducted in other parts of the country recently by other independent researchers using different research tools.

Below are photographs of FIPI volunteers administering questionnaires to participants.

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