Dealing With Cholera Joints: What’s The Best Approach?

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I stumbled upon them last weekend in, surprisingly of all places, Victoria Island one of the most “highbrowed” neighborhoods in Lagos. Rows upon rows of street food vendors with patrons hustling to get the attention of the food seller and jostling for a place to sit with their plates of indescribably cheap food. Welcome to what I would call “Cholera Alley” or “Cholera Cul de Sac”. Not the most enviable place to have your lunch except you are amongst the many Lagosians living below the poverty level of less than a dollar a day.

Popularly called Cholera Joints, they are familiar sights in this country, especially in urban centers. Preparing and selling food under the most unhygienic circumstances, these roadside food vendors have gained notoriety as public health menaces, perhaps the number one public health menace in our urban society. Sometimes late last year four persons died in Lagos, from what the Lagos State Ministry of Health confirmed to be cholera, after patronizing roadside food vendors like these.

I was told that the term “Cholera Joint” was coined on Nigerian University and Polytechnic campuses many years ago to describe those low life cafeterias with plank and plywood walls and pot-holed concrete floors situated on the fringes of campus society where food is sold cheap and usually patronized by those students who couldn’t afford the opulent restaurants located in the Student Union Building.

These dodgy canteens were aptly named cholera joints by students because except you are extremely lucky you stand the chance of bagging a dose of vibrio cholerae, the causative agent of cholera, in addition to the cheap meal you pay for. As it is “Cholera joints” are not limited to campuses, the entire society is dotted with them, encouraged and spurred on by the high poverty levels in the land and further enhancing the public health burden of food-borne illnesses.

The public health problem of street food vendors is not limited to Nigeria, it’s a phenomenon common to developing countries. The question is how should this problem be addressed here in Nigeria?

Should there be an outright clamp down on them? I don’t think this strategy will work for three simple reasons:
1. These vendors are so widespread that it is next to impossible to locate them all to implement any effective clamping down exercise, and because they are very mobile with few fixed assets it will be easy to avoid being detected.
2. Secondly clamping down outrightly may cause social upheaval no matter how minor it will be anyway. It can be viewed as the rich again taking it out on the poor, a regular sentiment in our classed Nigerian society because majority of the poor depend on street food as restaurants are beyond their reach.
3. Street food vending has significant economic relevance. It occupies a large portion of Nigeria’s informal business sector and may be too important to outrightly clamp down on for this reason.

Another option is to legislate and regulate their activities. This would have been an effective strategy if the appropriate government commitment especially at the state and local government levels is present and also if there is availability of resources to monitor compliance to regulations and legislations. The first is very questionable and the second is doubtful because of how widespread and ubiquitous these food sellers exist all over the urban areas.

A third option is to reach out to these street food vendors and engage them in awareness campaigns, teaching them basic food hygiene practices that will protect their patrons and themselves, helping them to understand the benefits of improved hygiene and sanitation and where possible providing basic infrastructure for them such as food warmers, brooms, napkins, soaps, etc. Now this approach will naturally be painstaking and requires patience and persistence. Each roadside food vendor needs to be convinced and convinced thoroughly of the need for change and there are hundreds of thousands of them dotting the landscape. But it can be done, resulting in a win-win situation for government, the food vendors themselves and their customers.

This third option can be effectively pursued by NGOs with adequate fundings and grants and this is part of the objectives of Food-Borne Illness Prevention Initiative to reduce the public health burden of food borne illness in the society.

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Avoiding Rotten Fish

Nowadays if you live in Lagos and frozen fish is a favorite of yours, you need to be careful.

I watched on the 8 p.m. news yesterday the Honorable Minister of Agriculture and his entourage ordered immediate closure of seven cold rooms of two Lagos-based companies on the basis that they stocked rotten fish.

The visibly angry minister held up a pile of frozen fish and stated “This is a rotten fish, can you see that? This is what these people are selling to Nigerians; they’ve been selling rotten fish. These importers bring in rotten fish to Nigeria; they don’t declare it to the government.”

So how can you be sure the fish you are buying is safe?

1. Smell the fish. A fishy smell is not good as it signals the fish is getting spoiled. Food experts describe the proper smell as being cucumber-like or with the clean smell of an ocean breeze.

2. Look at the scales and gills. The gills should be a bright color and the scales shiny. Dark gills and dull scales signal “old.”

3. Poke the fish flesh with your finger, if you you’re buying at a fresh fish market stall. If the flesh springs back quickly, it’s fresh. If your fingerprint stays, move on. Fresh fish should have a bright, firm appearance and should appear moist, not dry or dull.

Ten Years After

This year 2014 marks the tenth year anniversary of a significant food borne illness incident in Nigeria that for a moment brought the problem to the highest domain of public discussion.

I am referring to the Indomie Noodles scare that occurred in May 2004.

When the news started making rounds that Indomie Noodles, a very popular instant noodles brand, was resulting not just in sickness but in deaths of those that eat them, it sparked off a kind of negative nationwide reaction to a food brand unseen or unheard of before in this country.

Calls were being made from friends to friends, family members to family members, SMS were flying about (this was before the advent of social media like Facebook and Twitter in the country) and there was a wild stampede in almost every home across the country to get rid of the noodles. Even in schools, teachers were going from lunch pack to lunch pack of kids looking for anyone that brought noodles to school mainly so because Indomie noodles was a favorite meal of children at that time. Everyone was suddenly aware of and talking of food borne illness and its effects. In government corridors, social gatherings, schools, offices, homes, churches there was a frenzy of activity.

Never before and never afterwards till date has so much public attention been given to the notion that food can lead to death in the annals of this country.

The true story of what actually happened still remains unclear. But one thing that was established after the frenzy died down was that there were no sporadic deaths across the country resulting from eating Indomie noodles as was being rumored. What was confirmed was that someone did die in Lagos…but the connection of that fatality to the eating of a pack of Indomie noodles wasn’t scientifically established in anyway.

I recall without prejudice that I was a Quality Control Technician at the Indomie Noodles Plant of De-United Foods Industries Limited (Makers of the Product) and at the exact tenth year anniversary to be marked in May this year I hope to put a post up that looks into the entire episode.

One good but shortlived outcome of the whole episode is that ordinary folks became aware of the problem of food borne illness and the dangers of consuming contaminated foods.

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

Don’t Mishandle Me

If food could speak, these three words would probably be their motto. On a daily basis in this country, food is regularly mishandled. When I talk of mishandling food I mean carelessly handling food before eating.

I read about an outbreak of food-borne illness that occurred years ago in Ibadan, Nigeria, that claimed 20 lives. The outbreak resulted from sandwiches that were poorly handled. It was reported that the sandwiches were prepared in Lagos and kept without refrigeration until consumption the next day at Ibadan. When food is mishandled like this, it responds by baring its fangs with disastrous and often fatal consequences.

Mishandling of food occurs in many forms in homes and food businesses:

  • Leaving left-over food unrefrigerated to eat the next day or even several days after.
  • Defrosting frozen food on the kitchen shelf at room temperature.
  • Buying frozen food from the market (or supermarket) and not heading home straight to store in freezer.
  • Inadequate and improper heating of food.
  • Leaving food exposed and uncovered.
  • Preparing food with unwashed hands.
  • Preparing food too far in advance.
  • Using same utensils to prepare raw food and ready to eat food.
  • Keeping or storing ready-to-eat foods like cold sandwiches and salads at room temperature

These are all examples of poor food handling. Many folks do these things inadvertently and unknowingly but this doesn’t spare them the heart ache and ill health that results from it.

At a time when I was handling inflight catering for an airline, we served onboard an egg & mayo sandwich option on the breakfast menu. Nicely packaged in plastic sandwich packs it was a hit with passengers on the early morning domestic flights out of Lagos. But there was a problem; passengers were actually taking the sandwiches off with them when they disembarked at their destination. Why this was a problem was that egg & mayonnaise are highly perishable and high risk food that needs to be held in the chill chain to keep safe to eat and we weren’t sure how passengers were handling the sandwiches after the flight. We were concerned that someone would turn up later on to claim that he got food poisoning from the airline’s sandwich. My boss at that time, Paul Sharp (am certain he will get to read this post soon) decided we had to include a caveat note on the packaging of the sandwich strongly advising passengers that the sandwich be consumed on board during the flight.

Don’t Mishandle Me…that’s a warning that is wise to heed from food & drinks.

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.