Public Health Field Trip to the Village of Eyam

By Lee Houghton

Tuesday 8th October saw our newly bonded MSc Public Health students set forth for the wilds of Derbyshire, on a field trip as part of the Evidence Based Public Health Module. The aim of this field trip was to give us all an understanding of real-world public health in action, to show the development of public health through the ages, and to spend some time together as a group to get to know each other better.

I had never heard of this village and indeed began the trip by repeatedly pronouncing its name wrongly (think Eeeeeem—to rhyme with steam—rather than the two syllables you brain will probably go to initially). A quick Google search identified it as ‘The Plague Village’, which sounded intriguing but I avoided reading much more as I didn’t want to have too many preconceptions.

On the way to the village we stopped at the glorious Chatsworth House to see how the other half lived! I had always wanted to visit here and it did not disappoint, a perfectly grand National Trust property set in the most beautiful gardens and wider landscape, just walking round I got a real feel for how incredible it must have been to live here and the impact an estate like would have on the wider communities in terms of providing work/opportunities to sell/buy produce.

Chatsworth House — as you can see we are a little windswept and rained on here!

We continued on to Eyam to find a more realistic representation of how the majority of people would have lived in the 1600’s (whilst all secretly still wishing we lived at Chatsworth!). As a group we toured the village with tutors pointing out areas of interest. The village suffered terribly when the plague hit and as a community took positive action (potentially to their detriment) to avoid onward passage of the disease.

We saw the homes of those who had passed away and the innovative methods of intervention that the villagers put into place to avoid passing the disease on.

The sad tale of the residents of Rose Cottage
A definite improvement in the weather here! Students at the Boundary Stone

We visited the church and graveyard where a beautiful window has been installed commemorating the sacrifices made by the people of Eyam, and also displays showing some interesting facts and anecdotal stories of individuals…needless to say we were impressed with Margaret Blackwell’s accidental cure!

We were impressed with Margaret Blackwell’s accidental cure!
The beautiful window in the church in Eyam, commemorating the sacrifices made by the villagers

The afternoon of this first day was spent doing group work in the classrooms at the hostel, this involved research and working together to create presentations telling the story of the plague and exploring the implications of the villager’s choices. It was a great opportunity to work together in a relaxed environment, fortified by many cups of tea and the beautiful views from the classroom windows!

Beautiful views from the classroom windows
Fortified by many cups of tea

After dinner in the hostel it was onto the evening activity, which consisted of a rousing game of Pandemic! I had never played this boardgame before and after we were all initially confused by the YouTube video of instructions that never seemed to end, we decided to get on and have a go. Turns out we weren’t too bad and were soon working together to save the world (Disclaimer: we probably need another couple of practice games before we could actually save the world!).

A rousing game of Pandemic

Day 2 saw us back in the classroom working in groups to look at the modern-day issues around Plague, we were really surprised to find out that there are still significant pockets of it about, and to look at government and health agencies approach to tackling this. It was great way of looking at global inequalities and their impact on population health.

After lunch there was just time for look round Eyam’s museum which has so many interesting displays and resources on plague in the village. It was a useful way of consolidating what we had learned and seeing some effective visual representations of the spread and reach of disease, including really personal stories.

Eyam museum
17th Century Plague doctor with protective suit (waxed fabric overcoat, a mask with glass eye openings and a beak shaped nose, typically stuffed with herbs, straw, and spices)

The trip was a great success and we found it so useful to see public health in action through history. It was a great opportunity to spend some quality time together and definitely helped to bond us as a group, which will hopefully stand us in good stead for our next assignment where group work is vital.

Improving sanitation in Ugandan schools

Teams4U is a charity that brings volunteers from the UK to make a difference in children’s lives in countries including Bosnia, Belarus, Romania, Sierra Leone and Uganda. This was my third visit with Teams4U to the Mukongoro district of Kumi Region, Uganda, to participate in their work with schools to improve public health. In recent months Teams4U’s attention has focused on reducing the days missed from school due to sickness and diarrhoea. An intervention to improve hygiene and sanitation has been developed.

Teams4U volunteer with school children

 

 

 

Basic sanitation

There is no water supply or electricity supply to the public schools, although there is typically a hand pump installed at the perimeter of the school grounds, which is shared resource for the school and the local public. There are usually three or four pit latrines for the children to use. The latrines often have no doors for privacy and used by around 1000 children, making the smell and flies unbearable. There is no source of water nearby for hand washing.

Open pit latrine

 

When children are at home, there are also often no hand washing facilities. Each day water is carried from the nearest hand pump and stored in water containers for cooking and washing, but many homesteads lack a drum with a tap for easy hand washing. Some families are not aware of the importance of hand washing to prevent disease.

 

A typical homestead

 

 

 

 

Sanitation solutions

A ‘Tippy tap’ is a contraption that is simple to make with a small water container, rope and wooden supports. A child can easily tip the drum to let the water out by using the foot operated lever. They are suitable for use at a homestead. Some schools have been using them, although a single tippy tap is inadequate for the typical school which has over 1000 children.

 

Demonstrating the tippy tap

 

 

 

 

With support from the Welsh Government, Teams4U have begun to install simple hand washing facilities, comprising a large tank with two taps and bars of soap on string. These tanks can store sufficient hand washing water for a whole school. They still require filling by hand, but schools arrange teams of children to carry water from the pump to the tank as part of their daily chores. The tanks can be drained during holidays to allow them to be cleaned. Some schools fill their tanks with soapy water to get over the problem of soap bars going missing.

 

Hand washing using a new tank supplied and installed by Teams4U

 

 

 

 

 

The Teams4U installation also includes ‘toilet flappers’ fitted to each of the long drop latrines and signage about hand washing on the walls. The toilet flappers are simple devices that remain closed to seal off the odours and stop flies from entering the long drop. They function similarly to the flaps in the portable toilets that are used in festivals in the UK.

 

Toilet flapper to fit to a pit latrine

 

 

 

 

Volunteers get involved

The whole school also watched as Teams4U volunteers acted out a hand washing story about a Ugandan boy who does not wash his hands and becomes ill. In the story he then learns about hand washing and when to wash hands. The story features the family’s naughty goat, who causes great hilarity amongst the children when he runs amok. The use of the tippy tap is demonstrated, and the boy learns how and when to wash his hands properly. He learns to wash his hands after handling animals, after using the toilet and before meals. He finds in the future he is no longer ill.

 

Volunteers performing the play for the whole school

 

As in previous trips, the Teams4U volunteers visit a school each day for seven days. The morning activity is a physical activity intervention where all 1000 or so children take part in simple team games. In the afternoon, there are sessions for the older children that focus on puberty, development and respect for women. These have been the subjects of my previous blogs. There is also an opportunity for volunteers to play with the children. The challenge is to think of activities that overcome the language barrier and can be done with hundreds of children at a time! Successful activities include simple face painting, balloons and bubbles.

 

Teams4U volunteer face painting to entertain the school children

 

 

 

 

 

 

Click here to see a film of a volunteer entertaining the children with bubbles

https://www.facebook.com/penny.cook.75436/videos/10156365190389821/?t=1

 

The interventions with the children are supported by an education programme for the key church leaders, health care workers and senior women teachers. This is supported by funding from the Department for International Development (DFID). The training aims to provide a legacy for the ongoing education of the children in hygiene and disease prevention, dignity and respect, puberty, menstruation and sexual health.

 

Volunteers supporting the training of the teachers

 

 

 

How do we know it works?

The onus is on the charity sector to deliver an intervention that has a lasting impact. At schools we visited, there is evidence of previous well-meaning interventions that have had no impact. I asked why the schools needed Teams4U’s water drums when some had evidence of large water storage drums. I was told that the drums had been designed to collect rain water, but no one had ever installed the guttering to harvest the water. Boxes containing computers sit unopened in schools that have never had an electricity supply.

 

Volunteer in the classroom

 

In addition to the work to educate local leaders on how to sustain the benefits of the interventions, Teams4U will be collating data on school attendance in the coming weeks in order to determine whether the hygiene interventions have had an impact on absence due to diarrhoea. The aim will be to provide the intervention to all 150 primary/junior schools in the Mukongoro district. The charity has already demonstrated that its puberty and development sessions (‘Develop with Dignity’) are effective: knowledge of menstruation increased after the education sessions, and fewer girls miss school because of their periods.

 

Girls receiving washable sanitary ware as part of the Teams4U intervention

 

Get involved 

You can join in and help run the sports, ‘Develop with Dignity’ and sanitation programmes. Read more about volunteering opportunities on the Teams4U website. If you come as part of the University of Salford’s BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme during a heavily subsidised 10 day trip (the students pay £200 towards the cost of the trip).

 

A powerful experience for the volunteers

It is difficult to describe the pure pleasure that these children get from a little attention from the visitors. The impact on the volunteers is also profound as we experience the simple joy that children get from a hand shake or a stream of bubbles. It is also humbling to think how we take our children’s education for granted. In Kumi, there are no staff to clean the school. The sweeping of the classrooms, the fetching of the water and the cleaning of the toilets is all done by the children. Some of the forward thinking schools grow their own vegetables, and the children also tend to these. In several of the schools we are greeted with songs of welcome. The children also sing songs that describe how seriously they take their learning in order to better their lives. We found this truly humbling.

 

Children playing team ball games as part of the Teams4U intervention

 

 

MSc Public Health Trip to Eyam – October 2017

As part of the extended induction programme, the MSc Public Health students took part in a two-day field trip that was designed to provide an immersive experience for students to orientate towards the discipline (with a real word example of a past public health situation), get to know each other, form friendship groups, and begin to work in teams.

Students learned about the control of an infectious disease in history, and one village’s unique approach to dealing with the plague crisis. This was designed to enable students to learn lessons that can be applied to infectious disease today.

The field trip took us to Eyam, a small village in the Derbyshire Dales within the Peak District. In 1665, the village experienced an outbreak of the bubonic plague, and the villagers chose to isolate themselves to prevent the spread of infection. During the outbreak, 260 villagers died (double the rate of those who died in London from the bubonic plague).

On day one, the students took part in a guided transect walk around the village to learn about the history of the village, some of the key places, and the decisions that were made during the outbreak of the bubonic plague. The great British weather made this a very wet two hours, but a few hardy souls made it to the boundary stone, and we all learned a lot along the way about how the village dealt with the situation.

‘This event has brought public health to life in terms of location of historical plague being very real with houses in the village, the well etc.”


 

 

 

 

 

 

 

 

Upon warming up with cuppa soup, teas, and coffees back at the Youth Hostel, the students started completing more detailed maps in groups to present to the judges (the lecturing staff), and provide their overview of the village based on the transect walk. As you can see the judging was intense!

 

The final activity of day one involved an outbreak game: could our students and staff survive being infected by those who were the source of the outbreak? Our very own Margaret Coffey was infected twice, but was deemed allowed to stay in the Youth Hostel, once the class had worked out who were the sources of the outbreak, and how it had spread around to those infected.

‘The outbreak activity was a lot of fun! It helped us understand how infections spread and the concept of having carriers who come into contact with a specific infection but do not get sick’

 

On the second day, those who were unable to join us, and were based back at the University, carried out similar activities to those who were in Eyam. The students were split into groups to create a presentation related to either: the data and risk factors related to the plague outbreak in Eyam; or the modern spread of the plague, looking at Madagascar as a current case-study. Having a student from Madagascar on the trip with us really brought this work home for everyone, with their explanation of some of the measures that were currently in place.

‘The group work on the Plague worked very well, especially presenting in the order that we did – historical plague to current issues re: global plague. Definitely a learning experience’.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Finally, we finished off with a trip to the local museum to round up all the learning before people headed back to Salford on the coach. Despite the weather, we all had a great time getting to know each other, learning about Eyam, and thinking about how this relates to modern Public Health.

‘I feel like I know more people and am more relaxed around them’.

‘It has helped us get together. I think we will work together more effectively’.

The trip received overwhelmingly positive feedback, with 68% reported their experience on the trip as ‘excellent’ and 26% as ‘good’. Participants especially valued the chance to get to know each other.

‘I feel more confident now about my MSc programme and want to give my best in order to succeed’

‘I believe I am 100% ready to study this course. I have developed a better understanding and a new love for it. I know it’s going to be an enjoyable course. Looking forward to it’

We hope you will be able to join the MSc Public Health course in the future and come with us to learn more about the history of public health, and experience some of the English countryside. You even get to stay in a mini castle for a night that is owned by the Youth Hostel Association.

 

University of Salford and Teams4U Partnership: Uganda

With its numerous and diverse cultures, Winston Churchill wrote “Uganda is truly the Pearl of Africa” and went on to say “The Kingdom of Uganda is a fairy tale. The scenery is different, the climate is different and most of all, the people are different from anything elsewhere to be seen in the whole range of Africa….what message I bring back…concentrate on Uganda”. Over one hundred years later this is still true, and Uganda, relatively untouched by tourism, retains a taste of Authentic Africa.

Children at a primary school in Kumi

The University of Salford has been working with charity Teams4U for over eight years. Recently, the University’s partnership with Teams4U has been developed to allow students to gain hands-on experience of delivering a public health intervention programme in rural Uganda, learning how to break down cultural barriers and to communicate with the people they serve in order to make the programme a success. Students on our BSc Public Health and Health Promotion course have the opportunity to take a subsidised ten day trip to Uganda (the student pays £200 towards the cost).

The Teams4U Uganda programme is the brainchild of honorary Salford graduate Dr Dave Cooke, who wondered if physical activity could help primary school children to achieve better results at school. Since it began, the programme has evolved and changed to tackle some of the underlying issues that lock communities in a cycle of poverty.

Small changes make a big difference

The experience of handing a football to a child that has never touched a ball is something that is difficult to describe. Before the programme began, children in rural primary schools in the Kumi district of Uganda didn’t have PE lessons; with class sizes at over 100 children per teacher, finding an activity that they could all take part in was difficult. To make matters worse, the budget for most schools is just £1.50 per child for the whole year, meaning they can’t afford basic sports equipment like footballs. Often the schools aren’t funded at all – the money just ‘disappears’.

Playing the team games with Teams4U

The concept of the programme is simple, but the impact on the children is profound – headteachers have even said they felt inspired to change the way they teach as a result. However, this is where students can get involved in vital research, as many questions still need answering: does the experience of the teachers of the programme change their attitudes to physical activity? Does the donation of balls for football, netball and other activities have an impact on physical activity and sports in the schools?

Breaking the cycle of poverty

The programme also revealed other barriers to education that children in the community face. While both girls and boys are often kept off school to help out at home or work in the fields, girls in particular are not always encouraged to attend school. To add to this, we found that a big problem keeping girls from school was the lack of feminine hygiene products and limited access to water, meaning that they were missing up to a quarter of their schooling.

Keen to break the cycle of poverty where children drop out of school, girls have babies very young and have large families that they can’t support, the team set up two separate programmes to tackle these issues. The first, ‘Develop with Dignity’, provides washable pads for girls to use, meaning they now feel comfortable going to school on their period. Secondly, we organised educational sessions with parents, children and community leaders to discuss the importance of staying in school.

Girls receiving washable menstrual pads and underwear

Again, research is needed to understand exactly how these interventions work: does the intervention increase school attendance, for girls in particular? Are parents and the community more aware of the importance of education?

Join a trip to Uganda

You can join in and help run the sports and Develop with Dignity programmes. If you come as part of the BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme.

Our volunteers often find that while they go to Uganda with the intention of serving, they end up gaining more than they give: the experience of sharing time with children who get so much joy from the simple gift of your time and attention.

Find out more

Watch this video about the University of Salford’s public health and health promotion opportunities in Uganda

To find out more about the other public health and health promotion work that the University of Salford and Teams4U have carried out in Uganda, go to our related blog posts

Find out more about Teams4U and Develop with Dignity