prn8099 - Number 8, June 1996

BREAKING OUT OF THE FOOD 'POISONING' CHAIN
Dzulkifli Abdul Razak

Food-related poisoning can be described as a chain of events. It normally starts from a single source and tends to spread via the methods of food production, preparation, storage, distribution and lastly consumption. Perhaps the recent cholera panic is a case in point, coming allegedly from ice suppliers spreading eventually throughout the state of Penang, and finally the whole nation. In every one of this situation the challenge is to break out of the chain of events. Indeed this is easier said than done because the nature and incidence of poisoning can also be influenced by agricultural practices, food technology in industry and at home, as well as other ecological, environmental, socioeconomic and cultural practices.

If the outbreak of cholera cases is to be classified broadly under the category of food poisoning, then it must epitomise the ultimate in a series of food poisoning cases in the country in recent times. While there has been a number of food poisoning cases reported last year, none garnered the same severity and thus attention as the cholera outbreak. The last being the loh see fun incident in Perak in 1988 where 14 school children died.

Nevertheless, as observed in PRN8099 (No. 6, Feb. 1996), food poisoning seems to be a recurring theme, and its occurrences are quite prevalent with a number of cases involving more than 100 victims, namely school children. In fact according to the Ministry of Health, generally there has been an increase in food poisoning cases from 1599 in 1993 to 2283 in 1994. And according to the same source, last year too there were more than 2,000 cases of food poisoning reported to the Health Ministry. Looking at the latest statistics for 1996, the cholera cases alone already amounted to more than a thousand cases nationwide. At the last count more than 1,240 cases were involved in practically all states. Although the situation is now well under control, there are still new cases being reported.

But this is not just the question of statistics, which no doubt suffers from under reporting. It is more the question of awareness and about Malaysians of all walks of life taking control on the situation in tandem with the national aspiration of a healthy society as enshrined in Vision 2020. The rather frequent cases of food-related poisoning, especially the like of cholera is most unfortunate. It is a chain that must be broken.

If we examine the literature, cases of cholera outbreak were mainly reported in countries that are rather backward in terms of health status. Even then, not all of such countries are faced with this predicament. By and large it has been well under control such that cholera vaccination is no longer a require-ment in many instances. In this context, for Malaysia, noted to its rapid development and infrastructure, to be faced with such an outbreak can be quite embarrassing. It is perhaps not so much the physical infrastructure that is at fault but rather own mindsets, worst still when it started in an urban centre like Penang. One would expect that most city dwellers by now should be knowledgeable enough about simple cases of food-borne diseases and how to avoid them. All that is required to stay free from food (water) borne illness like cholera, is to a large extent common-sense, most of which are being cul-turally advocated and practised. Very little in fact are new or need to be learned anew. The key issue therefore is not so much what we know, but rather what we do with what we know.

For example, most we are too familiar with some of the pre-cautionary actions listed below, which is really fundamental in preventing the chain of events that spread the disease in the first place. But are they being carried out diligently?

Precautions to avoid foodborne poisoning:

According to WHO, even in industrialised countries, out-breaks of foodborne disease have been linked with inadequate cooking or re-heating, the use of contaminated ingredients and unsafe water, the preparation of food too far advance and its storage at room temperature, as well as cross-contamination between raw and prepared food. As it stands to day, cholera is one of those so-called re-emerging diseases, with some 384,403 cases reported world-wide in 1994, a 454 per cent increase from 1990. So much so that WHO has created a new division to deal with such situations.

The Outlook for 1996

Apart from the cholera-caused food poisoning, there are a number of food poisoning cases being documented as of this month alone. Just when the incidences of cholera were peaking in mid-May, there was an equally disturbing report of bad chocolate-flavoured milk supplied to schools under the Education Ministry's school milk programme. Despite paying for the milk packets, sixty-one primary school children had fallen victim to what was described as a mild case of food poisoning. If not being overshadowed by the cholera cases, even such mild cases can be another embarrassing incident, because this not the first time it has been reported to happen. Moreover, it is an official programme of the government in the attempt to ensure the good health of pupils in schools. Ironically still, in this case the packets were reported to carry an expiry date of October 5, 1996 - some four months away. Something then must be amiss.

Going by the past records, the figures on food poisoning consistently show a worrying trend. Although the number is relatively reduced as compared to that of 1989, the recent cholera outbreak does seem to indicate that the situation is rather fragile, and schools are indeed vulnerable.

Taking just the schools and other educational institutions, there are about 10 incidences involving food poisoning since the beginning of this year. One involving as many as 400 victims, a couple more than 100 students, and in one school the incidence of food poisoning happened twice within the span of three months. If the number of cholera cases are taken into account, there must be almost 2000 known food-related poisoning cases even before we progress into the middle of 1996. Coupled this with the many recent initiatives taken by the appropriate agencies to educate hawkers and food-sellers about food safety in various states, including those in schools, we may still have a long way to go in combating food poisoning in our society.

The incidences involving schools are particularly of concerned because the issue about cleanliness of food operators in school canteens is indeed a contentious one. The Ministry of Education in particular has drawn up regulations to tackle this problem and periodic checks are supposed to be carried out. Despite all these the situation remains precarious, not least because in schools and educational institutions is where we should be teaching our children (and indeed teachers-to-be) about good eating habits in a practical way. In fact, the recent cholera outbreak started of with trainees in a teacher's training college. And according to the statement by the Minister of Health recently, of 3508 school canteens inspected in 1994, only 21 per cent were classified as clean, and the majority (72.3%) are moderately clean. Meaning to say that only a small proportion of our school children are relatively well protected from food poisoning chain of events. If this is so, there must be something more that need to be considered in our effort to improve the situation.

Food for Thought

School canteens and cafeteria, besides providing gastronomic supplements, should at the same time be feeding the minds as well, on matters related to food and associated activities. In other words, it is not just the question of cleanliness per se but more so the practice the goes along with it. While aspects of hygiene are taught, they must also be constantly re-enforced and demonstrated as well as performed daily. These should involve active learning and not just rules and regulations to be implemented during breaks or recess times. The whole process in fact is the introduction to, and cultivation of a new set of food-related habits. The school canteens and cafeteria can be regarded as an extension of the classroom where we instill the training of the minds of the pupils as far as these aspects are concerned. After all habits are acquired, and schools can be an effective place where the good ones are instilled, and the bad ones changed, if the right approach is adopted. This is what learning is all about, and failing to do so would meaning there will be greater risk to food poisoning in this case.

There is also the question of making the right choice. This is imperative because we are what to eat and making preferences for the type of food is again basically an acquired habit and perhaps a matter of fine-tuning the taste buds over a period of time. This aspect has been too much taken for granted by parents, pupils and teachers alike that some of the current menu does not seem to reflect a healthy lifestyle that we are insisting upon. For example the sugary menus (especially in drinks and some local kuih) as well as sweet-eating habits between meals have not be seriously dealt with. This is something that we ought to reconsider because excess in diet is the major cause of dental decay and also in the long run be a factor in many diseases. Thus concerted health education on sweets and sweet foods can lead to the formation of healthy habits that can complement the government's effort to combat diabetes for example. In fact a study looking at the prevalence of diabetes amongst Malays and aborigines in various socio-economic locations in Malaysia, showed the pevalent of diabetes was closely linked to overweight. Students therefore should be weaned away from the so-called affluent diet, a pattern of eating dominated by high consumption of energy-dense foods of animal origin and of foods processed or prepared with added fat, sugar and salt. In contrast, we need a reasonable diet, with plenty of vegetables and fruits.

Many research findings have confirmed the well-founded suspicion that dietary preferences may influence the onset of several major chronic diseases. Our scientific knowledge is adequate, and we have enough experts to assist us in formu-lating new strategies. In short, new nutritional goals and eating habits for school children must be established. Schools too should take appropriate actions based on best information cur-rently available on the effect of diet and health (see accompanying report).

Perhaps it is also timely for schools to dwell upon the notion that food can indeed affect mental performances. It has been shown that by taking the different combination of foods or at the wrong time can result in sluggish mental functions. It reflects not only the quality and quantity of food we eat, but also shows the extent our bodies can tranforms it to nutrients that will protect our health, both mentally and physically. Apart from the concept of balance diet, this aspect is indeed very relevant to the learning environment in schools and many are still quite oblivious to it.

Thus in captive situations where canteens and cafeteria are located, they should be playing a role of more than just trading posts but be exampleries as what good eateries should be like. They should also educate, other than just sell, so that pupils can begin to appreciate what they are putting in their mouths. It is pertinent that the children put their knowledge into practice. This mental training is all important because it will be the ultimate guiding principles in assisting them the moment they leave the school compounds. What the children have learned will remain school knowledge unless they are able to transfer it to their lives in some relevant and practical ways. More important still is when they are confronted with the many junk food promotions that are specifically targeted to children of all ages, not least via the TV network. Already the younger generations have the tendency to regard traditional food as outdated even if they are nutritious. Only when equipped with a strong educational foundation and understanding about the value of foods, can they make informed decisions and begin to discern which eateries should be patronised and which ones they should stay away from; equally important what food to buy and which one to avoid. It is only at this stage can we hope that incidences of food poisoning can be drastically reduced.

As it stands today, it is rather disheartening to see that there are still many who are patronising the hawkers and food stalls situated outside the school fences, especially after the schooling period (even at times of the cholera outbreak). Judging from such daily occurrences in many schools, pupils seem to prefer the menu presented by the hawkers. This is certainly not an offence, but by and large the quality of food and the way they are sold remain much to be desired by most standards. For example, in the 1994, of the 1517 hawkers inspected, almost 10 per cent were put in the poor and very poor categories compared to only 6.4 per cent were categorised as good. The rest are just average (64.1%). In matters concerning food, average may not be good enough because casually one can still see many food operators and sellers handling food and money alternately with the same bare hands. Thus introducing whatever contaminants from the latter to the former and passing them on to the consumers, each time exposing them to greater risk of food poisoning.

In Malaysia, hawkering is a way of life and we can be proud of it if only they sell good wholesome food based on hygienic practices. At the same time, there are many localised reasons for the emergence and re-emergence of diseases and food can be just another reason if we are not careful. In accepting these new reality, there is therefore an urgent need to teach all the potential consumers not to be so gullible such that they unknowingly are endangering their health. And the next best thing to do is to sensitise them with the correct attitudes and role models. What better way if not to start at the very early stage in their schooling life. In this context schools canteens and cafeteria at all institutions of learning have a vital role to play and should be geared up to meet this purpose as well. It may be our only hope to break out of the food poisoning chain.

PRN CONSULT