Getting to the root of the problem
What game do you play at Halloween? This year you can forget apple bobbing. On Monday night schoolchildren taking part in a national campaign will be reviving the age-old pastime of hunt the head louse. Lice may not look much like evil spirits, but as those of us who have suffered a sustained infestation know, they must surely be hell sent.
The charity Community Hygiene Concern has designated October 31 as "Bug Busting Day". Using co-ordinated action, it says, schools can turn their classroom into nit-free zones, and they don't have to use a drop of insecticide to do it.
Organisers of the campaign, who run a "Louse Watch helpline", say they currently receive 80 calls a week from exasperated parents trying to put paid to an infestation. I know how they feel. When my daughter started scratching I wasn't over-worried - we'd had several leaflets home from school which stressed how simply lice could be treated. But in the course of the summer, the whole family tried three different treatments on five occasions and still the bugs came back.
Head lice, we all know, are nothing to be ashamed of. They love clean hair - and in the deluge of washing, ours became superclean. But when the bugs persist it's hard not to feel a bit of a pariah. Hairdressers balked at the thought and one refused us outright. Whenever our children were going to spend a day or two with friends, we dutifully doused them (and ourselves) again.
But, like many parents, I felt increasingly uncomfortable about exposing them time over time to insecticides, however weak the dose.
At the end of the summer we had one last bash with a proprietary lotion recommended by our health visitor, which we left on for the suggested eight hours. We spent the afternoon outside, but by the evening we had headaches. In the days that followed we removed several live lice - some so small they could only just have hatched.
For us the breakthrough came with a simple piece of information gleaned from the blurb on one treatment. Head lice don't lay eggs until about a week after they've hatched out. It follows that if you keep removing the live lice on a frequent enough basis, you can finish off an infestation by hand.
We went organic. We combed morning and night with a fine-toothed comb. We scraped off dead and hatched eggs with our fingernails. And by the time school started again, we were lice-free.
Joanna Ibarra, who co-ordinates the Bug Buster campaign, says the four most commonly used insecticides no longer offer realistic control.
Through regular home visits the charity has checked for themselves that families are following manufacturers' instructions to the letter, only to find the eggs hatch out after treatment while some adult lice are virtually unaffected.
Tests carried out at the London School of Hygiene and Tropical Medicine support suspicions that the insects are developing resistance to the older pesticides used in treatment - malathion and carbaryl.
Meanwhile, many parents turning to the charity's helpline report that phenothrin and permethrin, the more recently-launched alternatives, are also failing to kill all the eggs. But Heather Lowdon, senior product manager at Warner Wellcome Consumer Health Care, says its Lyclear rinse was shown to be "very effective" in trials. Napp Laboratories, which manufactures most treatments for head lice, refused to comment.
Ms Ibarra is concerned that children are being treated on a regular - sometimes weekly - basis and that there may be side-effects. She first became interested in the issue in the late 70s when her own children kept catching head lice. She took a degree in community healthcare before setting up Community Hygiene Concern which specialises in problems that can be overcome by co-ordinated action.
Some 600 schools taking part in Bug Busting Day have been supplied with posters and a teaching pack, complete with jaunty bug-busting songs. At a cost of 30p per family - usually borne by home-school associations - each child goes home with a sticker and a "Bug Buster comb".
Ibarra says that while teachers may feel squeamish about the subject, children enjoy the matter-of-fact approach, which can be slotted into the national curriculum as part of personal hygiene.
Publicity sent home to parents lets them in on the wily art of bug busting. The method relies on careful combing to remove hatched lice with a fine-toothed plastic comb, directly after washing with an ordinary shampoo. Families are assured they can be louse-free in a fortnight if they repeat the procedure every three days - but they are asked to take part whether or not they think they have lice, since without rigorous checking the bugs are all too easy to miss. Most outbreaks amount to 10 or fewer than 10 insects, and it may take three months for the tell-tale itching to begin.
The "nit nurses" who made routine school checks until the 1980s must have missed many cases with their cursory glances, says Ibarra, since research shows it takes a full five minutes with a fine-toothed comb to check a head has no lice.
The charity recommends that insecticidal treatments should be used only as the first step for heavy infestations. Parents are told to take care that remaining lice are combed out from wet hair immediately after treatment and at three-day intervals after that, in case unaffected eggs hatch out. Such advice is not generally made explicit in many product directions, says Ibarra.
While some shampoos and lotions come with a plastic comb, instructions explain that this is for the removal of dead lice and eggs (for "cosmetic" reasons, as one manufacturer puts it), and for checking future outbreaks.
Yet even if you're crawling, CHC says you don't have to turn to conventional insecticides if you don't want to. Believe it or not you can simulate the same "knock-down" effect on a heavy infestation by applying any alcohol such as surgical spirit or even brandy or vodka to dry hair - though never, it warns, in the presence of a naked flame. Lice then go into a drunken stupor making them easier to comb out.
The charity adds the provisos that poisonous spirits should never be used, eyes should be protected and that any spirit carries the possibility of an allergic reaction.
At St Paul's C of E Primary in Hampstead, north London, children will be bug busting for the third year running.
Headteacher John Wilkinson says the programme has successfully taken away the stigma. "Parents now accept that anyone can get nits - that they're a nuisance, but nothing to do with deprivation or being dirty. You can admit to it and do something about it."
The campaign does not eat up too much teaching time, he adds, since it can be accommodated within existing projects in a couple of classes. These children then lead the way for the others, performing songs and sketches in assembly.
Results have proved encouraging in schools that have been monitored.
At one rural primary, a group of 59 children had been repeatedly catching head lice, raising the incidence of cases to 117 per cent. There were no outbreaks in the three months after Bug Busting Day. Taking part cost around 55p per child - higher than usual since the school is small. But an estimated Pounds 620 had been spent on treatments in the nine months before.
Results were less dramatic in cities, where children mix more outside the school community, but parents still found a marked reduction in infestations before they began to creep back around Christmas. Just as important, they felt less like victims and better able to cope.
People have forgotten what was once common knowledge, says Ibarra. "We need to reconsider the wealth of information that we already had before we got on to the pesticide treadmill."
Now I understand why Victorian girls had to brush 100 times before bedtime.
How to be a Bug Buster
1 Use your usual shampoo, conditioner and a Bug Buster or other fine-toothed comb. ("Dust combs", as they are known, are available from chemists.) 2 Wash your hair in the normal way. Use lots of conditioner and leave it really wet.
3 Slot in the comb at the roots of a lock of hair. While the hair is still really wet, comb through a section at a time to at least six inches from the roots.
4 Any lice will land on the back of the comb, get caught between the teeth or fall on the towel. Check the comb after each stroke and remove any lice with a tissue, a cocktail stick or by rinsing under the tap.
5 Space at least 30 strokes over the head. Lice are easier to see off the head than in the hair. Louse eggs or nits are glued firmly to the hair strands, often near the roots. White eggs are empty eggshells. Live eggs are difficult to see. To check your own hair, comb out over a sheet of kitchen paper.
6 If you find anything, repeat the process every three days for a fortnight. Newly-hatched lice won't lay eggs themselves in their first week, when they are also unlikely to move to a new head. Make a habit to check rinsing water for lice whenever you wash your hair.
People with very curly hair can use the comb comfortably if they oil their hair well instead of making it wet.
For advice on Bug Busting and copies of the teaching pack, phone the Louse Watch helpline on 081-341 7167.