A visit to the hospital does not usually show what happens in the trunk. It is here where lost blood and body tissues and parts from surgeries, pharmaceuticals, medicine bottles — tonnes of hospital waste — go through. In the instance of the Kenyatta National Hospital, this might be as much as one tonne a day estimated to be half the medical waste generated from town. Quite understandably, it is not usually open to the general public.
Most of these normally wind up in incinerators — the most economical medical waste disposal system for the majority of hospitals. But a good deal of it slips through the system to get us stressed. Best practice dictates that such ash be buried.
However, as this author found out, this is much better said than done. Lack of adequate equipment to safely dispose of waste and failure to see best practices was a frequent characteristic in many hospitals visited in this survey.
From releasing harmful fumes and ash openly to the environment to dumping medical waste together with general waste, the local medical waste management scene still has quite a ways to go.
Raw medical waste and toxic ash from incinerators ends up in open dumps like Dandora and Eastleigh posing a health threat to thousands of individuals salvaging plastic and metal for recycling and residents living nearby. Major hospitals such as Kenyatta National Hospital which have great incinerators have run from reasons to bury toxic ash. Few physicians have a scrubber system where fumes are filtered to eliminate possibly toxic gases such as dioxins from burning plastic — a frequent material discarded by hospitals.
A current study on the global status of waste management ranks Nairobi as one of the worst in waste management. Residents living near Dandora reported a high number of respiratory diseases and have been discovered to have unacceptably high levels of heavy metals such as lead in their blood. Dandora dumpsite reeks of heavy metals that can hinder brain growth as our individual tests confirmed.
Walking throughout the dumpsite opened throughout the 1970s reveals unlikely materials that wind up here. Lying in the heap of an unsightly mixture of plastic bags and natural waste, one often discovers bloodied gloves, dressing bandages, needles, lost drugs and a plethora of other metals tucked off.
out of their small amounts, it’s not hard to conclude this come in smaller hospitals, clinics and dispensaries not willing to invest on the proper disposal of waste. Level five associations, previously called provincial hospitals such as Nakuru, are mostly nicely equipped with incinerators that may lighten esophageal waste into ash and water, states Kinoti.
A peek at the Dandora dumpsite reveals an unsightly mixture of plastic, food remains, animal goods and all manner of waste the town discards. Every couple of minutes a truck makes its way through the hills of garbage town has collected over decades. The steady stream of trucks falls quiet .
However, as dark drops, another group, mostly only trucks hurriedly enter the dumpsite, quickly offload their materials and also make their departure, all in just a couple of minutes — well conscious of their wrongdoing. A closer look in the chopped material reveals needles that are used, bloodied bandages, pharmaceuticals and a plethora of other waste in hospitals.
Early in the morning, a County Authorities of Nairobi earth mover turns over the waste mixing it with crap ready to get the next batch for your day.
Tens of individuals descend on the website, sorting out the garbage with their bare hands. Their interests are different. While some solely concentrate on milk packets that they wash at a sewage tunnelothers are interested in salvaging metals from the burnings heaps, fuelled by the excess gas beneath.
Still others are after the food remains which they accumulate to feed animals — all decided to earn a living. A prick from an infected needle and they might end up with serious illnesses including HIV.
They all seem too conscious of the threat, however they have to feed their children, a man, protected only by a pair of gumboots, states.
The National Environmental Management Authority and the County Authorities of Nairobi didn’t respond to our enquiries.
Nevertheless the threat of medical waste from the country does not begin or finish here. Medical facilities try to securely dispose of the waste to several levels of success. A large number incinerate their waste, but lack the prerequisite air pollution control equipment to guard against materials such as sulphur, known jointly as flue materials, getting into the environment.
In such cases, residents living near such facilities are vulnerable to respiratory ailments. A study carried out by a Yale University student recently discovered that elevated levels of toxic fumes from incinerators rending the atmosphere were responsible for respiratory ailments among residents living near such facilities.
A current report detailed that the elevated levels of heavy metals such as lead in vegetables grown and marketed in Nairobi. Lead is a dangerous metal which can cause retardation in children. Some farmers in Kinangop were recently in the spotlight for utilizing sewage to grow their plants largely sold in town.
Incinerators below standard
Dumping of toxic ash is not the sole problem facing the medical waste management scene. The state of equipment is needing, some dating several decades back and ill equipped to minimize contamination.
Most people hospital under level five have p Montfort incinerators where temperatures are not controlled and are very likely to pollute because they lack scrubber systems. “Unfortunately this kind of incinerators are typical in district hospitals and health centres,” Kinoti says.
“A wet scrubber is a compartment where the emissions are sprinkled with water to dissolve air pollutants, and what’s released to the environment is clean,” Kinoti describes. Employees are also not well protected in mid-level physicians. Due to the design of the incinerators, medical waste is loaded manually and workers who mostly don’t have protective gear are vulnerable, she states.
A moderate size incinerator costs an average of Sh20 million before installation, clearly a top shot for bicycles. Insert the high maintenance costs and also how these facilities guzzles several thousands of litres of gasoline to run daily and you wind up getting a rather high bill.
“However, the high price of incinerators isn’t any excuse for polluting the environment,” states Kinoti. “Hospital waste includes mercury and may produce furans that are extremely toxic and can cause cancer and acute respiratory diseases,” she states.
Medical facilities that don’t have incinerators are required to have contracts with specialised waste disposal businesses to take care of their waste. For many, this is just an unnecessary hurdle they have to undergo before obtaining a license to operate a hospital. Little is done to honor. A number do not follow through with all these requirements posing a massive health risk to people and the environment.
Hospitals categorize their waste otherwise due to their safe handling during transportation, storage, treatment and disposal, says Bernard Runyenje, assistant chief public health officer, Kenyatta National Hospital.
Highly infectious waste are those anticipated to be containing highly contagious pathogenic organisms such as bacteria and viruses while general waste might consist of office paper. Usually in red packs, infectious waste need special care throughout the process of waste disposal and therefore are assumed to be treated at origin. It is not however unusual to discover a worker carrying a yellow or red disposal bag without gloves or some other protective gear.
Tissues that decompose quickly such as amputated limbs are disposed of quickly or placed under refrigeration. Most African countries use incineration to dispose of medical waste.
Based on Dr Runyenje, incineration should be a controlled procedure and ought to happen in an enclosure. But he admits that incinerators in rural areas don’t meet these specifications.
A fantastic incinerator should have more than 1 room where waste is burned from the first room, so that there is increased temperatures at the second room and gases can be burnt at the third room, he states. In the end of the procedure, most of the waste was burned to a decent level. Clinics and dispensaries often working in highly populated areas often flout the regulations, publicly burning their waste with paraffin and charcoal to avoid the price of secure disposal. Half burned waste is easy to spot in dumps on roadsides and quite visible in municipal dumpsites.
Incineration nevertheless does not get rid of toxic fumes and heavy metals — if anything else it can disperse toxic fumes to a wide areas if not done correctly. The scrubber system is designed to reduce such contamination but the system is expensive and many hospitals visited don’t have it. Such gases may include carbon monoxide, carbon dioxide, dioxins and furans which can result in serious diseases such as cancer.
The minimal height of a chimney should be at least 10 feet above the tallest building around to minimise direct exposure to occupants. Whatever comes from the chimney ought to be dispersed away from neighboring buildings.
“Occasionally it is tricky to know what you’re devoting to the environment. A high chimney should not however be viewed as a substitute for a scrubber system, adds Kinoti. A high chimney simply disperses fumes further to residents who might not even be conscious of them, she finds.
To most, such as waste supervisors interviewed, ash from incinerators, or some other ashes for that matter is not harmful — a lost notion that may be contributing to its ditching. The fact remains they contain harmful metals such as mercury, lead and cadmium as our individual tests confirmed.
Incineration reduces the waste to approximately 10 percent of their initial volume. However, the residual ash generally contains very high content of heavy metals. How physicians and waste disposal businesses manage this will determine the health of our environment. Such should usually be buried in sanitary landfills to keep it from leaching to the ground, yet this practice seems rare in the country.
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Whether through sheer negligence, or lack of facilities and space or reluctance to satisfy the associated costs, medical waste nevertheless ends up in our environment. When disposed in open ground, heavy metals readily leach to the groundwater or make a direct method to our food chain.
Bottom ash under normal circumstances should be buried, but many health facilities don’t have disposal grounds. These burial grounds are not present either at Dandora where officials claimed the ash was chosen to be buried.
Some businesses are licensed to manage hazardous waste. However, Dr Runyenje nonetheless notes that not many manage general medical waste.
quite a few incinerators in public hospitals were in a state of disrepair leaving tonnes of toxic waste piling up and posing a threat to the general public.
Kenyatta National Hospital includes a ground where tonnes of waste are kept awaiting disposal. Two of its three incinerators are anticipating repair resulting in a backlog estimated at 170 tonnes.
Its newly acquired incinerator from India is the most innovative among the hospitals visited consisting of two chambers for maximum combustion. The wide system of smoke pipes contributes to a room where the smoke is passed through a fluid to eliminate fumes and other residue.
The resulting black slime comprises a number of the harmful metals. However, the layout and structure of the holding region does not meet specifications and some of it circulates to the ground, a source tells us.
The incinerator cannot be operated throughout the day because the nursing college is just metres away.
The location of incinerators in relation to offices, hospitals and other residential is a frequent problem in many facilities. The one in the Chiromo School of Physical and Biological Sciences for example Isn’t in operation since it sits close to an embassy.
One incinerator at Nakuru County is perilously close to the maternity ward, some smoke go straight to patients.
The situation plays out in many other hospitals around the country who also lack additional air pollution control equipment.
Ash dumped in open ground are still an open feature in a number of top facilities which may possibly poison ground water through leaching.
Ideally, ash from such waste ought to be buried in landfills, a practice that has been abandoned in the country.
With people living close to such facilities, they are inevitably exposed, and threat serious respiratory ailments and severe diseases including cancer. The Kenyatta National Hospital incinerators operate at night to minimise vulnerability to the pupils in the School of Nursing barely a dozen metres away.
A source told this author that the soils were so contaminated they will have to be skimmed away and buried. Meanwhile, residents will have to contend with dangerous, potentially carcinogenic, ash emanating from such facilities. “The price of the incinerator is too high for them to afford,” states Thomas Imboywa, who’s in charge of one of these at the Nairobi Women’s Hospital, one of the largest in the region. On a daily basishe manages the secure disposal of the days waste.
The incinerator, a massive blue structure sits on about 100 square metres of space slightly off the main construction and sports a top chimney, towering above the local construction. However, when a practice or hospital does not turn in any waste for weeks on end, it raises eyebrows, Imboywa states. He’s familiar with many such cases and the hospital is fast to repudiate such contracts according to their policy. Some healthcare facilities might just secure a contract together to wade through National Environmental Authority (Nema) regulations but have no intention to securely dispose of the waste, Imboywa observes.
individuals who don’t have incinerators are required by Nema to have a contract with hospitals such as Nairobi Women’s Hospital to dispose their waste. However, not all of medical waste ends up in such specialised facilities. Instead, in areas such as Kibera they’re doused with paraffin and burned in the open.
“But in this circumstance, sharps will stay and the waste may nevertheless stay infectious because it is impossible for them to reach the required temperature,” Imboywa said. In reality the material can stay infectious because they might not reach the required temperatures.
Devolution could make it worse
As more physicians come up in tandem with the growing population, a rethinking how medical waste is handled will be inescapable. The devolution of resources has witnessed more clinics and dispensaries set up in previously unreached areas.
Apart from being costly, Dr Runyenje agrees that if those facilities were to put up their own incinerators, there would be pollution and authorities will have more difficulty supervising them.
“There’s need to pool incineration facilities for hazardous and medical waste,” he states. These facilities can serve as emission monitoring points for authorities. “It will be easier to set controls from such a fundamental facility. “In the Technical Working Group, we are considering how counties can pool their facilities together and also have their health care waste incinerated in a central point. It will be rather costly in the long run to have every facility to have its own incinerator that cannot run at full capacity,” he states.
The ideal waste disposal method is controlled tipping being practiced in most of Europe and North America where it is buried in layers,” Dr Runyenje states. “The advantage with this system is that the property may nevertheless be used for other activities. It is the only assurance of disposal of any sort of waste,” he states.
Kariobangi, that currently hosts light industries, used to be a controlled tipping site before start dumping at Dandora. “Counties ought to be considering controlled tipping instead of investing heavily from incinerators,” he states.
General waste may have lots of recyclable materials however suitable segregation that can make this potential is still lacking in the country.
The effectiveness of recycling is determined by the efficacy of segregation.
The problem, according to Kinoti, is enforcement of the law. While larger hospitals are trying to correctly dispose of the waste, some smaller clinics may be spoiling it, she states. The fact that generators cannot track their waste once it is given to waste collectors is also an additional problem according to her.
“there are lots of quacks doing waste direction mixing household waste with hazardous waste. This may pose a significant health problem,” states Kinoti. Since they empty waste bins from houses, waste collectors can result in serious contamination in households. “Waste collectors who are collecting toxic waste ought to be committed waste handlers and should not manage other general waste,” Kinoti says.
Effluent in the scrubber system ought to be required for treatment to remove heavy metals and other pollutants.
“The law on sound medical waste disposal ought to be enforced, district and healthcare centres should install bigger incinerators to manage waste from smaller fee. We should have dedicated health waste supervisors,” Kinoti says.
The problem, according to Kinoti, is enforcement of the law. While bigger hospitals are trying to properly dispose of their waste, some smaller clinics may be spoiling it, she says. The fact that generators cannot monitor their waste once it is given to waste collectors is also another problem according to her.
“There are many quacks doing waste management mixing household waste with hazardous waste. This can pose a serious health problem,” says Kinoti. Since they empty waste bins from homes, waste collectors can cause serious contamination in households. “Waste collectors who are collecting hazardous waste should be dedicated waste handlers and should not handle other general waste,” Kinoti says.
Effluent from the scrubber system should be taken for treatment to remove heavy metals and other pollutants. But the sewerage system is broken and a lot is discharged on the way. Sewage pipes are sometimes deliberately punctured and effluent used as fertiliser for crops.
“The law on sound medical waste disposal should be enforced, district and healthcare centres should install larger incinerators to handle waste from smaller fee. We should have dedicated healthcare waste managers,” Kinoti says.