A visit to the hospital does not typically show what happens in the trunk. It’s here where discarded blood and body tissues and components from surgeries, pharmaceuticals, medicine bottles — tonnes of hospital waste — undergo. In the instance of the Kenyatta National Hospital, this might be as far as one tonne a day estimated to be half the medical waste created in town. Quite understandably, it isn’t typically open to the general public.
Many of these normally end up in incinerators — the most economical medical waste disposal method for most hospitals. But lots of it slips through the machine to get us stressed.
Incinerating waste at temperatures between 800-1,100 degrees Celsius kills germs, bacteria and other pathogens however, the ash still contains dangerous heavy metals like mercury and cadmium. Finest practice dictates that these ash be buried.
However, as this author discovered, this is much better said than done. Deficiency of adequate equipment to safely dispose of waste and failure to observe best practices was a frequent feature in many hospitals visited in this survey.
From discharging dangerous fumes and ash openly to the surroundings to dumping medical waste together with general waste, the regional medical waste management landscape still has a long way to go.
Raw medical waste and toxic ash from incinerators ends up in open dumps like Dandora and Eastleigh posing a health risk to thousands of individuals salvaging metal and plastic for recycling and residents living nearby. Major hospitals like Kenyatta National Hospital which have great incinerators have run out of reasons to bury toxic ash. Few hospitals have a scrubber system where fumes are filtered to remove potentially toxic gases such as dioxins from burning plastic — a frequent material discarded by hospitals.
A current report on the worldwide status of waste management ranks Nairobi among the worst in waste management. Residents living near Dandora reported a large number of respiratory diseases and have been found to have unacceptably substantial levels of heavy metals like lead in their blood. Dandora dumpsite reeks of heavy metals that can hinder brain development as our individual tests affirmed.
“Most health facilities take ash in their waste to municipal dumpsites straight or by collectors,” states Mary Kinoti, a lecturer on environmental and occupational health in the University of Nairobi.
Walking throughout the dumpsite opened during the 1970s reveals unlikely materials that end up here. Enrolling in the heap of an unsightly mix of plastic bags and natural waste, one often finds bloodied gloves, dressing bandages, needles, discarded drugs and a host 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 spend on the appropriate disposal of waste. Level five hospitals, previously called provincial hospitals like Nakuru, are largely well equipped with incinerators that can combust pathological waste to ash and water, states Kinoti.
A peek at the Dandora dumpsite reveals an unsightly mix of food, plastic remains, animal products and all manner of waste the town discards. Every few minutes a truck makes its way through the mountains of garbage town has accumulated over decades. The steady stream of trucks falls silent at dusk.
However, as dark falls, another group, mostly only trucks hurriedly input the dumpsite, immediately offload their contents and make their exit, all in just a few minutes — well conscious of their own wrongdoing. A closer look in the dumped material reveals needles that are used, bloodied bandages, pharmaceuticals and a host of other waste in hospitals. We even found syphilis and HIV test kits.
Early in the morning, a County Authorities of Nairobi ground inspector turns across the waste mixing it with crap prepared to receive the next batch to the day.
Tens of all individuals descend on the website, sorting out the garbage using their bare hands. While some solely concentrate on milk packets that they wash at a sewage tunnel, others are thinking about salvaging metals from the burnings heaps, fuelled from the excessive gas beneath.
Others are after the food stays which they accumulate to feed creatures — all decided to make a living. A prick from an infected needle and they might end up with serious infections including HIV.
They all seem too conscious of the threat, however they have to feed their kids, a man, shielded only by a pair of gumboots, states.
Nevertheless the threat of medical waste in the nation doesn’t begin or finish here. Medical facilities try to securely dispose of the waste to various heights of success. A massive number incinerate their waste, but lack the requirement air pollution control equipment to safeguard against materials such as sulphur, known collectively as flue materials, getting into the surroundings.
In these situations, residents living near such facilities are prone to respiratory ailments. A research carried out by a Yale University student recently found that high levels of toxic fumes from incinerators rending the atmosphere were responsible for respiratory ailments among residents living near these facilities.
A current report detailed that the high levels of heavy metals such as lead to vegetables grown and marketed in Nairobi. Lead is a hazardous metal that can cause retardation in children. Some farmers in Kinangop were recently in the spotlight for using sewage to cultivate their plants largely sold in town.
Incinerators below normal
Dumping of toxic ash isn’t the sole problem confronting the medical waste control landscape. The state of gear is wanting, some dating several decades back and ill equipped to minimize contamination.
Most public hospital under degree five have p Montfort incinerators where temperatures aren’t controlled and are likely to pollute because they lack scrubber systems. “Unfortunately this kind of incinerators are common in district hospitals and health centers,” Kinoti says. Employees are also not well shielded in mid-level hospitals. Because of the design of the incinerators, medical waste is filled manually and employees who largely don’t have protective gear are vulnerable, ” she states.
A medium size incinerator prices an average of Sh20 million before installation, clearly a top shot for bicycles. Add the high maintenance costs and the fact that these facilities guzzles several thousands of litres of fuel to run daily and you end up getting a rather large bill.
“However, the high cost of incinerators isn’t any explanation for polluting the environment,” states Kinoti. “Hospital waste contains mercury and can produce furans that are very toxic and can cause cancer and severe respiratory diseases,” she states.
Medical facilities that don’t have incinerators have to have contracts with specialised waste disposal businesses to take care of their waste. For many, this is merely an unnecessary obstacle they have to undergo before obtaining a license to run a hospital. Some don’t follow through with all these demands posing a huge health risk to the public and the environment.
Hospitals categorize their waste otherwise due to their safe handling during transport, storage, treatment and disposal,” says Bernard Runyenje, assistant chief public health officer, Kenyatta National Hospital.
highly contagious waste are those expected to be containing highly contagious pathogenic organisms such as bacteria and viruses while overall waste may include office paper. Normally in crimson packs, infectious waste require special care during the process of waste disposal and therefore are assumed to be treated at source. It isn’t however unusual to find a worker carrying a yellow or reddish disposal tote without gloves or some other protective gear.
Tissues that decompose quickly such as amputated limbs have been disposed of quickly or placed under refrigeration.
According to Dr Runyenje, incineration should be a controlled process and ought to happen in an enclosure. But he also admits that incinerators in rural areas don’t meet these specifications.
A great incinerator should have more than 1 chamber where waste is burned in the first chamber, so that there’s increased temperatures at the next chamber and gases can be burned in the third chamber, he states. In the conclusion of the process, the majority of the waste was burned to an acceptable degree. Clinics and dispensaries often working in highly populated areas often flout the regulations, openly burning their waste using paraffin and charcoal to prevent the cost of safe disposal. Half burned waste isn’t difficult to see in dumps on roadsides and quite visible in municipal dumpsites.
Incineration nevertheless doesn’t get rid of toxic fumes and heavy metals — if anything it can distribute toxic fumes to some broad areas if not done correctly. The scrubber system is designed to reduce such contamination but the machine 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 residents. Whatever comes out of the chimney ought to be dispersed away from neighboring buildings.
“Occasionally it’s difficult to understand what you’re devoting to the surroundings. A high chimney only disperses fumes farther to residents who may not even be conscious of them, she observes.
To many, such as waste supervisors interviewed, ash from incinerators, or any ash for that matter isn’t harmful — a lost belief that could be contributing to its ditching. The fact remains they contain harmful metals like mercury, lead and cadmium as our individual tests affirmed.
Incineration reduces the waste to about 10 per cent of the original quantity. However, the residual ash usually contains very large content of heavy metals. How hospitals and waste disposal businesses handle this will determine the health of our surroundings. Such should normally be buried in sanitary landfills to prevent it from leaching to the ground, but this practice appears rare in the nation.
Whether through sheer negligence, or lack of facilities and space or reluctance to meet the related costs, medical waste nonetheless ends up in our surroundings. When disposed in open ground, heavy metals readily leach to the groundwater or create an immediate way to our food chain.
Bottom ash under normal circumstances should be buried, but many health facilities don’t have disposal grounds. These burial grounds aren’t present either at Dandora where officials claimed the ash was taken to be buried.
Some businesses are licensed to handle hazardous waste. However, Dr Runyenje nonetheless notes that not many handle overall 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 has a ground where tonnes of waste have been retained awaiting disposal. Two of its three incinerators are anticipating repair causing a backlog estimated at 170 tonnes.
Its newly acquired incinerator from India is the most advanced among the hospitals visited consisting of two chambers for maximum combustion. The broad system of smoke pipes leads to a chamber where the smoke is passed through a fluid to remove fumes and other residue.
The resulting black slime contains a number of the dangerous metals. However, the design and structure of the holding area doesn’t meet specifications and some of it circulates to the ground, a source tells us.
The incinerator cannot be operated during the day because the nursing school is only metres away.
The location of incinerators in relation to hospitals, offices and other residential is a frequent problem in several facilities. The one in the Chiromo School of Physical and Biological Sciences such as is not in operation since it stays close to an embassy.
One incinerator at Nakuru County is perilously close to the maternity ward, a few smoke go straight to patients.
The situation plays out in many other hospitals across the nation who also lack additional air pollution control equipment.
Ash dropped in open ground are still an open feature in a number of top facilities that could potentially poison ground water through leaching.
Ideally, ash from these waste ought to be buried in landfills, a practice that was abandoned in the nation.
With people living close to these facilities, they are necessarily vulnerable, and risk serious respiratory ailments and severe diseases including cancer. The Kenyatta National Hospital incinerators operate at night to minimise exposure to the students in the School of Nursing barely a dozen yards off.
A source told this author that the soils were so polluted that they might need to be skimmed away and buried. Meanwhile, residents might need to contend with hazardous, possibly carcinogenic, ash emanating from these facilities. “The cost of the incinerator is too high for them to manage,” states Thomas Imboywa, who’s in control of one of these at the Nairobi Women’s Hospital, among the largest in the region. On a daily basis, he manages the safe disposal of the days squander.
The incinerator, a huge blue structure sits on about 100 square metres of space slightly off the primary building and sports a top chimney, towering above the nearby building.
“Medical waste is ideally incinerated within 24 hours,” states Imboywa. He is acquainted with many such cases and the hospital is quick to repudiate such contracts according to their policy. Some medical facilities may only secure a contract with them to wade through National Environmental Authority (Nema) regulations but don’t have any intention to securely dispose of the waste, Imboywa observes.
Those who don’t have incinerators are required by Nema to have a contract with hospitals like Nairobi Women’s Hospital to dispose their waste. However, not all medical waste ends up in these specialised facilities. Instead, in areas like Kibera they’re doused with paraffin and burned in the open.
“But in this case, sharps will stay and the waste can nevertheless stay infectious because they cannot reach the necessary temperature,” Imboywa explained. In fact the material can stay infectious because they may not reach the necessary temperatures. The devolution of funds has seen more clinics and dispensaries set in previously unreached areas. However, the resources are so confined to put waste disposal facilities such as incinerators.
Besides being costly, Dr Runyenje considers that even if those facilities were to put their own incinerators, there could be more pollution and authorities will have more difficulty supervising them.
“There is need to pool incineration facilities for hazardous and medical waste,” he states. These centers can serve as emission monitoring points for governments. “It will be much easier to set controls from such a fundamental facility. “In the Technical Working Group, we’re looking at just how counties can pool their facilities together and also have their health care waste incinerated in a central purpose. It’ll be rather costly in the long term to have every facility to possess its own incinerator that cannot run at full capacity,” he states.
The ideal waste disposal method is controlled tipping being practiced in the majority of Europe and North America where it’s buried in layers, Dr Runyenje states. “The advantage with this method is that the property can nevertheless be used for other pursuits. It’s the only pledge of disposal of any form of waste,” he states.
Kariobangi, that currently hosts light industries, used to be a controlled tilting site before start dumping at Dandora. “Counties ought to be thinking of controlled tipping rather than investing heavily in incinerators,” he states.
General waste can have many recyclable materials however proper segregation that can make this possible remains lacking in the nation.
The effectiveness of recycling is determined by the effectiveness of segregation.
The issue, based on Kinoti, is enforcement of the law. While bigger hospitals are trying to correctly dispose of the waste, a few smaller clinics may be spoiling it, ” she states. The simple fact that generators cannot track their waste once it’s given to waste collectors is yet an additional issue based on her.
“There are many quacks doing waste management blending household waste with hazardous waste. This can pose a significant health issue,” states Kinoti. Since they drain waste bins from homes, waste collectors can result in considerable contamination in families. “Waste collectors that are collecting toxic waste ought to be dedicated waste handlers and shouldn’t handle other general waste,” Kinoti says.
Effluent in the scrubber system ought to be taken for treatment to get rid of heavy metals and other pollutants.
“The law on sound medical waste disposal ought to be enforced, district and health care centers should install bigger incinerators to handle waste from smaller fee. We have to have dedicated healthcare waste supervisors,” Kinoti says.
“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.