Month: May 2004

Health Care Waste Management: Planting the seeds to sustainability within Africa

“Education for sustainability is a lifelong learning process that leads to an informed and involved citizenry having the creative problem-solving skills, scientific and social literacy, and commitment to engage in responsible individual and cooperative actions. These actions will help ensure an environmentally sound and economically prosperous future.”
The Vision of Second Nature

It was on April 16th that I left South Africa to attend a Health Care Waste Management Workshop in Uganda, Kampala. The Ugandan NGO, Pro-biodiversity Conservationists (Probico) through funding support from Health Care Without Harm (HCWH), organised the workshop. Since groundWork is a member of HCWH and has been working with rural hospitals in South Africa, Mozambique and Swaziland since 2001, groundWork had been invited by Probico to be one of the main speakers at this important event. I was excited to attend this workshop since it was the first of its kind being held in Uganda.

During the workshop, I was glad to see that key delegates were present. Besides many NGOs, other participants included members of the Ministry of Health, the Kampala City Council, NEMA, human rights lawyers, hospital institutions, the local University, as well as radio, media and television journalists. I was, however, disappointed to see that local community members were not present since it is communities and their children who are affected by the illegal dumping of medical waste and have no idea of its dangers. However, since health care waste is such a contentious issue all over Africa and has reached uncontrollable proportions, I was glad that this workshop was a start of an initiative to begin addressing this problem.

I was disappointed to hear the Ministry of health mention during the workshop that incineration would not be ruled out as an option for the disposal of waste in Uganda, considering the fact that the EPA has identified incinerators (medical and municipal) as principle sources of dioxin releases into the environment and since incinerators create dangerous emissions like dioxins and furans that are carcinogenic (cancer-causing) in nature. Incinerators also destroy resources, which can potentially generate income. Participants were shocked to hear about the health impacts associated with incineration. I was disappointed to hear that the Uganda government had neither signed nor ratified the Stockholm Convention on POP’s indicating its lack of global commitment to environmental management. Uganda however, seems to be referring to the Stockholm Convention by requesting for exemptions to use DDT for public health purposes.

However, despite the lack of instrumentalism on waste management by government and the fact that regulations are poor, I was glad to see many participants opposed government’s stance on incineration. Participants were glad to hear of the work regarding health care waste management taking place in South Africa, Mozambique and Swaziland and were amazed to see that through simple education on waste management and implementing the principles of reduce, reuse and recycling, rural hospitals in South Africa were achieving more that 50% in cost reduction per month, which was contributing to an increase in occupational health and safety for hospitals and communities.

Also, recognising the health and environmental impacts posed by incineration, delegates listened in eagerness about the initiatives undertaken by HCWH to promote low-costs treatment technologies in rural. During my presentation, I was delighted to sense an atmosphere of relief from participants who were excited to hear that alternatives to incineration for rural settings existed and the fact that pilot projects were currently been conducted in rural areas such as India, Swaziland and Kenya. After the presentation, participants expressed the need for government to explore alternative technologies as opposed to incineration and that the Ugandan government needed to implement a management system that would tackle the source of the waste problems being experienced.

The day after the workshop I had the pleasure of visiting a landfill as well as a few small-scale incinerators used for the burning of wastes. On the landfill, I was not surprised to see that waste was not being disposed of correctly. ‘Scavengers’ from the surrounding communities were present and were responsible for sorting through the waste and were being exposed to dangerous diseases, contributing to health impacts on their families and communities.

During my visit to the local University of Makerere, I was also shocked to find out from the head of the department of technology, that the Rockefeller foundation has been supporting his department in the building of incinerators in Uganda. If we are to truly solve the problems of waste management, then we need to work towards finding an African solution to African problems and not the support for dirty technologies from the North.

Overall, I felt the Uganda Workshop was of tremendous benefit to participants who are now expressing a keen interest in the management approached to solving their problems of waste. It is hoped that the Ugandan government will avoid incineration and look at other African countries such as South Africa (KwaZulu-Natal) where the government is moving away from incineration of medical waste to exploring alternatives and implementing waste management programs at their hospital institutions. It must be noted that no African country is alone in their struggle regarding waste management and in-house African models must be looked at as examples of insights for proper waste management.

Arusha: NGOs and CSOs unite

After a successful workshop at Uganda, I travelled to Arusha to attend the Eastern Africa CSOs / NGOs workshop on the implementation of the International and Regional Chemical Convention, organised by members of the International Persistent Organic Pollutants (POP’s) Elimination Network (IPEN), from 19 – 23 April. Some of the objectives of the workshop included the formation of working groups for further discussion on NGO participation in the implementation of conventions, on Pesticide Action Network (PAN) Eastern Africa, and the formation of a working group on the Strategic Approach to International Chemicals Management (SAICM). I was glad to see that many countries were present at the workshop which included Djibouti, Madagascar, Burundi, Ethiopia, Mauritius, Kenya, Eritrea, Seychelles, Somalia, Uganda, London and the US to name a few.

The provisional program for the workshop included introductions to important conventions and protocols such as the Stockholm, Basel and Rotterdam Conventions and Cartagena Protocol on Biosafety. Delegates also had the opportunity to adopt a strategic approach to NGOs participation in implementing chemical conventions. Other discussion surrounded chemicals management, community monitoring and reporting of chemical incidents, African Stockpiles and integrated pest management. I found the workshop to be most useful in understanding some of the key issues and technical debates and was glad to be part of the gathering.

After the IPEN meeting, the Global Anti-incineration Alliance (GAIA) together with Health Care Without Harm (HCWH) organised a daylong skillshare on Waste and Incineration on 24 April. The aim of the skillshare was to enhance participants’ awareness and understanding of the many-sided problems associated with waste incineration, to inform participants about the availability and viability of safe and sustainable alternatives in incinerating waste, particularly municipal discards and healthcare waste, and to identify pressing and emerging waste issues in the region as well as identify opportunities for collaboration.

I was glad to see that some 40 environmental health activists and proponents from a dozen of countries, mainly from Eastern and Southern Africa attended the skillshare. Participating countries had the opportunity to share some of the most pressing as well as emerging waste problems facing their regions. I was not surprised to see the overlapping health care waste challenges that were being experienced by all countries since it has become such a litigious issue. There was also the formulation of practical ideas to encourage information exchange and the sharing of skills and resources to address common needs and aspirations.

During the skillshare, we had the opportunity to launch the report by GAIA, entitled “Resources up in Flames: The Economic Pitfalls of Incineration versus a Zero Waste Approach in the Global South”. Resources up in Flames explains why incineration creates more problems than it solves in communities and why zero waste is the best choice for managing discards, it also explains how incinerator companies are seeking new markets for their obsolete technology in industrializing nations, why incineration is a losing proposition for host communities, and what alternatives are available for managing discards that protect the environment, generate jobs, bolster local economies and build vibrant communities. The report cites successful community approaches in discard management in Brazil, Egypt, India and the Philippines and outlines how to get started on the path to zero waste. What participants found exciting about the report was that it could be used to challenge policy makers to redirect the millions of dollars lined up for incinerators into waste prevention and reduction and zero waste systems.

Overall, the skillshare proved most useful to all countries. It is hoped that participating countries will use the information obtained to promote real solutions that will safeguard public health and the environment, generate jobs and contribute to local economic development in their countries.

Managing health care waste: Hospital workers unit

“All things are possible once enough human beings realize that everything is at stake.”
Norman Cousins

It was on the 5-7 May 2004, that groundWork hosted a health care waste (HCW) and incineration workshop, which took place at Edendale hospital in KwaZulu-Natal. The intention of this gathering was not only to highlight the problems regarding HCW and incineration but also to launch groundWork’s HCW manual regarding waste management.

I was elated to see that over 130 participants from hospitals all over the KwaZulu-Natal province had attended. This excellent turnout was not only an indication of the serious concerns that HCW waste poses to hospital staff and their surrounding communities, but also that health care institutions (HCIs) are committed to reducing the potential impacts that HCW poses to enhancing a sustainable society.

During the first day, various presentations regarding HCW and incineration were conducted. During the workshop, I noticed that participants generally lacked an understanding regarding the management approach to HCW; these included segregation techniques, occupational health and safety; as well as waste disposal. They also expressed that at their institutions waste management was not being taken seriously. Although participants understood the difference between infectious and non-infectious waste, they did not know how to apply the principle of reducing, reuse and recycling of waste so as to generate income.

The common voice expressed by delegates was that if a waste reduction plan waste to be implemented at their institutions, the support from top management would be essential if it was to be a success. They also expressed that top management needed to attend such workshops being held at Edendale for education and awareness.

Delegates also had the opportunity to tour Edendale hospital as a model institution in terms of waste disposal. groundWork has since 2001, been working with Edendale hospital in Pietermaritzburg and Ngwelezane hospital at Empangeni to provide insights into proper waste management. The aim was to make these institutions model hospitals for others to follow. Delegates were amazed at the tremendous cost savings that had been achieved at both institutions, with costs reductions of up to 50% through simply segregating of waste.

On the second day, participants had the opportunity to visit the Ixopo incinerator. Delegates expressed shock that government had allowed such a poor managed incinerator to continue operating illegally without a permit. It was also atrocious for delegates to see that workers did not have the required protective gears and were being exposed to dangerous working conditions. Some workers spoke of wearing the same clothing that they used at home. Participants, however, did applaud the KZN department of health for its move to phase out incinerators in the province and noted that government needed to ‘walk the talk’.

During the presentation on alternatives, participants were glad to hear that the possibility for affordable alternatives to incineration existed for rural areas but did acknowledge that the implementation of a particular non-burn technology was part of a much wider solution to waste management and needed to be implemented after a proper waste reduction program had been implemented. Much interest was expressed in the low costs treatment technologies and the pilot projects being conducted in India, Swaziland and Kenya (for more information

On the final day, groundWork launched its HCW manual entitled, “Managing hospital waste: A guide for Southern African health care institutions. The manual was a culmination of the work conducted at the model institutions. It was explained to delegates that through the manual, HCIs would be able to install an appropriate waste management system that could provide benefits such as an improved regulatory compliance, protection of human health by reducing the exposure of employees to hazardous waste, enhance community relations by demonstrating a commitment to environmental protection, economic benefits resulting from pollution prevention products that reduce and recycle waste, and the avoidance of long-term liability. Delegates did acknowledge that HCIs were the ones responsible for proper management and disposal of the waste they generated and that this manual would help increase employee confidence resulting from a healthier and safer work environment.

The workshop proved to be a major success. It is hoped that this manual will help many institutions in South Africa towards establishing improved HCW management practices, which will ultimately contribute towards sustainable development for the future generation. This manual must however not be seen as an end in itself since each hospitals waste management plan will not be identical to another hospitals plan and will need to be implemented accordingly.