African solutions to African problems: Developing countries doing it for themselves

“I don’t believe that the solutions in society will come from the left or the right or the north or the south. They will come from islands within those organizations, islands of people with integrity who want to do something.”
Karl-Henrik Robert – Founder of The Natural Step

It was in May that an initial Health care waste Skills share was conducted in Mozambique, Maputo. This visit was part of a much wider visit, which will be taking place in November when an expert from India will be visiting hospitals in South Africa and Mozambique to share their knowledge regarding health care waste management. Sristhi, an NGO in New Delhi, has already done great work in transforming some of their worst hospitals into model hospitals for others to follow. Such expertise from folk in India is essential for South Africa and Mozambique and will be of tremendous benefit since the situation in India has been much shoddier that than of Africa’s. The November skills share will be an exciting opportunity since it will be a collaboration between NGOs from South Africa, Mozambique, Swaziland and India. I look forward to welcoming the assistance from India since this developing country will be sharing their expertise with other developing countries, shifting the reliance away from being dominated by experts in the north. It would also be essential in terms of finding developing country solutions for a developing country.

Due to health care waste being a mounting problem in Mozambique, Livaningo an environmental justice NGO had requested that groundWork visit hospitals in Mozambique and share their expertise with regard to issues concerning health care waste. groundWork has since the year 2001 been committed to the process of reducing the impacts of health care waste and incineration and the potential impacts that it poses towards enhancing a sustainable society. groundWork has a Waste Project and has been working with two hospitals (Edendale in Pietermaritzburg and Ngwelezana in Empangeni) in South Africa to make them model institutions for others to follow. It was due to our intervention at these government hospitals and the substantial improvements in health care waste management, which have been achieved thus far that we were called into conducted audits of two hospital waste streams in Mozambique.

The first hospital that I visited was Maputo Central hospital. Katya Hassen the health care waste projects coordinator and Mauricio Sulila of Livaningo accompanied me during my visit to the institution. Upon arrival, excited staff members who were eager to start addressing waste issues within the institution warmly greeted us. Our visit to the hospital was conducted over a period of two days. An initial hospital meeting with management staff was conducted in the morning. Overall, I found that management staff were positive about our visit and genuinely showed their willingness at the hospital to start reducing waste.

During our walk through the facility, I was glad to see how staff members at the various departments eagerly answered questions that I had, this was so as to understand the hospital waste management system better. The staff also expressed their concerns and issues in a legitimate way. I could see that they looked at the skills share team in a way that seemed to indicate hope in terms of this visit being a start to resolving some of the pressing issues being experienced regarding health care waste. Some staff members were enthusiastic to ask questions and when we made recommendations, they keenly listened with open anticipation. One of the most common concerns expressed was the fact that all staff members would need to be educated on handling and disposal regarding health care waste issues and that all staff would need to be unified to work together.

From all my visits to health care institutions during the start of my work with hospitals at groundWork, I found the situation with regard to health care waste in Mozambique to be much worst than any other I had ever seen. Mozambique did not have a waste management system in place during my visit. I was shocked to hear that only in June this year for the first time ever were regulations for health care waste management implemented. Upon examination of these regulations, I found that they were, however, weak and did not adequately address the problems of waste management, although I did see it as a start towards the process for addressing health care waste management. According to the regulation, nothing is done to consider other waste solutions such as the 3 R’s (reduce, reuse and recycle).

Other findings during the audit of the hospital waste streams were that no waste management systems and policies were in place at the institutions, neither where any colour coded bagging system being used. Only black bags were used at the hospital for all types of waste, besides domestic waste, these include infectious medical waste (e.g. dressings, used swabs, sanitary pads, used gloves, in fact, all waste contaminated with blood and bodily fluids). This also included small aborted fetuses. Only body parts were separated from the rest of the waste stream either for burial or incineration.

I was disappointed to find that no medical waste contractors exist in Mozambique. Medical waste was mixed with the municipal waste stream. Although a municipal service existed, I was flabbergasted to see that the hospitals needed to find their own means of transporting this mixed waste to a dump site. No landfills existed in Mozambique. At the dumpsite, I was shocked to see that waste pickers (surrounding community members) were sorting through the hospital waste and were being exposed to the potential dangerous medical waste. According to some of the rag pickers that our team spoke to on the dumpsite, there have been numerous instances where rag pickers have been pricked by needles. I was sad to see that civil society was not mobilised on these issues and was not aware of the dangers of being exposed to such medical waste. This was due to the immense poverty being experienced in Mozambique since the ultimate aim for people was survival.

During my visit, I also had the opportunity to meet with the Mozambique Ministry of Health.
I was surprised to hear that incineration was the option for the final disposal of health care waste since the government is well aware of the health effects that incineration poses to human health and the environment. A government official told me that they needed a solution immediately to the waste problems and that incineration was seen as an immediate solution. In fact, the government has recently purchased two used incinerators costing millions and has not been instrumental in combating the problems being faced with regard to health care waste. The Mozambique government had been in the process of arranging a quick solution for the waste management crisis this year. It has been stated that government wanted to give a good impression to the participants of the AU meeting in July.

It is important for all to realise that a way to deal with waste, which can create jobs for people is to engage in projects that reduce, reuse and recycle waste. Money spent like this stays in the community instead of paying large amounts of money to private companies or companies from overseas who operate incinerators. The two hospitals in Mozambique that participated in the initial program for November acknowledged that they needed to immediately tackle the problem of health care waste at their institutions and will be working in the future with Livaningo to improve their current situation. Katya Hassen will be working with these facilities to establish environmental management plans at the hospitals. It is hoped that these hospitals can in the future be used as models for other hospitals in Mozambique to follow. This would ensure that future threats to communities in Mozambique could be reduced.

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