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.

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