Blog post written by Luqman Yesufu; GGHH Campaign Manager, Membership Outreach and Engagement in Africa; groundWork

Posted on: groundWork

The members of the Global Green and Healthy Hospital network aim to ensure that they do no harm while providing health services.

The prevention of illness, injury and disease is an essential part of healthcare. We engage in healthy life style habits such as exercising and not smoking to prevent obesity and lung cancer. We vaccinate our children regularly to stimulate immunity and thus protect them from disease. We educate young boys and girls in order to promote safe sex and thus prevent the spread of HIV and AIDS and other sexually transmitted infections. On the basis of this, there is remarkable evidence to show that prevention works better than treating a disease. If this is the case, the health care sector must lead by example by engaging in more sustainable practices that are aimed at preventing disease and promoting good health without compromising patient care and safety.

Hospitals produce enormous amounts of waste, but only a small portion (about 15%) is actually infectious or poses high risk; 75% – 85% of the waste is categorized as normal municipal waste which has low risk to ill health, except of course if it is burnt. This should be music to the ears of hospital administrators, especially as the bulk of the money spent on treatment and disposal of medical waste is actually spent on the infectious waste. So, since you produce less, you should spend less. Unfortunately this is not the case, as hospitals in South Africa pay over the odds to get their waste treated and disposed of. There are two main reason for this: poor leadership and poor waste management practices.

The acceptable form of treatment and disposal of medical waste in South Africa is to burn it using incineration. This often leads to toxic fumes being released into the atmosphere at concentrations that are harmful to health when inhaled. Often, the incinerators cannot deal with the amount of waste coming, so it is turned away at the gate if it cannot be burnt immediately. Which is how it ends up in a residential area – as in the case of Roodepoort – or on the beach front – as in the case of Durban. The recent discovery of tons of medical waste, packed floor to ceiling in a suburban west Johannesburg house, as well as the tons of medical waste spread across Durban beach last year, has drawn attention to the problems experienced in the disposal of this waste stream. Hospital management needs to take up leadership responsibilities to ensure that waste is properly segregated to ensure that what gets to the incinerator is actually very little.

Those charged with the responsibility to ensure hospital waste is managed properly are the health care waste officers. They are not only trained in managing hospital waste but they are even mentioned in the Health Care Waste Regulations as ”A health officer who is registered and qualified as an environmental health practitioner”. This group of professionals needs to be supported by hospital management so that they can do exactly what they are trained to do, which is ensure that health care waste is managed in such a way that it does not cause harm to the patient, staff and the community.

The idea of prevention of injury and disease is a key reason why health care waste management should be a priority in health care institutions. We don’t want to cause harm to a person in the name of providing care. In fact, it should be considered a violation of a person’s human right and a crime against humanity if the public is still exposed to infectious or hazardous waste from hospitals. Hospital management therefore needs to take more responsible and sustainable actions in dealing with their waste and the people responsible should be given the proper mandate and support to do this.

Just some of the Global Green and Health Hospitals heroes doing amazing work to make their health facilities sustainable, gathered in Pietermaritzburg during groundWork’s community planning meeting. Credit: groundWork

We recently sat down with *Dineo to discuss some of the issues and challenges faced by health facilitators. This is what was discussed:

Luqman: What is your role as a health facilitator and what are the challenges that limit you from adequately doing your job.

Dineo: My role is to develop waste management policies, train the staff and advise management on how to improve our waste systems, better the environment and protect the public. I also do inspections to find out about the hazardous tools we use and I develop corrective action plans. The challenges I face include staff. I was just recently employed and I have no staff to train. If I want to implement a recycling project, I can have all the ideas, identify proper disposal areas and find boxes, but there’s no one here to actually do the proper separation and disposal. I feel there is also lack of support from management. Maybe it’s because they don’t really understand my role, the post is fairly new, maybe it wasn’t introduced to them properly. You find that your immediate supervisor is supporting you, but when you get to finance managers or CEOs, your plans get turned down. They feel support components are not that important.

Luqman: How do you overcome these challenges?

Dineo: Trying to get through to management is very difficult. You can only write reports, invite them to meetings and try to communicate with them, but changing their minds is up to them. I just keep writing to them, expressing the challenges that I am facing and recommending that they give me a team to work with. When the feedback is negative, everything comes to a standstill. At some point, you have to go out yourself, because you see that your duties aren’t being carried out. I end up going out to the garden services people, who are contractors and not directly employed by the facility. I ask them to do collections for me. I give them small incentives for this work, like buying them cool drinks or cigarettes. Clinical orderlies are supposed to be doing this job in the interim: this was the decision taken by management. But they don’t see waste management and collection as their duty. So they feel like they are doing it as a favour to me. If one person doesn’t feel like collecting or transporting the waste that day, they don’t do it.

Luqman: Why is it problematic for the garden services people to be doing this job?

Dineo: I think it’s problematic because they are contracted to do other work. They might not be immunized, they are not given proper Personal Protective Equipment (PPE) to do such duties. It’s just not the right thing to do. You have not protected the people but have asked them to do dangerous work. They are also not trained to do this job. I have trained them on a basic level, but I still have fears because they aren’t mandated to do this work. But dangerous medical waste would pile up everywhere if I didn’t have their assistance.

Luqman: Why is it important for there to be better waste management facilities in hospitals?

Dineo: People don’t see the value because it’s things we don’t see with our eyes. People don’t understand that waste can make us sick. The waste generated from health institutions is full of bacteria, bodily fluids, blood; there’s a lot of infected people with HIV or TB. If we don’t manage this waste properly, any person can come and touch this waste and infect themselves. There’s a risk of health workers being infected and there’s also issues of cross contamination. The waste sometimes ends up in general waste and this increases the possibilities of needle prick injuries. Again, we’re trying to look after the environment. We don’t want to pollute the environment, the ground water. We don’t want our waste ending up in our communities and affecting our children and the public. These days you find children playing in dump sites. They might come across needles. If we don’t take care of our needles, our children will play with them and infect each other. Even the workers and the patients here have to be protected. We are also trying to decrease the spread of infectious diseases and the mortality rate.

Luqman: How many needle prick accidents have you had as a result of poor waste disposal?

Dineo: In our hospital, we have near misses. Sometimes when the needle buckets are full, the nurses will remove them from their work-spaces and place them in the passage way. Sometimes you find no one is collecting in the passage; maybe I’m not at work or I’m attending a meeting. Our institutions also have kids. Sometimes you find that they come and fiddle with the needles. Sometimes we find needles in the general waste, but so far we haven’t had any injuries. On average we have about two near misses a month. Last year we had more staff to deal with collection, but we’ve lost those staff members, so the number of near-misses is rising. The near misses are usually reported by the cleaners. Sometimes they find a needle on the floor while they are cleaning. Other times we catch kids while they are playing with medical waste.

Luqman: What would you like to see done differently

Dineo: It would be nice to have waste handlers in our structures and to work with management that understands the importance of waste management. We don’t have people who can be our power when it comes to operations. We have a well-structured waste area but it is not overseen by anyone. It’s not being cleaned. *The name of the health officer has been changed, to protect the identity of the individual

*The name of the health officer has been changed, to protect the identity of the individual