Our Way Forward in Uncertain Times

In February 2018 and after months of planning, we made our first trip to Douala, Cameroon to deep-dive into the problem of supplying Deido District Hospital with a medical waste incinerator. After our planned one week on the ground, we understood quite clearly that the problem we faced was one that would require additional trips and significant amounts of further planning. Local medical resources were substantially constrained, and the infrastructure for safe waste destruction simply did not exist in any affordable form. Bringing in an incinerator would require shipment from Europe or the United States to a hospital without sufficient expertise to manage such a complex piece of machinery. If used improperly, toxic particulate could have easily spread to the nearby homes and markets.

Still, we pushed on and attempted to create a collaboration with the local government. We were actively raising funds for a project we felt would be difficult, but for which we saw several realistic paths forward. In the end, the inability to reach an agreement with our local partners in Cameroon for how ongoing costs would be shared eventually made Healthy Hospitals Cameroon a project with ever-dimming promise. By late 2019, we had stopped actively fundraising for the project and were considering alternatives for how we might deploy the resources in a manner as true as possible to the spirit in which they were raised.

Of course, 2020 has been a year like no other. Without a clear path forward on Healthy Hospitals Cameroon and having entered a world brought to its knees by the pandemic, it is the unanimous decision of the Board of Directors of Concordia Humana to liquidate all unspent raised funds in a way that serves both the international causes they were intended for, as well as the new humanitarian needs in the communities of their origin. To accomplish this, we will be sending half of our cash assets to Doctors Without Borders, a world-renowned organization with medical operations in 70 countries. The other half will be delivered to food banks in Cincinnati, Atlanta, Washington DC, and New York in proportion with the size of donations we received from each of those donor areas.

We believe that this use of these resources is the highest and best at the present moment; we do not have the standing infrastructure to tackle any part of the coronavirus, and the organizations out there are ones that do. We defer the resources you, our donors, have so generously given us, to their long records of excellent work. We hope for a brighter future, and will continue our own good work when it is once again feasible to do so.

Posted on behalf of Danny Sexton

Why care about waste?

As we’ve begun to embark on our first project in this new area of medical waste management, I’ve begun to notice an interesting pattern when I tell people about what we’re working on.  I’ll admit, it was my first reaction too: “Surely, in a country like Cameroon, there must be a more pressing problem than this?”  But as I’ve read and traveled to the project site, I’ve come to understand that, while medical waste management may not be seen by many as an emergent need, it has wide-ranging impacts that are easily addressed by small-scale projects that are a perfect fit for our organization.

Signage at the entry to HD Deido

The public healthcare facilities we visited look, at first, not so different from the doctor’s offices and hospitals one might visit in the developed world.  Sure, they’re in the tropics, so they’re mostly outdoors. Sure, the throngs of people in and around the facility are mostly there for diseases like malaria and typhoid rather than the flu and chicken pox.  But the basic functions are there.

The shocking fact comes in the scale of the populations served – a small, community clinic that’s maybe 20 ft. x 50 ft., with 10 doctors on staff?  It serves 50,000 people. The regional hospital, which sees only the most serious cases? It has 60 beds for hundreds of thousands of people.

In this context, it’s no wonder that the majority of the problems these facilities face are budgetary.  Even beginning to provide healthcare services – even basic things like vaccinations – reaches mind-boggling levels of cost efficiency required.  And these facilities are expected to, and do, provide services with just a trickle of government funding, a little support from international NGOs here and there, and not much else. In this climate, every franc that goes to pay for a utility – water, power, or waste disposal – is a franc that can’t contribute to saving a life.  It’s no wonder that these issues fall by the wayside.

The hospital is situated within a dense urban neighborhood.

But waste disposal is of critical importance in the long term.  The low-cost options all involve a tradeoff of short-term hazards for long-term hazards.  You can bury the waste – but then you risk contaminating the soil and groundwater with infectious disease, poisioning the water for the entire community.  You can burn the waste in open pits – but then you spew cancer-causing chemicals and soot into the air, often in dense urban areas. Health facilities are left to choose which kind of chronic disease they will give their communities, all because of a lack of resources for waste disposal.

Fortunately, high quality incinerators for waste disposal are relatively cheap and easily constructed of local materials.  Combined with operator training and ongoing support, we can give a facility a way out of this choice for as little as $5,000 - a small price for saving lives and preventing future outbreaks.

The medical waste disposal system is unsafe and unsustainable.

So where does that leave us?  We’ve performed a detailed alternatives analysis and prepared a report for the local government and hospital management on the conditions we saw and the ways we can help.  While they decide which of the interventions would be most feasible, we’re beginning to fundraise to start fixing this situation as quickly as possible.

In our next update, we’ll feature more about the details of the interventions and - if medical waste wasn’t appetizing enough - how our co-founders learned to eat fish heads.  

What does hygiene in health facilities mean?

Imagine this: you’re at the doctor, sitting on the crunchy paper, reading a National Geographic, and listening to the woman in the room next to you have the coughing fit of the century. “I sure am glad I don’t have that,” you think to yourself, as you read about Polynesian seafaring before your annual physical. When the doctor finally comes in to your room, she’s already wearing a pair of gloves, and begins performing all the duties of your routine checkup – checking your pulse, inspecting your tongue, ears, and nose, and taking samples of your blood with the same pair of gloves she’d been using on the last patient, who was already sick! When you ask her to explain herself, she says that there wasn’t a trash can in the other room, so she just left her gloves on. A few days later, you’ve got the same ailment that your thundering neighbor-patient had a few days before.

As much as we’d never allow such a situation to happen to us, it can be unavoidable for patients in developing countries like Cameroon simply because of a lack of resources and training for the staff at a given medical clinic.

In this six part blog series, we’ll take a close look at each of the six key areas for medical waste management in any medical facility, with particular respect to those in the developing world. With it, we hope to communicate the motivation for our newest project, Healthy Hospitals Cameroon, the first site visit for which will be in early 2018 in Douala, Cameroon.

So what are the key ingredients to Part One, the patient room, the source of all infectious waste and the earliest opportunity to mitigate its negative effects on facility personnel, patients, and visitors? When we talk about “infectious waste”, it’s important to realize that there are two broad categories: sharps and non-sharps. The sharps, obviously, are needles used to puncture the skin, and should be disposed of in a tough-sided box. The infectious non-sharps are things like gloves, bandages, gauze, bedsheets, mop heads used to clean bodily fluids, and so on – anything a sick patient (or his or her fluids) has physically interacted with. Non-sharp infectious waste should be disposed of in a lined, specially-marked, covered waste bin. Finally, general waste that’s not been touched by a sick patient should simply go in a separate lined, covered waste bin. Waste should be discarded in the room in which it’s produced.

With two waste bins and a sharps box in every single room, we’re well on our way to making a much healthier hospital room. We still, of course, need to provide training to the staff so that they know which types of waste go in which receptacle, and we’ve assumed so far that the nastier types of ailments involving diarrhea, vomiting, and other bodily fluids are being cleaned up appropriately with disinfectant before they’re being disposed in the correct receptacle.

But we can’t let all that nasty stuff pile up in the different trash cans. Who’s going to pick it all up, and what are they going to do to protect themselves and their surroundings as they begin the process of relocating the waste to be destroyed? Find out next time in Part Two: Collection.

A new project to build a healthy community

Over four years ago, Concordia Humana embarked on its first venture to directly aid those in need.
Hoping to grow beyond our original role of collecting funds and supplies to pass on to other organizations, we chose to build a solar powered well for an Ethiopian community, securing reliable access to clean water and catalyzing the self-development of Ganda Boya. That well is now built, and we have spent the last several months determining what and where our next project will be. We decided to continue our focus on small-scale infrastructure with a large impact on community health by improving the medical waste management process at a hospital in Douala, Cameroon. While we have preliminary information on how the current process works and how it can be improved, in the coming months some of us will personally visit the site so that we, along with our partners at the hospital, can determine the point of intervention that will most efficiently improve the safe handling of medical waste and enable the community to make further improvements in the future. Stay tuned to hear more about the process and possible points of improvement.