Wednesday, April 11, 2018

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.  

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