A trip to the hospital does not usually reveal what happens at the back. It’s here where discarded blood and body cells and parts from surgeries, pharmaceuticals, medicine bottles — tonnes of hospital waste — undergo. In the case of the Kenyatta National Hospital, this might be as much as one tonne a day estimated to be half the medical waste generated in the city. Quite understandably, it’s not usually open to the public.

Most of these generally end up in incinerators — the most affordable medical waste disposal method for most hospitals. But a lot of it slips through the system to get us worried.

Incinerating waste at temperatures between 800-1,100 degrees Celsius kills viruses, bacteria and other pathogens but the ash still contains dangerous heavy metals such as mercury and cadmium. Best practice dictates that such ash be buried.

However, as this author found out, this is better said than done. Lack of sufficient equipment to safely dispose of waste and failure to observe best practices was a common feature in most hospitals visited in this survey.

From releasing dangerous fumes and ash openly to the surroundings to dumping medical waste together with general waste, the local medical waste management landscape still has a long way to go.

Raw medical waste and toxic ash from incinerators ends up in open dumps like Dandora and Eastleigh posing a health risk to thousands of people salvaging plastic and metal for recycling and residents living nearby. Significant hospitals such as Kenyatta National Hospital which have good incinerators have run from reasons to bury toxic ash. Few hospitals have a scrubber system where fumes are filtered to eliminate potentially toxic gases including dioxins from burning plastic — a common material discarded by physicians.

A recent study on the worldwide status of waste management rankings Nairobi as one of the worst in waste management. Residents living near Dandora reported that a large number of respiratory ailments and were found to have unacceptably high levels of heavy metals such as lead in their blood. Dandora dumpsite reeks of heavy metals which can hinder brain development as our individual evaluations confirmed.

Walking through the dumpsite opened during the 1970s reveals unlikely materials that end up here. Lying in the pile of an unsightly mixture of plastic bags and organic waste, one frequently finds bloodied gloves, dressing bandages, needles, discarded drugs and a host of other metals tucked away.

out of their small amounts, it isn’t difficult to conclude that this come from smaller hospitals, clinics and dispensaries not willing to spend on the proper disposal of waste. Level five hospitals, previously called provincial hospitals such as Nakuru, are largely well equipped with incinerators that could combust pathological waste into ash and water, states Kinoti.

A peek at the Dandora dumpsite reveals an unsightly mixture of plastic, food remains, animal products and all manner of waste the town discards. Every couple of minutes a truck makes its way through the hills of garbage the city has accumulated over decades. The steady flow of trucks falls silent at dusk.

However, as dark falls, another group, mostly only trucks hurriedly enter the dumpsite, quickly offload their contents and make their departure, all within a few minutes — well aware of their wrongdoing. A closer look at the dumped material reveals used needles, bloodied bandages, pharmaceuticals and a slew of other waste from hospitals. We found syphilis and HIV test kits.

Early in the morning, a County Government of Nairobi earth mover turns over the waste mixing it with garbage ready to receive the next batch for the day.

Tens of people descend on the site, sorting the garbage with their bare hands. While some solely focus on milk packets which they wash in a sewage tunnel, others are interested in salvaging metals from the burnings heaps, fuelled by the excessive gas underneath.

Still others are following the food stays they collect to feed animals — all determined to make a living. A prick out of an infected needle and they might end up getting serious infections including HIV.

all of them seem too aware of the danger, but they must feed their kids, a man, shielded only by a pair of gumboots, states.

The National Environmental Management Authority and the County Government of Nairobi didn’t respond to our enquiries.

Yet the threat of medical waste in the nation does not begin or end here. Medical facilities try to safely dispose of the waste to several levels of success. A huge number incinerate their waste, but lack the prerequisite air pollution control equipment to guard against materials such as sulphur, known collectively as flue materials, getting into the environment.

In such cases, residents living near such facilities are vulnerable to respiratory infections. Dioxins from plastics are known to cause serious respiratory complications and cancer.

A recent report detailed that the elevated levels of heavy metals such as lead in vegetables grown and sold in Nairobi. Lead is a dangerous metal which can cause retardation in children. Some farmers in Kinangop were recently in the spotlight for using sewage to cultivate their crops largely sold in the city.

Incinerators below standard

Dumping of toxic ash is not the sole problem facing the medical waste management landscape. The state of gear is wanting, some dating several decades back and ill equipped to minimize pollution.

Most people hospital below level five have de Montfort incinerators where temperatures aren’t controlled and are most likely to pollute as they lack scrubber systems. “Unfortunately this type of incinerators are typical in district hospitals and health centres,” Kinoti says. Workers are also not well protected in mid-level hospitals. Because of the design of the incinerators, medical waste is loaded manually and workers who mostly don’t have protective equipment are exposed, she says.

A moderate size incinerator costs an average of Sh20 million before installation, obviously a high shot for hospitals. Insert the high maintenance costs and the fact that these centers guzzles several thousands of litres of fuel to operate daily and you end up getting a very high bill.

“However, the high cost of incinerators is no explanation for polluting the environment,” states Kinoti. “Hospital waste contains mercury and can create furans which are extremely toxic and can cause cancer and severe respiratory diseases,” she says.

Medical facilities which don’t have incinerators are required to have contracts with specialised waste disposal companies to deal with their waste. For some, this is merely an unnecessary hurdle they have to undergo before acquiring a permit to run a hospital. Little is done to comply. A number don’t follow through with these requirements posing a huge health risk to the public and the environment.

Hospitals categorize their waste otherwise for their safe handling during transportation, storage, treatment and disposal,” says Bernard Runyenje, assistant chief public health officer, Kenyatta National Hospital.

Highly infectious waste are those expected to be comprising highly infectious pathogenic organisms such as bacteria and viruses while overall waste may consist of office paper. Normally in red packages, infectious waste require special care throughout the process of waste disposal and are assumed to be treated at source. It’s not however unusual to find a worker carrying a yellow or reddish disposal bag without gloves or some other protective equipment.

Tissues that decompose quickly such as amputated limbs are disposed of quickly or placed under refrigeration. The majority of these highly infectious waste — except radioactive waste — should most appropriately end up at the incinerator, Dr Runyenje says. But he also admits that incinerators in rural areas don’t meet these specifications.

A fantastic incinerator should have more than 1 room where waste is burnt in the first room, so that there’s increased temperature in the second room and gases can be burnt in the third room, he says. At the end of the process, the majority of the waste was burned to an acceptable level. Clinics and dispensaries often operating in highly populated areas frequently flout the regulations, openly burning their waste using paraffin and charcoal to avoid the cost of safe disposal. Half burned waste isn’t hard to spot in dumps on roadsides and quite visible in municipal dumpsites.

Incineration however does not get rid of toxic fumes and heavy metals — if anything it could disperse toxic fumes to a wide areas if not done correctly. The scrubber system is intended to reduce such pollution but the system is expensive and most hospitals visited don’t have it. The gas from the incinerator is passed via fluid to remove any particulate matter — inside a scrubber system. Such gases may include carbon dioxide, carbon dioxide, dioxins and furans which can cause serious diseases such as cancer.

The minimal height of a chimney should be at least 10 feet above the tallest building around to minimise direct exposure to residents. Anything that comes out of the chimney should be dispersed away from nearby buildings.

“Sometimes it’s difficult to know what you’re emitting to the surroundings. If you launch it directly to human beings, then you expect to have some health issues, while it’s inhalation of carbon monoxide, carbon dioxide, dioxins or furans,” Dr Runyenje says. A high chimney shouldn’t however be seen as a replacement for a scrubber system, adds Kinoti. A high chimney only disperses fumes farther to residents who may not even be aware of them, she observes.

To many, including waste managers interviewed, ash from incinerators, or any ash for that matter is not harmful — a misplaced notion that could be contributing to its dumping. The truth is that they contain harmful metals such as mercury, lead and cadmium as our individual evaluations confirmed.

Incineration reduces the waste to about 10 per cent of their original volume. However, the remaining ash usually contains very large content of heavy metals. Such should normally be buried in sanitary landfills to prevent it from leaching to the ground, but this practice appears rare in the nation.

Whether through sheer negligence, or lack of space and facilities or reluctance to satisfy the associated costs, medical waste nevertheless ends up in our surroundings. When disposed in open ground, heavy metals readily leach to the groundwater or make an immediate approach to our food chain.

Bottom ash under normal conditions should be buried, but most health centers don’t have disposal grounds. These burial grounds aren’t present either at Dandora where officials claimed the ash was taken to be buried.

Some companies are licensed to handle hazardous waste. But, Dr Runyenje nonetheless notes that not many handle general medical waste.

A number of incinerators in public hospitals were in a state of disrepair leaving tonnes of toxic waste piling up and posing a threat to the public.

Kenyatta National Hospital includes a floor where tonnes of waste are kept awaiting disposal.

Its newly acquired incinerator from India is the most advanced among the hospitals visited consisting of two chambers for maximum combustion. The wide network of smoke pipes contributes to a room where the smoke is passed through a fluid to remove fumes and other residue.

The resulting black slime contains a few of the dangerous metals. However, the layout and arrangement of the holding area does not meet specifications and some of it seeps to the floor, a source tells us.

The incinerator cannot be operated during the day because the nursing school is only metres away.

The location of incinerators in relation to offices, hospitals and other residential is a common problem in many centers. The one at the Chiromo School of Physical and Biological Sciences for example is not in operation as it sits near an embassy.

One incinerator in Nakuru County is perilously close to the maternity ward, some smoke move directly to patients.

The situation plays out in a number of other hospitals around the country who also lack additional air pollution control equipment.

Ash dumped in open floor are an open feature in several of leading facilities which may potentially poison ground water .

With people living near such facilities, they are inevitably exposed, and risk serious respiratory infections and serious diseases including cancer. The Kenyatta National Hospital incinerators operate at night to minimise exposure to the students at the School of Nursing barely a dozen metres away.

A source told this writer that the soils were so contaminated they might have to be skimmed off and buried. Meanwhile, residents will have to contend with dangerous, potentially carcinogenic, ash emanating from such facilities.

Larger hospitals such as Nairobi Women’s Hospital are stepping in to help smaller ones incinerate their waste. “The cost of the incinerator is too high for them to manage,” states Thomas Imboywa, who’s in charge of one of these at the Nairobi Women’s Hospital, one of the largest in the region. On a daily basis, he manages the safe disposal of the days squander.

The incinerator, a huge blue structure sits about 100 square metres of space slightly off the primary building and sports a high chimney, towering above the nearby building.

“Medical waste is incinerated within 24 hours,” states Imboywa. But when a practice or hospital does not turn in any waste for weeks on end, it raises eyebrows, Imboywa states. He’s familiar with many such cases and the hospital is quick to repudiate such contracts according to their policy. Some healthcare facilities may only secure a contract with them to wade through National Environmental Authority (Nema) regulations but have no intention to safely dispose of the waste, Imboywa observes. But, not all medical waste ends up in such specialised facilities. Instead, in places like Kibera they’re doused with paraffin and burnt in the open.

“But in this instance, sharps will remain and the waste can still remain infectious because they cannot reach the required temperature,” Imboywa said. The truth is the material can remain infectious because they may not reach the required temperatures.

Devolution could make it worse

As more hospitals come up in tandem with the growing population, a rethinking how medical waste is treated will be inevitable. The devolution of resources has seen more clinics and dispensaries put up in previously unreached areas. But the resources are so limited to place up waste disposal facilities such as incinerators.

Besides being expensive, Dr Runyenje agrees that if these facilities were to put up their own incinerators, there could be more pollution and authorities will have more difficulty supervising them.

“There’s need to pool incineration facilities for medical and hazardous waste,” he says. These centres can serve as emission monitoring points for authorities. “It will be easier to set controls from such a central facility. “In the Technical Working Group, we’re looking at how counties can pool their centers together and have their medical waste incinerated at a central point. It’ll be very expensive in the long term to have every facility to have its own incinerator that cannot operate at full capacity,” he says.

The best waste disposal procedure is controlled tipping being practiced in the majority of Europe and North America where it’s buried in layers, Dr Runyenje states. “The advantage with this method is that the property can still be used for other activities. It’s the only pledge of disposal of any form of waste,” he says.

Kariobangi, which currently hosts light industries, was a controlled tipping site before start dumping at Dandora. “Counties should be thinking of controlled tipping instead of investing heavily in incinerators,” he says.

General waste can have many recyclable materials but proper segregation which could make this possible is still lacking in the nation.

The effectiveness of recycling is dependent on the effectiveness of segregation.

The issue, according to Kinoti, is enforcement of the law. While bigger hospitals are trying to correctly dispose of the waste, some smaller clinics may be spoiling it, she says. The fact that generators cannot monitor their waste once it’s given to waste collectors is yet an additional issue according to her.

“There are many quacks doing waste management blending household waste with hazardous waste. This can pose a significant health issue,” states Kinoti. Since they drain waste bins from homes, waste collectors can cause serious contamination in households. “Waste collectors who are collecting hazardous waste should be dedicated waste handlers and shouldn’t handle other general waste,” Kinoti says.

Effluent from the scrubber system should be taken for treatment to eliminate heavy metals and other pollutants. However, the sewerage system is broken and a lot is discharged along the way. Sewage pipes are sometimes deliberately punctured and effluent used as fertiliser for crops.

“The legislation on sound medical waste disposal should be enforced, district and health care centres should install larger incinerators to deal with waste from smaller fee. We should have dedicated health waste managers,” Kinoti says.

 

by: http://allafrica.com/stories/201411111021.html

“There are many quacks doing waste management mixing household waste with hazardous waste. This can pose a serious health problem,” says Kinoti. Since they empty waste bins from homes, waste collectors can cause serious contamination in households. “Waste collectors who are collecting hazardous waste should be dedicated waste handlers and should not handle other general waste,” Kinoti says.

Effluent from the scrubber system should be taken for treatment to remove heavy metals and other pollutants. But the sewerage system is broken and a lot is discharged on the way. Sewage pipes are sometimes deliberately punctured and effluent used as fertiliser for crops.

“The law on sound medical waste disposal should be enforced, district and healthcare centres should install larger incinerators to handle waste from smaller fee. We should have dedicated healthcare waste managers,” Kinoti says.

 

by: http://allafrica.com/stories/201411111021.html

To clarify: It is Nearly waste. Not about recycle materials like paper, plastics, recycled glass or compostable organic waste.

Truth and cleanliness

What I noticed during the tour: In the plant, each step is carefully considered, it is worked with great precision. And even if that sounds paradoxical: it is squeaky clean! Just in the hallway where different wastes are blended on conveyor belts, there is the normal odor of rubbish, but also not as bad as originally expected.

Amazing for me: I didn’t know that by using residual waste a really large amount of electricity is generated. And reassuring for me: tools are won even from the last drop: metal, material for road building, plaster in good quality. The proportion of what is factually left and actually not recycled, seems negligible to low.

From waste to electricity — the process in detail

The residual waste incinerator in Cologne was set into operation in 1998 and is one of the most modern and best facilities in the world. It processes what’s landed in the residual waste after the individual group of private households, as well as the remains of sorting out of combined industrial and building waste. The railway containers are loaded in two waste transfer stations in the city of Cologne and collectively have a capacity of approximately 250,000 tons each year. The remaining waste is brought by truck.
From the enormous hall of the conveyor belts the waste enters the so-called remaining waste bunker. Here it is stored a while until enough moisture has dissipated, so it can burn nicely. By means of permanent temperature and humidity indicators it is controlled, in what condition the waste is. With large gripping cranes the waste is rearranged and eventually put in the kiln. The garbage gripper fill four enormous funnels. The waste comes from here in four independently powered boilers that operate around the clock. The waste moves on roller grates throughout the boiler. At an unimaginable heat of 1,000 to 1,500 degrees Celsius. The respective”new” waste ignites in the burning garbage. So no additional external energy is required for the combustion process. The combustion occurs after the DC principle: The burning of waste and the waste gases move in the exact same direction through the”hot flame” at the end of the grate. The heat generated during combustion is used. On the one hand, to heat the nearby Ford plant. However, this is just a great side effect. The majority of the heat is converted to electricity by generators. And even that the energy consumption of 250,000 people can be fulfilled. The waste incineration plant Cologne is thus basically a power plant and supplies a quarter of the city of Cologne with electricity. And because you could find the idea it is not too bad when so much garbage is produced — because it is used so well…

After combustion bottom ash, hot exhaust gas and residues remain. These substances are largely used again useful: The ash is cooled with water and kept in an ash bunker before it is processed at a bottom ash treatment plant and then utilized in street, landfill and landscaping.

Lately a dream came true for me. I had the opportunity to participate in a guided tour through the waste incineration plant in Cologne. That may seem strange. Sometimes I catch myself when I get stuck on documentary programs about recycling methods in the (rare) zapping through the TV channels. Obviously this subject fascinates me.

The BVMW (Federal Association of Medium-Sized Enterprises) invited to a lecture on the subject of generation Y. Host and the place was the waste recycling company in Cologne, AVG, which offered additionally a guided tour through their waste incinerator. Since I’m also quite interested in the subject Generation Y, I could kill two birds with one stone.
A special feature of the Cologne residual waste incinerator is the integrated treatment of the waste in a treatment room. Residues from sorting and residues from the domestic and bulky waste are distributed to the daily waste bunker on different chambers. The bulky waste is pre-sorted and crushed. Just the non-recoverable components are processed in the incinerator.

The household waste is sorted in a perforated drum to size and then passes on large conveyor belts so-called magnetic seperators. They remove ferrous scrap. Another ferrous metal deposition as well as an automatic non-ferrous residue occur after combustion.

Even commercial waste residuals are delivered to the Cologne plant. They have been processed previously in external sorting, so they can be added directly to the domestic and bulky waste. The various waste streams are mixed thoroughly, because this homogenization guarantees a high quality, a uniform as possible burnout and a fantastic quality ash.
The hot exhaust gas is used for electricity generation. It heats preheated water to steam, which meets at a temperature of 400 degrees Celsius and a pressure of 40 bar to a turbine. This pushes the downstream generator with which is generated electrical power. For own use just a small portion of the energy is necessary. The greater part is given in external electricity supply networks. The quantity of energy generated in the incinerator is enough to power more than 100,000 families.

In the combustion and the subsequent exhaust gas purification residual substances like dust and salts remain as well as ashes from the boiler. Gypsum can also be a waste material, which is obtained as a reaction product in the exhaust gas purification and has building material quality.

Emission control: the exhaust gases are almost entirely neutralized by the method used in the Cologne incinerator. There’s absolutely no waste water, as well as the legal requirements are clearly undercut. As a neutral auditor, the county government receives the actual exhaust gas readings permanently by direct line.

Rethinking at waste management companies

After the guided tour, I had the opportunity to talk to the media officer of AVG. In this conversation it became apparent how much the thinking has changed in the area of waste management in recent decades and years. While throughout the 1960s to the 1990s garbage was piled up completely unsorted in landfills and then abandoned, in the new millennium they have recognized the value of the waste. Climate change and CO2 emissions have pushed as important issues in focus for the residual waste processing. The heat generated during combustion is converted to electricity. Resources are regained, as far as is technically possible. Especially metal, wood and plastics. The recovered plastic from residual waste is used for example as fuel for cement plants.

Waste incineration plant are nowadays equatable to power plants, even when fuel value isn’t quite equivalent to the traditional fuels like coal, gas and oil. As more and more municipalities have started to generate their own electricity by means of residual waste incineration, the major electricity suppliers get in significant issues. That what is put in the residual waste in private families plus the industrial waste is, after all, still god to supply 100,000 families with electricity in Cologne.

And at the exact same time it’s scary, what unbelievable tonnes of waste we create. Yellow and blue ton even come on top of that.

Consumer society offers garbage

Waste incineration plants generating electricity for us and making us less dependent on fossil fuels, are the logical consequence of our consumer society. But incinerators aren’t built primarily to generate electricity. However, to become master of the mountains of waste that we produce continuously as a consumer society. Fortunately, with modern incinerators, a way was found to make up the stinking issue a clean thing. However, the reason, our consumption, is the true issue.

For the operators of the incineration plant, it is very important that enough waste is delivered. Garbage is their merchandise. The more they can get, the better for the system’s capacity. For then it’ll work cost-effectively, which in turn has a positive influence on the urban garbage fees. Not all incinerators in Germany are so well utilized as in Cologne. Since waste is added from adjacent areas.

However, the consumer society provides these masses of garbage. Goods are produced in large quantities, purchased, consumed or used and eventually discarded. The 2aste incineration plant will get food — in 2013 there were 707,000 tons in Cologne. And provides us even with electricity (282 million kWh in 2013 in Cologne). Actually a perfect cycle, so one may think. If not for this”but” would be. Since our conventional consumption goes at the expense of other nations, to the detriment of the environment, fair working conditions; Resources are wasted, the transportation around the globe has influence on the climate, production facilities in the Far East poison the local environment and so forth.

Well, I live in Cologne, a big town, where certainly only a small proportion of residents consider trash, disposal or even waste reduction and also practice this. That might be a negative point of view, but I think it is realistic. The average normal citizen does not necessarily ask the question what is actually happening to what he throws away in the course of a year. All the more it is interesting to follow the different paths. My next wish is to go to a recycling plant for plastics. The latest approach is waste prevention. In its most different version it is named Zero Waste. No waste. So far there are just a few leaders, whose reports and videos I read and watch with interest. And at exactly the exact same time I wonder how to implement this at a normal big-city life. It starts with the fact that — even if you use a togo box, which is compostable, then you do not know where to dispose of it along the way. So take it home and place it in the compost bin? Would everyone do that?

I think it’s great if it is possible, to be master of the situation (immense quantities of waste) through a well organized disposal system and beyond even to convert this residual waste to a large extent into energy, ie electricity and heating. There’s at least a enormous improvement as against the stinking landfill from earlier, where everything was thrown into a heap and then covered with the cloak of silence. The following step must be, to decrease the quantity of waste in total. And this will not be possible just from the civil society. Here politics and economy are asked to make the right framework and to set the practical implementation in movement.

by: http://blog.upcycling-markt.de/en/blog/muellverbrennungsanlange-waste-incineration-plant.html

But the consumer society provides these masses of garbage. Goods are produced in large quantities, purchased, used or consumed and eventually discarded. The 2aste incineration plant gets food – in 2013 there were 707,000 tons in Cologne. And provides us even with power (282 million kWh in 2013 in Cologne). Actually a perfect cycle, so one might think. If not for this “but” would be. Because our conventional consumption goes at the expense of other countries, to the detriment of the environment, fair working conditions; Resources are wasted, the transport around the globe has impact on the climate, production facilities in the Far East poison the local environment and so on.

Well, I live in Cologne, a big city, where certainly only a small proportion of residents think about trash, disposal or even waste reduction and also practice this. That may be a negative point of view, but I think it is realistic. The average normal citizen does not necessarily ask the question what is actually happening to what he throws away in the course of a year. All the more it is interesting to follow the different paths. My next wish is to visit a recycling plant for plastics.

Waste incineration and waste seperation versus waste prevention

Waste separation was yesterday. The latest approach is waste prevention. In its most distinct version it is called Zero Waste. No waste. So far there are only a few pioneers, whose reports and videos I read and watch with interest. And at the same time I wonder how to implement this in a normal big-city life. It starts with the fact that – even if you use a togo box, which is compostable, then you do not know where to dispose of it along the way. So take it home and put it in the compost bin? Would everybody do that?

I think it’s great if it is possible, to be master of the situation (immense amounts of waste) through a well organized disposal system and beyond even to convert this residual waste to a large extent into energy, ie electricity and heating. There is at least a huge improvement as against the stinking landfill from earlier, in which everything was thrown into a pile and then covered with the cloak of silence. The next step must be, to reduce the amount of waste in total. And this will not be possible just by the civil society. Here politics and economy are asked to create the right framework and to set the practical implementation in motion.

by: http://blog.upcycling-markt.de/en/blog/muellverbrennungsanlange-waste-incineration-plant.html