As she lays down her mat under a mango tree beside her house, 82-year-old Dorotia Nakiwolo wants to have her lunchtime meal but the odour around her is unbearable.
“They are at it again, burning their things,” she laments in Luganda. “What will a poor woman do?”
Nakiwolo’s house is at the backyard of Kikandwa Health Centre III in Mityana District, with only a barbed wire fence separating the health centre from her compound.
The health centre is burning waste, not merely paper or kitchen waste but medical waste, about 40 metres away from the main building.
“You can imagine the problem we have here every time that hospital burns its waste,” complaints Nakiwolo.
Nakiwolo’s neighbour, Gladys Nampijja, 31, echoes the concern: “There is an open pit where they (health centre) dump all waste including that from the maternity ward. And sometimes it takes three or so days before burning it causing an awful smell from the rotting matter and when they finally burn, the odour is much worse.”
While living nearby a health facility would be a blessing in a typical rural village like Kikandwa where residents walk kilometres to get to a health facility, Nampijja and Nakiwolo and their neighbours do not view their proximity to this health centre in the same light. They think the waste should be managed better.
Mr Ivan Ogwang, the Laboratory Assistant at Kikandwa Health Centre III, says the centre tries to manage its waste but is limited in capacity.
“We have got no incinerator so we burn all waste except waste from the maternity ward that is dumped in a deep pit,” he says.
But even then, the problem is not wholly solved. From Ogwang’s explanation, infectious waste like used gloves, syringes and cotton wool is burnt at the centre which Dr Michael Mungoma, a physician at Mulago Hospital, says is inappropriate.
“By burning medical waste, health facilities are simply improvising,” he says. “The problem with it is that you cannot be sure that you have totally destroyed the substance. What is recommended is incineration that burns substances to ash.”
Francis Bwire Ngegemi, the Quality Assurance and Environment Management Officer at International Hospital Kampala (IHK), says incinerators should burn at temperature of 9000 degrees centigrade.
Betty Nanziri, a clinical officer and the in-charge at Kikandwa Health Centre III, says they have since adapted measures of managing the waste up to where it causes minimum danger. One of these, she says, the centre has dug a deeper placenta pit of about 20 feet.
She add: “We do not burn waste everyday but over the weekends when there are fewer people at the health centre.”
Odour, Nanziri says is unavoidable because “even when using an incinerator, there will still be smoke and odour”.
What is medical waste?
Health facilities like any other entity generate waste such as paper, kitchen waste and what is termed as medical waste.
According to Bwire, medical waste is any thing which is generated and is of no use thereafter in the diagnosis, treatment or immunisation of human beings, animals or research carried out in a health facility.
Dr Mungoma says medical waste is in two categories, infectious and non-infectious waste.
“The non-infectious medical waste is one that does not cause direct health hazard like a bottle from which drug is drawn while the infectious waste is anything that is used on a patient,” he says. This includes used gloves, needles, cotton wool or operating theatre-generated waste like body tissues, among others.
The health hazards
The challenges of medical waste management are not unique to rural health centres but urban areas too.
“Many of the health centres in Kampala do not have safe areas to dispose of medical waste,” notes Dr Mungoma. Medical waste is thus mixed with other waste like paper and dumped on dust bins.