TOPE OMOGBOLAGUN writes about how scavengers resell surgical waste from hospitals dumped in a Lagos rubbish dump
Hospitals generate waste daily; some ordinary, others surgical and they all end up in a dump. The process of disposing of the waste is however largely unknown to many.
But SUNDAY PUNCH can authoritatively report that surgical waste from Lagos’ hospitals usually discarded at a rubbish dump often return to markets.
Our correspondent who spent three weeks investigating the dangerous trade in surgical waste found out that scavengers ransacked the dump daily after waste disposal officers had set fire to the surgical waste. They usually resell picked surgical waste like used syringes, specimen bottles and other hospital disposables to people for onward repackaging for medical uses.
A visit to the dump at Ginti, Ewu-Elepe in the Ikorodu area of the state shows that it is a city on its own. It has scavengers from diverse ethnic groups
SUNDAY PUNCH observed that the scavengers are of different nationalities with robust knowledge of the Ewu-Elepe terrain where the dump is sited. In fact, it is another city tucked in an emerging mega city. Trucks belonging to the state’s Waste Management Authority and allied registered vehicles lined the route like a column of bees. Traders selling liquor and operators of betting shops also populated the area dotted with makeshifts dwellings.
Inside Ewu-Elepe’s mounting waste domain
The discarded items which occupy Ewu-Elepe’s expansive dump nestling a pit range from used syringes, specimen bottles, cartons to cans.
Also used needles, drips, cannulas, and other items in red and yellow waste bags littered the ground.
SUNDAY PUNCH observed that the specimen bottles emptied at the dump had fresh blood, urine and water inside them. Some were as fresh as samples collected few hours before they were dumped while others had thick blood in them.
The urine in the different bottles showed yellow, brown yellow and white colours. Some of the syringes dumped in the landfill were also soaked in different samples of blood and water.
Our correspondent discovered that the syringes still had blood samples upto one millilmetres. Some of the syringes had very red and no so red blood samples in them while the special samples were almost black like a blood pudding.
Besides, the intravenous fluids (drips) also had blood and water flowing through the cannulas. The waste obviously did not pass through purification or sterilisation. Scavengers who thronged the dump pick these items and resell them. SUNDAY PUNCH observed that some of the items were burnt, others were intact.
One of the refuse collectors refused to answer when asked if the discarded items could be picked since they were carelessly dumped. However, the refuse collector rejected a request by a scavenger to pick one of the items in the presence of our correspondent.
Syringes, specimen bottles most scavenged items
One of the scavengers identified only as Usman first said the LAWMA officials often prevented them from going near the medical waste because it’s hazardous to do so. He, however, sang a different tune when persuaded to explain how he got some of the discarded surgical items in his possession.
He told our correspondent in Pidgin English that though the officials usually prevented them from picking the items, they always went to the dump at night to carry out the act.
Usman said, “We pick them (showing our correspondent syringes and specimen bottles). We sell in kilos; N30 or N40 per one. Me I no know wetin dem use am for. (We sell them to some people though I don’t know what they use them for). ”
Another scavenger, who requested anonymity, also said they often sold medical waste especially used syringes after picking them from the dump. Like Usman, he refused to disclose the buyers.
He said, “Madam we pick the thing for night.The people wey dey bring them no know. We gather dem and sell. If we get plenty, nah big money. We pick only this one and that one (pointing at syringes and specimen bottles).
Asked if they usually wore gloves while picking them, he answered in the negative, adding that they were aware of the dangers in having body contact with the items.
A LAWMA junior worker, who spoke on condition of anonymity, said the scavengers mostly picked the items at night when ‘chairman’ who monitored the dump had closed for the day.
He said, “All the guys (scavengers) usually come for the items in the night. I am not sure of what they pick but I have seen them twice. The LAWMA medical waste bus dumps surgical waste every day. The syringes are often emptied from cartons while the rest are dumped in red and yellow bags. Those who come to dump them wear hand gloves. Once the waste are in the landfill, we set them on fire.
“However, because they are often in large quantities, they can’t all burn at once, so the scavengers usually come from 9pm to pick the syringes and specimen bottles. I once asked one of them what they usually do with the items and he told me that they sell them but he didn’t tell me who they sell them to.’’
He further said though the dump had security men, they were not meant to monitor the dump but to control traffic and ensure safety in the area.
He added, “The security agents don’t prevent people from picking items from the dump.’’
Another LAWMA worker, who begged not to be named, said he was aware that the scavengers were fond of picking used syringes and stained specimen bottles from the site.
He added, “But I don’t know what they use them for. When the LAWMA medical truck dumps surgical waste, sometimes some scatter on the floor and if one is not careful, one can injure one’s feet.’’
Though it seemed the scavengers were on oath to protect the identities of the buyers, SUNDAY PUNCH investigation showed that they often sold the picked items to nurses and chemists who carry out medical services in homes.
Besides, after weeks of interactions with two of the garbage collectors, our correspondent got samples of the picked syringes after begging that she needed them for research purposes.
Where medical waste come from
The sea of anxious heads occupying the rows of seats at the waiting wing of the Lagos State University Teaching Hospital, Ikeja, chiefly underscored the gravity of health care in the nation’s life.
Some of them brought their sick relatives to the hospital from far and near that wet, dreary Friday morning, while others came for personal treatments.
Amid the unease that gripped the patients and visitors like a bad penny, a family of three battled to heap their father on a stretcher into a waiting car after being discharged.
With lightning speed, people in the waiting room glanced at them before exhuming the thoughts temporarily buried in their inner recesses. As if in a world apart, smartly dressed doctors and nurses walked briskly across the wards just as cleaners cocooned in a corner, after an early morning work, sang in hushed local tunes.
LASUTH, like its counterparts in different cities and private ones, generate vast hazardous waste from surgeries. Public health experts have noted that shoddy disposal of such waste can pose gross health and environmental hazards to the citizens.
The Chief Medical Director, LASUTH, Prof. Wale Oke, told SUNDAY PUNCH that he could not provide adequate information on the disposal of surgical waste in the hospital.
“I cannot give you much information about that because I am not in charge of waste. There is a department in charge of it. I can’t give you the information I don’t have,” Oke stated.
However, the Environmental Health Officer for LASUTH, Mr. Kareem Tijani, said the LAWMA officers were in charge of carting surgical waste away from the hospital’s waste house.
He said, “We have a waste house where we keep our waste. It is often partitioned into domestic, non-infectious and infectious waste. LAWMA agents come to the hospital to carry the waste. There is a PSP operator attached to LASUTH. It is called Urban Spirit. We have another LAWMA truck that comes for our yellow nylon referred to as infectious waste.
“We usually call one of the agencies called QMX to evacuate all amputated human parts almost immediately. They do not stay in the hospitals for long as other waste.”
At the Alheri Hospital in the Ojodu Abiodun area of Ogun State, some nurses in mint green uniform sat in the reception awaiting patients. The matron of the private clinic, with branches in the state, warmly welcomed our correspondent on a mission to know the system the hospital put in place to discard its surgical waste.
The matron, attired in a blue uniform of trousers and top, refused to disclose her name to SUNDAY PUNCH.
According to her, the hospital’s surgical waste including needles, surgical blades, and syringes are usually kept in a safety box for LAWMA to pick.
She said, “We don’t usually dispose of surgical waste like other waste. They are usually infectious and that is why we usually separate them from other waste. We keep such waste in the safety box till the LAWMA agents come to pack them.
“There is a particular LAWMA truck for hospitals. On the truck, it is inscribed ‘LAWMA Medical.’ It is the truck that packs our surgical waste. Our other waste like tissue papers, plates, and other normal waste are often kept differently because we have other waste apart from surgical ones. Those ones are disposed of like domestic waste.”
Also, a doctor at the Federal College of Education Medical Centre, Akoka, Lagos, Dr. Rotimi Adeyemi, corroborated the Alheri matron’s claims.
According to him, surgical waste in hospitals is properly disposed of so that it doesn’t cause infections to both humans and animals.
“Such waste includes body parts, placenta, blood, syringes, needles, specimen bottles and the rest,” Adeyemi added.
He explained that every registered hospital in Lagos had an agreement with LAWMA under the umbrella of the Lagos State Government to properly dispose of their medical or surgical waste.
He said, “There is a law in Lagos that mandates hospitals to dispose of their surgical waste in such a way that it doesn’t cause infections. There is a particular LAWMA truck responsible for such. It is called LAWMA Medical; it deals only with hospitals. It often goes to hospitals to pack surgical waste.
“In the hospital, we have what is called the sharp box where we put sharp objects like needles and syringes. If a needle mistakenly drops, it will drop into the box. The sharp objects are usually kept in the box till LAWMA agents come for them. For other waste like placentas, blood and the rest, they are usually kept in red waste bags. The waste bags are in different colours and serve different purposes.
“All hospitals registered in Lagos have been signed with LAWMA. Officers of the authority go around monthly to pick up their surgical waste. Hospitals don’t discard their surgical waste in open spaces so that scavengers will not be infected. They can contract hepatitis, HIV and other infections in the process of raiding the dumps.”
The doctor added that the hospital where he worked usually kept a separated bin for its surgical waste pending the arrival of LAWMA officers.
Besides, a nurse at the University College Hospital, Ibadan, Oyo State, who spoke to SUNDAY PUNCH on condition of anonymity, gave an insight into how the hospital discards its infectious waste.
She told our correspondent that harmful waste, such as needles, syringes and surgical blades were usually kept inside a safety box and later collected from different departments and put in an incinerator.
The nurse said, “The waste in form of tissue or body parts e.g. fibroid, amputated legs, bones etc, are put inside a container for laboratory investigations especially cancerous tissues to check if it is malignant or benign.
“They can also be given to the patients to see and do whatever they like with them. This is mostly applicable to cut-out body parts like legs, hands and placenta which are often buried by them. But surgical waste, in form of liquid, especially blood, is poured out through a sink connected to the hospital’s septic tank.”
According to the nurse, there are different colours of waste nylons and bags designed for different waste. She added, “For example, red nylon or bucket is used to convey bloody waste (i.e. any waste with blood stain), yellow is for non-infectious waste.”
How we dispose of our waste — UCH
The CMD, UCH, Prof. Temitope Alonge, said the hospital surgical waste could be classified into two—sharp objects and human parts.
Alonge stated, “In the hospital, we have what we call sharp boxes and in UCH, we have about 5,000 boxes in the store, that means we have more than enough at the moment. The sharp boxes are where we throw the needles, cannula, cannula needles and the rest.
“The waste is disposed of through incineration. We have an incinerator that has been in use for over 50 years. Once the safety boxes are filled, they are sealed in the red waste bag and environmental officers put them inside the incinerator.
“The soiled materials from the theatre waste go into the yellow waste bag which is known as the theatre bag. If we operate on a patient who we suspect may have highly infectious disease, we also incinerate the waste from such a person.”
The CMD added that in cases of blood spillage, the hospital would apply various chemicals to denature the blood and the components before they were disposed of.
“Also, there are two other incinerators supplied by the Federal Government for body parts after amputation. That is where we incinerate the body parts,” Alonge stated.
Asked how the hospital protects the incinerators from scavengers, the CMD said the incinerators were well protected, adding that it was impossible for anyone to pick anything from them.
Alonge added, “The incinerators are on the hospital premises. We have what we call the Environmental Monitor Scheme. The team monitors incineration every day. Since we don’t take waste outside the hospital, it is impossible for scavengers to gain access to them. It is only domestic waste that scavengers can get access to.”
We dispose of only surgical waste, not body parts — LAWMA
The General Manager, LAWMA, Mr. Segun Adeniji, told our correspondent that the authority only carried surgical waste generated by registered health facilities in the state.
He, however, said collection of body parts from hospitals for disposal was not part of LAWMA’s duties.
The LAWMA boss stated that the business of the authority was to dispose of needles, syringes and other sharp objects.
Adeniji said, “LAWMA has nothing to do with amputated human parts. The hospitals are in the best position to speak on how they dispose of body parts that are waste. We don’t deal with that but I know that the hospitals have a way of dealing with it. For example, Igbobi Hospital has a machine it uses for that, likewise LASUTH.
“For other medical waste, like syringes, needles, medical blades and the rest, we pick them up from the hospitals. LAWMA has a machine called autoclaves; the machine does the cleaning and disinfecting of the syringes and needles.”
Adeniji explained further that apart from picking surgical waste from both private and public hospitals, some contractors also assisted the agency in doing that.
“All hospitals registered under the Lagos State Government cannot dispose of their medical waste anyhow. The PSP go to the hospitals to collect their waste, take them to the autoclaves for treatment before finally discarding it. There is also an agency which monitors the hospitals to do the proper thing,” he added.
According to him, LAWMA has a special dump for medical waste separate from the ones used for domestic and general waste.
“There is a special dump for medical waste. For instance, the Epe General Hospital has a treatment machine. But for others, once the waste is collected, it is treated and disposed at Ewu-Elepe, in Ikorodu area of the state,” Adeniji stated.
Also, an official of an environmental utility group, Visionscape, who spoke on condition of anonymity because he was not authorised to speak to the press, said the firm was not involved in the disposal of surgical waste in the state.
He said, “Visionscape is responsible for packing domestic waste. We have no business with medical waste; so, we don’t know how the state disposes of that.”
How developed countries discard surgical waste
In developed countries, about 90 per cent of surgical waste is treated through incineration. However, a leading Medical Waste Disposal Company, stated that some states in the United States of America, including California, prohibited the incineration of surgical waste. Instead, autoclaves are used for that.
It noted that autoclaves are closed chambers that use both heat and pressure (and sometimes steam) to sterilise medical equipment. Autoclaves destroy microorganisms on surgical waste like scalpels for tool reuse and eliminate microorganisms that might be present in medical waste before it is put in a landfill. Essentially, autoclaving allows doctors to reuse tools and makes garbage safe to go in landfills.
Another comprehensive health care network stated that some medical devices, whether used or unused during surgery, can be reprocessed by a Food and Drug Administration-approved third-party company and sold back to the hospital for about half the original sales price.
This, it added, allows hospitals to save money and cut down on the volume of disposable supplies that end up in landfills.
The FDA is a federal agency of the United States Department of Health and Human Services, one of the United States federal executive departments.
According to resource.co, the recommendation by the Health Technical Memorandum 07-01, clinical waste is segregated using a range of containers with a set colour code.
The contents of four of the six bins—cytostatic (drugs like chemotherapy treatments that have a toxic effect on cells) waste and sharps; anatomical waste (amputated limbs and other body parts); pharmaceutical waste; and mixed medicinal and non-cytostatic waste — can only be disposed of through high temperature incineration. Even despite their common destination, all four need to be separately collected and stored.
Waste collected through HTI is burnt at Augean’s plant in Kent, the only facility in the United Kingdom capable of recovering energy from the process. Waste is burnt at 1,100 degrees centigrade to guarantee the destruction of any hazardous properties.
According to the site, the other two bins consist of orange bags for materials disposed of through ‘alternative treatment’ and black and yellow ‘tiger stripe’ bags for ‘offensive waste.’
Though infectious, orange bag waste does not have to be incinerated, it could be recycled through the aforementioned alternative treatment, which most usually, takes the form of autoclaving.
‘Nigeria’s surgical waste management ineffective’
An environmental activist, Nnimmo Bassey, said he was unsure that the nation’s waste disposal system was effective and efficient.
Bassey said considering the fact that solid waste management was not properly enforced in Nigeria, it was clear that surgical waste disposal was a big problem.
The environmentalist stated that it was one area the country had not paid sufficient attention, adding that Nigeria needed to create and enforce a strict health care waste management framework, including segregation of waste and suitable disposal systems.
He said, “Medical waste poses serious dangers to citizens because medical facilities and institutions are located in close proximity to residential areas and the waste generated tend to be disposed of without due consideration to related hazards. Unsafe health care waste management practices are rife in the country and something needs to be done urgently to address the menace.”
Bassey further said it was not safe for medical waste to be disposed in the open and members of the public should be restricted from gaining access to such dumps.
He added, “Medical waste should be handled by specialist agencies because of their toxicity. Besides, some of the waste such as syringes and other sharp objects cannot be dumped in the open or in dumps that are accessible to the public. Children and scavengers or waste pickers are especially vulnerable to the dangers in such dumps.’’
According to him, there is the need to treat chemical and pathological waste specially.
He further said every health facility should have colour-coded waste containers for suitable handling of waste including inculcation of safe waste disposal culture in health workers and patients.
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