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IV. THE WASTE OFMODERNITY
MedicalWasteManagementinKenya:
OpportunitiesforImprovement
Nashaat Mazrui, MEM 2010
Introduction
0ZH[PUHI\ZHZ^LKYV]L[OYV\NO[OLJVUNLZ[LK
YVHKZ VM 5HPYVIP L_OH\Z[LK HM[LY H SVUN KH` PU [OL
ÄLSK;OV\NO0^PZOLK[VMHSSHZSLLWMVY[OL[^VOV\YZ
[OH[ P[ [HRLZ [V NL[ [V T` KLZ[PUH[PVU [OL HJ[P]P[PLZ
VM[OLKH`SPUNLYLKPUT`TPUKWYL]LU[PUNTLMYVT
NVPUNPU[VT`ZS\TILY0SVVRLKH[T`ÄLSKUV[LZMVY
[OLMV\Y[O[PTLHUKZPNOLK0[^HZ\UILSPL]HISL[OH[
all the health facilities I visited that day had medical
^HZ[L PUJPULYH[VYZ ^P[OV\[ HKLX\H[L HPY WVSS\[PVU
control devices. Residential areas surrounded most of
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JOVRPUNZTVRL[OH[ZLLWLKPU[V[OLPYOVTLZ^OLU[OL
incinerator was operated. I closed my eyes for a while
to comprehend the enormity of the health crisis. There
PZUVKV\I[[OH[P[PZHNYH]LZP[\H[PVUHUKHZH2LU`HU
I consider it my responsibility to search for sustainable
solutions to the crisis. Thus for the rest of my journey,
0[OV\NO[HIV\[[OLTHUHNLTLU[VMTLKPJHS^HZ[LZPU
2LU`HHUKOV^P[JV\SKILPTWYV]LK
Medical waste, also called bio-medical waste
PU2LU`HYLMLYZ[V^HZ[LWYVK\JLKPUOLHS[OMHJPSP[PLZ
VY YLZLHYJO VYNHUPaH[PVUZ K\YPUN [OL KPHNUVZPZ
[YLH[TLU[ VY PTT\UPaH[PVU VM O\THU ILPUNZ HUK
HUPTHSZ>49;OL>VYSK/LHS[O6YNHUPaH[PVU
>/6 JSHZZPÄLZ Z\JO ^HZ[L PU[V [OL MVSSV^PUN
JH[LNVYPLZ! PUMLJ[PV\Z ^HZ[L ZOHYWZ WOHYTHJL\[PJHS
^HZ[LJOLTPJHS^HZ[LNLUV[V_PJ^HZ[LYHKPVHJ[P]L
^HZ[LWH[OVSVNPJHS^HZ[LHUKWYLZZ\YPaLKJVU[HPULYZ
(Pruss et al. 1999). Most health facilities worldwide
prefer to incinerate medical waste as it has many
HK]HU[HNLZ Z\JO HZ Z[LYPSPaH[PVU VM WH[OVSVNPJHS VY
anatomical waste, volume reduction, and waste heat
Nashaat Mazrui graduated with a Masters degree in Environmental Management at Yale FES.
She holds a Bachelor of Science (BSc.) degree in
Chemistry from the University of Nairobi, Kenya.
Currently, she is interested in toxicology and risk
assessment studies of air and water pollutants.
66 Volume 29, 2010
YLJV]LY` /`SHUK /V^L]LY ZPUJL TLKPJHS
^HZ[LZJVU[HPUOPNOHTV\U[ZVMJOSVYPULPU[OLMVYT
of disinfectants or plastic (polyvinyl chloride) (Hyland
PUJPULYH[PUN [OL TH[LYPHS WYVK\JLZ KPV_PUZ
;OLZL HYL JOLTPJHSZ [OH[ YLZPZ[ KLNYHKH[PVU HUK
therefore bio-accumulate in the food chain. They are
toxic to life and have been linked to the development
of cancer, suppression of the immune system, cause
of reproductive and developmental complications
HUKLUKVJYPULKPZY\W[PVU*VUUL[[ "+HYY`SHUK
7H[ +PV_PUZ LU[LY [OL H[TVZWOLYL HZ M\TLZ
/V^L]LYPUHUPUJPULYH[VYLX\PWWLK^P[OHPYWVSS\[PVU
JVU[YVSLX\PWTLU[TVZ[KPV_PUZHYLJVUJLU[YH[LKPU
[OLÅ`HZO^OPJOPZ[OLÄULZVSPKYLTV]LKMYVT[OL
Å\LZ[HJR+PHaL[HS
In addition to dioxin emissions, medical waste
incinerators release considerable amounts of heavy
metals that can be emitted as fumes, particles, and ash
-YP[ZR`L[HS"@\OHZL[HS ;V_PJKPZJOHYNLK
metals include cadmium, lead, mercury, chromium
HUK HYZLUPJ :PUNO HUK 7YHRHZO *OYVUPJ
exposure to toxic metals can result in the suppression
VMOLTH[VSVNPJHSZ`Z[LTRPKUL`MHPS\YLUL\YV[V_PJP[`
NHZ[YVPU[LZ[PUHSKPZVYKLYZYLZWPYH[VY`[YHJ[PYYP[H[PVU
HUK JHUJLY VM [OL S\UNZ HUK WYVZ[H[L <5,7 ;OLKYH^IHJRZVMPUJPULYH[PUNTLKPJHS^HZ[LZ
OH]L LUJV\YHNLK [OL KL]LSVWTLU[ VM HS[LYUH[P]L
[LJOUVSVNPLZ MVY [YLH[TLU[ HUK KPZWVZHS (S[OV\NO
]HYPV\ZUL^[LJOUVSVNPLZHYLILPUNJVUZPKLYLK^VYSK
^PKL VUS` TPJYV^H]PUN HUK Z[LHT Z[LYPSPaH[PVU
seem to offer realistic alternatives to incineration
3LLL[HS/V^L]LY[OLZL[^V[LJOUPX\LZKV
UV[ JVTWSL[LS` Z[LYPSPaL WH[OVSVNPJHS YHKPVHJ[P]L
SHIVYH[VY`HUKJOLTV[OLYHW`^HZ[LZ3LLL[HS
*VTIPUPUNPUJPULYH[PVUHUKUVUPUJPULYH[PVU
[LJOUVSVNPLZMVYTLKPJHS^HZ[L[YLH[TLU[PZ[OLYLMVYL
H NVVK ^H` VM YLK\JPUN WVSS\[PVU 0[ PZ [O\Z UV[
Z\YWYPZPUN [OH[ [OL YLN\SH[PVUZ VM 2LU`H ^OPJO HPT
[V WYL]LU[ [OL K\TWPUN VM \UZ[LYPSPaLK TLKPJHS
Medical Waste Management in Kenya
wastes, call for the employment of incineration and
Z[LHTZ[LYPSPaH[PVUILMVYLÄUHSKPZWVZHS/V^L]LYHU
emphasis on only the treatment of medical waste is
UV[ Z\Z[HPUHISL PU [OL SVUN Y\U >HZ[LZ HYL TLYLS`
residues that our economy has not yet learned to use
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IL HK]HU[HNLV\Z MVY 2LU`H [V L_WSVYL Z\Z[HPUHISL
^H`Z VM \ZPUN TLKPJHS ºYLZPK\LZ» +VPUN ZV ^PSS
not only have environmental and public health
HK]HU[HNLZI\[^PSSHSZVJYLH[LZ\Z[HPUHISLQVIZPU[OL
JV\U[Y`,_WSVYH[PVUVMZ\JOHS[LYUH[P]LZÄYZ[YLX\PYLZ
[OLLZ[HISPZOTLU[VMIHZLSPULKH[HVU[OLNLULYH[PVU
YH[L THUHNLTLU[ WYHJ[PJL [YLH[TLU[ HUK KPZWVZHS
of medical wastes currently employed. My study
therefore aims to establish this data.
-VY[OLX\HU[P[H[P]LHUHS`ZPZ0\ZLK4PUP[HI
[VJHSJ\SH[L[OLH]LYHNLX\HU[P[`VM^HZ[LNLULYH[LK
in each facility. The values were then subjected
to a t-test to establish statistical difference. Also, I
JHSJ\SH[LK ZPTWSL WLYJLU[HNLZ MVY [OL THUHNLTLU[
and disposal methods employed.
Results and Discussion
Quantity of wastes generated
/LHS[O MHJPSP[PLZ JH[LNVYPaL ^HZ[LZ PU[V [^V
THPU NYV\WZ! ZOHYWZ HUK PUMLJ[PV\Z ^HZ[LZ :OHYWZ
are taken to be items that can cut someone while
infectious waste was any solid waste that has come
PU[VJVU[HJ[^P[OHWH[PLU[»ZIVK`Å\PK>P[OPU[OLZL
[^VNYV\WZP[^HZMV\UK[OH[OVZWP[HSZNLULYH[L[OL
Methodology
OPNOLZ[HTV\U[VMIV[O[`WLZVM^HZ[LHUK[OLÄN\YLZ
In an effort to collect this information, I worked ^LYL Z[H[PZ[PJHSS` KPMMLYLU[ MYVT [OVZL NLULYH[LK I`
PU5HPYVIPMYVT1\UL[V(\N\Z[VM NH[OLYPUNKH[H the other three facilities (Table 2).
on medical wastes from health facilities. I choose
5HPYVIPMVY]HYPV\ZYLHZVUZ!ÄYZ[HZ[OLJHWP[HSJP[`VM 9LZ\S[ZMYVT[OPZZ[\K`Z\NNLZ[[OH[[OLNLULYH2LU`HP[PZ[OLTVZ[WVW\SH[LKHUKJVZTVWVSP[HUVM [PVUYH[LVMPUMLJ[PV\Z^HZ[LMVY5HPYVIPPZVU[OLOPNOLY
HSSJP[PLZPU[OLJV\U[Y`"ZLJVUK[OL<UP[LK5H[PVUZ ZPKLMVYHKL]LSVWPUNJV\U[Y`^OLUJVTWHYLK[VKVJ\,U]PYVUTLU[HS 7YVNYHT <5,7 OLHKX\HY[LYZ PZ TLU[LKYH[LZ+PHaL[HS;OPZJV\SKILILJH\ZL
SVJH[LK PU 5HPYVIP ^OPJO THRLZ [OL JP[` H WSHJL VM VM[OLWVVYZLNYLNH[PVUWYHJ[PJLHZL_WSHPULKILSV^
LU]PYVUTLU[HSPU[LYLZ[[V[OLPU[LYUH[PVUHSIVK`"[OPYK
5HPYVIPPZ[OLJLU[LYVMWVSPJ`MVYTH[PVUPU2LU`HHUK Waste management practice
PZ[OLSVJH[PVUVMNV]LYUTLU[VMÄJLOLHKX\HY[LYZ
;OL TVZ[ JVTTVU WYHJ[PJL PU VM [OL
<ZPUN H X\LZ[PVUUHPYL HUK [^V YLZLHYJO MHJPSP[PLZPU5HPYVIPPZ[OLZLNYLNH[PVUVMZOHYWZ^OPSLHSS
HZZPZ[HU[Z 0 ]PZP[LK OLHS[O MHJPSP[PLZ PU 5HPYVIP V[OLYRPUKZVMZVSPKTLKPJHS^HZ[LZHYLTP_LK[VNL[OLY
K\YPUN [OL [OYLL TVU[OZ VM ÄLSK YLZLHYJO 0 ZV\NO[ This practice leads to increased dioxin and metal
PUMVYTH[PVU VU TLKPJHS ^HZ[L NLULYH[PVU YH[L" [OL LTPZZPVUZ K\YPUN [OL PUJPULYH[PVU WYVJLZZ (S]PT
L_[LU[ VM ZLNYLNH[PUN TLKPJHS ^HZ[LZ" YLJ`JSPUN HUK -LYYHaHUK(MVUZVHI(KKP[PVUHSS`THU`
YLJVYK RLLWPUN WYHJ[PJL" HUK TL[OVKZ LTWSV`LK MVY facilities consider broken thermometers as sharps,
[YLH[PUN HUK KPZWVZPUN VM TLKPJHS ^HZ[LZ -VY [OL which leads to increased mercury content in the waste.
W\YWVZLVM[OPZZ[\K`OLHS[OMHJPSP[PLZPU5HPYVIP^LYL
KP]PKLK PU [V MV\Y JSHZZLZ! OVZWP[HSZ U\YZPUN OVTLZ 9LJ`JSPUNHUKYLJVYKRLLWPUNPZUV[WVW\SHY
dispensaries, and clinics (Table 1).
PU OLHS[O MHJPSP[PLZ 0 MV\UK [OH[ SLZZ [OHU VM
Table 1. Categories and definition of health facilities.
Type
+LÄUP[PVU
Hospital
(MHJPSP[`VMMLYPUNIV[OPUWH[PLU[HUKV\[WH[PLU[
services and with more than 70 beds
5\YZPUNOVTLZ
(MHJPSP[`VMMLYPUNIV[OPUWH[PLU[HUKV\[WH[PLU[
services with less than 70 beds
Dispensary
(MHJPSP[`KLZPNULK[VVMMLYV\[WH[PLU[ZLY]PJLZ
^P[OTHU`KVJ[VYZZLY]PUN[OLWH[PLU[Z
Clinics
(MHJPSP[`KLZPNULK[VVMMLYV\[WH[PLU[ZLY]PJLZ
^P[OVULKVJ[VYZLY]PUN[OLWH[PLU[Z
Tropical Resources Bulletin 67
Nashaat Mazrui
Table 2. Waste generated in each type of facility
Facility Type
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0UMLJ[PV\Z^HZ[LZRNWH[PLU[KH`
Hospital
0.9
5\YZPUN/VTL
Dispensary
0.009
Clinic
the facilities recycle pharmaceutical bottles and
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WHWLY @L[ TLKPJHS LX\PWTLU[ JHU IL YL\ZLK PM
KLZPNULK MVY YLJ`JSPUN HUK PM P[ JHU ^P[OZ[HUK [OL
Z[LYPSPaH[PVU WYVJLZZ 7Y\ZZ L[ HS 7SHZ[PJ
Z`YPUNLZ WYVIHIS` OH]L [OL NYLH[LZ[ WV[LU[PHS MVY
YLJ`JSPUN ZPUJL [OL` JVU[HPU H OPNO WSHZ[PJ JVU[LU[
HIV\[ HUK JVU[YPI\[L [OL OPNOLZ[ WYVWVY[PVU
of total medical plastic wastes (Lee et al. 2002).
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KPNLZ[LYZ[VJVUZ\TLWH[OVSVNPJHS^HZ[LZPU[VIPVNHZ
MVYLULYN`HUKU\[YPLU[YPJOZS\YY`MVYMLY[PSPaLY\ZHNL
analytical tools such as mathematical models
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;OL SHJR VM YLJVYK RLLWPUN OPUKLYZ [OL
development of effective medical waste policy.
Waste Treatment and Disposal methods
This study found that most health facilities
subcontract waste treatment and disposal to a private
JVTWHU`0UMHJ[Z\IJVU[YHJ[[VJVTWHUPLZ[OH[
HYLSPJLUZLK[VJVSSLJ[NLULYHS^HZ[L^OPSLVUS`
subcontract to companies licensed to handle medical
^HZ[LZ 6M OLHS[O MHJPSP[PLZ [OH[ KPK UV[ Z\IJVU[YHJ[
6US`VM[OLMHJPSP[PLZHKTP[[VRLLWPUN ^HZ[L KPZWVZHS PUJPULYH[L VU ZP[L HUK [OLU
some kind of records on the amount of medical YLNHYK YLZPK\HS HZO HZ NLULYHS T\UPJPWHS ^HZ[L HUK
^HZ[LZ NLULYH[LK 9LJVYK RLLWPUN PZ HU PU]HS\HISL KPYLJ[S`KLWVZP[HSS[OLPY^HZ[LZPUVWLUK\TWZ
WYHJ[PJL [OH[ JHU HPK H ^HZ[L THUHNLY PU ZL[[PUN
[HYNL[Z MVY ^HZ[L YLK\J[PVU HUK HSZV PU KL]LSVWPUN *VUZPKLYPUN [OH[ TVZ[ VM [OL MHJPSP[PLZ
Figure 1. Children playing in a municipal waste disposal ground
68 Volume 29, 2010
Medical Waste Management in Kenya
Figure 2. Pigs feeding in a municipal waste disposal ground
Z\IJVU[YHJ[ [OL KPZWVZHS VM ^HZ[LZ [V NLULYHS ^HZ[L
MVY[Z[VTPUPTPaL^HZ[LWYVK\J[PVUZOV\SKILLUJVSSLJ[VYZ H SHYNL HTV\U[ VM \UZ[LYPSPaLK TLKPJHS
JV\YHNLK[OYV\NOYLJ`JSPUNHUKYL\ZPUNYLZV\YJLZ
waste actually ends up in dumps. Toxic ashes from 2. :LNYLNH[PVUVM^HZ[LZPZWVVYS`JVUK\J[LKPUMHJPSPPUJPULYH[PVUHYLHSZVKPZWVZLKOLYLSLHKPUN[V^H[LYHUK
[PLZ`L[YPNVYV\ZZLNYLNH[PVU^PSSTPUPTPaL^HZ[LZ
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WVSS\[HU[ LTPZZPVUZ HUK HSSV^ MVY YLJ`JSPUN
:PUJL2LU`HKVLZUV[OH]LHZHUP[HY`SHUKÄSS`L[[OL 0U ZWP[L VM [OL MHJ[ [OH[ YLJ`JSPUN PZ HSTVZ[ UL]WV[LU[PHSMVY[V_PJZ\IZ[HUJL[VSLHJOPZT\JOOPNOLY
er done in health facilities, opportunities for
[OHUPUJV\U[YPLZ^P[OZHUP[HY`SHUKÄSSZ(KKP[PVUHSS`
YLJ`JSPUN WOHYTHJL\[PJHS IV[[SLZ TLKPJHS
[OL J\YYLU[ K\TWZ PU 5HPYVIP HYL HJJLZZPISL [V
WSHZ[PJ ^HZ[LZ HUK WH[OVSVNPJHS ^HZ[LZ L_PZ[
JOPSKYLU HUK HUPTHSZ -PN\YLZ HUK [O\Z 2LLWPUN JVTWYLOLUZP]L YLJVYKZ VM ^HZ[LZ
L_HJLYIH[L[OLOHYTZVMTLKPJHS^HZ[LTHUHNLTLU[
NLULYH[PVU PZ [OL ÄYZ[ Z[LW [V^HYKZ KL]LSVWPUN H ^HZ[L THUHNLTLU[ WSHU I\[ ]LY`
Last, but not least, this study found that all except two
ML^ MHJPSP[PLZ PU 5HPYVIP RLLW YLJVYKZ
facilities that incinerate medical waste are located in ;OL SLNHS H^HYLULZZ HTVUN ^HZ[L THUHNYLZPKLU[PHSHYLHZHUKKVUV[OH]LHKLX\H[LHPYWVSS\[PVU
ers in health facilities is limited, thus it is imcontrol devices. As discussed earlier, incineration is
WVY[HU[ MVY YLN\SH[PVUZ [V IL W\ISPJPaLK Z\JO
HZZVJPH[LK ^P[O THU` ULNH[P]L LU]PYVUTLU[HS HUK
[OH[ HSS [OVZL YLZWVUZPISL MVY NLULYH[PUN OHUhealth effects and it seems ironic that health facilities
KSPUN HUK KPZWVZPUN ^HZ[LZ HYL LUSPNO[LULK
[OLTZLS]LZ HYL JVU[YPI\[PUN [V [OLZL WYVISLTZ Almost all incinerators in the health facilities have poor or no air pollution con[YVS KL]PJLZ ;OLYLMVYL HKLX\H[L WVSS\Conclusion
tion control measures need to be employed.
;OV\NO[OPZWHWLYPZI`UVTLHUZL_OH\Z[P]L 7. ;OL NV]LYUTLU[ ZOV\SK JVUZ[Y\J[ H SHUKÄSS [V
P[OLSWZPKLU[PM`PTWVY[HU[HYLHZ[OH[YLX\PYLPTWYV]LTPUPTPaL [OL SLHJOPUN WV[LU[PHS VM PUJPULYH[VY
TLU[PMTLKPJHS^HZ[LTHUHNLTLU[PU2LU`HPZ[VIL
ashes and other pollutants in municipal wastes.
THKLTVYLZ\Z[HPUHISL;OLMVSSV^PUNSPZ[V\[SPULZ[OL
ZHSPLU[JVUJS\ZPVUZHUKYLJVTTLUKH[PVUZVM[OLZ[\K`! Acknowledgement
I owe the opportunity to do this study to the Compton
1. The amount of medical wastes produced in health
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-LSSV^ZOPW [OL ;YVWPJHS 9LZV\YJLZ 0UZ[P[\[L
MHJPSP[PLZ VM 5HPYVIP PZ OPNOLY [OHU [OL H]LYHNL
HUK
[OL
*HYLLY
+L]LSVWTLU[ 6MÄJL H[ @HSL :JOVVS VM
HTV\U[WYVK\JLKMYVTKL]LSVWPUNJV\U[YPLZ,M-
Tropical Resources Bulletin 69
Nashaat Mazrui
-VYLZ[Y` HUK ,U]PYVUTLU[HS :[\KPLZ 0 HT HSZV PUKLI[LK HUK,_OPIP[PVU(PY>HZ[L4HUHNL(ZZVJ7HWLY
[V T` HK]PZVYZ 7YVMLZZVY;OVTHZ .YHLKLS HUK +Y ,]HUZ 5V ;(+LU]LY*6¶1\UL
2P[\`P MVY [OLPY N\PKHUJL K\YPUN [OL KL]LSVWTLU[ HUK
implementation of the study.
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TLU[VMTLKPJHS^HZ[L0U[O(UU\HS4LL[PUN
9LMLYLUJLZ
HUK,_OPIP[PVU(PY>HZ[L4HUHNL(ZZVJ7HWLY
5V 9((*PUJPUUH[P6/ ¶1\UL
(N\U^HTIH1* :VSPK^HZ[LTHUHNLTLU[PU
5PNLYPH,U]PYVUTLU[HS4HUHNLTLU[! ¶
3LL)41,SSLUILJRLYHUK94V\YL,YZHZV
(S]PT-LYYHa4*4HUK:(=(MVUZVH
Dioxin emission factors for the incineration of
different medical waste types. Arch. Environ.
*VU[HT;V_PJVS!¶
(S]PT-LYYHa4*4HUK:(=(MVUZVI
0UJPULYH[PVUVMKPMMLYLU[[`WLZVMTLKPJHS^HZ[LZ!
emission factors for particulate matter and heavy
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¶
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5V ;7+LU]LY*6¶1\UL
*VUUL[[7 4\UPJPWHS^HZ[LPUJPULYH[PVU!(WVVY
ZVS\[PVUMVY[OLZ[*LU[\Y`[O(UU\HS0U[LY
UH[PVUHS4HUHNLTLU[*VUMLYLUJL>HZ[L¶[V¶
,ULYN`5V] (TZ[LYKHT
+HYY`S3HUK*7H[ ;LJOUPJHSJYP[LYPHMVY[OL
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WVSS\[HU[Z.YLLUWLHJL0U[LYUH[PVUHS:JPLUJL<UP[
+PHa3-33,NNLY[O:O,URO[ZL[ZLNHUK.4
:H]HNL*OHYHJ[LYPZ[PJZVMOLHS[OJHYL^HZ[LZ
>HZ[L4HUHNLTLU[! ¶
-PSPWWVUP7(7VSL[[PUP97VTPHUK7:PYPUP
Physical and mechanical properties of cement
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>HZ[L4HUHNLTLU[!¶
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7*++-KLZ[Y\J[PVUHUKWHY[PJ\SH[LJVU[YVSPUH
IHNOV\ZL!L_WLYPLUJL^P[OHJH[HS`[PJÄS[LYZ`Z[LT
at a medical waste incineration plant. J. Air and
>HZ[L4HUHNL(ZZVJ!¶ .LUHaaPUP*9ALYIPUV(9VUJV6)H[PJHUK.
.PHJJPV/VZWP[HS^HZ[LHZOLZPU7VY[SHUK
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¶
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,UNSL^VVK*SPMMZ!7YLU[PJL/HSS
/`SHUK9. 9LN\SH[VY`KL]LSVWTLU[ZHMMLJ[PUN
TLKPJHS^HZ[LKPZWVZHS0U[O(UU\HS4LL[PUN
70 Volume 29, 2010
Alternatives for treatment and disposal cost reduc[PVUVMYLN\SH[LKTLKPJHS^HZ[LZ>HZ[L4HUHNL
TLU[!¶
3LL)241,SSLUILJRLYHUK94V\YL,YHZV
(UHS`ZLZVM[OLYLJ`JSPUNWV[LU[PHSVMTLKPJHS
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