Syringes and blood-stained cotton wool are a common thing in the
dumpsites. Photo/ Jacinta Maiga.
Imagine a father who fears leaving his family each day, yet
the need to provide keeps him going. The work is physically demanding and
hazardous, but it pays for his family’s survival.
Paul Otieno has worked as a cleaner in a county hospital for
the past ten years. In 2022, while cleaning the wards, he suffered a needle
prick injury. At first, nothing seemed wrong. But weeks later, his skin
developed a yellow tint (jaundice), and he began experiencing flu-like symptoms
— fever, fatigue, nausea, and body aches. Something wasn’t right.
What followed was a long and confusing medical journey:
countless hospital visits, fluid buildup that left his belly swollen, and no
clear answers until a liver function test was done. Paul was finally diagnosed
with chronic hepatitis C. The condition causes long-term inflammation of the
liver, slowly leading to scarring (cirrhosis) and loss of function. Improper
medical waste disposal, including unsafe handling of needles and syringes, is a
known driver of such infections.
Dr. Ruth Kiato, medical superintendent at Kayole II Level IV
County Hospital, says training staff on clinical waste management not only
keeps employees and patients safe but also enhances public confidence. She
stresses that any effective program must cover several critical areas.
“The first area is waste segregation and identification,”
she explains. “You must train staff on how to identify different types of
clinical waste and ensure they understand the importance of segregation. This
includes understanding the colour coded waste bags and bins.”
She adds that staff also need clear guidance on safe
handling and disposal. “Training staff on clinical waste should include how to
handle clinical waste safely, including the use of personal protective
equipment (PPE),” she says.
Documentation, she notes, is non-negotiable. “Staff should
be familiar with the documentation required for clinical waste management, such
as consignment notes for hazardous waste. Regular audits should also be
conducted to ensure ongoing compliance.”
Preparedness is equally important. “In the event of a
spillage or exposure incident, staff need to know the appropriate emergency
procedure to minimise risk and ensure safety.”
And training must never be a one-off. “Ongoing training and
refresher courses are vital to keep staff up to date with the latest best
practices.”
In Kayole, we meet Raphael, a waste collector who has worked
at the dumpsite for 15 years. The job helps him pay his children’s school fees
and put food on the table, but it comes at a heavy cost.
“The sight and smell of the garbage dump can be unbearable,”
he says. “The heaps of trash are breeding grounds for disease.” The rotting
waste produces foul odours that cause respiratory problems, headaches, and
nausea.
The dangers go beyond human health. Waste products seep into
the soil, causing long-term damage to the ecosystem. Raphael also reveals
darker practices. “Street boys (chokora) receive Sh50 from local chemists and
clinics who don’t have the required documents for medical waste disposal, to
dump for them at the garbage site,” he says, adding that this waste is often
burned in the open.
Even more worrying, he explains, “The Ngong River, which
passes just across the dumping site, is a dumping site for aborted fetuses.
It’s not only the Ngong River that has aborted fetuses but also babies are
found tucked into dustbins. Aborted fetuses, syringes, and blood-stained cotton
wool are a common thing in the dumpsite.”
The author with Raphael, a waste collector in Kayole, and his friend. Raphael has worked in the garbage
site for the last 15 years. Photo/ Jacinta Maiga.
Burning medical waste in the open releases a cocktail of
pollutants — including dioxins, furans, and particulate matter from incomplete
combustion — which cause respiratory disease, cardiovascular problems, and
increase the risk of cancer. Gases such as sulphur dioxide and nitrogen oxides
further irritate the lungs, contribute to acid rain, and worsen urban smog.
Inhaling this toxic smoke harms nearly every system of the body. It is linked
to asthma, chronic bronchitis, heart disease, and cancer, while also causing
reproductive problems, neurological changes, and constant skin and eye
irritation. Open burning, far from being a disposal shortcut, is a hidden
public health crisis.
Geoffrey Mosiria, Nairobi City County Government Chief
Officer for Environment, says counties are training healthcare workers and
waste handlers on proper practices, including segregation, handling, and
disposal. “Counties play a role in raising public awareness about the risks
associated with healthcare waste and promoting safe waste management
practices,” he explains. They are also responsible for supervising operations,
monitoring contractors, and ensuring disposal sites are properly managed.
“Counties may collaborate with other stakeholders, such as healthcare
facilities, waste management companies, and non-governmental organisations, to
improve healthcare waste management. This collaboration helps to leverage
resources, expertise, and best practices.”
Lolem Lokolile, an assistant director of public health at
the Ministry of Health, adds that waste management is guided by the
Constitution of Kenya, the Public Health Act Cap. 242, the Environmental
Management and Coordination Act (EMCA) 1999, and the Occupational Safety and
Health Act 2017. Regulations have also been developed to operationalize the
Injection Safety and Medical Waste Management Policy of 2007.
James Mwita, a public health officer with Nairobi County,
outlines the treatment options for medical waste. The most common is
incineration, which burns waste at very high temperatures to destroy harmful
substances. “Other methods include autoclaving and shredding or microwaving and
shredding, which use heat and pressure to sterilize waste before it is broken
down. In some cases, steam sterilization is applied to kill infectious agents,
while certain categories of waste can be managed through chemical treatment,
which neutralizes hazardous components,” he says.
Francis Chwanya, head of the Environmental Impact Assessment
section at the National Environmental Management Authority (NEMA), explains
that the authority licenses waste transporters, treatment facilities, and
disposal sites to ensure they meet national standards. “NEMA also works with
healthcare facilities to promote proper healthcare waste management, including
training healthcare workers,” he says. The agency monitors local authorities to
ensure waste is collected, treated, and disposed of safely — particularly in
urban areas where volumes are high. “Through its monitoring role, NEMA ensures
that waste management processes do not contribute to pollution, human health
risks, or the degradation of natural resources.”