Wednesday, April 8, 2020

In the valley of the shadow of death

The Auditor General’s officers have seen it all: Money pinching government officials, uncurbed waste at the government enclave and runaway corruption. But in their gross-o-meter, very few things are in the same league as the moment a group of men in brown “Botswana Government” embroidered overalls lifted black rubbish plastic bags from the Princess Marina Hospital waste storage area and heaved them over their shoulders.

The work is filthy and dangerous.

Sometimes the labourers do not have protective clothing and have to carry the unfastened and spilling plastic bags on their backs. The overpowering stench hang heavily in the air, it was almost suffocating. The smell, however, is not surprising if you know that the plastic bags contain used syringes, needles, cannulas, gloves and swabs smeared with blood mixed up with other types of waste.

Last year in May, the team from the Auditor General’s office that went to Princess Marina Hospital could not believe their eyes: About nine labourers were carrying plastics of clinical waste over their shoulders. The situation was no better at Nyangabwe Referral Hospital where nine of the 15 waste disposal labourers used bare hands to carry the clinical waste.

“These bags were not always securely fastened as required by the Botswana Clinical Waste Management Code of Practice (BCWMCP), to avoid spillages that could lead to serious health hazards and injuries” observed the Auditor General.

In his report on “clinical Waste Management at Princess Marina, Nyangabwe and Lobatse Mental Hospital, the Auditor General worries that these men in brown overalls are “ exposed to all forms of infections, not forgetting the nauseating stench that may make handling almost impossible. Proper handling of different types of clinical waste is of paramount importance for health and safety at the workplaces. Therefore, it is imperative for operatives to know the dangers and hazards that may occur.”

For Ministry of Health officials however, clinical waste management hardly ever registers on their radar screen. No one gets fired for mixing clinical waste with household waste, never mind failing to ensure that used needles and swabs are safely stashed away. Clinical waste is dumped outside the incinerator house.
“This attracts rodents, birds and dogs.

Moreover, this waste is left in the direct sun for an unknown length of time and thus accessible to scavengers and rain that might seep through it, absorb hazardous components and carry them into surface and ground water.”

Nyangabwe Hospital on the other hand has one of the best permanent storage built to store clinical waste. Problem is that waste is thrown indiscriminately, damaging bags, leaving them torn and resulting in spillage outside the storage facility adjacent to the food preparation area and bulk food storage area, observed the Auditor General.

Amid BCWMCP guidance and policy documents, it is hard to find anything at government health facilities about clinical waste management that is compulsory, let alone a high priority.

Staff is not properly trained on how to handle clinical waste. “The training is informal as it is peer orientation, inadequate in that, at times, it is just a mini lecture/a day’s workshop and lacks continuity in that it is conducted once in a while or no training at all. The training does not include doctors, who were noticed to segregate clinical waste haphazardly, and facilities’ management, who is charged with ensuring that waste produced by hospitals within their jurisdictions is appropriately managed, stated the Auditor General’s report.

Wards at the three hospitals do not have enough containers to stash away clinical waste. At the Nyangabwe Referral Hospital Theatre Ward “needles were not appropriately disposed of. The containers were overflowing and needles had spilt on the floor and sticking out of containers. This posed great dangers to operatives who ultimately picked them up.” At Princess Marina Hospital the team from the Auditor General’s office “observed instances where sharp needles were overflowing (in Orthopedic Ward Male) and thoratic needles protruding from small sharp containers (surgical Ward Female).

BCWMCP requires that clinical waste be “separated from household waste at source because clinical waste presents greater risks and needs to be handled with caution. The Auditor General, however, “observed that clinical waste was mixed with household waste. The report warns that “ inappropriate segregation of clinical waste does not only pose a serious threat to the general public, operatives and the environment but mostly to refuse collectors for both contractors and local authorities employees, who are not equipped with appropriate protective facilities to handle such waste.”

Medical staff at the three health facilities is sometimes expected to work without protective clothing in the event of needle stick and other accidents.

“For instance, the orthopedic thick gloves were said to have been out of stock for six months at Princess Marina Hospital Main Theatre, different sizes of gloves were out of stock at Marina and Lobatse Mental Hospital for periods ranging between three days to six months and face masks were also out of stock at the mental hospital for periods ranging between 14 days to one year”, states the report.

These workers run the risk of “inhaling organic solvents that can injure lungs, the liver and other internal organs” warns the report.

Most are paying dearly, sometimes with their lives for this lapse in clinical waste management.

At least 194 health professionals at Princess Marina Hospital, Nyangabwe Referral Hospital and Lobatse Mental Hospital were exposed to Hepatitis B infection last year after being injured by needles at work ÔÇô and the figures are believed to be much higher.

Although BCWMCP requires that “all Health Care Workers and Operatives be offered vaccination against Hepatitis B as and when they start work,” an investigation by the Auditor General on Clinical waste disposal has revealed that the health workers were not vaccinated at the time of the accident.

According to the report, 81 health-care workers at Princess Marina Hospital, 112 at Nyangabwe Referral Hospital and one at Lobatse Mental Hospital were only given Hepatitis B vaccinations after the needle stick accidents.

According to the report, the number of accidents is believed to be under-reported because some of those who had been exposed feared that “they might be positive” and decided to hide their status. Besides, “there was no compensation for such cases as motivational incentives for reporting.”

The under reporting is also associated with an increase in HIV\AIDS
BCWMCP requires that “mercury from broken thermometers should be collected in a plastic container and when sufficient quantity has been collected about 1 kg, it should be returned to the Central Medical Stores for recycling.

The requirement for storing the mercury is adhered to. The problem is its return to the Central Medical Stores because it takes time to top the 1 kg mass.

“For example, at Lobatse Mental Hospital, the Office of the Auditor General observed that a quantity of 12.5 milliliters of mercury had been there since 2000, kept in the pharmacist’s office waiting for it to reach the 1kg mass. The effect of keeping such a neurotoxin substance for such a long time is that it may affect the nervous system or cause kidney failure.

Furthermore, the storing of mercury until it is 1kg full encourages its accumulation at rather dangerous quantities that can end up having further breakages and spillages and thus causing more harm” states the Auditor General’s report.

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