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March 2002
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UPDATE
Reports from the sharp end
3: West Africa: small, locally built incinerators
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Adama Sawadogo is nicknamed
le pyromane – the pyromaniac – because he has
been charged with the task of overseeing the safe disposal
of injection waste in a multicountry measles immunization
campaign. The disposal project is one function of a WHO logistics
team, headed by Souleymane Koné of WHO’s Côte
d’Ivoire office in Abidjan, and covering five countries
in West Africa: Burkina Faso, Mali, Togo, Benin and Ghana.
The project was put together rapidly, beginning in September
2001, in time for a major measles immunization campaign starting
in the region in December.
"We had to find a solution
before the campaign started," says Sawadogo, an engineer by
training. The team anticipated that the campaign alone would
generate about 300 tonnes of injection waste across the five
countries. "We had to destroy it all."
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Wide open:
clinical waste heaped in a mound in a shallow open pit in an
African district hospital |
Sawadogo and his colleagues identified
a simple type of incinerator, known as the De Montfort, which was
devised by a British researcher, James Picken of De Montfort University,
with initial funding from the UK Department of International Development.
It is made of bricks that are fired to be especially resistant to
heat, able to withstand the temperatures of up to 1500ºC that
are necessary for waste destruction, and which can be manufactured
locally.
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The De Montfort has two combustion chambers
and two doors: an upper door through which the safety boxes
are inserted, and a lower door through which the ash can be
removed after burning. The fire can be started with paper,
cardboard or wood with a small quantity of firelighter. Up
to four 5-litre safety boxes fit into the incinerator at once,
stacked two on two.
After receiving training in the building of
this incinerator from its inventor in a workshop in Bamako,
the multicountry team supervised the building of 277 incinerators
across the five countries. To ensure all safety boxes were
burnt, each district had to record each box sent to the incinerator
and an operator logged the arrival of each. Overall 65% of
the campaign waste was burnt in De Montfort incinerators,
and in some of the countries the figure was as high as 100%.
Other methods were permitted for clinics in isolated areas
in the largest districts, says Dr Sawadogo, where the distance
to the nearest incinerator was too great to assure safe and
economical transport.
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| Hazards everywhere: clinical
waste at a regional hospital in east Africa |
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Dr Sawadogo judges the overall performance
of the incinerators during the campaign a success. He says there
are a few structural problems that are being addressed with the
inventor. Some of the incinerators had to work overtime, burning
safety boxes from 9 am to 11 pm at the height of the campaign –
particularly in Burkina where 6 million children had to be immunized.
In a few cases, cracks have appeared in the bricks, suggesting that
some might not have been fired at sufficiently high temperatures,
while a few incinerators showed faults resulting, he believes, from
the speed at which they had to be built. Nevertheless, the overall
performance was efficient, affordable and manageable. "We already
have proposals for improving the incinerators," he says. "At the
same time, we are keeping the door open for using other methods
alongside the De Montfort."
For more information contact Dr Sawadago, seamesaw@yahoo.fr
or Dr Koné, kones@oms.ci
Phyllida Brown
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