By Peter Oliver Ochieng

The Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), popularly known as Russia, is now home to a fully operational medical microwave shredder tackling biomedical waste from major hospitals in Kisumu County.

The shredder which costs about Sh131 million, an equivalent of EUR 1 million, was purchased under a partnership deal between Kenya’s Ministry of Health (MOH) and the Government of Belgium, before being officially commissioned on May 19, 2021.

The outlet of the shredded waste

Almost a month since the commissioning, the machine is operational and is already registering positive impacts in tackling biomedical waste, alongside ensuring environmental conservation. The equipment was installed at the lower side of the hospital, not far away from the Kenya Medical Training College (KMTC), Kisumu Campus.

According to a section of KMTC students who reside in the institution’s hostels, the shredder is proving to be an environmentally friendly machine. Justine Okoth is a second-year student, undertaking a course in biomedical engineering at the KMTC, Kisumu Campus. He knows too well the effects of using an incinerator in tackling biomedical waste.

He says the medical shredder is much safer. “Every time the incinerator is on, you feel dizzy and the urge to sneeze catches up with you because of the fumes that it emits. On the other hand, the shredder does not emit smoke hence no effect at all,” said the student.

His assertion is attested to by Cecilia Mbithe, another second-year student taking a medical engineering course. She has been juggling between KMTC Kisumu Campus and JOOTRH since 2019. “The shredder works in a cool and efficient manner. However, the good part of it is that it does not emit fumes which would otherwise be dangerous to the environment.”

The shredded and incinerated remains of waste majorly from JOOTRH and the Kisumu County Referral Hospital (KCRH) are taken to the dumpsite at Kachok, a massive waste dumpsite in Kisumu City.

John Orinde has been the Kachok dumpsite Manager since 2003. He says that initially it was a challenge handling waste from the two major public hospitals in Kisumu City but has noticed a significant change since the installation of the shredder.

“I used to get so many medical wastes within the dumpsite, like sharps (needles) and even body parts. It was a very big problem in terms of health safety, for example JOOTRH I had challenges with them because I used to get raw medical waste from them,” said the Manager.

John Orinde, Kachok Dumpsite manager

However, with the introduction of the shredder at JOOTRH, Orinda indicated that things are changing for the better. “Nowadays, I can say that they are doing a lot to prevent raw waste from landing here. The shredding machine has led to a reduction of the amount of medical waste from Russia to this dumpsite.”

“I paid them a visit a while ago and saw how the shredder is working. The machine is changing things for the better. The remains of the crashed waste are not harmful to me as a dumpsite Manager, my colleagues and the environment for that matter because there are neither sharps nor anything harmful,” he added.

He said that remains of the shredded waste do not form heaps, a phenomenon that was commonplace initially. “The remains are already dry because of a high degree of heat released when shredding. As such when it is brought here, it cannot form a heap as was the case before,” added Orinda.

The equipment has the capacity to crash over 200 kilograms of waste per minute, an equivalent of an estimated 5 tons of waste per day. On the other hand, an incinerator can do between 600 to 800 kilograms of waste in a day.

The medical microwave shredder at JOOTRH is manned by four male staff – three operators and a biomedical engineer. Kennedy Aluko is one of the operators. He said JOOTRH produces about 300 kilograms of biomedical waste per day, which is a drop in the ocean compared to the machine’s daily capacity.

However, other major hospitals in Kisumu County are now taking their waste to Aluko’s place of work, of course at a fee. “We get waste from this hospital and some facilities around, like The Agha Khan Hospital, Kisumu Specialist and other small facilities and clinics around. They pay Sh 100 (about USD 1) for every kilogram of waste.”

Kennedy Aluko operating the shredder

While commissioning the equipment, Prof Anyang’ Nyong’o, the Kisumu County Governor, directed the department of health to speedy up the process of retiring use of incinerators in the County. “With this technology, I am directing the county department of health to come up with regulations that will retire the use of incinerators from facilities in Kisumu County.”

Aluko, however, says the shredder has limitations. “We they are yet to stop the use of incinerator at the facility” because the shredder does not crash waste that comes in the shape of sharps. But on a positive note, he indicated that the hospital has a small shredder specifically for dealing with sharps.

“This is a small shredder for tackling sharps such as needles. We intend to start using it as soon as it is installed. That will make us stop using the incinerator all together in this facility,” he added.

At the KCRH, the incinerator is manned by Mr. Francis Amollo, famously known within the facility’s corridors as Mrefu, absolutely due to his towering figure. He has been at the facility since 2006, meaning he has acres of experience in handling non-infectious, infectious and highly infectious medical waste.

He operates both the incinerator for destroying sharp waste and a burning chamber, which destroys general medical waste at the facility. The 40-year-old man destroys at least 120 kilograms of waste per day, generated at KCRH and other health facilities in the County.

The incinerator uses diesel. As such, facilities which supply their waste – mostly sharps to be incinerated do not pay, but provide diesel in instead. Amollo says the incinerator and the burning chamber are all synonymous with producing smoke, which is hazardous to the environment.

“Most of the time we like to incinerate or burn the waste very early in the morning or very late in the evening.  At that particular moment, the weather is calm so that even if smoke comes out it goes up the sky straight without interference,” he said.

He welcomes the commissioning and smooth running of the shredder at JOOTRH, and is eagerly looking forward to the day when the use of incinerators will be totally retired in Kisumu County.

“The shredder does not emit smoke. The smoke mostly causes upper respiratory infections. Again, I believe the shredder will largely lower the cost of dealing with biomedical waste, since it does not use fuel. It only uses electricity,” he added.

The matter is however cited as challenge by Aluko, who insists that it slows down work whenever there is power blackout. “This shredder only uses electricity. That is why it has its own Kenya Power transmitter. Because of its magnitude, even a generator cannot operate it. That proves to be a challenge when power goes off. But again, the power does not always go off for long periods of time.”

Kisumu County’s CECM) in charge of Health and Sanitation Professor Boaz Otieno Nyunya

Still, looking at the wider picture, Kisumu County’s Chief Executive Committee Member (CECM) in charge of Health and Sanitation Prof. Boaz Otieno Nyunya says a broader plan aimed at retiring the use of incinerators in the Lakeside County’s hospitals is in the pipeline.

“There are plans. How soon is not easy to say because it has major financial implications. Recently, I presented to the Kisumu County cabinet an environment, health and sanitation bill that is partly going to address some of those things, including funding health facilities to retire the use of incinerators. It is an ideal and an ambitious goal which we will pursue,” said Prof. Nyunya.

He said the bill, known as Kisumu County Environmental and Sanitation Bill, 2021 was approved by the cabinet, for onward transmission to the Kisumu County Assembly.

But going forward, Prof. Nyunya says, research ought to be conducted to prove if the outcome of the shredder can be used as manure. “I would want to take it up with the necessary experts in that area involving environmentalists and scientists to see what the outcome would be,” he concluded.