Bangladesh: Tackling a huge waste problem

Saving lives doesn't always mean medicine. Eben blogs about a Médecins sans Frontières / Doctors Without Borders (MSF) team that's not afraid to get its hands dirty in order to fight infection...

A cow grazes in the old Waste Zone at the hospital

In my previous blog post from Bangladesh I wrote about my experience visiting a Rohingya refugee camp.

In that post I mentioned then that I would write more about the project I’m working in a future post. This is it, or at least part one of it... 

Working for the local community

In this blog post I will focus on our projects’ waste zone operations. In the next post I will focus on our infection prevention and control (IPC) efforts.

Our project is not directly involved with the Rohingya refugee camps. We are based in the city of Cox’s Bazar, which is  where we offer support to the local Sadar District Hospital.

When they come to hospital, patients should be free of the risk of becoming more sick than they already are.

Although it is also a referral hospital for the refugee Rohingya communities from the camps (meaning they are transferred here when they need more care than can be provided in the camp's clinics and health centres), this hospital primarily services the local Bangladeshi host community.

The bulk of the international NGO efforts in this region of Bangladesh are focused on the refugee community. This means that it can be easy to overlook the plight of the local community, who face severe challenges of their own.

Vital, meticulous, well-functioning

There are a few other international NGOs supporting Sadar Hospital, but MSF’s focus here is on waste management. Looking at the pictures you will realise why.


The waste zone at the hospital
The waste zone before the MSF team began work

When they come to hospital, patients should be free of the risk of becoming more sick than they already are. This means reducing infections people actually pick up in the hospital itself through proper infection prevention and control processes.

Medical waste contains biological products (bacteria, viruses and bodily fluids) that can be highly infectious, and if not disposed of properly it poses a health and environmental danger. That’s why it’s vital to have a meticulous and well-functioning waste collection, sorting and disposal programme. 

I am the project administrator and I’m responsible for financial and HR management. (With all your generous donations, I am able to pay for everything we have to do ?.)

Our hospital

The Sadar hospital provides medical services to a community of approximately 2.2 million people and is officially a 250-bed hospital. However, the reality is closer to 600 – 800 patients on average. This does not include the relatives of patients who attend to sick family members.

There is severe overcrowding and seeing patients laying on the floor in passages is nothing strange here.

Medical waste contains biological products (bacteria, viruses and bodily fluids) that can be highly infectious...

I visited the hospital shortly after my arrival in early August. I have travelled a fair bit before arriving in Bangladesh and I’m not new to witnessing poverty and severe challenges on resources – but this was something different altogether.

The hospital is severely under-resourced and access/crowd control is non-existent. Wrestling my way through the never-ending stream of people I couldn’t help notice the dirt and the smell. To my utter disbelief a cow lazily walked past me – on the hospital grounds. 

The "waste zone"

I soon realised where the smell was coming from, and where the cow was heading: the “waste zone”, an open area at back side of the hospital.

All kinds of waste is just dumped in the waste zone. General waste, kitchen waste, discarded used syringes and of course hospital biological waste. All this in the open air next to the boundary wall. Across the road there is a school.

There is no consideration of waste segregation. Cattle, crows and dogs all scavenge off the waste. Did I mention biological waste from the hospital?

General waste, kitchen waste, discarded used syringes and of course hospital biological waste...

Hospital staff walk through the waste wearing open sandals, notwithstanding the eminent dangers of all the discarded needles and are left without rubber gloves or other protection equipment. You have to see the pictures to believe it.

It is no wonder MSF identified waste management as a critical element requiring support in the overall hospital management, and our focus area. 


The new waste centre under construction
The new waste centre under construction

The goal

Once the waste management system is completed, this will be the only public hospital in Bangladesh to boast such a facility. The whole project team is very dedicated to ensure the success of this project and it is our hope that this can serve as a model to other public hospitals in the country.

Our water and sanitation expert team, with support from our logistics and supply teams, has been very hard at work at constructing a waste zone set up to MSF standards and protocols. (I’ll let the "before", "during" and "after" photos speak for themselves.)


The foundations of the new waste management centre
The foundations of the new waste management centre are laid

Construction has just wrapped up and we are now awaiting the delivery of our waste incinerator (which is being imported from the UK).

In the meantime, we have identified a crew of local cleaners to be trained specifically as waste zone operators.

With construction finalised, we can start using the sharps pit (for discarding used needles), glass crusher (to crush glass ampoules), safety box reducer (for the burning of needle boxes) and organic pit (for biological waste).

Once our incinerator arrives and is installed we can proceed to burn general waste and start utilising the ash pit.


The gardens around the new waste management centre
The gardens around the completed waste management centre

With construction wrapped up, we also did a bit of landscaping around the new waste zone. (I’m sure you will agree it is a huge contrast to the situation before.) 

To my colleagues in the water and sanitation team: well done! I’m proud to be associated with all of you and this project. You will leave behind something that will benefit the host community of Bangladesh for many years to come.

As I’m writing this we are just approaching the festive season in December. This is the season of giving and if you feel moved please consider a donation to MSF. Every little bit helps when the need is so great.

Thank you!