Ebola waste task force responds to challenge

Written by: Maxine Perella | Published:

What greater challenge could there be for a waste management specialist than working in an Ebola stricken country? Maxine Perella, freelance writer, reports on how a special Ebola waste task force has been set up to deal with waste handling in exceptionally demanding circumstances.

The on-going devastation caused by the spread of Ebola in West Africa - the largest and most complex outbreak of the virus since it was discovered nearly 40 years ago - serves as an urgent reminder of the challenges involved in both dealing with and trying to contain, such an infectious disease. During this current epidemic, Ebola Virus Disease (EVD) has claimed nearly 7,000 lives with more than 18,000 people infected, according to the World Health Organisation (WHO).

Towards the end of last year, the international waste management industry was called on for its support to help combat the spread of EVD. The call stemmed from a special Ebola waste task force - set up by new charity WasteAid International and established NGO Disaster Waste Recovery (DWR) - that aims to provide assistance in various areas relating to waste handling, disposal, communications and training.

"Our main role is to get the word out that there is this need," says WasteAid International CEO Simon Penney. "There are very real challenges that [Ebola] presents in terms of dealing with waste materials, and tragically also deceased people. It is essential that appropriate waste management is implemented within [affected] communities in order to reduce the impact of this disease."

Those countries worst affected by the current crisis include Guinea, Liberia and Sierra Leone; communities which not only house some of the poorest and most vulnerable, but have weak healthcare infrastructure. Shortages of qualified doctors and nurses coupled with a lack of appropriate equipment and resources have only served to compound the problem.

Penney says one immediate priority is to raise awareness that there is help available.

"Many in the development sector are unaware of the fact that there is a whole waste industry with waste management expertise," he explains. "We have direct links to the people that make the equipment that is needed, expertise in personal protective equipment and its use, protocols, communications and ways of working, field training in terms of dealing with public health, and also long term planning so that future challenges can be dealt with more efficiently."

Volunteers needed

The task force is also seeking volunteers - professional waste managers who are prepared to travel to West Africa to help with the planning, building and improvement of waste systems across the various local, regional and national health hubs.

"So far, we have had somewhere in the region of five to 10 volunteers that we are seeking to place with frontline organisations on the ground in West Africa. We need more," emphasises Penney.

Increasingly, dealing with EVD means working across borders in West Africa and that presents a challenge in itself. According to Olmo Forni, research consultant at DWR, each of the affected countries has specific characteristics, legislation, and available infrastructures. "Even within one single nation there are usually tens of ethnic groups, each one with their own different cultural and religious beliefs, traditional practices, aesthetics, livelihood, and languages," he says. "To complicate even further, it is often the case that these groups are spread across borders and don't really consider different nationalities as part of their identity."

He adds that from a cultural perspective, there can be a mistrust of public institutions.

"In Liberia and Sierra Leone, two countries emerging from civil war, the public wouldn't fully trust public authorities and sometimes even challenge the very notion of Ebola as a real disease. Fortunately, the situation is now improved in this regard."

Safe burials is another delicate issue. They are considered necessary to help stem EVD; between 60 and 80% of all new infections at the early stages of the crisis were linked to funeral attendance and traditional burial practices whereby relatives touch or wash the deceased.

"Cremation, an ideal option, was first tried then abandoned in Liberia because it was perceived inacceptable from a cultural perspective," points out Forni. The other option, which is to lay individual and mass graves in dedicated Ebola burial sites, requires the promotion and adoption of culturally sensitive burial protocols.

Technical challenges

In terms of waste handling, several technical challenges come into play - the amount of waste arisings, available disposal options, lack of infrastructure and the characteristics of the waste itself in regard to its wetness and infectiousness. But the biggest challenge, says Forni, is that any activity undertaken within the high risk area of an Ebola treatment centre must be carried out by staff wearing personal protective equipment (PPE).

"This, combined with the local climate, means it is only possible to work for a short time in the protective equipment before dehydration and fainting can occur," he explains. "In addition, such equipment is highly sensitive to high temperatures and open flames, making handling and disposing of waste an even more dangerous activity."

Generally speaking, all waste produced inside an Ebola treatment centre is disposed of in a dedicated zone within the high risk area. In addition, all material that enters the high risk area must be either disinfected or disposed of. Generated waste is sprayed with chlorine solution and double bagged in leak-proof bags that are also chlorinated inside out prior to their use.

Depending on the facility, the final disposal method varies from open burning on a burning platform to dual chamber incinerators. Some cities such as Monrovia and Freetown have also recently employed rotary kiln incinerators and autoclaves.

Asked what measures would be of most benefit to improve waste handling within these centres so that risk from infection can be minimised, Forni replies: "Having fire-resistant and heat-proof protective equipment comes to mind." He says that the greatest risk for those in charge of Ebola waste management activities is related to the disposal process and the potential flammability and vulnerability to high temperatures of the protective equipment.

Contaminated sludge

Managing contaminated sludge from latrines (toilets) is another priority area identified by the task force.

"We do not know the virus survival time in faecal matter," says Forni. He adds that the sludge must be sanitised prior to its removal, which is challenging in itself, before being transported to a treatment plant.

"This requires specific protocols that are being redacted as we speak, and the use of dedicated vehicles and structures."

Given the fact that there have been reports of Ebola cases outside of Africa, what opportunities are there for international knowledge transfer, particularly from those who have first-hand experience of dealing with contaminated materials resulting from EVD?

"Let's not forget that for any international staff working in an Ebola treatment centre, there are up to 10 local staff who are just as important in providing clinical care and the safety of all those working within the centre," says Forni. "Much of the new knowledge we do have on the virus comes from West Africa and the workers involved in the response. From this perspective, there is plenty that NGOs, foreign governments and international organisations have learned from this response, which we should not forget is unprecedented in scale, timing and geographic reach."

Penney adds there is a pressing need to build up local capacity in West Africa.

Countries like the UK, where climate controlled hospitals, good risk management and safe handling of hazardous materials are taken for granted, have a valuable role to play in helping to assist this drive. "In every sense we need to give the experience, training and networks to individuals within these communities so that they can be the frontline in future challenges."

If you can offer support and would like to get involved, contact WasteAid at ebolawasteresponse@wasteaid.ca

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