Gongoni and Mambrui

Today I got to see where Malindi District Hospital incinerates its waste, since their waste incinerator was vandalized and is non-operational. There are two facilities with identical incinerators (more of the work of the United States Marine Corps) about 15 kilometers up the road toward Lamu, Gongoni and Mambrui. We took the waste to Gongoni today (they alternate between the two).

Here's a picture of the incinerator, which they use to incinerate sharps waste (glass bottles, needles, etc):

The incinerator was built in May 2010, when the Marine Corps essentially went down the coast of Kenya and built one for every hospital and clinic, but as you can see in the picture, the concrete can't hold up to the heat of the incinerator. It's still operational, but I can't help but wonder how much longer it will be so. I wonder who I should contact from the Marines to inform them of this problem, so they can improve on the design in the future.

Unfortunately, the incinerator is only for sharps containers. The rest of the infectious waste produced at the hospital is incinerated in the incredibly high-tech incinerator pictured above: a hole in the ground. Obviously, this is not an ideal situation for anyone (it can't reach the heat necessary for proper incineration and to prevent the formation of dioxins, which are carcinogenic), but as far as I know, nobody's doing anything to rectify the situation.

The new "incinerator" that will be going in at Malindi isn't actually an incinerator at all, but an autoclave, followed by a grinder. This will sterilize all infectious wastes (sharps and non-sharps) and then grind it to a course powder for disposal. Since nothing is burning, there's no smoke, so no concerns of carcinogens, which means that it doesn't have to be set away from where people live/work/play/etc, which is what the WHO recommends (I think the distance is 50-150 meters, depending on the climate conditions of the area).

This is Mambrui Dispensary, which is the other site they use for incineration. We didn't burn anything there today (I'm really not sure why we made that side trip, actually). Just a little bit about the different terms: there are six levels of government health care in Kenya. Level 1 is the community health workers. Level 2 is the dispensaries, which have a head nursing officer (I don't think they have a clinical officer), delivery room, maybe one or two rooms for inpatient care, and a consultation room. They have a pharmacy and vaccine clinic as well, but the only vaccines they do are the routine pediatric vaccines. Level 3 is a health clinic (such as Gongoni), which has at least one clinical officer, more inpatient wards, etc, etc. Levels 1-3 are run by the Ministry of Public Health and Sanitation. Levels 4-6 are run by the Ministry of Health, and these are the hospitals of increasing size (district, provincial, and national). So, Malindi District Hospital is a level 4 facility, and the dispensaries and health clinics in the district fall under it, even though they're run by two different ministries of the government. Confused yet?

Random picture of the day: Salt farm. Yes, they farm salt here.