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Script 115.0

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Exposure to hazardous medical waste can result in illness or injury. Medical waste involves several risks: 1) it may contain infectious agents; 2) it can damage human genetic material and cause mutations in cells which can lead to cancer; 3) it may contain toxic or hazardous chemicals or pharmaceuticals; and 4) it may contain sharp-edged objects, defined as sharp instruments that can pierce or cut the skin, such as needles or syringes.

Any person exposed to medical waste is potentially at risk, including persons in medical facilities that generate hazardous waste and persons outside those facilities who handle or are exposed to such waste due to careless management. The main groups at risk are: physicians, nurses, health care aides, and maintenance staff in hospitals; patients in health care facilities; visitors to health care facilities; workers in support services related to health care facilities such as laundries, waste handling, and transportation; and workers in waste disposal facilities such as landfills or incinerators, including containers for waste disposal.

This radio script tells the story of a woman who was injured by a syringe with a needle while working in a medical centre. She feared that she might be infected with a disease such as HIV or hepatitis, and immediately asked for a test. We also interview a doctor who talks about the risks a person faces while working in a medical centre and the types of care and rigour that medical staff must use to protect themselves, their patients, and the general public from such accidents with sharp objects and other types of medical hazardous waste.

If you wish to produce a program on this topic, talk to medical staff and others at your local health centre. Ask them what procedures they have in place to deal with such problems, and try to talk to people who have been accidentally injured through contact with medical waste.

Estimated duration with music, intro, and extro, is 20 minutes.

Script

JOURNALIST:
The World Health Organization estimates that 16 billion injections are performed worldwide each year. All of these needles and syringes are part of what is known as medical waste, i.e., the waste produced by the human and animal health sector during diagnosis, monitoring, treatment, and research.

Because of their dangerous nature, these wastes should be sent to treatment and disposal centres. But in reality, they are often found close in close proximity to people, exposing them to potential infections.

What risks do these wastes represent to people, especially children, users of medical facilities, and health centre workers?

Can we recognize the signs when we are infected by this waste? What should be done about it? Can we avoid the danger of these wastes?

These are the questions that we will answer in this program by interviewing a woman who was accidentally wounded by a syringe. We will also listen to the wise advice of another woman, a surgeon in a Burkina Faso medical centre.

JOURNALIST:
Good morning, listeners. To understand this theme, we are with Mrs. Zourata Bandé / Derra. She is a ward attendant at the medical centre with surgical unit, CMA from Yako. Good morning. Also with us is Dr. Aline Judith Korogo / Tiendrébéogo. Hello, doctor!

So, Mrs. Zourata Bandé / Derra, you are a member of the cleaning team at Yako medical centre in northern Burkina Faso. And you are married, the mother of two children. But in your profession, you are referred to as a “ward attendant.” Is that correct?

MRS. BANDE / DERRA:
(LAUGHS) Yes, I’m a ward attendant at the Yako medical centre with a surgical unit, CMA of Yako. And the men who do the same job are called orderlies (LAUGHS).

JOURNALIST:
What is your daily job as a ward attendant or orderly?

MRS. BANDE / DERRA:
The role of the ward attendants or orderlies is to clean, collect, treat, and dispose of medical waste. We are in charge of hygiene and environmental sanitation. Currently, I work at the maternity ward. My shift starts at five in the morning every working day.

JOURNALIST:
And one day, you had an accident that left its mark on you?

MRS. BANDE / DERRA:
Yes, that’s true. It occurred one morning in early 2017. After training school, I had just been posted and I had less than six months of service. That day, while we were in an emergency room cleaning, I saw a syringe package on the floor. When I picked it up, I felt I was pricked by a needle.

JOURNALIST:
What was your reaction?

MRS. BANDE / DERRA:
Ah, I was in shock, but not because of the pain. I was scared. There are many diseases … I wondered if I was going to be contaminated with diseases like hepatitis, or HIV and AIDS.

JOURNALIST:
What did you do immediately after the accident?

MRS. BANDE / DERRA:
With all these questions in mind, I immediately ran to my supervisor, who took me to a doctor. With the doctor’s prescription, I went to the laboratory where they took a blood sample for tests: HIV and hepatitis A, B, and C. I was at risk of being infected with one or all of these diseases. It was complicated.

JOURNALIST:
What happened after the tests?

MRS. BANDE / DERRA:
Pending the results and according to procedure, my working day ended there. I went home very worried. I even cried because of the risks I was exposed to. I called my husband to explain. He told me to calm down and pray because nothing could be done until we got the test results. I hardly slept that night.

JOURNALIST:
What was it like waiting for the results?

MRS. BANDE / DERRA:
The next day, the District Medical Officer called me into his office to inform me of the results. To my great relief, they were all negative. But despite this, I was put on ARVs (antiretrovirals) for a month to rule out any risk of HIV infection. This is a precautionary measure recommended in such a situation. In addition, the records of patients who were in the emergency room at the time were checked. None of them had any of the above-mentioned illnesses.

And a month later, the same tests were repeated, all of them negative.

Hum! I was completely relieved.

JOURNALIST:
Mrs. Bandé, according to the World Health Organization, a person injured by a needle already used on a patient has a 30% chance of being infected with the hepatitis B virus, 1.8% with hepatitis C, and 0.3% with HIV. You were very lucky. But looking back, what do you think caused this accident?

MRS. BANDE / DERRA:
I can say that I am partly responsible for this accident because I didn’t wear my protective gloves. But that needle was not supposed to be there. Normally, caregivers place sharp objects in what we call safety boxes.

This accident taught me a lesson. Today I am more vigilant in my work. And I ask everyone to do their job properly. If the caregivers followed the sorting instructions well and if we who removed them protect ourselves well, I think this kind of accident would not happen anymore.

JOURNALIST:
We also know that there is a significant risk for healthcare users. What advice would you give them?

MRS. BANDE / DERRA:
Yes, that’s true. I would ask them to be careful, because a health centre is a place where you can get germs on any medium. So, I would ask them to be more careful about hygiene. For example: always wash your hands with soap before putting anything in your mouth. Avoid touching surfaces as much as possible, especially with your hands. Avoid handling objects you come across. And when you return home from a health centre, you should wash your hands with soap before touching anything. Ideally, you should go directly to the shower. This is to avoid carrying germs into the house. You should stay away from all garbage. Having good hygiene and being careful about what you touch, I believe that this can help avoid exposing yourself to danger when you go to a health centre.

JOURNALIST:
Thank you, Mrs. Bandé / Derra, for agreeing to share this chapter of your life that has left its mark on you.

JOURNALIST:
Dear listeners, we are now going to speak with Doctor Korogo / Tiendrebéogo. You are a surgeon at the Dr. Sédogo de Leo Medical and Surgical Centre in central-west Burkina Faso. Doctor, we are talking about medical waste. What is the definition in simple terms for the general public?

DOCTOR KOROGO / TIENDREBEOGO
: Medical waste is garbage generated from human and animal health services, including anything that is sharp, such as syringe needles, surgical scalpel blades, and all non-sharp consumables.

JOURNALIST:
Why should such waste be given special treatment for disposal?

DOCTOR:
Because it carries the germs of contagious as well as non-communicable diseases. In addition, it contains sharp objects that can cut or injure. This waste is given special treatment to protect people, especially the most vulnerable.

JOURNALIST:
You followed the account of Mrs. Bandé / Derra. Is this type of accident common among health workers?

DOCTOR:
These are incidents that occur, but not only among those in charge of cleaning up. Even doctors can be pricked when handling a syringe or a sharp object. That is why it is important to always draw the staff’s attention to the need to follow protocols and to use their instruments and protective materials appropriately.

JOURNALIST:
We can also alert everyone because in hospitals there is a routine for treating this waste, but sometimes medical waste can be found in landfills and ordinary garbage dumps, close to people. How dangerous is this?

DOCTOR:
With the case of Mrs. Bandé / Derra, we have an idea of what a prick or a cut by a sharp or blunt piece of waste can expose you to. It could also be, for example, compresses used to make bandages, antiseptics …

JOURNALIST:
Please explain the example of the compresses, Doctor.

DOCTOR:
Yes, we use compresses to make bandages—for example, for a patient who has an infected wound. This means we have infected compresses with pus or blood. And if the facility that did the treatment does not have an incinerator to dispose of the swabs, and they are disposed of in an inappropriate place where they come into contact with other waste, children, for example, may handle them.

JOURNALIST:
And that’s dangerous for children?

DOCTOR:
If these children have minor skin wounds, they are at risk of being contaminated and developing skin infections. They may find that these wounds do not heal, or they become infected and get worse without understanding why. This is because they have been in contact with infected objects that have aggravated the infection. If the child is taken to a health centre but is not reported to have been in contact with soiled or contaminated objects, the child will not receive proper care. This can lead to more serious illness.

JOURNALIST:
Is there special care for people who are infected with medical waste?

DOCTOR:
The specific type of care depends on the injury and the nature of the waste involved. For example, when someone comes in with simple wounds, it is enough to use an ordinary bandage combined with antibiotic therapy. But for a person who has been pricked or injured by a contaminated needle or blade, if the incident took place outside a health centre, one should go to a health centre as soon as possible. Screening tests for common communicable diseases will be done and the necessary vaccinations will be given if these tests are negative. Then the appropriate management of the wound would follow. In short, appropriate treatment is provided according to the situation.

JOURNALIST:
What kinds of hazards are people most exposed to with medical waste?

DOCTOR:
They are most at risk from being injured by sharps and from various infections from other types of waste. For example, contaminated water from health centres needs to be treated before it goes into gutters. Normally, each health centre should have spillways where this water is disinfected before it goes into sewers. But if there is no treatment system, polluted water will be discharged into waterways and homes and threaten people’s health.

JOURNALIST:
Are there any signs or symptoms that tells a person whether they have been exposed to medical waste?

DOCTOR:
Sometimes you can tell if you have direct contact with a contaminated or sharp object in a health centre, but you may not. Let me explain: it is usually children who play with garbage. Perhaps some children are looking for scrap objects that they can sell. A boy may put his hand in the garbage to see if there is something worthwhile for him. And a syringe pricks his fingertip. He may believe it’s trivial because he doesn’t bleed. A few days later, the finger that has been pricked swells and becomes painful. When the parents take him to the health centre, if he reveals what really happened, he will be taken care of accordingly.

JOURNALIST:
What if the victim didn’t know that he or she had been in contact with garbage?

DOCTOR:
The other case where we may not know is if untreated health centre wastewater is dumped into the sewer system. It may contain a certain amount of iodine. And there are people who are sensitive to iodine. If these people come into contact with this water in a puddle, they may develop dermatitis on their feet in reaction to the iodine. But the person may not know this, and may not make the connection, because they don’t know what was in the water. So it will be treated as a simple dermatosis. And such a dermatosis can take a long time to heal or heal and reappear. So right now it’s up to health workers to push their questioning of patients further to try to identify the real cause and provide appropriate care.

JOURNALIST:
What should a person do when exposed to medical waste?

DOCTOR:
Whenever you experience this kind of problem, you have to seek help from health care workers. If it’s a child, the accompanying person should help the caregivers understand the circumstances under which it happened. No detail should be overlooked. If everything is not said, the care will be minimal, and it can become complicated later on.

JOURNALIST:
Do you have any advice for families?

DOCTOR:
Parents first, especially those who may be taken to health centres: I would tell them to avoid handling waste, or even handling the drips that are given to the patients because there can be incidents that go unnoticed. They should follow the instructions given by health workers. They should ask health workers about anything they do not understand. In any hospital ward, there are three types of garbage cans. Two of them are for use by health workers (one for sharps and one for non-sharps). And the third one, usually placed outside the ward, is for patients and their relatives. They should follow the instructions given to them to avoid infection while in the hospital due to improper behaviour or handling of medical waste.

JOURNALIST:
Any advice for health care workers?

DOCTOR:
Health workers should be careful what they do during their work. They should check and use their protective equipment properly. For example, when dealing with liquid waste, they should remember to wear their protective bibs so that they don’t breathe odours which are toxic or to which they are allergic. They must protect themselves as much as possible when handling medical waste.

The other advice for parents concerns children. Tell them to avoid touching any garbage. Explain that garbage is meant to be destroyed and not to be handled.

JOURNALIST:
Do you have any final words?

DOCTOR:
My final word on the subject has to do with awareness. I call on health workers to sensitize everyone on attitudes toward risk. It is up to parents to sensitize their children about the dangers of exposing themselves to waste or swimming in stagnant water. For health workers and cleaners, I recommend caution in their work and in handling. And the media can contribute to this awareness. This is why I welcome the opportunity of this interview. Thank you very much!

JOURNALIST:
Ladies and gentlemen, we have come to the end of our program. We advise you to be careful when you go to a health centre to avoid being contaminated by handling medical waste.

Goodbye to you all!

Acknowledgements

Contributed by: Sébastien Zongo, journalist at the Radiodiffusion télévision du Burkina (RTB)

Reviewed by: Dr. Aline Judith Korogo / Tiendrebéogo, surgeon at the Dr. Sédogo de Léo Medical-Surgical Centre, Central-West Burkina Faso

Information Sources

Interview with Jean De Dieu Ouattara, Sanitary Engineering Technician, Hygiene and Sanitation Manager at the CMA of Yako, September 16, 2019

Interview with Dr. Isabelle Ouedraogo, Chief Medical Officer of the Yako Health District, September 16, 2019

Interview with Zourata Bandé / Derra, ward attendant at the CMA of Yako, September 16, 2019

Interview with Dr. Aline Judith Korogo / Tiendrebéogo, Surgeon at the Dr. Sédogo Medical-Surgical Centre of Léo, Central-West Burkina Faso, July 16, 2020

This article was produced with the support of the Government of Canada under the project “Promoting the Sexual and Reproductive Health and Rights and Nutrition of Adolescents in Burkina Faso” (ADOSANTE). The ADOSANTE project is led by a consortium formed by Helen Keller International (HKI), Marie Stopes-Burkina Faso (MS/BF), Farm Radio International (FRI), the Centre d’information de Conseils et de Documentation sur le Sida et la Tuberculeuse (CICDoc) and the Réseau Afrique Jeunesse Santé et Développement (RAJS).