Representatives from PAHO/WHO, UNEP, and World Vision stand between mountains of rotting garbage at Truitier Municipal Dump (TMD) in Port-au-Prince. The stench alone would drive most people away at the entrance, but Sally Edwards, a PAHO/WHO advisor on environmental health, brings everyone further into the site to see the waste managementprojects. Amid thunderous dump trucks and scrappy 700-pound pigs mingling with goats, Sally explains where pits for medical waste stand in relation to the newly constructed road they are standing on. Truitier has always been a city dumping ground, but over the last six months a consortium of health partners have been working to increase its capacity for a more sustainable waste management system in Haiti.
After the earthquake, waste management became an increasingly complex problem. Medical products like needles, disposable gloves, and bandages piled up at field hospitals and health centers with no system for disposal. Left in trash piles, they increase the risk for transmission of diseases like HIV, hepatitis, and tuberculosis. The displaced population of 1.5 million living in spontaneous settlement sites posed outsized challenges for liquid and solid waste. In particular, the build-up of excreta in camps can contaminate water sources and serve as a breeding ground for flies to spread dangerous salmonella and E. coli bacteria.
During the initial response in January, PAHO/WHO provided public health institutions and NGOs with 20,000 colored plastic bags for safe disposal of health care waste and 1,000 sharps containers for needle disposal. This was only the first step in developing a more robust medical waste management system. To ensure timely and safe pickup, PAHO/WHO contracted Haitian Solid Waste Collection Agency (SMCRS) personnel, trained them to safely remove this type of waste and then provided vaccination against diseases. The staff used two specially designated trucks to pick up waste at 24 health facilities in Port-au-Prince.
The system was not perfect, but as Sally Edwards noted, “It was imperative. Hospitals needed to be supported in managing the huge amount of waste generated following the earthquake. A lot of space surrounding their facilities was used as tent wards and infectious waste needed to be taken off site as quickly as possible.” Once the medical waste was collected, it was dumped at Truitier, where PAHO/WHO worked to build capacity for disposing of this hazardous material by paying for construction of two medical waste pits.
In addition to the hazards posed by medical waste, PAHO/WHO environmental health experts recognized the urgent need to remove latrine excreta from internally displaced persons (IDP) camps. While health care waste pits were being dug, three sludge pits were also constructed at Truitier to complement a program run by the Water Sanitation and Hygiene Cluster. Under that initiative, IDP camps throughout metropolitan Port-au-Prince were identified, and donated de-sludging trucks were dispatched to remove 3,000-5,000 cubic meters of excreta each week.
Sometimes the best laid plans hit unforeseen obstacles, which in this case happen to be more trash. “I remember arriving here in April and discovering the road leading to one of the medical waste pits had become totally impassable because of solid waste and mud,” noted Sally as she reflected on the situation. “Rather than drive a half mile to the correct site once in Truitier, some truck drivers had dumped solid waste in the middle of the road. This action had a cascading effect. The next trucks to arrive were blocked, and had no choice but to dump their trash in the road. It definitely felt like major setback.” To address the issue, PAHO/WHO quickly funded repairs of the blocked 2,000 meter road and turning circle that allowed access to the pits. Two supervisors at Truitier were also hired to oversee disposal of waste in designated sites. This will prevent truck drivers from dumping in the road in the future.
More recently, PAHO/WHO has been working with the Ministry of Health and other partners to establish a longer term solution to the health care waste disposal system in Haiti. A plan is underway to reestablish the incinerator network and disposal options for waste that cannot be incinerated are being proposed. A new training initiative within hospitals on health care waste management is about to begin, which will continue to build capacity in the health system. Finally, PAHO/WHO continues to support partners removing liquid waste from settlement sites. Two additional lagoons for excreta, each with the capacity to treat 25,000 cubic meters, were built in June and July. These pits are an interim solution while a long-term plan is being designed by the partnering agencies. Going forward, PAHO/WHO plans to continue its technical support of waste management projects in collaboration with SMCRS and the Ministry of Health.