05 Mar 19
Eben Van TonderEben Van TonderSouth AfricanProject AdministratorBangladesh

Getting our hands dirty

Saving lives doesn’t always involve direct medical care. Eben Van Tonder writes about an MSF team that’s not afraid to get its hands dirty in order to fight infection...

“The project I’m working in is based in the city of Cox’s Bazar, Bangladesh, where we offer support to Sadar district hospital. I’m the project administrator and am responsible for financial and HR management (with all your generous donations, I’m able to pay for everything we have to do!) Although Sadar hospital is also a referral hospital for Rohingya refugees 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 public hospital primarily serves the local Bangladeshi community.


Sadar hospital provides medical services to approximately 2.2 million people. Officially it’s a 250-bed hospital, but the reality is that it has closer to 600 to 800 patients on any given day – and this doesn’t include all the relatives accompanying their sick family members. The overcrowding is so severe that seeing patients lying on the floor in passages is nothing strange here. 

The hospital is severely underresourced, and controlling the flow of people through the building is impossible. Wrestling my way through the never-ending stream of people, I couldn’t help noticing the dirt and the smell. To my utter disbelief, a cow lazily walked past me – in the hospital grounds.


I soon realised where the smell was coming from and where the cow was heading: an open area at the back of the hospital known as the ‘waste zone’. All kinds of waste were being dumped here: general waste, kitchen waste, discarded used syringes and hospital biological waste – and all this in the open air next to the boundary wall, just across the road from a school. 

Cattle, crows and dogs were scavenging off the waste. Hospital staff were walking through the waste wearing open sandals, despite the danger of discarded needles. It was little wonder that we quickly identified waste management as a critical element requiring our support.


When they come to hospital, patients shouldn’t face the risk of getting sicker than they already are. This means reducing the infections that people pick up in hospital through proper infection prevention and control processes. Medical waste contains biological products – bacteria, viruses and bodily fluids – that can be highly infectious. If not disposed of properly, it poses a health and environmental danger. That’s why it’s so important to have a meticulous and well-functioning programme to collect, sort and dispose of waste. It was vital to construct a waste zone that conformed to MSF standards and protocols. Our water and sanitation team set to work.


After a few weeks’ work, 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 as waste zone operators.

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

Once our incinerator arrives and is installed, we can start burning general waste and utilising the ash pit. To finish things up, we also did a bit of landscaping around the new waste zone. I’m sure you’d agree that it’s a huge contrast to how it was before.


Once the waste management system is fully completed, this will be the only public hospital in Bangladesh to boast such a facility. We’re hoping that the success of this project will serve as a model to other public hospitals in the country. To my colleagues in the water and sanitation team: well done! I’m proud to be associated with all of you and with this project. You’ll leave behind something that will benefit this community for many years to come.”