"My mother often gets bottles from the National University Teaching Hospital (CNHU) or other health centres where we have friends," Aicha told IPS. "We wash them, then refill them with condiments like powdered shrimp, hot pepper, ginger…"

But these vials and small bottles are medical waste that should be properly disposed of. Raymond Da Silva, inspector general at the CNHU, said: "We do what we can to incinerate our waste. But the question of the serum vials is a tough one for all health facilities in Benin."

He warned that these containers, even emptied and cleaned out, are not safe for re-use. "Never accept snacks or spices packed in these vials."

Biomedical waste consists of solid, liquid or laboratory waste of biological origin or generated by medical or paramedical activity. It must be properly managed to protect the general public.

Amina Sylla, the head of biomedical waste services at the non-governmental organisation Bethesda, frowns at the lack of interest by health centres in managing their waste properly. "They don't recognise the need to spend money on waste disposal, yet we manage waste for around 40 hospitals (in and around Cotonou)."

The Regional Medical Centre (CHD) in Parakou in the northeast of the country is a happy exception to this rule. The centre has its own incinerator, Issa Mama Djibril, director of the centre, told IPS.

"We try to manage our waste as best we can and our facilities are also heavily used by the hospitals around us. The big problem is how to ensure that our staff do the work up to the required standard."

But this conscientious attitude is rare. Environmentalist Nikita Topanou, the president of Flambeau du Progrès, a local NGO responsible for collection of household waste in the Abomey-Calavi administrative region in the south of Benin, says the group finds large amounts of biomedical waste mixed into the refuse they work with.

"It's an irresponsible attitude that we are trying to discourage. We are working to raise awareness, so that all health facilities manage their waste properly."

Bethesda has bought a large plot in Hêvié, a suburban area some distance from Cotonou, to comply with regulations requiring that incineration facilities be sited at least 200 metres from the nearest homes, where they consolidate all the waste they collect and destroy it.

"I burn eight 50-kg containers when the incinerator is working well. But when it's malfunctioning, I can only manage three," said Célestin Houndjo, the site manager.

Bethesda has another incineration site at Pahou, about 26 kilometres from Cotonou, but this one is now surrounded by residential areas that have sprung up since the facility was built. "We work in the night," Pahou site manager Yaovi Koffi told IPS. "During the day, people complain about the smoke and gases emitted by the incinerator."

These gases can be very toxic, according to Eustache Houéto, director of the Précis Plus laboratory: "When combustion is incomplete, it can produce carbon monoxide. When the environment is carbon monoxide-rich, then it is very oxygen-poor."

People living in such areas can develop respiratory problems, he said. "You could even say that the poor management of biomedical waste can reduce people's life expectancy."

Dr Agossou Sènami, an ear-nose-throat specialist, says that improper incineration and disposal of waste can damage the mucous membranes lining the nose and throat. "Individuals exposed in this way can develop rhinitis, sinusitis and even cancer. Careless handling of liquids can quickly lead to nosocomial infections – highly dangerous infections typically contracted in hospital settings."

Aware of the many challenges in this sector, the Health Ministry is trying to assume its proper role through its Department of Hygiene and Sanitation. "Basically, we're running training sessions, raising awareness and carrying out monitoring in all 34 health districts, in a total of more than 1,000 public and private health facilities," said Pie Djivo, one of two people responsible for the management of biomedical waste at the ministry.

A national guide to sound management of biomedical waste in Cotonou, produced in cooperation with the Canadian government in December 2008, recommends clarification of the roles and responsibilities of the actors involved to ensure a smoothly functioning system of disposal of this hazardous waste.

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