It’s easy to ignore Albania. After its freedom from the tyranny of hard line communist rule and the totalitarian regime of Enver Hoxha, there isn’t much more to say.

But Albania is a county with a population of around 3 million, with a need for healthcare that is perhaps greater than our own. When they do get care, the clinical and other waste that are generated must then be managed but in all probability we neither know nor care what happens to it.

But we should. There is a market to exploit, albeit a rather small one. There are concerns regarding public health and environmental protection, but before that we should be concerned regarding safety of those who might be exposed to those wastes by virtue of their job, or otherwise. We have so little information about Albania, and in particular its healthcare systems and waste management operations that we must glean information in piecemeal manner.

Fortunately, the World Bank can do better than that. It supports development in countries such as Albania, and reporting on its action we can identify the scale of the challenge, the innovations that are in hand, and those which must still be addressed.

“Luciana Havale is busy at work bagging sterilized medical waste from the hospital where she works in Tirana, Albania.

She was able to disinfect the potentially hazardous material with a hydro-clave, which the Ministry of Health provided, and taught her to operate.

“It trained me about how to separate waste, and I communicate with the different wards here and help them separate the different wastes into different boxes,” said Havale.

“The hydroclave uses steam to sterilize dangerous materials, such as needles, syringes, glass vials, and gloves used for operations – all potential sources of harm and disease to the public if the materials are contaminated and spread.

“The Albanian Health Ministry distributed seven of the hydroclaves to hospitals and other medical institutions around the country as part of a government-run Health Sector Modernization Project, supported by the World Bank.

At Tirana’s public University Hospital Center, named for famous Albanian, Mother Teresa, medical waste often exceeds 800 kilograms a day.

“Until recently, the waste was burned by hospital employees, like Sotir Gjermeni, at this now-defunct incinerator on hospital grounds, causing terrible smoke and terrible smells.

“There was extreme pollution around the area and for hundreds of meters, and the residents complained,” Gjermeni said.

The health project has since provided the Hospital Center with a hydro-clave, and trained Sotir and other employees how to use it.

“They work in shifts sterilizing the medical waste and bagging it for safe disposal afterwards at municipality landfills. They also sterilize waste for other medical institutions that don’t have their own hydroclaves, said Hospital Technician, Latif Gurthi, as he shovelled piles of incoming used syringes, empty bags from the hospital’s blood bank, and old bandages into the hydro-clave.

“First, they bring here the waste from different hospitals, we check it, weigh it, and separate it.  And then we sign off on it, and so do the people bringing it,” Gurthi said.

Hospital staff and residents living near the inoperative incinerators say the cleaner and safer process for eliminating medical waste has led to a cleaner and safer environment.

At a small café and restaurant which sits directly across from the University Hospital Center’s incinerator, 86-year-old Bardhyl Kadesha was just finishing having coffee with a friend.

“For the area around the hospital, the climate was harmed due to smoke and the smell,” he said of the days before the arrival of the neighboring hospital’s hydro-clave, and consequent closing of the incinerator.

He no longer got the sore throats he used to, said Kadesha, adding that he and the entire neighborhood were breathing better for the first time in many years. World Bank

So there are improvements, first with the availability of seven Hydroclaves to replace an old and polluting incinerator. That is a major step forward, but will not address the effective management of that small fraction of waste which is unsuitable for autoclave treatment including pharmaceutical and related wastes. and tissue waste.

However, reports of clinical wastes left for someone else to shovel into sacks is of great concern. The country needs to manage its waste safely, from the point of arising in hospitals and clinics, through to final treatment. That requires training and education at all levels and at every point along the disposal chain, without which those Hydroclaves will be of some but limited value. It could be so much better.

Once again, the World Bank has been working quietly to fund an important project in Albania that is an important part of the solution to the wider problem of healthcare waste management.  To train effectively, it would be necessary to identify and engage local staff at various points, in nursing and hospital administration, clinical and scientific staff, waste managers, environmentalist and charitable organisations (for oversight and local engagement), to regulators and politicians, and many more. They must each communicate effectively, working together to develop systems for safe waste management. This will embrace matters of hospital and environmental hygiene and safety, infection prevention and control, regulation and regulatory oversight of the disposal process, health and safety management and overarching financial management which may include involvement of private sector partnerships.

There is clearly a long way to go.