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April 2024 Trials and tribulations of desludging operators in Uganda Tonny Ssekamatte

© WaterAid/ Basile Ouedraogo

Part of the blog series 'Researchers for Sanitation Workers’ Rights' by UNC Sanitation Workers Research Awards 2023 awardees

In the world of desludging, where unsung heroes brave the murky depths of pits and tanks, a hidden realm of hazards silently awaits. It's where rodents, like rats, scuttle through the shadows, where disease vectors buzz ominously in the air, and where pathogens, unseen and relentless, lie in wait for their next victim. Amid the putrid smells that permeate the scene, sharp objects, such as needles and broken glass, hide beneath the surface. Meanwhile, harmful gases waft through the confined spaces, and a mix of chemicals lingers in the air, keeping operators on edge. As they maneuverer through the ever-changing landscape, operators must also watch their step, wary of falls, slips, and trips.

To support desludging operators, our research team in the Department of Disease Control and Environmental Health (Makerere University School of Public Health) has been working closely with these brave operators across the country, particularly in the Greater Kampala Metropolitan Area, to identify occupational risks, understand the health outcomes, and provide recommendations.  

We discovered that the hazards extend beyond the immediate physical risks, as other symptoms emerge as silent cries for help: 21.8% of operators reported that headaches had become a frequent companion, a reminder of the environmental stress they endure; 13.9% experienced fevers, a reflection of the hidden battles fought within their bodies; 10.6% suffered from chest pains, a testament to the constant pressure they endure; and 16.2% experienced back pain and 13.2% endured muscle aches as their bodies bear the weight of their labour. In the shadows, depression and anxiety take hold, afflicting 18.1% of these unsung heroes, reflecting the emotional toll of this challenging work.

Two sanitation workers during a desludging activity in Arua City, Uganda

Two sanitation workers during a desludging activity in Arua City, Uganda

With Musculoskeletal Disorders (MSD)[1] being a significant issue within this profession, our research team decided to take a closer look, collecting data from 303 desludging operators across Uganda. Desludging operators engage in physically demanding work, often involving heavy lifting, repetitive motions, and awkward postures, which can significantly increase the risk of developing MSDs. We found that nearly half (49.8%) of the operators have faced an MSD within the past 12 months, with 29.7% attributing their discomfort to work-related MSDs (WMSD). Of those who had experienced WMSDs, about 63.3% bravely reported their struggles to their employers, seeking recognition and support for their pain. More than a third of these committed individuals (34%) were unable to perform their normal tasks, at home or at work. These disorders, like silent phantoms, choose their battlegrounds within the body. The elbow was a point of vulnerability for 4.6% of operators, while 5.0% bear the weight of discomfort in their shoulders. For 6.3%, it's the wrists and hands that bear the brunt of the struggle.

What we found equally concerning was the extensive use of medication to manage pain and illnesses. More than a third, a staggering 37.3% of operators resorted to painkillers like Panadol, diclofenac, ibuprofen, and tramadol to find relief from their aches and pains. Workers also regularly reached out for de-wormers and antibiotics, with approximately 6-7% of operators having used one of these medications over the past two weeks to grapple with the immediate hazards and lingering effects of their work.

Beyond the physical symptoms and medication, we also explored the emotional and psychological toll of being a desludging operator. We found that for many of these individuals, their mental health was a delicate balance. Over 37% of operators reported they were not able to control crucial aspects of their lives (such as financial stability, personal relationships, or access to resources critical for their well-being) and 35.3% experienced emotional strains that weighed heavily on their shoulders. While nearly half (49.8%) of these operators experiencing emotional strains sometimes found confidence in their ability to handle personal problems, a significant portion (46.9%) occasionally grappled with the feeling that things weren't going their way.  External factors, such as societal stigma, economic challenges, interpersonal conflicts, workplace conditions, and access to resources, often wield power - occasionally provoking anger beyond their control.

“We (desludging operators) are undermined, when a person sees you coming from that truck what comes into their mind is that we don’t understand. This even becomes hard for us to convince the client of the money we have worked for, we are taken as useless humans in the community. It makes our work difficult but you just have no option because it's your job."

- Desludging operator in Kampala City


“I will talk about the challenges we face as women in the field, it's about the stigma and disrespect associated with women in this work. Then as women, we cannot climb walls like the males and the nature of our work requires that since it is more masculine work we end up getting injuries from falls”

- Woman desludging operator in Kampala City

As we ventured deeper into the world of desludging, it became clear that these operators carry not only the physical but also the emotional and medical burdens of their crucial yet perilous profession. In this hazardous world, safety measures, comprehensive training, and protective equipment are not just luxuries – they are lifelines. They ensure that these dedicated individuals can stay safe and keep our environments clean and safe.


For more details, please read our two preprint articles:


Acknowledgments: This blog was written with support from Aisha Nalugya, Winnifred Kansiime, and John Bosco Isunju from Makerere University School of Public Health. This project was made possible through a research grant from the Initiative for Sanitation Workers.

Tonny Ssekamatte, the author of this blog is a Research associate at the Department of Disease Control and Environmental Health, Makerere University School of Public Health, and Consulting Partner, SWEEH Health Consult Ltd. For any questions, please contact him using the following email addresses:;


[1] According to the WHO, musculoskeletal health refers to the performance of the locomotor system, comprising intact muscles, bones, joints and adjacent connective tissues.