NATIONAL10 (Spotlight Weelky)]

Hidden Hazard

A study shows how medical wastes have emerged as a major threat to public health

By KESHAB POUDEL

A few years ago, panic gripped the Bagbazar area after some pedestrians saw parts of the human body in a pile of garbage in the street. Police conducted an investigation to establish whether criminal activity was involved. It emerged that the body parts were dumped following a surgery by a private nursing home in the area.

However, the practice of dumping infectious hospital wastes in regular municipal containers continues, posing a serious threat to public health.

From government hospitals to private medical facilities, only a few health institutions are careful about how they manage such infectious wastes. Most health centers do not respect the basic principles of hygiene and sanitation they have been established to safeguard.

Bir Hospital and Teku Hospital mirror the gravity of the situation. Bir Hospital has been in a peculiar position ever since local residents destroyed its incinerator a few years ago. "We are now dumping hospital waste in the container provided by the municipality," said a former director of the country's oldest hospital.

Program on hospital waste management : Burning issue

Teku Hospital treats patients affected by all kinds of infectious diseases, including HIV\AIDS, Hepatitis B, C and cholera. For many, it is the only lifeline. While the hospital works to save lives of patients coming from all over the country, however, the absence of incinerators forces it to dump infectious waste in normal containers, threatening the health of local residents.

One can find used syringes, half-burnt lab wastes and other infectious matter lying around in hospitals and garbage containers in different parts of the country. Regardless of how hazardous the wastes may be, such dereliction seems to have become the norm in most government hospitals and private clinics.

"More than 90 percent of health care institutions do not practices safe waste handling, storage and disposal methods and most health-care institutions rely on municipal services for their ultimate disposal," says Chanda Rana, president of Save the Environment Foundation (SEF), which recently conducted a study on Nepal's hospital waste-management system under the Colorado Nepal Environmental Exchange Program.

"Hospitals lack waste-management and infection-control responsibilities," says Rana. "Healthcare wastes such as biological waste, infectious waste, sharps, chemical waste, toxic waste, pharmaceutical waste are disposed along with municipal waste."

As part of the study, funded by the Colorado Nepal CSG\SEI grant program, the SEF conducted a survey of all the major hospitals, private nursing homes, pathological laboratories of Kathmandu and Lalitpur and visited two hospitals outside the valley.

The problem created by the lack of landfill sites is exacerbated by poor public awareness about the real dangers infectious medical wastes pose. According to the SEF, hospitals and health centers produce about 1189 kg of harmful and infectious wastes.

Over the years, hospitals have made efforts to manage waste. However, the limited number of incinerators constructed over the past 10 years has not helped to improve things. With the growth of the country's urban population, there has been a significant expansion of health-care facilities. This has resulted in a sharp rise in hazardous solid wastes.

In Kathmandu Valley, Tribhuvan University Teaching Hospital and Patan Hospital have incinerators to treat their wastes. Other hospitals and health facilities, however, rely on containers provided by Kathmandu Municipality.

Officials insist they are aware of the gravity of the problem and promise action. "We will take all necessary measures to manage hospital wastes," Minister of Health Sharad Singh Bhandari said in an address to a function organized to hand over the report. "We will bring necessary legislation to regularize the [treatment] of hazardous medical wastes."

Hospitals collect all medical wastes, including pathological wastes, syringes, bandages and others, in a normal bin and dump it into the municipal containers, according to the study. Those handling the waste do not use even gloves while dumping the material.

"The SEF has been talking about the need for proper disposal of medical waste for a long time," said Rana. "Our study reveals how necessary it is to take urgent steps toward developing land-fill sites."

In the absence of legislation mandating the safe disposal of medical wastes, the authorities are unable to regulate the activities of health institutions. The World Health Organization has classified health-care waste as a by-product of health care that includes sharp, non-sharp, blood, body parts, chemical, pharmaceuticals, medical devices and radioactive materials.

Although the second health plan (1997-2017) has explicitly pointed out the need to link environmental and occupational health to health service while taking growing environmental degradation and industrialization into account, the government is yet to introduce the new regulations.

"We are happy to share our experiences and knowledge on hospital waste management system with Nepal," said participant from Colorado. "We hope the study will help Nepal develop a system to regularize hospital waste."

Thank to the efforts of Colorado Nepal Environmental Exchange Program, the SEF has taken a significant step toward highlighting the consequences the Nepal's current practice of disposing of hazardous medical wastes. It is now up to the government to develop an effective strategy.