Halls of healing, dens of decay

Halls of healing, dens of decay
Ravi Aggarwal

Several workers became sick after being exposed to stored, untreated infectious waste in a Delhi hospital some days ago. Similar cases of untreated wastes were uncovered in a recent survey covering over 30 hospitals. The waste, which includes used bandages and body fluids, was also found to put the lives of hospital workers, wastepickers and local residents at grave risk.

Allowing such dangers to remain is unpardonable, especially for a well-administered health care system that promises to `first do no harm'.From this July onwards, medical institutions in eight mega cities risk closure and fines if they do not comply with a new law, the `Bio Medical Waste Handling and Management Rules, 1998'.

However, of the scores of health care providers in these cities with over 150,000 hospital beds, less than 5 per cent have been following the required procedures. During the past four years the law has been in the making, NGOs and committed individuals have acted as catalysts to the process, with the help of the media. In a spirit of affirmative action, they have been disseminating information through well-designed field guides, creating model programmes, and imparting training to help the health care sector cope with the risk. However, as has been continuously revealed, the response has been wanting.

The risk from some forms of bio-medical wastes is particularly grave and well documented. For instance, studies show that more than 20 per cent of those who administer injections, mostly nurses, are stuck by syringes and suffer ``stick injuries''. Worldwide, as per the WHO, 8-16 million hepatitis B, 2.3 to 4.7 million hepatitis C and 80,000 to 160,000 HIV infections are estimated to occur from the reuse of syringe needle without sterilisation. Two months ago, a racket encompassing the whole of north India, involving the collection and resale of such syringes was uncovered in Delhi. Earlier, bandages and used cotton wool were found to be sold to the manufacturers of mattresses and quilts. The new law clearly puts the onus on the waste generator.

Simple procedures of waste segregation and disinfection are all that is largely needed to mitigate the problem. It requires an emphasis on the training of nurses and wardboys. They need to be made aware of the personal risks they face. The cost of operating such as system in hospitals has been calculated to be less than one rupee per bed per day, besides final treatment costs. Surprisingly, there is an unwillingness on the part of the medical authorities to take responsibility for this. They have, so far, preferred to pass the buck.

Despite advice to the contrary, there has been a rush to install on-site incinerators to burn the waste, when safer alternatives such as autoclaves and microwaves are locally available. Materials such as chlorinated plastics, when combusted, emit carcinogenic super toxins like dioxins and furans. Delhi alone has more than 30 such machines, almost all of which burn such plastics. Several surveys have revealed that none of them are functioning as per required standards and are, in fact, creating more pollution than the waste did in the first place. The operators, who wear no safety gear, are exposed to these fumes, as are the people living in the vicinity.

However the regulatory body, in spite of knowing about the acute toxicity, has not shut down a single incinerator. Unless regulatory agencies take action, how will medical institutions realise the seriousness of their intent? For the law to work at the national level, the government must initiate a national coordinating mechanism involving the ministry of health and other stakeholders, like industry and the municipal authorities. There have to be efforts to improve compliance and to institutionalise training and capacity building. For once, the citizenry, media and the NGOs will be fully behind them.