Medical nemesis: How careless healthcare is giving us disease

In 2003, a rag-picker, but for whose tribe Mumbai would have been a dirtier place despite having a civic body in place, found a human hand on a garbage dump. The incident raised a hue and cry which brought to light the fact that the city’s healthcare system did not give a damn about how it disposed of its biomedical waste. One thought things would change. Two years down the road, a child from a city slum, playing near the garbage dump, picked up a thing with a pointy end and playfully sprayed his friend with its content. That cost his 7-year-old pal his eye, all in innocent but decidedly deadly fun. When a social worker took up the blinded boy’s cause, it once again focused attention on biomedical waste management practices in the city. The law demands the segregation of such waste, and placing them in differently coded bags for disposal. These two cases relate to what was seen and done on garbage heaps. Things that ought not to have arrived there at all had found their way there. The hospital concerned and the city’s solid waste managers had failed again. Nine years on, have there been any noticeable improvements in this scary scenario? Guess again! A report in Mumbai Mirror points to the pathetic ways in which the city deals with it even though there is a local government and the Maharashtra State Pollution Control Board supposedly monitoring the situation. Read the following scary quotes from that report: • “On April 5, heaps of medical throwaways from Masina Hospital were found scattered on a footpath of a busy street in Byculla. Rag-pickers rummaged through the waste, unmindful of the diseases it may have been carrying.” • “It may seem to be a minor lapse, but what happens is that BMC workers mistake the garbage for regular trash and collect it. This way, dangerous items enter the city’s disposal system,” Director, SMS Envoclean, Chetan Bora, said. Envoclean is a contractor charged with collecting and processing the biomedical waste. • “We hardly get used syringes and saline bottles. We suspect hospitals send these items for recycling without carrying out a proper disinfection process,” said an employee of Envoclean. The sum and substance is that the entire system is hogwash: hospitals, nursing homes, and dispensaries just don’t give a tinker’s curse and put the city to serious risks of infection and even worse: a possible chain of infection which could be catastrophic. Who knows what biomedical waste carries what virus or bacteria. [caption id=“attachment_277519” align=“alignleft” width=“380” caption=“This discovery of biomedical waste on a sidewalk can be described as a terrible offence, but looking at the broader picture it seems to be the norm. AFP”]  [/caption] This discovery of biomedical waste on a sidewalk can be described as a terrible offence, but looking at the broader picture it seems to be the norm. If not on the sidewalk, dump it elsewhere. The hospital and the collecting agencies can point accusing fingers at each other. There are untold stories of careless and penny-pinching doctors running dispensaries who are equally guilty. It is known that up to 15 percent of such hospital wastes — bio-medical waste which includes amputated limbs, umbilical cords, blood and pus-soaked cotton and gauze and discarded bandages — require to be incinerated. The remaining 85 percent requires to be autoclaved prior to transferring it to the civic dump yards which we know are overflowing. In mid-2000, it was estimated that some six tonnes of untreated hospital wastes were floating around the city, posing a threat to public health. This, if you do the math, is about one per cent of the total waste generated by the congested city. The latest estimate indicates close to four tonnes of waste generated a day. This, however, is not typical to Mumbai but a malaise across Maharashtra where the legislation with regard to managing biomedical waste was brought in as far back as 1986. A 2011 status report of the Maharashtra State Pollution Control Board shows that in the previous year, of the 45,784 healthcare centres, only 14,438 were bedded and 31,346 were not. It showed that 1,417 health establishments with beds have been authorised to generate and handle their wastes, but only 6,702 of the rest had this facility – indicating a huge gap. Reputed hospitals like Bombay Hospital have been categorised for “low” awareness” and “bad” biowaste management level in the same status report and so has been the Asian Institute of Medical Sciences. And, curiously, no violations were reported in the report which, to say the least, is strange. This needs some explanation, doesn’t it? “This composition indicates difficulty” in making an inventory “as well as towards the enforcement of the rules”, it says, which is some confession! A third of the biomedical waste surfaces from the non-bedded units, scattered all over, and carelessly managing their wastes and their disposal. And of all the biomedical waste generated, a third is from Mumbai alone. A report from The Hindu with regard to the status of handling biomedical waste in Mumbai and Maharashtra in 2003 says a “truckload of biomedical waste containing body parts” was found scattered on a dumping ground, triggering an uproar in the public domain. MPCB officers, who fanned out across Maharashtra to study how things were working, found that nothing was being done properly, from segregation of the biomedical waste at source to treatment facilities. Even the incinerators and autoclaves were not fired up to the required temperatures to be effective. The biomedical waste was not picked up daily. The collection was invariably poor when the hospitals and nursing homes were charged on a per kg basis. If its levy was on a per bed basis, “all sorts of waste” were handed out in a bid to save money. “Generally non-incinerable/autoclavable waste” was “directly sold” for recycling “without any treatment.” Obviously, it is a huge problem which persists, endangering the residents of the city. And this is done largely by expensive health care providers. What can one say?