55 tonne medical waste, one plant: How Kerala treats additional waste during pandemic

With the onset of the pandemic, an additional 18 tonnes of medical waste is being been generated per day.
Heap of biomedical waste at IMA plant-INAGE-in Kerala's Palakkad
Heap of biomedical waste at IMA plant-INAGE-in Kerala's Palakkad
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Kerala, on average, generates 37 tonnes of biomedical waste per day. Add to this, 18 tonnes of biomedical waste generated during the COVID-19 pandemic – the huge amount of Personal Protection Equipment (PPE) kit, masks and now syringes as part of the vaccination drive.

As a result, the only biomedical treatment plant in Kerala, located at Puthussery panchayat in Palakkad district, has been functioning round-the-clock to treat the additional waste. Set up and managed by Indian Medical Association, the IMA Goes Eco-friendly (IMAGE) is the sole biomedical waste treatment and disposal facility in the state and was commissioned on December 14, 2003. 

Pandemic generated additional waste

Before the onset of the COVID-19 outbreak in February 2020, the IMAGE plant used to treat about 37 tonnes of waste per day. “Even during the lockdown, the waste generated was less than the average, as hospitals had fewer patients,” an authority, who is part of IMAGE management and did not wish to be named, told TNM.

However, the situation changed by July 2020 when the COVID-19 cases in Kerala began showing an upward trend. The biomedical waste also began to accumulate as the state government set up more and more first-line treatment centres (FLTCs) to isolate and treat COVID-19 patients. Around 530 FLTCs were opened across the state, which added to the biomedical waste burden. Around 200 FLTCs were closed as the daily COVID-19 cases in Kerala began showing a declining trend by November, although it continues to remain high.

Currently, the plant has five incinerators. Two more incinerators with the double chamber will be installed at the plant in a couple of months. “The existing incinerators have been running round the clock to meet the additional biomedical waste. The double-chamber incinerators will meet any emergencies in the future, and ensure the existing capacities of the plant will not be worn out,” Dr PT Zacharias, President of IMA Kerala, told TNM. 

The Indian Medical Association has already made payment for the double-chamber incinerators and will be used as a reserve. 

IMA is set to establish a new biomedical plant at Brahmapuram in Kochi, Ernakulam district. “In the future, two new incinerators will be shifted to the new biomedical plant,” added Dr Zacharias. 

How the additional waste is treated

According to IMAGE authorities, the additional biomedical waste generated due to the pandemic has been treated by enhancing or increasing the capacity of the existing incinerators as well as by operating those for extra hours.

The State Pollution Control Board (PCB), which monitors the functioning of IMAGE, permitted the plant to treat 37 tonnes of biomedical waster every day, until the pandemic. In October 2020, PCB raised the limit of waste to be treated per day from 37 tonnes to 55.8 or 55.4 tonnes, increasing the capacity by about 18 tonnes. 

“That is the quantity of the additional waste we are treating per day due to the pandemic. The COVID-19 biomedical waste is mostly generated from government hospitals as the most number of treatment centres are government hospitals,” the IMAGE authority said.

Currently, around 16,000 hospitals, both government and private hospitals, are affiliated to IMAGE for waste treatment. Of this, 1,800 are government hospitals, including 1,350 COVID-19 treatment centres.  

IMAGE collects biomedical waste from hospitals and transports it to the plant in Palakkad. It charges Rs 3.80 per bed from government hospitals and Rs 6.35 per bed from private hospitals. 

The plastic conundrum

Segregation and treatment of plastic waste is always a challenge for IMAGE, but it is even more challenging now as the quantity of plastic waste generated as part of the COVID-19 waste is huge. Besides, the COVID-19 plastic waster comes unsegregated. The PPE kit, which consists of gowns, gloves, face shields and masks, are plastic, made of plastic fibres such as polypropylene. 

If plastic waste is fed into the incinerators, the whole mechanism will become faulty, which require frequent maintenance of incinerators, said a former office-bearer of IMA, who is also part of the IMAGE management.

“Earlier, if one out of the five incinerators was stopped for maintenance, the functioning of the entire plant won’t be affected. It takes up to one week for the maintenance of one incinerator. Now, there hasn’t been ample time for the maintenance as the quantity of waste is high,” he explained, adding that this also necessitated additional incinerators. 

Due to the lack of proper waste storage facilities at hospitals, all types of waste – plastic, food and degradable – get mixed up, affecting efficient segregation.

Dumping waste continues

Some hospitals dumping Kerala’s biomedical waste on state borders has been a grave issue in the recent past. In January 2020, the Mysuru police arrested two men from Kerala for dumping two tonnes of general and biomedical waste on an empty plot in Nanjangud in Karnataka.

According to the IMAGE authorities, a few hospitals, which are not affiliated with the biomedical waste management body, were behind the offence. Many hospitals choose not to be part of IMAGE in order to avoid paying a monthly charge. The state Pollution Control Board is much sterner on such institutions and will not issue the license to operate if they are not affiliated with IMAGE. 

However, there are times when hospitals, even though affiliated with IMAGE, end up dumping the medical waste elsewhere, especially in situations where the authorities cannot directly monitor the situation during COVID-19. 

For instance, residents living near the Government Medical College Hospital in Thiruvananthapuram complained of a mounting pile of waste on the hospital premise, although the authorities claimed it as non-medical waste. Used syringes, gloves, PPE kits, blood-stained cotton and bandages and other garbage were seen in the pile of waste.

“During the pandemic, Kozhikode Medical College Hospital, although affiliated to IMAGE, once dumped its biomedical waste along with other waste on the outskirts of the district, which has been brought to the notice of the Pollution Control Board,” the IMAGE authority said.

The proposed biomedical plant in Brahmapuram

Though the Kerala government allotted three acres of land for setting up a plant in Brahmapuram in Ernakulam, the ownership of the land is still with the Cochin Corporation. The IMA is yet to get the Non-Objection Certificate (NOC) from the Cochin Corporation to begin the work.

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