K Chandraiah wheels in his trolley slowly as he makes his way towards the dumping area of the Gandhi hospital in Hyderabad. His trolley is full to the brim and he takes slow, steady steps to ensure that nothing spills.
Once he reaches his destination, he carefully segregates the wastes. Yellow bags are tossed in a stationary truck while black bags are disposed in the next truck.
“When anyone says hospital, many people only think about doctors and nurses and thank them. Without us, the entire place will collapse in a few days,” the 52-year-old chuckles.
(Chandraiah)
How much waste are we dealing with?
According to the Pollution Control Board, there are 1,634 registered hospitals in Telangana, which generate a staggering 8.7 tonnes ofmedical waste every day. Out of this, close to seven tonnes is generated in Hyderabad’s 800-odd hospitals. It excludes the scores of private clinics and nursing homes that dot the city.
What comes under Bio-Medical waste?
The Bio-Medical Waste (Management and Handling) rules, 1998, classify waste into ten different categories, each with a specified method of disposal.
What is supposed to happen?
It is mandatory for hospitals dealing with more than 1,000 patients a month to tie up with bio-medical waste disposal companies.
Human anatomical waste such as body parts and tissue removed during surgery, and other potentially contagious objects generated as waste, should be incinerated at 1,100º Celsius.
Plastic, rubber and glass disposables like gloves, bottles, syringes, tubes and urine bags are supposed to be sterilized and shredded.
Where does Hyderabad's bio-medical waste go?
Private clinics and nursing homes
Dr Shankar, who runs a private clinic says there are other methods of disposal if you do not want to tie up with the firms
“The main things that have to be disposed in clinics are syringes, as no amount of boiling can kill some viruses like HIV.” The solution? A simple incinerator machine costing a few hundred rupees does the trick.
The tip of the syringe is put into a slot in the machine which burns it off. The glass body of the syringe is sterilized, then smashed and disposed of as regular municipal waste as it becomes harmless.
However, a lot of the smaller private clinics as well as nursing homes are known to throw their needles along with regular waste.
According to Dr Shankar, it is mostly due to lack of awareness. “Back in the 80's, segregation was not done. Later, as more awareness was created, doctors started segregating and incinerating their waste. There is still a long way to go.”
Hospitals
Private hospital chains follow the colour code and train their waste handlers. Employees are also given face masks and gloves and the segregation is carried out in a separate area. A truck from the private firm collects the waste every evening to ensure proper disposal.
Government hospitals on the other hand, aren’t as thorough.
In the Gandhi hospital for example, body parts and other bio hazards generated from operation theatres are taken to a chemical chamber situated near the mortuary and incinerated.
Waste from the wards however, is not dealt with as carefully. Emergency situations, the general chaotic nature of a government hospital and some amount of indifference, means that gloves, tubes and needles often mixed with the general waste and join the other municipal waste.
Once dumped onto the Greater Hyderabad Municipal Corporation truck, general waste, including some amount of medical waste, travels to the Tank Bund Transport Section (TBTS), from where it is taken to Jawahar Nagar landfill on the outskirts of the city.
(The TBTS sees a constant stream of GHMC trucks carrying the city's solid waste)
The Jawahar nagar dump is managed by private firm Ramky who have completed eight years of their 25-year contract with the GHMC. They have 340 acres of land and get around 150-200 tonnes a day.
"Though we don't have any exact figures, there is a considerable amount of medical waste that makes its way. At least a few tons," a Ramky official who wished to remain anonymous, admits.
The result?
Medical waste dumped along with other waste from households can pollute soil and water, and also affects ragpickers.
According to a study conducted in January 2014, many children run the risk of coming in contact with or even injured by needles, syringes, saline bottles, soiled gloves and other hospital wastes which they try to clean and resell in Hyderabad's landfills.
This can cause respiratory problems, worms, anemia, fever etc.
(The Jawahar Nagar dump is an entire mountain full of waste that accumulates from the city)
Who is responsible?
The Pollution Control Board is the agency entrusted with ensuring that the law is complied with.
"In most of the hospitals, the disposal fault is not with the doctors but with the ward boys and nurses. Suppose, the PCB finds any defaulters, we take action depending on the degree of the fault," says N Raveendhar, senior scientist with the Pollution Control Board.
The PCB has an internal committee to record and review non-compliance with bio-medical waste disposal.
Ward boys and nurses are trained in handling waste. When a warning in not enough, the PCB is empowered to initiate legal proceedings, Reveendhar says, adding that it is not easy to shut down violators as a long battle in court ensues.
The PCB is also supposed to conduct ground level checks, which it has not done in many months. Deccan Chronicle reported that the PCB conducts checks when an order from the head office comes, which is a rarity.
What can be done
The government set up the National Accreditation Board for Hospitals and Healthcare (NABH) in 2006 to accredit health care providers on quality. Ranking parameters include bio-medical waste disposal.
The NABH is said to come down hard on private hospitals and go easy on government hospitals.
According to A V Ratnam, President of Parirakshana, a hospital management consultancy that trains employees in handling waste, the problem is dual – the PCB lacks commitment, and the government is reluctant to release separate funds.
"The act is there, but only on paper. If you approach the Administrative head of a government hospital, he will claim that he has already briefed all the superintendents, who in turn claim that they have told the nurses, who in turn claim that the ward boys have been briefed. However, the ward boys are clueless. The entire thing is lost in bureaucracy and pointing fingers," he says.