Shafiul Azam Ahmed
And Tanveer Ahsan
THERE ARE ABOUT 65 small to medium sized private hospitals, clinics, diagnostic centers and laboratories in Khulna city. It is a normal practice at these establishments to simply dump their waste into the nearest dustbin or even throwing those in low-lying areas. This waste, whether dumped in a ditch or dustbin, remain in the open environment as it is not possible for the Khulna City Corporation (KCC) to collect waste from each dustbin everyday. Hospital waste, however, is not like ordinary domestic waste. This waste contains highly infectious pathogens and dangerous chemicals. Open dumping of hospital waste poses a serious threat to public health. There is a high risk of outbreak of infectious diseases from the pathogenic germs in the waste. Moreover, waste pickers (tokais) regularly rummage through dumpsites and dustbins in search of saleable items. They not only expose themselves to hazardous materials like contaminated needles, but also open the route of transmission for infectious diseases to the general public by collecting used syringes, needles, blood bags and IV bags. They sell these items to unscrupulous traders. They, in turn, resell these contaminated items to unsuspecting consumers. This presents a grave risk of spreading deadly diseases like hepatitis and AIDS.
Managing hospital waste
Water and Sanitation Programme-South Asia (WSP-SA) and Swiss Agency for Development and Co-operation (SDC) came forward with an innovative solution for managing hospital waste in Khulna city. A local NGO named Prodipan was engaged to implement a hospital waste management project in collaboration with the KCC and the Bangladesh Medical Association (BMA). This initiative has been in operation for about a year and now covers 24 participating hospitals and clinics. The objective of this project is to formulate and demonstrate a safe hospital waste collection and disposal process that may be replicated in other towns and cities of the country.
In-house waste management
Under the above project, in-house waste management procedures were introduced in each participating healthcare establishment. The first step in safely handling hospital waste is to segregate the waste into hazardous and non-hazardous category. Hazardous wastes include contaminated cotton, gauge, syringes and needles while food, paper, and packages, etc, are non-hazardous. Hazardous and non-hazardous waste are stored in different coloured containers. Needles and other sharp items are stored in plastic bottles contained in metal boxes. Hospital staff has been given rigorous training in following the above waste management procedure.
Transporting the waste
An auto-rickshaw van was specially designed to collect waste from hospitals. This vehicle has lockable, completely covered compartments to accommodate waste bags. This van arrives at the hospitals everyday to collect waste. After collecting waste from all hospitals, it moves to the final disposal site at Rajbandh - about eight kilometres away from the city.
Upon arrival at the final disposal site, wastes from the van are unloaded. The needle bottles and sharp items are deposited into a concrete lined pit. The pit is covered with a lockable lid to prevent unwanted access. The contaminated hazardous wastes are burned in a specially designed furnace located at the disposal site. The non-hazardous wastes are disposed of in the normal dumping ground for municipal waste.
Paying for the service
Participating clinics and hospitals pay monthly charges ranging from Tk. 100 to 600 depending on the amount of waste. This covers about half of the operating and maintenance costs. The rest is still supported by the project. This hospital waste management project will become financially self-supporting with more hospitals and clinics joining the project, an increase in the monthly charge or subsidy contribution from the KCC. It is heartening to know that already many healthcare organisations have expressed keen interest to join the program. It is hoped that similar initiatives will begin in other towns and cities of Bangladesh.
Source: Study Report on Hospital Waste Management in Khulna City by Dr. N. M. Kazi
Source: The Daily Star, Dhaka, July 20, 2001