What do we do with the refuse of our Covid-19 afflicted healthcare system?

Management of medical waste has remained a persistent problem for Bangladesh. Proper disposal of these wastes—general, infectious, hazardous, radioactive, and often containing pathogens—has never seemed to be taken seriously by the authorities, resulting in rampant mishandling by all concerned. This newspaper has published numerous lead stories on this over the last few years, and written dozens of editorials, but these seem to fall on deaf ears. And while the hazards posed by mishandling of medical waste are myriad and dangerous, they have been exacerbated by the ongoing global health emergency, putting millions of lives at risk of contamination.

Although according to the Directorate General of Health Services (DGHS), any healthcare facility must have an incinerator, autoclave and effluent treatment plants to dispose of hazardous medical waste, in reality, only a few do. The operational ability of many of these facilities are also questionable at best. Let's take the case of Rajshahi for example, as pointed out in a report published on December 22, 2019, titled "Inaction making situation worse". While there are 205 healthcare centres in Rajshahi, there is only one incinerator, and that too in derelict condition—in fact, its chimney had broken down at the time the report was published. Even with a fixed chimney, the efficiency of the venerable incinerator remains uncertain—its burning capacity having fallen to 300 degree celsius from the required 3,000, as mentioned in the report.

Covid-19 has made the task even more difficult, for many reasons. First of all, the volume of medical waste has increased significantly in the wake of the ever-spreading pandemic, and so have the kinds of medical waste. According to the Environment and Social Development Organization (ESDO), 14,500 tonnes of medical waste had been generated in the month of April alone in Bangladesh. Personal protective gear—especially masks, gloves and other one-time use items, featured prominently among the waste.

The problem is, these items are often not considered as medical waste—these items are after all "casually worn" by people to keep the germs at bay, and are equally casually dumped on the sideways, on the roads and in the open dustbins, like candy wrappers. A pictured published by this daily a few weeks ago, showed a PPE casually discarded near the Corona-isolation unit of DMCH. Used masks and gloves were floating on a fountain there. These images are symptomatic of the lack of understanding among PPE users of the significance of proper medical waste management, and perhaps even their apathy towards the issue.

Moreover, as reported by a local newspaper recently, some hospitals dump their medical waste in their backyards to be rid of them. These are later picked up by waste collectors—often young children who pick these up with their bare hands, gloves and masks being luxury items for them—and transported to Matuail Landfill, near Kuwait Bangladesh Friendship Government Hospital, in small open vans or sometimes in garbage trucks. Scraps falling from these open vans or garbage trucks are not an uncommon scenario in Bangladesh, but while these are unpleasant sights under normal circumstances, they can be deadly during a pandemic.

But there is another side to this problem, a more sinister one: at a time of high market demand, discarded masks, gloves and empty bottles of hand sanitisers become valuable commodities, often traded on the black market and resold to the public, creating a greater risk of mass infection. According to news reports, one such "trader" has been apprehended by law enforcers, but there might be others out there right now, selling used surgical masks, gloves, and fake hand sanitisers to innocent buyers in the streets.

At times, hospital authorities themselves become involved in the illegal trading of medical waste. In a report titled "Hospitals breach disposal rules", printed by this daily late last year, it was reported that "The main reason behind lack of proper disposal is that used plastic items can fetch money from the recycling businesses. While recycling without any harm to public health and environment is permissible, hospital records and evidence collected by The Daily Star point to the fact that even medical items made of plastic end up in the black market in connivance with the hospitals' authorities." While this is alarming even under usual circumstances, during a pandemic this can become fatal, putting hundreds and thousands of lives at risk. 

Unable to deal with the surmounting volume of medical waste, some healthcare facilities are resorting to burning it out in the open, resulting in exposure of the people living in surrounding areas to the toxicity in the air released by the inappropriate burning of medical waste. Incinerators are recommended for burning medical waste for a reason, but only a few deign to care.

There is a set of "rules" to manage medical waste—the Medical Waste (Management and Processing) Rules 2008—but it seems they are not being followed properly. For one, one of the rules suggest that "medical waste could not be mixed with other waste at any stage—while producing inside hospitals, while collecting from hospitals, while transporting, and would be processed separately based on classification". If we look around carefully, we would see the contrary mostly.

Perhaps it is the lack of political will on the part of the policymakers and concerned authorities to deal with this persistent problem that had led to its snowballing, especially in the aftermath of the Covid-19 outbreak. We are in the middle of a pandemic and medical waste will only pile up in the weeks and months to come. The government, with whatever resources are available at its disposal, need to take immediate steps to address the situation before it endangers further lives.

The World Health Organization (WHO) and Asian Development Bank (ADB) have issued clear guidelines on how medical waste should be managed during Covid-19. The United Nations Environment Programme (UNEP) has also published a "Compendium of Technologies for Treatment/Destruction of Healthcare Waste" to support relevant authorities in fighting this other menace.

The authorities in Bangladesh should immediately form a committee consisting of medical experts, epidemiologists, environmentalists and legal experts to review the existing rules related to medical waste management and update them to face the emerging challenges posed by the upward trajectory of the pandemic.

Developed countries are now grappling to cope with the piling medical waste generated by Covid-19. And for Bangladesh, the situation is likely to get worse from here. Effective and immediate measures are now required to address this issue. The authorities need to learn from the best practices from countries that have already overcome the first phase of the pandemic, such as China and South Korea, and take inputs from the guidelines issued by WHO, ADB and UNEP, to prepare revised guidelines for Bangladesh. And of course, we need to ensure their strict implementation to make sure lives are not lost due to causes that could have been prevented. Our words are only as good as our actions.

Tasneem Tayeb is a columnist for The Daily Star. Her Twitter handle is: @TayebTasneem