To cure a patient Many suffer

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E-Pao! Opinion - To cure a patient: Many suffer

To cure a patient: Many suffer
— Let doctors decide —

By: Irabanta Oinam *

A rural hospital in Punjab is better than the existing condition of sanitary & hygiene of JN Hospital – Dr. SS Sidhu, the Governor of Manipur said during his visit at the hospital on 14th February, 2006.

Hospitals and public health care units are supposed to safeguard the health of the community. However, the waste produced by the medical care centres if disposed off improperly, can pose an even greater threat than the original diseases themselves. It proves to be harmful to the environment. It, not only, possess a threat to the employees working in the hospital, but also to the people surrounding that area.

Hospital wastes are categorised according to their weight, density and constituents. The WHO has classified medical waste into different categories.

These are:
Infectious material-containing pathogens in sufficient concentrations or quantities that, if exposed, can cause diseases. This includes waste from surgery and autopsies on patients with infectious diseases;

Sharps disposable needles, syringes, saws, blades, broken glasses, nails or any other item that could cause a cut; Pathological: tissues, organs, body parts, human flesh, fetuses, blood and body fluids;

Pharmaceuticals drugs and chemicals that are returned from wards, spilled, outdated, contaminated, or are no longer required;

Radioactive solids, liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter; and

Others waste from the offices, kitchens, rooms, including bed linen, utensils, paper, etc.

There are no systematic approaches to medical waste disposal in many health centers and private clinics in Manipur. Hospital wastes are disposed off similarly just like the existing open municipal waste disposal method in Manipur. Some waste is simply buried without any appropriate measure which looks like to save the waste.

The reality is - one is the lack of necessary equipment and the second is even though there is exists of necessary equipment to ensure the proper management of hospital waste, however the main problem is that the staff fails to prepare and implement an effective disposable means. It seems, there exists no proper measures for management of hospital waste.

They just throw them in a dustbin or other similar places either within the premises or in nearby municipal open dump bins, because they think that these practices are inexpensive, safe, and a easy solution to dispose off a potentially dangerous waste item.

The different coloured garbage bins for different types of waste are missing in many health centers or the doctors and nurses are not taking care of the need to segregate the waste. Infectious waste release form the treatment of diseases like Hepatitis A & B, AIDS, Typhoid, Boils, etc. are very dangerous if they dispose off openly.

Open burning of medical waste is a serious source of air pollution. When waste containing plastics are burnt, Dioxin is produced, which can cause Cancer, birth defects, decreased psychomotor ability, hearing defects, cognitive defects and behavioural alternations in infants - WHO report. We have seen frequent open burning of hospital waste.

Two incinerators have been installed - one at RIMS complex and the other one at Shija hospital which are not functioning well. Some say it is due to low voltage of power supply. The prescribed temperature for complete and proper destruction of pathogens and necessary control of other emission is 12000C. Burning bio-medical waste incompletely in the incinerator is also releasing acidic gases, heavy metals, and dioxins & furans (a dangerous by-product of toxic chlorinated compounds) into the air.

The incinerators are beneficial when their performance is monitored under strictly controlled conditions and medical wastes are segregated properly. Unfortunately, even the rated standards of incinerators are in doubt and strict control is impossible. The USA has shut down 90 pc of medical wastes incinerators for fitting new pollution control devices to meet the standard.

Flies also sit on the uncovered piles of rotten garbage. This promotes mechanical transmissions of fatal diseases like Diarrhoea, Dysentery, Typhoid, Hepatitis and Cholera. Under moist conditions, mosquitoes transmit many types of infections, like Malaria and Yellow fever. Similarly, dogs, cats and rats also transmit a variety of diseases, including Plague and Flea born fever, as they mostly live in and around the refuse.

As per Supreme Court order, Bio-medical waste (Management & Handling) Rule 1998, prescribed by the Ministry of Environment & Forests, Govt. of India, came into force on July 28 1998 which shows the type of hospital waste category and treatment & disposal method to save the environment/ contamination of land, water and air from the hospital toxic waste. At present we have no much significance on the ground in Manipur.

We need to take up steps for the minimisation of hospital waste before any clear improvement can be made in medical waste management and scientifically based definitions must be established. Then the waste should be segregated. Imposing segregated practices within hospitals to separate biological and chemical hazardous waste will result in a clean solid waste stream, which can be recycled easily.

If proper segregation is achieved through training, clear standards, and tough enforcement, then resources can be turned into useful materials with small portion of the waste stream needing special treatment. New emphasis should be put on the reduction of waste, workers’ safety should be ensured through education, training and proper personal protective equipment.

Furthermore, many poisonous chemicals are also mixed with hospital waste dumped in open air at garbage collection points. In the presence of sunlight the chemicals start different reactions and emit poisonous fume, which not only enhances environmental pollution but also turn whole heap of garbage into a lethal dump.

Due to improper management by civic authorities towards removal of waste from garbage collection points, especially during rainy season, the waste flows into the drains and sewerage lines leading to collapse of drainage system besides making the sewage poisonous to a catastrophic level.

All the effluent is discharged in the rivers creating pollution to the drinking water sources. For instance we can gauge the dangerous effect of when the Mercury inside a broken single clinical thermometer can pollute large volume of water. We need to take care because the drainage systems of Lamphel areas discharge into the Nambul River which falls in Loktak Lake.

Establish more hospital and private clinics with the aim to improve both quality and quantity of health services. But without proper management of their waste is our great mistake. Environmental quality is usually a low priority in the race to develop more health centers in Manipur.

Improvement of environmental quality is the first step to improve the health for all. The key to future development lies in providing the products and services which people want by using the most efficient technologies, and consuming the lowest possible level of resources.

Irabanta Oinam wrote this article for The Sangai Express.
This article was webcasted on March 18th, 2006

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