MEDICAL WASTE HANDLING IN CALCUTTA
[Mohit Ray of Vasundhara boards a Medical Waste Collection Van of Calcutta Municipal Corporation to find that the rules are being violated at every step]
Calcutta people might still remember those huge hoarding proudly put up by Calcutta Municipal Corporation announcing that the city to be the first in the country to introduce ‘scientific medical waste management’. White vans with Clinical Waste written across them can now be seen in the morning. Calcutta Municipal Corporation first must be thanked that the medical wastes are now at least being not dumped here and there and not at common disposal site. But medical waste management means something more than that. Medical Wastes are the wastes generated in the hospitals, nursing homes, diagnostic centres during the diagnosis, treatment, immunization or research activities which are potentially hazardous due to infection. Bio-Medical Waste (Management and Handling) Rules came into force two years back, in July 1998, to ensure safe management of these wastes.
Vasundhara decided to find out the reality. So Vasundhara representative boarded one of those white vans of Calcutta Municipal Corporation in a morning trip with the medical waste collectors to find out the real scenario. The van first entered into a big private hospital on the southern end of EM Bypass. At the back of the hospital in the open there was a yellow big garbage vat as can be seen on the roadside. The vat was full of garbage and a few coloured bags were also there. Red bags, Yellow bags, Blue or White bags – all are killer bags. They need to be handled differently, treated differently. We got down and the medical waste collectors started to bring those coloured bags to load into the backside of the van. And then it was revealed that none of the medical waste collectors had any gloves, any mask or even a proper shoe. Those killer bags did not have any identification symbol and information label as required under the rule. The coloured bags were cheap thin plastic bags which we get free while buying anything from the local shops (though this practice has been banned in some of the states in our country). The bags were also not sealed. The hazardous wastes from the coloured bags can get mixed easily with general waste by a stray dog or birds. And all these carelessness is taking place in a huge expensive private hospital!
NO CARE FOR RULES
Bio-Medical Waste (Management and Handling) Rules, July 1998 has laid out some specific steps to be followed for handling of medical waste. The basic aim of the rule is to separate medical waste from general waste and then segregate those into separate groups according to the required treatment and disposal [See Box]. The biohazard symbol separates a medical waste bag from others. Rule 6(2) specifically mentions that each container should bear that symbol. During our whole tour not a single bag had that symbol on it. Rule 6(3) states that if the bag is transported from hospital to the treatment facilities, the bag should have a label stating a number of information about the waste e.g. category of waste, description, date of generation, senders name etc. etc. No bag had any such label. The hospitals and Calcutta Municipal Corporation are violating the rule of the country.
The van started for its next destination. Our discussion gradually moved towards the hazards of waste collection. Why are they not provided with any gloves, mask or other protective gears? Well, they are not corporation employees at all. They are temporary workers hired by a contractor. Calcutta Municipal Corporation has assigned this hazardous job to the private contractors (one of them is a NGO, a new nomenclature for sanitizing private contractors?). They were initially provided with some gloves but there was no system for cleaning those gloves or replacing them daily. The waste collectors found those contaminated gloves a more potential source of infection. So they stopped using them. Do they know why there are bags of different colours? No, they don’t. They have no proper training. Then how is this contaminated compartment of the van washed after days job? It is not washed either. Though they have some idea about the hazards of handling medical wastes; they are extremely casual about the entire process, the potential hazards to themselves, to their immediate kin, people they interact with, the people around in general.
As we reached our next destination, a nursing home at the southern fringe of the city, we first checked the contents of the bags. There were red and white bags. Red bag had used syringes in it, which should have been in a white one. The thin plastic bags got slit from the sharp end of the needles, syringes, ampules. Cotton dressings stained with blood were overflowing from the white bag, something that should have been in a red one. It was found that nursing home workers are not aware of the segregation rules either. They just know that the wastes are to be kept in a coloured plastic bag. As the van moved to a number of nursing homes and diagnostic centre, it was the same scene everywhere. We could find food wastes, food packages in those waste bags. Worst of it was that the black bags which are supposed to carry non-contaminated wastes are also being used to carry all sorts of wastes. At one of the diagnostic centre close to Jadavpur Railway Station even the colour bar was ruled out. Its all waste were stored in six (6) green bags, a colour not listed at all in the rules.
Worst scenario waited for us at the government run hospital for tuberculosis at Jadavpur. Its waste bins are of old type, open cylindrical ones. These are left unguarded in the hospital compound full of long grasses and weeds. These are common waste bin for all types of garbage and medical wastes in some coloured bags are kept in it. A good rain will wash the bloods and other contaminants to mix with general waste. Birds, dogs, waste scavenger – it is open for use to anyone. The plastic bags were torn and all kinds of wastes mixed up in different bags. There were thirteen (13) black bags but filled with all types of wastes.
In fact all the hospitals and nursing homes are violating the Bio-Medical Waste (Management and Handling) Rules as none of them have proper waste treatment system. Rule 5(2) states that “all hospitals and nursing homes in towns with population of 30 lakhs and above” should have waste treatment facilities by 31st December 1999. How far, if at all any treatment has come up here? The query continued. After about four hours the collection job was finished. At the end of the day’s collection, the waste collectors have kept record of all types of bags from each hospital/nursing homes. The van finally reached Dhapa dumping ground of Calcutta Municipal Corporation. This complex now has a separate zone for the disposal of medical waste. At the entrance of the dumping complex, the weight of the total waste is recorded and then at the final disposal area, the number of different coloured bags are also recorded. But why this effort either? As the colour of the bag is meaningless in absence of any segregation, this data may be wrongly used and interpreted in some future research. All the wastes are finally disposed in “deep burial” system though at least two categories of wastes need disinfection before disposal. Still it is an acceptable alternative till the other options become available. But as the wastes are not segregated, non-contaminated wastes are also being dumped there together with the contaminated one, though those can be safely dumped into ordinary sanitary landfill. This is unnecessarily limiting the space for the deep burial of the contaminated ones. As the wastes are being buried in plastic bags, their biodegradation will be difficult too.
PROTECT THE HEALTH OF MEDICAL WASTE COLLECTORS
The medical waste collectors are doing a hazardous job for the citizens of Calcutta. They should be cared better. They should be provided with better safety gears, washing facilities, proper training and of course a better pay for performing such a hazardous work. There should be health insurance for these workers and their families. Care for the workers and respect for the Rules are the minimum requirements to protect the city from any disaster generating from the medical waste.