Hospitals breach disposal rules

On October 28, The Daily Star published a story that focused on how untreated medical wastes were accumulating in landfills in all divisional cities, apart from the capital, posing serious threat to public health.

The scenario in Dhaka is not much different.

An independent investigation by The Daily Star has now revealed quite a shocking picture of medical waste mismanagement, in the underbelly of which thrives an illegal business network of medical waste. But no monitoring or scrutiny in this regard is present. 

In the capital city alone, there are over 1,000 healthcare facilities that generate around four tonnes of medical wastes daily. 

Almost all private entities providing healthcare have an agreement with PRISM Bangladesh Foundation, an NGO working for waste disposal, since such an agreement was made mandatory by the Directorate General of Health Services. Licence cancellations or non-renewals follow the absence of such an agreement.

Under it, hospitals are to segregate medical wastes depending on the type -- infectious, sharp and recyclables -- and store those at a designated point, from where Prism will collect and properly treat those at its treatment plant in Matuail before disposal.  

To not get caught by the DG Health, healthcare facilities make the agreement.  But it is not something they adhere. Neither do they comply the Medical Waste Rules 2008.

Even in regards to this, there is money to be made off illegally.

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.

The correspondents visited eight private hospitals in Shahbagh and Dhanmondi and four public hospitals. They all are flouting the system.

EVIDENCE OF RULES VIOLATION

The Central Hospital Limited log book which keeps data of wastes handed over to Prism every day was blank.

There were zero kgs of infectious, sharp and recyclable wastes in October, September and in previous months of the year, if hospital records are to be believed. For a hospital that serves about 160 patients on a daily basis, producing zero waste is inexplicable.

The 2008 rules have a provision of weighing different types of wastes and maintaining data by both sides -- the waste disposal organisation and the healthcare unit. The record keeping is one of the tools for monitoring and ensuring accountability.

Khalilur Rahman, deputy administrative officer of the Central Hospital, said Prism was responsible for the missing data. “Those [from PRISM] involved in data keeping are not educated,” he claimed.

He also claimed his organisation had proper in-house waste management but could not answer why the authority didn’t complain if it was not getting the required services from Prism, especially as they were charged a monthly fee of Tk 16,500, as suggested by the records.

This kind of book-keeping was also seen elsewhere.

Popular Medical College Hospital generated only infectious waste, as per its records. The columns of the data sheets for sharp and plastic recyclables were blank for October and in the months prior. 

Hafizur Rahman, biomedical engineer of Popular hospital, said separated wastes were kept in polybags and weighed together, but that was not to be as per the 2008 rules.

Anwer Khan Modern Medical College and Hospital didn’t share its data under the pretext that the designated official who looks after waste management had gone on leave. When requested for the data of the day during the visit, hospital Director Jasim Uddin Khan said it was not available.

Mazibur Rahman, hospital superintendent of Ibrahim Cardiac Hospital and Research Institute, said the hospital didn’t keep records of waste disposal. Prism takes only sharp wastes and other wastes are disposed of with general waste, he added. 

In response to queries over the hospitals’ records or no records that bring into question the services they get, Mazharul Islam, programme coordinator of Prism, said the monthly payment bill was always attached to the data sheet and “if there were any mistakes from our part, the authority would have raised it while making the payment.”

About three years ago, the Department of Environment (DoE) conducted raids at private hospitals and fined some of them when they were found guilty of flouting the waste rules. The actions were followed by sudden fixing of in-house waste management but with time things went back to as it had been, Mazharul said.

The scenario at public hospitals is more or less similar and the mandatory condition of waste management doesn’t apply to them. For the services that they get from Prism, DG Health disburses the payment. 

Records of Sir Salimullah Medical College Hospital show that the hospital that treats about 1,300 to 1,400 patients a day gives away on an average 2-3 kgs of used plastic items to Prism.

To understand if the data gives the real picture of plastic waste generated in the hospital, The Daily Star talked to officials of the medical store. About 150-250 saline bags are supplied to patients every day from that store. Each used saline bag weighs 50gm and so the total weight of only saline bags is 7.5- 12.5kg. 

Ward master Sazzad Hossain said the items supplied by the store were dealt with separately after use. But Abdur Rahman, a staff looking after the operation of the store, said all used plastic items were given to Prism.

Prism official Mazharul said, “We cannot point the finger at anybody…. Our job is to collect waste from designated places at hospitals, diagnostic centres. As an NGO we cannot do more than that.”

Aminul Hasan, director (hospital and clinics) of DGHS, who has the licensing authority, said he had no knowledge about the malpractices by healthcare facilities. “We have to see if this is happening and then will take measures.”

PRISM OPERATING AT THE OPTIMUM LEVEL

While healthcare facilities are not abiding by the rules, Prism is working beyond capacity.

Right now, it has 10 covered vans servicing about 1,200 facilities in Dhaka, Narayanganj and Savar every day.

Each van collects medical waste from 120 healthcare units.

Experts though believe Prism alone cannot do much. They say the present scenario offers no solution as Prism was the only organisation authorised to deal with medical waste management and there was only one treatment plant for the purpose.

Experts also said that more third-party contractors like Prism need to be engaged to deal with medical wastes, so that there is competition, and more efficiency and accountability.

According to Satyakam Chakraborty, line director of hospital services management, DGHS, it is not his organisation’s responsibility to oversee medical waste management outside the facilities. “It is between city corporations and Prism.”

“We only check in-house management. Actions are taken if any anomaly is found during random inspections,” Satyakam said.

The city corporations and the Department of Environment also shift the responsibility to each other and the blame game continues, while people’s lives are put at risk.