Living on medical wastes

Md Rasel, a 27-year-old peddler, regularly visits hospitals and diagnostic centres in Dhaka's Sher-e-Bangla Nagar area to collect recyclable medical wastes.

He collects syringes, test tubes, saline sets, and any objects made of metal, glass, rubber or plastic. In some hospitals, he has to pay a fee to collect these wastes, whereas, in other hospitals, he might collect the waste for free.

Rasel washes blood, pus and chemicals from these materials and then sells these to recyclers at the rate of around 100 taka per kilogram of medical waste.

"I also sell paper, plastic bottles and metal objects, but medical waste is more valuable," says Rasel. "The price of normal wastes varies between five to 20 taka per kilogram, whereas in the case of medical waste, I can earn 50 to 60 taka per kilogram by just selling unwashed medical waste. If washed, then this price rises to 100 taka per kilogram," he adds.    

Due to such a lucrative business prospect, thousands of waste pickers and peddlers like Rasel have to resort to looking for a livelihood by regularly handling such toxic and hazardous medical waste.

According to a report titled "Biomedical Waste amid Covid-19: perspectives from Bangladesh" published in The Lancet on August 13, 2020, around 206 tonnes of medical waste are generated daily in Dhaka alone.

However, Prism Bangladesh Foundation, a development organisation that collects medical waste in Dhaka and a few other cities, only manages to collect six to seven tonnes of medical waste from Dhaka, Narayanganj City Corporation, and Savar municipality daily.

Before the pandemic, the organisation collected around 12 tonnes of medical waste daily from Dhaka, Narayanganj and Savar areas.

Furthermore, a study by BRAC revealed that last year, around 93 percent of medical waste in Bangladesh was unmanaged.

Such huge volumes of uncollected and unmanaged medical wastes end up in garbage containers and waste transfer stations all over the city, where waste pickers attempt to collect them.

In one such waste transfer station in Indira Road, we met Topon Kumar, a waste picker who was busy rummaging through vast piles of trash in search of medical waste he could resell.

Topon said, "We get huge amounts of waste from government hospitals. We communicate with the cleaners of the hospitals who sell this waste at around 1000 to 1500 taka per sack."

Najmul, another waste picker, said, "A couple of days ago, I purchased a large sack full of medical waste from a government hospital for 1500 taka. I then sold the sack for 3000 taka. Had I washed it before selling it, I could have sold it at an even higher price. Unfortunately, I did not have the time to clean such a large amount of waste."

"However, we need to remove blood, pus or other fluids from the materials when cleaning, and this reduces the weight of our collected waste, resulting in us receiving a lower price," adds Najmul.

After collecting wastes directly from the hospitals and diagnostic centres, the waste pickers also explore garbage containers near those establishments and nearby waste transfer stations.

"Patients and their relatives often dump the wastes in the garbage containers outside the hospitals. Many drug stores and dispensaries also dump their wastes in nearby containers. So, we explore these containers and the nearby transfer stations in hopes of chancing upon some unclaimed medical waste we can resell," said Rasel.

29-year-old Heeron Haoladar has made garbage containers near Dhaka Medical College Hospital (DMCH) his permanent source of income.

"I regularly collect 400 to 500 taka worth of medical wastes from these containers. Since the COVID-19 pandemic broke out, the number of masks and hand gloves in these containers have increased significantly, and most of these items are not of any use to us," said Heeron.

However, there is a competitive nature to collecting the waste, as there isn't enough waste readily available for everyone to collect.

"Waste pickers are often involved in fights with each other when trying to claim certain areas. Sometimes, we also have to bribe the security guards and senior cleaners at these transfer stations. That is why I prefer collecting wastes directly from the hospital. Sadly, I cannot always convince the hospital staff to allow me to do so," said Heeron.

These waste pickers—many of whom are children—collect these toxic materials without any protective gear. They never wear gloves, shoes and face masks while processing and cleaning the medical waste. This constant exposure to highly hazardous medical waste can cause significant health issues and side effects to the already malnourished bodies of these people.

"A couple of weeks after I started working with medical wastes, I contracted chronic jaundice. I almost died," says Topon. "However, a kabiraj (traditional healer) was able to save my life. Still, we frequently suffer from fever and skin disease, but by the grace of God, we recover automatically," he continues.

According to Heeron, "We frequently find ourselves injured by used blades, needles and different types of surgical knives. If you look at my leg, you will find hundreds of scars and wounds. But we cannot afford to purchase the gloves and boots required to rummage through medical waste safely."

According to experts, exposure to medical wastes may cause long term health complications to these people.

The Directorate General of Health Services (DGHS) and Dhaka's city corporations have provided clear instructions to hospitals regarding medical waste management to prevent such health hazards.

All the hospitals, clinics and diagnostic centres are legally bound to dispose of the medical wastes to designated waste collectors. Additionally, they are also required to sterilise and incinerate any waste that is too hazardous to dispose of themselves. 

A large number of these facilities are failing to abide by these regulations.

When asked about the issue, Dr Farid Hossain Miah, Director (hospitals and clinics) of DGHS, said, "There are around 14,000 hospitals, clinics and diagnostic centres in Bangladesh. Among them, only 8,000 of these facilities are licensed. We issued licenses on the condition that they would follow the medical waste management guidelines.

"We cannot monitor medical waste management in the unauthorised clinics and diagnostic centres. We also have a shortage of human resources, making it difficult for us to monitor even the large number of authorised facilities."

Air Commodore Badrul Amin, Chief Waste Management Officer of Dhaka South City Corporation, said, "We are aware that all the medical waste is not being collected and managed properly. We have raised this issue to the health ministry. If necessary, we will engage more organisations to collect and manage medical wastes."

Commodore M Saidur Rahman, Chief Waste Management Officer of Dhaka North City Corporation, said, "Without strong monitoring and enforcement from the health ministry, proper management of medical waste will be challenging. However, we are planning to install a modern medical waste management plant at Aminbazar landfill where all the wastes will be sterilised before eventually being destroyed."