Major findings of the study
The following observations were made through a pre-structured interview of key persons responsible for bio-medical waste disposal as well as through video coverages of dump sites.

• the investigators met with non-cooperation and resistance everywhere.
• generally the sweepers took away the BMW to dumping sites without any protective gears. In 23 facilities, the BMW was taken by hand in buckets to the dumping sites. At 3 places hand trolleys were used and at 4 others some type of mechanical transport was available.
• the management, the medical personnel, sanitary workers etc. were ignorant of the regulations of BMW disposal, except in one facility.
• Only two out of 30 respondents reported that they send the reports to the competent authority on BMW.
• BMW were dumped outside the premises, on road side, in residential areas, on public waste dumping sites, thrown in nearby drains/sewers indiscriminately and carelessly.
• no scientific sorting of BMW was done.
• dumps made by 27 organisations were swarmed by rag-pickers. At 11 dump sites there were high stench and bad odour because of decomposing. All the dumps were swarmed with flies, insects, maggots etc.
• of the 30 organisations total indoor and outdoor patients were 21289 and 106860 respectively with 4913 hospitals beds and 71 full fledged operation theatres.
• total BMW generated per month ranged between 15000 kgs to 450 kgs. depending upon the size of the institutions.
• only 5 organisations reported that they were using incinerators. Two organisations reported that they dispose the waste in sealed packets, 3 said it was sorted, 5 said they burnt and 11 they buried it under earth.

The video film of the dumping sites give a very revealing picture of the filth, squalor, flies/insects, dead bodies of animals etc. They give a very abhorrent and abysmal look. The dumping sites put the adjoining heavily populated areas in grave danger of infection. The insurable rag-pickers who disturb the dumps further aggravate the situation. They are often injured by sharp instruments like needles, broken glasses etc. found in the dump besides exposing themselves to the high risk of infections.

Recommendations

• Organize training and orientation of sanitary, supervisory and managerial staff in medical waste management.
• Arrange debriefing workshops for government, media, medical personnel and activists.
• Do lobbying for enactment of BMW law in UP and to activise of the enforcement mechanism.
• Open discussions among technical experts, producers and people’s representatives for evolving a strategy and method for proper disposal of BMW.
• Stop the recycling industry based on hospital waste.
• Distribute video film and study report to other organisations to enable them to conduct similar studies in other towns of UP. It is hoped that the findings of this study will be of pragmatic value to stakeholders who are trying to solve the problem of medical waste disposal.

Centre revises rules for treatment of hospital waste
The Centre has framed new rules to deal with the problem of disposal of hospital waste. In a set of guidelines issued in July 1998, the Ministry of Environment and Forests has acknowledged the environmental hazards posed by the use of incinerators to burn hospital waste and restricted their use to disposal of human, animal and microbiological wastes.
As per the Bio-Medical Waste (Management and Handling) Rules, 1998, December 1999 is the deadline for implementation of the Rules. The guidelines apply to more than 11,000 hospitals and over 27,000 dispensaries in the country, of which 1000 health care institutions are in Mumbai. Hospital waste comprises some 40 tonnes of the 6000 tonnes of garbage that the city spews out every day.
Hospital waste has been classified into 10 categories and the disposal methods include autoclaving, microwaving, chemical treatment, shredding, incinerating and disposal in secured landfalls. Bio-medical waste will be segregated at the point of generation.
The Centre has also recommended colour coding for different categories of bio-medical wastes. For instance, yellow include human anatomical waste, animal waste, laboratory waste and solid waste contaminated with blood. These will have to be put in plastic bags and incinerated or buried deep. But chlorinated plastic is not to be incinerated.
The guidelines make it mandatory for containers carrying hospital waste to prominently display wash proof labels saying "bio-hazard" and "cytotoxic hazard". The Government has also laid down standards for treatment and disposal. For instance, the combustion efficiency for incineration has to be at least 99 per cent. Microwave treatment should not be used for cytotoxic, hazardous or radioactive wastes and contaminated body parts. And for deep burial, the trench should be two metres deep and waste covered with 10 cm of soil.

Cedric B. Finch is the Administrator of Voluntary Health Association of India and Rama Kant Rai is the Executive Secretary of UP Voluntary Health Association, Lucknow.

[top] [index]