Hospital Jeopardy

The institutions that uphold values of cleanliness in Kashmir are contradicting the very essence of what they teach. Sameer Yasir reports on the increasing rate of dangerous medical waste found outside hospitals.

Plastic bottles. Syringes. Soiled dressings. Surgical equipment’s. Dissected body organs. And bags and bags of pungent waste.

This is not a waste management facility. This is the appalling scene that one encounters right behind the District Hospital of Baramulla. A hospital is ideally an example of excellent hygiene, but these conditions prove quite the opposite. The piles of medical waste that lie openly behind the hospital are increasingly becoming a threat to life in the vicinity.

At the end of the day, a group of young boys quietly sift through the garbage behind the Baramulla hospital. These boys are mostly migrant laborers, and every day they clear the piles of medical waste left behind by “sanitation” workers at this hospital. The laborers ‘specialize’ in choosing the right kind of waste – waste that can be recycled. But as they sift through the trash, the blatant violation of government norms becomes all too clear.

There are unbroken syringes everywhere in this sea of garbage. However, by law, a syringe needs to be broken after it is used, in order to eliminate the possibility of it being recycled. Injuries from ‘sharps waste’ such as syringes and blades can pose a large public health concern. Experts state that by penetrating the skin, it is possible for this waste to spread “blood-borne pathogens.” The spread of these pathogens is directly responsible for the transmission of blood-borne diseases such as Hepatitis B, Hepatitis C and the deadly HIV.

But these young boys are perhaps unaware of such consequences. They are simply looking for anything that can sell. They walk around the medical waste, carrying huge plastic bags, and skillfully separating out the syringes, plastic  glucose bottles and surgical equipment’s. They collect sharp objects like needles, blades and scalpels with bare hands, often getting injured and exposing themselves to deadly diseases.

Imran Ahmad, a migrant laborer from Uttar Pradesh, says they send this medical waste to Jammu. From there, it goes to different parts of India and then is recycled. “We earn Rs. 300 to 400 for a day’s work. And you don’t have to do much—just come to the hospital, and take the empty bottles and syringes,” he says.

In the past few years, public concern over the disposal of medical waste has increased significantly. This rise in concern was stimulated by reports of such waste showing up on the main streets of Baramulla. Residents complain that the hospital lacks a proper waste management plan, and that has been putting the lives of hundreds of patients and sanitation workers at risk.

Researchers believe that there have also been rare and isolated instances of public exposure, when children were found playing with needles and vials discarded by hospitals.

The District Hospital of Baramulla does not have a proper shredder to destroy the sharp medical waste. Although trash cans had been constructed for segregating medical waste, they were quickly rendered useless.

The 220-bed hospital produces more than 400 kilograms of garbage per day, and has an incinerator for disposing off the medical waste. But even this incinerator doesn’t work anymore. Hospital workers say that even when it was functional, it was used perhaps just once, and the rest of the garbage would inevitable find its way in the Jhelum River.

Sheikh Rizwan, a medical shop owner outside the hospital, says the hospitals’ sanitation workers throw the medical waste directly into the river, and it collects on the banks of the river—resulting in a foul odor.

“The bandages and disposable syringes float on the river, and there are several layers of hospital waste in the river,” says Rizwan as he looks down at the river from the Baramulla Cement Bridge.

Meanwhile the situation is no different at a new hospital in the nearby area of Sheeri. This hospital was established just a few years ago, but the waste from it is directly dumped into River Jhelum. The hospital authorities refused to comment on the situation.

A doctor who spoke to Kashmir Life on condition of anonymity said, “We had written about the issue to concerned authorities, but no one came to help us.”
In the sub-district hospital of Pattan on the Srinagar-Muzaffarabad highway, the waste is simply dumped, almost mindlessly, in any location that the hospital sanitation workers can find. This hospital has 50 beds, and it generates more than 85 kilograms of waste every day. At first glance, this hospital seems to be in a far worse situation than even the District Hospital of Baramulla, which at least has a pit to throw the waste into.

The waste generated from the hospital in Pattan is thrown in the backyard.

The conditions at the District Hospital of Baramulla, the sub-district hospital of Pattan and others are not unique. The same story echoes throughout hospitals in the Kashmir Valley. There are very few hospitals in Kashmir who have a proper waste disposal facility.

In South Kashmir’s Pulwama district, hospital authorities have constructed a three-walled waste disposal system, which was supposed to accumulate the hospital waste but most of the waste finds itself outside it, and not inside.

Bashir Ahmad Dar, a resident of the region says the syringes pose a threat in many ways. “Sometimes the needles get stuck in people’s shoes,” he says. According to Dar, hospital authorities are making no effort to clean up the area. “It is dangerous. Sometimes children of migrant laborers play with them, and who knows how many infections they get because of this waste,” he adds.

In Islamabad, at the Mirza Muhammad Afzal Beg hospital, there is again no proper mechanism to dispose off the waste. To add to the problems, no one knows where the “sanitation” workers throw the waste. The hospital produces more than 300kgs of medical waste every day.

Experts opine that the management of bio-medical waste should be prioritized and due care should be taken to minimize chances of spread of infectious diseases. Doctors detailed nine different categories of waste that needed proper disposal: Human waste, animal waste, biotech waste, sharp waste, solid waste (contaminated), solid wastes like plastics, incineration ash, microbiological wastes.

Syringes used should ideally be destroyed immediately after use, in needle destroyer. But there are no needle destroyers available in the wards, the paramedical staff said. On an average about four hundred syringes are used in a day in the hospital casualty section.

Different hospital authorities claim that the domestic waste is taken care of  by the municipality, while the infectious waste is disposed off by the hospitals themselves.But surprisingly, there are hospitals in Kashmir that are filled with this waste creating fear among the masses. Even the biggest hospitals in the valley take the route of unscientific and improper disposal of biomedical waste.

A study titled “Current Practices of Bio-Medical Waste Management at SMHS Hospital”, found that the lack of proper treatment of the Bio-medical waste (BMW) generated in the hospital is dangerous for patients and sanitation workers. But it seems the administration hardly cares.

The issue of proper disposal of medical waste is a global one, found more frequently in developing countries. Striking social and economic differences make implementing new technologies in waste management difficult and somewhat unrealistic in these countries. Researchers state that contrasts between the industrialized and the developing world can be seen in accidental needle stick injuries. These occur “at a rate of 0.18 to 0.74 per person per year in industrialized nations, and 0.93 to 4.68 per person per year in developing and transitional nations.”

Every 24 seconds, a person dies somewhere in the world because of unsafe injections. Kashmir is perhaps just another statistic in the overall scenario of improper medical waste disposal. But the effects can clearly prove to be lethal, and need to be addressed immediately.

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