The Quiet Emergency of Hazardous Medical Waste in Developing Countries

by Andrew Maynard on December 24, 2011

This past semester, I set my second year Masters of Public Health students a deceptively simple task: Write an opinion piece for a lay audience on a topic related to environmental health sciences and public health.  Deceptive, as anyone who has attempted to write an op ed will tell you, it’s fiendishly difficult to find that balance between making an evidence-informed point and keeping your readers engaged.  The class rose to the occasion though – so much so that I thought I would post some of my favorite pieces here (with the authors’ permission).  So over the next few days, keep an eye out for a flurry of pointed, poignant and entertaining pieces on public health.  While reading them though, please remember that these were not originally written to be published, and the students were encouraged to express their opinions – some of which I am sure will be controversial!

This piece comes from Jennifer Jenkins

Usually, people feel pretty good about themselves at a non-profit medical relief agency. But when I showed up to volunteer this past summer, I met a program director who was starting to wonder if all his hard work was doing more harm than good.  The director had just finished a tour of several South American hospitals (the recipients of donated medical supplies), and although he would have liked to focus on the gratitude expressed by the medical personnel, his attention was consumed by a problem no one had considered previously – infectious waste.  Unsurprisingly, these understaffed hospitals, where even gloves are a luxury, did not have waste management programs in place.   Frequently, infectious waste was disposed of with all the other trash, and then dumped in an open pit behind the hospital.  The director recognized what many other non-profits never consider – the medical supplies that we keep out of our landfills in the US will have to be disposed of eventually, and if this is done improperly, unintended illnesses and injuries can result.

Inappropriately managed medical waste presents a risk to healthcare workers, patients and the community at large, especially in the form of sharps.  In 2002, 2 million healthcare workers worldwide experienced a needlestick injury.  The mixing of sharps with regular hospital waste puts additional workers in danger because the needles may be hidden from view.  Needles should be disposed of in labeled, thick-walled containers with lids that are designated for sharps only.  This container could be as simple as a sturdy cardboard box.

A more insidious threat comes from the scavenging of sharps from landfills.  Contaminated needles disposed of in unprotected dumps are often reused, or repackaged and sold again.  The World Health Organization (WHO) estimates that 32% of all new hepatitis B infections (21 million), 40% of all new hepatitis C infections (2 million) and 5% of all new HIV infections (260,000) are due to injections with contaminated syringes.  These infections are preventable with the use of needle removers, which physically detach the needle from a syringe after use.  Although high-tech versions exist, hospitals in developing countries do not always have access to electricity.  Fortunately, hand-operated versions are available, and one recent design involves attaching a simple snap-top device to used cola cans for a truly low-cost solution.

In an attempt to provide more effective infectious waste management, some agencies have rushed to donate or build small-scale incinerators.  However, without proper planning, these incinerators are not a sustainable investment.  A survey by the Pan-American Health Organization (PAHO) found that many medical centers had abandoned their incinerators due to lack of fuels and/or lack of knowledge regarding proper use and repair.  Furthermore, incinerators that are not pre-heated and burned at a high temperature can release dioxins and furans into the air.  These compounds are produced when plastic waste containing polyvinyl chloride is burned at lower than 800 °C or not wholly incinerated. Dioxin is a known human carcinogen, and low-level exposures to both compounds have been linked to problems with neurological development in children, and adverse health effects in the immune, endocrine and reproductive systems of adults.  A lack of technical training and limited fuel makes it very likely that incinerators will burn at these lower temperatures or not burn at a uniform temperature.

The developing world continues to struggle with dangerous wastes.  In 1989, there was an outcry over the shipping of the hazardous wastes from industrialized nations to the developing world in an attempt to save money on disposal costs.  Since then, almost every country in the world has signed the Basel Convention agreement, which includes a pledge for “environmentally sound management” of hazardous waste.  However, the economic reality for many countries leaves them with a very limited capacity to deal with this problem.  In 2000, the World Health Organization estimated that 18-64% of healthcare facilities in 22 developing countries did not have adequate disposal methods.

Clearly, countries receiving donated medical supplies could benefit from additional support in the arena of waste management.  Large shipments of medical supplies should not be sent to developing countries without also providing for their safe disposal.  The examples given earlier demonstrate that proper waste management can be done using low-cost supplies.  In fact, lower technology donations are usually more sustainable.  Furthermore, proper waste management is primarily about forethought and separation at the source.  If these hospitals work to keep hazardous waste separate from all other kinds of waste, the volume of material needing special disposal will decrease dramatically.  The non-profit organization that I volunteered for does an excellent job of following-up with clinics and making sure that donations consist only of products that the facility has actually requested and finds useful.  These visits could easily be modified to include some basic hazardous waste safety training.  A short class and easy-to-understand guides and flow charts could make a big difference for the health of the community.

Although waste management issues may not always capture the hearts and minds of donors, non-profit medical relief agencies must think broadly and consider the entire life cycle of their donation.  Unsustainable or hazardous donations will not improve the health and welfare of underserved communities.

References:

UNEP. Origins of the Basel Convention. Available Online: http://basel.int/convention/basics.html

WHO. Needlestick injuries. Available Online:

http://www.who.int/occupational_health/topics/needinjuries/en/index.html

WHO. Health-care waste management. Available Online: http://www.who.int/mediacentre/factsheets/fs281/en/index.html


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