The cruel irony is that hospitals and clinics in the country have become sources of both health and diseases. A look at the hospital environment and disposal of clinical waste will make the point clear. Healthcare centres, especially the public ones, have turned so not only because of their filthy and unhygienic in-house environment but also for their unscientific disposal of clinical wastes. While the internal environment is a bit better in private clinics than in the public ones, the situation with waste management in both of them is almost the same.
The country's medical waste generation is increasing at an estimated rate of 3 per cent per year, with overall waste production standing at approximately 25,000 tonnes per day. Research published in 2022 found that medical waste generation in Dhaka ranges between 1.63 kg and 1.99 kg per bed per day, a figure that significantly increased after the Covid-19 pandemic.
Healthcare centres are supposed to have separate units with secure methods of disposal of harmful wastes but management of clinical wastes in them is not better than kitchen waste management. In utter disregard for public health, irresponsible hospital and clinic authorities throw away in open places tonnes of untreated wastes like discarded blood, bandages, body fluid, chemical and pathological reagents and even amputated limbs, which are again littered by dogs and crows. Clinical wastes, as dangerous sources of bacterial and viral infection and other contagious diseases, pose a serious threat to public health. Syringes and hypodermic needles, broken ampoules and sharp surgical equipment may cause serious injuries to the cleaners.
A highly placed official of a renowned hospital in the city informed that they dump different categories of waste in separate bins. While this shows recognition to the need for scientific management of wastes, the prime question is one of destroying them. Under the Medical Waste (Management and Treatment) Rules 2008, hospitals are required to cut or puncture plastic tubes and other waste items to prevent reuse. However, a study by Transparency International Bangladesh (TIB) found that 31 per cent of hospitals fail to comply with this regulation, while 49 per cent lack needle destroyers.
An even more alarming issue is the illegal collection and resale of used medical equipment. TIB has revealed that certain hospital staff members sell reusable medical waste-such as glass bottles, syringes, saline bags, and blood bags-to unscrupulous recyclable waste collectors. A syndicate reportedly cleans and repackages these items without proper sterilisation before reselling them to drug stores, hospitals, and clinics. What is the use of separating medical wastes if those are not destroyed and allowed to reappear in medical stores and healthcare centres?
Clinical wastes are fundamentally different from kitchen wastes and need to be treated differently - either to be burnt at high temperature or disinfected. But, it is ironic that though the country has thousands of healthcare centres producing tonnes of waste every day, there is no dedicated national authority for its scientific disposal.
Although the 2008 regulations mandated the formation of an Authority, this has not been materialised yet. Instead, city corporations and hospitals have outsourced waste management to privately owned contractors, some of which are even unlicensed.
Private organisations such as PRISM Bangladesh, Waste Concern, the Centre for Sustainable Development (CSD), the Environment and Social Development Organisation (ESDO), and ICDDR,B have set up medical waste treatment facilities, particularly in Dhaka. But it is beyond these organisations' capacity to handle the enormous quantities of waste. And in the absence of large-scale treatment plants, clinical waste continues to spread diseases and pollute the environment.
The authorities concerned are expected to pay due attention to the problem. While expanding arrangements for the proper management of clinical wastes, adequate arrangements for scientific disposal of wastes must be made a precondition for registration of hospitals and clinics.
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