Waste generated in healthcare facilities usually contain mixtures of different types such as waste of purely municipal nature like food, packaging, waste papers, and secondary raw materials; toxic chemicals like drugs and reagents; and bio-hazardous substances like body parts, surgical instrument, contaminated bandages and dressing, post surgical waste, blood and sharps, etc. Different surveys show that about 15-25 per cent of the total waste generated in the healthcare facilities is toxic and bio-hazardous, while the rest is mostly of municipal type. Therefore, proper segregation and storage of waste at the point of source may significantly reduce the volume of medically hazardous waste. If, at the point of source, they are not properly segregated and stored, the whole lot can be contaminated, resulting in a large volume of hazardous waste-load for the treatment plants.

Bio-hazardous medical waste is a component of the total waste generated in the healthcare facilities, which are potentially risky for human health and the environment. In a broad sense, they may include: human or animal tissues, body fluids and excretions, pathological waste, human blood and blood products, used and unused sharps, animal waste, drugs and other pharmaceutical products, swabs and dressings, contaminated material, products of surgical operation and discarded surgical gloves, and toxic chemicals and reagents.

The agencies producing this medical/clinical waste are termed as generators, which include hospitals, clinics, diagnostic laboratories, medical research centres and colleges, centres for immunisation, dentist's chambers, veterinary, blood transfusion centres, residences using home-treatment, and similar other agencies. Small generators may produce less than 25 kgs of waste per month while big generators may produce several hundred or thousand kgs.

As the bio-hazardous components of the total medical waste poses potential threat to humans, animals, and the environment, their disposal should be strictly regulated. Non-bio-hazardous components can be disposed of as ordinary solid waste with less or no potential to infect humans or animals. The medical/clinical waste including sharps may also contain chemical carcinogens and or hazardous chemicals and radioactive materials, which are equally dangerous to human health.

Sharps constitute a special category of medical waste that include needles, syringes, lancets, scalpel blades, tubes, pipettes, glasses, instruments and tools, etc. used to puncture, cut or scrape body-parts, and or storing, testing or culturing bloods and other body fluids. They have sharp edges, corners, points or protuberances capable of punching or piercing through bags, containers and the human body during collection, transportation, and disposal. They can also punch or pierce through the body-parts of waste pickers, pedestrians, sportsman, and health conscious people practicing regular morning or evening walks.

Such sharp waste contaminated with bloods containing HIV-AIDS virus, Hepatitis-B virus or similar other deadly diseases can put many people at risk just piercing or punching through their body-parts. Some studies report that the risk of medical waste spreading HIV-AIDS is less than that of Hepatitis-B as the HIV-AIDS virus cannot survive long in a normal environment, while that of Hepatitis-B can survive up to 7 days. However, the risk is still there. To avoid the yet unknown risks, the universal precaution -- an approach to infection control that assumes that all blood and certain body fluids are infectious for HIV-AIDS, Hepatitis-B Virus. and other blood-borne pathogens, must be followed. If under certain circumstances different body fluids cannot be distinguished from each other, all body fluids should be treated as potentially infectious.

Can we think of the risks involved in dumping medical waste in public places? The risks have equal potential for everyone. Just one prick by any of these indiscriminately disposed sharps may lead to the potential risk of transmitting the deadly HIV-AIDS virus and put a person in the so-called social dustbin for the rest of his or her lifetime and finally to the grave cursed, hated, and unlamented because of the traditional belief that the primary cause of this disease is some kind of sinful act.

Similarly, other non-sharp waste can also cause various deadly and infectious diseases from occupational or accidental contact with them. Therefore, continued negligence in disposing of these medical wastes can one-day bring about a catastrophic disaster if not taken care of today.

A report with vivid photos in The Daily Star (May 10) testified to how carelessly and irresponsibly hospital waste in Bangladesh is being dumped in open places, and many hazardous components are sold for reuse. According to the report, quoting the health ministry, there are more than 700 clinics and hospitals in Dhaka, producing an estimated 300 tons of waste a day. Since there is no system of segregation at the source, the whole lot can be termed as hazardous or infectious waste as they are mixed up. They are simply dumped in public places without any treatment.

The largest generator of this waste is perhaps the Dhaka Medical College Hospital, where Medical Assistants (Ayas) collect contaminated saline bags, syringes, and needles, and carry them in plastic bags for selling to other healthcare facilities. The report also says, it's a business controlled by some union leaders of DMCH, surely under somebody's umbrella. Nobody seems to be aware of the fact that open dumping of medical waste and reuse of the contaminated sharps carry a potentially dangerous risk for the people and the environment.

As citizens of the country, can't we expect from our learned medical experts, civil servants, politicians and law enforcement agencies a minimum sense of responsibility to protect the health and lives of the people? We can as this is our constitutional right. According to The Daily Star, DMCH bought a new incinerator three years back and installed it in a building built at a cost of Tk 27 lakhs (cost of the incinerator must be much higher). Since then, the plant has remained almost inoperative as two out of its three trays went out of order and could not be repaired because of lack of funds. More interestingly, one of the operators was a bus helper and the other was an electrician without any training. There are many examples such as these where costly equipment purchased at public expense is unable to provide the desired service because of lack of maintenance, which is again because of lack of money.

Sanitation of medical waste usually means disinfecting and sterilising the waste, which destroys the micro-organisms and their spores through physical and chemical processes so as to convert them into biologically inert materials. In many countries the safe disposal of medical waste is very important and handled in a very professional manner. They have effective systems of tracking waste generators, and follow specified regulations for segregation, collection, treatment and disposal of medical waste. The staff and people are trained in the use of separate bins and bags for different types of medical waste. At the very generation point, the waste is segregated into bio-hazardous, non-bio-hazardous, sharps, toxins, pharmaceuticals, carcinogens and ordinary solid waste, etc. and stored in designated bags and bins with identification tags and or barcodes. This minimises the actual volume of potentially infectious or dangerous medical waste to almost one quarter and makes the disposal less costly and more effective.

There are technologies, which though costly, are not impossible with effort. So far the most widely used method of medical waste treatment was incineration, which in the course of time was found to be even more dangerous than the medical waste itself because of the potential risk of air pollution through emission of dioxins and other toxic gases. However, recent incineration technologies with multistage burning process and strict control of temperature, time and turbulence can significantly reduce these toxic substances; but the cost per kg of treated waste is significantly high. Therefore, many countries are now making a shift from the traditional incineration to alternative treatment methods, which are much less costly but more effective and the resultant output can be disposed of just as ordinary solid waste.

The most common alternative treatment technologies are steam sterilisation/autoclave, chemical treatment, microwave technology and stabilisation with cement (preventing migration of toxic substances to ground water or surface water). Most of these alternative technologies are more cost effective for larger healthcare facilities having more than 250 beds, dictating a central system for several medical waste generators.

Depending on the size and technology, the initial investment cost of such a unit with shredding before, after or during the sterilisation process may vary from $100,000 to 15,000,000 with per kg cost ranging from 4-20 cents, the bigger the system the lesser the cost. Some very large units may even cost more than $50,000,000. The volume reduction is also significant, almost 50-75 percent, requiring much less disposal cost. So, it's time for us to think over the potential hazards of medical waste and adopt appropriate policies and means to save ourselves and our future generation.

The writer is a development consultant and chairman of Muzaffar Ahmed Foundation.