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Kurunegala collapse reveals continuing clinical waste horror
View(s):Most hospitals of Sri Lanka are still wrestling with the continuing nightmare of thousands of kilos of hazardous clinical waste and solid waste they produce every day.
And yet again, the Kurunegala Teaching Hospital is in the news for massive piles of stinking clinical waste posing health hazards to patients, a children’s ward, visitors, staff, and neighbouring households. Some hospital workers and visitors have appealed publicly through the media to Health Minister, Keheliya Rambukwella.
Piling up: Stinking hazardous clinical waste at the Kurunegala hospital. Pic by Athula Bandara
In Sri Lanka’s hospitals, the collection, segregation, and disposal remain problematic despite assistance from the World Bank, WHO and Australia. There are many parties responsible for the waste management including the Ministry of Health and Central Environmental Authority, and local authorities.
In August, 2019, the Sunday Times found that clinical waste dumped illegally in Thirappane in Anuradhapura, was from Kurunegala Teaching Hospital. Separately, clinical waste was found buried in a Mahaweli Reserve at Ketanwewa in Hambantota.
A UNDP report early last year found that about 44% of large state hospitals do not have health care waste treatment facilities in their premises and instead send the waste to local authorities or to private facilities. Some burn clinical waste in open pits.
A team visited 40 health care facilities.
National hospitals generate 2,750 kilos of infectious waste a day, 158kg of sharps such as needles a day, and 143kg of pathological waste a day. Teaching Hospitals produce 4,169kg of infectious waste a day, the UNDP found.
The report revealed that the majority of incinerators do not function at the recommended level because there is no money, there are no spare parts, and no skilled people to operate them.
When health care waste is not disposed of properly, the entire community is exposed to the toxic and chemical materials and the environment is polluted. A total of 179kg of mercury is released to the air every year from the burning and incineration of clinical waste of large state hospitals.
According to WHO classification, health care waste falls into seven categories such as infectious, and pathological waste, pharmaceutical, chemical, and radioactive waste, as well as general waste including food and other waste.
The report found that 17% of healthcare facilities “do not have acceptable forms of bins’’ to collect waste and “10% do not have acceptable forms’’ of boxes to collect sharp wastes. Janitors at some hospitals do not follow guidelines, the UNDP report says. Hazardous healthcare waste is mainly handled by assistants, known as Saukya Karya Mandalaya.
Data show that of the 7,000 metric tonnes (4,200 MT in the Western province) of waste generated every day in the country, local councils only collect half of this volume.
At the Teaching Hospital, Kurunegala the loads of medical waste has increased and one waste incinerator has broken down. The hospital has decided to send the clinical waste to the District General Hospital, Chilaw.
The Deputy Director of the hospital Dr. K.W.C.U.K. Kendangamuwa, told the Sunday Times that the hospital generates about 2,000 kilos of waste per day, but only about 1,000 kgs can be disposed of.
“As a temporary measure, we will move some to Chilaw to be disposed of immediately. However, the hospital is in the process of reducing our daily waste,” he said.
“Clinical waste due to COVID-19 has resulted in hospitals struggling with excess generation of waste. Personal Protective Equipment (PPEs) as well as disposals from COVID-19 wards have burdened major hospitals,” said consultant community physician Dr. Inoka Suraweera.
“Before COVID-19, hospitals ensured segregation of clinical waste, and with supervision they were done in wards, clinics, and labs. But during COVID-19, patients in COVID-19 wards were requested to put their waste in segregated containers.’’
Dr. Suraweera, who is also the head of the Health Ministry’s Occupational Health Unit, said hospitals attract mice, rats and crows due to increased food waste. “Once food is mixed with clinical waste, especially from COVID-19 wards, this can definitely be a health hazard.’’
Saman Ratnapriya, president of the Nursing Officers Union, noted the lack of funds for medical waste disposal, ranging from the maintenance of incinerators, MetaMizers to payment for contractors on time.
Since 2007, with World Bank and WHO funds, Sri Lanka has taken some initiatives to streamline the clinical waste management, and in the three years to 2016, with a soft loan from Australia, 20 MetaMizers and five incinerators were set up.
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