Managing waste is one of the most complicated and risky tasks among the many challenges of running a hospital in Nepal. Few health facilities comply with the applicable waste disposal laws, which can jeopardize patient and practitioner health. But one government hospital is using eco-friendly methods to reduce its waste.
“When I first came to Bir Hospital [in Kathmandu, the capital] it was a complete mess,” said Mahesh Nakarmi, director of the Health Care Waste Management Programme at Health Care Foundation-Nepal (HECAF), an NGO promoting affordable, safe healthcare. He found that waste was stored in buckets under the patient’s bed, and there were no procedures in place to safely dispose of infected materials, including syringes.
The UN World Health Organization (WHO) defines healthcare waste as including needles, chemicals, pharmaceuticals, medical devices, radioactive materials blood and body parts. “Poor management of healthcare waste exposes healthcare workers, waste handlers and the community to infections, toxic effects and injuries,” warns the agency.
Since HECAF started working with the facility two years ago to improve its waste disposal, the 121-year-old Bir Hospital in central Kathmandu has nearly halved the amount of waste it dumps into municipal systems, is routinely separating hazardous materials from non-hazardous garbage, and has begun experimenting with new disposal procedures, such as vermicomposting, in which waste is fed to various types of earthworms.
“It is generally accepted that 70 percent is about the maximum recyclable amount,” Ruth Stringer, international science and policy coordinator at Health Care Without Harm, an international organization advocating environmentally friendly healthcare systems, told IRIN during a field visit to HECAF’s programme. “Bir's figure of 55 percent is remarkable. Few low-income country hospitals have systems as efficient and effective as theirs.”
The waste management campaign has also enhanced safety. “Before this programme started we went shopping in the pharmacies near the hospital and found several types of fake syringes that were made from used syringes… from this hospital,” Nakarmi said. Bir Hospital now uses both electronic and manual needle-cutting devices in all inpatient wards so medical staff can destroy syringes properly, immediately after use.
“This way we can keep the plastic pieces, put them in the autoclave, then recycle the parts,” said Saraswoti Thakuri, a nurse and project coordinator with HECAF. An autoclave uses pressurized steam to sterilize medical items. Bir purchased a pair of autoclaves to sterilize waste and to ensure a backup would be available in case one unit had a technical problem..
“Autoclaving is essential for safety when it comes to hazardous materials, but it also means we’re not just burning waste and creating more air pollution,” Nakarmi said. “Burning plastic creates carcinogens. We’re a healthcare facility, how could we do that?”
HECAF also is trying out other organic options. “We have ongoing experiments with worms eating contaminated gauze that hasn’t been autoclaved,” said Nakarmi. It will take several rounds of testing to determine whether the worms’ digestive process sterilizes the material or not. A 2006 study in India suggested that worm digestion could sterilize infectious waste, but no large-scale trials have been conducted.
Nakarmi is also experimenting with the hospital’s first biogas system to dispose of tumours and severed body parts for bio-degradation alongside food waste. Biogas is a mixture of methane and carbon dioxide produced by fermenting organic matter like animal or human waste, biodegradable waste, and municipal solid waste.
Nepal’s 2011 Solid Waste Management Act mandates each hospital to sterilize its hazardous waste before handing it over to the municipality, in line with the WHO “polluter pays” guidelines, but compliance is still low.
Sumitra Amatya, executive director of the government’s Solid Waste Management Technical Support Centre (SWMTSC), which monitors healthcare waste management and refers violations to municipalities, said several institutions have been fined up to US$1,000 per violation for poor waste management in recent years.
Some facilities are warming to Nakarmi’s recycling philosophy. Paropakar Maternity and Women’s Hospital in Kathmandu has recently begun experimenting with composting placentas.
Changing the minds of staff to follow new procedures has been one of biggest challenges at
Bir, the city’s oldest hospital, which operates at 10 times its 460-bed capacity.
“I thought if I can change waste management in the worst place, then everyone else can follow,” said Nakarmi.