Deep in the heart of Hyderabad city, in a congested bazaar lies the government-run Syed Hafiz Mubarik Ali Shah Hospital (or the Tara Chand hospital as it is more commonly known). It is a very old hospital, located atop a bustling bazaar, and one has to drive up a ramp to arrive at the main door of the building. This large building was once owned by a wealthy Hindu merchant; hence the name Tara Chand. A couple of years ago, the hospital used to dispose of its medical waste by dumping it in the bazaar below where it was hoped that the city’s municipal authority would remove it.
In spite of being hazardous and containing infectious components, hospital waste is not properly taken care of by most hospitals in Pakistan and there are no formal mechanisms/disposal sites available in the country with the exception of a few progressive hospitals which have installed special incinerators.
Outside the Tara Chand hospital, scavengers would quickly go through the hospital waste in the mornings and recycle the used syringes and drips. After a quick wash, they would then repackage these syringes and drip sets and sell them in the local market. People would buy them because they would be available at Rs2 per syringe, a much cheaper rate than the Rs6 for a proper, sterilised syringe. Hepatitis is widespread in Sindh and HIV is becoming a problem as well.
“It was a big problem and even some of the doctors were not aware of what was going on. So we started our project by first conducting trainings on hospital waste management involving doctors, nursing staff and sanitary workers,” explains Naseer Junejo of the Mashriq Foundation who received funding from the UNDP’s Global Environment Facility’s Small Grants Programme (SGP) to implement a hospital waste management project in 2009. According to Masood Lohar, the National Coordinator of the SGP, “We like to support innovative projects which focus on neglected themes”.
The Mashriq Foundation is a young NGO owned and operated by health professionals in Hyderabad city. They set up a waste management team in the hospital comprising one doctor, one sanitary worker, a member of the nursing staff and a member of the administration. The hospital has 30 beds and sees almost 300 patients a day mostly in their Out Patient Department (OPD), so on a daily average around eight kilogram of waste are produced. Dr Tariq Sheikh was appointed the focal person for the project, which he says has brought many positive changes to the hospital.
The project introduced two waste bins in different colours to be placed all over the hospital. Yellow is for hazardous waste and blue is for general waste. Syringe cutters were also introduced, as were hand gloves to handle the toxic waste. The really innovative aspect of this project was the setting up of a low cost incinerator. According to Dr Sheikh, “This was the first time that such an incinerator was introduced in Hyderabad. During the last government’s tenure, very expensive incinerators costing millions of rupees were given to hospitals.
Since these incinerators run on CNG cylinders and most hospitals can’t afford to run them, it was a waste of money. Our low cost incinerator has been specially designed for Third World countries by an English professor and costs only around Rs400,000 and runs on burning paper waste. We got the technology free of cost and a local engineer copied it using bricks for the construction”. Other technologies used abroad like boilers and microwaves (which do not require any burning) are still too costly to import to Pakistan.
The low cost incinerator ran very well for the first year of the project, producing ash which only needed to be cleaned up once in three months, but now it has to be shifted upstairs to the roof because of complaints from the neighbours whose apartments are built very close to the hospital’s walls. According to the medical superintendent of the hospital, “We will be shifting it soon… the incinerator has been very useful for the hospital”.
The project was completed in one year and has now received another round of funding from the UNDP’s One Joint Programme on Environment’s Grass Roots Initiative Programme.
“We have been able to control the dumping of hospital waste,” says Naseer Junejo, who is also doing similar work in four other hospitals in Hyderabad. “Often this hazardous waste would pile up outside hospitals as the municipality would not pick it up on time, giving ample opportunity to scavengers to recycle the waste, or someone would end up burning it out in the open or dumping it in the canal. It was a big problem for the city. Now at least we are doing what we can to address this problem”.
He adds that it is the people most directly affected — the paramedics and the sanitary workers — who really appreciate the project. The best result, he says, is that “the illegal sector has completely disappeared — there is nothing left for them to scavenge and recycle!” Let’s hope that other hospitals in the country learn from this low-cost model and start disposing of their toxic waste in a safe manner.