Various research reports have proven time and again that the air pollution level of the Kathmandu Valley is on a steady rise, comprising high levels of respirable particles (PM10/ PM2.5 – particulate matter up to 10 micrometers in size and particulate matter up to 2.5 micrometers) that are responsible for respiratory diseases like allergies, asthma, COPD (Chronic Obstructive Pulmonary Disease), and even lung cancer in the long run.[break]
According to WHO, air pollution is responsible for increases in out-patient visits, hospital admissions, and in extreme cases even mortality. According to an analysis of hospital records done by Clean Energy Nepal and Environment & Public Health Organization (EPHO) in Kathmandu, the number of COPD patients admitted and the percent of such patients as a percentage of total medical patients have increased tremendously in the past decade.
The waste management system of hospitals, especially the incineration process, a form of waste treatment which involves combustion of organic substances, contributes largely to the air pollution of the Valley; moreover, since hospitals are being constructed in almost every nook and corner, and cases like Limbu’s are on a steady rise.
Bandana Pradhan, associate professor of Community Medicine and Public Health Department at Tribhuvan University Teaching Hospital (TUTH), blames this on the lack of consciousness of hospital authorities regarding environmental issues.
“Hospitals are only concerned with the curative aspects of treatment. They aren’t at all giving a thought to hospital-induced infections by mismanagement of toxic and hazardous wastes,” says she, adding that incineration has harmful impacts on both the environment and health as it produces dioxin and furan, two environmental pollutants that are highly carcinogenic.
According to Pradhan, the new hospitals that are being established don’t carry out Environmental Impact Assessment (EIA) or Initial Environment Examination (IEE) which are crucial in determining the adverse effects of hospital waste management on the environment. Pradhan is of the view that if these assessments were carried out, then a lot of negative effects on the health of patients during hospital visits could be nipped in the bud.
Incineration zone near the children’s ward at Tribhuvan University Teaching Hospital at Maharajgunj. Majority of the hospitals in the Kathmandu Valley have incineration plants situated in close proximity to wards and are burning hazardous wastes without taking the patients’ well-being into consideration.
Since Kathmandu Metropolitan City’s garbage collection system does not accept hazardous hospital wastes like tissues, organs, body parts, among others, it is mandatory that the hospitals themselves handle its disposal. In such cases, incineration comes as the only viable solution.
Bhushan Tuladhar, Regional Technical Advisor of South Asia at UN-Habitat, adds that incineration is not a good technology as the possibility of hazardous chemical emission is high. But the technique is prevalent in almost every hospital as there are no other cheaper ways to do away with the wastes.
“High-temperature incineration where the temperature is above 800 degrees Celsius would however minimize the emission of organic pollutants and carcinogens. Also, there should be a safe distance between the incinerator and the wards in hospitals,” says Tuladhar, reiterating that normal incineration can be potentially hazardous, so the temperature of incineration and the location of incinerators – at least a few hundred meters away from hospital buildings – should be the two major factors to take into consideration before beginning a waste disposal process.
However, the practice of having incineration zones located in the hospital building itself, like in the case of B & B Hospital at Gwarko in Lalitpur, where incineration is carried out on the topmost floor of the same building, and in the case of Teaching Hospital at Maharajgunj where a ward is situated in close proximity to the area where waste disposal is carried out, is still largely prevalent in hospitals within the Valley. This brings us to question the very concept of hospitals being a place one visits to alleviate our sufferings.
According to the report “Situation of Health Care Waste Management in Nepal” by Dr. S.R Upreti of the Curative Services Division at the Ministry of Health and Population, health care activities generate large amounts of hazardous waste and it is the patients who face the greatest risks. According to the same report, 72.2% of hospital waste is disposed of through incineration.
Private hospitals like Bharosa Hospital in New Baneshwor, Shubhatara Hospital and Research Center in Lalitpur and Kathmandu Model Hospital in Bag Bazaar also aren’t handling their hazardous waste properly. What is astonishing is that the wastes are segregated and sent out on a monthly basis to other hospitals where incineration is carried out, adding to the already dwindling conditions of those hospitals and their patients.
Another private hospital, Star Hospital in Lalitpur, carries out incineration within the hospital premises. Hari Dhakal, its Public Relations Officer, defends his institution by pointing out that since it is a small hospital, the wastes produced are not all that much. Dhakal got outright offended and refused to talk any further when The Week counter questioned his statement by saying that hazardous waste, no matter how less, is detrimental to people’s health. With such reckless attitude of hospital authorities, the situation shows no signs of ever being addressed.
Dr. Padam Bahadur Chand, spokesperson at the Ministry of Health and Population, points out that it is the lack of proper policies and enforcement of rules regarding hospital waste management that are responsible for the deteriorating conditions of the hospital environment.
Yogesh KC, Chairman of Nepal Sanitation Workers Association at Kathmandu Metropolitan City Office, further validates Chand’s statement by adding that though KMC did come up with a plan to regulate hospital waste and set up an incineration zone within the premises of its Teku transport station, the plan couldn’t materialize due to resistance from the residents in the surrounding areas.
“Though KMC wanted to manage hospital waste in a proper way, it couldn’t implement the idea it came up with due to complaints from the locals of the area where we would set up the incinerator,” says KC, adding that hospitals are compelled to handle hazardous wastes by themselves.
In Nepal, there are no healthcare waste management policies or rules, and there is also a lack of proper monitoring. Healthcare waste management is not properly addressed despite awareness of the health hazards associated with it. Neither the government nor the hospital authorities seem to be concerned about its impact. Meanwhile, the steadily rising and worsening health impacts of air pollution is making waste management, especially in hospitals, a pressing issue to deal with.
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