Waste: Despite significant progress, efficient management of medical waste still remains an issue in health facilities across the country.

Records with the health ministry show that from 2014 December to 2015 December, health facilities across the country produced about 358 metric tonnes (MT) of medical waste categorised as general, pathological, infectious, pharmaceutical, sharps, chemical, pressurised, and radioactive waste.

During the same period from 2013 to 2014, the health centres produced about 279MT of medical waste. Records indicate an increase in medical waste by about 15 percent annually.

There are 28 hospitals, 156 Basic Health Units and 654 Outreach Clinics as of 2014.

Globally general medical waste generation should be about 80 percent followed by other type of wastes, according to health officials. However, in Bhutan’s case about 60 percent is general waste and the rest infectious waste, which is a concern.

Some of the challenges that health facilities face in managing medical waste are poor segregation of waste at source, lack of resources, expertise, and dedicated focal persons for waste in health facilities.

Department of Medical Services’ deputy chief programme officer Pem Zam said lack of waste storage facilities in most health facilities is another concern. “Health centres have to use municipal waste facilities, which is not there in all dzongkhags,” she said, citing the example of landfills.

Infectious waste that the health centres produce comprises of blood soaked bandages, discarded surgical gloves, cultures, stocks, and swabs that are highly infectious. Pathological waste includes body parts, placenta or fetuses, and are said to contain pathogens that can give rise to diseases. Hazardous waste is a non-infectious waste that can harm humans like needles, syringes, and surgical instruments. Radioactive waste is produced from nuclear medicine treatments and cancer therapy medical equipment that uses radioactive isotope.

Health secretary Dr Ugen Dophu said that the ministry is working on ways to manage liquid hazardous waste such as chemicals and blood.

Except for a few hospitals, Dr Ugen Dophu said most were not equipped to manage liquid hazardous waste. “These wastes joins the normal sewer lines, which gets diluted as the amount is less,” he said. “Proper management of liquid waste produced is an issue.”

Dr Ugen Dophu said that most health workers are trained on medical waste segregation and disposal. “We are able to manage other solid waste although it’s not the best method,” he said.

Solid waste like sharp objects are disposed in deep burial pits while body parts are incinerated. Infectious wastes are autoclaved.

Meanwhile, the new hospitals of Gelephu, Samtse and Haa will have standard waste shortage facilities.

Deputy chief programme officer Pem Zam said the issue will remain in the existing health facilities given the lack of resources.

However, a pilot project on medical waste management has been initiated in Phuentsholing general hospital with support from the World Health Organisation (WHO). As part of the project, a waste storage house has been constructed along with a deep burial pit.

“If it does well, the same method would be incorporated in all other hospitals as well,” Pem Zam said.

The health ministry will also receive five autoclaves through WHO support.

With the completion of a deep burial pit at the Thimphu referral hospital in June this year, officials are hopeful of better management of general waste.

The Thimphu referral hospital produced about 145.5MT of medical waste from January to November this year.

Besides the burial pit that is expected to last for 10 to 15 years, the hospital is also equipped with an autoclave machine and shredder.

“We also have plans to build a waste storage house,” deputy nursing superintendent Chhimi Lhamo of Thimphu referral hospital said.

Chhimi Lhamo said that cleaners and waste handlers are also taught the risks of exposure every year. “They are also provided adequate personal protection equipment like gloves, masks and boots, among others,” she said.

The waste management and prevention Act 2012 has several provisions on managing various types of medical waste. The Act also prescribes the responsibilities of the implementing agencies in managing medical waste.

The health and agriculture ministries shall monitor the implementing agencies such as health clinics, BHUs, hospitals, the livestock department, Bhutan Narcotics and Control Agency and the Drug Regulatory Authority, states the Act.

According to WHO, poor management of health care waste exposed health care workers, waste handlers, patients and the community to infection and toxic health effects, and polluted the environment. It is essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely.

Kinga Dema