Eco Friends rapid assessment of BMW and compliance status of BMW Rules in Kanpur

Hospitals, one can say temples of humanity and doctors can be considered as the priests. Doctor is like a messenger of God, a priceless gift to this world. But the definition of a Doctor has been changed in recent times. Majority of doctors are abusing this noble profession when it comes to Bio-Medical Waste Management (hereafter BMW) and handling. We can accept the excuse of uneducated and illiterate persons that they are not aware of this aspect, but what excuse can we accept from the so called highly educated, highly trained and highly qualified and professional doctors. They are fully aware of BMW handling and its management practices and rules, still they are not paying any attention in this regard. They are not ignorant but they are ignoring very crucial aspect of BMW which can produce extremely deadly consequences. To be very precise they are playing with the lives of innocent people who trust them like their God.

If we think about the whole concept of hospitals, anyone of us can come to this conclusion that it is one of the best ways of serving the mankind. The very pure and sacred thought of serving the humanity is being profaned for the selfish purposes and pecuniary motives. These days it has become an industry for making money and like other industries it is emitting enormous waste which includes very hazardous substances which can trigger extremely dangerous results if, not treated properly.

Keeping this aspect of hospitals in view, Bio-Medical Waste (Management and Handling) Rules, 1998 (Amended in 2000) were laid down. So, we have the full list of proper scientific rules regarding the management and handling of the BMW. But what is the utility of such rules, if these can not be enforced at the ground level?

Hospital waste consists of various harmful substances like infected cotton, contaminated needles and other disposables, limbs, medical equipments used for operation, expired medicines, stool, sputum, blood, urine etc. that can be very dangerous for all of us if released in our environment wither proper treatment.

Eco Friends did a rapid assessment of BMW and compliance status of BMW Rules in Kanpur from May 27 to June 1. Eco Friends team visited Ursula, LLR, KMC, Murari Lal Chest Hospital , Lakshmipat Singhania Heart Centre, Regency, Madhuraj, Ratan Cancer Hospital , Chandani Nursing Home, Sri Ram Hospital , Chandrabhal, Madhulok Nursing Home National Pathology, Parakh Pathology, Doctors X_Rays and Pathology, Sarswati Pathology, Life Line, Sanjivani and Universal Blood Banks, 7 Air Force and OEF Hospital . The team also visited the Veterinary Hospital , Common BMW disposal facilities (MPCC at Bhaunti and Will World Enviro. Inc at Sootarganj) and scrape markets at Brahmanagar and Jareeb Chowki.

OVERVIEW OF HOSPITALS IN KANPUR

Kanpur is the 9 th largest city in India . The main diseases reported in the city are respiratory, dehydration/diarrhea, gastroenteritis and cancer. Asthma and Tuberculosis are very common in Kanpur , especially in congested areas due to poor living and unsanitary conditions.

SN	TYPE OF HEALTH CENTRES	TOTAL NUMBER	BED CAPACITY	WASTE GENERATION (KG/DAY)
1.	Govt. /Semi Govt. Hospitals	43	7670	1400
2	Private Nursing Homes/Hospitals	360	3220	2100
3	Defense Hospitals	4	250	50
	Total		11140	3550

Source- CPCB REPORT 1993

ACTUAL STATUS OF BIO-MEDICAL WASTE IN KANPUR

Highlights of the report

As per BMW Rules all the hospitals, nursing homes, pathology centres, blood banks, dispensaries, animal houses etc. in Kanpur should have taken all steps before June 2000 to ensure that BMW is handled without any adverse effect to human health and environment. Rule 6 (Schedule II) lays immense emphasis on the process of segregation. It means the BMW shall not be mixed with other wastes and it shall be segregated into separate containers/bags at the point of generation .

But nowhere in the above mentioned hospitals is segregation being practiced. Most of the staff is ignorant about it? There are containers placed at various spots in some hospitals with different labels but they are never used. There should be specific coloured containers for specific type of waste. But the funny thing is that these containers are being used indiscriminately like red coloured waste is dumped in red container, black coloured waste is put into black container or simply any kind of waste in any container. This practice is very common in all the hospitals. Obviously the staff was never trained for this.

In some hospitals , ( Ursalla Hospital and Hallet Hospital , Laxmipat Singhania Cardiology Hospital ) BMW is burnt in the open right in the midst of the hospital premises. They are not only burning the waste but with that they are also burning the law made for the welfare of the people.

Some of the hospitals have their own incinerators but most of them are lying dysfunctional and in complete disuse. There are two incinerators in the LLR Hospital but both of them are not working. There is one incinerator in Ursula which is fortunately functioning and is maintained by Lucknow based private company.

There are two common incinerators, one is MPCC plant at Bhaunti and the other one is Will World Enviro Inc at Sootarganj."MPCC plant alone is sufficient for the entire BMW generated in the city but only 150 hospitals are registered with this plant. Most of them don't even remember that they have to send their waste to this plant. Forget about segregation" told Mr YS Garg, Manager MPCC. MPCC does not get enough waste to sustain itself. Still worse, plant owners have not been able to recover even the capital cost of the plant, laments the manager.

BMW Rule 5 (Category no.8 of Schedule 1) very clearly states that the liquid waste generated in the hospitals should be disinfected through chemical treatment before discharging it into the sewer system but not even a single hospital is doing this. Roughly 2.5 MLD of highly infectious and hazardous wastewater from our hospitals is entering river Ganga through sewer system. Also stagnant pools of highly infectious water can be seen around general wards of hospitals.

Pathology labs and Blood banks in the city are no exception. They are also not following any process of segregation. Most of the labs and blood banks are affiliated with MPCC but majority of them are neglecting their duty towards bio-medical waste management. Some of the Pathology labs like Doctors X-Rays have put up a board stating all the rules pertaining to Bio-Medical Waste management and handling but it's of no use because no one is bothered about putting them into practice

But one community is very happy with this irresponsible behavior of the hospital staff and they are the rag pickers and the scrape-dealers. The rag-pickers collect the disposables like used glucose bottles, syringes, catheters, gloves and other wastes from the hospitals and sell them to whole sellers at Brahmanagar and Jareeb Chowki. The whole sellers sell it to Delhi scrape-dealers. In some cases hospital staff is also a beneficiary.

Good work should be credited. During our survey we found that OEF and other Military Hospitals and private nursing home Chandrabhal in Kidwai Nagar and Sanjivani Blood Bank are performing better with respect to their bio-medical waste.

Everybody knows about the bad condition of government hospitals but what about private hospitals. Private hospitals charge enormous amount of money, much higher than any government hospital and also they claim that they are ultra modern, highly sophisticated, very well equipped, have highly trained and specialized staff. Even they are not paying any attention to bio-medical waste and also they didn't allow us in and refused to give any information related to bio-medical waste.

We very firmly demand that

1. There should be proper documentation of all the clinics, nursing homes, pathology centres, blood banks etc. in Kanpur .
2. With reference to Section 11 of the BMW Act, there should be proper documentation of the records related to the generation, collection, reception, storage, transportation, treatment, disposal, and/ or any form of handling of bio-medical waste in accordance with these rules and any guidelines issued.
3. Private hospitals should be made more accountable and transparent as they charge plenty of money.
4. Proper and actual status report should be made by the hospitals about BMW management and handling.
5. Penal action should be taken by the concerned authority against the erring hospitals.
6. Time bound target should be set for each and every hospital so that a fool proof BMW management system as per the Act could be evolved.
7. Hospital staff dealing with BMW should be trained. This should be accorded top priority.
8. Those government hospitals that do not have incineration facility should be directed to send their segregated waste to common facility.
9. A Multi-stakeholders Monitoring Committee should be set up to review the progress of the implementation of the BMW rules.
10. A Green Rating process of the hospitals should be initiated.
11. Public should also be educated so that they could keep a vigil on the wrong doings of the hospitals.

Eco Friends Team which gathered information from the field and prepared the report: