88 hospitals, 182 diagnostic centres, ZERO incinerators

Not a single hospital or diagnostic centre in Chattogram has the capacity to dispose clinical waste properly, posing serious health risks.   

Even the lone private organisation entrusted by Chattogram City Corporation (CCC) and Department of Environment (DoE) to dispose medical waste in Chattogram, does not have an incinerator.

According to health service officials, a total of 88 hospitals and 182 diagnostic centres are operating in Chattogram.

Sources said none of the hospitals and diagnostic centres have their own mechanism to incinerate clinical waste.

Even Chattogram Medical College Hospital (CMCH) and Chattogram General Hospital (CGH), the two main government hospitals of the city, do not have incinerator machines.

According to experts, clinical waste must be collected separately, and should be disposed with incinerator to avoid any public health risks.

Contacted, Dr Serajul Islam Chowdhury, a former professor of dermatology at CMCH, said if hospital waste is not disposed separately, it may pose risk of communicable diseases and infections to others. Pneumonia, diarrhoea, tetanus, hepatitis B and C and even HIV/AIDS are common diseases contaminated due to improper waste management, he said.

Only one private organisation, Chattogram Seba Sangstha, has been working to dispose clinical waste since 2015, after signing a memorandum of understanding with CCC.

The organisation collects clinical waste only from those hospitals and diagnostic centres that have signed contracts with it. According to officials, 60 percent hospitals and diagnostic centres operating in the port city have signed contract with them.

However, this organisation does not have an incinerator machine, and disposes the waste in a designated place on the CCC landfill in Halishahar, using some local machines and manual process.

Upon a visit to the spot recently, workers of the organisation were seen using pit-hole method to burn the wastes, causing air pollution.

Meanwhile, the 40 percent hospitals and diagnostic centres which do not have contracts with Seba Sangstha continue to dispose of medical waste together with general waste.

The 1,313-bed CMCH -- that accommodates over 2,500 patients a day -- generates seven and a half tonnes of waste a day, including general waste.

The hospital is equipped with three clearly marked, covered bins across the building -- red for sharp objects, yellow for infectious but non-sharp objects and black bins for general waste.

During a recent visit there, clinical waste was seen being mixed with general waste and dumped in the central garbage bin of the hospital, with dogs and crows spreading those around.

Asked, Dr Akhterul Islam, deputy director of CMCH, said they initiated the process of buying an incinerator but could not due to its high price. “It will cost Tk 10 crore,” he said, adding, “Instead, we have signed a contract with Seba Sangstha to collect and dispose our waste at a monthly charge of Tk 79,000.”

Asked about dumping clinical waste mixed with general waste, he said sometimes patients’ attendants put general waste in red bins, mixing it up with medical waste.

“We have instructed staff at wards to monitor it, but despite this, it cannot be controlled,” he said.

CMCH has at least signed a contract with Seba Sangstha for waste disposal. Chattogram General Hospital has not even done that. During a visit recently, it was seen that gauge and saline sets were put in open garbage bins, with a murder of crows gathered around it.

Contacted, Dr Asim Kumar Nath, superintendent of CGH, said they burn clinical waste once a week through the pit-hole method.

Asked why they did not sign a contract with Seba Sangstha, he said the organisation charged a high price, which -- as government hospital -- they “could not afford”.

The same situation prevailed in Jameson Red Crescent Maternity Hospital in Anderkilla. Clinical waste including saline sets and blood transfusion sets were seen in the dumpster in front of the hospital.

Locals said street children often collect saline sets and blood transfusion sets from the bin. Stray dogs were also seen picking up gauge and other clinical waste.

Contacted, Dr Sheikh Shafiul Azam, president of Chattogram district unit of Red Crescent Society, said clinical waste should be disposed separately and carefully.

“But we cannot do it as we cannot buy an incinerator due to its high price,” he said.

Asked why did they not outsource the job to Seba Sangstha, Shafiul said they would contact the NGO.

Jamir Uddin, chief executive of Seba Sangstha, said some 160 hospitals and diagnostic centres out of some 270 in operation have signed agreements with them to responsibly dispose clinical waste.

“Almost 40 percent hospitals and diagnostic centres are yet to sign up with us,” he said.

Asked whether they use an incinerator, Jamir said they could not buy an incinerator as it would need a vast area to install the machine, which they did not have.

“We use a machine to destroy the sharp objects, and other clinical objects are burnt out,” he said, adding, “Department of Environment (DoE) has given us approval to do so.”

Contacted, Azadur Rahman, director, DoE (Chattogram metropolitan) said all the hospitals and diagnostic centres approved by DoE have signed agreements with Seba Sangstha. Asked about Seba Sangstha causing air pollution by burning waste, he said he would look into it.

According to the Medical Waste (Management and Processing) Rules 2008, a divisional authority -- led by divisional director of Directorate General of Health Services, including a representative of the respective city corporation, and a representative of the Department of Environment (DoE) -- is supposed to look after the medical waste management.

Asked whether it is a gross loophole in medical waste management that none of hospitals and diagnostic centres in Chattogram district have an incinerator, Dr Hasan Shahriar Kabir, director (health) of Chattogram division, said many government hospitals use pit-hole method to destroy medical waste.

 “Although pit-hole method creates air pollution, it saves people from being infected with diseases by medical waste,” He said.

Hasan said he will monitor all the hospitals and diagnostic centres in the district step by step to oversee their medical waste management.

Contacted, CCC Chief Conservancy Officer Shafiqul Mannan Siddique said the conservancy workers collect clinical waste of those hospitals and diagnostic centres which were yet to sign agreement with Seba Sangstha.

Asked whether the workers collect clinical waste separately or together with domestic waste, he said they collect all sorts of waste in the same vehicle.

Asked about the health hazard of the method, he said, “We have limitations, so we signed the MoU with Seba Sangstha. Now, if any hospital or diagnostic centre does not sign up with the organisation, what can we do? If they dump clinical waste in open bins, we cannot leave those that way. We have to collect and dispose those.”

Contacted, CCC Chief Health Officer Dr Selim Akter Chowdhury admitted that clinical waste should not be mixed up with general waste. Asked about CCC workers collecting clinical waste -- which remain out of purview of Seba Sangstha -- with general waste, Selim said he would talk with CCC conservancy officials about it.