Special report: Garbage collectors exposed to diseases from hazardous medical waste

Reda Youness seems to have gained nothing from his job of collecting trash and cleaning the streets in al-Magzar area in Mansoura City, Daqahliya, except disease. He spent one third of his 55-year old age between garbage on streets and the garbage dumps.

Youness has been suffering Hepatitis C virus since he was twinged in his hand by a contaminated syringe as a result of the bad sorting system of hazardous medical waste of hospitals and clinics.
“We are victims. We are the biggest segment who suffers diseases, as hospitals and clinics throw away their medical waste in regular garbage places,” said Youness.
In the garbage, hospitals throw away solutions packages, used syringes, contaminated blood bags, used tissues, resected human organs, fetuses and remains of poisonous mercury.
Garbage collectors find these items within the trash, which consequently exposes them and their families to infection with dangerous diseases.
The state of chaos and overlapping powers between ministries of health, higher education and environment warn against aggravating crisis. Add to this, hospitals’ ignorance of terms of the national guide to fight infection, drafted by Health Ministry, in collaboration with World Health Organization (WHO) in 2004.
Article no.29 of environment law bans handling the hazardous medical waste without permission by authorities in question. Penalties of violators reach five-year imprisonment at least and a fine between LE20,000 and LE40,000, according to article no. 88 of the law.
Reports are barely filed against violators. And if filed, penalty hardly reach LE1,000,  which is the minimum rate of throwing regular, not dangerous, waste onto streets
In Daqahliya, there are 602 medical establishments, affiliated to the ministry, 16 governmental establishments, affiliated to the medical insurance authority, nine medical centers and hospitals affiliated to Mansoura University and 5,038 private medical centers, according to data by the governorate’s health department.
These establishments get rid of around 19 kilograms of medical waste daily, according to report by the environmental affairs agency in 2013.
Regarding violations by medical establishments of the safe disposal of medical waste, they included not having permission for handling waste, not sorting the waste, not keeping records over handing waste or safe disposal of the medical waste.
According to the national guide, regular solid waste like papers, boxes and eating utensils should be placed in black bags, while hazardous waste should be put in red bags with name of the hospital and weight of the bag written on it.
Another form of violation was seen at the sharp tools like syringes and scalpels that should be put in plastic or cartoon packages that are tightly closed.
What happens on the ground is different as the regular and dangerous waste are randomly dumped, threatening lives of garbage collectors and all inhabitants at the surrounding areas.
Only eleven sanitary incinerators were established by the government at public hospitals in Daqahliya, in addition to another one established by a charity organization. One of these incinerators is not operated by the residents who fear dangers on public hygiene.
Medical establishments that do not have sanitary incinerators should send their dangerous waste to hospitals of licensed landfills via vehicles that have tightly-closed containers.
Due to absence of accountability, some mediators get rid of these waste through selling them to agencies that recycle them.
“The need and low income pressure us to gather the refuse and sell them,” said Mostafa al-Baz, garbage collector adding that they sell solutions packages, plastic syringes and others for LE2.5 per kilo. They sell it to someone called Um Hamada who then sell it to plastic factories and traders from Cairo in return for huge profits. “It might be wrong what we do, but the government doesn’t estimate our circumstances,” he added.
Um Hamada refused to comment on the remarks by al-Baz saying she buys anything plastic from any one. No violations were recorded against her, since she rents the legally the garbage dump, where she can sorts the garbage.
A secret report by the Administrative Control Authority during the first quarter of 2014, revealed the presence of large amounts of medical waste in public garbage dumps in Daqahliya, despite the life-threatening danger caused by seepage of hospital's hazardous waste.
The report also showed that Mansoura University medical establishments did not receive licenses required to handle hazardous medical waste.
“We did not know we needed permission to handle medical waste,” said Ashraf Sarhan, head of administrative affairs at Mansoura University hospitals. “When notifications by the environment affairs agency were received, we filed request to health department demanding the permission in February. The permission has not been issued yet.”
Meanwhile, Magdy Hegazy, deputy health minister in Daqahliya, said, “No requests in this regard were received. We only received one letter from the university asking to dispose of waste by the pathology section. The ministry demanded information about the amount of the waste, but the university did not respond.”
According to WHO estimates, usage of contaminated syringes lead to infection of 21 million patients with Virus B, two million patients with hepatitis C and 260,000 patients with AIDS.
Sayyed, a garbage truck driver, said, “My job is to transfer the refuse to the dump. It’s not my business to look at components of the bags. It’s the job of the garbage collectors and nurses of the university hospital.”
In February and June 2014, a Al-Masry Al-Youm reporter found red bags containing dangerous medical waste thrown inside the yard of the hospital next to the wall.
No sanitary landfills were found in Daqahliya. There is only one landfill in Alexandria, according to Refaat al-Sonbaty, head of the safe disposal of medical waste at the governorate’s health department, and Hesham Rabei, head of the environment affairs agency of east delta sector.
He said disposing of the waste at hospitals of Mansoura and Health Ministry properly is very challenging. “It’s hard to deal with that landfill due to the long distance and costs. Transfer costs reach LE1,000 per ton, while the landfill get LE500 for burying one ton of waste,” Sonbaty said. Private hospitals and clinics have a contract with one incinerator at al-Shubban al-Muslimeen hospital, affiliated to a charity organization.
Although conditions of issuing license to hospital include contracting with an incinerator to get rid of the dangerous waste, a number of private hospitals directors said that Health Ministry incinerators refuse having contracts with private hospitals, making the one of the charity organization their only way to get rid of waste.
“Private clinics and hospitals do not want to contract with Health Ministry incinerators, as costs of transferring the refuse to these incinerators are high,” Sonbaty added.
A report by the environment affairs agency on 19 August 2014 revealed a difference between weights of the medical waste produced by several sections and the amounts handed to sterilization unit. The difference pointed to a decline in amount of waste sent to the incinerators by 500 kilograms of the amount produced each time.
“The difference indicates a leakage of the dangerous waste into regular garbage dumps. However, no evidence is there, as we do not know where the amounts have gone,” said, Osama al-Baz, general director of the university hospitals.
Baz added that he made decision ordering all workers to sort the garbage, holding violators accountable and ordering a security personnel that should be changed every week to guard the regular garbage on way to public dump.
However, an informed source from Mansoura University spoke on condition of anonymity saying, “University does not have direct control on its hospitals. Notifications on violations are sent to heads of the hospitals.”
Baz refused saying that they are controlled by the university as well as the environment affairs agency. He also confirmed that several violators were referred to prosecution, without disclosing their number.
The Administrative Control Authority report also showed that workers of the hospitals put the plastic packages in bags in order to sell them. The expired blood bags were also found out to be kept at the same refrigerators of the valid blood bags at Mansoura University’s Gastrointestinal Center. The bad blood bags were not disposed of at the Emergencies hospital as well.
In October 2013, the environmental committee filed a report against the Egyptian company for transferring hazardous medical waste. One of the company’s vehicles was found out to have handed 2.7 kilograms at al-Shubban al-Muslimeen incinerator and kept 42 kilograms. Investigations are still underway by prosecution.
The reporter also noticed that most of the hospitals did not have the environmental records and the solid waste records, as stated by law. If found, the classification was inaccurate.
Article no.33 of the environment law states that owners of medical establishments that produce hazardous waste, should keep these records as well as lists of authorities contracted with. Violators should be imprisoned no less than a year and/or fined between LE10,000 and LE20,000.
Penalty of whoever throws medical waste at unallocated places is imprisonment for no more than a year and/or fine between LE5,000 and LE100,000.
Penalties against violators are weak, according to Rabei, who demanded harsh ones. The minimum rate of the fine, LE1,000, is imposed in all the violations. This rate is the minimum of throwing regular solid refuse on streets.
However, prosecution official said, “We impose the minimum rate as the writing of the reports by the environment affairs agency are usually weak. They do not clearly specify the violations, the violator or whoever in charge. If the reports were referred to courts, violators would be cleared.”
Lobna Abdel Naby, general director of east Mansoura environment affairs department, said, “Many private hospitals dump their dangerous medical waste at the regular garbage. When we inspect, we find the records correct and that the waste were transferred to the incinerator. However,reality shows that the waste are dumped on streets.” She called on health ministry deputy to issue decision closing the violating hospitals, but no closure decisions were made over the past five years.
Hegazy said that closure decisions for any private medical establishment should be issued by either the governor or the secretary general of the governorate based on report with the violations. He also blamed the reluctance on the local councils.
A decision was issued by Health Ministry in 2010 over handling the hazardous medical waste, which was not implemented at any of the hospitals visited.
Rabei, of the environment affairs agency, said, “The agency has a pivotal role in controlling the safe disposal of hazardous medical waste. But health Ministry shares the responsibility with us being the administrative authority in question by law.”
However, Hegazy, of Health Ministry, responded saying that Health Ministry’s role is supervisory only, especially on the private sector. “The main oversight is for the environment affairs agency, which has the right to watch the work inside health department and its hospitals and can file reports of the violations. For university hospitals, “we don’t have authority over them. We submit reports over their work to health minister, who refers them to higher education minister.
At such labyrinth, garbage collectors and their families remain exposed to dangers.
Edited translation from Al-Masry Al-Youm

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