NHSL’s clinical waste woes

By Maheesha Mudugamuwa and Randev Jayasinha

The inability by the National Hospital of Sri Lanka (NHSL) to properly deal with the ongoing clinical waste crisis, which began in August last year, has raised its ugly head once again, NHSL employees alleged.

They claimed that keeping patients and staff of the hospital should become the first priority of the hospital’s management and the leaders on the front lines of healthcare in the country.

Transitory solution at a stand still

All Ceylon Nurses Union (ACNU) President S.B. Mediwatte told The Sunday Morning that the NHSL had failed to dispose its own garbage in a proper manner, and as a result, the employees and patients were in danger.

During the last rainy season, the garbage had mixed with rain water and had created chaos within hospital premises. As a result, several healthcare workers suffered from dengue, he claimed.

Mediwatte believes that proper waste disposal practices are a crucial part of a safe working environment.

“Hospitals must foster safe working environments for clinical staff, so that they can focus on taking care of patients,” he stressed.

Further explaining the situation at NHSL, Mediwatte noted that the problem was there since last August and from time to time they had informed the relevant authorities to take action.

But these authorities failed to take action and some of NHSL staff members were infected with dengue.

“However, after we spoke to the media, the authorities somehow collected the garbage and took it out from the hospital, but we don’t know as to where it was deposited,” he alleged.

“We are unaware of where the waste is being taken or whether it is being disposed of in a healthy manner or not, but the authorities had cleaned out the waste that was collected there over this period,” he added.

Even though the garbage problem has been temporarily solved, the hospital needs a permanent solution, Mediwatta stressed.

Earlier, the garbage that was collected in the hospital was burnt at the hospital premises itself. But later on, the management decided to grant a tender to a private company, and the private company was supposed to collect the garbage and deposit it somewhere, he explained.

According to Mediwatte, previously, clinical waste from NHSL was destroyed on a property belonging to the Mulleriyawa Base Hospital.

However, amidst opposition by residents in the area, a stay order was issued temporarily, preventing the destruction of clinical waste on the premises.

“Previously, the national hospitals had granted the tender to a private company to dispose of this waste.The task was carried out to good effect. However, after complaints had come in with regard to the disposal of this clinical waste, the proceedings came to a halt.Over a period of time, since this private company had not been collecting the waste, the waste had accumulated in the compounds of these hospitals.These accumulations led to a widespread number of diseases, including dengue inside the hospital premises, with some of the employees at these institutions being infected,” Mediwatte stressed.

A wake up call to the authorities

When The Sunday Morning contacted the NHSL Deputy Director Dr. Lionel Muhandiramge to inquire as to what was actually happening at the hospital and what steps they were planning to take to prevent such issues from recurring in the future, Dr. Muhandiramge said: “The problem has been there for about two months. The court intervened with regard to the disposal of waste by the private company, so we made internal arrangements to tackle this clinical waste problem with the aid of the private company.”

“Now, the clinical waste that accumulates is completely cleaned and cleared. Yet we get daily collections of this waste – that has also been arranged to be sent to secure sites for their disposal, but this is until the Minister of Health finds a permanent solution for this, in collaboration with the Central Environmental Authority (CEA),” Dr. Muhandiramge added.

“Why the waste caused a problem was because we had no place to dispose of it, as the company that had been given the tender to get rid of this waste was suspended by court. Therefore, when the clinical waste accumulated, it had to be kept on the premises of the national hospitals, as a place wasn’t designated for us to dispose of it,” he further noted.

“But now, we have handed the task over to the Public Health Inspectors Department (PHID) and they have taken maximum precautions to avoid a public nuisance as a result of this waste crisis,” Dr. Muhandiramge said.

The medical experts stressed that the Ministry of Health and the CEA, who were the responsible agencies for waste management, failed to fulfill their duties.

They claimed that the Government should be held responsible for arranging a proper system for scientific management of waste at government hospitals and also to strictly monitor the expensive private hospitals, clinics, and diagnostic centers so that they are forced to properly manage medical waste.

In Sri Lanka, the National Environment Act (NEA) No. 47 regulates healthcare waste management, and according to the legislation (2008), facilities are required to obtain two licences: Environmental Protection License (EPL) and Scheduled Waste License (SWL).

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