The one day in the last five months that 17-year-old Abdul Rafiq decided to sleep in and not report for work, was the day he missed all the excitement when Shaniera Akram, wife of cricket legend Wasim Akram, sounded the alarm over Twitter and Instagram of "kilometres of medical waste including hundreds of open needle syringes" strewn on Clifton beach, on Tuesday September 4, urging authorities to close the beach to public.

The following day turned out to be the same mundane work. Sitting on the red tractor, Rafiq continued with scraping the sand, manoeuvring it deftly, then masterfully hauling the bloated plastic bags and dumping them on a heap. He stopped his work, for a few minutes to speak to Dawn.com.

"I don't know really what happened, but I see far more workers today than ever," he said, after spitting the gutka from his mouth.

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But his supervisor, Zahoor Ahmed, a contractor working for the Cantonment Board Clifton, and who has been supervising the cleaning up of the area for the last 14 years — from the Village Restaurant to Hyperstar — was present that ominous day. He, along with 150 brigade of labourers, reported on duty to clean the beach of all the bio-hazardous vile, sickening stuff that the sea had spewed.

In his many years of service, he said, he had seen the sea bring in many strange things, to the beach, including nearly "35-40 huge sacks" filled with pages from the Holy Quran last year, but never this kind of waste.

"I have a feeling the waste was in the drains and somehow got pushed into the sea by the rainwater", was Ahmed's considered opinion.

"Or someone may have deliberately thrown a sack full of this hazardous material into the sea but forgot to attach weights and therefore it never drowned but surfaced and the waves returned it to the shore," he suggested.

Who dumped it?

Some have even suggested it may be a deliberate effort to discredit the ruling government.

"Who knows?" said Dr Salma Kauser Ali, director health and medical at Karachi Municipal Corporation. She, too, had visited the beach that evening. To her mind, it could well have been thrown by any of the scores of private clinics and hospitals, maternity hospitals (even in informal housing), laboratories, dental colleges etc, around Clifton, who are completely oblivious to the spread of infections this irresponsible act causes.

Sindh Environmental Protection Agency's (Sepa) director general, Naeem Mughal, also visited the site and said the same: "There are several hospitals in the vicinity and anyone one could have dumped this waste in the sea; we were not able to identify the source."

But finding the culprit may not be an impossible task if you ask Islamabad-based public health specialist, Dr Nuzhat Khan.

"The syringes and IVs usually have codes inscribed on them and these can be traced back to the suppliers who would be able to then tell you who purchased the medical equipment from them bearing those numbers," she said.

With over 25 years of experience in the health sector, she is well aware of the lackadaisical attitude towards disposal of hospital waste, toxic and otherwise. Often on field visits she said she found un-used needle destroyers sitting pretty in cupboards of district government hospitals "under lock and key".

Disposal methods

Meanwhile, Sepa will be issuing notices to all the area medical facilities to make their hospital disposal plans available to them.

"I would be interested to know how they segregate, whether they use of colour-coded drums for disposal that they claim they do and what happens to the waste before it is transported to the incinerators," said DG Mughal, adding that his officers do visit health facilities "off and on". He said he was also not very sure if the two incinerators of KMC were running efficiently.

"I plan to visit Mewa Shah (where the two are installed) soon to see for myself," but conceded a more coordinated effort and cooperation from all medical facilities and waste management authorities was needed.

"Our incinerators are working well. We religiously collect and incinerate waste, both the hazardous and non-hazardous kind, from 14 of our hospitals and one dental college, under us," responded Dr Ali confident the waste thrown out by the sea could not have come from any of the KMC-run medical facilities.

But it is not just about whether there are enough incinerators in Karachi or whether they are in working order. Dr Seemi Jamali, heading the Jinnah Post Graduate Medical Centre (JPMC) says the waste generated and collected at hospitals may not even reach the incinerator or the landfill site.

"Much of it may well be stolen from within the premises. Despite our best efforts to manage waste in a scientific manner, the possibility of it being pilfered is quite real," she said. And once out of the hospital compound, it finds its way into the hands of recyclers, who hire very young kids, segregating syringes from mounds of waste.

"I myself have caught kids busy doing this work, have even reported them, just behind JPMC. They vanish for a few weeks and then return and continue separating the used waste," she said. Not only that, often the contaminated hospital waste finds itself mixed with the municipal waste.

Nevertheless the furore by Shaniera's tweets has created a few ripples within the medical fraternity.

"Though not a huge quantity, the surfacing of three dozen or so used syringes gives a glimpse of how ineffective safe management of hospital waste is by our authorities," pointed out Dr Khan.

Saleemuz Zaman has been running a private waste disposal company called the Global Environmental Lab (Pvt) Limited, collecting and disposing hazardous industrial waste since 1998, specially from pharmaceutical companies.

He is not very happy with slipshod way waste is handled in the city, specially the hazardous kind. "It's very unfortunate that a dozen or so Sepa-certified companies have taken on this serious task without any checks," he said, having misgivings about its safe disposal.

"I am not even sure if the incinerators work efficiently; and for all we know the waste may be thrown somewhere midway."

Putting the record straight, Mughal, director general of Sepa said those companies "cannot transport and dispose hospital waste" only permitted to lift industrial waste.

While his company does not lift and transport hospital waste, Saleemuz Zaman is willing to set up a system for disposal of medical waste — both hazardous and otherwise — "only if I am given assurances" of smooth running without interference or pressure from vested groups of such a facility.

The important thing, said Dr Khan, is that waste should not leave the hospital premises, "not even the non-hazardous kind". And incinerators should burn the waste with minimal damage to the environment, she said. According to her, the best incinerators are those that not only leave a very small carbon footprint, but also leave a reduced quantity of ash.

"We do have such state-of-the-art incinerators in our country; I know Lahore does, but I am not sure how qualified the operators are or if they have been imparted knowledge to differentiate between the different kind of waste and treat it thus?"

'Time for government to step up'

Dr Wasif Shahzad, executive director operations and chief operating officer at The Indus Hospital, is happy the recent outcry by Shaniera has resulted in putting the authorities on the spot.

"Without proper monitoring, it is easy for those responsible for disposing of medical waste, to get away without following the protocols."

He hoped the Sindh Health Care Commission would jump into the fray. "I know it's still in infancy, but hopefully if it has the teeth, it will carry out thorough investigations."

And therefore, Shaniera suggests, all departments and agencies — be it the Sindh Solid Waste Management Board, or the Health Department, the DHA, Clifton Board, the KMC or even Sepa — "need to work together to ensure that every single hospital, clinic and lab in Karachi is disposing of their medical waste appropriately", she said while talking to Dawn.com. Now is the time, she said, that appropriate departments step up to ensure the safety of the people living here in Karachi.

Header photo: 17-year-old Abdul Rafiq collects trash on the Clifton beach. — Photo by author