KARACHI: Barring a few tertiary care hospitals in the city, no healthcare facility in Karachi has a proper mechanism to safely collect and dispose of its medical waste.

The highly hazardous refuse is either sold by healthcare facilities, unsafely dumped within the neighbourhoods or taken to the decades-old government incinerators lacking independent monitoring, medical experts told Dawn on Tuesday.

In addition, they said, the government was yet to install incinerators at eight hospitals in the province — a project which the government initiated last year on the directives of the Supreme Court-mandated water commission.

The experts were sharing their views against the backdrop of a debate generated on the media following Shaniera Akram’s posts on Twitter in which she shared her observations, pictures and a video showing parts of the Clifton beach littered with clinical waste.

“There is kilometers of medical waste, including open syringes, vials of blood, broken glass medical containers, that has come in from the ocean spread out over kilometers across the beach.

“Our beach is a bio-hazard zone and needs to be shut down immediately. I am so sorry to the people including myself who use and love our beach but this is beyond safe,” she said.

Shaniera Akram posts a video on social media saying Clifton beach is a bio-hazard zone and needs to be shut down immediately

Reacting to this alarm, the affected area reportedly was cordoned off and the Clifton Cantonment Board collected the waste.

Experts, however, criticised government’s ad hoc approach towards what they described as ‘a very old serious issue’.

“We appreciate what Ms Akram did and would request all concerned citizens to do the same, if that’s how the government would work,” said Dr Qaiser Sajjad of the Pakistan Medical Association.

He added that the association had been raising this problem for ages but it could never attract official attention.

“We want to know which department is responsible for collecting medical waste from hundreds and thousands of clinics, maternity homes, hospitals and labs in the city.

“What we see on the ground is horrifying; clinical waste being dumped in lanes and streets as well as educational institutions,” he said.

He warned that “citizens are in the midst of a health disaster, urging the government to wake up and put systems in place”.

Waste from clogged drains?

Answering a question as to how medical waste might have ended up on the beach, Dr Nuzhat Khan, currently heading the National Institute of Oceanography, said that it probably came from clogged drains carrying waste from the city.

“I think it all flushed onto the beach as we have been experiencing heavy spells of rain. There are three to four drains which directly discharge waste on the Clifton beach,” she said, adding that pollution seriously affected the whole coast from Korangi fish harbour to Port Qasim.

She also referred to a 2017 incident in which massive flushing of sewage on the beach was erroneously reported as an ‘oil slick’ by the media.

Dr Altaf Ahmed, representing the Medical Microbiology and Infectious Diseases Society of Pakistan, regretted that while Punjab had shown progress on safe disposal of medical waste, Sindh lagged far behind.

“We have seen hospitals selling their medical waste to garbage collectors. Some waste is taken to the government incinerators in Gutter Baghicha but nobody knows about its efficiency and operation as it’s a restricted area,” he said, adding that a few government hospitals had incinerators (an old technology) but that too were either found out of order or run half of their capacity.

The government, he pointed out, should see whether healthcare facilities had a system to manage and dispose of waste at the time of their establishment and then give them licence for operation.

Categorised as ‘highly infectious waste’, the clinical refuse must be segregated at source.

“It’s so easy to do. But, when it gets mixed with domestic waste, it turns the whole (the large quantity of non-infectious domestic) waste into infectious waste,” he said.

‘Antibiotic resistant germs in food’

It is important to recall that concerns over poor medical waste disposal practices have frequently been highlighted by experts.

A Karachi University study carried out on the food being sold in and outside 10 public sector hospitals of the city showed that it was unfit for human consumption and that the germs contaminating it had resistance against a number of commonly used antibiotics.

The samples were picked up from the Civil Hospital Karachi, Landhi Medical Complex, Abbasi Shaheed Hospital, Sindh Government Hospital, Liaquatabad, Qatar Hospital, Sindh Government Hospital (UP Mor), Lyari General Hospital, Jinnah Postgraduate Medical Centre, Dow University of Health Sciences (Ojha campus), and Sindh Social Security Hospital.

The study identified dumping of waste (especially medical waste) in the open, lack of infection control measures at healthcare settings, mixing of sewerage lines with water mains, and poor hygiene practices of food handlers as major contributors to the evolution of these germs and their spread.

Published in Dawn, September 4th, 2019