At 7:30 in the morning the garbage truck arrives in the driveway of a hospital in Kathmandu. Waste tied up in plastic bags is taken away. The truck winds its way along the Ring Road until it reaches the banks of the Bagmati at Balkhu. In the unbearable stench of the rotting garbage, amidst flocks of crows and kites, a large crowd from the nearby slum is waiting. The tiptruck empties its rubbish and men, women and children scramble over the fresh garbage with their metal tongs, rummaging for pieces of plastic, glass and other valuables that can be sold for recycling.
The garbage from the hospital contains a plastic bag with discarded placenta and other human organs, there are used syringes and plastic bottles. "Sometimes the drug addicts come around to see if they can find needles," says one young garbage forager as he walks off with a sackful of plastic water bottles. As Kathmandu Valley's population grows, so do the numbers of hospitals and clinics. This has lead to a rise in the volume of hospital waste, and there is mounting evidence that not all hospitals are disposing of hospital waste in a safe and proper manner.
In the course of investigating this article, the worst waste mismanagement was found at the infectious diseases hospital in Teku. We found open waste buckets with used syringes in paper boxes. The danger of Hepatitis B and HIV infection to hospital staff, waste handlers and scavengers at the landfill sites from such careless disposal is high. Two years ago, the municipality installed an incinerator in Teku for burning hospital and other waste, but it never went into operation because of public opposition. Now, Kathmandu mayor Keshav Sthapit is fed up, and says he is going to get the incinerator started no matter what. "I don't care who opposes it, the hospital waste problem is getting serious," he told us.
Public interest litigation group Pro-Public says an incinerator for hospital waste in the city's centre will in fact be more of a risk to the public due to dioxins and toxic ash from the emissions. "We are not for or against anybody, we just want to flag this danger and urge the authorities to look at alternatives," says Ashoke Dev Pande of Pro-Public.
A lot of the problems could be solved if hospitals did their own sorting and disposal. The Maternity Hospital in Thapathali has its own incinerator, but it was moved to Banepa five years ago because the UN Park was being set up nearby along the Bagmati River. "We never got any help from the government, and now there is no more space left here for another incinerator,' says Sharmila Ligan, matron of the hospital. As a result, much of the blood and human organs from the maternity and surgical wards are disposed along with other urban garbage.
Some of the newer private hospitals show more care: they segregate their waste in coloured buckets and even have needle destroyers and small incinerators to dispose of the more hazardous wastes. But Manohar Lal Shrestha, superintendent of Bir Hospital, says sorting waste at the source doesn't solve the problem. "So you separate the plastic, glass and biodegradable into separate containers, but what is the use if all the contents are ultimately dumped into the same garbage truck?" he asks. Nepal has laws for hazardous waste disposal. The Environmental Protection Act of 1996 requires all hospitals with more than 25 beds to first present an environment impact assessment. "Not a single hospital since then has followed it," says Health Secretary Lok Man Singh Karki. There have also been numerous hospital waste management conferences, the latest in February on upgrading hospital waste disposal organised by the Nepal Health Research Council (NHRC) with support from WHO.
The NHRC's Chandra Shekhar Yadav admits there have been many workshops and seminars to make hospitals and health workers aware of the problem. "But there is a lack of political will, an absence of national policy and a real problem of ignorance and carelessness among hospital management," he told us.
Urban waste management experts say although hospitals have to do their bit, hospital waste management will never be completely solved until Kathmandu can solve its overall garbage problem. In the long term, this can only come with greater public awareness through education and advocacy about the health implications of garbage. In the short term, the municipality has to once and for all make sorting and recycling a priority. Eight percent of Kathmandu Valley's garbage is still biodegradable and can be converted into valuable compost fertilizer. Much of the remaining plastic, glass and paper can be recycled. Such waste management can drastically cut the volume of garbage that has to be actually dumped at a landfill site like Balkhu.
Pro-Public's Sushil Bahadur Karki admists Balkhu is not a longterm solution. "We have to find an alterantive site. Chobhar is being proposed, but no one wants someone else's stinky garbage in their backyard."
Everyone agrees that hospitals have to be much more responsible about how they dispose of their most hazardous wastes, and those with incinerators have to make use of them, taking care that the chimney filters out hazardous emissions and also take care to dispose of the toxic ash that comes out of emissions.
Says environmentalist Ashok Dev Pande: "We must stop the blame game, stop passing the buck and stop this trend that makes hospitals themselves health hazards." (KPK)
Biratnagar turns trash into cash
Babu Raja Shrestha has changed the way we look at garbage
If Kathmandu wants to learn how to manage garbage, it doesn't need any expensive foreign consultants. It doesn't have to go begging to donors. Its officials just need to go to Biratnagar and see how they do it down there. True, Nepal's second biggest city has industrial suburbs where foul-smelling black and purple industrial effluents flow out into the ditches along the Itahari highway. But when it comes to solid waste management within the town, Biratnagar is a role model for private-public partnership.
"Waste is not the problem, it is the peoples' negative attitude towards it that is a problem," says Babu Raja Shrestha, the engineer who has the first-ever private company to work with a municipality in Nepal to manage waste.
Shrestha's Silt Environment Services has a joint venture with Biratnagar Municipality, which has been successful in the last four years in sorting garbage and turning biodegradable waste into valuable fertiliser. "Biratnagar's waste is not waste, it is not toxic, it is mostly organic," Shrestha says, explaining that this is ideal to turn into compost.
Households in Biratnagar are given two colour-coded plastic buckets: red for biodegradable rubbish and blue for plastic, glass and metal. They must pay to have their garbage lifted and there is also a sidewalk and street cleaning service that comes as a bonus.
Once they pay for it, households take the service seriously and comply with the sorting requirements. Although only one in every five households in the city centre have become members, there has already been an appreciable drop in solid waste along the streets and river banks.
"The Singhe River used to be a garbage disposal site, today there is less trash there," says Umesh Ojha of Biratnagar Municipality. But Ojha admits that Biratnagar's hospitals are still dumping their garbage along the river and it is full of used needles and plastic packs. Shrestha says he is not equipped to handle medical waste, and that needs special management.
Shrestha's company has leased a 2.5 hectare property to compost biodegradable waste and set up a renewable energy park with wind power and solar energy. The fresh garbage is laid out in decomposition pits and rotated every month. Non-biodegradable waste is used as landfill for ditches and placing up to 20cm of top soil for conversion into parks and playgrounds.
Wooden and garden waste is turned into biomass briquettes which can be used in place of firewood. Shrestha himself uses a wind charger and solar panels for lighting his home and also to pump ground water for irrigation. All waste paper in the garbage is recycled and sold in the market.
Shrestha has not only managed to clean up Biratnagar, but has challenged the traditional notion that only 'low caste' people should handle waste and made a community service also a good business proposition.
(Pragya Shrestha in Biratnagar)
