PICS: BIKRAM RAI

As hospitals go, Nepal's oldest hospital makes the news for all the wrong reasons: corruption, mismanagement and filth. However, Bir Hospital is becoming a model for recycling hospital waste not only for other hospitals in Nepal but around the world

Each year hospitals in Nepal generate more than 365 tons of medical waste with most of it thrown into municipal garbage dumps: syringes, plastic, bandages and even some human body parts.

In the absence of proper storage, disposal facilities and sterilisation instruments like autoclave and incinerators, Bir Hospital was dumping 323 kg of infectious waste into the public garbage system every day. Not surprisingly, waste had become a major source of infection among patients and staff exposed to the polluted environment.

Last year, the Health Care Waste Management Program was launched with Healthcare Foundation-Nepal (HECAF). Today, Bir is quickly becoming a pioneer in the field of hospital waste management as the hospital now segregates waste at the source significantly reducing the toxicity. The waste is then thoroughly disinfected and passed along for recycling and reuse. "We have been following non-incineration techniques to manage medical waste because of the risks associated with burning them," says Mahesh Nakarmi, director of the Health Waste Management Program.

Organic waste is fermented in underground digesters to generate methane gas which is then used for cooking. Non-biodegradable waste is recycled and sold to hawkers or used to make handicrafts. The hospital has also begun vermin-composting to turn used cotton and gauge to create compost manure and hopes to sell 32 tons of fertilizer annually.

So far the hospital is recycling nearly 80 per cent of its total waste and the program has improved overall hygiene at the hospital. Ms Tulsi Malla of the surgical ward believes this has had a positive effect on the recovery of patients.

The patients are recovering faster, because the rate of infection from waste has been reduced drastically. The program should have started much earlier," she said. The centralised health waste management system has made all wards mercury-free and there is increased injection safety in the hospital.

The program is also becoming commercially viable. With the hospital earning Rs 30,000 a month selling fertilizer the monthly cost of disposing of other waste has been considerably reduced. Even though the hospital is yet to recover the handling cost for waste management, officials believe that good recycling and responsible waste management will pay for itself in the future.

During its initial phase the program was implemented in 20 wards and the hospital aims to cover the remaining wards in the next six months. The hospital staffs are pleased with the success of Hospital Waste Management Program and believe that it has boosted their confidence and made them more committed.

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