The responsible institutions accept the disposal of hospital waste to the public garbage containers. The environmental associations publicize the alarming report that denounces the chaotic situation of the hospital waste by requesting to get measures. There are publicized photos and videos that show the disposal of the hospital waste in and out of the bins in the public spaces.
By Sonila Mesareja
The hospital waste thrown here and there has turned out into a “timer bomb” for the health of the citizens. Even though there exist some companies licensed from the National Environmental Agency, which are contracted from the state hospitals and private ones to get and treat the waste in the established incinerators, the reality is disappointing, and even more chaotic. The hospital waste is easily identified to be disposed in the garbage bins that are located in each street and even worse in places where even the disposal of the urban waste is not allowed not to mentioned the hospital waste which is strictly forbidden.
During a survey in situ, and as the citizens denounce, near to the premises of the University Hospital Centre “Mother Teresa” (QSUT) are found different hospital waste thrown out of the bins, that are mainly syringes, plastic gloves or other materials that are used by the medical staff. But such hospital materials that are used during the medical treatment of the patients are not only found near to QSUT, but in other areas where there are private clinics or hospital premises. Based on the fact that the state hospitals, but also the private ones have signed contracts with the companies for the treatment of this waste, the survey of investigim.al started from the biggest hospital in the country “Mother Teresa”, where have also been identified big amounts of hospital waste thrown here and there.
The QSUT Directorate did not give any official reply to the flagrant case, to which the sources verbally said that this is a sporadic case. But even through the verbal reaction stated from this directorate there has been accepted the disposal of the hospital waste into the garbage bins, where they express that they have also taken some measures for their personnel. Nevertheless, they accept that even their personnel have done mistakes and the materials could have been thrown away by them, but they do not hesitate to charge the mistake to the others, i.e. to the private hospitals. “We have a very good incinerator to recycle this waste. The case that you have is a sporadic case, where there is irresponsibility from the side of the personnel to whom we have also taken administrative measures”, admitted the representatives of the QSUT Directorate. Furthermore, in the reaction for the investigim.al, the representatives of QSUT raise the accusations towards the private hospitals that are located near them. Official sources from QSUT after accepting that their personnel has thrown the hospital waste several times to the garbage bins , they also say that another problem remain to be even the private hospitals which throw their waste to the QSUT’s garbage bins.
After that, from the side of the QSUT directorate has come a request to the investigim.al to put at their disposal the photos taken, in order to get some measures towards such actions that bring a lot of consequences to the lives of the citizens, which also aggravate the health of the patients that are under treatment to the Hospital Centre “Mother Tereza”. Related to this concern, investigim.al requested a reaction even from the Public Health Institute (ISHP), but they responded by directing us to another directorate. After contacting the director of the Directorate we were oriented to as being the responsible institution that deals with the monitoring of the hospital waste management, even this director answered to investigim.al that it is not them that deal with the waste but another directorate. In this way, in the impossibility to give any answer to the concerning phenomenon of dumping the hospital waste here and there from our hospitals being either public or private ones, the directorates turned the responsible authority on reacting towards such situations into a ping pong game.
Hospital waste dumped near to the QSUT in Tirana
Investigim.al contacted the Ministry of Environment to get a reaction related to the management standards of the hospital waste in our country and especially in Tirana. Through an official reaction this institution expressed that:”On regard to the management standards of the hospital waste, the legal requirements and standards must match with the requirements of the law ‘On the integrated waste management’ and with the common instruction between the Ministry of Environment and the Ministry of Health. The national standards are in accordance with the best European and international standards. Furthermore, in the reaction of the Ministry of Environment it is explained that “the responsibility for the implementation of these standards is to the institutions that generate the waste, such as the public and private hospitals and the hospital centres that offer their services in this sector. From the data that the Ministry of Environment has, there operate several licensed subjects for the management of the hospital waste. Nevertheless, the legal responsibility for their management in compliance with the national standards falls to the subjects that generate such waste, i.e. the public and private hospitals and health centres”.
The Ministry of Environment makes it known that actually, on the frame of the promotion of the private investment in the field of integrated waste management, there has been offered another new opportunity on the treatment of the hospital waste that is the incinerator of the waste in Elbasan. According to the Ministry of Environment, this incinerator offers the possibility and the managing infrastructure for the treatment of the hospital waste for all Albania. The Ministry of Environment put at our disposal even the data on the performed audits on situ from the Environment Inspectorate. According to the official sources of this institution, from the audits and the so far verifications done on situ from the Environment Inspectorate, it results that there is still a lot to be done either from the public institutions or the private ones. “The Ministry of Environment will follow with a high priority and will monitor and report in progress the standards and the way of management of this waste”, concludes its official reaction the Ministry of Environment. Currently, from the National Agency of Environment have been licensed 10 subjects that are categorized as units for the treatment of the hospital waste. Among them, 6 include state and private hospitals and 4 private companies.
The environmental organizations have monitored in situ the situation on the treatment of the hospital waste coming to the conclusion that from the state institutions there must be a continuous monitoring out of the signing of the contract between the hospitals and companies that had to deal with the treatment of the hospital waste. Through a report that has become public sometimes ago, “The network for the Environment Vigilance: ‘An eye for the environment”, has made public the findings on the field, concretely in five cities of the country and the recommendations for the state institutions that have to monitor this process. “Come to my neighbourhood near to the Military Hospital and raise your voice for the hospital waste that is dumped everywhere into the bins. The dogs of the neighbourhood spread it. We see blood, used syringes, organs, amputations etc. We are afraid of getting any infections and we cannot let free our children. It is terrible!”, this was the denouncement done by a woman during an environmental activity that put into motion a group of environmental associations to identify in the field the whole problem.
Hospital waste dumped into public spaces
From the monitoring in situ, the environmental associations came to the conclusion that none of the licensed private companies was supplied with the proper infrastructure/technology for the treatment of the pharmaceutical waste, which raises the doubt about them if this waste is currently treated in our country and if yes, then the process is performed by companies which do not act based on the legal requirements. In the 78 subjects that generate hospital waste, and contacted by the environmental organizations resulted that out of the total only 53 of them were equipped with an environmental permission and 21 do not possess this document. This is thought to be a considerable number (about 27%) as there results that 21 subjects have broken the legal obligation to be supplied with an environmental permission according to the Decision of the Council of Ministers No. 798, date 29.09.2010, for the approval of the regulation “For the administration of the hospital waste”, even though 68 of them answered that they were aware about the legal obligations they had to fulfil.
The most concerning was the answer given from these subjects on the management of the hospital waste. “When discussing about the ways of the hospital waste management, the interviewees told about the diverse ways they ‘manage’ the waste they produce. Only 25 of the subjects manage the waste by contracting a third party such as the private companies for the treatment of their hospital waste. The majority of them, 50 subjects (64%, as 4% have not given any answer), choose other ways out of the legal obligations for their administration such as the dumping in the public waste bins, burning, burying or depositing them within a specified deadline”, it is mentioned in the report of the Network of Vigilance, which has been officially sent from the environmental organizations to the two respective ministries, the Ministry of Health and to the Ministry of Environment.
Nevertheless, the upcoming problems do not end. These subjects have shown even the time when they have signed the contracts with the companies for the treatment of the hospital waste, at a time that there were subjects that expressed that it is not necessary for them to have such a contract as they do not produce much waste and what they produce is dumped into the public garbage containers. “A big number of subjects (18) do not prefer to give the reasons why they do not have a contract, but 10 of them tell that they do not produce a lot of waste and as a result of this they do not judge it as being consistent to sign a contract with a company. This is a very evasive answer if we analyze what does it mean to have a lot of waste especially when you consider the fact that the majority of these subjects do not have any register on the generated waste”, it is further mentioned in the report. The subjects also accept that one of the strongest reasons is that they do not have this information, but they also do not feel on having any obligation to sing any contract, as no one is respecting the law and they do not want to be among them that pay. The case “the commune deals with their management” represents a health centre in Rrethina commune in Shkodra, where it is declared that the hospital waste, divided from the urban ones, is collected by the commune, but the subject was not aware what was the commune doing with it.
In the report is written that among 25 subjects that manage the hospital waste with a private company, the first contracting has started in 2004 and the majority of them have signed a contract in 2011 and 2012. “This fact brings us to guess on having a historic precedence in the treatment of the hospital waste, but also shows us that in 2012 two of the subjects have signed their first contract in 2012 at a time that they had started work before 2011. Out of 25 subjects, 19 have signed a contract with ‘MediTel’ l.t.d, which makes this company the best service supplier on the treatment of the hospital waste. The subject that declares that it is connected with the hospital for the management of the waste, represents a health centre in Vlora which follows all the rules and policies of the hospital on the treatment of this waste” it is mentioned in the report on the hospital waste.
What does the hospital waste cause if thrown here and there? Referring to the report of the “Network of Vigilance”, WHO assesses that in 2000, the injections with contaminated syringes caused the infection to 21 million people with the virus of Hepatitis B (HBV), 2 million infections of the Hepatitis C and 260,000 infected with AIDS around the world. Many of these infections could have been avoid if the syringes had been eliminated in a safe way. Furthermore, the infectious and anatomic waste represent the majority of the dangerous waste, it is up to 15% of the total of the waste generated from the health care activities. The syringes and needles represent about 1% of the total of the waste, but they are a main source on the transmission of the disease if they are not properly managed. The chemical and pharmaceutical substances constitute 3% of the waste generated from the health care activities and 1% from the radioactive substances on the total of the health care waste.
The health care waste contains potentially dangerous microorganisms, which may infect the patients in the hospital, the workers of the health sector and the wide public. Other possible infectious risks may include the spread of the chemical substances resistant to the environment and burning as well; contamination and pollution through the sewage waters; contamination and pollution from the toxic elements or their compounds, such as mercury or dioxin that are released into the air during the process of the elimination of the waste. In the countries under development, additional risks come from the feeding of the cattle with the garbage in the dumping sites and from the manual classification of the dangerous waste from the health care centres. Out of the total generated waste from the health care activities about 80% of it is a general waste and 20% is considered to be a dangerous material that can be infectious, toxic and radioactive.
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