FEATURE

As per the Indian Demographic Profile (2013) there are 0.9 beds available per 1000 of the country’s population. That leaves me to wonder that besides those individuals who end up as inpatients in acute medical cases, there must be a substantial number that takes medicines at home for recovery; a huge lot that gets into accidents but is not admitted and perhaps an increasingly growing figure of those who do not suffer from illnesses that require hospitalization but need to be administered medicines at home. What happens to the biomedical material once used, in these cases? More importantly, what ‘should’ happen to this material once used? Since medical waste generated at home is not regulated as per the gazette definition of biomedical waste (Biomedical Waste Management and Handling Rules, 1998), this problem becomes severely acute.

The harmful effects of needle stick injuries leading to diseases like AIDS and Hepatitis, occupational hazards to waste haulers, children, recycling workers or animals and contamination of natural resources due to the infectious nature of biomedical waste, is all well documented now and has been for over a decade. However, unlike some of the developed nations where established collection routes (either through local pharmacist, hospitals and in some cases mail back services) exist, India still lags behind in formulating rules of domestic biomedical waste management. So what is the need of the hour in this context? Perhaps, beginning with a definition? For instance, would you classify the carcass of a dead pet as biomedical waste just the same as a needle used for administering insulin; what is a the urine soiled bed sheet of a sick family member; what are expired medicines that cannot be used anymore or X- Ray films that are old; is a used condom, razor blade or pregnancy and sugar test strips biomedical waste; and what happens to sanitary pads contaminated with human blood; what is mercury from a broken sphygmomanometer or thermometer? Where does this waste go and again where should it go? Surprisingly, there is nothing that any of our gazette rules on biomedical waste say about this.

Domestic medical waste not only causes serious health hazards but when added to the 800-1100 grams of unregulated infectious medical waste that is generated in hospitals per bed per day in India and coupled with lack of adequate segregation practices at home, it assumes the character of a grim administrative malady. It is well established that urban India is on a massive waste disposal crisis. With migration and change within urban populace in terms consumption and lifestyle, a need for community engagement is rapidly developing for driving the point of waste segregation at source, home. In December 2012, an initiation in this regard was observed in Bangalore, however, no follow up studies are available to ascertain implementation levels.

More recently, lack of any rules pertaining to household biomedical waste management in the country have been brought to light by the state of apathetic waste disposal in cities across Uttar Pradesh. This again points out to the crucial significance of increasing efforts right now to bring about policy shifts in regard to management of biomedical waste generated at domestic levels.

The problem of domestic biomedical waste management is not just urban in nature as is exemplified by the fact that diabetes affects more of rural India than urban cities! Also per the Indian Diabetes Federation, there is an increase of 2 million diabetics per year in India. Studies have shown that prevalence of Hepatitis C in India amongst individuals who inject drugs ranges from 33 per cent to 95 per cent, both in populous and remote areas. As per the Indian Council of Medical research, there are 2.4 million individuals in India infected with HIV. What do these established facts scream? India is projected to become world’s most populous country by 2030 and faces important challenges and opportunities in the sphere of public health. One such challenge facing the country is management of household biomedical waste. Therefore, it becomes imperative to step back and assess the scope and magnitude of this problem to nip I tin the bud.

May be it is time now to at least begin with conceptualizing that domestic biomedical waste is an ignored malady in India, a potential cause of spreading infections, co-infections and full blown diseases to lead on to a blanket guideline to inform care takers at home about how to handle and dispose biomedical waste. But would that lead to successful accomplishment of safe management in absence of any collection routes for this kind of waste and how can such systems be fully functional in lack of integrated step by step layout for segregation, treatment and disposal on part of each and every stakeholder? Perhaps it is time to shout out to policy makers for a safer home environment rid of diseases – perhaps it is time take a first step ourselves, now.

By :Anubhuti Sharma