A meeting was held at St. Stephens Hospital in April, as an experience sharing exercise between medical professionals and Dr. Ingrid Ackerman from Swedish Doctors for the Environment coalition, on the issue of mercury management and reduction in hospitals.
Since the issue of mercury as a occupational hazard is critical to the safety of medical staff, the meeting was focused primarily on perceptual and procedural challenges faced by medical staff in shifting to and sustaining mercury alternatives.
The ball was set rolling by Dr. Ann Mathew from St. Stephens Hospital. She welcomed participants, who included representatives from some of the largest hospitals in Delhi.
Dr. Mathew made a detailed presentation on the hospitalís mercury management and replacement initiative that has been under implementation for close to five years now. Stephenís is among Delhiís oldest hospitals and is currently a 700-bed facility and had initiated its mercury management programme in 2002, with training assistance from Toxics Link.
Some salient aspects shared by Dr. Mathew were:
1. Engaging the nursing and maintenance staff in safe handling and reduction of mercury-based equipment has been successful, as it wasnít imposed through an administrative intervention only but through awareness campaigns and informed training. The hospital has close to a thousand medical staff and most of them have been involved in the exercise in one way or the other.
2. The hospital has managed to make the neo-natal section of the hospital healthcare a zero mercury area. Mercury based thermometers and blood pressure measuring instruments were targeted as medical products for replacement.
3. One of the greatest hurdles that the hospital has to contend with is that of calibration and reliability of these equipments.
4. The hospital has achieved great success in replacement of thermometers and as per the figures provided by her in 2002 over 600 mercury-based were in use and the figure has now dropped to zero at present.
5. The introduction and current maintenance of digital thermometer has been difficult. According to Dr Mathew, the greatest challenge has been pilferage of digital thermometers, which is compounded by its higher cost. She said the rate at which these are lost is much higher than was the case with mercury ones. For a government facility, such losses add up to large volume and hence higher costs.
6. A critical issue raised by her was of the hospitalís experience with mercury-based blood pressure measuring instruments or sphygmomanometers. The hospitalís engagement with digital alternative to this equipment has had only a limited success, as the issue of calibration has not been resolved satisfactorily.
7. Stating that the issue of calibration needed to be resolved, she said the problem of accuracy might be specific to the brands that were being used.
The presentation was followed by sharing of everyday experience by a representative from the nursing staff.
The visiting guest Dr. Ingrid Ackerman from Swedish Doctors for the Environment, made a broad presentation on how the whole issue of healthcare products, ranging from instruments to pharmaceuticals, needs to be looked at in terms of the environmental and chemical hazard that it causes. She cited instances from her home country to highlight her claims.
On the issue of mercury in hospitals, she reacted to the issue of accuracy and made two broad observation:
1. The skills and training levels of the medical staff in using and monitoring readings from the mercury-based instruments. She said that those who use this instrument should be familiar with the correct way of using it, and also know how to protect it from damage.
2. She also stated that the issue of accuracy has been completely addressed in Swiss medical institution and healthcare facilities. There is a very long list of examples of its successful implementation of zero-mercury environment health facilities. This means that it is possible.
3. She also agreed with Dr. Mathew on the issue of calibration and good brands with more reliable standardisation.
Following this presentation, Dr Joshi made a broad presentation on mercury in healthcare by detailing through a PowerPoint presentation how mercury poses a threat in such settings and stressed that an ultimate resolution of this threat would be possible through legislative intervention.
All these presentations were accompanied by interactions involving participants from leading hospitals in the National Capital. The underlying theme that emerged from the discussion was the need for professionals to create a peer group network that not only allows dissemination of information on mercury management and replacement, but also facilitates demonstrable examples in day-to-day scenarios.
All the participants concurred on the need for similar interaction on thrashing out the issue of accuracy and cost-effectiveness that poses a challenge in eliminating mercury from healthcare settings.