Sometime last year, a strong smell of rotting flesh started to emanate from the waste dumping area of the Bir Hospital. Workers from Metrocity Waste Management, which collects Bir Hospital’s general waste, started to sift through the garbage. Metrocity Waste Management collects non-risk general waste from hospitals, clinics, medical shops, medical laboratories and households. They soon found the source of the smell—an amputated leg. This was the second time in a year that workers had found a body part in the general waste.

The hospital staff apologised, said Laxmi Shrestha, managing director of Metrocity Waste Management, but Shrestha, disturbed by what they had found, refused to go back for two days. When she returned, the company signed a contract with Bir Hospital that clearly states that if her workers find any pathological or risk-waste such as a human body party during collection or segregation of general waste, the hospital will have to pay a fine to Metrocity Waste Management.

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Although most of Kathmandu’s medical institutions have adopted basic waste management methods like reducing, reusing, recycling and recovering healthcare waste, many are still failing to maintain waste disposal standards for hazardous waste due to lack of knowledge and resources, putting both workers and the environment at risk.

At Bir Hospital, all pathological waste, including amputated body parts and fluids, are disposed of in a 20-foot pit on land owned by the National Trauma Centre, said Sarita Shrestha, housekeeping department in-charge and waste coordinator at Bir Hospital. Amputated body parts, organs, tissues and blood are brought to the pit in buckets and dumped in.

“We dump a layer of salt followed by a layer of soil,” said Sarita. “I know that this isn’t the proper way of disposing of the pathological waste but since the Health Care Foundation has not objected, we’ve been continuing with this procedure.”

The amputated leg that waste disposal workers found probably came from outside the hospital, said Sarita.

[Read: Managing biomedical waste is imperative]

“We have people guarding the hospital’s dumping area but it isn’t possible for them to notice every single disposal or monitor the people passing by,” Sarita told the Post. “Someone may have thrown those body parts as there are many hospitals and clinics in this area where pathological waste is produced. Maybe it was an attempt to tarnish the hospital’s reputation.”

Before the 2015 earthquake, all biodegradable waste from the hospital was used in a biogas plant built with the technical support of the Health Care Foundation (HECAF) Nepal, a non-governmental organisation that works to provide healthcare and waste management training services across Nepal.

“We used the gas generated from the biogas plant to light gas stoves and cook food,” said Sarita. “It was completely safe but after the 2015 earthquake, due to construction of new buildings nearby, the biogas plant had to be destroyed.”

Mahesh Nakarmi, HECAF director, said that they had supported Bir Hospital with the biogas plant but did not approve of the pit dumping.

“This pit dumping system is a traditional method used to get rid of biodegradable waste but it isn’t the ideal method,” said Nakarmi. “In the long term, it can lead to underground water contamination, which can be very dangerous.”

The pit is also employed by the National Trauma Centre, but even its nursing administrator agreed that the pit wasn’t the best method as it isn’t environmentally safe.

“We haven’t figured out the proper way to dispose of liquid waste either,” said Suchana Sapkota, hospital nursing administrator at the National Trauma Centre. “Such waste must be treated before disposal but we haven’t been able to do so.”

Body parts and bodily fluids are non-recyclable medical waste and they can be dangerous when disposed of improperly. Such waste is generally contaminated with disease and pathogens, which can spread to waste collectors and the general public if disposed of incorrectly.

Recyclable waste, on the other hand, consists of saline bottles, syringes, masks, cotton, gauze and gloves. While this kind of waste is also classified as risk-waste, it is sorted at source into different categories and sterilised with the help of an autoclave machine, which gets rid of all the bacteria with high-temperature steam and converts risk-waste into non-risk waste. This non-risk waste is sold in bulk to recycling companies like RN Suppliers.

“We collect and sell non-risk recyclable hospital waste to factories in Nepal where the waste is turned into smaller fragments,” said Rajesh Neupane, managing director of RN Suppliers. “Since there aren’t any factories that convert recyclable wastes into new salable products, 50 percent of waste fragments are loaded into trucks and sold in India where factories turn them into things like keyrings, egg crates, cups, brooms and craftwork.”

RN Suppliers collects recyclable healthcare waste from the Tilganga Institute of Ophthalmology, Patan Hospital, Madhyapur Hospital, Valley Maternity Hospital, and B&B Hospital, among others.

“We put the hospital waste through the autoclave procedure which strips the waste of bacteria and protects our workers from getting infected,” said Neupane. “Every hospital, clinic and medical lab has to sterilise medical risk-waste before submitting it to any waste collector as such waste contains glass and needles. They need to be separated before submission.”

Tilganga, Bir, National Trauma Centre and Teaching Hospital all have colour-coded bins in every room with stickers that contains both written and visual instructions explaining where specific waste should be disposed of. Light blue is for plastic waste, black for biodegradable waste, green for paper, and red bins for risk-waste. These hospitals also have a separate waste segregation area where non-recyclable risk waste is disposed of and an autoclave machine sterilises recyclable risk waste.

The proper way to get rid of non-recyclable hospital waste like body parts and fluids is a biogas plant, according to Nakarmi.

“All hospitals that generate pathological waste should consider building a biogas plant as it is a one-time investment which is not only environment-friendly but also durable and lasts for years,” he said. “One gram of contaminated waste can contaminate the entire bulk. The waste collected by collectors and the waste in the landfill are all 100 percent contaminated because some labs, clinics and hospitals don’t autoclave healthcare waste.”

As Nakarmi points out, numerous clinics and hospitals don’t take enough care while disposing of hazardous waste, as the severed leg at Bir Hospital showed. Sometimes, the solids that remain after draining the biopsy fluid from formalin are dumped into garbage containers outside the hospital in small quantities, said Sarita, Bir Hospital’s housekeeping in-charge.

Oftentimes, waste collectors find hospital waste tied up in plastic bags like household waste. Workers only find out what’s inside when they open the bags for the first time.

“Two months ago, our workers found syringes in garbage bags that came from the Baneshwor area. Our workers always wear protective clothing like thick gloves, masks, boots and aprons while segregating waste. So thankfully no one was hurt,” said Laxmi Shrestha who, in addition to Metrocity Waste Management, is also the managing director of Action Waste, another company that collects recyclable hospital waste along with general waste. “We tried to investigate and find out where the needles came from. But as there are many clinics, hospitals and labs along the Baneshwor route, we couldn't hold anyone responsible and had to pay a fine.”

The fine for mixing risk waste with general waste ranges from Rs5,000 to Rs100,000, depending on the quantity, type and whether or not the waste has gone through the autoclave procedure, according to Hari Kumar Shrestha, chief of the Environment Management Department at Kathmandu Metropolitan City.

Following the discovery of the needles, Action Waste refused to collect any waste for two weeks. They only resumed after Shrestha sent a letter to all hospitals, clinics and labs informing them of the fine they would have to pay if her workers found any risk waste mixed with general waste again.

“Just because our workers spend their day collecting and segregating garbage doesn't mean they don’t have a life outside the landfill,” said Shrestha. “People tend to forget how risky this job is.”