I’ve spent a lot of time over the last month with my mind in the gutter. And I mean this literally: I’ve spent an extraordinary amount of time worried about trash.
Part of this is because Dhaka does have a huge waste problem: the city generates over 4,000 tons of waste per day according to one study and only 37% of this is collected.
The rest is not hard to find, making its way into streets, rivers, lakes, and fields. The collection system itself — from what little I have seen — is a fairly filthy and unhealthy looking process, consisting of rickshaws which carry waste to sorters who, ungloved and in bare feet, organize trash into piles of organic and recyclable materials.
However, my current obsession is with only a fraction of this refuse: medical waste. And this because the work I am currently doing creates some small amount of this waste. Searching for zoonotic viruses involves taking samples — be it blood or spinal fluid or a number of others — from very sick people. And the needles, tubing, and vials get added to the pile of medical waste.
And this all becomes more concerning because safe disposal and handling of medical waste in Bangladesh has been largely overlooked. In a 2003 article on medical waste in Dhaka, the BBC reported that the city produced 200 tons of medical waste per day, much of that dumped onto the street. A more recent study suggested similar oversights: needles and tubing dumped into bins with regular trash, reports of body parts dumped on the streets, and liquid and solid wastes containing hazardous materials dumped into drains and garbage heaps. Needles and tubing indiscriminately dumped are salvaged, often by women and children, then resold, and likely then reused.
As far as I know, there are no studies predicting how many people contract infectious diseases by coming into contact with medical materials on the street. Nor is there any data that I can find putting a number on the proportion of hospital equipment being reused after being scavenged from garbage dumps. But there is certainly risk — be it of HIV or the hepatitis viruses or other diseases — spreading from used needles and contaminated medical equipment.
All of this means that in hospitals where we work searching for new pathogens, many of which are in less developed areas, we need to be especially careful that waste is handled properly. Although we don’t necessarily know how these diseases spread, we need to assume that exposures to contaminated equipment is a bad thing, perhaps even deadly. We don’t want children pricking themselves on needles used to draw samples from our patients as they resell them in a market or tubing with retained bodily fluids being reused in the hospital.
And so my obsession — driven partly by fear of infectious diseases that we know nothing about — leads me to stay up late into the night planning on ways to sterilize waste and get it to a place where it can safely be destroyed. Needles and tubing will be collected, sterilized, and stored in the field in jugs containing disinfectant at concentrations mixed specifically to kill pathogens. Every few weeks these jugs will be transported back to Dhaka where they can be incinerated. We ensure that hospitals have all of the supplies that are required to clean workspaces and handle samples appropriately, and if these are lacking they must be bought, supplied, and staff trained in their use.
Thankfully, given the public health risks of dumping of medical waste, things may improve on a national level. There are growing attempts to develop systems to handle waste properly and at least one NGO is working to dispose of materials at certain locations. And while this is certainly a move in the right direction, I’m not convinced that these attempts are widespread or reach rural and less well supplied and funded hospitals.
Until functioning systems are in place to assure the proper disposal of infectious medical waste everywhere, I assume that my obsession will continue and I will spend at least a little time with my mind in the gutter.