Editorial | Managing medical waste

The question is: What happens to the rest of the stuff – the remaining 160,000 tonnes of medical waste Jamaica produces each year?

That is a lot of material. It does not just evaporate in thin air. So, it must be disposed of somehow.

But how and where were not appropriately answered by the island’s health authorities, including the health minister, Christopher Tufton, this week. Neither does Dr Tufton’s characterisation of the matter as “thorny” and “complex”, and one that pre-existed his, or this administration’s, tenure substitute for clarity.

For the immediate issue is that Jamaica faces a potentially grave public health risk, to which those in charge have been slow to respond. In the event, notwithstanding the specific agency that may be responsible for regulating the waste management sector, it is the health ministry’s business to know, or at least have a very good sense of where every kilogramme of medical waste ends up, and how it gets there. That obligation is compounded by the fact that it is its facilities, public hospitals and clinics that produce the bulk of the waste material.

Concerns over how Jamaica deals with its healthcare waste has been reignited by the discovery in Hartlands, St Catherine, of a crude, and seemingly unregulated, or, at best, very poorly supervised, medical waste incinerator.

Residents complained of acrid smoke from the facility – apparently contained in a shipping container – that triggers, or exacerbates, respiratory illnesses.

When reporters from this newspaper visited the facility, access was unrestricted. The facility has no perimeter fence and, at the time, no noticeable security.

But worse was what they found. In large ash-filled drums, as well as strewn around the place, were glass vials and partially burnt packing for medicines and pharmaceuticals. Who knows what they did not see and was not detectable with the naked eye.

NOT TO BE TAKEN LIGHTLY

If this was an incinerator authorised and regulated by the National Environment and Planning Agency (NEPA) – which did not immediately respond to The Gleaner’s questions on the subject – neither Dr Tufton nor his director of health promotion and protection, Dr Simone Spence, seemed to know. They, at least, should have been aware, if it was not. It is in their interest to know.

Although Jamaica accounts for a small proportion, medical waste can be nasty.

Globally, an estimated 4.7-billion tonnes of the stuff is generated annually, of which Jamaica, based on the estimate of Christopher Burgess (his CEAC Outsourcing company operates an incinerator in St James, in the island’s northwest), contributes 400,000 tonnes, or 0.0085 per cent of the total. Only 15 per cent of healthcare waste is generally considered hazardous, in the sense of being infectious, toxic or radioactive.

That amount ought not to be taken lightly. A small proportion of a big number is still large. In Jamaica’s case, it is approximately 60,000 tonnes.

There are risks that waste of this kind poses if improperly handled or disposed of. Indeed, as residents of Hartlands fear, chemicals from such waste could leach into and contaminate aquifers and other water sources. Or, someone pricked or cut by a ‘sharp’ – things like needles and scalpels, which account for around four per cent of medical waste – could contract, and spread, a disease.

The Government operates a medical waste incinerator next door to the Kingston Public Hospital (KPH) in west Kingston. That facility, however, is overburdened and is technologically outdated.

According to CEAC’s Mr Burgess, the Government’s plant handles around 120,000 tonnes of waste. His company disposes a similar amount. How the rest is dealt with is not clear. It is probably safe to assume that a good portion of it goes to facilities like the one at Hartlands.

WHERE DR TUFTON SHOULD START

Dr Tufton is right that the problem of managing medical waste did not start with the current administration. Nearly a quarter of a century ago, the discovery of an informal landfill of pharmaceuticals in Black River, St Elizabeth, set off a similar outcry. Contraceptive jellies, birth-control tablets, dextrose and other drugs, including Valium, were found at that Black River dump. The discovery spurred a policy document a few years later on the handling of healthcare waste. There were also calls for the updating and streamlining of regulatory legislation.

More recently, there has been talk and additional policy drafting to address continued weaknesses. But it does not appear that really fixing the problem has been a priority.

“I am concerned that the management of our medical waste is very challenging, and that over the years the toxic waste has had to be stored,” Dr Tufton said last week. He said he asked his technocrats to explore shipping waste abroad.

We should probably wish the minister the best of luck in this effort to offshore Jamaica’s waste. But ensuring the development of modern healthcare waste facilities in the island, with environmentally friendly incinerators and autoclaves, is perhaps where he should start.

Dr Tufton has been the health minister since 2016, more than seven years, which is past the time for reminding people what problems he inherited.