After more than a week of trying to coordinate a visit to the new hospital site, we were sitting in the office of Miguel, the resident engineer, discussing the hospital’s plan for its medical waste. The hospital is technically referred to as a “capsi”, a facility that is somewhere between a clinic and a hospital based on its size. The capsi is located at the point of entry into the Carti region and takes approximately 20 minutes to reach from the four program islands. As Miguel rummaged through his desk and pulled out the floor plans for the hospital, we recounted the disappointing discussion we had with the Ministry of Health regarding the capsi’s waste management plan.
After months of attempting to schedule a call with someone from the Ministry of Health, we were finally able to get an official on the phone to discuss the medical waste plan for the new facility the day before we left for Panama. He told me that there was no current plan for the final disposal of medical waste. The project went over its 12 million dollar budget and there was no funding left for a waste management plan. Within the capsi, all waste would be separated, recombined, and dumped into the same mangrove that the four program islands are currently using, further exacerbating the problem we were trying to solve.
Along with many residents of the islands, a small health center on the island of Suitup also dump their waste to the mangrove, where they douse it with gasoline and light it on fire with the hope that the heat will sterilize the hazardous waste and melt the sharps. However, as the fire is not controlled, there is no way to ensure that the heat reaches the temperature needed to sterilize the waste nor is there a way to be certain that all the waste has been burned. This current strategy is not only dangerous for janitors that handle the waste, but the fire also releases hazardous pollutants into the atmosphere and anyone who enters the mangrove faces the risk of bumping into this toxic waste.
Image by Laura Stilwell
Although I was disappointed, it did not surprise me that a 12 million dollar project would not prioritize a plan to handle their medical waste. The research that I have conducted on the issue of medical waste over the past several months has made me realize that for many health systems, the creation of a plan for medical waste is often only an afterthought. Yet, medical waste poses a significant threat to the health of populations. According to a 2002 report by the World Health Organization (WHO), injections with contaminated syringes that were not properly disposed off led to 32 percent of all new hepatitis B infections and 40 percent of all new hepatitis C infections.
I knew we could not accept the capsi’s strategy as a given. I set my main goal for the trip to meet with the resident engineer of the hospital to first confirm the information that we had received from the Ministry of Health and then work with him to figure out what were some possible alternative solutions that required little funding or could be implemented in a few years.
Image by Poncie Rutsch
After we finished informing him about our call with the Ministry of Health, we were surprised to hear him say that there actually was a plan for the medical waste. In the capsi, they were going to separate the waste into hazardous and non-hazardous streams and everything was going to be stored in a cold room until it was taken to Panama City. In the city, the hazardous waste would be properly incinerated and the non-hazardous waste would be taken to the dump site. Seeing this as an opportunity, we instantly asked if he thought that perhaps in exchange for use of the project’s vertedero to dispose of the capsi’s non-hazardous waste, the hospital would take the hazardous waste from the health center on Suitup along with them to Panama City. Therefore, the waste from the health center on Suitup could also be properly disposed of. The buy-in for this was critical as there is little money in the project’s budget to tackle the issue of final disposal of the medical waste. Immediately, Miguel nodded and agreed to the idea. I was ecstatic. Finally, after months of trying to figure out how best to dispose of the hazardous waste and what would be the cheapest and most viable option, the pieces fell seemingly into place.
Post by Laura Stilwell