Sagar*, a 39-year-old pourakarmika (civic worker) in Bengaluru’s Rajaji Nagar’s was pricked by a needle one morning in March this year when he was transferring waste discarded on the side of the road on to the auto tipper. Sagard's finger began bleeding and when he looked inside the garbage bags, he found three used syringes, one of which had pierced Sagar’s finger. “This is not the first time I have picked up used syringes or blades,” Sagar says. Fortunately for Sagar, he did not contract any disease or illness due to the illegal disposal of biomedical waste. Just like Sagar, Tara*, a 52-year-old pourakarmika from Mahadevapura says that she too has sustained minor injuries due to the cuts from surgical blades and needles. “There are some clinics in the area I work and sometimes, they give me waste bags to dispose for a small fee. Sometimes if the bags are big, they give Rs 100. If the bags are small, they give me Rs 50. But these days I have been saying no to disposing their waste as I learnt recently that its illegal,” she says. Officials of Bengaluru’s civic body, the Bruhat Bengaluru Mahanagara Palike (BBMP) maintain that they have never heard of a case where a pourakarmika has fallen ill or succumbed to illness as they come into contact with biomedical waste. “See, there are cases where pourakarmikas fall sick and we have been monitoring their health but there is no way we can say conclusively that they fell sick because they come in contact with the biomedical waste as there have never been any formal complaints lodged by the pourakarmikas,” says Hemalatha, health officer at BBMP, who conducts medical exams for pourakarmikas. The lack of data, however, does not discount the fact that not just Bengaluru but the entire state of Karnataka is facing a problem of illegal biomedical waste disposal. Speaking to TNM, Appaji, a member of the BBMP Contract Pourakarmika Union alleged that the BBMP officials and the health department “are not bothered about the health of pourakarmikas”. “Syringes, Intravenous (IV) sets, blades and these things are seen commonly in municipal waste bags. The thing is, these bags are kept outside on the roads in the mornings and the auto tippers or pourakarmikas end up picking it up without realising what is happening. The health department of BBMP does not check up on these clinics. And when we complain about this problem, the pourakarmikas are transferred to work in another ward. This is not right. It’s us pourakarmikas who end up facing the consequences,” Appaji says. What the rules say Biomedical waste is any waste generated during the process of diagnosis and treatment of humans or animals from hospitals, veterinary hospitals, clinics, research institutes, chemists, diagnostic centres etc. Biomedical waste is highly toxic and has the risk of causing injuries or infections during handling and disposal. A major part of biomedical waste includes used needles, scalpel blades, anatomical body parts, blood samples, contaminated body fluids, dressings and IV lines. The Ministry of Environment, Forest and Climate Change brought in the Biomedical Waste (Management and Handling) Rules on 27 July 1998, under the Environment Protection Act 1986. This was after the Supreme Court judgement in the case of Dr BL Wadhera v Union of India, where the court had issued directions to the Municipal Corporation of Delhi regarding scientific disposal of waste. The rules were amended in 2016 and later in 2018 and 2019. The Pollution Control Board of each state are responsible for implementing these rules. Under these rules, healthcare establishments must categorise and dispose of biomedical waste into different couloured bags to identify the type of waste. Yellow for waste meant for incineration. This includes pathological waste. Syringes, IV sets, catheters, gloves etc must be put into the red bag. Needles, surgical blades, scalpels and syringes must be disposed in the white bag and broken glass and metals used in healthcare establishments goes into the blue bag. Once the waste is categorised, the health care establishments must give it to the Common Biomedical Waste Treatment Facilities (CMBWTFs), where they will have to be disposed in designated hazardous landfills. According to the Biomedical Waste Management Rules 2019, those persons held responsible for violating the norms can be jailed for a term of five years or be imposed up on, a fine of Rs 1 lakh or both. Speaking to TNM, Ramprasad, an environmental activist, says that inefficient management of bio medical waste can create public health risks to sanitation workers, health workers, waste handlers, and the general public. “Bio medical waste contains used syringes, IV bags, needles, scalpels and items used in hospitals on patients who are suffering from some kind of illness. If this waste is not disposed properly, it can lead to contamination of air, water and soil. Because it is a potential breeding ground for vector-borne diseases and if civic workers who come into contact with it they may contract dangerous diseases,” Ramprasad says. According to Chief Medical Officer of the BBMP, Dr Vijayendra, inadequate bio medical waste management can cause growth and multiplication of disease-bearing insects, rodents and worms. “This may lead to transmission of diseases like typhoid, cholera, hepatitis and AIDS if people come into contact with used syringes and needles contaminated with human blood,” he says. Dr Vijayendra says that the used syringes can be misused as some miscreants collect such waste and recycle it. “Miscreants collect syringes, sterilise it and resell it. This is dangerous and can spread diseases,” he said. The reality Karnataka is the second highest producer of biomedical waste in the country and produces 65,621 kg of biomedical waste per day, according to the Karnataka Pollution Control Board (KPCB). Although Karnataka is the only state to have 26 CBMWTFs, there are glaring gaps in the implementation of the methods of waste disposal. In March this year, a diagnostic centre in Bengaluru’s Rajaji Nagar was fined Rs 1 lakh for dumping biomedical waste into BBMP auto tippers. Focus Diagnostics was fined after a video of the waste being dumped into auto tipper went viral. According to the KSPCB, which monitors the disposal of biomedical waste, a large quantity of it gets mixed with municipal waste and is currently ending up in landfills. This is reflected in the data from KSPCB. In 2014, of the 27,211 registered health care establishments in the state, KSPCB recorded that 29,974 tonnes of biomedical waste was generated that year. This number fell drastically to 18,818 tonnes in 2015. This, officials say, is because a large chunk of the waste that was generated that year ended up getting mixed with municipal waste. In Bengaluru, KSPCB’s environmental officers allege that the biomedical waste from smaller clinics and diagnostic centres is ending up in the Mitaganahalli landfill. As on August 2019, there were 35,869 healthcare establishments in Karnataka and 9,055 of them are operating without licenses, as per figures from KSPCB. A large chunk of these healthcare establishments includes small clinics and currently, there are 20,139 of them in Karnataka. “When it comes to unscientific and illegal disposal of biomedical waste, it is the diagnostic centres, veterinary hospitals and small clinics that are violating the norms. The larger hospitals have been giving their waste to the CBMWTFs regularly,” said Dr A Ramesh, Chief Environment Officer of the KSPCB. In 2019, 5,427 healthcare establishments were allegedly not disposing the waste properly, says the KSPCB. The number increased drastically from 2018, where, 4,066 establishments were found violating the norms. In 2016, 1,416 establishments were violating the norms but this drastic increase within a span of three years is alarming, Dr Ramesh noted. The KSPCB issued closure notices to these establishments. However, after receiving assurances from these establishments that the waste would be disposed of according to the norms, KSPCB imposed a fine of Rs 1 lakh and allowed the establishments to continue their operations on the assurance that they would handover the bio medical waste to designated CBMWTFs. “With the new rules since 2016, it became mandatory for all healthcare establishments to furnish copies of the contracts they have made with the CBMWTFs. Without this, they will not be given trade licenses. Those who do not have trade licenses also continue to flout norms,” said Dr Vijayendra, Chief Health Officer of BBMP. Government hospitals are violators too The Comptroller and Auditor General’s report on biomedical waste disposal, which was released in December 2018, shows that out of the 36 government district hospitals in Karnataka, 21 of them were not disposing biomedical waste as per norms and 19 out of 34 government veterinary hospitals were not disposing the waste properly. Senior officials with the KSPCB say that these hospitals still continue to flout norms. “These hospitals have entered into agreements with the CBMWTFs registered in the area but these facilities were located at places away from urban limits. In Ballari and Bagalkote, government hospitals are disposing biomedical waste in landfills that contain municipal waste,” the official said. In eight districts, the biomedical waste was being burned in municipal waste landfills, the CAG report noted. “It is evident from the above observations that compliance to BMW Rules was weak in test-checked ULBs (Urban Local Bodies), which would not only affect public health but also lead to contamination of environment,” the CAG report states. Speaking to TNM, Member Secretary of the KSPCB says that there is no provision to penalise biomedical waste generators who do not dispose the waste properly. Besides levying fines, there are no provisions to take action against these establishments, with FIRs rarely ever filed in such cases. And despite closure notices being issued, violators continue to operate after paying the fine amount, say officials. Activists also point out that a concerted effort is required from other bodies including the BBMP to tackle the issue. “The KSPCB can only issue show cause notices to establishments violating the norms. The BBMP or the local municipal bodies must conduct regular inspection of these healthcare establishments. But that is not happening, which is why a lot of them are violating norms. Generally, the healthcare establishments have to pay the CBMWTFs for disposing the waste. In order to bypass this charge, they end up dumping the waste along with municipal waste,” alleges Ramprasad, convenor of Friends of Lakes. Lack of adequate monitoring Dr Srinivas, the District Health Officer (Health and Family Welfare), Bengaluru Urban, says that the health department does not have a system to monitor the healthcare establishments and identify whether they are violating the norms. The Karnataka Health Department does not have a system to monitor the violators and completely rely on documents furnished by healthcare establishments regarding the disposal of biomedical waste. “We don’t have any officer who conduct raids or anyone to monitor the smaller clinics and diagnostic centres. Before we issue licenses to healthcare establishments, they have to furnish copies of the contracts signed along with the CBMWTFs. Only then do we issue licences. We rely on local municipal bodies to monitor and issue notices. Once the KSPCB issues closure notices, it is communicated to us and we cancel licences after probing the matter,” Dr Srinivas added. However, officials with the Department of Health and Family Welfare said that the local municipal bodies like the BBMP only conduct raids at healthcare establishments when locals report suspicious activity. The health officials with the local municipalities are supposed to conduct random checks every month to determine whether healthcare establishments are adhering to the biomedical waste disposal norms. “Even if we take the most recent case in Rajajinagar too, the raids happened only because the media reported it. The BBMP Health Department is supposed to conduct checks and monitor these healthcare establishments but that has not been effective at all. It's because of this that civic workers end up getting hurt,” the official added. However, BBMP officials maintained that they conduct raids only when they receive complaints and that the KSPCB is the agency, which has to monitor biomedical waste disposal by healthcare establishments. “KSPCB is the monitoring agency. We conduct raids when we receive complaints but constant monitoring is not in our purview,” a BBMP official said. KSPCB officials placed the blame on the BBMP’s shoulders by stating that the agency issues closure notices and imposes fines on violators only when the BBMP or local municipal bodies intimate them of such violations. “Local municipalities have more manpower and they have separate health departments. These officials must conduct regular checks and report it to us. Our job is only to take action,” Dr Ramesh added.
