Mercury, one of the most toxic natural elements, is found in sources such as rock formations and volcanoes. Over the past century, anthropogenic sources of mercury have increased dramatically. Many researches estimate that the amount of mercury entering the environment has increased manifold due to a wide variety of human activities, ranging from coal-burning power plants and waste incinerators to common consumer products that contain mercury such as thermometers, electronic goods and dental amalgams. Mercury is a global contaminant and transports over long distances and is even found in the Artic ice though the closest sources are thousands of miles away.

Mercury poisoning has an adverse effect on the human nervous system and other body systems. Mercury is a neurotoxin, meaning it affects the nervous system. The ‘mad hatters’ of the 19th century suffered from mercury poisoning, which caused personality changes, nervousness, trembling and even dementia. The hatters were exposed to mercury in the felting process of hats, where mercury was rubbed onto cloth as a preservative. 

It was theorized that the Hatter in Lewis Carrol’s Alice’s Adventures in Wonderland was ‘mad’ as a result of mercury poisoning. Between 1932 and 1968, a petrochemical and plastic manufacturing unit in a small fishing village in Japan dumped 750 kg of mercury compounds every year into the Minamata Bay, which by mid-1950s caused a decline in the fish population, while symptoms of blurred vision, numbness in limbs and speech impairment emerged in people who consumed the fish. Most victims complained of severe convulsions, loss of consciousness, repeated lapses into crazed mental states and they finally slipped into coma. By 1992, the Minamata tragedy had affected 2,200 people of which over 1,000 died. Since then, mercury in the environment has been a focus of attention all across the globe especially for its health and environment risks.

Mercury is signifi cantly associated with the healthcare industry. It is mostly found in healthcare products in its elemental or liquid form. It is used in thermometers, blood pressure cuffs, esophageal dilators and dental amalgams.Nurses and other medical staff work with mercury-based products on a routine basis and are in danger of inhaling toxic vapour when breakages or leakages occur. Mercury free alternatives are available for almost all the products. Many countries across the world have shifted to mercury free alternatives and have proper mercury management policies. 

Toxics Link fi rst took up the issue of ‘Mercury in Health Care’ in 2004. Through research and advocacy the mercury hazard was revealed and various positive movements have taken place in the past fi ve years of campaign. The city of Delhi woke up to the danger of mercury toxicity when a report released in 2004 showed that an Mercury Movement in India average sized hospital could release, conservatively, around 3 kgs of elemental mercury in the environment in a year. With very conservative estimates, a city like Delhi would be releasing around 51 kgs of mercury each year through dental practices alone. The city’s total release would come from hospitals, dental clinics, crematoriums and laboratories. The problem is compounded as mercury generating sources are scattered and non-regulated. Since there are no laws and guidelines governing the release of mercury, no one seems accountable.

Viable alternatives exist for most mercury usage, yet, mercury use continues in the country without any regulation. The use of mercury-free products is a cost effective choice, when the direct and indirect costs of the products are considered although on the basis of purchase price alone, the cost of mercury-free equipment is generally higher than mercury-based products. There was an urgent need to bring in policy for a gradual shift from mercury equipment to safer alternatives. More so, an awareness drive was needed amongst the healthcare institutes which could pledge to do away with mercury proactively without any compulsions from the government.

Both of the above happened, the Delhi government and the hospitals started dialogue on this heavy metal. Some big, private hospitals in Delhi decided to shift from mercury days after the report was released. The government started to put out public notices in the newspapers to sensitise the healthcare community and within the span of four years there were public notices, office orders, guidelines and directives and the journey continues. Delhi has taken up the move to use mercury free products in a big way and hopes that others would join hands to make the nation mercury free.

This document tries to present the efforts and initiatives taken so far by some people fighting against this lurking menace in Health Care Settings. A lot has happened after a small report was released. This report was an attempt to amplify the phenomenon and encourage more states to take up the cause of ‘mercury-free healthcare’. To be mercury-free might be a voluntary decision for a few more years, but as environmental laws and quality accreditations become stricter this might be a mandatory requirement soon. Thus it is time for all of us to do some introspection and start changing. The experiences of people who have changed have been documented in the report and a small chronicle of what has happened on the mercury front has been profi led to help people in their journey to go ‘mercury free’.

Government Initiatives

Department of Health and Family Welfare, Government of NCT of Delhi 

After all the reports on mercury, including the one on usage, breakage and disposal patterns (2004) and the one on presence of mercury in ambient air(2007), revealed the mercury poisoning taking place through the healthcare industry, Toxics Link called upon the Department of Health and Family Welfare to take action. The Department was very proactive and forthcoming and arranged a meeting with all the stakeholders. This meeting led to the formation of a ‘Mercury Phase-Out Committee’, to look into the use and reduction possibilities of this heavy metal in healthcare. The committee plans to expand its scope with time. The health department has asked all the healthcare facilities to budget for mercury free alternatives in the next fi scal year. Any breakage needs to be managed properly by staff and requisite training should be provided to them. Broken or new instrument requirements (thermometer/sphygmomanometer) need to be replaced with digital/aneroid products.

Department of Environment, Delhi Government

The Delhi Pollution Control Committee (DPCC) has been very proactive in addressing new issues emerging with medical waste management. Subsequent to the report released by Toxics Link (2004) and subsequent campaign and awareness drives, the Department of Environment issued its fi rst public notice, warning the hospitals about the hazards of mercury and its safe management and recycling. This was the fi rst public acknowledgement by any pollution control board on the hazards of mercury. The Department of Environment also played an important role in pursuing the issue of mercury in the health care sector. In May 2008, in a public notice, it clearly stated that usage of mercury is problematic and the hospitals should initiate steps to stop its use. All hospitals are required to provide a template on its commitment to minimise/ eliminate mercury containing waste, and this declaration needs to be signed and placed at prominent locations in the institute. Moreover, this has to be treated as a condition for seeking authorization. The declaration also asks hospitals to adopt the safe mercury handling standard international procedures to collect and store split mercury in suitable containers without affecting occupational health or the environment.

Centre for Occupation and Environmental Health (COEH)

The centre is located at the Maulana Azad Medical College and is headed by Dr. T.K. Joshi. Dr. Joshi specialises in Occupational Medicine and thus handles most of the work done by the Delhi health department on this issue. The Centre and Dr. Joshi presented various data on the hazards of mercury and dangers to health care staff from the occupational health perspective. This has created an immediate necessity for taking action on the issue of mercury in health care. The centre has trained nearly 10,000 health personnel in Delhi and the effort continues. COEH has conducted health assessments for healthcare workers in the Delhi government hospitals to assess occupational exposure to mercury.