Ironical as it may seem, India has been struggling to master the simple colour coding even 10 years after it was first devised to hygienically manage hospital waste. Hospitals and nursing homes across India have not yet learnt that discarded medicines go into black plastic bags, body parts into yellow and laboratory waste into red bags. As a result, bio-medical waste management is poor in India, says Ravi Agarwal from Toxics Link, a New Delhi-based NGO that has been working on sensitising municipalities and the medical fraternity to this issue for over a decade.

Dumping grounds with specialized machinery to treat hospital waste have to deal with nonsegregated mass— plastics, biological waste and bandages all go into incinerators and release extra doses of deadly dioxin pollutants into the air. In fact, a report of the Central Pollution Control Board prepared by the Indian Institute of Management, Lucknow last year revealed that more than 50 per cent of medical waste is left untreated. In 2007, the Comptroller and Auditor General found that only half the states were monitoring implementation of the Bio-Medical Waste (Management & Handling) Rules, 1989.

The CPCB-IIM report said that “of the 420,461 kg per day of waste generation, only 240,682 kg is treated’’ . It added that the rest of this highly contaminated waste probably got dumped with regular municipal waste. Last month, the Maharashtra Pollution Control Board issued notices to 72 hospitals and nursing homes in Mumbai for not segregating waste. In contrast, accreditation agencies in the United States grade hospitals on their bio-medical waste management, punishing errant hospitals. Not surprisingly, many hospitals in the US and the UK have their own autoclaving plants, which are expensive but effective.

Not so in India. Delhi, which is the other leading mass producer of medical waste, has its own set of problems. Close to 8,600 kg of bio-medical waste is generated everyday. With more hospitals and nursing homes coming up in the Capital, waste generation is expected to touch 10,000 kg in the next few years. But, at present, there are only three over-loaded bio-medical waste treatment facilities in Delhi. A new facility is coming up at Nilothi. The biggest challenge before the Delhi Pollution Control Committee (DPCC), responsible for monitoring disposal of bio-medical waste, is to make all healthcare facilities comply with rules regarding waste management.

Though all healthcare establishments are expected to register with DPCC, experts say small hospitals and clinics routinely break the rules. There are close to 1,800 healthcare facilities registered with DPCC, excluding small clinics. Then there’s the other problem — treatment plant operators expect to be paid to process biomedical wastes and healthcare establishments, in Delhi and outside, are loathe to do so. “As they don’t want to pay, a lot of them give less biomedical waste to the treatment plant than they generate.

They often throw a good portion of it along with municipal waste,’’ says a senior doctor in charge of waste management at a Delhi government hospital. Clearly, thrift scores over safety and ethics. The Capital has 17 incinerators, 19 autoclaves and three microwaves where hospital waste is disposed of. Sadly, none of it adds up to a solution, as health activists allege. In fact, nationally, it is thanks to their hectic lobbying that the Bio-Medical Waste (Management and Handling) Rules, 1989, came into force. They had built a strong case for the Act, pointing out and proving that many rag pickers had contracted terminal diseases such as HIV by merely handling biomedical toxic waste. According to the rules, the state pollution control boards should monitor implementation of the Act even as healthcare institutions should tie up with various service providers to transport and dispose of the waste.

Initially, awareness about the Act was zilch, resulting in very few healthcare institutes registering themselves with various PCBs and fewer still signing up with the service providers. Dr Rohini Kelkar of Tata Memorial Hospital says, “Most hospitals are at the mercy of facility providers (transporters of waste or incinerator operators) who have a monopoly and charge a huge sum for their service. Thankfully, we have our own autoclave facility.” Pollution is another concern. Says Mumbai-based cardiologist Sandip Rane, who has been fighting against an incinerator facility that has come up near his home, “These plants are meant to get segregated waste, but they are fed both dry as well as solid waste.

This releases toxins in the air.” If there is a silver lining to the dark, pestilential cloud of med-waste accumulating across the country, it is not visible. (WITH REPORTS FROM RISHA CHITLANGIA) In the bin Across India, more than 4.2 lakh kg of bio-medical waste is generated every day Only 2.4 lakh kg of this waste is scientifically treated India has 84,809 hospitals and healthcare facilities, but only 48,183 use either common bio-medical waste treatment facilities or engage private agencies to treat their waste There are 391 incinerators, 2,562 autoclaves, 458 microwaves, 145 hydroclaves and 6,047 shredders *Data from the CPCB survey prepared by IIM-Lucknow Mumbai has around 1,354 private, 293 municipal and 12 government hospitals that generate about 10 tonnes of bio-medical refuse every day Delhi, with 1,800 healthcare institutes, generates close to 8.6 tonnes daily