Shivam Saini: Unhealthy silence

Little is known about the number of healthcare waste collection personnel in India and the job-related hazards to which they are exposed

Rummaging through a waste bin one day, Raju, a 38-year-old sanitation worker in a leading government hospital in New Delhi, felt a twinge in his ankle. On a closer look, unease gave way to panic. Raju had accidentally pricked his ankle on a used syringe that had fallen out of the bin. As he hobbled into the emergency ward, Raju was directed to the out-patient department (OPD). “The OPD was overflowing with patients. I couldn’t wait that long. The syringe could be infected. When nothing seemed to work, I covered the wound with a strip of cloth and left. Later, a friend told me that I should use a matchstick to disinfect my wound,” says Raju, who did act on his friend’s advice.

 

Raju is not alone. Hired by healthcare facilities all over India to collect, segregate and dispose of waste and carry out cleaning jobs, these sanitation workers, often employed by private manpower outsourcing firms, are exposed to a myriad of potential health risks.

Notable dangers include blood-borne pathogens such as Hepatitis B virus, Hepatitis C virus and HIV, biological hazards, potential chemical and drug exposures, respiratory problems, ergonomic hazards from lifting and repetitive tasks, laser hazards and risks associated with radioactive material from laboratories.

Of these, bloodborne pathogens pose a distinctive risk — so much so that the Occupational Safety and Health Administration of the US Department of Labour includes it in one of the top 10 most accessed general industry standards, requiring employers to protect workers who are occupationally exposed to blood.

According to the Central Pollution Control Board’s latest data (2009-10), as much as 405,701.9 kg of biomedical waste is generated in 129,511 healthcare facilities in India every day. Little is, however, known about the number of healthcare waste collection personnel and the job-related hazards to which they are exposed. The Central Bureau of Health Intelligence, the nodal agency for collecting human resources data in the healthcare sector, doesn’t provide any data on the number of sanitation workers employed at hospitals.

“You will hardly find any substantial data on occupational diseases and incidents of injury and accidents in hospitals. The country has yet to recognise the existence of occupational hazards in this sector,” says Dr Tushar Kant Joshi, Director, Occupational and Environmental Programme, at the Centre of Occupational and Environmental Health (COEH) at Maulana Azad Medical College, New Delhi. Set up in 1998, COEH has trained some 12,000 health care workers so far.

“The healthcare profession is now recognised in the West as a high-risk occupation since many doctors, nurses, technicians and even ordinary healthcare workers have been shown at risk from hazardous chemical use and dangerous infections such as AIDS, physical violence, stress, burnout and other risks,” Joshi adds. But in India, where healthcare facilities are still trying to get their waste disposal mechanisms right, the occupational health and safety of workers is less of a priority for many hospitals.

“Many hospitals now have biomedical waste management committees, but few have infection control committees. These workers are not even considered to be at risk. I have actually met a hospital waste handler who had gone deaf from a needle stick injury,” says Dr Iqbal Malik, founder of the not-for-profit organisation Vatavaran. Last year the organisation conducted a study on the waste collection methods in three leading hospitals in New Delhi — All India Institute of Medical Sciences, Sir Ganga Ram Hospital and Holy Family Hospital.

According to a World Health Organisation document titled “Health and safety practices for healthcare personnel and waste workers”, the workers collecting and handling healthcare waste require helmets, face masks, safety goggles, overalls (coveralls), industrial aprons, leg protectors or industrial boots and heavy-duty gloves. In India, although sanitation workers at hospitals may be seen wearing gloves and masks, goggles and gumboots are a rare sight.

But healthcare facilities alone are not to blame. “There is an absence of a comprehensive legislation to ensure the healthcare personnel’s occupational health and safety in India. So these employees fall off the law’s radar,” says Ravi Agarwal, Director, Toxics Link, a Delhi-based non-government organisation.

The lack of a concrete legal structure is conspicuous. The garbage generated in healthcare facilities is divided into 10 categories under the Biomedical Waste (Management and Handling) Rules, 1998, which are notified by the Ministry of Environment and Forests (MoEF) and are covered under the Environment (Protection) Act, 1986. The problem is that infection control is a health aspect.

“Due to the dichotomy in the rules, effective and safe management of healthcare waste remains deficient. Rules have been promulgated by the MoEF whereas implementation is by the hospitals which functionally are under health departments/ministries,” noted a delegation at the Indian Society of Healthcare Waste Management Conference 2010, held in collaboration with the Delhi government’s Department of Health. The labour ministry’s role is limited to the safety of workers at factories (The Factories Act, 1948), mines (The Mines Act, 1952) and docks [The Dock Workers (Safety, Health and Welfare) Act, 1986].

India has much to learn from the West in giving its healthcare workers due attention. In 1970, the US implemented the Occupational Safety and Health Act (OSHA). Thirty years later, in a far-off land, a large number of workers still await occupational protection. “I have never had the time or money to run around seeking treatment for an injury I suffered on the job. We have other worries,” says Raju.

Legislation even remotely close to OSHA would go a long way in helping many Rajus secure the right to a healthy and safe workplace. So how about an OSHA for India?