Medical Waste Circulates without Control

Medical waste from healthcare facilities is not managed in a serious and comprehensive manner, resulting in it circulating widely without control despite the dangers it poses to the environment and public health.

KOMPAS/PRADIPTA PANDU MUSTIKA

Piles of medical waste are seen in Panguragan, Cirebon, West Java, on Saturday (23/11/2019). The medical waste is leftovers of a case that has not be resolved by the Environment and Forestry Ministry.

BANDUNG, KOMPAS – In line with Health Ministerial Regulation No. 7/2019, all medical waste is categorized as hazardous to health and the environment. Medical waste management is done safely and in a closed system by waste producers and licensed third parties, as stipulated by regulations. The waste must not leak into the environment.

A Kompas investigation in November and December 2019 found that it was relatively easy to procure medical waste from trash scavengers and at recycling centers. Several types of medical waste, such as used IV bottles, are commonly sought after by plastic recycling businesses. An illegal medical waste processing center in Cirebon, West Java, which was shut down by the police, is still in operation today.

In its investigation on an illegal medical waste distribution center in Bandung, West Bandung, Cirebon and Tangerang, Kompas found leaks in the medical waste distribution mechanism, which should be a closed system of waste producers and licensed waste managers.

An illegal medical waste processing center in Cirebon, West Java.

Medical waste at Bandung’s Hasan Sadikin Hospital (RSHS), which has implemented a strict medical waste management system, still finds its way to the public. Used IV tubes from the hospital are commonly sold at waste recycling locations.

In Cirebon, locals are still managing an illegal medical waste processing center, which was already shut down in 2017 due to a lack of monitoring. Piles of medical waste in the illegal processing center reached 2 meters high across an area of 100 square meters.

In Tangerang, Banten, used IV tubes are sought after as they are low-density polyethylene (LDPE), which is commonly used in the making of plastic chairs, LPG canister lids and 5-gallon plastic water jug lids. Recycled IV tubes are cheaper than brand new LDPE plastics.

KOMPAS/PRADIPTA PANDU MUSTIKA

Container trucks and mini trucks owned by PT Tenang Jaya Sejahtera (TJS) are seen at the pool of PT TJS, in Karawang, West Java, on Sunday (17/11/2019). The fleet was used by PT TJS to collect medical waste from a number of health service facilities to be destroyed.

Mixed with needles

Ros, the owner of a plastic recycling center that also processes used IV tubes in Tangerang, said that she procured the used IV tubes from a recycling site in Bandung and a hospital in North Jakarta. In her storage, Ros has whole and chopped-up used IV tubes.

Her piles of used IV tubes reaches almost 1 meter high. All the IV tubes are empty. Upon arriving from the hospital, Ros said, the used IV tubes were already separated from the hose. In some shipments, however, the tubes are still mixed in with needles.

To prevent the needles from causing harm, Ros puts them in a can labeled “needles” before throwing them away. “It’s safer. Sometimes, a trash scavenger comes by and takes the cans,” she said.

Used IV tubes are among the types of medical waste that most easily leak into the environment. In Bandung, Kompas procured 15 kilograms of whole used IV tubes for Rp 142,500 (US$10.30). The used IV tubes were procured from plastic waste chopper Wiji.

We have proof, such as manifests and certificates.

Kompas learnt of Wiji’s business from trash scavengers in Sarimukti Landfill in West Bandung regency. Wiji packs used IV tubes in a huge sack. When opened, the sack was found to contain around 100 used IV tubes. Some of them still have RSHS labels.

RSHS cooperates with licensed medical waste processor PT Jasa Medivest. When Kompas showed RSHS environment health installation head Maudy Dirgahayu Hussein photos of the hospital’s used IV tubes at Wiji’s place, she said medical waste from the hospital should not have made its way to a public landfill.

“We have proof, such as manifests and certificates, that we process our waste legally. Every time our vendor takes our waste, there is a manifest,” she said.

KOMPAS/SATRIO PANGARSO WISANGGENI

Officers weigh medical waste before being put into the incinerator of PT Tenang Jaya Sejahtera on Friday (13/12/2019) in Karawang, West Java. The weighing process is needed to measure the amount of waste that will be put into the incinerator. The capacity of the incinerator is 300 kilograms per hour.

Jasa Medivest corporate secretary Manti Afiandi said further investigation would be required to find out how used IV tubes with RSHS labels could circulate at a recycling center, as the hospital was responsible for waste sorting.

Manti explained that Jasa Medivest immediately destroyed all received waste as it was not allowed to sort the waste. “During transporting, we are not allowed to open the [medical waste] containers. All we know is that everything is in the containers, we transport it to the processing center, we process it and we incinerate it into ash,” Manti said.

Based on information from waste scavengers in Bandung, used IV tubes can also be procured from a hospital in Lembang, West Bandung regency. In an investigation of Lembang General Hospital’s medical waste processing, Kompas found used medicine bottles and bandages burnt with leftover food.

Hospital employee AD explained that some medical waste in the hospital was incinerated as not all of it is transported by Jasa Medivest. The transported waste is in line with the quota established in the contract between the hospital and Jasa Medivest. To prevent the waste from exceeding the quota, the waste is sorted. “Needles are destroyed by Medivest. It is infectious waste. Some of the used IV tubes are taken by trash scavengers,” AD said.

KOMPAS/SATRIO PANGARSO WISANGGENI

Handoko (left), a janitor at Fatmawati Hospital, waits as Fredy Yulianto, the medical waste supervisor at Fatmawati Hospital, inputs data on Monday (16/12/2019) in Jakarta. Every janitor receives incentives for their participation in sorting out hospital waste.

Traceable

Illegal medical waste management in Pangurangan Kulon village, Cirebon regency, is taken care of by Nurcholis. Previously, a military officer and several locals, including Agus and Nasikhin, processed the medical waste. After the scheme was shut down in 2017, the military officer and two civilians were arrested and jailed.

Environment and Forestry Ministry environment pollution investigation sub-directorate head Anton Sardjanto said medical waste leakage could be traced to companies in cooperation with hospitals for waste transport. “Transporting [of medical waste by third parties] is the crucial point,” he said.

Regarding the medical waste finding in Cirebon, Anton said the prosecutor’s office had requested the ministry take care of it. He said a ministry lab check of the soil under piles of medical waste found bacterial infection, including by anthrax-causing bacteria.