Re-use of unsterilised syringes and needles - often scavenged from dumpsites - causes an estimated eight to 16 million new hepatitis B infections annually around the world, according to the World Health Organisation (WHO).

The results of a WHO assessment conducted in 22 developing countries further revealed that the proportion of health-care facilities that do not use proper waste disposal methods ranges from 18% to 64%.

Shocking revelations published in the Sunday Times of 29 November uncovered extensive illegal dumping of medical waste in South Africa, allegedly perpetrated by a waste management company which has multimillion-rand contracts with state and private hospitals, to dispose of medical waste safely and according to the law.

Grocott’s Mail has reported incidences of illegal dumping of medical waste in Grahamstown as recently as August this year.

Medical waste is defined as waste generated by health care activities and includes a broad range of materials, from used needles and syringes to soiled dressings, body parts, blood, chemicals, pharmaceuticals, medical devices and radioactive materials.

Untreated medical waste poses serious health risks, beyond the obvious risks of infection and injury to those in its vicinity. Leached pharmaceuticals and chemicals contaminate groundwater. Harmful bacteria such as hepatitis B and C form spores which can become airborne and travel. Rats, flies, fleas and birds feed on waste and transmit infections such as drug-resistant TB, and other infectious diseases to humans in areas remote from dumping sites.

The medical waste management policy of South Africa’s Department of Water and Environmental Affairs (DWEA) stipulates that “All medical waste must be incinerated for at least 1 second at 800 °C in an incinerator with a valid licence in terms of the Atmospheric Pollution Prevention Act, 1965 (Act 45 of 1965), which has available capacity.” View the policy document.

According to the Sunday Times there are only six such operating incinerators in South Africa, where about 42 000 tons of medical waste is generated each year and an estimated 800 tons illegally dumped.

Building more incinerators is, however, not the answer. Incineration has health and environmental costs of its own. Combustion of wastes, - especially polyvinylchloride (PVC) plastics such as blood and drip bags, catheters and drawsheets - generates noxious emission of several toxins, notably dangerous dioxins, furans and polychlorinated biphenyls (PCBs) which cause cancer and attack immunity.

These toxins are released into the air that we breathe and, through bioaccumulation in the food chain, contaminate the food we eat. The ash residue from indiscriminate incineration, which is sent to landfills, contains pollutants such as arsenic, mercury, lead and cadmium that can leach into the water we drink.

In addition, incineration is expensive, which disincentivises responsible waste management and encourages dumping by unscrupulous organisations, as evidenced by recent reports.

Are we damned if we do and damned if we don’t? Not necessarily. To fulfil the medical ethic of “first, do no harm” we need to re-examine our waste management practices. While the generation of medical waste is unavoidable, it can be reduced and it does not all have to be burnt. There are alternatives to incineration for certain types of medical waste, which make it possible, legal and non-harmful - to both people and planet - to render this waste safe.

Not only are these alternative methods more beneficial for health and environment, but they also cut costs considerably. It remains essential to incinerate anatomical, chemical, and pharmaceutical waste but infectious materials such as sharps, syringes, and blood-soaked material can be treated by two other emerging techniques, namely autoclaving (steam sterilisation, used for surgical instruments) or microwaving. After sterilisation, this waste may be compacted and taken to a general landfill site. While still less than ideal, this is an improvement over incineration.

The key to financially and environmentally sound management of medical waste is correct sorting at its point of origin. Careful waste segregation and handling significantly reduces the burden of incineration, relieving pressure on the few existing legal incinerators in South Africa and potentially saving millions of rands as well as reducing harmful emissions.

DWEA’s waste management policy makes allowance for other methods of waste treatment than incineration, but these have been poorly explored in South Africa, partly due to a lack of diligence in sorting. Alternative methods of waste treatment enables small organisations to treat portions of their waste on-site, reducing the amount of waste that has to be outsourced and trucked – generating further emissions - to available incinerators for disposal.

There is no reason why Grahamstown could not take up a role in these methods of waste management. The majority of our healthcare services have contracts with waste management companies from out-of-town, who fetch their waste and truck it away. We could reduce the amount of this waste and potentially keep both money and jobs in Grahamstown by conscientious sorting of waste and the building and responsible operating of dedicated autoclaves or microwave ovens which meet all legal, health and environmental requirements.