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PARAGUAY: Hospitals – Generating Health or Pollution?

David Vargas

ASUNCIÓN, Aug 1 2007 (IPS) - A thousand inflated transparent plastic bags labelled "Pathological Garbage" cover the floor of one of the exhibition rooms at the Juan de Salazar Cultural Centre in the Paraguayan capital.

The bags form part of artist William Paats’ Asepsia (asepsis) exhibit, which is aimed at drawing attention to the serious problem of hospital waste disposal in this South American country.

The exhibit opened in early July, a year after the government’s declaration of a health emergency when the two obsolete incinerators that disposed of the waste generated by the city’s public hospitals were closed down.

That coincided with the Asunción city government’s decision to cancel the contract with the Sudamericana company, which was in charge of collecting and incinerating the waste from private hospitals in the capital, after authorities found that it was not complying with the requirements set by the local government.

Given the lack of other means of disposing of hospital waste, collection was suspended for nearly two months.

The hospitals in Asunción produce over 4,000 kg of pathological medical waste a day, according to the Health Ministry.

The accumulation of waste reached levels incompatible with minimal hygiene standards, to the point that scheduled surgical operations had to be cancelled for fear of the spread of hospital infections.

But the imaginary garbage dump created by the artist is not even remotely similar to the one that inspired his work and that opened a year ago in the community of Remansito, 15 km from Asunción, in western Paraguay.

The dump is located on five hectares provided by the Defence Ministry. The Sermat company, which was hired to incinerate the waste after the incinerators were shut down and Sudamericana’s contract was cancelled, transports to the site the more than four tons a day of waste produced by the hospitals in the metropolitan region.

The company has a single incinerator with the capacity to burn just 200 kg an hour. Four large pits have been built to store the excess waste.

The incinerator and the waste dump have been a constant source of concern for the people living in Remansito. When they found out that the waste would be trucked into their area, local residents created the Coordinating Committee for the Struggle for a Healthy Life, and organised a series of protests and roadblocks to keep the trucks out.

In August 2006, the Coordinating Committee filed a lawsuit against the company, but the complaint was thrown out. The appeal was also rejected by the Supreme Court, in June.

"Local people frequently fall ill, and they are afraid to fish, hunt or use the water from their ‘tajamares’," small irrigation ditches built to accumulate rainwater, Ignacio Cantero, the priest at the San Vicente de Paul church, told IPS.

"Pollution of the area is an imminent threat. When it rains, the company drains the water from the pits where the waste has been deposited, and the water goes into a channel that runs into the Paraguay River," he said.

One member of the Coordinating Committee, Benita Ramírez, even blamed Sermat for the death of a 19-year-old young man who lived in the area. The cause of death has not been clarified, and Ramírez suspects that he died as a result of pollution generated by the pathological waste.

"We believe he died of some infection caused by the garbage," she told IPS. "We hope they can prove that&#39s not true, but in the meantime we will continue to believe that José Ramírez was the first victim of this attack on our area."

The company issued a communiqué denying responsibility in the case.

Sermat also announced that a second, larger incinerator would be installed this month, to help keep up with the daily influx of waste and to gradually eliminate the accumulated garbage.

"We have been notified that an incinerator with the capacity to process 300 kg per hour has arrived," Víctor Jiménez, a waste management adviser with the Public Health Ministry’s department of health services, told IPS.

"That will give the plant a capacity of 500 kg per hour, which will practically cover demand, and the excess waste that is in the pits can also be incinerated," he said.

According to Sermat, there is currently around 600 tons of pathological waste buried on the plot loaned by the Defence Ministry.

Paraguay has one of the highest rates of production of waste per hospital bed in the region. The Public Health Ministry reports that an average of three kg per patient are generated, far above Argentina’s 800 grams and Brazil and Chile’s 900 grams.

The Public Health Ministry launched a programme last year to reduce that quantity by means of in situ separation of waste.

The department of health services is training health personnel to classify garbage by disposing of it in three different kinds of bags: black for general waste that requires no special treatment; yellow for uncontaminated plastics; and red for pathogenic waste.

"Management of hospital waste is a grave deficit that we face, but we are bringing our rules up-to-date," Carlos María Romero, the director of health services in the Public Health Ministry, told IPS.

Under a draft law that is in debate in Congress, management of hospital waste "would be the exclusive responsibility of the health centre that generates it, whether public or private," said Romero.

Health facilities that do not have the capacity to deal with their waste would be able to resort to the municipal and provincial sanitation services.

The hope is that approval of the law would lead to the granting of increased funds to public hospitals, to help them acquire incinerators or adopt other waste disposal methods.

The practice of incinerating waste is increasingly criticised by environmentalists and doctors because of the large quantities of gas, solid and liquid waste that the process generates, including extremely toxic substances like heavy metals and persistent organic pollutants.

Chile and Mexico have already eliminated the practice, not only because of the environmental problems it poses but also due to the high costs of treating the gases and other waste products generated by burning.

In Paraguay, however, the debate is just beginning.

The state social security institute’s central hospital announced that this month it would begin to use a new system, in which waste would be treated and sterilised with chlorine, ground up, and disposed of as general waste. But this is the only new treatment system for which there are testing plans in the country.

Another possible alternative would be the sterilisation of pathogenic waste using cobalt-60, a radioactive isotope.

However, Romero acknowledged that for now, incineration is the only possible option. "It’s worse for the waste to be in an open air dump. But over the next year, we have to change our methods and do whatever is possible to bring ourselves into line with the new tendencies," he said.

In the meantime, Paats’ exhibit, made up of over 1,000 plastic bags strewn over the floor of the white-walled room to recreate a garbage dump, is helping to make people aware of the risk and the need to do something about it.

"I called it Asepsia because this garbage supposedly comes from aseptic places, like hospitals, but which due to poor management actually end up hurting the environment instead," the artist explained to IPS.

"This is not a protest, but a wake-up call," he underlined.

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