Masum A. Patwary

Quantitative assessment of medical waste generation in the capital city of Bangladesh

There is a concern that mismanagement of medical waste in developing countries may be a significant risk factor for disease transmission. Quantitative estimation of medical waste generation is needed to estimate the potential risk and as a basis for any waste management plan. Dhaka City, the capital of Bangladesh, is an example of a major city in a developing country where there has been no rigorous estimation of medical waste generation based upon a thorough scientific study. These estimates were obtained by stringent weighing of waste in a carefully chosen, representative, sample of HCEs, including non-residential diagnostic centres. This study used a statistically designed sampling of waste generation in a broad range of Health Care Establishments (HCEs) to indicate that the amount of waste produced in Dhaka can be estimated to be 37+/-5 ton per day. The proportion of this waste that would be classified as hazardous waste by World Health Organisation (WHO) guidelines was found to be approximately 21%. The amount of waste, and the proportion of hazardous waste, was found to vary significantly with the size and type of HCE.

An illicit economy: scavenging and recycling of medical waste.

This paper discusses a significant illicit economy, including black and grey aspects, associated with medical waste scavenging and recycling in a megacity, considering hazards to the specific group involved in scavenging as well as hazards to the general population of city dwellers. Data were collected in Dhaka, Bangladesh, using a variety of techniques based on formal representative sampling for fixed populations (such as recycling operatives) and adaptive sampling for roaming populations (such as scavengers). Extremely hazardous items (including date expired medicines, used syringes, knives, blades and saline bags) were scavenged, repackaged and resold to the community. Some HCE employees were also observed to sell hazardous items directly to scavengers, and both employees and scavengers were observed to supply contaminated items to an informal plastics recycling industry. This trade was made possible by the absence of segregation, secure storage and proper disposal of medical waste. Corruption, a lack of accountability and individual responsibility were also found to be contributors. In most cases the individuals involved with these activities did not understand the risks. Although motivation was often for personal gain or in support of substance abuse, participants sometimes felt that they were providing a useful service to the community.

The motivations of young people moving into medical waste scavenging as a street career

This paper discusses the impact of sociocultural exclusion influences and biographical disruptions on adolescents moving into street involvement associated with hazardous medical waste scavenging. Data were collected in Dhaka, Bangladesh, using a variety of qualitative techniques, including adaptive sampling for roaming populations. Observation distinguished a distinct group of people (‘medical waste scavengers’) who were involved in unauthorised scavenging and reselling of medical waste. This trade is linked to homelessness, sexual abuse and drug use. These individuals have given accounts of underprivileged family backgrounds, exclusion due to ethnicity or caste, and of horrific experiences through early childhood and adolescence. From this difficult position, they have demonstrated flexibility and resilience to develop the street competence required to survive by specialising in scavenging extremely hazardous items to be repackaged and resold to the community.

Social Ostracism and Criminality among Medical Waste Workers in Bangladesh: Neurobiological Aspects

Background: Complex relationships exist between socio -economic inequality, social stratification, drug addiction, and criminality in society. A great deal is now known regarding the neurobiology underlying behaviours such as drug addiction and criminality. Most sociological and psychological theories of why such behaviours and phenomena exist have been constructed based on observations made in Western cultures. The unique social, economic, and cultural characteristics of the developing world, and in particular South A sia, have not typically been taken into account. Medical waste workers are a particularly marginalized population in this region, and are uniquely vulnerable to becoming engaged in these behaviours which are harmful to them and to society. OriginalResearch Article