DISPOSAL CHALLENGE Personal protective equipment, like these biohazard gear worn by workers during Friday鈥檚 Mine Safety and Environment Conference in Baguio City, go a long way toward keeping the human body safe from disease but they leave a huge plastic footprint and take a toll on the environment. 鈥擡V ESPIRITU
SINGAPORE 鈥� There鈥檚 a ticking time bomb in Philippine hospitals and it鈥檚 made of plastic.
Every year, the country produces 2.15 million tons of plastic waste, more than a third of which leaks into the open environment, while another third is thrown into landfills.
Only 345,000 tons of the nonbiodegradable material is kept in homes and less than half of that is recycled, according to Health Care Without Harm (HCWH), an international nonprofit with offices in Manila, Brussels, and Washington, D.C.
That problem became magnified in hospitals at the height of the COVID-19 pandemic, as doctors, nurses and other medical staff had to wear all manner of single-use plastics, from head covers and goggles to coveralls and shoe protectors.
Health protocols require that personal protective equipment (PPE) be discarded after each use. This led to truckloads of plastic for disposal at tremendous cost.
At St. Paul Hospital in Dasmari帽as City, Cavite province, an average of 219 kilograms of waste was produced every day鈥攁lmost three-fourths or 72 percent of that volume being plastics, according to Ramon San Pascual, HCWH executive director for Southeast Asia.
Multiply that by 1,800 鈥� the number of hospitals in the country 鈥� and one can imagine the enormity of the crisis and its impact on both public health and the environment.
But there are solutions.
Hospital interventions
On Nov. 9, San Pascual presented a number of interventions on the plastic problem facing health systems at the 7th World One Health Congress held at the Sands Expo and Convention Center in this city-state.
He centered his talk on four practical and doable actions that any hospital management could perform on its own:
The use of washable or customized reusable PPE with silver taffeta cloth; a COVID-19 waste audit, with proper segregation of PPE after their doffing and reprocessing; a digital waste registry, or intensified waste management with color-coded trash bins; and sustainable procurement, like one with a mechanism for the return of used plastics like dialyzers and dialysis tubings to their suppliers.
San Pascual said it wasn鈥檛 even his group that proposed these interventions.
Innovation by hospitals
鈥淚nnovation was generated by the hospitals themselves, some 鈥� in partnership with us, as a result of the sheer situation that emerged from COVID-19,鈥� he said in an interview with the Inquirer.
鈥淲hen COVID 鈥� happened in March 2020 then expanded and expanded, initially the hospitals had a crisis of shortage of PPE,鈥� he recalled.
鈥淪o they began looking for alternatives. They saw they can use reusable, washable PPE, and at the same time, it won鈥檛 contribute to pollution,鈥� he added.
This was what St. Paul鈥檚 Hospital in Iloilo City did.
鈥淲hat is good about St. Paul鈥檚 is they had been working with us as a 鈥榗lean hospital鈥� prior to COVID,鈥� San Pascual said about the 265-bed tertiary hospital managed and owned by the Sisters of St. Paul of Chartres.
According to him, the hospital 鈥渞ealized early on that there鈥檚 too much use of plastics. They鈥檙e paying so much for hauling and disposal [which have caused] harm to the environment.鈥�
Waste reduction, savings
By customizing PPE to become washable, the Iloilo hospital was able to save tens of millions of pesos in a matter of months.
From April to December in 2020, St. Paul鈥檚 saved P65 million from dispensing with disposable PPE. The hospital also saved 33.7 percent from waste expenses through recycling between January and November that year.
San Pascual, in his presentation, also cited the Cahaya Qalbu Clinic in West Java, Indonesia, which came up with its own system of reducing plastic waste through washable PPE.
The outcome was even more dramatic鈥攁 90-percent reduction in medical waste and, in turn, a 90-percent increase in savings.
鈥淲ithout talking to each other,鈥� the Philippine and Indonesian hospitals arrived at similar solutions and achieved the same goal, San Pascual explained to the Inquirer.
DOH 鈥榖ureaucracy鈥�
HCWH also partnered with the Department of Health (DOH) in other interventions鈥攑articularly the COVID-19 waste audit and the registry of discarded waste.
The DOH asked the group to perform the audit on five pilot hospitals, which San Pascual said 鈥渉ad no choice鈥� but to comply.
Yet the audit, while compulsory, turned out to be 鈥渧ery helpful鈥� to those hospitals, he said, as he noted how they realized soon enough that 鈥渘ot everything should be considered infectious,鈥� and that 鈥減rotecting public health is also about protecting it from plastic pollution and this can be done side by side.鈥�
But encouraging those endeavors was not easy, he admitted.
鈥淲e鈥檙e dealing with the bureaucracy in DOH, which is complex,鈥� San Pascual said, adding that, ultimately, HCWH wanted 鈥渢o encourage DOH 鈥� to mandate hospitals to look thoroughly at their waste management system and to include sustainable solutions.鈥�
Too cautious
The hardest challenge for these institutions is 鈥渙vercoming fear,鈥� he said.
Most doctors and nurses were not comfortable with the idea of multiple-use PPE, while many among the public had also become too cautious amid the surge in cases early during the pandemic.
But San Pascual said health-care workers must reject the notion that hospital gear should be used only once.
鈥淵ou don鈥檛 need to overuse gloves. Infection can be prevented with a simple washing of hands,鈥� he said.
鈥淲hat we observed in many hospitals not only in Asia but [in] different parts of the world 鈥� is that the biggest contributor to plastic waste is the use of medical gloves,鈥� he pointed out, adding that a typical doctor or nurse may discard as many as 10 gloves a day.
鈥淚t鈥檚 disposable, single-use and made up mostly of plastic,鈥� San Pascual said. 鈥淚magine the environmental pollution that is creating.鈥�
He said it鈥檚 important that not only middle managers and staff become reoriented in the use of their plastic articles 鈥渂ut also the top leaders鈥� as well of any hospital.
San Pascual credits the management of hospitals like St. Paul鈥檚 in Iloilo and Indonesia鈥檚 Cahaya Qalbu Clinic for being more open to 鈥渁n easy exploration to find alternatives.鈥�
鈥淲hat makes them innovative 鈥� is their understanding and acceptance of the problem,鈥� he said.
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Note: This solutions story was written for the Journalism in the Age of Pandemics 2.0 program supported by World Association of 黑料社 Publishers and Temasek Foundation.