Mr Soap's foreleg...

During my stint in the medical waste industry, I was faced with a quandary which still begs a satisfactory answer.

As a premise, let me provide a little illuminating context. Medical / clinical or health-care risk waste is a highly regulated industry, falling under the umbrella classification of Hazardous Waste. It is, furthermore, divided up into several different waste streams, each one calling for unique handling, disposal, packaging, storage and treatment methodologies.

In this instance, I wish to focus purely on infectious human anatomical waste. This includes all wastes derived from healthcare facilities which are recognizably human tissues, organs or body parts removed by trauma, during surgery, autopsy, studies or likewise hospital procedures. Grim, I know.

As it stands, DEAT (Department of Environmental Affairs and Tourism) is the designated regulatory authority governing medical waste. Infectious human anatomical waste warrants strict storage criteria, and the only authorized method of destruction for this stream is, currently, via incineration. Having said this, there are no incinerators left in KwaZulu Natal, all of which were shut down due to non-compliance and strong objection from environmentalists. Therefore, all human anatomical waste stemming from KZN healthcare facilities has to be transported across provincial borders to relevant accredited incineration plants. It is to be noted, though, that the global trend is moving away from incineration altogether, as it continues to pose substantial environmental and human challenges. Control measures can be installed to make incineration safer, but these very controls can cost more than four times the incinerator itself!

Hence, with all this in mind, here is the dilemma:

Mr Joe Soap is booked in at a hospital in Durban. Tragically, his left foreleg is gangrenous and an emergency amputation has been scheduled accordingly. Following surgery, his amputated foreleg is double-wrapped in thick plastic, recorded on the Human Tissue Register, and placed into a red colour-coded specibin, ready for collection by the contracted medical waste service provider. Once collected, it is then placed into cold storage pending its timeous transport to a fully compliant incinerator in another province.

In the meantime, Mr Joe Soap succumbs to a virulent septicaemia. Once his body has crossed the red tape of bureaucracy, his immediate family decides on whether he should be buried or cremated…dust or ashes.

Back at the waste plant, where his foreleg awaits, coldly, the final leg of its journey, the waste contractor hears that the incinerator they frequent in Gauteng has been temporarily shut down by the Green Scorpions following a raid. They frantically contact their Plan B whilst their refrigerated units fill steadily, up to capacity. Incinerator plant number 2 has burnt out! The remaining alternatives are scanty and risky. The broad-scale cost implications are escalating and the responsibility nothing less than daunting.

So…while Mr Soap is finally laid to rest, without objection or complication, his foreleg lies frozen in a bucket and delayed by logistics and legalities.

His foreleg may not be incinerated by a non-compliant incinerator. His foreleg may not be treated by available alternative technologies. His foreleg may not be buried in a landfill site because law has not found it palatable to write it in as a back-up plan due to several aesthetic, ethical and cultural antipathies.

What will we do when the last incinerator goes down? And what will become of Mr Soap’s foreleg?

It’s so easy to say: “We can’t do that.” But something has to be done, so what can we do? Sound regulatory frameworks, and policies and procedures are critical, indeed. But are they wholly implement able? And does the section on “contingency planning” hold any real value? Desperate times call for desperate measures… It’s no wonder some waste contractors end up breaking the rules.

Personally, I think we need to practise a whole lot more foresight – the kind that is PRACTICAL in its application. What do you think?