VIETNAM STRUGGLES TO MANAGE MEDICAL WASTE

UNCLAS SECTION 01 OF 02 HANOI 001794 SIPDIS SENSITIVE SIPDIS E.O. 12958: N/A TAGS: SENV TBIO ECON SOCI VM SUBJECT: VIETNAM STRUGGLES TO MANAGE MEDICAL WASTE REF: HANOI 1706 HANOI 00001794 001.2 OF 002 ¶1. (SBU) Summary. A recent scandal involving the improper disposal of medical waste from Hanoi area hospitals highlights Vietnam's weak waste control infrastructure. While prominent press attention led to a quick GVN response, small penalties, limited enforcement capabilities and lack of funding for needed technological upgrades ensure that hospitals will continue to struggle to manage increasing amounts of medical wastes. End Summary. Widespread Improper Hospital Waste Recycling -------------- ¶2. (U) Over the past month, the local media reported that Hanoi-area hospitals sold medical waste that was then improperly recycled into consumer products. Inspections by the Vietnam Environmental Protection Agency (VEPA) and the Vietnam Environmental Police Department (EPD) uncovered the delivery of nearly one ton of unsterilized waste, including used medicine bottles, syringes, and intravenous tubing, from Viet Duc hospital, Hanoi's main trauma center, to local recyclers for processing into various household appliances. The EPD concluded that medical waste sales from Viet Duc totaled over 50 tons, though one trader implicated in the transaction noted that she had purchased approximately 200 - 300 tons of waste from the hospital since 2002. Contractors for the hospital's counter-bacterial contamination faculty, which supervises the hospital's waste processing, sold the materials at VND 1,500- 6,000 (.10 to .35 USD) per kilogram. A local newspaper also implicated Bach Mai hospital in Hanoi, northern Vietnam's primary facility for avian influenza treatment, in a similar garbage-selling scheme. Hospital Wastes Should Be Managed Properly . . . -------------- --- ¶3. (U) Medical wastes often carry various potentially-dangerous bacteria and viruses and, pursuant to GVN regulations, must be classified, preserved, and managed. The MOH and Ministry of Natural Resources and Environment (MONRE) share responsibility generally for waste management. MOH has the lead on medical waste, but coordinates with MONRE. Article 39 of the Environment Protection Law of Vietnam, effective as of July 2006, stipulates that all types of waste coming from patients must be preliminarily processed to eliminate potentially infectious disease germs before delivery to concentrated processing establishments. . . . But Rarely Are -------------- ¶4. (SBU) Until now, neither hospitals nor the GVN has had the ability to properly manage medical waste. While GVN law only allows entities with hazardous waste processing permits to transport and process medical waste, Colonel Luong Minh Thao, Deputy Director General of the EPD, recently told ESTHOff that most hospitals sell waste for recycling. According to the Ministry of Health (MOH), hospitals and health care units each year discard more than 400 tons of solid waste, one tenth of which is classified as hazardous. Only one third of the total is burned in modern incinerators with the remainder placed in outdoor fires, buried underground, directly sent to common garbage dumps, or sold. ¶5. (SBU) According Dr. Nguyen Khac Hai from the National Institute of Occupational and Environmental Health (NIOEH),the GVN and provincial Peoples' Committees will not take health funds from patient care or medical professional compensation and health care institutions do not consider waste processing a priority. The GVN has found it difficult to implement Article 39 and Dr. Hai expects amendments this year. Few hospitals have proper treatment equipment or staff specialized in operating the waste processing stations. Even those that have trained staff or adequate equipment often do not operate the equipment due to the high costs of electricity or chemicals used in the treatment process. While MOH claims that some 60 central and provincial level hospitals have waste incinerators, many of these incinerators are ineffective due to poor burning capacity, high levels of emissions and large energy consumption. Further, the NIOEH recently found that hospital wastewater contains high levels of pollutants, including bacteria such as E. coli. However, only one third of the over 1,000 hospitals in Vietnam have waste water processing systems, most of which do not operate effectively. Enforcement (What Else?) Remains A Problem -------------- ¶6. (SBU) Though the recent VEPA/EPD investigation shows increasing GVN attention to the issue, penalties remain low and are not likely HANOI 00001794 002.2 OF 002 to deter misconduct. Authorities recently subjected violating hospitals to 20 million dong (approximately USD 1250) administrative fines. Despite the lengthy and large-scale of the violations, Col. Thao from EPD asserted they reflected the actions of a few individuals seeking monetary gain, not a high-level conspiracy to avoid waste management requirements. According to Thao, the hospitals fired directly implicated individuals, but did not pursue supervisory personnel. Director Hai from NIOEH noted that the newly created EPD (reftel) still does not fully comprehend its enforcement capabilities. GVN Looking for Comprehensive Solutions -------------- ¶7. (SBU) In response to the hospital waste scandal, MOH created two multi-agency investigatory delegations to travel throughout the country to check compliance at provincial and district hospitals. MOH plans to strengthen supervision of hospitals to ensure that proper processing of medical waste and prevent improper sales and just adopted a 10 billion dong (approximately USD 625,000) national program to better manage and process medical wastes. By 2010, all hospitals (over 1,030 existing large and small institutions, plus any newly constructed hospitals, as well as private clinics) should have solid waste processing systems and waste-water treatment facilities. The GVN continues to build large incinerators to concentrate waste from many hospitals (though this requires transportation and storage of wastes and incineration causes a variety of other pollutants, including dioxins). EPD plans to begin recommending criminal prosecution for improper disposal of medical wastes. NIOEH is planning to partner with Environmental and Chemical Safety Educational Institute, a U.S. NGO, to better train hospital staff in waste disposal techniques and possibly look at U.S. waste management technologies. Opportunity for U.S. Waste Management Sector -------------- ¶8. (SBU) Hospital waste management difficulties are only one of many growing pollution control problems facing Vietnam and are indicative of the regulatory, informational, and resource challenges the country faces in limiting environmental degradation from economic growth and industrialization. The GVN at least recognizes this problem and is searching for answers. NIOEH's interest in U.S. waste management expertise provides the U.S. with an opportunity to bolster Vietnamese capabilities. We recommend that U.S. environmental and trade promotion agencies highlight U.S. medical waste management technologies and services. Comment -------------- ¶9. (SBU) Vietnamese medical waste management must be seen in the context of overall waste management practices. Vietnam "recycles" nearly all waste through formal and informal networks of workers who collect, sort, and redistribute discarded material for profit. From an efficiency perspective, the waste management market generally functions smoothly. From a health or environmental perspective, the market is riddled by externalities - wide-spread pollution and threats of disease and illness caused by improperly managed materials. In addition to improved waste management technology, Vietnam needs to change societal norms towards waste creation and treatment and must increase enforcement to internalize the environmental and health costs of improper hospital waste management. ALOISI