Court-ordered consultative process on hospital waste disposal faces holdup
On the directives of the Sindh High Court, Sepa had initiated a process of receiving input from public and private hospitals on safe, workable disposal of waste generated by them. Only one meeting of the committee has taken place, despite a four-week timeframe.
By M. Waqar Bhatti
Over a fortnight has passed since the Sindh High Court (SHC) ordered the Sindh Environmental Protection Agency (Sepa) to establish a broad-based committee to "formulate uniformed guidelines and policy" so as to ensure that all private and public sectors hospitals, as well as other medical services providers dispose of their waste scientifically and hygienically.

Categorising hospital waste
Waste generated by hospitals and health facilities in mega cities of the world has emerged as a major concern for municipal and health authorities. Despite being considerably less in quantity as compared to municipal waste, hospital waste poses a greater risk to health of community and the environment.

Education, mobility breaking shackles of caste system
By Shahid Husain
Education, mobility and communication are fast breaking the caste system in the impoverished district of Tharparkar that borders the Great Indian Desert.
"There was a time when we were given food on leaves and we had separate crockery in restaurants," 32-year-old Ghulab Rai, a Dalit hailing from Kehri village, some 70 km from district headquarters Mithi, told Indus Watch. "Things, however, are changing fast. Rajput youngsters now mingle with Dalits and even eat together — the credit goes to education. Previously, we sat on the floor while the Rajputs sat on a Charpoi."

Whose land is it anyway?
Mukesh Meghwar writes about the lives of religious minorities in Sindh
In the wake of the recent commemoration of Sindhu Day, a large number of columnists, writers and intellectuals from Sindh said that the real heirs of this land were the Dravidians — worshippers of the Indus (Sindhu) River. Sindhu River worship is also mentioned in a number of Hindu Granths, Vedas and Shasthris.

Voices from Thar 
Dr Sono Khangharani
His mother told him it was the mythical night of "Amawas" (a day after the full moon), the "Junum Ashtimi (birthday) of Krishan Bhagwan," when he was born in August 1956 as a very healthy boy in Mithrio Soomra village in Tharparkar. He was given the name ‘Sono’ (gold) by his parents.

READERS’ VOICE
Justice denied?
Seventeen-year-old ‘K’ Kolhi, a resident of village Mokryo, Taluka Nagarparker, district Tharparkar, was allegedly kidnapped and gang-raped by Ramzan Khoso and his companions, Pakistan People’s Party (PPP) leaders from Taluka Nagarparker.

 

On the directives of the Sindh High Court, Sepa had initiated a process of receiving input from public and private hospitals on safe, workable disposal of waste generated by them. Only one meeting of the committee has taken place, despite a four-week timeframe.

By M. Waqar Bhatti

Over a fortnight has passed since the Sindh High Court (SHC) ordered the Sindh Environmental Protection Agency (Sepa) to establish a broad-based committee to "formulate uniformed guidelines and policy" so as to ensure that all private and public sectors hospitals, as well as other medical services providers dispose of their waste scientifically and hygienically.

With less than two weeks remaining before the SHC’s preferred time frame of four weeks elapses, however, the committee has met only once, with members of the working group informing Kolachi that the process is being held up as members of the committee have been unable to find an agreed-upon time to meet with each other.

"The problem is frequency of consultation between all committee members, as no more meetings could be held since the first one," a member of the committee, who represented a major private hospital in Karachi at the first and the only meeting of the committee, told Kolachi on condition of anonymity. "The minutes of the previous meeting have also not been provided to us thus far," he said.

When asked whether the committee was capable of fulfilling its task within the time frame given by the SHC, the health expert said that it was not a "big task" as all the persons in the committee were experts of their respective fields, and all they had to do was to sit down and formulate a system for hospital waste disposal under the already-prescribed national and international rules and regulations.

The 11-member committee had been formed on the directives of the SHC’s division bench, headed by Justice Mushir Alam, during proceedings on February 3, 2010 in a pro bone petition filed by Qazi Ali Athar (Advocate) that sought the immediate closure of incineration plants at hospitals and other medical set-ups.

The petitioner had submitted that the incineration of hospital waste and burning of solid waste had put the lives of the citizens of Karachi at risk, as such a practice resulted in the emission of highly toxic fumes, which was also in violation of the fundamental rights guaranteed in the Constitution.

Further, the petitioner had argued, the City District Government Karachi (CDGK) and others were "regularly using incinerators at major hospitals, including Jinnah Postgraduate Medical Centre (JPMC), Civil Hospital Karachi, Aga Khan University Hospital (AKUH), Liaquat National Hospital, Ziauddin Hospital and Kidney Centre...besides pharmaceuticals companies."

While accepting a suggestion put forth during proceedings regarding the constitution of a committee of experts, to be led by a representative of Sepa, the court had directed the provincial environmental watchdog that a meeting in this regard is convened on February 6.

Unfortunately, this was the only time the committee assembled.

Regardless, members of the committee believe that there was some headway made in the first meeting, as representatives of major public and private health institutions were joined by officials from Sepa, as well as health officials from both the Sindh and city governments to deliberate the various options for the safe disposal of hospital waste.

At the meeting, Sepa officials sought the input of all leading public and private hospitals of Karachi on safe and workable disposal of hospital waste, which would be in accordance with national and international environmental quality standards. "Two methods of disposal of hospital waste were mainly discussed at the meeting, including incineration and autoclaving, and the merits and demerits of both options were thrashed out in detail," a member of the committee, on condition of anonymity, told Kolachi.

"Actually, the petitioner who had challenged the existing method of disposal of hospital waste argued that incineration was not currently being used anywhere in the world, and he suggested that hospitals should be asked to adopt the process of autoclaving," he said.

During the meeting, it was learnt that most of the local health facilities were incinerating hospital waste, but in a manner that was harmful not only to the environment but also to human health. The committee member said that most hospitals are currently using the technique of incineration for the disposal of hospital waste, but also admitted that this technique had been abandoned by hospitals in the modern world years ago, on the basis that it produces certain gases that are hazardous for human health.

"Autoclaving is the most used procedure for disposing of hospital waste, under which high pressure steam is used to sterilise the infectious hospital waste while burying the hospital waste in air tight containers is also being practiced in the world" the official maintained.

Similarly, double-chamber incinerators have also been devised, which burn the hospital waste at a much high temperature, he explained, adding that these new incinerators do not produce hazardous gases as compared to previous incinerators.

Participants of the meeting were apprised by Sepa officials that as per court directives, the committee has to come up with some effective and workable guidelines for the disposal of hospital waste, which are not only in accordance with the National Environmental Quality Standards (NEQS) but also in compliance with Hospital Waste Management Rules-2005.

Segregation and sorting of hospital waste prior to its disposal into various categories, including hazardous and non-hazardous waste, was also discussed in the meeting, the committee member said, adding that it is hoped that if the consultation continued, the committee would come up with some effective guidelines in this regard.

Hospital Waste

Total no. of hospitals 200

Total no. of beds 9,000

Approximate generation of hospital

waste per day in the city 2.7 tons

Per bed generation of waste per day 3-4 kg

Hazardous waste 540 kg

Non-hazardous waste 2,160 kg

Source: Sepa

Hospitals which operate their own incinerators

• Civil Hospital Karachi

• Jinnah Postgraduate Medical Centre

• Liaquat National Hospital

• Aga Khan University Hospital

 

 

Categorising hospital waste

Waste generated by hospitals and health facilities in mega cities of the world has emerged as a major concern for municipal and health authorities. Despite being considerably less in quantity as compared to municipal waste, hospital waste poses a greater risk to health of community and the environment.

Health and environment expert generally categorise hospital waste into two major groups: medical or hazardous waste, and non-medical or non-hazardous waste.

Only a certain portion of hospital waste contains risk for health and environment, but if not segregated, it can convert entire waste generated by a health facility into hazardous waste.

Medical or hazardous waste can be sub-categorized into:

Infectious waste

Potentially infectious waste includes all waste items that are contaminated with or suspected of being contaminated with body fluids, such as blood and blood products, used catheters and gloves, cultures and stocks of infectious agents, waste from dialysis and dentistry units, from isolation units, wound dressings, nappies, discarded diagnostic samples, infected animals from laboratories, and contaminated materials (swabs, bandages, and gauze) and equipment (disposable medical devices, e.g IV fluid lines and disposable spatulas).

Anatomic wastes

Anatomic wastes consist of body parts and tissues (e.g placenta), waste from clinical labs, and animal carcasses.

Sharps waste

Sharps waste consists of used syringes, needles, scalpels and blades.

Chemical waste

Waste containing chemical substances e.g laboratory chemicals, empty bottles of lab or pharmacy chemicals, disinfectants that have expired or are no longer needed, solvents, diagnostic kits, poisonous and corrosive materials, and cleaning agents and others.

Pharmaceutical waste

Waste containing pharmaceutical substances including expired, unused & contaminated pharmaceuticals, e.g., expired drugs, vaccines and seras.

Genotoxic waste

Genotoxic waste consists of highly hazardous, mutagenic, teratogenic, or carcinogenic waste containing substances with genotoxic properties. Examples include: Cytotoxic, neoplastic drugs used in cancer treatment, their metabolites and genotoxic chemicals.

Radioactive waste

Radioactive materials are also part of waste generated in hospitals, and they include unused liquids from radiotherapy or laboratory research; contaminated glassware, packages, or absorbent paper; urine and excreta from patients treated or tested with radioactive substances. –WB

 

Education, mobility breaking shackles of caste system

By Shahid Husain

Education, mobility and communication are fast breaking the caste system in the impoverished district of Tharparkar that borders the Great Indian Desert.

"There was a time when we were given food on leaves and we had separate crockery in restaurants," 32-year-old Ghulab Rai, a Dalit hailing from Kehri village, some 70 km from district headquarters Mithi, told Indus Watch. "Things, however, are changing fast. Rajput youngsters now mingle with Dalits and even eat together — the credit goes to education. Previously, we sat on the floor while the Rajputs sat on a Charpoi."

Rai said that despite oppression and absolute poverty, Dalits acquired education while the Rajputs, "suffering from grandeur," ignored it to a large extent. As a result, today one finds many Dalits at key positions in Tharparkar and the Sindh government. "I was a herdsman up until Intermediate. We drew water from wells with extreme care, making it a point that our hands did not touch the water. In villages, this practice continues even today," he said.

Migration to barrage areas during drought and construction of road networks also helped in breaking the shackles of the caste system because people who went to barrage areas of Sindh learnt that the caste system existed only in Tharparkar. With the advent of road networks, Dalits now have access all the way up to Karachi, and are employed in different sectors such as garment factories, laboratories, petrol pumps along the National Highway and as cooks and masons in the financial hub of Pakistan.

"In 2002, Parkar Hotel was built in Mithi and was inaugurated with a big bang. Its proprietors placed an advertisement in newspapers, announcing that they will not be discriminating between Dalits, Rajputs and Muslims, and everybody will have to use the same crockery. Since the vast majority of Mithi comprised of Dalits, the hotel business skyrocketed, forcing other hotels and restaurants to follow suit," Rai said. "This practice was followed by restaurants in Islamkot as well. Today, you will find only one hotel in Islamkot where Dalits and upper castes have separate crockery. However, discrimination against Dalits continues in Chachhro and Nagarparkar because people are not very educated there. You see, education makes a difference. Non-governmental organisations (NGOs) also played a role in creating awareness among the people of Tharparkar."

Forty-two-year-old Kenraj Thakkur, an assistant social welfare officer based in Chacchro, agreed that previously there was lot of discrimination against Dalits in Tharparkar since there was no education. "People from the schedule castes ate dead animals and were very poor. The Rajputs therefore looked at them with contempt," he said. "Military dictator Gen. Ziaul Haq accentuated division based on the caste system while yet another military dictator Gen. Musharraf introduced the local bodies system and tried to bridge the gap. The media also played a vital role in breaking the shackles of the caste system."

Thirty-two-year-old Zahid Hussain Channa, an M.Phil. student of rural development at the Sindh University in Jamshoro, concurred. "Migration brought about a significant change. The people of Thar migrate to barrage areas as well as other parts of Sindh during droughts and find that there is no discrimination between Rajputs and Dalits there. When they return home, they inform their families about life in areas other than Thar and it makes a difference," he said.

The word Dalit literally means "backward and oppressed" and they comprises the majority of the Hindu population in Tharparkar. They have, however, been looked upon with contempt and hatred by Rajputs and Brahmins. According to the last census conducted in 1998, the population of Hindus in Pakistan was 2,443,514, including 2,111,171 higher caste Hindus and 332,343 from the schedule caste. Dalits, however, reject the census and maintain that a large number of schedule caste people have also been registered as Hindus.

"The census is religion-based and 70 to 80 per cent of the population which was counted as Hindu and Schedule Caste was actually scheduled caste population because the census identified Hindus and schedule caste as a single identity," said Schedule Caste Federation of Pakistan Founder President Surender Valasai.

He said that 20 to 25 per cent of upper caste Hindu population in Pakistan enjoyed social and economic rights at the cost of the majority schedule caste population.

 

 

Whose land is it anyway?

Mukesh Meghwar writes about the lives of religious minorities in Sindh

In the wake of the recent commemoration of Sindhu Day, a large number of columnists, writers and intellectuals from Sindh said that the real heirs of this land were the Dravidians — worshippers of the Indus (Sindhu) River. Sindhu River worship is also mentioned in a number of Hindu Granths, Vedas and Shasthris.

Actually, one feels slightly relieved at the fact that the thinkers of Sindh have finally remembered the Dravidians (Kolhi, Bheel, Meghwar and Oad) who have lived in Sindh for thousands of years. History is replete with the struggles of these tribes, who have sacrificed their lives in multiple attempts to save their land, culture, language and traditions. Rooplo Kolhi, for instance, preferred death by hanging to slaving under Colonial rule.

Despite all this, however, one feels at times that there is a difference between what our political, social and nationalist leaders, intellectuals and writers preach and what they practice. Much of what they say is never converted into action. On the ground, we have always been treated as step-siblings — outsiders. We feel like we are merely tools to be used for political mileage and personal gain.

No one protests against atrocities that are meted out to our community. Pens stop writing, speeches become muted, and voices die when it comes to speaking on behalf of religious minorities in Pakistan. The most recent example of this is the case of an Oadh girl’s grave in Khudadad village, five kilometres from Hyderabad. Seventeen-year-old Shahmira Oadh was buried nine months ago in a corner of the 400-year-old Mir graveyard. For nine months, no one spoke; and then all of a sudden, local landowners (Waderas) and Maulvis got Fatwas (religious edicts) from 17 different Ulema, saying that the graveyard belonged to Muslims, and a Hindu girl could not be buried there. They said that Shahmira’s grave desecrates the Muslim graveyard, and that, her remains should be dug up and thrown out.

Activists from Hyderabad inspected the site and said that Shahmira’s grave was at a distance from the Muslim graves. Despite this, the Hyderabad Sessions Court ordered that Shahmira’s remains be thrown out. It breaks one’s heart to think that the ‘real heirs’ of this land are being denied the right to bury their loved ones here. Meanwhile, not a single political, social or nationalist leader uttered a word in support of the victimised Oadhs. It is as if their tongues have been padlocked. They are watching from the sidelines, as one would watch a street theatre. Not a single rally, protest or sit-in has been organised by them for Shahmira. Why are they silent? How does one interpret their silence?

This wasn’t the first time either. When the bodies of Hindus were thrown out of their graves by Maulvis in Pangreo and Digh Mori, everyone remained silent. When Jagdesh was beaten to death by a mob in Karachi on ‘charges’ of blasphemy, no one spoke. When Poon Kumar’s body was recovered from beside the Indus River, no one said a word. Not a peep is uttered when Hindu women are kidnapped, or when Hindu businessmen are murdered in Southern Sindh. Why?

We have never refrained from raising our voices against injustice meted out to any resident of Sindh. We have stood shoulder to shoulder with protesters, and given every sacrifice possible for the larger good. One is extremely disappointed, however, when no one supports us or even lends an ear when injustices are meted out to members of our community. We are treated like second-class citizens in our own land.

It is not like no one knows what is going on. In this age of communication, news travels fast — even if incidents occur in remote areas. Despite this, however, not only are we discriminated against while alive, even our dead are oppressed; and not a single Mard-e-Momin turns around and says, "Hold on, what’s going on?" Does no one feel for us at all?

I appeal to humanitarians and supporters of justice to take a stand against these insults against humanity, and help us prove that we are human beings too.

— The writer is a social activist based in Hyderabad.

 

Voices from Thar

Dr Sono Khangharani

His mother told him it was the mythical night of "Amawas" (a day after the full moon), the "Junum Ashtimi (birthday) of Krishan Bhagwan," when he was born in August 1956 as a very healthy boy in Mithrio Soomra village in Tharparkar. He was given the name ‘Sono’ (gold) by his parents.

Sono’s father was a herdsman, who later worked as a cobbler, carpenter and village doctor. His mother had a small shop in the village. He acquired his primary education from his village school, and was then enrolled at the Islamkot High School where he had to bring his bed and utensils along with him. In class VIII, Sono ran away from school to become a herdsman. His teacher, Sadiq Junejo wrote a letter to his father, saying that Sono should continue his education. His father replied he couldn’t afford to bear the expenses of education, and Junejo promised to help, financially. Sono rejoined the school, but lost a year due to the 1971 Indo-Pakistan war. In the meanwhile, his cousin, Bhano Mall, who had joined Wapda took him to Hyderabad. "I saw a train in 1972, for the first time in my life," Dr Sono Khangharani, the chief executive officer of Thardeep Rural Development Programme (TRDP), a grass-root NGO of Tharparkar, told Indus Watch. "I was enrolled at the Government High school, Hyderabad, but came back to Mithi and completed my Matriculation examinations in 1974 in first division."

In 1974, Tharparkar had a severe drought. Sono’s father migrated to Tando Mohammad Khan and started working at a brick kiln. He asked Sono to come over and work with him. "I cooked food for Seth Kundan Lal. When I told him that I had passed my Matriculation exams in first division, he took me to Seth Hari Ram who owned the Tando Ghulam Ali Cotton Factory. I was hired there as a Marka Munshi," Sono said. He wanted to become a medical doctor but the admission date had expired. "My brother advised me to get admission in the Tando Jam College where I would get a scholarship of Rs80 every month," he said.

In 1981, Sono graduated as a veterinary doctor and joined the Agricultural Technical Institute in Sakrand as an instructor. He told his professor Basheer Shaikh, however, that he did not like the job and was soon enrolled in M.Sc. classes. While he was in his first semester, he got a job as a lecturer at the university and worked there for five years. In May 1987, he joined a farm established by Farooq Textile Mills at a hefty salary of Rs4,000 per month. In February 1992, he joined the National Rural Support Programme (NSRP) in Islamabad as a programme officer. This was a turning point in his life because he got the opportunity to work with Dr Akhter Hameed Khan, an eminent social activist of Orangi Pilot Project-fame. Thereafter, Sono joined Save the Children Fund in Tharparkar despite the fact that it offered less salary. This culminated in the establishment of the TRDP, which has now developed into the largest NGO in district Tharparkar. Dr Sono Khangharani never looked back.

– Shahid Husain

 

Dominic Stephen

Dominic Stephen was born on December 20, 1945, in Umerkot, Sindh. "Umerkot is where the great Mughal King Akbar was born. I, however, was born of very poor parents," he told Indus Watch. "My father converted to Christianity from Hinduism in 1945."

Stephen originally belongs to a Hindu tribal group called ‘Parkaris’. The tribe has a total population of about 150,000 in Pakistan – only five percent of them are Christians; the rest are Hindus. "Dutch Missionaries helped me receive a primary education at St Joseph’s Urdu School in Matli, and matriculation from St Mary’s High School in Sukkur in 1966," Stephen said.

He got married in 1966 and began his career soon after as a junior office clerk at the 100-bed St Teresa’s Mission Hospital. "I then worked my way up to become senior accountant and administrator," he said. "I went to work for the Aga Khan Maternity Homes as their administrator in 1981 and worked in this position until the end of 1982."

Meanwhile, Stephen completed his B.Com., and then went on to obtain two Masters degrees, including an MBA from the Philippines. "In 1989, I joined the Thardeep Rural Development Programme (TRDP), which was established by the Save the Children Fund UK," he said. "I worked there as project manager till September 1997. I resigned my job with Save the Children in September 1997 to establish the Participatory Village Development Programme (PVDP) in October 1997."

Stephen is presently the executive director and founder member of PVDP. His area of interest is arid land which is dependent on rainfall for subsistence agriculture and livestock farming. PVDP works in the Thar Arid Zone to improve the natural resources of the communities.

PVDP, however, does not support micro-credit schemes in the Thar Desert. "Ninety per cent of the poor in the area are indebted to moneylenders and shopkeepers. Any cash handout in the form of repayable loans will hardly get invested for the purpose it was taken," Stephen explained. "People are under a social obligation to use the credit money to retire their old debts to moneylenders and shopkeepers. When borrowed credit does not get invested in productive income-generating activities, it becomes a huge liability which is hard to get rid of. When the time comes to pay the instalments on micro-credit with high mark-up rates, people are forced to sell their meagre domestic assets, such as livestock or jewellery. In extreme cases, they end up leasing or selling their lands to pay back the loans to NGOs. Thus, they go deeper into debt to both, NGOs and moneylenders, at the same time, and turn themselves from being poor to being destitute."

Micro-credit, Stephen maintains, should be accompanied by a package of safe investment options; it should be delivered based on the concept of ‘build on what people have’.

– Urooj Zia

 

READERS’ VOICE

Justice denied?

Seventeen-year-old ‘K’ Kolhi, a resident of village Mokryo, Taluka Nagarparker, district Tharparkar, was allegedly kidnapped and gang-raped by Ramzan Khoso and his companions, Pakistan People’s Party (PPP) leaders from Taluka Nagarparker.

The next day, K’s father approached the Nagarparker Police to register a case against the rapists but the police refused. Following this, a large number of people from the Kolhi community and civil society organisations protested on February 12, 2010, and pressured the police into registering a case. They also sent an application to the Sindh High Court Hyderabad Circuit Bench to issue a notice to the Nagarparker Police for lodging an FIR.

On the orders of the court, the police registered an FIR on February 17 against Habibullah Khoso, Ramzan Khoso, Ghulam Nabi Khoso, and Veroo Mehraj. The police, however, are protecting the rapists and providing shelter to them. Before the FIR was lodged, the alleged culprits called a Jirga with local Kolhi community leaders and advised them not to bring the case up in the media. They went as far as to make a shameful "offer," asking K’s family to hand the girl over to them. They said that they would make her convert to Islam, and then marry her off to a youngster from their tribe. They also threatened the girl’s family with dire consequences if an FIR was lodged against them.

On February 18, a police mobile, along with a large number of policemen in civil vehicles, raided village Dhana Gam, union council Pithapur. This is my native village, and the raid was an obvious attempt at pressuring us because as the Hyderabad coordinator for Mehargarh and a member of the Kolhi Association, I had played a main role in appealing to the high court for lodging the FIR. The policemen beat up women and children in my village, and arrested 13 people on charges of cutting ‘Gugraal’. All the people who were arrested are close relatives of mine. The police threatened them and said that if they persisted in following up the rape case, charges of ‘smuggling’ will be brought against them.

I appeal to the central PPP leadership, human rights and civil society organisations and individuals to protest and pressure the local PPP leadership and the police to arrest the alleged rapists, and stop harassing innocent people from Dhana Gam.

— Veerji Kolhi, Nagarparker, district Tharparker.

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