Two garbage disposal workers spent half an hour rummaging through mounds of medical waste with their bare hands on a recent morning outside the Bahosi Hospital in Yangon.
Dressed in orange uniforms issued by the Yangon City Development Committee (YCDC) they plucked blood-stained intravenous drip tubes and used syringes from red trash bags and tossed them into yellow ones.
These bags were destined for neighbourhoods in Yangon’s outskirts, where residents process and clean the high-grade plastic before selling it on to be made into household goods.
Even at the best of times, this illegal practice risks spreading diseases like hepatitis, HIV, dysentery and respiratory tract infections. But with Myanmar’s count of confirmed coronavirus cases rising, it raises the prospect that waste from patients infected with the highly contagious new virus could also be mishandled.
There is not yet enough research into the novel coronavirus to say exactly how much it could spread via medical waste, said Dr Meru Sheel, an expert on the spread of infectious diseases at the Australian National University.
“What we do know is the virus can survive on surfaces for varying amounts of time. Depending on the material, but it does survive,” she told Myanmar Now.
Research published last month by the National Institute of Allergy and Infectious Diseases in the US found the virus can persist on plastic and stainless steel for up to three days.
Myanmar Now approached Bahosi Hospital for an interview, but a doctor there named San Win declined the request.
The health ministry has confirmed 16 coronavirus infections and one death in Myanmar as of Wednesday, with just under 600 people tested out of a population of some 53 million.
Several embassies in Yangon last month urged their citizens to leave the country amid warnings that an already underfunded and fragile healthcare system could be overwhelmed with cases.
Myanmar Now’s investigation found that local bylaws requiring waste disposal workers to safely bury or incinerate hazardous medical waste are routinely flouted.
Three of the 2,500 tonnes of waste produced in Yangon every day – or about 0.12% – come from medical facilities, according to the YCDC website. The World Health Organization estimates about 15% of such waste is hazardous.
The needles, scalpels, intravenous tubes, catheters and expired drugs collected by specially designated YCDC trucks are supposed to end up at the incinerator in Htein Pin cemetery in Hlaing Tharyar, on Yangon’s industrial western outskirts.
But much of it is diverted to residential areas. During a visit to Bonmar Street in North Okkalapa in January, Myanmar Now saw bags full of bloody tubes piled up by a fence near the edge of a drainage ditch.
In a building on the other side of the fence, about 10 people sat sorting through a two-foot high pile of used syringes before taking them to a nearby water tank to wash.
The syringes are then laid out along the street to dry in the sun.
The plastic pellets from this waste are sold to manufacturers of water hoses, flower pots, chairs and other consumer goods, said U Tun, chairman of the Myanmar Plastic Industries Association.
Since the plastic is not used for kitchen utensils or food storage products, the practice is completely safe, he claimed.
But staff at the North Okkalapa plant told a reporter posing as a potential buyer that pellets from used syringes are mixed with other plastics to make spoons.
Regardless of whether the final products are used for food, doctors and health officials say the practice endangers the health of the people handling the waste and the wider public.
‘It reeks of chemicals’
In Shwe Pyi Thar township, Cho Cho Aung’s front yard is covered in plastic sacks that her family buys from wholesalers in Sawbwa Gyi Gon market in Insein, north Yangon.
The bags, which arrive at the market straight from hospitals and clinics, are full of used syringes, nasal breathing tubes and urine and blood bags.
Her family cleans the plastic and sells it to manufacturers of plastic pellets, who sell the pellets to producers of household goods.
To clean intravenous tubes, workers like Cho Cho Aung cut them open and hang them up. Then they use a roller clamp to squeeze any residual blood or bodily fluids out onto the ground.
The tubes are washed with bleach or a weak acid solution, then with soap and water, then left out to dry. Workers often tip the wastewater out onto the street or in their front yard, where it flows into drainage ditches.
“This waste is not like other waste. It reeks of chemicals,” Cho Cho Aung said while sitting on a pile of empty garbage bags in front of her home. “I start to feel dizzy after breathing it in for a while.”
Guidelines from WHO urge hospital staff to use protection like masks, gloves, boots and leg guards while handling biohazardous waste. Garbage collectors should use designated, enclosed trucks to transport them, the guidelines say. Those rules shape guidelines for YCDC staff.
According to the most recent guidelines from the health and sports ministry, used needles and other sharps should be put in red biohazard bags, and all other infectious waste in yellow bags.
“Sharps and infectious waste must be collected properly and transported directly to the disposal area. Our department does not allow staff to rummage through hospital garbage bags,” a YCDC representative who declined to give her name told Myanmar Now.
‘Poor waste management’
A plastics trader in Insein township told Myanmar Now they buy more than 700 pounds (317kg) of medical waste a week from YCDC garbage collectors in Yangon, Mandalay, Kyaukse and Pathein.
Staff at pellet plants in Mayangone and North Okkalapa townships told Myanmar Now they bought hazardous waste directly from hospital and YCDC employees.
Dr Thar Tun Kyaw, director general of the health ministry, disputes these claims.
“I am sure that waste isn’t coming from hospitals because we have separate garbage bins for that,” he told Myanmar Now.
He said hospitals, public or private, would lose their operating licenses if they’re found to be improperly disposing of waste.
Dr Tin Nyo Nyo Latt, head of the Shwe Lamin hospital in North Okkalapa township, said poor supervision at hospitals is a problem.
A 2017 report by the health ministry and the Myanmar Medical Association, which she helped write, documented poor waste management practices at Yangon hospitals, including a failure to separate hazardous and non-hazardous waste.
Improper disposal of hazardous waste is punishable by up to three months in prison and fines up to 500,000 kyat under YCDC bylaws.
Businesses are usually not allowed to process plastics outside of industrial zones, but last year YCDC issued temporary licenses to households in North Okkalapa after local residents applied for permission to do so in their homes, said Kyaw Min Tun, the township YCDC officer.
In January YCDC found three households were recycling used syringes, he said, but they have yet to take any action.
Cho Cho Aung worries about the effect of such work on her health, but she is struggling for money and sees few other options. “I’m scared I’ll get hepatitis,” she said. “I know it’s risky, but I don’t have a choice.”
(Editing by Danny Fenster, additional reporting by Joshua Carroll)