A Tale of Waste Management

The History of Waste Management – Part 1:

Prior to 8 months ago in Achham, all waste was burned in a burning barrel or a brick chimney type incinerator.  Plastics, medical waste, paper, bottles, and cans were all burned, or in riverside communities went directly into the water source.  The local joke is that “It’s ok because it all ends up in India,” though some people might not think this is very funny.  This is the way in Achham: everything gets swept into a small pile and burned in a small fire in the street, yard, rice field, or anywhere else it might develop.  So inevitably the smell of smoldering trash is as much part of the environment as the smell of dead fish is part of the ocean.  As a practice in the general community, when you open something that generates waste you drop it where you stand or, if indoors, simply throw it out the nearest portal to the outside world.  There is more consideration of where you might spit, and certainly of where your dishwasher, laundry water, or post-foot-washing water may end up.

The Non-History Current Practice/Vision of Waste Management – Part 2:

A “sustainable” waste management system was developed and decided upon about 8 months ago, complete with green concepts and money-making potential.  These are either the facts, or at a minimum the facts that I have deciphered via mixed stories, power struggles, emotional toil, and scattered half-English, half-Nepali conversations:

  • About 8 lakh ($9,200) or more (the bills are still rolling in) was spent on the project.
  • A business from Dhangadhi was going to buy the sorted recyclables for between 1 rupee ($0.0085) per kg for paper, and as much as hundreds of rupees per kg for metals.
  • Hazardous medical waste is sorted by hand, then autoclaved, and finally buried on site.
  • “Mercury-free” designation was hypothetically gained.
  • A future food-producing garden was envisioned, with dirt supplied by composted biodegradable waste (proposed not launched).
  • A “biodigestor” would be employed for methane collection and use as cook stove fuel (proposed not launched).
  • This system would stand as the paragon of environmental sustainability practices in Achham.
  • In a few years, it was projected that this program would fully fund itself.

How the System Works (from the perspective of a waste-generating individual):

At two select exterior locations (the main Outpatient Department double doors, Inpatient Department, and the Emergency Room door) you can find the full monty: a commingled paper/plastic bin, bottle/can recycling, and biodegradable composting bins.  To supplement the main locations listed above, paper/plastic bins are placed in about every room.  For clinical staff, waste management trolleys were custom-fabricated by a local welder.  They hold 4 large bins, 4 smaller bins, and 2 micro bins.  These carts can be found in two locations: Emergency Room (ER), and Inpatient Department (IPD).  The clinical staff should be able to easily decide the proper receptacle of waste generated, based on the following labeled bins: “infectious, syringe style glass medicine container, needle, syringe, plastic odd ends/plastic tubing and non infectious waste bins.”

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In the canteen, they have been issued 2 extra large bins, for bio-degradable compost and commingled paper/plastic, as well as a 3 outdoor, aerated composting containers.  The dirt from these compost bins was envisioned to eventually go to a garden that would grow vegetables to be cooked at the canteen.  Lastly, once all previous stages had been completed, a “Biodigestor” would be installed.  As very few people fully grasp how this system works, I will cite the Biodigestor website: “You put cow manure in one end and get out usable cooking gas and organic fertilizer.  The odorless gas is piped into the kitchen where it can be burned for 4-5hrs a day, replacing the need to collect firewood.  The liquid fertilizer is rich in nutrients to boost crop production.  And, the patio is no longer littered with cow manure.  Biodigestors are relatively simple to construct and made with cheap local materials.” At the hospital, there is no shortage of cow manure.

Unforeseen Shortcomings of the Waste Management System – Part 3:

The final cost of this project was far greater than the expected/approved cost.  The system’s tangible goods include but are not limited to: a mid-sized room, an outbuilding attached to designated room, signage, waste buckets, 2 rolling waste trolleys, 2 autoclaves, digital thermometers, rubber gloves, landscaping tools, shelving, aprons, masks, trash bags, and 3 additional staff.

There is a recurring cost of autoclaving used needles pre-burial, and ideally there is sufficient electricity to run an electric autoclave.  However, from what a waste management staff member tells me, electricity is not available as often as you would think, and therefore they must occasionally run a generator to supply power to the autoclave (they now have the old hospital gasoline based generator for this).  At 150 rupees per liter (about 25% more than US prices) this practice can get a touch spendy to prep garbage before its buried.  The other option is to use the second autoclave, which is propane based, and which we have the supplies to run but propane is not cheap either.  The details of how often this autoclave is used and any particulars about this method were unfortunately lost in a series of conversational tangents.


When viewing the storage outbuilding for the sorted and baled recyclables, you cannot help but notice that each partitioned segment intended for a certain type of waste was overflowing; literally spilling over the top and now building up around the exterior of the shed and canteen building.  After a brief talk with the waste management staff, it came to my attention that the “business” from Dhangadhi has never come to hospital to pick up or purchase the processed material, despite being contacted on a regular basis.

As for the composting it has completely fallen into obscurity and I cannot even find the containers despite much searching.  The canteen staff now feed the cows with the compostable material.  The nonexistence of a garden may be my own failure, as I was asked to pursue it and make it happen.  I researched potential materials, costs, size, and the staff support surrounding the issue.  As for my findings about the cost/size: a small garden with fencing is not too expensive, and would cost less than $50  using locally available materials.  But to make a garden that could even remotely offset the cost of the kitchen would be out of my scope of practice, not being a gardener in the slightest, and from what I could speculate would be quite expensive compared with the cost of produce.  This also would require a fair amount of labor-hours to run and I didn’t dare suggest another staff member to add to recurring costs knowing it was a touchy subject.

The waste management staff does not use the designated rubber gloves to sort the waste.  These gloves must either be inferior in some way or must be regularly unavailable.  The sorting staffs seem to greatly prefer sterile surgical gloves instead.  At $3-5 a set, sterile gloves boost the cost of the program without even hitting waste management cost radar.  All modest efforts to redirect staff members back to using appropriate reusable cleaning gloves have been unsuccessful.  Without being able to understand the underlying reason for this behavior, no change can or will be made.

What was Learned Versus What was Gained – The Non-parted Segment:

In a nutshell, I feel as if this whole tale sums up the reality of being in Achham.  The plan, the construction, the well-intentioned improvement, all spiralling to a complete and utter standstill as dedicated volunteers leave semi-aborted projects behind and businesses fall through on agreements.  This is where I will stop with my own conclusions as I’m often told I should stop one sentence short of a complete thought.   Instead, I will add a few more bits of what I believe is speculative fact into this story.  As a true believer of the proverb “Don’t believe half of what you see and none of what you hear,” I’ve seen no better waste management system in all of Achham.  Although its just bundled up in bales sitting about the building, excess infectious waste isn’t anywhere to be found, nobody is hauling trash down to the river and dumping, the air doesn’t taste of smoldering plastics, ever.  Three local community members (actual locals, not transplants), of mixed castes now make a living by bettering their environment.  This is what I call public health net gain.