Baganuur Hospital in critical condition

MP Ts.Oyungerel speaking with Baganuur Hospital staff


Member of Parliament Ts.Oyungerel visited Baganuur District’s central hospital, water treatment plant, and waste disposal facility last week for reserarch for her draft law on waste disposal. The law is expected to be submitted to Parliament in May.
“There is a great risk of the sudden outbreak of contagious diseases related to the problems with waste management. Therefore, we have to know where we have buried this waste, how much waste is buried, and how to prevent outbreaks of disease. These have to be regulated by the law,” MP Ts.Oyungerel highlighted.
The MP also noted that the recent state distribution of land and increased construction due to rapid economic growth might pose hidden dangers related to waste management.
“There is a lot of land being distributed and sold, and people build anywhere they like. What if someone digs up this buried waste during construction and sets off an outbreak?” she added.
Ts.Oyungerel brought experts, legal advisors and the press along to the visit to Baganuur, 138 km from the nearest Ulaanbaatar district, to assist her in drafting the law and to bring awareness of waste disposal issues to the public.
The most pressing waste disposal problems in Baganuur District, with a population of over 27,000 as of January 2013, were discovered at the district’s central hospital.
According to Baganuur Central Hospital Director Enkhbayar, the hospital has major issues in the disposal of medical waste such as syringes and single use materials used by patients, as well as liquid and solid waste.
“We need reconstruction of the water treatment system, because liquid waste coming out of hospitals has to go through a special treatment system before being drained to the central treatment plant, as it might contain hazardous elements,” explained Enkhbayar. “This system is located in a special building, but the treatment process stopped because of technical failures seven or eight years ago. There is remaining sludge left in the system because of the failure. The amount is critical and must be addressed swiftly, or it could stop the whole hospital’s operations.”
To resolve the issue, the hospital director proposed cleaning out the entire sewage system and replacing it with a new one, as the old ones pipes are blocked and have never been cleaned before.
“Other hospitals have these pipes cleaned once or twice an year, but our hospital has never done this because there are no experts on waste disposal and management here. When there are problems with the sewage pipes, only plumbers are sent down to solve the issue,” Enkhbayar said.
In response, MP Ts.Oyungerel said, “In the law, we want to state that if an organization houses a sewage tank, they have to know its precise location on a map, clean and sterilize the tanks, and take preventative measures to ensure that no hazardous waste leaks into the environment. Medical waste treatment tanks seem most dangerous to me.”
“I have visited the Khan-Uul District Hospital and their waste tanks were full and overflowing, and they wanted to bury the tanks as they were. It seems to me that all the dangerous waste is being dumped straight into the environment, which has the potential to cause any number of disease outbreaks,” she added.
The disposal of used medical supplies, especially from infectious disease wards, are also causing major issues at the hospital.
“Most urgently, we need an autoclave to sterilize equipment and supplies with high pressure, saturated steam. We currently use a combustion method to dispose of used medical supplies, which is not consistent with standards because it pollutes the surrounding air. Syringes, needles, cotton balls, gloves and other single-use supplies have to be sterilized by autoclave and then crushed before being disposed of,” explained Dr. Gerlee of Baganuur Hospital.
The medical staff who met MP Ts.Oyungerel all noted that supplies for disposing of medical waste are insufficient, as the hospital’s budget is unable to cover the costs.
“In 2014, our budget was 391 million MNT, but it was reduced to 324 million MNT in 2015. Our workload has increased in these last few years, but the budget has decreased. We aren’t able to address these disposal issues and other finer matters because we are more concerned with making do with what we have on a daily basis,” said Enkhbayar.
According to the director of the hospital, the poor financial management system has “truly crippled” the hospital’s operations.
“We receive 75 percent of our funding from the Health Insurance Fund, but they give us funding on the principle that we treat patients first, to justify the receiving of funds. We don’t want to do this. We want our load to be as light as possible. But we are given financing after we use medicine and supplies for patients. We need to make this more flexible,” he argued.
The hospital staff also notified MP Ts.Oyungerel about more issues that are related to poor financial structure, such as three patients who had kidney removal surgeries who weren’t able to receive proper treatment at their local hospital, the closing of their laboratory, and a broken X-ray machine leaking radiation.
Enkhbayar also noted that the cleaning and washing of medical staff and patient clothing and sheets is an issue of concern. “Although we have been given 79 million MNT in laundry equipment, it’s not being used because the machines requires much higher voltage than the hospital can provide… We asked the ministry to give this equipment to places that need it so we can get the equipment that we need, but this has not been resolved,” Enkhbayar said
As the tour of the hospital continued, what was clearly visible was decades of neglect. The hospital’s main infrastructure was built in the Soviet era, in the 1980s, and major changes hadn’t been made since. The water treatment system of the hospital had obviously not been used, or visited in many years. Dust, debris, and damp air greeted us at the facilities. The main waste pipe was blocked with thick dried sludge as hard as concrete. A plastic overhead pipe had been set up and held with thin rope across the ceiling. The hospital director informed that the overhead plastic waste pipe fell one time and caused a massive leak.
The laundry facility was heavily used but most of the equipment was either broken or poorly patched up. Pediatric, maternal and infections disease ward sheets and clothing had separate washing machines, all made in 1983, but two were broken. The central washing machine was working, but a part of the laundry was being done by hand in two bath tubs filled with bleach. The 79 million MNT washing machine was at the laundry facility, unused.
After seeing the issues firsthand, MP Ts.Oyungerel underlined the threat that poor waste management poses to society and the need for addressing the issue immediately.
“These waste disposal issues never occurred in Mongolia before because there was no centralization. There were no waste and water treatment plants, there was no collection of waste that turning into biological time bombs. Now it’s like every street faces this risk, as well as every hospital and every place that collects waste. If this whole waste management issue isn’t addressed through the law, through its entire cycle, this will cause major problems in the future,” she concluded.

More on waste disposal issues will be published on Wednesday and Friday

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