Research

Continued Medical Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil

Tara Rava Zolnikov,1 Background. Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas Daisy Ramirez-Ortiz,2 at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are Hayssa Moraes,3 Vanessa Resende a group of workers who, in addition to having a low socioeconomic status and residing in Nogueira Cruvinel,3 vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession Aldira Dominguez,3 puts individuals at risk, resulting in death, mutilation, and disease for workers. Dayani Galato,3 Objectives. The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks. 1 National University, San Diego, Methods. A qualitative study was conducted, using interviews with 34 participants at California, USA Estrutural. 2 Florida International University, Miami, Results. Collectors were exposed to several hazards, including biological, physical, and more Florida, USA extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was 3 University of Brasilia, Brasilia, Brazil not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, Corresponding author: homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries Tara Rava Zolnikov instead of seeking out proper medical care. [email protected] Conclusions. Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers. Participant Consent. Obtained Ethics Approval. This study was approved by the Research and Ethics Committee of the Introduction Health School of Brasília University under Opinion n. 1.517.670/2016. Competing Interests. The authors declare no competing financial interests. There are approximately 15 million Keywords. recyclable material collectors, recyclable collectors, healthcare waste, occupational people engaged in health and safety, qualitative research, Brazil worldwide.1 In low- and middle- Received May 20, 2019. Accepted June 11, 2019. income countries, recyclable collectors J Health Pollution 23: (190905) 2019 represent 1% of the urban workforce.1,2 © Pure Earth Data from two Latin American countries suggest that recyclable collectors account for 0.6% of the urban informal employment in Lima, Peru and 0.5% in Brazil.2 Although not recognized as a profession or as into issues of a safe environment for working part of the waste management system and recyclable waste collection for individuals.7,8 Second, in 2010, the in many countries, informal waste a number of reasons. First, Brazil is government created a strategy to collection serves as a sustainable the only country that systematically dismantle dump sites.5,9 The aim income generating activity that offers collects statistical data on recyclable was to decrease negative outcomes a livelihood for waste pickers and their collectors because it formally related to unsafe waste gathering families.3-5 legalized informal waste collection techniques. However, even though as a profession.6 ‘Recyclable material many sites are now officially closed, Informal recyclable waste collection collector’ is a profession recognized they continue to be worked in an accounts for a significant percentage by the Brazilian Ministry of Labor informal fashion, contributing to of urban employment in Brazil. The and Employment, which is tasked continued adverse health effects for situation in Brazil provides insight with guaranteeing the right to workers.5 The final reason Brazil’s

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waste management is important is Abbreviations because Brasilia, the capital of Brazil, currently has the largest dumpsite in PPE Personal protective the Americas, Estrutural. According equipment to the Brazilian Association of Public Sanitation and Special Residue Companies, approximately 30 million tons of garbage have accumulated in the dumpsite of Estrutural. Since the mid 1960’s, this site has received all solid waste produced in all the collectors in Brazil by strengthening in 12.5% of medical waste being Federal District; per data provided health and safety standards.14 disposed in dump sites and mixed by the technical directory of the together with other types of waste.23 Sanitation Department in 2014, Recyclable collectors in the informal Consequently, this may be a cause of this amount translates to about 860 sector experience increased occupational accidents and diseases 000 tons of waste annually.10 Thus, occupational health risks due to among informal waste collectors, who despite the national policy on solid direct contact with waste, manual are at a higher risk (compared to the waste, the governance enforcing handling, and lack of personal general population) of encountering dumpsites closures in Brazil, many of protective equipment (PPE).4,5 inadequately disposed medical waste.24 these dumpsites continue to operate Waste collection is linked to adverse Recyclable collectors are at risk of informally, including Estrutural, which health effects, including injuries (e.g. exposure either directly (e.g. syringe was ‘closed’ at the end of 2017.10 cuts), hearing loss, musculoskeletal puncturing skin) or indirectly (e.g. disorders, respiratory diseases (e.g. environmental, occupational, and food Te Brazilian national policy on bronchitis, pneumonia, allergies), skin factors).25 solid waste has drawn more visibility diseases (e.g. dermatitis, sun burn), to the sector, allowing communicable diseases (e.g. HIV/ Previous research studies conducted in the creation of cooperatives and AIDS, sexually transmitted infections, the recycling sector in Brazil have not associations, and several programs for hepatitis B and C), waterborne typically focused on the perceptions the recovery of recyclable waste.11 This diseases (e.g. dengue, leptospirosis, of the risks and hazards of waste situation can promote awareness and diarrhea), and psychological disorders pickers regarding work in unregulated decrease adverse effects in affected (e.g. depression, stress, anxiety).5,14,15 dumpsites and landfills. Since Brazil populations; however, the working and has recently officially closed all living conditions of informal waste One of the key contributors to this open-air dump sites, research could collectors have not actually improved, increased occupational risk is exposure be used to better understand the with the great majority operating to medical waste.16-19 Contact with health and safety risks associated without technical guidance from the medical waste improperly disposed of with waste collection in these newly local government and basic benefits by the healthcare industry can result informal sites. This information may of employment, and being poorly in exposure to biological, chemical, be essential to tailor the national compensated for recovered materials.12 radioactive and sharp objects.20-22 policy on solid waste to incorporate In fact, only 5% of waste collectors Among the most common objects the management of medical waste in Brazil have contracts and income responsible for these accidents are and integrate all groups of informal above the national minimum average.12 syringes, needles, glasses, spikes, and recyclable collectors, as well as to In the Federal District dumpsite, there objects that cause cuts and injuries. ensure adequate occupational health are about 1500 recyclable collectors In Brazil, despite the mandatory and safety standards in this work who are part of six associations for implementation of the medical waste setting and improve the efficiency of recyclable materials, although it is management plan in health-care waste collection methods in Brazil. estimated that 230 000 people work settings, very few establishments Thus, the objective of this qualitative as recyclable collectors (of all types currently comply with internal and study was to understand recyclable of waste) in Brazil.13 Although some external regulations for medical collectors’ risks, opinions, and progress has occurred, there is still waste management.23 This lack of perceptions regarding occupational a need to improve the health and universal compliance with the medical hazards, with a focus on medical waste working conditions of recyclable waste management plan has resulted in the Federal District in Brazil.

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Methods validity of the research. In this codebook; some examples of codes case, the researchers established included “safety,” “medical waste,” This study took place in 2016 in trustworthiness through credibility, and “treatment.” These characteristics Brasilia, Brazil at the Federal District multiple participant perspectives, were reviewed for themes and patterns waste site of Aterro Controlado do peer debriefing and review, reflexive to help understand the experiences Joquei. Participants were selected journaling, and field notes. The of the subject, as well as perceptions through convenience sampling, which interviews were conducted on an and other phenomena. Themes were was used to provide an adequate individual basis, which sought to then generated from the codebook; sample of person-time hours spent in provide a greater bond and trust these themes represented information the Federal District, age, and gender between the researcher and the supporting the experiences of waste differences. Inclusion criteria were that interviewee, who were from the pickers sorting through medical waste individuals must be over 18 years of age same city and communicated in in open air dumps. Themes were and be present at the waste site during the native language of Portuguese. then re-analyzed and verified by the interviews. The present research was Questions focused on experiences research team. approved by the Research and Ethics with waste picking, safety, access to Committee of the Health School of treatment, and ideas for improvement Results Brasília University under Opinion n. in the sector. Multiple participant 1.517.670/2016; all participants gave full perspectives were sought and females A total of 28 females and 6 males informed consent. and males of various ages were all (n=34) were interviewed by the included in the interview process. Peer Brazilian research team (e.g. principal In this area, recyclable collectors debriefing and review occurred before investigator, additional researchers, have historically gathered recyclable and after the development of interview and graduate school students). materials to sell to recycling companies questions and analysis of answers. The participants were garbage for profit. As such, the recyclable Reflexive journaling and field notes collectors who actively worked at collectors are exposed to a variety of occurred in the field diary, which was the dumpsite. A convenience sample garbage, as they sift through waste used to report on questions related was taken, although more females in search of recyclable goods. Semi- to field immersion and impressions were interviewed because the sector structured interviews of recyclable of each visited location. Supra- is comprised of a greater number of collectors were used to understand the segmental features such as pauses and women waste pickers. Most waste types of hazards associated with this silences were identified with a “+” in pickers were between the ages of 30 to recyclable waste collection. parentheses, vowel elongation was 39 years old (41%). Total time spent represented by colon; these behavioral working as a ranged from Qualitative methods were used in aspects can improve the analysis of 7 months to 40 years; work hours this study. Qualitative methods are an critical discourse. Nonverbal resources, averaged 8 hours per day at 6 days per important tool for researchers who are such as laughter, were also provided in week. In general, most participants seeking to understand deeper cultural the transcripts and were represented had low education levels (32% implications including multiple by double parentheses that were used were illiterate) and did not obtain a participant perspectives in varying to insert a comment on something that formal education (49% received an contexts.26 A phenomenological occurred during speech. elementary education and 17.5% went study was specifically used, which to high school). Most waste pickers seeks to understand the experiences All interviews were recorded, racially identified as “parda” (63%), of participants. The expectation was transcribed, and later analyzed. which is mixed Black and White, with that by interviewing participants and Codes were manually generated 25% identifying as Black and 11% teasing apart complexities amongst based on the conceptual framework identifying as White. self, others, culture, and environment, of a phenomenological study as a greater understanding of the described by Moustakas and from Through these interviews, substantial perspectives of waste pickers regarding the research questions.27 Codes information was gathered to provide occupational health hazards would be allowed the researcher to provide an accurate description of recyclable uncovered. direct and indirect information, collectors’ exposures to hazardous such as descriptions and quotes, to medical waste. Furthermore, In general, qualitative research support themes and patterns. Codes participants’ answers were similar must provide measures to ensure were generated and made into a for each question and did not

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introduce any additional information, on the day of the interview. “We find all the [stuff] that [you] confirming saturation of the study cannot even imagine. [We find] junk questions.27 The participants’ answers “… I punctured myself with a syringe like small fetuses and dead people. And highlighted environmental exposures because it came in an ordinary [white [other times], [we find] dirty things that collectors were often faced with trash bag from the supermarket].” with blood, urine sample containers, while working at the waste site. (Participant E-9) umbilical cords, and placentas full of Key concepts that developed and blood.” (Participant E-24) arose during the research analysis According to standards set forth by the became the main themes; these Brazilian legislation, common waste Slips, trips, and fall hazards themes focused mainly on continued should be appropriately packed in exposures and hazards in an industry black bags or according to regulations With workers focused on sorting, this that has effectively become illegal set forth by each district. Sharp objects could present a hazardous situation in Brazil (Supplemental Material). should be packed in hard-walled boxes that could result in injury or fatality This information suggests that both with the infectious symbol visually due to falls, trampling, and burial major and minor hazards are likely to placed on the outside; these boxes must by waste. Especially in landfills, this continue despite waste site closures. be leak-, puncture- and burst-resistant. situation can arise when recyclable While most recyclable collectors are collectors compete for space with Physical and biological exposures aware of these safety procedures, tractors and trucks while removing some participant responses confirmed and sorting garbage at the waste site. Occupational accidents experienced that they were unaware of the proper by recyclable collectors typically occur packaging and disposal of this type of “... we are in a hurry—there is no time because of the hazardous nature of the waste. Other studies confirmed that to talk, because if we talk, inattentively, work environment. Interviews detailed syringes are often placed in hard the machine [can run us over] (+). many accidents with sharp objects. bottles or milk cartons.28,30,31 These There was a friend of mine who’s dead These accidents occur because medical discrepancies can make it difficult to because the guy at the machine did not waste often contains syringes, scalpels, avoid hazards because of inconsistencies see her.” (Participant E-16) and needles. Syringes appeared to be in packaging and waste bag colors. the most common physical exposure This situation was also confirmed by for recyclable collectors. “They come in bags of all colors (+)… another participant who explained that we know that when it’s white, it’s from she was also hit by a tractor when she “I’ve been punctured here several the hospital. But the problem is that was not paying full attention to it. times—not just once. Here, everyone [syringes] come in bags of other colors gets punctured…” (Participant E-28) too. Here, they also come in plastic “… I was hit by a tractor [and it] bottles with the syringes inside; they crushed my leg… I was not paying Some participants spoke about the also come in milk cartons.” (Participant attention [and then] when I [finally] presence of syringes with the needle E-31) saw it, [my leg] was crushed. attached without the protective cover, [Afterwards], I fell into the slurry not only in medical waste, but in Recyclable collectors were also pond… I just did not die because my general trash as well. In general, this exposed to biological waste such as daughter—[when] I sank down [in the was found to be common practice in body parts, urine, blood and serum. water up] to my neck—she saw me and hospitals, as employees and patients “I’ve found medications and even pieces pulled me out.” (Participant E-23) alike mistakenly mix biological, of people, in fact this is common here.” chemical, and common waste (Participant E-1) Other participants In fact, from 2009 to 2014, there were together.28-32 These items caused many confirmed these biological exposures 14 accidents involving recyclable injuries to the workers, especially to and provide more detail on the types collectors in “Lixão da Estrutural” and the hands and upper extremities, as of waste. “… I have also seen colleagues 11 were related to trucks and tractors.33 well as near the feet and legs. Workers get contaminated with blood bags explained that “there are a lot here; I’ve and tubes of serum.” (Participant Personal protective equipment already [cut] myself with a syringe” E-12). Other participants provided and that they had “already cut [their] information on occupational biological One way to reduce exposure of finger”, suggesting that these injuries waste exposures. individuals to risk agents is to use were commonplace and had occurred PPE. This equipment could include

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gloves, goggles, sun-protection, [with gloves or glasses], [they only give medicine through a pharmacist. hardhats, protective clothing, and us] a few [pairs] or [sometimes] do not more. It was expected that some give them to us [at all].” (Participant “I poked the tip of my finger with a type of protection would be used by E-11) hospital needle... look at my swollen recyclable collectors in order to reduce finger. (+) [My friend] told me to go harmful exposures. In addition, it is Healthcare and homemade remedies to a hospital and I said, I’ll go to the also the responsibility of the Brazilian pharmacy [instead] and buy medicine Ministry of Labor to establish rules Some collectors understood the there [because] the pharmacist will give and regulations regarding workforce biological hazards associated with me the medicine.” (Participant E-24) health, while considering the unique sharps punctures and actively tried features or tasks of each sector (see: to minimize the risks associated Another solution to avoiding needle Article 200 of the Consolidation with sharp objects. Unfortunately, pricks was to throw the needles of Labor Laws). Under Brazilian sometimes these solutions did not “into the bushes” and at least avoid regulations, individuals are required work, and waste pickers were wounded personally stepping on them. to wear equipment that protects the as a result. Subsequently, individuals head, eyes and face, upper limbs, lower often resorted to self-treatment for “Sometimes the needles are facing limbs, core, skin, ears, lungs, and that injuries. Most of these solutions were upwards and it is the worse, because provides protection from falls. homemade remedies, such as saltwater it sticks in the foot of the colleagues.” and other concoctions. (Participant E-11) In the present study, PPE was reportedly used by most of the “When I opened [and reached in the Use of collected medical waste participants. However, the equipment trash bag], I punctured my finger... So, was inadequate and did not protect I pressed the finger [to stop the blood] Some collectors gathered or saw them from the danger of contact with and put [a mixture of] cachaça, lemon other workers gathering medicine sharp objects. Participants reported and salt on it—some people do that from waste for personal use or to sell. using rubber gloves which are not here.” (Participant E-11) These medications included diabetes suitable for the risks to which the medication, inflammation or pain recyclable collectors were exposed These individual solutions result in pills, vaginal ointment, and cancer because “they tear easily” (Participant individuals not accessing adequate medication. One reason mentioned for E-30). The specific type of gloves was preventive measures, such as the use using these drugs was “out of necessity” not described, so that information is of vaccines, serums or prophylactic (Participant E-34). The availability not provided. drugs. Some participants reported that of the medication and the timeliness seeking medical care would result in of encountering it appeared to be “... this one time, I felt that there was “lost time”, as the time spent waiting major reasons for the decision to self- something strange… when I pulled out for care in a healthcare setting would medicate. “I used a vaginal ointment my hand, there was a syringe stuck in mean lost work time at the waste site, that was sealed. I cut myself and my glove. So then, I took off the glove resulting in less pay. Others reported used it [as an ointment] on the cut.” [to remove it] and blood was coming that there were significant delays in (Participant E-2). Other participants out of my finger. I was so afraid, I care as well as social stigmatization on reported taking advantage of the started to tremble (+), but I kept behalf of the health professionals who convenience of found medication, working.” (Participant E-24) treated them. especially to aid with health issues they experienced while working at Cost and limited provisions were “... yesterday I got punctured with a the dumpsite. “When it’s not out of barriers to obtaining and using needle. It didn’t have blood [on it]... I date, yes [I take it]. What I found was appropriate equipment for protection. think it was serum. But I did not seek an anti-inflammatory for pain… I assistance. … We do not even have have a lot of pain here in [my] back.” “… here we receive two gloves every time to go, because when we get [to the (Participant E-28) 15 days; if one rips, we use the other.” hospital] it takes too long to be seen [by (Participant E-30) a physician].” (Participant E-10) Other participants reported profiting from finding medicine and then selling “The gloves are expensive, the glasses Instead of receiving care at a hospital, it. “Some people take the expired drugs are expensive. When they do provide us collectors self-medicated or received or also sell [them]; sometimes, they

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[even] find sealed packages to sell.” (Participant E-8)

Perception of risk

Many workers understood the danger posed by encountering medical waste, particularly because of their potential exposure to contaminated syringes. However, they lack knowledge of all of the risks and consequences associated with exposure to medical hazards.

“…we do not have much knowledge, but we are thinking about the patients who use it [the syringes], if it comes contaminated and we are stuck, it is a huge risk. …the work we do is already very harmful.” (Participant E-22) Figure 1 — Recyclable waste collectors sorting through waste in Estrutural, Another participant described how Brasilia, Brazil, June, 2016. Published with permission. exposures might affect the health of workers in this sector. “I think it’s bad [being exposed to medical waste] and sometimes it’s dangerous, but sometimes instead of determining occupational collectors are a population that is it’s not dangerous.” (Participant E-20). exposures.34,35 The present qualitative particularly vulnerable to occupational This perception seemed to indicate research study sought to understand and environmental hazards, and are a neutral attitude towards waste the hazards, medical exposures, risks, therefore susceptible to accidents and exposures and their effects, despite and treatment choices directly from the effects of work site exposures.36 knowledge of some of the hazards waste pickers. involved. This research identified key In addition, since this site was officially information on the type of hazards “[I know people] who use syringes that closed in late 2017, it is important that collectors may be exposed to, have AIDS. We [should] get scared, to highlight the working conditions especially regarding medical waste right? [But, we don’t know if syringes] of a population that is not currently and wounds from syringes. Hazards are contaminated or not.” (Participant supported by national workforce primarily included pricks from needles E-21) governmental standards or treated as a and syringes. These pricks can cause recognized working class. Participant exposure to a variety of biological Discussion responses provide further insight on hazards (e.g. HIV/AIDS).37-39 There are specific occupational exposures that multiple reasons for these exposures, Recyclable collectors are a group continue to be threats for recyclable including worker complacency, as of individuals who make a living collectors, ways in which workers well as inadequate disposal of medical by sorting through waste to find address these hazards, barriers to waste in common garbage, that put recyclable goods, which are then accessing healthcare or treatment, collectors at risk. This information traded in for money. Te waste and suggestions for improving confirms the need for solutions to presents many occupational hazards work conditions (Figure 1). Since mitigate these types of exposure. (e.g. needle sticks), and exposures this type of work continues despite occur when sifting through garbage. governmental shutdowns of sites, it One important mitigation step is Previous research has reviewed health is imperative that other organizations the use of PPE. However, the use of outcomes among collectors, but has (e.g. academic, nonprofit, etc.) work such equipment does not completely primarily focused on solutions to to create safer work environments prevent the occurrence of accidents, prevent these hazards, such as PPE, for waste collectors. Recyclable it only minimizes direct contact of

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collectors with hazardous waste. In equality (e.g. access to healthcare and new points of collection of sharp an earlier study conducted in the standards) set forth by governmental objects have already been installed. Federal District, it was found that the regulations. By acknowledging The program provides insulin users frequency of occupational accidents recyclable collection as a profession by with a home collector that must was higher among those who reported the government, one major gain is that be stored in a safe place and then using some type of PPE, and one workers could have improved access to discarded in specific collectors reasonable explanation could be and better treatment from healthcare provided by the program.45 However, due to the quality of the equipment services, which was reported as an there are barriers that prevent (e.g. old disposable gloves) used by issue by the recyclable collectors.42 significant advances in medical collectors.40 Most recyclable collectors As reported by respondents, workers waste disposal, including lack of reported using some type of PPE, who had accidents with sharp objects governmental pressure to administer but others gave reasons for not using often did not seek medical care or these changes, lack of attention by this equipment, such as the fragility testing, possibly demonstrating a public authorities on health issues of gloves against contact with sharp lack of education about the risks of in the waste sector, lack of technical objects, difficulty of handling waste contracting diseases or the denial of training on solid waste management materials, the high cost of appropriate risks. Respondents also mentioned and urban cleaning systems, and few gloves, and limited provision of that they often do not seek care research centers examining issues of equipment by the government. because they do not want to take time municipal solid waste.37 The current Requiring recyclable collectors to wear off from working, as this would lead programs working to make medical PPE (e.g. sturdy gloves, hats, boots, to lost wages.42 This can be addressed waste disposal safe could be reviewed, long-sleeved clothing, goggles) does by creating an official space for waste enhanced, and redistributed to not solve the problem of hazardous pickers to work. decrease hazards in target groups, such working conditions at dump sites, as waste pickers. however, providing more education Third, initiatives need to be developed and monitoring may contribute to encourage people to practice proper Possible limitations to the study to increased worker safety. Te disposal of health services waste. included social desirability and government of Brazil supports the use Currently, only 10.5% of medical translation errors. Social desirability is of gloves by distributing them to waste waste with sharps disposal are stored a bias that suggests participants may pickers, but this outreach could by appropriately in plastic containers.28 respond in a manner that is suitable to improved by adding more equipment Correct disposal practices should the researchers, seeking to be viewed and education to encourage the use of be taught and encouraged by health favorably. This may result in under PPE. services professionals, as they seek reporting to avoid persecution or to increase safety in the handling of pity from the researcher. Translation Second, this informal occupation these types of waste. In particular, errors could also have occurred when should be treated as an actual healthcare waste should be segregated the transcript was translated from profession. This has been partly and disposed of separately from Portuguese to English. In addition, implemented by the government, common waste. Tere are programs in the interviews were conducted in as official sorting facilities, known place throughout Brazil that encourage one specific location, and therefore, as selective collection centers, have safe disposal practices. In Jaraguá do information that was gathered may uprooted many waste pickers from Sul, Santa Catarina, the Basic Health not be generalizable or transferable informal open-air dumps to formal Units promote campaigns to educate to all people who work in dump site work settings. These actions have insulin users about the importance of waste collection. Finally, non-response occurred because of Brazil’s adherence proper disposal of these materials.43 bias should be noted, as people who to the Business Commitment to In Uberaba, Minas Gerais, patients participate in research are inherently Recycling regulations (Compromisso are advised to deliver needles and different from those who do not, and Empresarial para a Reciclamen); as a syringes in appropriate industrialized this may have affected the results. result, fences have been built around containers or use packaging that has open dump sites, entrances have been a lid, such as a powdered milk can, As the study site is the largest waste identified, slurry and burn off gas a mayonnaise container, or plastic site in Brazil, the present study has been drained, and landfill sites bottles.44 The “Conscious Disposal” provides insight into similar or smaller have been established.41 This type program has expanded its waste scale dump sites around the world. The of movement may help to ensure collection services; in Porto Alegre, results may be generalizable to workers

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who experience similar types of waste population. of change.13 Addressing issues faced collection hazards, such as E-waste by waste pickers can improve many sifters who may encounter sharp wires. Measures to mitigate these aspects of their lives. Ultimately, occupational exposures include these findings demonstrate that it is Future research could examine providing proper PPE, improving of utmost importance to create a safe differences in recyclable collectors access to healthcare, increased working environment for recyclable versus special materials collectors education on workplace hazards (e.g. collectors worldwide to address these as well as gather quantitative data in biological risks), and government occupational hazards and to foster fair order to quantify the results of the support for upholding occupational labor standards. present study. This information could health and safety standards in this provide a more comprehensive view work setting. Unfortunately, it is Acknowledgements on hazards experienced by waste unlikely that there will be increased The authors would like to thank all pickers around the world. government support in this setting, of the participants who volunteered as many of these sites are now illegal for this study. The authors would also Conclusions or officially “closed” in Brazil. As is like to thank the reviewers for their apparent by the continued work of critical insight and comments on this Informal waste management in Brazil recyclable collectors, these closures do manuscript. The author(s) received has officially come to an end with not impede workers from continuing no financial support for the research, the formal closing of all dumpsites using these sites, as it remains one of authorship, and/or publication of this throughout the country. The Brazilian the only livelihood options for many article. government has created formal people.1 To change this scenario, working spaces for garbage sorting workers must become organized and Copyright Policy and distributes PPE (e.g. gloves). demand governmental support and This is an Open Access article Unfortunately, despite these actions, social protection. However, because distributed in accordance with recyclable waste collectors continue recyclable waste collectors have not Creative Commons Attribution to work and face occupational historically demanded these rights, License (http://creativecommons.org/ hazards associated with their informal the government should be aware of licenses/by/3.0/). occupations. One major hazard the benefits than can occur from encountered by recyclable collectors formalization or legalization of is encountering sharp objects while recycling activities. Legalizing and sorting. These sharp objects, typically regulating recyclable waste collection from medical waste, can result can aid in reducing poverty through in physical injury and biological maintained jobs, decreased costs exposures. Waste collectors are at risk of recycling for municipalities, and References due to improper waste disposal at conserved and protected natural 1 healthcare facilities, a need to work resources. Other areas that can aid 1. Medina M. The informal recycling sector in quickly to avoid other more serious in creating changes in this space developing countries: organizing waste pickers to hazards (e.g. being run-over by include organizational support. enhance their impact [Internet]. Washington, D.C.: dump trucks), complacency or poor For example, Women in Informal The World Bank; 2008 Oct [cited 2018 Mar 26]. education on the use of proper PPE, Employment: Globalizing and Available from: http://documents.worldbank.org/ and lack of acknowledgement of the Organizing is a network comprised of curated/en/227581468156575228/pdf/472210BRI0Box profession by government officials and individuals and institutions that use 31ing1sectors01PUBLIC1.pdf healthcare workers (e.g. physicians). data and research to provide services 2. Dias SM. Statistics on waste pickers in Brazil The results of the present study or shape policies to help empower [Internet]. Manchester, UK: Women in Informal confirm the barriers surrounding workers in informal industries. This Employment: Globalizing and Organizing; 2011 recyclable collectors to seeking organization has worked with waste May [cited 2018 Mar 26]. Available from: http:// treatment for injuries associated with pickers in Brazil to create frameworks www.wiego.org/sites/default/files/publications/files/ garbage sifting. Recyclable collectors for hiring waste pickers outside of Dias_WIEGO_SB2.pdf often face social stigmatization and informal employment, negotiated 3. Linzner R, Lange U. Role and size of informal are frequently overlooked by policy with policymakers and municipalities sector in waste management: a review. Proc Inst Civ measures to improve the working on improving waste pickers income Eng Waste Resour Manag [Internet]. 2013 May [cited conditions and livelihood of this and quality of life, and other areas 2019 Jun 12];166(2):69-83. Available from: https://doi.

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org/10.1680/warm.12.00012 Subscription required 2018 Mar 26]. Available from: http://www.wiego.org/ provides other measures]. Brasilia, Brazil: Conselho to view. informal-economy/occupational-groups/waste-pickers Nacional do Meio Ambiente (CONAMA); 2005. 4. Wilson DC, Velis C, Cheeseman C. Role of 14. Gutberlet J, Baeder AM, Pontuschka NN, Portuguese. informal sector recycling in waste management in Felipone SM, Dos Santos TL. Participatory research 22. da Silva CE, Hoppe AE. Diagnóstico dos resíduos developing countries. Habitat Int [Internet]. 2006 revealing the work and occupational health hazards de serviços de saúde no interior do Rio Grande Dec [cited 2019 Jun 12];30(4):797-808. Available of cooperative recyclers in Brazil. Int J Environ Res do Sul [Diagnosis of medical in central Rio from: https://doi.org/10.1016/j.habitatint.2005.09.005 Public Health [Internet]. 2013 Sep 27 [cited 2019 Grande do Sul State]. Eng Sanit Ambient. 2005 Apr- Subscription required to view. 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