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Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil

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Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil Research Continued Medical Waste 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 waste collection 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 waste management 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 1 Journal of Health & Pollution Vol. 9, No. 23 — September 2019 Zolnikov et al Research Medical Waste Exposure of Recyclable Collectors in Brazil 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 The Brazilian national policy on bronchitis, pneumonia, allergies), skin factors).25 solid waste has drawn more visibility diseases (e.g. dermatitis, sun burn), to the recycling 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. 2 Zolnikov et al Journal of Health & Pollution Vol. 9, No. 23 — September 2019 Research 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
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