Cablegate: Vietnam Struggles to Manage Medical Waste

VZCZCXRO9290
RR RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1794/01 2880557
ZNR UUUUU ZZH
R 150557Z OCT 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6513
INFO RUEHHM/AMCONSUL HO CHI MINH 3801
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHC/DEPT OF INTERIOR WASHINGTON DC
RUEAWJA/DEPT OF JUSTICE WASHINGTON DC
RUCPDOC/DEPT OF COMMERCE WASHINGTON DC
RHMFIUU/HQ EPA WASHINGTON DC

UNCLAS SECTION 01 OF 02 HANOI 001794

SIPDIS

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: SENV TBIO ECON SOCI VM
SUBJECT: VIETNAM STRUGGLES TO MANAGE MEDICAL WASTE

REF: HANOI 1706

HANOI 00001794 001.2 OF 002

1. (SBU) Summary. A recent scandal involving the improper disposal
of medical waste from Hanoi area hospitals highlights Vietnam's weak
waste control infrastructure. While prominent press attention led
to a quick GVN response, small penalties, limited enforcement
capabilities and lack of funding for needed technological upgrades
ensure that hospitals will continue to struggle to manage increasing
amounts of medical wastes. End Summary.

Widespread Improper Hospital Waste Recycling
--------------------------------------------

2. (U) Over the past month, the local media reported that Hanoi-area
hospitals sold medical waste that was then improperly recycled into
consumer products. Inspections by the Vietnam Environmental
Protection Agency (VEPA) and the Vietnam Environmental Police
Department (EPD) uncovered the delivery of nearly one ton of
unsterilized waste, including used medicine bottles, syringes, and
intravenous tubing, from Viet Duc hospital, Hanoi's main trauma
center, to local recyclers for processing into various household
appliances. The EPD concluded that medical waste sales from Viet
Duc totaled over 50 tons, though one trader implicated in the
transaction noted that she had purchased approximately 200 - 300
tons of waste from the hospital since 2002. Contractors for the
hospital's counter-bacterial contamination faculty, which supervises
the hospital's waste processing, sold the materials at VND 1,500-
6,000 (.10 to .35 USD) per kilogram. A local newspaper also
implicated Bach Mai hospital in Hanoi, northern Vietnam's primary
facility for avian influenza treatment, in a similar garbage-selling
scheme.

Hospital Wastes Should Be Managed Properly . . .
--------------------------------------------- ---

3. (U) Medical wastes often carry various potentially-dangerous
bacteria and viruses and, pursuant to GVN regulations, must be
classified, preserved, and managed. The MOH and Ministry of Natural
Resources and Environment (MONRE) share responsibility generally for
waste management. MOH has the lead on medical waste, but
coordinates with MONRE. Article 39 of the Environment Protection
Law of Vietnam, effective as of July 2006, stipulates that all types
of waste coming from patients must be preliminarily processed to
eliminate potentially infectious disease germs before delivery to
concentrated processing establishments.

. . . But Rarely Are
--------------------

4. (SBU) Until now, neither hospitals nor the GVN has had the
ability to properly manage medical waste. While GVN law only allows
entities with hazardous waste processing permits to transport and
process medical waste, Colonel Luong Minh Thao, Deputy Director
General of the EPD, recently told ESTHOff that most hospitals sell
waste for recycling. According to the Ministry of Health (MOH),
hospitals and health care units each year discard more than 400 tons
of solid waste, one tenth of which is classified as hazardous. Only
one third of the total is burned in modern incinerators with the
remainder placed in outdoor fires, buried underground, directly sent
to common garbage dumps, or sold.

5. (SBU) According Dr. Nguyen Khac Hai from the National Institute
of Occupational and Environmental Health (NIOEH), the GVN and
provincial Peoples' Committees will not take health funds from
patient care or medical professional compensation and health care
institutions do not consider waste processing a priority. The GVN
has found it difficult to implement Article 39 and Dr. Hai expects
amendments this year. Few hospitals have proper treatment equipment
or staff specialized in operating the waste processing stations.
Even those that have trained staff or adequate equipment often do
not operate the equipment due to the high costs of electricity or
chemicals used in the treatment process. While MOH claims that some
60 central and provincial level hospitals have waste incinerators,
many of these incinerators are ineffective due to poor burning
capacity, high levels of emissions and large energy consumption.
Further, the NIOEH recently found that hospital wastewater contains
high levels of pollutants, including bacteria such as E. coli.
However, only one third of the over 1,000 hospitals in Vietnam have
waste water processing systems, most of which do not operate
effectively.

Enforcement (What Else?) Remains A Problem
------------------------------------------

6. (SBU) Though the recent VEPA/EPD investigation shows increasing
GVN attention to the issue, penalties remain low and are not likely

HANOI 00001794 002.2 OF 002

to deter misconduct. Authorities recently subjected violating
hospitals to 20 million dong (approximately USD 1250) administrative
fines. Despite the lengthy and large-scale of the violations, Col.
Thao from EPD asserted they reflected the actions of a few
individuals seeking monetary gain, not a high-level conspiracy to
avoid waste management requirements. According to Thao, the
hospitals fired directly implicated individuals, but did not pursue
supervisory personnel. Director Hai from NIOEH noted that the newly
created EPD (reftel) still does not fully comprehend its enforcement
capabilities.

GVN Looking for Comprehensive Solutions
---------------------------------------

7. (SBU) In response to the hospital waste scandal, MOH created two
multi-agency investigatory delegations to travel throughout the
country to check compliance at provincial and district hospitals.
MOH plans to strengthen supervision of hospitals to ensure that
proper processing of medical waste and prevent improper sales and
just adopted a 10 billion dong (approximately USD 625,000) national
program to better manage and process medical wastes. By 2010, all
hospitals (over 1,030 existing large and small institutions, plus
any newly constructed hospitals, as well as private clinics) should
have solid waste processing systems and waste-water treatment
facilities. The GVN continues to build large incinerators to
concentrate waste from many hospitals (though this requires
transportation and storage of wastes and incineration causes a
variety of other pollutants, including dioxins). EPD plans to begin
recommending criminal prosecution for improper disposal of medical
wastes. NIOEH is planning to partner with Environmental and
Chemical Safety Educational Institute, a U.S. NGO, to better train
hospital staff in waste disposal techniques and possibly look at
U.S. waste management technologies.

Opportunity for U.S. Waste Management Sector
--------------------------------------------

8. (SBU) Hospital waste management difficulties are only one of many
growing pollution control problems facing Vietnam and are indicative
of the regulatory, informational, and resource challenges the
country faces in limiting environmental degradation from economic
growth and industrialization. The GVN at least recognizes this
problem and is searching for answers. NIOEH's interest in U.S.
waste management expertise provides the U.S. with an opportunity to
bolster Vietnamese capabilities. We recommend that U.S.
environmental and trade promotion agencies highlight U.S. medical
waste management technologies and services.

Comment
-------

9. (SBU) Vietnamese medical waste management must be seen in the
context of overall waste management practices. Vietnam "recycles"
nearly all waste through formal and informal networks of workers who
collect, sort, and redistribute discarded material for profit. From
an efficiency perspective, the waste management market generally
functions smoothly. From a health or environmental perspective, the
market is riddled by externalities - wide-spread pollution and
threats of disease and illness caused by improperly managed
materials. In addition to improved waste management technology,
Vietnam needs to change societal norms towards waste creation and
treatment and must increase enforcement to internalize the
environmental and health costs of improper hospital waste
management.

ALOISI

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