By Agnes Winarti
Published in Bali Daily/The Jakarta Post Wednesday, June 13 2012
The phasing-out of mercury-based equipment is proving to be an uphill struggle as it faces resistance from hospitals in Denpasar. This is despite the United Nations Environment Programme (UNEP) planning a global legally binding treaty on mercury.
In 2013, the UNEP expects to launch a global legally binding treaty on mercury to gradually terminate the use of mercury worldwide. The World Health Organization (WHO) and Health Care Without Harm have also targeted a 70 percent reduction in the usage of thermometers and sphygmomanometers at worldwide medical facilities by 2017.
“Resistance comes from some hospitals, as they argue that digital thermometers and sphygmomanometers are lacking in accuracy. Speaking subjectivity, the mercury-based blood pressure measurement tools are actually more subjective and less accurate due to mercury leakages inside the measurement tube that are often left unnoticed,” Bali-based environmental NGO Balifokus founder Yuyun Ismawati told Bali Daily recently.
For the past five years, Prima Medika private hospital in Denpasar has been promoting the use of digital thermometers to service patients. The hospital’s general affairs manager, Dr Dian Ekawati, said that currently some 80 percent of the thermometers used in the hospital were digital, while the remaining 20 percent were mercury-based.
“Digital thermometers are easier to use. When measuring patients’ temperatures with the mercury-based thermometers, we sometimes need to wait longer for the Hg movement,” said Dr. Dian.
“However, to monitor blood pressure we prefer using the mercury-based equipment, because when we are reading the blood pressure we also feel and listen
to the systolic and diastolic pressure [of the heart muscles when relaxing and contracting]. If we use a digital monitor we have to fully rely on the equipment, so the result is less convincing and sometimes erratic,” Dian added.
Sanitation coordinator at Bali’s top referral hospital, Sanglah, Ketut Gede Surata, acknowledged that the process of gradually ending the use of mercury equipment was a matter of changing the medical staffs’ behavior and mindset, which he said, “is not as easy as turning the palm of your hand”.
Money matters also speak volumes in hampering hospitals to terminate the use of mercury-based equipment.
“The purchase of the non-mercury equipment would cause a bulging allocation from the hospital budget. A mercury sphygmomanometer only costs between Rp 700,000 [US$74.2] to Rp 1 million, while the digital or aneroid ones are Rp 3 million to Rp 5 million,” said Surata, adding that Sanglah currently planned to reduce the use of mercury fluorescent lamps and was working on setting its own Standard Operational Procedure (SOP) to cope with the chance of mercury spills in the hospital’s compound.
Balifokus staffer specializing in toxic waste, Luh Putu Kusuma Ririen, said that all 20 hospitals in Denpasar had yet to have a special storage for their mercury waste due to budget constraints.
Yuyun highlighted that the mercury phase-out efforts were seen as disrupting the long-standing business cooperation between hospitals and vendors of mercury-based equipment.
“We hope the vendors are willing to share responsibility with the hospitals to recycle the waste from their products. Equipment vendors are only concerned with selling their products, but they have no idea what to do with their products’ waste,” said Surata, citing that Sanglah also faced confusion in dealing with its silver bromide liquid waste, which was the end-product of developing x-ray films.
Every month, Sanglah’s x-ray lab uses 60 liters of liquid and at the end of the month there is about 1.5 liters of silver bromide chemical waste. “There are currently about four cans, or 20 liters, of silver bromide chemical stored in our warehouse. We still don’t know what to do with it,” said Surata.
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