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Viewing cable 07HANOI1794, VIETNAM STRUGGLES TO MANAGE MEDICAL WASTE

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Reference ID Created Released Classification Origin
07HANOI1794 2007-10-15 05:57 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Hanoi
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