Intervention Mercury Healthcare
Toxics Link has been working continuously on the issue of mercury since 2003, starting with the publication of the report “Mercury in India, Toxic Pathways” for the UNEP based global mercury assessment. Since then it has worked extensively both in India as well as with partners regionally and internationally, to help reduce its use in various sectors like health care and lighting, to raise public awareness, and to conduct research about its impacts on food (fish, water) and the environment. Toxic Link was part of negotiation process in INC since the negotiation started as NGOs representative and has worked closely with Ministry of Environment and Central Pollution Control Board on many occasions. Toxics Link’s intervention on mercury is largely divided in two categories – a) Research & Advocacy and b) Training & Capacity Building.
The studies conducted on mercury in healthcare during all these years were majorly covered the healthcare instruments & dental amalgam. Both the areas were focused with two way approach. One is through research & advocacy and another is through training programs.
a) Research & Advocacy
1. Mercury in health care instruments:
Fever thermometers and sphygmomanometers are used in all healthcare settings across the globe. Elemental mercury (Hg80), which is used in these instruments, is in liquid state at room temperature and pressure. There is a high risk of breakage of these instruments leading to the release of Hg, because in both the cases the Hg columns are made of glass.
Toxics Link conducted primary and secondary research through engaging with different stakeholders. The first study report ‘Lurking Menace’ came in the year 2004 which depicted the fact that, a medium sized hospital (300-350 bedded) with a dental wing can generate approximately 3 kg of mercury annually.
In continuation to this study, another attempt was taken in 2007 when major focus was on the presence of mercury in hospital indoor air, clinics and labs. It was found that there is significant exposure to doctors, nurses, other health care workers and patients through elemental mercury. The details are available here “Mercury in Hospital Indoor Air ”.
Toxics link conducted a study on presence of mercury in healthcare instruments (Sphygmomanometers and thermometers.) and came up with these two reports “Moving towards mercury free healthcare ” in 2009 and “Estimation of mercury usage and release from healthcare instruments in India ” in 2011. According to these studies, the total amount of estimated Hg released through healthcare instruments in India is eight tons in which the share of Hg in thermometers and sphygmomanometers is 31 percent and 69 percent respectively.
Our latest report in 2014 called “Mercury free India – Right Choices ” was an effort to suggest a possible roadmap for mercury reduction and its ultimate elimination in India. This actually focused on phasing out mercury in India in line of its signing the globally binding treaty called “Minamata Convention”.
Followed by this study, another attempt was taken in 2007 in the form of another report named “Mercury in Hospital Indoor Air” where major focus was on the issue of mercury spills in hospitals, clinics and labs and through that exposure to doctors, nurses, other health care workers and patients to elemental mercury.
2. Mercury in dental amalgams
The second highest consumer of Hg in the health care sector after health care instruments is dental restorations. Dental amalgam contains about 50 % mercury, as well as other toxic metals such as tin, copper, nickel, palladium, etc. The contact amalgam (generated due to removal of old fillings and due to polishing of the new ones) and the residual non-contact amalgam (the amalgam which has been prepared but never gets filled) gets thrown into the bins or goes to the sewer or emitted into the air during the procedure of dental restoration.
Toxics Link conducted research on this issue and came up with a report in the year 2012 named ‘Mercury in our mouth’ According to this report there are two types of amalgam i.e. a. Contact amalgam & b. Non-contact amalgam. The disposal of amalgam depends on how it was used. The excess amalgam that is unused after a tooth is filled is called ‘non-contact’ amalgam: it was never placed into a tooth and was never in contact with any human tissue. As much as up to 15-50% of the amalgam may remain unused after the use. Contact amalgam is amalgam that has been in contact with human teeth or tissue. Processes like replacing amalgam fillings, polishing a fresh amalgam filling to remove the excess amalgam can generate contact amalgam.
Mercury based dental fillings has prominent impacts on the health of people and the mercury emissions caused due to cremation of such people also has serious effects on the environment. The estimated annual use of mercury in dental sector in India stands around 65 tons, where 49 tons gets into cavities and 16.2 tons is mostly thrown into the environment as non-contact amalgam
(Source: http://toxicslink.org/docs/bmw/MercuryCamp/Mercury_in_Our_Mouth.pdf)
To further substantiate this study, Toxics Link tried to assess the position of the dental sector for its preparedness to deal with the issues of mercury pollution. Recently, a survey was conducted among dental practitioners covering the states of Delhi, Uttar Pradesh, Haryana, Karnataka & Tamil Nadu. A total of 24 healthcare facilities were covered (including dental colleges and hospitals with a dental wing). The survey was intended to assess the various aspects, including
1. The acceptability and availability of mercury alternates on the ground
2. Policy level changes required by the Indian Dental sector to get synchronized with the Minamata Treaty
3. Preparedness of this sector to deal with mercury pollution
4. Emerging trends in this sector
The study revealed thatthere is a considerable shift in the filling material used in the country. Increasingly people have moved away from mercury fillings to the composites, owing to aesthetic reasons. Reduced cost discrepancy between the two materials, increased life and stability of alternate fillings and increased awareness about mercury toxicity has all resulted into this shift.
b) Training & Capacity Building
Following the secondary research various workshops were also conducted in association with local NGOs in the state of Gujarat, Meghalaya, Assam, Manipur, Punjab (Amritsar,Ludhiana), Tamil Nadu, Kerala and Andhra Pradesh on the issue of phasing out mercury from their respective healthcare sectors. In Delhi Toxics Link convinced the Central Pollution Control Board (CPCB) to come up mercury phase out orders. The SPCBs, Hospital Managements, Doctors, Nurses and other stakeholders like the Indian Medical Association (IMA) and its state chapters were also actively involved in these workshops. The partner NGOs trained hospitals to become models in the management of mercury in their respective states.
Manipur, Punjab, Delhi, Hubli Dharwad municipal corporation and Ministry of Health, Govt. of India under the Central Government Health Scheme (CGHS) issued mercury phase out orders due to our interventions. Trainings on mercury toxicity awareness have been conducted in healthcare facilities of 16 states in India till date. Target groups for these trainings included doctors, administrators, nurses and other class IV employees.
Major achievements
1. Hospitals in Delhi, both government and private, shifted from mercury-based thermometers and Sphygmomanometers
to alternates
2. Delhi Government issued instructions for procurement of only non-mercury measuring instruments for the hospital
3. States of Punjab and Manipur issued instructions for phasing out of mercury-based healthcare instruments. Under the
similar kind of intervention in Hubli Dharwad Municipal Corporation (HDMC), a mercury phase out order was passed by
HDMC for all the health care facilities under them.
4. CPCB issued guidelines for storage of surplus mercury-based measuring instruments