The UST Hospital has formed a team to begin phasing out of mercury, complying with an order from the Department of Health (DOH) to phase out mercury in all Philippine healthcare facilities and institutions.
The hospital’s Mercury Management Team is tasked to identify all the uses and sources of mercury, create a mercury minimization program to lessen the use of mercury-containing devices, require suppliers to disclose mercury content in their products, and remove unnecessary practices requiring the use and distribution of devices containing mercury.
Hospital medical director Dr. Mateo Bagsic said, the Mercury Management Team was ahead of its six-month implementation deadline.
“Even before the directive of the DOH, the hospital has already been minimizing the use of mercurial products since this is a worldwide concern,” Bagsic said. “But when the directive finally came, we started with the documentation or inventory of all mercury-containing devices allowing us to be ahead of our deadline.”
Controlling mercury
DOH’s Administrative Order 0021 was issued by Health Secretary Francisco Duque III to raise awareness on the dangers of mercury, develop a clear preference for the use of alternatives to mercury-containing devices among health care personnel, and prevent further mercury exposure to the environment.
The committee that drafted the order was headed by Dr. Edwin Sanchez, Director III of the DOH National Center for Health Facility Development.
Highly toxic and volatile, mercury is a natural metal that is fatal if inhaled and absorbed by the skin. Exposure to the liquid metal may lead to tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, developmental deficits during fetal development, and attention deficit and developmental delays during childhood.
According to the World Health Organization (WHO), health care facilities are one of the main sources of mercury release into the atmosphere because of emissions from the incineration of medical waste. They are also responsible for mercury pollution in water bodies from the release of untreated waste water, which constitute 5% of all mercury releases in wastewater.
In healthcare facilities, mercury can be found in medical equipment such as sphygmomanometers, thermometers, laboratory staining solutions and preservatives, feeding tubes, and gastrointestinal diagnostic equipment. It is also present in fluorescent and ultraviolet lamps.
A first in Southeast Asia, the order mandates all healthcare facilities to stop the distribution of mercury thermometers to patients, submit an inventory of all mercury-containing devices when applying for a license, and create a mercury minimization program.
The DOH directive came ahead of two house bills filed by Aurora Rep. Juan Edgardo Angara and Iloilo Rep. Ignacio Arroyo, seeking the reduction of the distribution of products containing mercury and the proper disposal of the substance to reduce the exposure of mercury into the environment, Sanchez told the Varsitarian.
Staging a “gradual” exit
In the Philippines, there are several “best management practices” for mercury elimination but putting an immediate stop to the use of mercury in healthcare facilities and institutions is impractical as of the moment, Sanchez said. This is because the shift from mercury-containing to mercury-free products will still have to consider accuracy, cost, and storage.
“It may not be possible to replace all of the healthcare facility’s mercury products at once and, in some cases, there may not be a substitute that is considered to be reliable and cost-effective,” Sanchez said. “For these products, best management practices are best.”
Also, an instant switch to mercury-free products poses financial challenges to some medical institutions and hospitals, Sanchez said.
“A mercurial thermometer normally costs P30 to P40, but a digital thermometer’s price ranges from P300 to P350 or more. Definitely, a state-owned hospital will have a difficult time adopting [the Administrative Order], compared with private-owned hospitals, which will charge to their patients the hospital’s expenses,” Sanchez said.
At UST Hospital, patients will still have to bear the added cost of the shift from mercurial to digital thermometers in their hospital bills.
“Patients from the pay division will have to pay an [approximate] of 15-percent while charity division patients will have to pay around 3-5-percent in their hospital bills,” Bagsic said.
In terms of storage, proper mercury recycling facilities are not yet widely available in the country. Only waste treatment facilities accredited by the Department of Environment and Natural Resources can handle the proper disposal and storage of mercury.
The DOH directive did not sit well with some doctors and healthcare personnel who have long been used to mercury-containing devices.
Although the hospital has been minimizing the use of mercurial products prior to the Administrative Order, it cannot instantly shift from mercurial sphygmomanometers to its alternatives because of its “accuracy issues.”
“Although our stakeholders want an accurate measurement, we have no choice but to follow the DOH directive because it is now a requirement to renew our license to operate,” Bagsic added.
However, according to Sanchez, there is no difference between mercurial products and their digital counterparts in terms of accuracy, citing a study performed by Dr. Esperanza Cabral, then director of the Philippine Heart Center and now Social Welfare secretary.
Reputable organizations such as the WHO and Health Care Without Harm (HCWH), a global coalition of organizations from different countries working to protect health and reduce pollution in the health care sector, have conducted tests on alternatives and have found most mercury-free products as suitable replacements.
Sanchez, the DOH, and the HCWH claim that mercury-free products are also economical in the long run as they eliminate the risk of mercury poisoning, spills, breakage and training costs.
“With all these factors taken into consideration, the DOH thought that for the Philippines to have mercury-free health-care facilities and institutions, it should be a gradual phase-out, starting with the gradual exit of basic medical devices such as mercurial thermometers and sphygmomanometers,” Sanchez said. Alena Pias P. Bantolo, Francis James B. Gatdula, and Arian Anderson R. Rabino
Where can we send unbroken mercury thermometers and sphygmomanometers for disposal?
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