By Adelle Chua
In gatherings like last week’s Asian Regional Conference on Mercury-Free Health Care held at the Gateway Suites in Quezon City, it is as interesting to listen to question-and-answer portions and feedback from members of the audience (whose expertise comes from years of exposure to the situation on the ground) as it is educational to use information from the official speakers.
Health Care Without Harm, one of the conference’s organizers (the others are the World Health Organization and the United Nations Development Programme-Global Environment Facility Global Health Care Waste Project) says this particular meeting is a big step from the previous one held five years ago. In 2006, the main job was to impress upon participating countries the health hazards posed by mercury, commonly used in thermometers and sphygmomanometers.
In response, health department executives from developing countries like the Philippines started phasing out mercury-containing medical devices. Our own Department of Health, under then-Secretary Francisco Duque, issued Administrative Order 21 to phase out all such devices by December 2010.
In this year’s conference, the countries – Thailand, Indonesia, Vietnam, India, China, Nepal and the Philippines -- reported varying degrees of success in their phaseout efforts. At the very least, everybody seems to be moving in the same direction.
The focus of this year’s meeting has decidedly veered away from the dangers of mercury (that is now a given) and whether or not to phase such devices out. The issue now is about how alternatives are being introduced, how people receive these alternatives, as well as how the phased-out devices would be stored in the short and long term. Mercury in these devices will not harm anybody so long as the devices are not broken or leaking, so the task is to ensure they don’t break collectively and cause even more damage.
Here in the Philippines, for instance, a public health official working in the Southern Tagalog region says people from poorer communities have yet to develop confidence in digital alternatives. They have become used to taking their temperatures using the all-too-common mercury-based thermometer. They have been using it since they were little, and they seem to be fine. Newer digital brands just do not enjoy the same level of confidence. As a result, health centers use the old devices anyway, but since it is officially phased out, they do it on the sly.
The government doctor also says that “storage” in some hospitals and health centers simply means putting the phased-out devices in a box and keeping them in a room somewhere. The WHO has issued guidelines, of course, but not everybody has the ability – or the awareness of the matter’s importance – to actually heed these guidelines to the letter.
But what will happen if the room is flooded, or damaged by an earthquake, or razed by fire?
The developed world has all but embraced the no-mercury-in-healthcare-facilities mantra. They are now helping their developing counterparts do the same. Unfortunately, the deed is not free from paranoia (rich preying on poor) or resistance due to habit, or due to the lack of faith that alternatives are just not as good.
A heart specialist for a big hospital, for instance, asks a speaker why a mercury-based sphygmomanometer—just one—cannot be used in the emergency room for a patient whose blood pressure breaches the 200 systolic mark. Apparently, newer types of blood pressure taking devices cannot accurately determine levels beyond 200. But the speaker, Peter Orris from the School of Public Health of the University of Illinois, is uncompromising. The mercury-based device has no place in any healthcare facility, and that the patient has to be treated anyway.
Last week’s conference yielded the Manila Declaration where the participants renewed their commitment to a mercury-free healthcare system. We look forward to the next conference. Maybe then we will have more inspirations on how to ensure that every facility – from the most sophisticated hospitals to the lowliest, remotest barangay health centers – is able to translate all these noble ideas into practicable action.