When protesters began driving combines down Main Street in Beiseker, mayor Warren Wise was shocked, if not a little frightened. It was 2019, he recalls, and the Alberta-based biomedical waste company G-M Pearson had approached the village of 800 people with a proposal. It had purchased a quarter section of land on the south side of town, and it wanted to build a medical waste incinerator.
The company collected from medical, dental and veterinary offices, as well as from labs, nursing homes and tattoo shops, and had been in business for 30 years. It was hardly a fly-by-night operation. What’s more, Beiseker had been, not that long ago, a destination for medical waste. Cristallo Engineering Technologies opened an incinerator in town in the late 1990s and operated it until about 2007. “From a council standpoint,” Wise tells me over a coffee in a café in Beiseker, the new incinerator “looked like a good idea. The company mentioned jobs; they mentioned tax [revenues]. It sounded pretty safe to me.”
But when it came time for an open house on the proposal, 130 people showed up. “One person spoke for [the incinerator], and probably 40 spoke against it,” Wise recalls. “Some didn’t like G-M Pearson, some didn’t like the idea of an incinerator, and of course some people didn’t like either.” The company had faced similar community pushback three years earlier when it tried to open a facility southeast of Edmonton in the village of Ryley, just a year after its incinerator 120 km to the east in Wainwright had been shut down after emissions of dioxins and furans were found to be “well above” provincial limits.
Once the residents of Beiseker had spoken, Wise says council had no choice but to refuse the new incinerator. But the mayor admits to being disappointed. He was looking forward to some good-paying jobs for people who might live in town, send their kids to the local school and join the volunteer fire department. With Beiseker’s annual budget of $1.5-million and small tax base, it’s hard to keep the roads paved and the water system up to date.
“Any development in any small village is welcome,” Wise says. “Little towns, if they don’t grow, they die. We’re desperate for it, really.”
I made three requests to G-M Pearson for comment and was asked three times to call back again. For now, the quarter section that might have meant a couple of dozen jobs remains cropped farmland taking in the sun.
Beiseker mayor Warren Wise points to the land intended for the waste incinerator facility. Photo: Monica Kidd.
Warren Wise steered Beiseker through a classic NIMBY problem: everyone generates medical waste, even if indirectly, but no one wants it in their backyard. What’s new about this problem is how much bigger it’s grown of late, and how much stronger the resistance to it is.
In Alberta, biomedical waste is generated by healthcare facilities (including hospitals, doctors offices and long-term care homes), medical research and teaching facilities, clinical testing laboratories, facilities involved in the production of vaccines, and other sites. The mess includes soiled gloves and masks and needles and examining room paper, not to mention blood and various tissues removed in surgery.
The waste is designated as a dangerous good under federal transportation regulations because it can contain pathogens. Although some biomedical waste can be sent to landfills if it’s sterilized first, the preferred disposal option is incineration.
According to Alberta Health Services communications adviser Jason Morton, AHS with its subsidiaries Covenant Health, Alberta Precision Laboratories, Carewest and CapitalCare Group generated over two million kilograms of biomedical waste in 2021–2022. Since G-M Pearson’s Wainwright facility was shut down in 2015, all AHS waste that requires incineration has been sent 220 km northwest of Edmonton to the Swan Hills Treatment Centre. In 2022 Swan Hills processed 1.5 million kilograms of biomedical waste.
AHS has been working on improving its environmental image, if not actually shrinking its environmental footprint. In 2019 it created an Office of Sustainability; the following year it issued a policy to make reasonable efforts to track greenhouse gas emissions, source local food and reduce waste. Also in 2020, Calgary’s Rockyview General Hospital became the first AHS facility to participate in the Canadian Coalition for Green Health Care’s “Green Hospital Scorecard,” a benchmarking tool for comparing hospitals’ conservation efforts.
No one from AHS was made available for an interview, but I was provided a slide deck of the Rockyview’s efforts and accomplishments. Energy use at the hospital remained largely stable from 2017 to 2021, with its usual peak in July (because of the need for air conditioning) and nadir in February each year. The hospital has put out blue bins for paper and plastic recycling. Food services has been transitioning from plastic and Styrofoam containers to molded sugarcane-fibre dishes and compostable paper cups. But data for 2021 show garbage and recycling tonnages and costs have not fallen. Some waste streams from operating rooms are being diverted to recycling (plastic and paper wrappers that surgical tools come in, for example) and the hospital has begun switching to disinfecting wipes that use non-toxic hydrogen peroxide rather than ammonium chloride, which is hazardous to aquatic organisms.
None of that would convince a skeptic. In truth, healthcare has been a johnny-come-lately to environmentalism. The three Rs have been considered so much window-dressing in the face of life-and-death situations.
But increasingly, conservation issues are life-and-death. In a highly publicized 2019 report, the international non-governmental organization Health Care Without Harm found that if healthcare were a country, it would be the world’s fifth-largest carbon emitter, much of that coming from single-use items in vast supply chains. Then came the pandemic, and reusable items everywhere fell under an ominous cloud of suspicion. As a family doctor who delivers babies, my own personal protective equipment use in the hospital and clinic skyrocketed. Most of it was disposable. In wider society too, everyone seemed to become an expert in PPE, conversant with the merits of the simple procedure mask versus an N95. Then there were the untold billions of plastic home COVID tests.
In 2022 the World Health Organization produced a report on the state of the world’s medical waste in the context of COVID-19. None of the case studies examined were from Canada, and the report’s data only addressed PPE handled by the United Nations, but the findings are sobering from a global perspective. The report found that in five Asian cities, healthcare waste increased by a factor of 10. In 2020 as many as 3.4 billion single-use masks were thought to be discarded globally every day, although gloves were (by volume) the largest item of personal protective equipment waste created during the pandemic. Few of us were thinking about what to do with it all afterwards. Meanwhile evidence shows that globally only 66 per cent of healthcare facilities are thought to handle medical waste safely, and that it’s often the most vulnerable people living next to the waste who suffer most.
A field where a new waste incinerator would have gone, had local citizens approved. Photo: Monica Kidd.
While the pandemic broke our hearts in so many ways, it provoked particular torment for those who had been trying to make healthcare responsible for its role in planetary health. “I’m probably being Captain Obvious here,” says Calgary family physician Clark Svrcek, “but you just saw a tidal wave coming.” In April 2022 Svrcek co-authored a report for the University of Calgary’s O’Brien Institute for Public Health on climate-resilient and sustainable health care, with proposals for AHS. Among the report’s many recommendations is for clinics and hospitals to throw away less stuff.
Take a speculum for example, the tool used in a Papanicolaou (or Pap) test for cervical cancer. Back in the day, these were reusable metal instruments that were sterilized in an autoclave, just as surgical tools still are. Then along came disposable specula, often packaged in individual plastic bags, sometimes pre-equipped with a light and two batteries. I remember that transition. Whereas the metal specula were cold, sometimes pinchy, and more than a little intimidating to look at, disposable plastic specula were seen as convenient and modern.
Svrcek points out that none of that plastic is recyclable, because it has come into contact with body fluids. And though neither he nor I have seen it in practice, urban legend has it that if the light is left on when a speculum is discarded, it can set the garbage on fire.
Reverting to metal specula could be one easy way to reduce medical waste, as it requires no new testing or innovation. But easier said than done, according to Svrcek. He asked physicians in his academic teaching clinic their thoughts about going back to reusable specula. Many were open to making the switch, but because his clinic is located in a hospital, choices about clinic supplies come with their own layers.
“I’ve got to find out who does the procurement in our clinic, then I’ve got to go talk to that individual and find out how you order this,” Svrcek says. “I may be told it’s just what the hospital stocks. I may have to go to the department level.” He says this can leave even motivated physicians feeling “a bit disempowered and disenfranchised.”
The same dynamic is in play with the decision over which procedures require clean gloves from a box on the wall versus the much more expensive sterile gloves that come in two layers of additional packaging. Or in the choice between fabric gowns versus paper gowns. Buy reusable items and pay for their cleaning, or buy single-use items and forget about them once the cleaners haul away the trash? Financial and environmental arguments can be made on both sides.
Svrcek says putting that responsibility on individual doctors is doomed to fail. As with other decisions in medicine, physicians often rely on advice from people who have examined a question closely. In 2014, Canadian clinicians started an organization called Choosing Wisely. Its mandate is to reduce unnecessary treatments and tests by providing well-researched recommendations and patient handouts to help the doctor communicate why not every knee sprain requires an MRI, or why not everyone needs a mammogram when they turn 40.
He’d like to see a Choosing Wisely approach for medical waste, he says, “so that the beleaguered physician who’s got zero time and energy left for this stuff can take that to their clinic management and say, ‘Here’s the suggestion from an organization that has already vetted all of the data behind this. It’s feasible, it’s viable, let’s do it.’ ”
But money is a quick way to stop talk of reform. Cleaning reusable items comes with a cost, especially when services are centralized and soiled items must be trucked around the province and then returned. Decentralization can reduce the length of supply chains, but it can contradict a government’s privatization agenda. In 2021 AHS announced K-Bro Linen Systems would take over laundry services, which cost 428 Alberta Union of Provincial Employees members their jobs.
In the end, improving the environmental balance sheet in medicine would require making it cost more money to throw something away than to reuse it—a premise of the circular economy—or would require convincing citizens that reducing disposability would be short-term cost for long-term gain. “We need to couch things in those terms,” Svrcek says. “[Disposability] might be cheaper up front, but the way we do things right now isn’t sustainable, so it’s going to translate into higher taxes down the road.”
Biomedical waste in Alberta is big business, costing the province millions annually. The auditor general reported in 2015—back when the province was still able to send most of its used syringes, gloves and blood-soaked gauzes to Wainwright’s polluting incinerator—that AHS spent $3-million on medical waste disposal. An AHS spokesperson declined to share current numbers. The Swan Hills Treatment Centre currently being used to burn Alberta’s medical waste was designed in the 1980s to treat polychlorinated biphenyls (PCBs), and so to use the facility to dispose of other waste is, according to an Alberta Infrastructure spokesperson, “inefficient and expensive.”
And the companies that incinerate waste aren’t exactly keen to reduce their profits. What unfolded in Beiseker in 2019 is a reminder of the stakes on all sides: disposal companies with lucrative contracts come up against citizens and taxpayers who don’t want to burn hospital garbage in their backyard, towns that are struggling to make ends meet and attract new industries, health workers and patients balancing their own safety against mounting evidence of the harms of plastic waste.
While Svrcek waits for system change, he makes small improvements on his own. When he excises a mole, and must use a disposable electrocautery pen to stop the bleeding, he takes out the nearly full battery and gives it to a medical student or resident to use at home. “At least then the battery gets used up,” he says, “and it’s just the plastic going into the garbage -and it’s not going to start a fire.”
Monica Kidd is a family doctor and writer. Her latest book is Chance Encounters with Wild Animals (Gaspereau Press, 2019).
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