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This article first appeared in The Edge Malaysia Weekly on February 20, 2023 - February 26, 2023

Every month, Baxter Healthcare (Malaysia) Sdn Bhd sends 120 dialysate bags to 4,000 patients who are undergoing peritoneal dialysis (PD) at home in the Klang Valley. 

The bags are made of PVC and filled with dialysis solution, which is essentially water with salt and other additives. The solution flows from the bag into the patient’s body through a catheter. After the bag is emptied, it is disposed of in a bin.

But in New Zealand and Australia, these bags — that have no contact with bodily fluids — are collected by Baxter from hospitals and recycled. When Roberto Benetello, executive director of the Business Council for Sustainable Development (BCSD) Malaysia, discovered these projects, he thought it was low-hanging fruit that could be replicated in Malaysia.

He brought together Baxter, healthcare services provider Zuellig Pharma as well as waste management experts Dialog Eseco Sdn Bhd and Cenviro in August last year to do exactly that. The Jom Recycle pilot project found its first collaborator in Hospital Kuala Lumpur, thanks to the support of Dr Sunita Bavanandan, head of the department of nephrology.

It is the first extended producer responsibility (EPR) initiative in the healthcare sector in Malaysia, according to Benetello. The EPR concept holds manufacturers responsible for collecting packaging waste from their products that end up with consumers.

“When we started, we thought this was a no-brainer because we identified a problem and we had a solution. The reverse logistics of taking back this used plastic was very straightforward. We approached recyclers because we wanted to close the loop and reuse the plastic we recover as secondary raw material. This is the definition of circularity,” says Benetello.

Zuellig, which is in charge of the logistics, sends the dialysate bags to patients, alongside equipment like a clean bin. Based on the instructional videos and information provided by Baxter, patients would cut and clean the bags before putting them in the bin. When Zuellig’s trucks arrive the following month to deliver new PD bags, they would also pick up the used bags from the bin.

The used bags are then sent to recyclers, who clean them again and recycle the plastic, which can be turned into things like garden hoses, toys and cones.

Around 30 patients are now part of the programme.

“In the grand scheme of total medical waste, this project may not make up a huge amount because the collection is currently only from patients’ homes, as opposed to collections from hospitals. That is done in Australia and New Zealand. Malaysia has the first programme to collect the bags from patients’ homes,” says George Kazzi, general manager of Baxter Healthcare Malaysia.

But “the bags that we are collecting still make up a large number of plastics that will be prevented from going to landfills”.

They hope to refine the programme using lessons learnt from the pilot project before expanding it to other centres or hospitals. There is also the potential to expand this programme to other non-clinical medical waste generated in hospitals.

A regulatory environment that encourages circular economy needed

As simple as the process sounds, however, challenges inevitably arose. For instance, Benetello had to jump through several regulatory hoops to get the project going because medical waste is categorised as hazardous and can only be collected by appointed concessionaires, who often incinerate the waste without regard for whether it is clinical or non-clinical waste.

“We had to talk extensively to the Ministry of Health and engage the Department of Environment to explain what we were doing. Recently, we just received a letter from the Department of Environment granting us permission to do this,” says Benetello.

Some medical waste is considered non-clinical waste, as it is not contaminated and made of valuable materials like plastic. Instead of being disposed of in common bins, it could be collected and recycled. 

“This is one part of the regulatory framework that needs to change. Incentives need to be created. Also, the behaviour of healthcare professionals and people in the hospital needs to change, so that they segregate clinical and non-clinical waste and the types of plastic.”

There could also be key performance indicators or incentives put in to encourage medical waste concessionaires to recycle more, suggests Kazzi.

Another challenge has to do with cost. For Zuellig, handling the reverse logistics of picking up the used bags does not incur much additional costs, says Louis-Georges Lassonnery, managing director of Zuellig Pharma Malaysia & Brunei. The company just needs enough scale to justify it.

“It takes a little bit more time, but it’s not significant compared to the benefits of recycling, sustainability and reduction in carbon emissions,” says Lassonnery.

It is not the same for Baxter, which has to create the educational materials for patients who are part of the programme and provide a clean bin, among other things.

“The cost is not small. But we think this is something that is important. Our first priority is to think about this obligation as part of our EPR. We have tested this in other countries, so we have an idea [of what it takes],” says Kazzi.

“However, once we expand the project and the volume of plastic collected increases, we hope to monetise it by selling the plastic and recouping some of our costs.”

When the project reaches a larger scale, it will also be possible to calculate the greenhouse gas emissions avoided thanks to this project, which the participating companies can reflect in their sustainability reports, adds Benetello.

“The immediate value of this project is enormous. We have a proven model. The scale is not big yet but we have closed the loop for the first time and we hope to expand the project to other companies or industries.”

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