Doing away with mercury

When I was a kid I had this toy, a maze enclosed in hard transparent plastic, which you had to tilt up or down or sidewards so that a droplet of liquid could find its way through the broken lines and corners. I remember being fascinated with the beautiful silvery-white bead as it moved to find its way through my puzzle. Later I learned that the bead was called mercury, although another term, quicksilver, was more descriptive.

It is the same thing found in thermometers and sphygmomanometers (blood-pressure checking device). Mercury easily reacts to changes in temperature and pressure, hence its use in these instruments. But when these instruments break, and the mercury is released into the air, that’s where the danger begins.

“Mercury is toxic,” says the World Health Organization in a policy paper, “It may be fatal if inhaled and harmful if absorbed through the skin. Around 80 percent of the inhaled mercury vapor is absorbed in the blood through the lungs. It may cause harmful effects on the nervous, digestive, respiratory, immune systems and to the kidneys, besides causing lung damage. Adverse health effects from mercury exposure can be: tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, deficits during fetal development, and attention deficits and developmental delays during childhood.’’ In 1991, the WHO conclude that a safe level of mercury exposure, below which no adverse effects can be had, had never been established.

There has been an international effort to ban mercury-containing thermometers and sphygmomanometers in Swedish, French, Danish, Norwegian and American hospitals since the early 1990s. Initiatives in Southeast Asia came much later, in 2006,with the first Southeast Asia Conference on Mercury in Health Care. Here in the Philippines, the Health Department released Administrative Order 21 in July 2008. The order established guidelines for the gradual phase out of mercury in all Philippine health care institutions.

The AO mandates all hospitals to immediately discontinue the distribution of mercury thermometers to patients, stick to the prescribed timeline in phasing out mercury in their facilities and undertake a mercury minimization program.

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Faye Ferrer, program officer for Southeast Asia for Healthcare Without Harm—a Virginia, USA-based international non-government organization that seeks to “implement ecologically sound and healthy alternatives to health care practices that pollute the environment and contribute to disease”—says the Philippine situation is unique because of the popularity of mercury-based thermometers here. In hospitals, for instance, there is an almost 1:1 ratio of beds to thermometers. Once the patient goes home, he is given a kit which includes a thermometer. These are also available over the counter.

Ferrer describes mercury as a “traitor.” It is widely used in hospitals and households, it is odorless and beautiful to look at. You would not think it is toxic. She recalls the mercury-poisoning case in St. Andrew’s School in Parañaque City in 2006. The teacher, who should have known better, passed a beaker containing mercury to the class. The unsuspecting children were fascinated with the substance’s properties. Soon members of that class had to be rushed to the hospital and one of them now has an advanced case of Alzheimer’s disease. “How can you ever compensate for a future that has been lost?” Ferrer asks.

Mercury poisoning is not limited to people who come in contact with the element. The moment it is released into the air, it travels and eventually collects in waterways. Some people who have been exposed to mercury do not manifest the symptoms, but it is their children who do.

Still, Ferrer credits the Health Department, especially Secretary Francisco Duque, for its commitment to the phase-out program, which targets all hospitals to be mercury-free by the end of 2010. Hospitals, both public and private, have generally been compliant to the drive. Healthcare Without Harm has recognized 16 hospitals (one in General Santos, one in Tuguegarao, two in Baguio and 12 in Metro Manila) for their phaseout efforts. Other hospitals are not doing so bad, either. It helps that the Health Department has set complying with the AO as a condition to the issuance or the renewal of licenses to operate.

But the phaseout is just part of a comprehensive program to stamp out mercury in health care settings. Ultimately, there is really no place to dump all the mercury that has been rounded up. Certainly it cannot be mixed with other waste materials. It cannot be destroyed, too, without exponentially raising the dangers. Last month, HCWH gathered stakeholders to a forum that sought to resolve the issue of an intermediate storage facility for mercury.

The Environment Department is expected to set up the guidelines for long-term collection and storage of mercury phased out from health care facilities. But the department is already saddled with too many responsibilities (and constrained by limited funds) so that it argues that there is no need to establish new guidelines for mercury. It already has a Chemical Control Order for Mercury and Mercury Compounds (Administrative Order 38, series of 1997). The Department’s representatives, however, concede that the control order needs review and expansion. There will be more talks to settle this issue.

For now the more pressing concern is educating citizens on what to do if their mercury-based thermometers break. Hospital staff already know what to do. They are provided with “spill kits” that would enable them to put away the mercury safely. What about households? Not everybody is aware, in the first place, that mercury is toxic and that it is not safe to treat a broken fever gauge as you would a discarded pen.

Here is the prescribed how-to: The area should be evacuated and internal ventilation should be turned off. Use a face mask to avoid inhaling mercury vapor. Use clothes and shoes that can be discarded. Remove all jewelry as mercury sticks to metal. Put on rubber or latex gloves. Identify the affected surface and locate the mercury beads. Use an eye dropper or a needle-less syringe to draw up the beads. Use sticky tape to collect hard-to-see beads. Place everything in a zip-lock bag. Gather every item used in the clean-up in a leak-proof bag, label it and put it way. Finally, keep the affected area ventilated to the outside for at least 24 hours. Do NOT use a vacuum cleaner. If it’s a sphygmomanometer that broke, contact the Health Department immediately, This is so because there is a bigger amount of mercury involved.

Although digital thermometers and sphygmomanometers are gaining popularity, mercury based ones are still very much in the market. Why, a few months ago I was able to get one from Mercury (a coincidence, I suppose) Drug. It is hoped that the campaign for the phaseout of mercury will kill the demand, and soon.

We have yet to hear about other sectors’ own efforts to stamp out this deadly element’s use. Workers in small-scale mining communities who are exposed to mercury for prolonged periods are unfortunate because it is highly likely they aren’t even aware of the perils of their job. Do they have a choice? What protection and livelihood alternatives does their local government give them?

On the other hand, the Philippine Dental Association has said it was no longer using mercury-based dental amalgams for aesthetic purposes, according to Ferrer. Nonetheless, in dental missions to far-flung rural communities, this kind of “pasta” is still the most popular. Again, ignorance and lack of access to alternatives are the main problems.

As for my toy, I honestly don’t know what became of it. I’ve transferred houses at least four times since and I don’t remember bringing the maze with me. Even if it’s a long shot, I’m hoping that it has not been broken and then somebody who knows about mercury’s real ugly nature finds it and puts it away the proper way. –Adelle Chua, Manila Standard Today

adellechua@gmail.com