by MIRA S. MENDOZA

IT’S A shimmery, shiny substance that seems to have a mind of its own when held between one’s fingers. In the Philippines, it is commonly found in thermometers that are widely used in hospitals to check on patients’ temperatures or are sold over the counter for household use. Other medical devices, in fact, still use elemental or metallic mercury — even if this is a known toxic substance that can be absorbed by the skin and can easily penetrate biological membranes, including the blood-brain barrier. When inhaled, mercury vapors can cause neurological and behavioral disorders, and sometimes can lead to death. Even at low doses, these vapors can have harmful effects on the kidneys, and the digestive, respiratory, and immune systems.

	SPILLS from broken thermometers were stored in this bin prior to the Philippine Heart Center's switch to non-mercury devices. [photo by Mira Mendoza]

The Philippine healthcare system has been slow to respond to the concerns raised over the continued use of mercury in medical equipment, including the lowly thermometer. Yet even foreign observers say the country has finally stirred into action regarding the use of the toxic substance in health devices.

Indeed, in its latest report on global mercury reduction, the international organization Health Care Without Harm (HCWH) cites the Philippine experience as a model in switching to alternatives and creating policy solutions. This is even though the Department of Health (DOH) has yet to release a much awaited administrative order (AO) that outlines what needs to be done to reduce the presence — and use — of mercury in the healthcare system.

The United Nations Environment Programme (UNEP) has already identified mercury pollution as a major environmental and human health problem. In a 2002 report, it also tagged the healthcare sector as a significant source of mercury releases. It added that Asia accounted for over half the global emission of 5,000 metric tons a year.

The Philippines has no available statistics on the country’s own mercury releases. Nevertheless, the health department’s draft AO, which was crafted earlier this year and cited by the HCWH as a major plus in the country’s mercury-reduction efforts, mandates the phaseout of mercury-containing thermometers and blood pressure devices along with other products that make use of mercury (dental amalgam and some laboratory chemicals). The AO also orders the substitution, where possible, of safer alternatives for batteries and certain vaccines that use mercury. Emphasis on mercury-waste management, fluorescent lamp recycling, and safe disposal are among the other high points in the proposed AO.

But if DOH seems to be taking its time releasing the AO, at least it’s not because it suddenly lost its political will, as is often the case with many government agencies on the verge of a big switch. It’s because, explains Ana Rivera, supervising health program officer of the DOH-Environmental and Occupational Health Office, the health department belatedly realized that it cannot implement the change by itself.

"After our initial meeting on the proposed AO,” says Rivera, “we realized that we had to coordinate with partner agencies. Given the scope of the proposed AO, the health department will need the assistance of the Department of Trade and Industry (DTI) in giving accreditation for alternative products based on the criteria that the Bureau of Health Facilities Development will provide."

Meanwhile, last February, the DOH issued a memorandum containing guidelines for handling accidents involving mercury at home, school, and medical facilities. The memo, which is similar to a previous HCWH fact sheet released four months earlier, includes first-aid/pre-hospital treatment for mercury victims. But Faye Ferrer, HCWH Southeast Asia’s program coordinator for mercury says the memo’s real highlight is when it says that “the best way to prevent mercury spills is to not store mercury at home, in schools, and in the workplace.”

IN ITS 2002 report, UNEP said that 10 percent of the mercury releases generated by the healthcare sector came primarily from the incineration of medical waste that contains significant concentrations of the substance. Fortunately, the Philippines has banned the incineration of hospital waste, with the law on this taking full effect in 2003. But hospital facilities have since been left wondering how best to dispose of the various products and devices that use mercury.

In truth, this is among the problem points in the draft AO. Rivera says that issues regarding a centralized storage facility for the phased-out products would first have to be discussed with the Department of Environment and Natural Resources (DENR). An engineer, she mulls aloud, "Do we store the mercury-containing products in the hospital, or in the DOH? Where will the temporary storage be set up until a final disposal area is established?"

Aside from the ubiquitous thermometer, medical devices containing mercury include blood-pressure monitors, gastrointestinal tubes, and dental amalgam and other laboratory chemicals. Mercury is present as well in some pharmaceutical supplies like vaccines, nasal sprays, and diuretics. Fluorescent lamps, batteries, switches, thermostats also use mercury.

Dumping waste with mercury in landfills enables the toxic substance to enter and accumulate in bodies of water where it can transform into the more dangerous methylmercury. This inorganic form of mercury is absorbed by fish tissue and increases in predator fish that are on top of the aquatic food chain. In recent years, several warnings have been issued by both international and local environment agencies to avoid eating mercury-contaminated fish.

Methylmercury affects a person’s neurological functions. Even low doses can have dire consequences on children, who can have their cognitive thinking, memory, and language and motor skills seriously affected. Even a developing fetus is not spared as methylmercury can pass through the placenta, targeting the unborn child’s brain where it causes permanent harm.