Medical waste: Who gets it, and what happens to it?

This article was originally published on April 9, 2018, in the El Paso Inc. Medical Section. The article was edited for length and slight stylistic reasons; the original version can be found below.

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The Mediwaste autoclave, closed. Photo by Jorge Salgado.

 

Every day, box trucks pull up to a nondescript warehouse on the far-east side of El Paso to unload a fairly grotesque cargo. The trucks are carrying used catheters, bandages, diapers, syringes, and soiled gowns collected from around the city. The trucks belong to Mediwaste Disposal, a locally-owned company that handles the medical waste of more than five hundred clients in El Paso and New Mexico. If you’ve ever wondered what happens to the contents of those ominous red buckets in your doctor’s office, the Mediwaste fleet is the group to follow.

Companies that produce “regulated medical waste,” such as funeral homes, tattoo parlors, veterinarians, dialysis centers, and dentists, are required by law to dispose of it properly. While the waste eventually ends up in El Paso’s Clint Landfill, the process is not as simple as chucking it there. Texas law requires that a company fully licensed and vetted to treat medical waste pick it up and treat it.

“This is stuff you don’t want any Tom, Dick, and Harry handling,” said Mike Perez, one of the company’s co-founders. (There are other medical waste transporters in the city, but they take their loads elsewhere to be treated.)

To begin, Mediwaste supplies each business with containers that fit their needs. The containers are picked up as often as needed and loaded into the back of a box truck, which is legally required to have extra leak-proof capabilities. Labels are affixed denoting the containers’ provenance and are transported back to the warehouse. Each truck does approximately 35-40 pickups per day, Perez estimates.

The surprisingly innocuous Mediwaste facility is spare and clean-swept, with a few indistinct apparatuses in one corner and the smell of disinfectant lingering in the air. The day’s haul is taken off of the truck and dumped wholesale into what look like metal minecars.

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A Mediwaste cart filled with…medical waste! Photo by Jorge Salgado.

 

Up to four of these carts are wheeled into a giant autoclave to begin the sterilization process. Superheated water from the adjacent boiler bathes the carts and their contents in steam for almost an hour. A sensor on the autoclave records the entire process to make sure that necessary temperatures are met, and these records are kept on file for five years. (If for some reason the autoclave goes down, the waste is stored in a refrigerated truck until it’s back online.)

Following their steam bath, the carts slide back out of the autoclave and their contents are dumped into a trash compactor, which crushes the assorted waste together in preparation for transport to the landfill. Though the prospect of dumping medical waste into a standard landfill seems questionable, Perez said that the autoclave process ensures that pathogens and other malicious contaminants are killed. In fact, he said, “our waste is probably the cleanest waste in the landfill.” Not only that, but it is an arguably cleaner way of dealing with the waste than earlier methods, such as incineration, which could release hazardous chemicals into the air.

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The autoclave can hold up to four medical waste-bearing mine carts. Photo by Jorge Salgado.

 

Every aspect of the process is governed by stringent health and safety guidelines dictated by the Texas Commission on Environmental Quality, which Perez said are some of the strictest in the country. On top of the regulations governing transport and treatment, the facility is required to have security cameras and a fence running the length of its perimeter. At the end of each day, employees are required to patrol an area stretching two miles in any direction from the facility to make sure that no telltale red bags have dropped from any of the trucks.

When Perez began the arduous process of applying for permits and licenses to open the facility, many area residents expressed concern about seeing recognizable body parts. This kind of waste is called “pathological waste,” Perez explained, and as of yet Mediwaste does not have the equipment to appropriately process it.

However, those capabilities are forthcoming. Squeamish readers may want to proceed with caution – the company will be getting a shredder within the next month. True to its name, the shredder will allow them to render body parts “unrecognizable” before the pulp is treated along with the usual regulated medical waste. This is partly done on the behalf of landfill operators, who may not only get freaked out by finding an intact foot but would have to shut down operations in case the remains are evidence of a murder.

The homegrown company kicked off its operations when it picked up its first load from a pediatrician’s office in 2015 and is considering branching off into other unpleasant territories when the time is right, such as treating asbestos and chemical waste. Perez is as surprised as anyone that he finds himself running such a strange operation, but he is glad he is. In addition to appreciating the company’s success, Perez takes pride in the fact that the company can offer something positive to the community he grew up in. The facility is the first located in El Paso County, which means that tax revenue stays local and that trucks carrying hazardous waste don’t have to drive for hours to the next closest location to dispose of it.

“We took a chance and rolled the dice,” Perez said. “It’s not every a mom and pop operation shows up and says ‘Hey, I’m here to take your medical waste.'”

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Sidebar: What happens to pharmaceuticals and similar waste?

Mediwaste is able to collect and process most pharmaceuticals for disposal. “As long as it’s non-hazardous, it can be run through the autoclave and taken to the landfill,” Perez said.

“Non-hazardous” in this context refers to pharmaceuticals whose components will be rendered inert in the autoclave process and thus won’t leach into groundwater or soil. However, certain medications must be incinerated in order to fully destroy them, as do items such as asthma inhalers, which can explode in the autoclave, and medications like warfarin, which contain explosive chemicals. Chemotherapy waste, such as canisters and related supplies, likewise must be incinerated.

Other options for disposing of pharmaceutical waste include treating it with chemicals, or in the case of pills, encasing them in concrete and burying them in a landfill.

Sidebar redux: How can I properly dispose of my household medications?

According to the El Paso Department of Health, disposing of most household medications is a fairly easy process. First, take an old plastic container with a screw-on lid and fill it with an unappetizing substance, such as dirt, coffee grounds, or kitty litter. Next, take pills, patches, syrups, etc. and put them in the plastic container. Put the lid back on and shake the contents. The moisture that collects in the container will dissolve the pills safely. The container and its contents can then be put out with the regular trash. Disposing of medications in this capacity instead of dumping them down the toilet reduces the amount of chemicals that pollute waterways and ecosystems.

However, such a method won’t work for items like syringes, home medical tools, and asthma inhalers (the latter of which can explode if punctured or heated). These items can be taken to hazardous waste collections sites around town. Some medical facilities or pharmacies are also equipped to take this waste as well as unused and expired medication. Fort Bliss also has collection points.

The helpful, needed work of a sexologist

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The sexologist has a difficult job: the very focus of her work is hard for people to talk about. Honest discussions of sex and sexuality – her areas of expertise – are at best circumscribed and at worst forbidden.Talking about sex is usually either shameful, funny, or awkward; rarely can sex (and especially sexual problems) be talked about honestly. Yet sex is of such tremendous spiritual, emotional, and physical importance to many people’s lives that not being able to talk about it often leaves people to navigate their problems alone. This is where the sexologist steps in – she helps people and couples of all sexual proclivities regain control of sex in their lives. Whether confronting difficulties or spicing up an already spicy love life, she can help people better understand the needs of themselves and their partners. Her work reflects her own spiritual and educational journey, and she discusses it below. 

Every time I say I’m a sex therapist, people think I’m in a couple’s bed with them, cheering them on. Which isn’t necessarily untrue, though I’m not actually in the room with them. I do most of my work online, video calls and phone sessions. It’s a sixty-minute session, you get homework, and there are email check-ins between sessions. After a session, I’m thinking a lot about what was talked about and will write a client to give more insight and give suggest more work they can do. I am here to help and encourage everyone to liberate their sexuality.

Sex is such a difficult subject for people to talk about – there’s so much shame and guilt, and we’re taught that we’re just supposed to know how to do it, how to ‘perform,’ how to orgasm. Sometimes its lack of experience and lack of confidence, and other times it does have to do with their past. Maybe there’s trauma. Performance anxiety is one of the biggest sexual concerns. We’re so influenced by movies and porn. People are silently struggling with their sexual experiences. We have to debunk every myth that we carry, and de-condition and critique our inner dialogue about sexuality. In listening to my clients, we listen to what happens in the act of sex from beginning to end. I listen for what is happening in the mind, emotions, body, energy and spirit of my clients, this guides me to find where the client is blocked.

Every couple is different, every person is different. It’s all relative. There are different issues in the trans community, different issues in the lesbian, gay, queer community. I can help ignite a passionate spark in a relationship that will result in deeper intimacy and pleasurable sex. For individuals and couples, sex coaching can help people wake up to the power of sexual energy and bring them into a deep intimate relationship with life. Sometimes the techniques I recommend work for everybody, but mostly I cater to an individual’s needs. I give simple solutions. I give them tools and techniques. Maybe one of the issues is that someone is not the greatest lover, but I can teach techniques to people to boost their confidence. I get to tell people what to do, and I’m really good at that. [Laughs] I give a home assignment every session, whether it’s for self-pleasure, for a couple, or for more than two people. When they go home, they have something to work on.

It saddens me to think that all around there are so many people, and so many partnerships in marriage, that end up sexless. It is very common for couples, especially after having children, to feel like they are in a relay race all day, often forgetting that they were once a romantic, sexual, and passionate couple. This is one of the most common sexual concerns people have, and why they seek out my services – there is no more sex in their partnership, or it’s rare, or one partner has a higher desire than the others. There is no typical explanation for the disparity.

For the person who has less interest, I work with them to find out why. Have they always had lesser interest? Do they want more than what they are experiencing? Some people have low desire but want to have sex more, so we’ll refer them to have their hormones checked. Hormones in food and plastics affect people and can affect sexuality. We’re finding more and more that there are lower testosterone levels in men, whereas four years ago it was reversed. We look at physical issues, medical issues. Medication is a big factor in sexuality. SSRIs are a major libido killer. You can’t just take someone off their medication, so we’ll work with them to regain their libido or help them have a satisfying sexual experience even when desire is at its lowest. Some people have naturally low desire, and that’s OK too.

I think sexuality can be terrifying. It’s a very lonely, isolating experience to grapple with whatever concern you have, especially when we are raised with parents who never talk about it, with no sex education, or abstinence only education. It is something that is not acceptable to talk about in our culture, especially in religious communities. You are not supposed to talk about sexuality or sex or orgasm, at all.

So many people are embarrassed or ashamed to talk about how they are feeling sexually. Often, we have shame around what we desire. Many people are ashamed to have particular fantasies or desire something outside of what is considered ’normal.’ I encourage my clients to embrace their sexuality, whatever what form it takes, as long as it is healthy, harmless to everyone involved, and between consensual adults. My job is to give them permission to do it. And usually, most people really need that permission. “You’re normal, your desire is OK, and if everyone is doing it in a healthy, consensual way, there’s nothing wrong with it,” even though everything else in society tells you there’s something wrong with it, or even diagnoses you with a disorder.

I always knew I wanted to be a therapist, and I was always very interested in relationships. I’ve always been fascinated with relationships because I didn’t know how to be in one. I didn’t know how to do it. I knew how to have sex but I didn’t necessarily know how to cultivate intimacy, longevity, and trust.

I did a three years master’s program at Berkeley, and that was for Marriage and Family Therapy. I saw individuals and couples when I began working. I did a depression group for years. I felt like I was just getting my big toe wet, like I was on to something but it wasn’t quite what I wanted to do. Then I started a PhD program in Los Angeles, also for Marriage and Family Therapy. In marriage and family therapy, there would be no extensive training in sexuality. We would help couples communicate and mediate in divorce, but we weren’t heavily trained in actual sexual concerns and issues. I went through two programs and there was never any talk about sex. Most psychotherapists and psychologists do not have extensive sexuality training, but when I started working as a therapist, sex was a big concern.

But it was through this program that I met my current mentor and trainer, Dr. Patty Britton, a world-renowned sexologist and sex educator. I started to train with her, and I did my certification through her in Clinical Sexology.

Dr. Britton was one of the first sex-positive doctors. She didn’t pathologize sexual problems; there were no “dysfunctions.” In the 90s there was the whole movement concerning men’s sexual dysfunction, founded and funded by the pharmaceutical company so they could promote Viagra and Cialis. And now they have a new movement for women’s sexual dysfunction, and a related drug. As a Sexologist, I am very weary of these drugs for a few reasons. For one, the Viagra-type drugs for men are simply to help sustain an erection, they do not generate erections. A man who has trouble getting an erection in the first place would not benefit from these types of drugs, but these drugs are marketed in such a way that leads men to believe otherwise.

I think with men, it’s often about performance and being able to please, and penis size. Usually with men, there’s so much performance anxiety that it causes them not to get an erection. Usually, that’s in the mind. Sexologists get to where their concern is – is it in the body? Is there low testosterone? Is there something we can do with hormone therapy? Is it in the mind, emotions, stemming from childhood? A lot of times men who come in with delayed ejaculation, it has to do with not trusting their partner. It has to do with something about the relationship outside of the bedroom. They are not comfortable entering into someone else.

I found that through the conversations I was having with women, they didn’t feel like it was their right to enjoy and receive and give as much pleasure as they wanted to. If you get married, that’s it. The women I talked to felt like, “well, you get married, then sex kind of ends, especially when you have children,” or you’d only have sex every couple of months after you have kids. But the power that women hold with their own sexuality is extremely powerful. Once a woman comes into her sexuality and has the power to give herself an orgasm and be responsible for her own orgasms, it is so liberating. We don’t want to empower women to have that ability, to be liberated.

But I think I’ve gained a lot more compassion for men as well. I don’t think I realized the emotional depth to which they thought about and worried about and had anxiety about giving pleasure and that being enough for someone. Now I feel that our society doesn’t allow men to access that emotional component. But I don’t think men are going to be able to talk about this until their penis stops working. If your penis is working, and you’re getting off, there’s no problem. They’re not going to see themselves the way they potentially could if something goes wrong. If you’re not a spiritual seeker and you aren’t trying to experience your full self, then you’re not going to look [for something that’s missing] if nothing’s going wrong. That’s the way our culture is set up.

When you can open up to sexual desires, whether you’re with a partner or by yourself, you get to know yourself in a really deep way. If you’re secure in a partnership or in a group relationship, if you can share that with others, there is a very, very deep intimacy that can arise from that kind of connection. You are giving yourself in sex. You are allowing yourself to be entered, or enter yourself into another person. There is nothing more intimate.

For me, sex was my gateway into understanding humans and human behavior and how we relate. I learned and got so much information through my sexual experiences. As a young adult, I remember learning about pleasure and sex and being completely fascinated that I could potentially contain a super power. I was able to see the connection between spirituality and sex and I was determined to incorporate sex into my spiritual path. I was able to heal myself and I uncovered a wealth of energy and knowledge around sexuality.

I have an understanding and non-judgmental view in religious communities with regards to sex and relationships. Having been raised in a Jewish community, I wanted to understand how religion, spirituality and sex fit together. I understand the complications that may arise with sex and relationships within a religion. Although there are challenges and hurdles with sex and intimacy, I can help people find pleasure and sexual fulfillment within a religious structure.

Speaking again on the spiritual side of things – I’m also a yoga teacher – it plays to the energetic systems of the body. Once you have orgasms on a regular basis or simply just cultivate sexual energy in the body, you have a tremendous amount of vitality. If you are not exercising your sexual organs, they atrophy. Once you start to re-engage in sex and orgasm – no matter what kind of sex you’re having – you regain a tremendous amount of energy, and life force. Use it or lose it!

I think when someone gains control over their sexuality, there is nothing more empowering. I focus clients to feel comfortable talking about their sexuality. Sex coaching is not sex therapy. The past will come up, but we don’t do any deep therapy work around the past. We acknowledge it and see where problems come from, but I try to stay in the present and move to the future. While sex therapy delves deep into the past, sex coaching is solution focused and result driven. Sex coaching is not just about processing feelings, it is also about finding concrete answers to keep a person moving forward and reaching their sexual and intimacy goals.  As a sex coach, I am dedicated to helping people make changes in their lives as quickly as they would like to change.

I haven’t seen a pedophile. To be quite honest, I would refer out if I saw someone with those tendencies. It’s not my area of specialty and I just don’t have the capacity for it. Bestiality, I understand, I have less judgment. I know where my boundaries are. Thoughts are different than actions. If they are acting on something illegal, I’m obligated to report them. But if they are thoughts, illegal thoughts that harm people or animals in some way, I help them not act on them. Thoughts are OK, actions are not. Violent fantasies are actually pretty common. Rape fantasies are very common, more common than you’d think. I absolutely deal with those. If someone wants to play out their fantasy in real life, I can help them do that in a safe way. I can teach them how to get the experience with someone who knows boundaries and safety. There’s a way to set up any fantasy. It may not be exactly what they are looking for, but I can help them.

From what I have gathered, there aren’t many Sexologists in Ohio. But now I feel like there are more and more people seeking this kind of help. They realize they have a choice, and that they don’t want to live the unfulfilling [sexual] life that they’re living. Perhaps there wasn’t ever passion [in someone’s relationship], and they think it’s too late to discover it. But once the conversation starts, then maybe we start to feel more empowered to look at our own lives and make those changes.

I have a lot of anxiety going to parties where I don’t know people, because I don’t really know how to start a conversation. But once someone brings up my profession, it’s the most fun thing because everyone wants to talk about sex but can’t just bring it up. I can answer questions and talk about what I do and it’s totally comfortable.

I sort of don’t care what people think of me. For personal and scientific reasons, I could think about and talk about and look at sex all day, every day for the rest of my life and I’d be the happiest person on earth. This is my path – it feels so right, I know that I’m meant to do this work. I know that I’ve helped people and helped couples and partnerships. I’m pretty straightforward and say it like it is. Some people are going to really like that, and some people are going to think I’m the devil coming to town.

I understand how important it is to have a healthy sex life, whether you’re alone or with other people. I want people to know there is no normal, or that everything’s normal. Everybody has sexual concerns. Everybody. So let’s just start the conversation. Everybody’s got their issues. It’s beautiful to watch people come into their sexuality. Healthy sexuality makes for a healthy human being!

This post originally appeared in an abbreviated form at the Yellow Springs News.

I produce 9,000 pounds of bean sprouts each week

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In 1982 I was just getting out of the Peace Corps. My dad had bought a farm wanted to do something with property. So we decided to go into business together. He bought the farm originally to grow grapes but that didn’t pan out. At the time, we thought that to really promote your wines you had to have a festival, and that would mean you had to bring thousands of people here for a wine tasting. It was a major thing that we didn’t want to do. So we built a greenhouse and started growing herbs, tomatoes, watercress, European cucumbers. There was an emerging market for hydroponic lettuce so we started growing lettuce hydroponically. Every year we added a greenhouse and pretty soon we had 20,000 square feet of produce.

We sold produce wholesale. There’s a big produce market around, especially in Cincinnati because of the river. There’s an established warehouse district there. We knocked on doors and did cold calls. We were supplying the Meijer chain for a while. And then one of our alfalfa sprout growers lost their supplier and wanted a replacement and asked if we knew how to grow alfalfa sprouts. We didn’t but of course we said yes anyway. (Laughs)

We tried to build our own equipment and grow sprouts in the greenhouse, but it just didn’t work out. Months later we bought the right equipment and did it the way it really needs to be done. The alfalfa sprouts are grown in a large rotating drum. You add water and light, and they green up after a few hours. You load in about 80 pounds per drum, and you get about a 10- 15:1 ratio after about five days. They were used primarily for salad bars, sandwich shops.

The green sprouts (alfalfa) business declined. A lot of the chain grocery stores dropped green sprouts – the green alfalfa sprout has an inherent problem with salmonella and E.coli. The structure of the seed has more crevices for bacteria to hide. We got out of alfalfa ten years ago but alfalfa sprouts led to us see the market for bean sprouts. The bean sprout market is pretty good – a lot of Asian markets and grocery stores.

Bean sprouts are a highly perishable product so there aren’t a lot of growers around. They can’t bring a decent bean sprout in from another state without paying huge shipping costs, so it favors the local grower. You want to get them sold within two days of harvest, and they need to be consumed within 10 to 14 days. I think the distributors we use ship in some sprouts from Chicago and I know there’s a grower in Columbus, but he only has a few sales in Dayton.

The process we use is unique to bean sprouts. The equipment we have is specifically for growing them. We’ll load up 110 pounds of seeds in a 3’ x 4’ x 4’ bin. The bean seeds themselves come from China. I don’t know why – maybe they grow the best beans? The bins are in a dark room and we spray them with water every two hours. We do a test and send it to a lab in Cincinnati twice a week to test for E.coli and salmonella to make sure the product is safe. We have a recycling system that cleans 80 percent of the water we use. The beans sprout on the bottom and push successive layers to the top. Kind of like they’re in dirt. On the sixth day of the process, we process them, package them, and put them in a cooler. We ship them on Mondays, Wednesdays, and Thursdays. We sell about 9000 pounds per week. It’s an amazingly big market. (Laughs) And that’s just the Dayton and Cincinnati area.

 

(Let me interject and say that a bin full of fully sprouted sprouts is totally surreal – the bins are four feet tall and are completely, completely packed with sprouts. You can reach your hand in and it’s this weird tangle of dense but loose sprouts with seemingly no end. They are so dense that you could probably walk on them. The bins are in a dark, damp room, and standing on a bucket and peering over the top into a bin and seeing an ocean of yellow-green fibers makes for a really odd sight. Not to mention that if you opened the vertical door on one of the bins, a few hundred pounds of sprouts would avalanche out and cover you in their watery, earthy essence. Maybe I’m just used to seeing them in small cartons in grocery stores, so the sheer amount of sprouts in one place is hard to process, not to mention that this is just one of seven bins.)

It’s been a nice business. It’s profitable, the market’s consistent, and it grows. But it takes a lot of commitment. Someone has to be here every day to check on them. We have alarms for malfunctioning pumps In fact, the most catastrophic event we experienced was when the computer that controls the watering cycle broke down last winter. I had to come in every two hours for a whole week and push the watering server bar over the bins by hand. I had help doing it during the day but I had to stay overnight every night and get up every two hours to do it. That’s the thing about small businesses – you make enough to survive, but a lot of times you don’t make enough to pay a manager to take responsibility for things. (Laughs) The responsibility comes back to me.

I graduated from college with a degree in Zoology. I had never even tasted sprouts before we started. In the Peace Corps I was raising fish – it was a kind of farming, but I really had no experience with growing. I learned my business sense along the way. Raising sprouts isn’t something I ever saw myself doing, but isn’t that how most people end up in life – not really doing what they thought they were going to do?