Much of what we know about human history comes from studying things that have been discarded. The archeology of dumps and dumps has long taught us about societies and their pasts. It includes how people survived and supported themselves, what they collected, made, hoarded and discarded.
Trash stories also showed that beliefs about sanitation, and what makes a clean environment, change. These changes are, in turn, influenced by developments in technology, forms of governance and consumer norms.
I led a study on an archive of medical equipment collected over three years from public dumps around the Eastern Cape in South Africa. What I call “pharmatrash” serves as a proxy for which drugs were provided or purchased, consumed, and then discarded. Pharmatrash in post-apartheid South Africa shows the vast proliferation of medical waste, a result of increased access to health products in the public and private sectors – and in formal and informal markets.
I set about unpacking the meaning of the trash I found. I was able to identify preferences in particular contexts for certain drugs – legal and illegal. These preferences reflected global market flows, advances in science, medicine, and marketing, local and domestic consumption patterns, and changing social norms and desires.
Medical waste growth
In post-apartheid South Africa, there was a massive expansion of public health care, with improving access to medicines and diagnostics.
In turn, these improvements have led to the proliferation of medical waste. Under South African law, hospitals are required to follow protocols for waste removal. Since waste is meant to be disposed of, garbage governance is seen to work effectively when garbage is removed and destroyed. But, when these systems fail and waste ends up where it doesn’t seem to belong (on beaches, in parks, and in people’s neighborhoods), public interest is aroused.
In 2016, for example, a landfill went wrong deposited medical and pharmaceutical waste several miles up the KwaZulu-Natal coast. Syringes, condoms and packets of pills were strewn on Durban’s beaches. The public panicked and city officials closed beaches pending cleanup. Scandals about mismanaged medical waste often capture the popular imagination. They are understood as evidence of state incompetence, corruption, corporate greed and disregard for public safety.
But these scandals mask larger realities about waste in contemporary South Africa. Rather than focusing on spectacular examples of waste displacement, my research has focused on pharmaceutical waste in its most ordinary form, as found in the household waste stream, produced by health care practices. daily health and household savings.
For four years, I have built up an archive of pharmaceutical waste by collecting and classifying waste in the Amathole neighborhood and Municipality of Buffalo from South Africa Eastern Cape Province. I picked up rubbish in poor, middle class and affluent neighborhoods in and around the cities of East London and King William’s Town.
I picked up litter from sidewalks outside hospitals and clinics, and in public places where people gather, work, shop and play. I identified the days when garbage was collected by municipal services in different areas, and I often visited these sites the day after scheduled collections to study what pharmaceuticals had escaped from split or overturned garbage bags, remaining in domestic surroundings.
I mapped official or licensed domestic dump sites, often on “islands” of municipal land adjacent to homes or apartment buildings, as well as illegal dump sites. These “informal” landfills were among the richest sources of pharmaceutical waste.
The pharmaceutical basket of this archive includes both prescription and patent medicines. These represent pharmaceuticals in common use and the prevalence of medical conditions or health care needs at the source of their purchase, supply, consumption and disposal.
Painkillers such as codeine-containing tablets and syrups, and Grandfather’s “headache powder” (which combines aspirin and caffeine), were the most common waste artifacts in this study.
The popularity of vitamins and dietary supplements was also evident, revealing strong consumer demand for pharmaceutical products marketed as performance enhancers and energy boosters.
Pharmaceutical waste from the streets around taxi ranks, markets, malls, taverns and brothels showed what products people were using for food and amusement. These included energy boosters, painkillers, vitamins, sexual performance aids and condoms.
Pharmaceutical waste from public health facilities showed what drugs people were prescribed and what forms of pharmaceutical equipment were used to treat them.
It also showed the failures of state institutions to manage waste production in accordance with laws protecting public health and safety.
Pharmaceutical waste from residential neighborhoods revealed the prevalence of infectious and non-communicable diseases in South Africa and punctuated the desire of consumers and citizens to feel vital, productive and pain-free.
I have concluded that the sale of over-the-counter drugs remains largely unregulated and understudied. There is little empirical data on the extent of their use and their safe consumption. The pharmatrash archives allow us to track new forays into the world of drug use. For manufacturers, distributors and users of these products, their shelf life is short. But their afterlife as trash portends eternities.
This is the sixth and final article in a series on drug regimes in southern Africa. They are based on research done for a special edition for the South African historical newspaper. Read the full article here.