Experience

Inviting Environmental Awareness Through Small,

Sustainable Acts: Medical Students Impacting the
Community
Richard Christian Suteja,1 I Komang Hotra Adiputra,1 Cokorda Agung Wahyu Purnamasidhi,2 Kadek Diana Harmayani,3 Ni
4 1 1 5 1
Made Susilawathi, Jerry, Putu Kintan Wulandari, I Gede Purna Weisnawa, Giovanca Verentzia Purnama, Darren
6 6
Junior, Dewa Ayu Fony Prema Shanti.

The Experience is very crucial for health protection, these masks may pollute the
Impacting the community does not always mean creating environment physically and biologically, thus minimizing the
exponential growth, it can also mean bringing small and effects of health protection plans. These masks could contain
sustainable changes to improve people’s quality of life. Living in sufficient pathogens capable of infecting susceptible hosts. If this
a developing country, we had a first-hand experience of seeing waste is not discarded appropriately, cross-contamination to
life in underprivileged communities. This experience expanded scavengers (both humans and animals) in landfills may occur,2
our desire to serve communities around us. However, due to the perpetuating a never-ending chain of infection in the
emergence of COVID-19 in Indonesia, most of the plans to environment. Post-landfill, leachate may flow to nearby or even
contribute to our community were halted. Strict outbreak control further areas, spreading COVID-19 through fomites while also
measures, which restricted people’s mobility, prohibited visits to being a threat to marine environment.3,4 Apart from the risks of
these underprivileged communities. infection, the polypropylene in face masks will eventually
disintegrate into smaller micro- and nanoplastics which are
The situation within Indonesia went awry during the within the genotoxic and cytotoxic to terrestrial and aquatic species.5 The
first two years of the pandemic. However there were microfibers that are broken down from face masks may enter soil
improvements in 2022. As a group of medical students, we were and water as leachable compounds, thus polluting human food
given a chance to organize a community service in collaboration chain in the ecosystem. Furthermore, it was found that direct
with faculty members and hospital authorities in September 2022. disposal of masks into aquatic environment would release more
As a part of the service, we were trusted to provide community microfibers, which might aggravate threats to the aquatic
counseling regarding the impact of the COVID-19 pandemic and ecosystem.5,6
how to dispose of used medical masks safely (Figure 1 ).
In addition to microfibers, certain types of masks which contain a
nose wire made from metals were also found to produce heavy
We were inspired to educate on this topic after observing heaps
metal substances, such as lead (Pb), cadmium (Cd), and chromium
of used masks piling up at the side of beaches we visited.
(Cr). These substances could cause toxicological effects to the
Disposable surgical masks are commonly made of polypropylene
environment and especially to human health, such as
arranged into three layers. Each layer serves a different function,
carcinogenic effects, kidney and neurological damage, asthma, or
restricting the transmission of small particles and pathogens from
even death. Even if the masks were to be incinerated instead of
both directions.1 Increasing numbers of medical masks at the
direct disposal, the volatile organic compounds (VOCs) that are
household level observed during recent years meant a global
produced should be considered since some of them are
increase in the production of plastic waste. While wearing a mask
hazardous in nature.5

1 Fourth-year Medical Student. Faculty of Medicine, Udayana University, Denpasar, Indonesia.

2 MD. Faculty of Medicine, Udayana University, Denpasar, Indonesia / Udayana University Academic Hospital, Badung, Indonesia.
3 MD, Ph.D. Faculty of Medicine, Udayana University, Denpasar, Indonesia / Udayana University Academic Hospital, Badung, Indonesia.
4 Ph.D. Faculty of Engineering, Udayana University, Badung, Indonesia.
5 Fifth-year Medical Student. Faculty of Medicine, Udayana University, Denpasar, Indonesia.
6 Third-year Medical Student. Faculty of Medicine, Udayana University, Denpasar, Indonesia.
About the Author: Richard and Hotra are currently fourth-year medical students of the Faculty of Medicine, Udayana University, Indonesia, in a 5 and a half year long program.

Correspondence: Editor: Francisco J. Bonilla-Escobar Submission: Sep 20, 2023

Student Editors: Johnmark Boachie Revisions: Jan 25, 2023, Apr 20, 2023
Cokorda Agung Wahyu Purnamasidhi & Joseph Tonge Responses: Jan 28, 2022, Apr 25, 2023
Address: 86G9+HCW, Jl. P.B. Sudirman, Dangin Puri Klod, Kec. Denpasar Bar., Kota Copyeditor: Leah Komer Acceptance: May 20, 2023
Proofreader: Amy Phelan Publication: Jun 20, 2023
Denpasar, Bali 80232, Indonesia Layout Editor: Ana Maria Morales Process: Peer-reviewed
Email: purnamasidhi@unud.ac.id

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Experience

Inviting Environmental Awareness Through Small, Sustainable Acts:

Suteja RC, et al.
Medical Students Impacting the Community

Figure 1 . Community Counseling about the Proper Ways of being disposed of must first be disinfected to avoid the possibility
Disposing of Medical Masks. of cross contamination towards workers within the area.7
Temporary and proper storage of the disposed masks could act
as a conventional method of disinfection since studies have
reported that viruses can only survive up to 9 days depending on
several factors. The installations of developed mobile and on-site
disinfection units to further reinforce the disinfection process
should also be considered by the government. Regarding
chemical valorization, the method of incinerating masks is not
recommended due to the toxic compounds it produces in the
process. Several alternatives have been discovered and should be
considered by developing countries. These alternatives include
pyrolysis, which is an environment-friendly process of converting
solid plastic waste into liquid fuel, and carbonization, which is an
energy-saving process of converting polymer waste into different
valuable carbon materials.8 As for physical valorization,
developing countries could benefit from integrating plastic fibers
of masks waste into building materials. Several researchers have
The management of medical mask waste can be divided into
shown that the addition of mask fibers could improve the
upstream and downstream management. The focuses of
strength and endurance of asphalt, pavement, and even
upstream management include mass education and strict
concrete.8,9
community monitoring to maximize household-based waste
management. This process includes sorting out infectious waste
As an alternative, sterilizing face masks for reuse through heating
from other organic and inorganic waste and decontamination via
is proven to be effective in killing pathogens and results in
heating or disinfectant baths. Keeping this infectious waste dry is
minimal reduction in particle filtration efficiency (PFE).10,11
crucial to prevent leachate.7 Proper labeling and categorization
However, even though this solution is environment-friendly,
will help garbage collectors identify which waste must be treated
standardization and ethical concerns may be an issue. Moreover,
separately.7 Downstream management focuses on the
this solution would drive up the costs of masks as special and
formulation of a novel system and readjustments of existing
calibrated equipment is required. This may exacerbate the health
operational protocols regarding these kinds of infectious waste
inequity gap in underprivileged or overcrowded communities. As
to countermeasure rapid fomite spreading of the pathogen.
for the ethical issues, this may include the possibility of mask
These include specific scheduled pickup times, specialized waste
reuse by different people. Therefore, governments usually opt to
management areas, chemical valorization, and physical
appeal to the public to disfigure medical masks before disposal
valorization.7,8
to prevent misuse by unwanted parties.

Figure 2 . Symbolic Handover of Labeled Trash Cans by Faculty

All things considered, we were required to think holistically and
Members and Hospital Authorities to Local Representatives.
to act based on public health by educating the community about
the potential harm of improper handling of medical waste.
Putting our theoretical knowledge into action, we learned to
apply a lot of skills and 'practical' knowledge we obtained from
our lectures and textbooks. We learned to act based on our scope
and capacity, educating the upstream while trying to gain
attention from authorities regulating the downstream processes.

The activity by itself was heartwarming. We had the opportunity

to converse with people who were part of the local Family Welfare
Movement. They raised their concern, later urging us to speak
with local trash regulators out of concern that the trash-collecting
regulations from the authorities might not have supported this
movement. Faculties and hospital authorities also sponsored our
activity, which was shown by the handover of labeled trash cans
(Figure 2 ). Afterwards, news of our action was spread through
social media. We were then invited to speak at a local radio
Specialized areas for the management of personal protective station to provide the same presentation and moral message as
equipment (PPE) waste should be assigned, where every waste we had previously given, but this time in front of a larger audience

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 Experience

Inviting Environmental Awareness Through Small, Sustainable Acts:

Suteja RC, et al.
Medical Students Impacting the Community

(Figure 3 ). We also uploaded an original animated video to improper handling of medical waste may have brought, but we
YouTube, which is watchable at also helped our community and children strive for a greener
https://www.youtube.com/watch?v=boV28Pf8tz0, to help the future. These small actions bring sustainable impact in our
younger portion of our community understand the steps to community. Now is not the time for medical students to be
dispose of medical waste safely. Again, through small and impractical intellectuals, but it is time for them to understand
sustainable changes, we can also bring about an impact in the theoretical knowledge holistically, to process real-life issues
community and improve the people’s quality of life. critically, and to act upon it decisively for the betterment of our
community and our future.
Figure 3 . Invitation to Speak at a Local Radio Station about Proper
Disposal of Medical Masks. Summary – Accelerating Translation
In this article, as a group of medical students, we organized a community
service in collaboration with faculty members and hospital authorities.
During the service, we provided community counseling regarding the
impact of the COVID-19 pandemic and the proper way to dispose of used
medical masks. This topic was brought up out of concern regarding the
harm towards the environment and human health that could be caused
by infectious waste. There are many methods, whether upstream or
downstream, that should be considered to countermeasure the adverse
effects of infectious waste. From this real-life situation, we were required
to think holistically and to act based on public health principles through
community education. We had a heartwarming experience as we were
able to converse with and to receive the point of views of the local people.
The news of our action was spread through social media and we were then
invited to convey our moral messages at a local radio station. We also
uploaded an original animated video to YouTube, which may help with the
understanding of the younger portion of our community. Lastly, medical
students are not meant to be impractical intellectuals, but they should able
to understand theoretical knowledge holistically, to process real-life issues
critically, and to act upon it decisively for the betterment of our community
This was a wonderful experience for the community and us. Not and our future!
only did we spread awareness about the physical harm that

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Inviting Environmental Awareness Through Small, Sustainable Acts:

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Medical Students Impacting the Community

Acknowledgments
The authors would like to acknowledge Prof. Dr. I Dewa Made Sukrama, M.Si, Sp.MK(K), the director of Udayana University Academic Hospital.
Conflict of Interest Statement & Funding
The Authors have no funding, financial relationships or conflicts of interest to disclose.
Author Contributions
Conceptualization, R.C.S. and I.K.H.A; Writing – Original Draft R.C.S; Writing – Review & Editing, R.C.S, I.K.H.A, C.A.W.P; Visualization D.J,
D.A.F.P.S, J, G.V.P; Supervision, C.A.W.P, I.K.D.H, N.M.S; Funding Acquisition, I.K.H.A, C.A.W.P, I.K.D.H, N.M.S, J, P.K.W, I.G.P.W.
Cite as
Suteja RC, Adiputra IKH, Purnamasidhi CAW, Harmayani KD, Susilawathi NM, J, et al. Inviting Environmental Awareness Through Small,
Sustainable Acts: Medical Students Impacting the Community. Int J Med Stud. 2023 Apr-Jun;11(2):150-3.

This work is licensed under a Creative Commons Attribution 4.0 International License
ISSN 2076-6327
This journal is published by Pitt Open Library Publishing

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