Slow Poison

Sixty-nine-year-old Renubala Ari of Deganga village in West Bengal’s North 24 Parganas district is counting her last days. But it is not her death that worries her.

Blind in both eyes and with painful lesions all over her body – the effects of arsenic poisoning (or arsenicosis) caused due to drinking contaminated groundwater – Renubala fears that her children and grandchildren are likely to meet the same fate as her, sooner or later.

If more than a million people in West Bengal suffer from debilitating arsenicosis, in Andhra Pradesh, and the northern and western States in particular, water poisoning takes another form: fluorosis.

Eighty per cent of the students at the Government Primary School at Khudabhakshpally in Nalgonda district of AP, show signs of fluorosis of various magnitude. Four of them use wheelchairs. Sirisha, 10, is a bright student. Her three siblings are down with fluorosis.

Sugunamma, her mother, doesn’t know why all of her four children have become ‘victims’. Sindhu, 8, the last of her children, looks normal but she looks four years younger than her age. “She has just begun to complain of severe pain in the hips,” Sugunamma says, wiping tears.

Arsenicosis is a sheer killer, turning into cancer over time; fluorosis destroys bones and saps the afflicted forever. Millions in India are condemned to lead wasted lives. It is to combat innumerable such cases of arsenicosis in 2,000 habitations and fluorosis in 12,000 rural habitations in the country that the latest Budget has proposed to provide Rs 1,400 crore towards water purification plants. How long will it take before these plants start to make a difference, if at all? How many more lives will be laid waste?

The devastation

“I lost my husband, his brother and wife, and my son within a span of two years. They all died of cancer caused by arsenic-poisoned water we drank all these years. My third son and his wife have been admitted to the hospital with cancer and I have been told that their days are numbered. I have lost all hopes to live now,” Renubala said.

Fifty-year-old Malathi, a resident of Merudandi village of Basirhat in North 24 Parganas district, is keeping her fingers crossed. Her only son has developed skin lesions. “He cannot wear any clothes as his body itches all over. My husband died vomiting blood due to liver cancer from drinking arsenic water. Now people tell me that my son could be affected too,” Malathi says.

Dr Subhas Chandra Mukherjee, head of the department of Neurology, Medical College, Kolkata, explains: “Long term arsenic poisoning usually manifests as black spots on skin followed by lesions. It can also cause neurological problems, pre-natal deaths and, in many cases, gangrene leading to amputation. Chronic arsenic poisoning can cause a wide variety of diseases, including cancer of the skin, lungs, kidney and bladder.”

Cancer, however, takes more than 10 years to develop, clarifies Dr Mukherjee.

On the widespread fluorosis in Andhra Pradesh, Kanchukatla Subhash, Convener of Fluorosis Vimukti Porata Samithi, points out: “"The condition will slowly deteriorate. This is quite normal in children.”

Socio-economic impact

Arsenicosis and fluorosis have their socio-economic and psychological fallout. People in the arsenic-hit districts of West Bengal face difficulties securing jobs, selling property and finding a bride or groom. In areas where awareness on arsenic poisoning is low, people are ostracised.

Renubala’s community makes a living with bamboo products. Being poor, it doesn’t help at all that her family is “arsenic affected”. Renubala’s eldest son - Pasupati Ari – has lesions all over his body; he can’t walk or even hold a glass. Pasupati, who used to earn his living by working in the fields as a farm hand till about a few months ago, is forced to sit idle.

Married at 17 and widowed at 19, Tandra Sarkar, now 49 years old, in Merudandi village of Basirhat in North 24 Parganas district, wants to sell her property and settle in some other “safe village” with her son, daughter-in-law and three-year-old grandson.  “Nobody is ready to purchase my property even if I agree to sell it at rates lower than the market price,” she rues.  Dasdiha, Nonaghata and Haringhata in Nadia district, approximately 120 km from Kolkata, are known as ‘widow villages.’

In Sivannagudem in Nalgonda district, Andhra Pradesh, one meets Amsala Swamy, a victim and an activist. A little under two feet, the 33-year-old proudly says he had met former Prime Ministers P. V. Narasimha Rao and I. K. Gujral and Justice M.N. Venkatachalaiah, to recount the miseries of his people. Swamy narrates the psychological impact of the problem: “I lost two sisters – one due to the disease, while another committed suicide. My mother could not take this and she lost her mental balance,” he says, adding that she’s improved now.

But he faces a big question now. “I am okay now with parents to take care of me. But what will happen when they die?” he asks.

SO, HOW DOES IT HAPPEN?

Drinking groundwater with naturally high quantities of fluoride (and not industrial pollution) is the single biggest cause of fluorosis. As with fluorosis, Unicef’s ‘Arsenic Primer’ says, “It is naturally occurring arsenic that exposes the greatest number of people to contamination.”

Prof Chandan Mahanta of IIT-Guwahati, who has studied the prevalence of fluorosis and arsenicosis in Assam, explains: “The acceptable level of fluoride in water is 1.5 mg per litre. The lower limit is 0.4 mg per litre. In the case of arsenic, which is sheer poison, it is 10 microgram per litre, if there are alternative sources of arsenic-free water and 50 microgram per litre if there are no alternative sources.”

WHO’s fluoride report says that “waters with high fluoride concentrations occur in large and extensive geographical belts associated with (a) sediments of marine origin in mountainous areas (b) volcanic rocks and (c) granitic and gneissic rocks.” The region from Iran and Iraq through Syria and Turkey to the Mediterranean region, as well as southern parts of US, Europe and parts of the former USSR come under the first category. The second includes the Jordan Valley, Sudan, Ethiopia, Uganda, Kenya and the United Republic of Tanzania.

India, Pakistan, West Africa, Thailand, China, Sri Lanka and Southern Africa come under the third category. Interestingly, the report points to the “general negative correlation between fluoride and calcium concentrations in Indian groundwater.”

A “UN synthesis report” on arsenic says: “The characteristic chemical features of the high arsenic groundwaters are high iron, manganese, bicarbonate and often phosphorous concentrations and low chloride, sulphate, nitrate and fluoride concentrations, with pH values close to or greater than 7.” Also that, “There is considerable evidence that arsenic is released from the soils following flooding…” Not surprisingly, arsenic is found closer to the surface, whereas fluoride levels tend to increase with depth.

FLUOROSIS PROBLEM

In Bagepalli town as well as in other parts of Chickballapur and Kolar districts, the water table is well below 1,000 feet. Says C. V. Nagaraj, a human rights activist based in Kolar who has been extensively involved in the fluorosis issue: “The fluoride contamination level in many places would have increased from 3 mg/litre a decade back to about 4.5-5 mg/litre now, due to the falling water table in a dry area. Therefore, the extent and severity of fluorosis has increased.”

Arun Kumar a doctor at the Government hospital in Bagepalli explains: “Thirty to forty per cent of our outpatients show symptoms of fluorosis. Of these, about half have general fluorosis, with complaints of body ache, fatigue, gastritis, loss of appetite and anaemia. General fluorosis develops into cases of dental and skeletal fluorosis. Dental fluorosis is common among children.”

Another WHO report, Fluoride in Drinking Water, says; “In 1991, 13 of India’s 32 states and Union Territories were reported to have naturally high concentrations of fluoride in water, but this had risen to 17 by 1999 (due to greater dependency on groundwater). The most seriously affected are Andhra Pradesh, Punjab, Haryana, Rajasthan, Gujarat, Tamil Nadu and Uttar Pradesh.”

The report cites Unicef’s estimate that in the affected States in India, 10-25 per cent of the rural population is estimated to be at risk, or a total of 60-70 million. “In India, one million people suffer from serious and incapacitating skeletal fluorosis,” the report says.

Arsenic poisoning

According to a recent study by the School of Environmental Sciences (SOES), Jadavpur University, more than 3,400 villages in 107 blocks in nine districts of West Bengal, including Malda, Murshidabad, Nadia, North 24-Parganas, South 24-Parganas, Bardhaman, Howrah, Hugli and Kolkata are highly affected with arsenic concentration of above 0.05 mg a litre.

Five districts in the northern part of the State, including Cooch Behar, Jalpaiguri, Darjeeling, North and South Dinajpur, with arsenic concentrations below 0.05 mg a litre, are “mildly affected”, the SOES study said. The population at risk in rural West Bengal is nearly 16 million, while that in urban areas is around 12 million. 

According to Unicef’s ‘Arsenic Primer', “Globally more than 130 million people are now estimated to be potentially exposed to arsenic in drinking water at concentrations above the WHO guideline of 10 ppb.” Of this, 70 million are in India and Bangladesh.

According to the Unicef report on the ‘Global Extent of Arsenic Pollution’ in Groundwater and its Potential Impact on Human Health, roughly 375 million people in the world are at risk. The worst-affected regions are Bangladesh, India (the Ganga-Meghna-Brahmaputra basin), Vietnam, Cambodia, Pakistan, Taiwan and Hungary. In the less affected category are Italy, Argentina, Nepal and Mexico.

NUTRITION ASPECT

Even while arsenic from contaminated drinking water is the single largest source of poisoning, arsenic intake also takes place through food, primarily rice and vegetables produced by using contaminated groundwater, says Dipankar Chakraborti, Director of Research, SOES.

Cow dung, which is largely used for burning chulhas (oven) in rural households, also contains arsenic (as cattle drink the water and consumes it along with the hay), which can eventually lead to lung cancer, he pointed out.

In arsenic-affected areas, those consuming nutritious food suffer less from arsenic toxicity. Nearly 80 per cent of the affected population could be saved from arsenic toxicity if they had better nutrition, Chakraborti said.  

“In cases where the skin lesions are not so severe then the symptoms could regress once the person stops consuming contaminated water. But if a pre-cancerous symptom already exists then the person might develop carcinogenesis even after discontinuing it. This will again depend upon the level of nutrition and hygiene,” explains Dr Mukherjee.

Dr Arun Kumar of Bagepalli explains: “General fluorosis conditions, those representing an earlier and less severe form of the disease, can be reversed by consuming fluoride-free water. Fluorosis can also be prevented by consuming nutritious food. But dental and skeletal fluorosis are irreversible conditions. ”

Fluoride is less lethal than arsenic, although fluorosis-affected regions are perhaps more widespread. Indeed, fluoride at levels less than 0.5 mg/litre is said to prevent tooth decay. Unlike in the case of arsenic, there is no evidence of a link between flourosis and cancer, “or for that matter, neurological disorder,” says Dr Arun Kumar. Fluorosis affects bones, teeth and overall well being.

TOWARDS SOLUTIONS

Dealing with fluorosis and arsenic poisoning requires having in place an extensive network of groundwater testing facilities, supplying surface water or safe groundwater, and improving the nutritional intake of the population in the affected regions. But what about water purification plants?

The 12th Plan Working Group report says: “…water treatment plants, viz., deflouridisation plants, iron removal plants, desalination plants, etc, installed in various States…have not met with much success… Setting up of reverse osmosis and other water treatment plants should be restricted to only places where there is no other option available, considering its prohibitive cost, wastage of water and other environmental hazards.” The “environmental hazards” being referred to are disposal of filter residues.

Similarly, the National Drinking Water Programme blueprint talks of moving “away from high cost treatment technologies for tackling arsenic and fluoride contamination to development of alternative sources through surface water supply and rain water harvesting.” (As mentioned in the Outcome Budget 2011-12.)

As Prof Mahanta explains: “By increasing the allocation under the National Rural Drinking Water Programme over the years (from Rs 4,060 crore in 2005-06 to Rs 15,260 crore in 2013-14), the Centre has provided the scope to adopt a long-term approach to policy.” This could mark a shift away from merely digging borewells to address water shortages and improving groundwater testing. He, however, says: “As for providing surface water, carrying it too far is difficult as it involves heavy capital investment. What makes matters complicated in Assam is of rivers changing course.”

For most drinking water schemes, the States need to come up with a matching contribution – and this could include the latest water purification outlay in the Union Budget, the details of which are yet to be finalised. The Budget allocation is likely to give a leg-up to private players involved in water purification and distribution.

Finally, addressing contaminated water supply is also about reviving surface water sources. N. Sampangi, the sitting Congress MLA for the Bagepalli region, said the Centre has connected 120 villages to the nearby Chitravati river, which is bone-dry now. “Once rains come, the problem will be taken care of.” We’ll have to wait and see.

Says activist Nagaraj: “This is a dry area. So, what about all the water conservation schemes announced in the past?” This is among the many questions that the government needs to answer.

With inputs from Shobha Roy/West Bengal and K.V. Kurmanath/Andhra Pradesh.

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