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Article From News From Bangladesh archives by SYLVIA MORTOZA E mail : zainah@mail.bdonline.com The cause of our concern must be highlighted over and over as continuing to drink water containing arsenic at high levels is not good for the nation.This may sound like an obvious statement but it would seem that the government is still not ready to come to grips with it. As the maximum permissible limit of arsenic in water has been set at 0.01 mg/litre by theWorld Health Organisation, it is time the government brings the current permissible level for Bangladesh (currently 0.05 mg/litre) in line with this figure, especially as a move is now on to reduce it even lower. That consuming arsenic is extremely hazardous must be made known to the vast number of people who are unable to conceive of the consequences due to a lack of understanding of the complexities involved. But they must be made to understand that to continue to drink the contaminated water is to sign one’s own death warrant. Of course there are exceptions for a good deal depends on a) the quantum of arsenic ingested; b) the period of time ingested; c) the nutritional status of the person; and d) the immune-response of the individual. But as arsenic-poisoning in its early stages can be treated and its progress reversed, it is important for people to report any symptoms to the nearest health centre or clinic, for reversal can be achieved by a very simple remedy - STOP PEOPLE FROM DRINKING THE CONTAMINATED WATER! The effects of ingesting arsenic can also vary from skin pigmentation, development of warts, diarrhea, and ulcers and in more severe cases, liver and renal deficiencies or cancer, people must be made aware of this for the ultimate result is death. But apart from this, arsenic-poisoning is having a large number of social effects which must be dealt with immediately such as, for example, the idea that the skin lesions caused by arsenicosis is actually leprosy - an ancient scourge. This is sad for this has resulted in isolation, sometimes for whole villages as arsenic patients are barred from taking part in social activities and face rejection, sometimes by their families. With women unable to get married and wives and children abandoned, it is becoming a social problem of increasing proportions especially as children with symptoms are not being sent to school in an effort to conceal the disease. Recently a copy of the UNDP study, "Emergency Programme for Mitigation of Arsenic Contamination of Groundwater in Bangladesh" has emerged and is reportedly now part of a Health Ministry document. This study had covered 200 villages in 48 selected thanas in 21 districts and although it must be understood that these villages were chosen because they were the "hot spots" and ma not necessarily be typical of every village, still there are questions to be answered such - why has it taken so long for a 1998 study to be released? However, now that it is available, analysis should be done in as desegregated a manner as possible. Although the problem is severe, if this data is to help provide any insightful solutions and not just noises to satisfy vested interests, now that the report - and hopefully the full data - has been made public, there should be some thoughtful enquiry. In brief the findings are that more than 7000 people are suffering from arsenicosis in these 200 villages and new cases are being detected everyday. As the vast majority of the people in the affected villages had no idea of their cancer status because there are no visible signs, this should also tell us something. Males in the age group of 16 to 40 appear to be the worst affected but children below the age of 5 have not been spared either. Internal damage to organs cannot also be ruled out. The Dhaka Community Hospital Trust that had conducted the study under contract also took part in a field survey from 1995 to the year 2000 in conjunction with SOES, Javadpur, Calcutta. The results are as follows. Of 22,003 samples from 64 districts, samples from 54 districts have arsenic above 0.01 mg/l and 47 arsenic above 0.05 mg/l. In the 918 villages identified with arsenic above 0.05 mg/l patients have been found. Of the 32 districts surveyed for patients people with arsenical skin-lesions were found in 30. Out of 11,000 samples of hair, nail, urine, skin-scale it was found that approximately 90% of the people have arsenic above normal. Water samples from tubewells at a depth of 6.4 m to around 400 m in the 47 affected districts had arsenic above 0.05 mg/litre. These were further analysed and the results showed a high level of arsenic at a depth of at about 15 - 20 metres. The concentration of arsenic however decreases at greater depths. From data collected it has been estimated that 3.5 million tubewells in 43 districts of Bangladesh contain arsenic above 0.05 mg/l. This means the number of people in these districts that are exposed to arsenic-contaminated water above 0.01 mg/l are 51 million and the number exposed to arsenic-contaminated water above 0.05 mg/l is estimated at 25 million. Recently a group of people working on the arsenic problem called on the authorities to create alternative sources for drinking water without wasting any more time screening tubewells for contamination. Enough is now known about the problem to put action programmes first, by-passing the need for more testing to confirm what we already know. The money saved could be put to better use such as providing small water purification plants in each affected village for when 25 million people are known to be consuming arsenic-contaminated water at a high level, and millions more at a lower level, it makes no sense to wait. Policy-makers must now take the initiative to arrange for alternative supplies of drinking water other than ground water. Reports that more than 55,000 new deep-tubewells have been sunk and news of a government plan to sink 50,000 more deep-tubewells for the purpose of supplying drinking water to people is tenacious at best as around 21 percent of deep-tubewells have also been found to be contaminated. That an extensive and intensive public awareness programme on the danger of drinking from the arsenic-contaminated water has not had any effect is distressing but if the contaminated water is the only water available, what is the alternative? Although all of this has been said before, due to the widespread contamination of groundwater, it is time once to review the four known stages of arsenic-poisoning: Stage 1. Preclinical: the patient shows no symptoms, but arsenic can be detected in urine or body tissue samples. Stage 2. Clinical: at this stage various effects can be seen on the skin. A general darkening of the skin (melanosis) is the most common symptom, often observed on the palms. Dark spots on the chest, back, limbs, or gums have also been reported. Oedema (swelling of hands and feet) is often seen. A more serious symptom is keratosis, or hardening of skin into nodules, often on palms and soles. WHO estimates that this stage requires five to ten years of exposure to arsenic. Stage 3. Complications: clinical symptoms become more pronounced, and internal organs are affected. Enlargement of liver, kidneys, and spleen have been reported. Some research indicates that conjunctivitis (pinkeye), bronchitis and diabetes may be linked to arsenic exposure at this stage. Stage 4. Malignancy: tumours or cancers (carcinoma) affect skin or other organs. In this stage the affected person may develop gangrene or skin, lung, or bladder cancer. As more and more evidence comes to light of what arsenic can do to the body, it has to be understood it is not just a threat to the nation’s health but threatens to annihilate us as a race. Therefore a far greater effort has to be made to help people comprehend the dangers. This is very important for experts now say arsenic-poisoning will soon result in more deaths from lung cancer than from smoking. That it is a loss in productivity for the nation and threatens to leave behind cripples and orphans - much like the AIDS pandemic, the time for action is now - if it is not already too late for all too many cases have reached the stage where gangrene has set in and amputation is necessary. Fortunately there are some who understand and are doing their best to help - as for the rest of us, we should all do what e can to limit people’s exposure to arsenic so that they may be able to avoid the more acute toxic effects of consuming arsenic on a daily basis. It is therefore important to put alternative water supplies in place before more people succumb to the chronic effects of prolonged exposure to arsenic. The United States for instance is concerned about its people and are taking steps to safeguard them from the effects of arsenic poisoning. It is even contemplating the reducing the present standard to as little as 0.002 mg/litre so that calculated risks are only 1 in 10,000 per lifetime of exposure. The sole reason for reducing the standard for arsenic in water is out of concern for the people’s health but if the government of Bangladesh continues to act in the way it has up to now, how can we expect other nations to take the crisis seriously?
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