Article From News From Bangladesh archives

The Arsenic Saga Updated

By Sylvia Mortoza

For centuries, Bangladeshis relied on a multitude of rivers and streams to provide them with water. Unfortunately, over time, mainly due to the unwarranted pressure of population, this water supply also became the route for the country's sewage system and this coming together brought with it untold distress in the form of water- borne diseases caused an untold number of deaths.

With diseases like typhoid and cholera stalking the land, UNICEF, the UN's children's fund, decided to do something about it and thus funded the sinking of bore holes to tap into the groundwater they believed would not be contaminated. As a result many, many shallow tube wells were dug all over the country to meet the daily water requirements of the local people. People were thus encouraged to use the "safe" water and pretty soon, the country proudly announced that 97 percent of the population had access to a "safe" water supply.

But "safe" is a relative term and today around half of the estimated 14 million tube wells in the country are dispensing arsenic along with the water. The problem now is that, due to the lack of alternatives, many people are still drinking the contaminated water - with predictable results. As the only sure way to avoid arsenic toxicity is to avoid the intake of arsenic-contaminated food or drink, there is an urgent need to provide arsenic free water, and one alternative is to go back to using surface water from rivers, ponds, lakes, and canals, etc.

But surface water is today so polluted it has to be purified either by boiling or by ferrous salts, both of which might prove too expensive for poor people, so both the people, and the government became so confused, neither seemed to know what to do and for a time, an inexorably long time during which people fell sick, there seems to be a hiatus and nothing is getting done.

At least, that is how it seemed, but something was being done. Interested parties began to examine how they could individually benefit the most from the situation and so many techniques and treatments were developed but all ignore the fact that although the arsenic in the water may be reduced, no-one seems to bother to find out if the remaining level of arsenic in the water is still too high. And nobody seems concerned about the arsenic sludge.

Besides there are other problems of acceptability and convenience. Most social workers are aware that it is difficult to teach rural people something new and reports say at least one-third of the people refuse to adopt any of these methods. Meanwhile the most important question hydro-geologists must study is whether the pumping of all this arsenic contaminated water will in time accumulate in the surface water. We already have a problem with crops, so we need to know how bringing the arsenic to the surface will affect the crops in future.These are questions that must be studied.

Prof Allen Smith, of the University of California at Barkley, and a WHO adviser, has constantly warned us that arsenic is the major cause of cancer deaths and " In some places it kills more people than cigarettes." He said this will soon be true of Bangladesh but the only treatment victims are getting is a handful of multi-vitamin tablets.

Although both government and non-governmental partners have been working on the problem, their efforts have been limited to small pockets and no comprehensive national strategy has beem/or is being followed.

Below is a brief history of arsenic contamination in Bangladesh.

1983 - Dr K. C. Saha, former Professor of Dermatology at the School for Tropical Medicine, Calcutta was the first to recognize his patients had been poisoned by arsenic.

1985 Bangladeshis were crossing the border into India for their skin complaints and were coming back with a diagnose of arsenic poisoning.

1988 - The Disaster Forum of Bangladesh, an amalgamation of several NGOs, began inquiring into a rumour that people were suffering from arsenicosis due to contamination of ground water. They apprised the World Bank and ODA of their findings and fears. Their fears were not ungrounded but nobody listened to them so the Forum elicited the help of the Dhaka Community Hospital and other institutions and supported them in their efforts to determine the full extent of the problem.

1988 - The World Health Organisation published an article on arsenic in its Bulletin. 

1988 - A "Technology Mission" was formed to find the source of arsenic contamination in Bangladesh. It discovered an underground layer at a depth of 20 to 80 metre which contained an arsenic compound, whereas there was virtually none below the 100 metre level.

1988 - Scientists at NIPSOM reportedly told Fred Pierce of The London Guardian that the arsenic problem was known in government circles in 1990.

1988 - The Civil Surgeon of Pabna reportedly identified arsenic patients in his domain and reported it to the Health Authorities of Bangladesh but he was told to "shelve the file." 

1992 - By 1992 the secret could be contained no longer as a doctor in West Bengal, puzzled by the appearance of skin lesions on a woman when no-one else in the family had them, discovered she had recently arrived from Satkhira in Bangladesh. He alerted the authorities there.

1993 - According to the World Bank the first indication of arsenic poisoning occurred a year later in 1993.

1995 - After two years of "investigation" the World Bank confirmed there were high levels of arsenic in numerous shallow and deep wells in various parts of Bangladesh. That year a "Rapid Action Programme" was taken up by the Ministry of Health and Family Welfare, Government of Bangladesh with funding assistance from UNDP. 200 villages out of a total of 60,000 in the country were surveyed. The tube well and patient survey was contracted to the Dhaka Community Hospital. They measured both concentrations in the wells and diagnosed chronic arsenic poisoning. Most regions in the country had villages that had wells above the Bangladeshi standard of 0.05 mg/litre. By a rough extrapolation they estimated that half of all the wells in the country exceeded this limit.

1996 - That year the UK medical journal, Lancet, published an article on the arsenic contamination of groundwater of Bangladesh. SOUTH Magazine also published an article on this topic.

1997 - The World Health Organisation (WHO) finally acknowledged there was a "Major Public Health Issue" which should be dealt with on an "Emergency Basis." It launched an initiative with other concerned agencies like UNESCO, IAEA, UNICEF, UNIDO, FAO and the World Bank to test household arsenic removal techniques and the quality of alternative drinking water sources.

1997 - In a bid to tackle the arsenic menace, BRAC and UNICEF are pursuing the treatment of surface water with: Pond Sand Filter (PSF), Rainwater Harvesters (RWH), treatment of ground water with home-based filters and use of shallow ground water through dug-wells. That year the National Water Policy was promulgated. The Plan will be reviewed and updated every five years and is set in the context of development indicators for the coming 50 years.

1997 - It is now clear that multiple solutions have to be adopted by the rural people of Bangladesh in order to tackle the arsenic menace. Not one of the options have proven to be flawless, not one has been found as easy to use as tube well water directly however, the home-based three pitcher filters which can be manufactured easily by using local materials, are proving most popular of the systems on offer as they are low in cost and easy to use. It may however be necessary to sterilize the pitchers before use to avoid secondary contamination of the water with bacteria during filtration.

1998 - 1999 - A research study aimed at identifying the bio-chemical markers of arsenicism, a state of chronic arsenic contamination, to aid in diagnosis, treatment and prognosis. was carried out at the Biochemistry Department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. As blood arsenic is not considered to be a good indicator because it is passed through the blood stream within hours of absorption, the study compared and contrasted three different bio- markers - hair, nail and urine - of arsenicism from drinking water.

In an unexposed person, arsenic concentration in urine ranges from 0.01-0.05 milligram/litre. In hair usually below one mg/kg and in blood 0.0015-0.0025 mg/litre. Samples were collected from Hatkapa, Moghbazar, Millkanda, Charalal of Sonargaon, Narayanganj, Nababganj of Rajshahi and Daudkandi of Comilla which were already declared arsenic-contaminated areas. A total of 30 subjects were included in the study. They were categorised into two groups - Withdrawal group (Group-I): Subjects who had arranged more or less safe drinking water and Exposed group (group-II): Subjects who were consuming more or less arsenic- contaminated water.

Urine samples positive for arsenic were significantly higher in the exposed group and researchers said their findings indicated that one cannot tell whether a person is still consuming arsenic-contaminated water or not from hair or nail samples but one can from urine samples. They also found a strong correlation between arsenic in hair and arsenic in nails, indicating that nail samples may provide a suitable alternative to hair in diagnosing chronic arsenicosis.

2000 - Dr. McArthur, Lecturer at University College London accuses the British Geological Survey (BGS) of denying him -- and others -- access to the analytical results from Phase I of the study but BGS continued to refuse to allow other scientists access to the full data set from a major field programme in 1998.

2000 - A study by Dr. Allan H Smith, Professor o Epidemiology at the University of California at Berkeley was published in the WHO BULLETIN of September, 2000 In his study Dr. Smith predicted there would be a big increase in the number of cases of arsenic-related diseases in the coming years ranging from skin lesions to cancers of the bladder, kidney, lung and skin and cardiovascular problems. Dr. Smith urged the government to do more to provide arsenic-free water, educate communities about the risks, and treat and monitor the patients.

2000 - The Third International Arsenic Conference organized by the Dhaka Community Hospital was held in May when it was agreed that all agencies, whether government, non-government, donor, academic, national or international, must act now to stop people from drinking arsenic contaminated water. This would be affected through social mobilization and involvement of villagers and local government bodies in the screening and mitigation activities and by tapping into the indigenous knowledge of the villagers themselves and validating it through scientific methods.

2000 - A seminar regarding "Arsenic Contamination in Groundwater of Bangladesh - Cause, Effect and Remedy" was held in June. The late Dr. Shibtosh Roy Consultant of Dhaka Community Hospital said the hospital had identified about 7,000 thousand arsenic affected people in 30 districts. 7% children, 53% male and 40% female.

2000 - The World Health Organization (WHO) said Bangladesh is facing a long- term epidemic of "cancer and other fatal diseases" because of contamination of water supplies by naturally-occurring arsenic, and apprehended "the catastrophe is on a vast scale and needs to be declared a public health emergency."

2000 - A panel comprising fifty experts recently held a meeting where they drew up a summary of recommendations. The purpose of the meeting was to review the available data and advise on the technical feasibility of using the deeper aquifers for safe water supply. 

2001 - BIAN, an international organization, arranged a meeting for seeking to place a ban on the installation of any new shallow tubewells in the country and also initiated a legal process for compensating the families of the dead and for the affected.

2001 - A national survey conducted by BRAC, a Non-Government Organisation (NGO), in collaboration with the Public Health Engineering Department (PHED) and UNICEF was undertaken in Sonargaon upazila in Narayanganj district.

2001 - Martyn Day, of Leigh Day & Co, Solicitors of the UK visited Bangladesh to prepare the ground for making a case in the UK court for suing BGS for negligence and for seeking compensation for the victims of arsenic-poisoning.

2002 - A number of alternative safe water options are in operation as demonstration units to raise the level of awareness in the community. These options have been assessed after considering initial and running costs, ease of implementation, requirement for maintenance, provisions of intermittent or continuous supply, susceptibility to bacteriological contamination and acceptability by the local community. In some villages the home-based three-pitcher filter is in use. However about one-third of the affected people refuse to use any of these treatments.

2002 - In a writ lodged with the High Court, UK Bangladeshi villagers claim that the British Geological Survey (BGS) was negligent in the work it did in central and eastern Bangladesh in 1992 to assess toxicity. The claim form alleges that the agency did not test for arsenic, despite cases of poisoning from wells in the neighbouring Indian state of West Bengal. As a result, the villagers allege, five years passed before cases were first diagnosed in Bangladesh.

In the lead case, Binod Sutradhar, 43, who lives in the village of Ramrail in the country's Brahmanbaria region, claims he drank, on average, three litres of groundwater a day from a tubewell contaminated with arsenic. Mr Sutradhar has since been diagnosed with arsenicosis and has developed ulcers and burns. Doctors say that he has become much more vulnerable to skin cancer and other forms of cancer. Levels of arsenic in the tube well drinking water when tested in December 2001, were found to be much higher than recommended safety levels.

Mr Sutradhar, who has been awarded legal aid to bring his action in Britain, is claiming for a loss in his earning capacity as a carpenter, because he is only able to work two days per week. His solicitor Martyn Day, of the solicitors Leigh Day & Co, said yesterday: "Thousands of Bangladeshis have suffered the most serious injuries as a result of the arsenic contamination. On the face of it, a significant amount of that suffering could have been avoided if the BGS had tested for arsenic back in 1992." Mr Day said their case was that the BGS could and should have undertaken that test: "If this is right, they should be made to pay, just as they would be made to pay if the same thing had happened in this country," he said.

2002 - A spokeswoman for the Natural Environment Research Council, which represents the BGS, said it was aware that Leigh Day & Co was preparing legal proceedings. She said: "We will be defending the action and do not believe we have any liability in this case."

2002 - There is no strategic plan to comprehensively address the public health issues related to arsenic at the national level and at the present time, the majority of the population is still unaware of the hazard and ways for dealing with it. Their water sources have not been tested and the majority of health care providers have not been trained to recognise and counsel or treat the affected patients.

2002 - Concerted effort by BAMWSP to complete the initial round of screening in all 249 sub-districts. 

2003 - The World Bank plans a new project to address the issue of arsenic contamination for May.

2003 - Rigorous research into the effectiveness and sustainability of various home- based and community-based safe water mechanisms is underway. A recent short- term study identified three technologies that consistently reduce arsenic to below 50 ppb, and two other technologies that were effective in more than 80% of trials cases, and the longer-term effectiveness of these and other technologies is currently being evaluated. Results are expected in mid -2003.

The objective of the new World Bank sponsored Arsenic Public Health Project (APHP) is to assist Bangladesh in reducing the incidence and prevalence of arsenic- related diseases caused by arsenic contamination of drinking water and strengthen national capacity to address public health aspects of arsenic in the long term, including the capacity for surveillance, monitoring and evaluation.

The project has four components: (a) behavior change communication (BCC) focusing on risk reduction strategies and individual responsibility (to complement the information campaigns carried out by the water sector); (b) capacity-strengthening, including training programs for all health care personnel on identifying arsenicosis and counseling patients and diagnostic facilities; © research on the epidemiology, prevention and management of arsenicosis, including pilot activities that could yield scientific data on efficacy, safety, feasibility and costs of treatment options; (d) management of patients, suffering from the consequences of arsenic poisoning. This last component will only be initiated as pilots to field test the feasibility of present treatment options within the public health system. The project will not include water testing or provision of drinking water alternatives, as these activities are under the responsibility of Ministry of Local Government and are being covered under BAMWSP and numerous local NGO programs.

However there is no treatment that is proven to be effective against chronic arsenic poisoning except the stoppage of drinking the contaminated water.

Sylvia Mortoza writes from Dhaka. Her email : zainah@bdonline.com

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