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Khan, a
fighter in the 1971 war that liberated Bangladesh from Pakistan,
is among thousands of victims of the deadly disease. His wife, two
daughters, and the only son, who live in Izerapara village under
Northern Jamalpur district, also suffer from cancer. They don’t
have enough money for treatment, so don’t know if they would win
the battle against the dreadful disease.
The
doctors at Dhaka Community Hospital (DCH) say Khan’s chances for
survival are very slim. He developed cancer from regular drinking
of arsenic-contaminated water, and has already lost three fingers
of his left hand. The remaining two decomposed fingers are about
to come off anytime. Other parts of Khan’s body show clear
indication of decay. Numerous
black and white spots (“melanosis” and “keratosis”)
showing signs of the final stage of this particular type of cancer
called “arsenicosis” mark his entire body.
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Symptoms of disease:
Like Khan, Rahela Begum from Dayalnagar village in another
northern district of Pabna suffers from similar
pain. Her left leg had to
be amputated two years ago for arsenic poisoning whose
symptom usually starts with rotting (causing gangrene) in the limb
and then spreads onto other parts of the body. Her right leg
already shows clear signs of decay as both of her hands.
Also
being treated at the DCH, Rahela says, "Until three months
ago, all of our village were in panic. No one knew what caused
this terrible disease and we were very scared."
About
three months ago, officials from neighbouring Kashinathpur thana
of the same district visited Rahela's village to test water sample
from a tubewell shared by at least ten families. "They later
sealed off the tubewell and advised us not to drink water from
that tubewell anymore. Since then, we used to collect water from
another source."
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| Courtesy: Dhaka
Community Hospital |
| THE DISEASE -The
Cancer-damaged feet of a victim of arsenic
poison |
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Experts
predict more such patients if further field surveys are conducted
in newer areas. The World Bank predicts that one out of every ten
adults in Bangladesh will die from cancer due to arsenic
contamination of groundwater on a massive scale.
Authorities
unconcerned:
But authorities seem unconcerned despite the growing calamity.
Experts,
donors, affected people and even a section of government officials
confirm the lack of adequate measures to combat the grim
situation.
Latest
official statistics show that the deadly disease affects some 59
of the country's 64 districts, the detection and treatment of
which is still far behind the need.
Thousands
of villagers—not knowing anything—continue to drink poison and
suffer at the affected districts, including the ones where
the government claims to have warned against drinking contaminated
tube-well water. At least 1.5 million people still drink tube-well
water with arsenic concentration over the permissible level.
Treatment unavailable:
Unaware of the fatal consequences, entire family members suffer
from this deadly disease at many places. Treatment of the new and
fast-spreading cancer is still unavailable. Furthermore, experts'
strong recommendation for a rich diet containing vitamins along
with non-contaminated water, which may reverse the poisoning
process, is not affordable in this impoverished country of 125
million people and thus largely ignored in most of the affected
villages.
Outcome
of an emergency arsenic mitigation project in the 200 most
affected villages provides solid evidence of the horrific
condition.
It shows
that three in every thousand of villagers are affected by arsenic
poison in the 200 villages surveyed. Sixty-three per cent of all
the tube-wells tested in those villages show presence of arsenic
more than the permissible level of 0.05 mg/L.
It has
been more than three years since the first tube-well with arsenic
contaminated water was detected. But people still continue
drinking tube-well water without any test.
While
detection of all arsenic victims still remains a huge task,
experts say only detection will not solve the problem, since many
patients are discovered to be in their last stages of suffering
from arsenic toxicity. It often becomes too late for treatment and
a cure is still unavailable in the country.
Detection
of tube-wells with arsenic contamination will stop further spread
of the disease only if the patients are provided with alternative
and safe drinking water, according to experts who stress for a
thorough scientific research on the subject.
National
disaster:
People of the affected areas accuse the government officials of
doing little to do away with their sufferings despite declaring it
a 'national disaster' more than three years ago.
They
confirm seeing the officials visiting their villages but allege
that officials hardly give them accurate information on diagnosis
of the disease or guidance on how to use alternative sources of
water.
Surprisingly,
the doctors at government hospitals in the rural areas have little
knowledge about arsenic poisoning and most of them lack training
as to how to detect symptom of the disease on patients and send
them to a so-called 'referral hospital' which, in fact, does not
exist.
Search
for alternative sources of safe drinking water is still on, but
the authorities continue to dig new tube-wells bringing millions
more at the risk of exposure.
The Department of Public
Health Engineering (DPHE), the government body responsible for
ensuring drinking water supply to unserved and under-served
regions, continues to install new tube-wells.
But
the DPHE engineers are not ready to guarantee that such tube-wells
at new places will supply water free from arsenic contamination.
An estimated 1,100,000 tube-wells have so far been installed by
the DPHE while about 2,000,000 have been installed at private
initiatives.
There
are 4.5 million tube-wells all over Bangladesh supplying drinking
water to 80 per cent of its population.
Difficult
challenge:
Arsenic catastrophe has become a difficult challenge for the
government, which in collaboration with donor agencies, had so
long campaigned for drinking water from tube-wells. Hand-pumped
tube-wells have been the primary source of drinking water since
the awareness campaign in the 1970s was launched to convince both
the rural and urban communities of the health risks associated
with untreated surface water. Now it has to find another and safer
alternative for the people.
Pockets
of areas in the central and north-eastern parts of the country
have recently reported presence of dangerous levels of arsenic in
some tube-wells. People of this vast region are still exposed to
the arsenic toxicity here and this health hazard is alarmingly
engulfing entire delta region.
Slow response:
Outcome of various studies on the country's arsenic situation has
concerned big donors like World Bank, UNICEF and UNDP. The donors
have already suggested for 'immediate action' to ensure
alternative sources of safe drinking water. But the critics find a
slow response on the part of the government.
"There
is an immediate need for providing relief to those suffering from
the dreadful disease", observed a recent meeting of the
donors in Dhaka.
The
scientific study on 200 arsenic-hit villages reveals a vast
majority of the people have no idea of their cancer status. Report
of the UNDP-funded study was made available to a local newspaper a
few weeks ago.
The study
titled "Emergency Programme for Mitigation of Arsenic
Contamination of Groundwater in Bangladesh" shows the males
are predominant among the sufferers and the majority belongs to
16-40 age group.
"It's
a serious problem and is a silent emergency. What we need to
address this massive disaster is a co-ordinated effort," says
Shahida Azfar, Country Representative of UNICEF, Bangladesh.
She says
the UNICEF is working on an integrated program of testing
tubewells and finding alternative safe drinking water options for
the affected community.
"We
also deal with the health implications, mainly public awareness.
But the most important message is to tell the people to stop
drinking contaminated water."
The UNDP
study further reveals the under-five children are also not spared
from the toxic effect of arsenic present in drinking water drawn
from hand-pumped tube-wells in the households. But the World Bank
report shows an average of 50 per cent of the contamination rate.
Yet, the government finding of contamination is only 26 per cent.
"We
have touched only the tip of an iceberg. There are many such
icebergs," says Dr Quazi Qaumruzzaman, whose private Dhaka
Community Hospital (DCH) conducted the study.
First
patients:
The DCH, in collaboration with the Jadavpur University of
Calcutta, first identified arsenic patients in the country back in
1993. Immediately after, the DCH warned the government about the
severity of the problem but the government failed to act on time.
Referring
to the study report, Dr Quamruzzaman says, "It clearly
indicates the severity of the problem in vast areas, but
unfortunately the government is not doing enough particularly for
the victims. We have found patients where there is high
concentration of arsenic in tube-wells but what about their
diagnosis?”
The
report does rule out internal damage to organs. The dreadful
arsenicosis—the disease--takes between two and 20 years to
develop symptoms, depending on age and nutritional status of an
individual.
The
arsenic poisoning from the contamination of underground water is
chronic in nature. In most cases, the victims do not complain of
symptoms until they are detected through screening. Survey shows
visible signs in only 0.33 per cent of the victims.
A World
Bank official in Dhaka, Babar N Kabir says, "Arsenic has
emerged as a very serious problem here in Bangladesh. But
unfortunately, we are yet to understand the magnitude of the
problem."
"From
health aspects", he adds, "we are really in the dark. We
can only identify those who have visible signs, but what about
those who develop arsenicosis without visible signs?"
Kabir
hastens to add: "Until recently, we knew that the effect of
arsenic takes years before turning deadly. But the death of a one
and a half-year-old child which was reported in the New York Times
taught us a previously unknown fact -- the poison has no specific
time to kill."
Poor
knowledge:
Experts find the government move for identification of patients
and management of arsenic cases still at a poor state. Even the
doctors, having so-called training on identification of patients,
are not confident of their practice. "To be frank, we need to
learn a lot more about the proper diagnosis of patients suffering
from arsenicosis," admitted a doctor in Narayanganj, one of
the badly affected districts.
Obviously,
health workers, too, have almost zero knowledge about detection of
arsenic cancer.
"Training
and workshops on arsenic cancer are organised for doctors in the
divisional towns only. But the physicians serving at the hospitals
in districts and local administrative units still don't know how
to identify and treat a patient suffering from arsenic
cancer," says Dr A Z M Iftikhar, a top government official
managing arsenic related programs.
Dr
Ittikhar underlined the need for preventive measures against
arsenic toxicity. He says "there is no definite cure for
arsenic poisoning, but uncontaminated water and nutritious food
over a period of time nurture sufferers back to health".
But, he
adds, that there are few alternative water supplies in the
affected districts and most people in the rural areas cannot
afford nutritious food.
In
response to the donor agencies including the World Bank which
co-ordinates the arsenic mitigation programs in the country, the
government now plans to expand its study areas to another 70
thanas or local administrative units.
Till date, the government, UN bodies and the
World Bank have taken measures to assess the affected people and
the arsenic contaminated tube-wells while they keep on searching
for alternative options for safe drinking water. But provision of such safe alternative sources of
drinking water is still a far cry for the millions in the affected
areas who quietly await an unknown fate.
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