While the attention of the public is focused on arsenic poisoning in Bangladesh, West Bengal and other places, fluorosis is quietly exacting its toll elsewhere in South Asia. For more than a decade, Assam has been in the limelight for its multiple insurgencies. Because of this almost exclusive focus on violence, a new danger confronting Assamese society may go unnoticed to the point where it assumes an uncontrollable magnitude. Hydrofluorides have begun to loom as potential health disaster and today over one hundred thousand people of the state suffer from hydrofluorosis, a disorder caused by continuous consumption of ground water contaminated by excess fluorides.
Hundreds of villages on the southern bank of the Brahmaputra in middle Assam are affected by the contamination. The problem is so serious that, besides the Assam valley, the rainforest belt of Karbi Anglong and regions neighbouring the state’s Nagaon district have now been included in the “fluoride map” of India. Karbi Anglong, which has an area of 10,332 square kilometres, is by far the worst affected, with 10 per cent of its population of 700,000 suffering from dental or skeletal fluorosis. Of the Assamese population afflicted by flourosis, 70 per cent are from Karbi Anglong. The affected areas include Tekelangjun, Dokmaka, Lungnit, Taradubi, Tuplem, Garampani, Karbi Anglong, Ratiagaon, Haldiati, Parakhowa, and the Neelbagan area of Nagaon district.
The first fluorosis case in the Northeast was discovered in 1999 in the Tekelangjun area of Karbi Anglong, where fluoride levels were found to be as high as 5 to 23 mg/litre. According to World Health Organisation guidelines, the permissible limit of fluoride in drinking water is only 1 mg/litre. This creeping tragedy came to light following a study conducted by the Public Health Engineering Department (PHED) of Assam. Subsequent independent organisations, including the Central Ground Water Board (New Delhi), The All India Institute of Hygiene and Public Health (Calcutta), The School of Environmental Studies (Jadavpur University, Calcutta) and the Public Analyst in Guwahati, have corroborated the findings of the PHED survey. Interestingly, as late as 1998, the country’s geological and public health scientists had declared the Northeastern region safe from fluoride contamination.
Available statistics indicate that all over India more than six million people are seriously afflicted by fluorosis and another 62 million are exposed to it. In Assam, at least 20,000 young people suffer from severe fluorosis. Fluorosis has no cure but deterioration can be arrested if the disease is diagnosed sufficiently early. Fluorides, when consumed in excess, replace hydroxide in bones, causing a chronic condition called skeletal fluorosis. It affects people of all ages. Victims of skeletal fluorosis suffer severe pain in the joints, back bone and hips, as well as increased bone density, calcification of ligaments and paralysis. Fluorosis also leads to severe anemia, painful and restricted movement, mottled teeth, loosened muscles, kidney failure and premature death. Many victims are crippled for life.
Fluorides enter the human body through edibles, toothpaste, oral rinses and, most swiftly, through drinking water. A colourless and odorless natural pollutant, fluoride comes into contact with groundwater from its source of origin in mineral rocks. The concentration of fluoride in ground water basically depends on extended contact of the water with fluoride-bearing minerals. Three major sources of fluoride in India are fluorspars, rock phosphates and phosphorities. Most fluoride compounds in the earth’s upper crust are soluble in water. Because of differences in geographical, chemical and physical characteristics of water bearing aquifers, the porosity of rocks, the pH and temperature, fluoride content in ground water varies between 1 to 25 mg/litre. When fl l come into contact with groundwater, they release fluoride into water by the process of hydrolysis. Geologically, Karbi Anglong and parts of the Nagaon district have numerous joints, fractures and faults. In addition, the area also has large quantities of sedimentary rocks and unconsolidated material like gravel, sand, clay with intrusive granite and quartz shale, all of which are known for their high fluoride content.
The effects of fluorosis may vary from person to person, depending on the strength of the individual’s antibodies. Sometimes the effects begin to manifest themselves almost immediately, but occasionally they may take a long time to develop. Women and children are more prone to the malady as they remain at home for longer periods and thus are exposed to prolonged contact with contaminated water. Moreover, malnutrition during childhood makes women more vulnerable to fluorosis.
The life of a fluorosis victim is painful and without hope. Paulina Lakra, a victim of skeletal fluorosis from Ratiagaon, cannot walk without assistance. Her six children also suffer from dental and skeletal fluorosis. The family used to drink water collected from springs but then switched over to tube well water. They have received no medi-cine from government hospitals and they are too poor to purchase such supplies from private sources. More than 150 Adivasi families practise farming in Ratiagaon and are in a similar situation.
Ironically, it is the government-sponsored schemes to provide drinking water to villages that have unwittingly been the cause of the problem in some areas. According to Lonki Teron, the village chief in Lungnit Bazar, near Diphu, the villagers used to use collect potable water from the nearby Lungnit River until the government water supply scheme was launched in the early 1990s. The scheme was abandoned in 1999 following the report of fluoride contamination. Now they prefer to collect water from Kacha Kuwa, a low depth well. The residents of Burha Teron were lucky that they relied on groundwater. Despite the scale of the tragedy, health officials in Karbi Anglong have been slow to react. Affected villagers say that government doctors have not even bothered to visit the villages. Some health officials have tried to evade the issue by arguing that fluorosis is a manifestation of other disorders. There is also the resort to the pretence that the problem is not yet clearly identifiable. The tragedy is still “suspected” to be caused by fluorosis. A senior health official in Diphu claimed that they had to follow strict instructions from the authorities in Guwahati, Assam’s capital, and that they were, with current resources, unable to manage the time, funds and energy to deal specifically with fluorosis. He was even reluctant to recommend a survey and study exercise on fluorosis in Karbi Anglong to the head office. The civil administration of the district is no more concerned than the local health functionaries. The deputy commissioner, when approached, candidly admitted that the district administration had not formulated any policy or visualised any solution.
What compounds the problem of official negligence is that fluorosis is often overlooked in diagnosis by doctors, who sometimes mistakenly believe that it only attacks teeth and bone-joints. In reality it can cause numerous other ailments that are neurological, muscular, allergic, or gastrointestinal in nature. Reportedly, physicians sometimes find it difficult to differentiate the early stage of skeletal fluorosis from other common bone diseases such as arthritis, spondylities and osteoporosis. Hence doctors as well as public health engineers (who are responsible for providing safe drinking water), water analysts, health workers and community leaders need to be given training in identifying fluorosis. There is a strong correlation between poverty and fluorosis, and the fact is that almost 70 percent of the affected people in Assam are very poor. Socio-economic deprivation plays a significant role here. One major remedial factor is nutrition, the la is complications. The spread of fluorosis has led to increasing social dislocation in the affected areas, with restrictions in social interaction and even the marriagibility of young Karbi Anglong women. In some instances, fluorosis victims have been abandoned by their spouses and fluo-rosis victims generally suffer from social inferiority. When the disease cripples the principal income earner of the household, the entire family descends deeper into poverty. To prevent a fluorosis disaster it is imperative that safe water supply is made available, with more emphasis placed on surface water sources, as they are generally free from fluoride contamination. Rainwater harvesting is potentially an effective and cheap method of storing clean drinking water.
De-fluoridation techniques can also be employed as an alternate arrangement, but these are complicated and time-consuming exercises and will require concerted action and investment by the government. A few local NGOs, including Jirsong Asong, Lions Club, and Nehru Yuva Kendra, have been involved in health awareness drives in the affected areas of the district. Jirsong Asong has so far conducted several preliminary investigations in fluorosis-affected villages. For the moment, some non-governmental groups have been active in tackling fluorosis in Assam, launching programmes to educate doctors, community health workers and community leaders, but overall the response has been scattered and ineffective. These are not sufficient to avert a disaster that is being piped into every household and every individual on a daily basis. The state government of Assam must wake up.