When Kusum Kalita joined the teaching staff at Tekelangjun High School 12 years ago, she encountered a rather peculiar experience in the classroom. Many of her students would cover their mouths with their fingers while talking to her. As Kalita was soon to learn, the students were embarrassed to smile because their teeth looked ‘dirty.’
The students’ ‘dirty teeth’, however, was not a product of poor hygiene. The dental problems were a consequence of the high level of fluoride now found to exist in their ground water.
Water which contains a high level of fluoride creates a disorder known as fluorosis. While there is no doubt that fluorosis affects the teeth, that is not the end of the tragedy, for fluorosis may also affect the functioning of the bones, joints, stomach and kidney.
Assam Province – Endemic to Fluorosis
Assam, a north eastern province of India, is currently experiencing a widespread problem with fluoride contamination of water. Recent estimates suggest that approximately 100,000 people in the state are suffering from fluorosis.
Hundreds of villages in Karbi Anglong, the district where Kusum Kalita lives, along with a few areas in its neighboring district of Nagaon, are reported as being prone to fluorosis. People in these areas are complaining of severe anemia, stiff joints, painful and restricted movement, mottled teeth, muscle degeneration, kidney failure, and premature death. Many in the area have become crippled for life.
Well known for its greenery and scenic beauty, comprising of hills, valleys, rivers, springs and thick rainforest, Karbi Anglong has recently been included in the fluorosis affected map of India. Among Karbi Anglong’s 700,000 habitants, one tenth of them are suffering from some form of dental or skeletal fluorosis, the latter of which can lead to paralysis.
The first fluorosis case in the state of Assam was discovered in the middle of 1999 in the Tekelangjun area of Karbi Anglong, where fluoride levels were reported as high as 5-23 mg/liter. (The permissible limit, according to WHO guidelines, is 1.5 mg/liter.) The tragedy, first of its kind in the North-East of India, was revealed following a study conducted by the Public Health Engineering department of Assam.
“In the affected villages of the district, it was found that one in every four persons was suspected to be with fluoride-related diseases,” said Amalendu Bikash Paul, additional chief engineer, Public Health Engineering, Diphu. Speaking to this writer at his government residence recently at Diphu, (which is the district headquarters of Karbi Anglong and is around 200 km away from Guwahati, the capital city of Assam), Mr. Paul, the man who first detected the disease in the area, also added that out of 2,300 people spoken to during the survey, more than 600 were found affected.
Independent Studies which have been conducted since this initial survey by organizations such as the Central Ground Water Board ( New Delhi), the All India Institute of Hygiene and Public Health (Kolkata), the School of Environmental Studies ( Jadavpur, Kolkata) and Public Analyst in Guwahat, Assam, have confirmed the findings by Assam’s PHED.
That the ground water in various parts of the hill district is highly contaminated with fluoride was also confirmed by the test result of urine samples from the victims.
Up until 1998, however, India’s geological and health scientists had declared that the North-East region of the country was safe from fluoride contamination – a claim that was shown to be false by the above-mentioned water samples tested in the PHE Departmental laboratory at Diphu.
“The affected area includes Tekelangjun, Dokmaka, Lungnit, Taradubi, Tuplem, Garampani, Nambar of Karbi Anglong and Ratiagaon, Haldiati, Parakhowa, Neelbagan area of Nagaon district,” stated Mr. Paul. “Meanwhile local habitants in the affected areas are asked not to use contaminated water for either drinking or cooking purposes. At least 85 tube wells were painted red as a warning signal there. For the habitants of Tekelangjun now, water from a distant surface source (hill stream) has been tapped and distributed in particular locations,” added Mr. Paul.
Some more affected areas in the region have yet to receive a notice, however, as the underdeveloped infrastructure, inaccessibility, and disturbed law and order situation, has limited the studies up to this point. Mr.Paul stated though that “Manipur and Meghalaya( two other provinces in north eastern India) are also vulnerable for fluoride contamination.”
Skeletal Fluorosis – The Disease without a Cure
Unfortunate to the hundred thousand victims of the state, fluorosis has no cure. But, of course, it can be prevented if the disease is diagnosed at the early stage. Initially the fluorosis patients suffer from sporadic pain and stiffness of joints, which turns to chronic joint pain, arthritic symptoms and calcification of ligaments. Finally the situation deteriorates to severe anemia, painful and restricted movement, loose muscles and even kidney failure.
“Fluoride in drinking water, while consumed, replaces hydroxide in bones and this is deposited in the bones and causes a chronic effect called skeletalfluorosis. It affects both young as well as older individuals. As a result of skeletal fluorosis, severe pains in the joints and back bone, hip region stiffness of backbone and joints, increased density of bone, along with calcification of ligaments and paralysis are experienced,” told Mr. Paul quoting a health journal.
Fluoride can enter the human body through food, toothpaste, mouth rinses, other eatable products and of course more swiftly through drinking water. A colorless and odorless natural pollutant, fluoride comes in contact with the groundwater via erosion of fluoride bearing rock minerals. Three major sources of fluorine in India are fluorspars, rock phosphates and phosphorities. Most of the fluoride compounds found in the earth’s upper crust are soluble in water.
It should be mentioned that at least 20 states of India, including the new creations Uttranchal, Jharkhand and Chattisgarh are endemic to fluorosis. States like Andhra Pradesh (first ever case of fluorosis in India was detected here in early 1930), Gujarat, Rajasthan (where 70-100% districts are affected), Bihar, Punjab, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu, Uttar Pradesh, some parts of Delhi (40-70% districts affected), Assam, Kerala, Orissa, West Bengal, Jammu & Kashmir (10-40% districts affected) can be identified as significantly affected. India thus has been facing another public health problem after arsenic. But statistics reveal that fluoride poisoning is more wide spread than arsenic in the country.
In the international arena, flourosis is found in more than 23 countries including Japan, China, Thailand, Jordan, Iraq, Iran, Palestine, Bangladesh, Pakistan, Sri Lanka, Algeria, Australia, England, Italy, France, Spain, Portugal, Czechoslovakia, Libya, Morocco, Mexico, New Zealand, Germany, Syria, Turkey, UAE, USA, Argentina, Egypt and African Nations (Senegal, Kenya, Tanzania, Ethiopia, Uganda).
The Life of a Fluorosis Victim
The life a fluorosis victim faces is frustrating, painful and often hopeless. With acute poverty and without hope of recovery, some victims have nothing to do but count their days.
Gita Deb (44), a resident of Tekelangjun area in Karbi Anglong, is suffering from the disease since 1994-95. Now leading a crippled and paralyzed life, (she’s been a bed patient for the last three years), Mrs. Deb feels severe pain in her waist, legs, hands and finger joints. Earlier she could move with the help of a stick, but now she cannot stand on her legs at all. She can hardly sit up on her bed for 30 minutes.
While talking to this writer in her hut, Gita Deb showed a few prescriptions of medicine prescribed by a physician named Dr A Bagchi from Nagaon district. The prescriptions however have been stopped as the poverty stricken family cannot afford the cost. No medicines were ever supplied from the nearby government health centers, she lamented.
Gita’s husband takes utmost care for her. He had a temporary shop in nearby Baghpani bazaar, which is around 90 km away from Diphu, to run the family. But when his wife had to go for death bed, he had to abandon the shop and serve her. The family has no bedpan and the husband uses a plastic sheet for the purpose. He himself cleans the sheet regularly for re-using later. To get washed at least twice in a month, Gita has to be carried outside. A kind of arrangement has been made outside their hut for these occasions.
Leaving aside all these works, the husband has to look after their son and cook for the three member family. Their son, a student of 4th standard in Tekelangjun High School, is also getting affected slowly with dental problems. Two daughters of theirs, who had already got married to distant villages, have their own families and kids. Unfortunately they are also complaining of pain in several joints, pain which is turning into semi- paralyzing conditions.
Gita Deb and her husband migrated to Karbi Anglong around 25 years back from Tripur, another north eastern province of India. They had five children, but two of them had died of unknown diseases at early ages. The family used to take spring water until around ten yeas ago when the PHE water supply scheme was launched. The family then started taking ground water and continued the practice till fluorosis was discovered in the area in 1999. The PHE then immediately stopped the supply scheme and warned the people not to take ground water for drinking and cooking purposes. Now the department has arranged for spring water that is flown to the village from a nearby hillock. Of course, many families in the villages, including Gita Deb’s, prefer the “Kacha” well (depth of around 10 feet) that has been dug in their residential campus.
Similarly Son Sing Ingti (35), the chowkider of Tekelangjun High School, who lives near the institution, has been suffering from waist pain since 1995. His teeth are mottled and cause him pain from time to time. Both of his legs are bending and losing strength. All the time he feels tired.
Son Sing argued that he never saw his parents suffer from such kinds of diseases. “My parents had good teeth and no problems with bone,” claimed Son Sing.
His wife Kaku Singnarpi, who hailed from a nearby village, enjoys good health of teeth, which are clean and bright, but she complains of waist pain. While Kaku was in good health when she came to the village 14 years ago, she is now experiencing stiffness in her hand movement along with pains in her waist while sitting. The medicine which Son and Kaku used to take to treat their condition provided relief for a few hours at a time. Now, however, they have stopped the medicine for good as it is difficult for them to afford.
Son and Kaku have three children (two sons and a daughter). Unfortunately all of them have mottled teeth.
Revati Rohangpi (35), a poor woman from Thoiso Timung village (which is around 100 km away from Diphu), told this writer that all of her four children are now suffering from physical problems. The family mostly depends on tube well water and they hardly get the chance to use the PHE scheme. Not aware of the quality of the tube well water, the family is still using the ground water for daily house hold works including drinking and cooking. The PHE statistics, however, show that the ground water of the area is contaminated with high levels of fluoride.
Rohangpi herself has been suffering from dental and skeletal fluorosis since long back. Her children have had mottled teeth since childhood and have been suffering from pain in their joints. Even their youngest daughter,Geeta, who is barely four years old, is complaining of stomach trouble and pain in her hands and legs.
Another victim of skeletal fluorosis in Ratiagaon, Paulina Lakra (60), cannot walk without a stick. The sixty year old woman is suffering from a series of troubles with her digestion, as well as a stiff neck, and severe pain in her legs and hands. Her three sons and three daughters are also suffering from dental and skeletal fluorosis. Her daughters had already been sent to other villages after marriages. But now they too are complaining of pain in the waist and other joints. All of the sons are with stiff neck and pain in the joints. The poor family used to drink water from springs and later shifted to a tube well. They have not received any medicine from government hospitals and they are too poor to buy the same.
So the suffering continues. Ratiagaon, which is 100 km away from Diphu, inhabits more than 150 “Adivasi” families. All are farmers by profession and too poor to survive. Affected villagers alleged that they were receiving neither treatment nor medicine from the government doctors and no doctors had ever visited their village.