Life for Gita Deb (44) of village Tekelangjun in the Karbi Anglong district of Assam is an endless odyssey of pain. For the last seven years she has been bedridden, suffering from perennial body pain. She is also without medical care, even medicine. Her husband looks after the family and also takes care of the wife’s needs. As they cannot afford a bedpan, he uses a plastic sheet, convenient for repeat use.

Gita suffers from skeletal fluorosis, water borne disease, caused by excess fluoride in drinking water. Her son, a fourth standard student of Tekelangjun High School, is also showing signs of dental fluorosis. The two elder daughters, married and staying in distant villages, are also now complaining of tiredness and severe pain, sure signs of skeletal flourosis.

One can find many Gitas in the area, showcasing an impending tragedy. Around 100,000 people in the state, at least half of them women, are in the grip of hydrofluorosis. Hundreds of villages in Karbi Anglong and few areas in neighboring district of Nagaon, are reported to be prone to excess fluoride. Severe anemia, stiff joints, painful and restricted movement, mottled teeth, loose muscles, kidney failure, premature death and physical disability are manifestations of the disease. Women and children are more prone to the disease as they remain at home and thus are in contact with the contaminated water for a longer period. Moreover, malnutrition during childhood makes the women more vulnerable to fluorosis. According to statistics, more than six million children (all together 62 million people in India are suffering from fluorosis) are presently in the grip of fluorosis. Of them, at least 20, 000 are in Assam.

Well known for its scenic beauty and thick rainforest, Karbi Anglong district has recently been included in the fluoride affected map of India. Of the 700,000 habitants, one tenth are suffering either from dental fluorosis or skeletal fluorosis, The first fluorosis case in the state was discovered in the middle of 1999 in the Tekelangjun area where fluoride levels were found to be as high as 5-23 mg per liter, whereas the permissible limit is only 1 mg per liter (according to World Health Organization guideline). The tragedy, first of its kind in the North-East, was revealed following a study by the state Public Health Engineering (PHE) department.

“In the affected villages of the district, it was found that one in every four persons was suspected to be with Fluoride related disease,” informs Amalendu Bikash Paul, additional chief engineer (PHE), at capital Diphu. Later independent studies conducted by various organizations including Central Ground Water Board, All India Institute of Hygiene and Public Health (Kolkata), School of Environmental Studies ( Jadavpur University) also confirmed the findings. It may be worth mentioning that geological and health scientists of the country had declared North Eastern region as safe from fluoride contamination till 1998.

Unfortunately, fluorosis has no cure. However, it can be prevented from deterioration if diagnosed at an early stage. The fluoride replaces hydroxide in bones and this is deposited in bones and causes chronic skeletal fluorosis. It affects both young and the old.

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 to contact with the groundwater from its original source of rock minerals. Another important aspect is that most of the fluoride compounds in the earth’s upper crust are soluble in water. When fluoride containing minerals come in to contact with ground water, they release fluoride into water by the process of hydrolysis.

Geologically, the area around Karbi Anglong and adjoining Nagaon district is full of joints, fractures and faults. Besides ancient and younger sedimentary rocks and unconsolidated materials like gravel, sand, clay with intrusive granite, quartz shale, which are known as high fluoride content, are abundant in the area.

At least 20 states in India including newly created 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 Nad,u 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 water-related public health problem after arsenic. But statistics reveal that fluoride poisoning is more wide spread than arsenic in the country.

There is a distinct relation between poverty and fluorosis. Almost 70 percent of the affected population in Assam are very poor. Healthcare awareness is certainly the need of the hour. But to create awareness the people have to be economically self- dependent. Besides, malnutrition adds to the aggravation of the disease.

There are other socio-economic implications. Girls from endemic villages with their mottled teeth due to dental fluorosis find it tough to get married, or abandoned after marriage. The skeletal fluorosis, which can cripple a working individual, directly affects the earning of the family.

The UNICEF and few local Non Governmental Organizations (NGO) have been involved in health awareness drive in the affected areas of the district. Jirsong Asong, an NGO and the official organ of the Catholic Diocese of Diphu, has so far conducted several preliminary investigations in the affected villages. Father Paul of the Diocese says that along with, providing safe drinking water from alternative sources and medication for the victims deserve urgent attention. Since last year, the organization has been encouraging economic development among the poor villagers with formation of self help groups in the affected areas.