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ARSENIC EXPOSURE- CARCINOGEN

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ARSENIC ESTABLISHED CARCINOGEN

Background

In the face of the heavily polluted surface water, the Indian and Bangladeshi governments and foreign aid agencies took action in the 1970s and ‘80s in order to provide the masses with safe water. These governments and agencies dug over a million public pipewells to shallow aquifers, providing the population with water that was believed to be clean and safe. A pipewell or tube-well consists of a 5cm diameter tube inserted into the ground and capped with a iron or steel hand pump. The majority of the wells were sunk by the United Nations Children’s Fund, UNICEF. Ironically these wells led to the largest arsenic contamination crisis in the world. In later years, privately sunk wells became more prominent, eventually outnumbering public wells. Currently more than 90% of the drinking water in Bangladesh derives from aquifers less than 300m deep, with most aquifers less than 100 meters deep.

as-contaminated-redIn the 1980s health problems associated with arsenic poisoning were discovered in West Bengal. Despite these clues, the arsenic problem remained unknown until a 1993 examination of pipewell water n the Nawabganj district led to the discovery of high arsenic concentrations. The number of people drinking water from wells contaminated by arsenic is staggering. 27% of the shallow pipewells have concentrations of arsenic exceeding the Bangladeshi standards of 50µg/liter, which is five times the World Health Organization’s standard of 10µg/liter. It is estimated that up to 30-35 million people in Bangladesh and 6 million people in West Bengal are exposed to 50µg/liter arsenic in their water or more. 57 million people in Bangladesh are estimated to be exposed to 10µg/liter or more.

The crisis in Bangladesh and West Bengal highlights the health problems associated with arsenic poisoning. Skin problems such as keratosis, pigmentation and de-pigmentation, and skin cancer are widespread. Patients who have been exposed for a longer period of time have developed internal organ problems such as cancer, and many more have died. The arsenic poisoning was first identified in West Bengal in July of 1983. Since then, the numbers of arsenic victims has grown with each new study.

Nine districts in West Bengal, India, and 42 districts in Bangladesh have arsenic levels in groundwater above the World Health Organization maximum permissible limit of 50 µg/L. The area and population of the 42 districts in Bangladesh and the 9 districts in West Bengal are 92,106 km2 and 79.9 million and 38,865 km2 and 42.7 million, respectively

What is Arsenic?

Arsenic – a metalloid element – is a natural part of the earth's crust in some parts of the world and may be found in water that has flowed through arsenic-rich rocks. Arsenic is also emitted into the atmosphere by high-temperature processes such as coal-fired power generation plants, burning vegetation and volcanic action. High concentrations of arsenic in drinking-water are found in various parts of the world including Argentina, Bangladesh, Chile, China, Hungary, India (West Bengal), Mexico, Nepal, Pakistan, Thailand, USA, and Viet Nam. A variety of instrumental techniques available for the determination of arsenic in water and air. (WHO Environmental Health Criteria, No. 224: Arsenic).

There is a theory that Napoleon Bonaparte suffered from arsenic poisoning, and samples of his hair did show high levels of the element. This, however, does not imply deliberate poisoning by Napoleon's enemies: Copper arsenate has been used as a pigment in some wallpapers, and microbiological liberation of the arsenic into the immediate environment would be possible. The case is equivocal, in the absence of clearly authenticated samples of the wallpaper.

Even without contaminated wallpaper, there are many other routes by which he could have picked up arsenic: arsenic was used medicinally for centuries and, in fact, was used extensively to treat syphilis before penicillin was introduced; it was replaced for treating other conditions by sulfa drugs and then by antibiotics. Arsenic was an ingredient in many tonics (or "patent medicines"), just as coca (unrefined cocaine) was an ingredient in Coca-Cola when it was introduced.

Carcinogen category notice: Category 1. Established human carcinogen known to be carcinogenic to humans. There is sufficient evidence to establish a causal association between human exposure to these substances and the development of cancer.
Carcinogen Category 1 (Confirmed Human Carcinogen)

The heaviest occupational exposure to arsenic has traditionally been in copper smelters, but arsenic is also used in the microelectronicsindustry, in glass production, in pesticides, for wood impregnation and in tanning.
Because arsenic is a recognised carcinogen, the scientific and regulatory focus has been on cancer risks. Studies have also examined effects on atherosclerotic diseases and peripheral vascular diseases in different geographical areas and under varying exposure conditions. In this paper, we reconsider data from an epidemiological study that was conducted in Bangladesh (Rahman et al., 1999a,b; Tondel et al., 1999) and present some additional evaluations regarding exposure to arsenic through drinking water, skin lesions and the prevalence of hypertension and glucosuria.

Degrees of toxicity:
As (III) > As (V) > Organic arsenic compounds.

Arsenic poisoning does cause a variety of systemic problems when and if an individual does get the toxic of arsenic poisoning. The typical symptoms are; diaphoresis, muscle spasms, nausea, vomiting, abdominal pain, garlic odour to the breath, diarrhoea, anuria, dehydration, hypertension, cardiovascular collapse, aplastic anaemia and death. The degree to which symptoms a person has will be determined by the severity of the exposure.

Possible methods of exposure to toxic substances is common to all products. The possible methods of exposure are contact, ingestion and inhalation.
The first method is by contact and when the substances is arsenic the initial complication is a corrosive effect to the dermal layers. Over a prolonged contact exposure the resulting symptoms can be very dangerous and can cause focal hyperaemia, which means it decreases to blood flow to your arteries and veins and vesicular eruptions.

vesicular eruptions      contaminated person    amputee  feet amputed leg

The second possible method of poisoning with an arsenic compound is by ingestion. The ingestion of arsenic will typically lead to the development of symptoms within thirty minutes. The initial symptoms may include a metallic taste in the mouth, hypersalivation, and dysphagia. The progression of symptoms would then include; vomiting, cramps, diaphoresis, breath odour (garlic like), and diarrhoea. If the exposure was of a large concentration then the progression of the arsenic poisoning event would lead to seizures, electrolyte disturbances and systemic shock. An exposure of an individual to arsenic that has resulted from a large quantity or concentration usually will result in death. If death does not occur with in a few hours then death will occur during the next few days due to renal failure.
The third method of exposure is by inhalation. The inhalation of arsenic compounds can lead to inflammation of the mucous membranes of the nasal and oral pharyngeal passage ways. The process may be delayed by this type of exposure because the concentration may be lower, but the end result will be the same symptoms as arsenic poisoning by contact, and by ingestion . Regardless of the method of the exposure toxic event can end in the same result, death!

Grade I Mild a) Diffuse melanosis.
b) Suspicious spotty depigmentation / pigmentation over trunk/limbs
c) Mild diffuse thickening of soles and palms.
Grade II Moderate a)Definite spotty pigmentation /depigmentation on the trunk and limbs, bilaterally distributed.
b) Severe diffuse thickening (with/without wart like nodules of the palms and soles).
Gradelll Severe a) Definite spotty pigmentation/depigmentation as above with few blotchy pigmented/depigmented macular patches over trunks or limbs
b) Pigmentation involving the undersurface of tongue and/or buccal mucosa.
c) Larger nodules over thickened palms and soles occasionally over dorsal aspect of hands and feet. Diffuse verrucous lesions of the soles with cracks and fissures and keratotic horns over palms/soles.

Guha Mazumder et. al 2001

Tani, 1999 classified affected villagers as 1 were suffering from malanosis (hypopigmentation and hyperpigmentation). Villagers in category 2 were suffering from melanosis and keratosis on the hands and/or feet. Villagers in category 3 were the most severely affected and were suffering from melanosis and developed (late stage) keratosis on the hands and/or feet. This classification is similar to that proposed by A.W Khan (WHO 1997). He suggested that arsenicosis could be categorised into 3 sequential stages:

  • 1. Melanosis;
  • 2. Keratosis with or without anaemia, conjunctivitis, bronchitis, gastroenteritis and blackfoot disease;
  • 3. Developed keratosis and skin cancer.

    • Arsenic is a metal compound that can easily find its way into the environment and the human population. The substance is found in our water, soil, food products. Even though we have governmental guidelines for controlling such toxic "substances" or "compounds" on a daily basis, we drink contaminated water and eat contaminated food products. This will lead to some degree of arsenic poisoning in each of us, according to Joe Harrison the technical director of Water Quality Association. Daily consumption of water with greater than 50 micrograms per liter of arsenic less than 1 % of the fatal dose, can lead to problems with skin, circulatory and nervous systems3. Greater problems can occur if the arsenic poisoning is of a chronic nature and resulting in neural disorders, vital organ damage and eventually death.

    Arsenic is a compound that should be more closely monitored by parents, teachers and children because of its fatal results. The three main methods of exposure are contact, ingestion and inhalation. Regardless of the method of exposure all can produce basically the same symptoms.

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    HEALTH PROBLEMS

    WILL ARSENIC IN MY WATER CAUSE HEALTH PROBLEMS

    If you are exposed to arsenic, several factors that work in combination with each other will determine whether harmful health effects may occur. These factors are:

    • DOSE How much arsenic am I exposed to?
    • DURATION How long and how often have I been exposed?
    • TYPE of ARSENIC Have I been exposed to inorganic or organic arsenic?

    GENERAL HEALTH, NUTRITIONAL STATUS, AGE, and LIFESTYLE

    Some people may be affected by lower levels of arsenic than others. Young children, the elderly, people with long-term illnesses, and unborn babies are at greatest risk of being affected. They can be more sensitive to chemical exposures. Babies are not exposed to arsenic through breast milk at levels of concern even when their mothers have been exposed.

    WHAT ARE THE HEALTH EFFECTS ASSOCIATED WITH ARSENIC EXPOSURE?

    foot amputee     feet infection    infected hands

    Based on studies in other countries, long-term exposure to high arsenic levels in drinking water has caused the following health effects:

    • THICKENING and DISCOLORATION of the SKIN. Sometimes these changes can lead to skin cancers. These cancers can be easily cured if discovered early.
    • STOMACH PAIN, NAUSEA, VOMITING and DIARRHOEA.
    • NUMBNESS in the HANDS and FEET.

    Many of the health effects of arsenic exposure are often seen with other common illnesses, which makes it difficult for a doctor to recognise. If you or your family members are concerned about health problems you believe are related to arsenic in your well water, you should discuss them with your doctor. You should also consider having your well water tested.

    TOXICOKINETICS

    The half-life of inorganic arsenic in blood is about 2 hours; the half-life of the methylated metabolites range from 5 to 20 hours.

    Absorption

    Pentavalent arsenic is well absorbed through the gut, but the trivalent form is more lipid soluble. Toxicity results from the arsenite form (As+3), especially by dermal absorption. Inhalation can result in symptomatic chronic exposure, particularly with arsine gas, which causes severe symptom by inhalation. Arsenic compounds are well absorbed parenterally within 24 hours.

    The absorption of small doses of so-called toxins that would be without noticeable consequence if they are eliminated normally, wil, after a time, lead to a toxic threshold concentration being reached in the target organ or tissue, causing disorders in which the symtoms are highly variable.

    Distribution

    Arsenic initially localizes in the blood bound to globulin. Redistribution occurs within 24 hours to the liver, lungs, intestinal wall, and spleen, where arsenic binds to the sulfhydryl groups of tissue proteins. Only small amounts of arsenic penetrate the blood-brain barrier. Arsenic replaces phosphorus in the bone where it may remain for years. Within 30 hours postingestion, arsenic deposits in the hair. Arsenic levels in hair sections may provide an indication of the time of exposure based on length from growth site. The hair of an individual who died 6 to 8 hours after ingestion of an arsenic overdose generally does not contain arsenic.

    Organic Arsenic Sources

    The two most commonly found organic, nontoxic variants of arsenic found in food regularly consumed by humans are arsenobetaine and arsenocholine. Considerable concentrations of organic acid are found in shellfish, cod, and haddock. After arsenobetaine and arsenocholine are ingested, they are rapidly cleared in the urine where they are completely excreted within 1 to 2 days (Fig. 1). No residual toxic metabolites are present. The half?life of organic arsenic is 4 to 6 hours.


    Figure 1.

    Pregnancy

    Inorganic arsenic crosses the placenta. A 22 year old female at 20 weeks of gestation ingested 340 mg of sodium arsenate. The initial 24 hour urinary arsenic level was 3030 mg/L. Dimercaprol was administered. Fetal heart tones were normal. A healthy infant was delivered at 36 weeks. At birth 24 hour urinary arsenic levels were <50 mg/L in the infant and <100 mg/L in the mother. Another case of maternal arsenic ingestion at 30 week gestation resulted in infant death shortly after birth. Dimercaprol appears to be the agent of choice. D penicillamine has been associated with teratogenicity.

    Gastrointestinal Tract

    Dilation of splanchnic vessels causes submucosal vesicle formation. Rupture of these vesicles leads to rice?water stools and bleeding. Subsequently, a protein?losing enteropathy may develop.

    Despite aggressive management of arsenic intoxication and a rapid decrease in blood and urine arsenic levels, neurologic defects may persist. It appears that distribution into neural tissue is rapid and may be irreversible even with chelation.

    Muscle

    Fatal rhabdomyolysis dysfunction has been reported after an acute arsenic overdose.

    Metabolic/Hepatic

    Negative nitrogen balance, hepatic fatty degeneration, central necrosis and cirrhosis, antagonism of thyroid hormone.

    Skin Appendages

    Alopecia (late), brittle fingernails, Mees's lines (horizontal white lines that appear after exposed nail bed area grows to exterior).


    Blackfoot Disease

    Blackfoot disease is a unique peripheral artery disease in an endemic area of chronic arsenicism on the southwest coast of Taiwan. Humic acid in well water may be the main cause of the disease. Platelet activation and hypercoagulability may play a role in causing this disease.

    LABORATORY Analytic Methods

    The current standard for arsenic analysis is atomic absorption spectroscopy, which measures total arsenic, does not distinguish between pentavalent, trivalent, or organic arsine.

    Blood Levels

    The short half?life of arsenic in the blood means that blood arsenic levels are less useful than urine levels unless exposure occurred on the same day. Serum (or blood) arsenic levels are detectable only during the first 2 to 4 hours after ingestion, after which arsenic in any form is not readily detected in blood or serum.

    Inorganic AS+3 and AS+5

    AS+3 is more toxic than AS+5. AS+3 and AS+5 are detected in the body shortly after ingestion. Monomethylarsine and dimethylarsine predominate more than 24 hours after ingestion. Urinary AS+3 and AS+5 levels present about 10 hours and return to normal in 20 hours. Urinary monomethylarsine and dimethylarsine levels peak at 40 to 60 hours and return to baseline in 6 to 20 days after ingestion. The half?life of inorganic arsenic in blood is 2 hours and that of the methylated metabolites 5 to 20 hours. Serum (or blood) arsenic levels are only detectable during the first 2 to 4 hours after ingestion.

    Organic As (Fig. 1)

    Arsenobetaine and arsenocholine have a half-life of about 4 hours and are completely excreted in I to 2 days.

    Urine: No exposure-less than 25 mg/daily.

    Toxic levels 50 to 50,000 mg daily.

    After seafood-50 to 2,000 mg daily.

    Hair Levels

    Hair analysis for arsenic is a semireliable method for confirming chronic toxicity. It does not discriminate between externally deposited arsenic and arsenic found within the hair shaft.

    Fingernails

    Fingernail arsenic may provide an estimate of the air arsenic exposure for a worker.

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    HEALTH EFFECTS - RESEARCHES

    Associations Between Drinking Water and Urinary Arsenic Levels and Skin Lesions in Bangladesh

    The present study examined the associations between drinking water and urinary arsenic levels and skin lesions among 167 residents of three contiguous villages in Bangladesh. Thirty-six (21.6%) had skin lesions (melanosis, hyperkeratosis, or both), of which 13 (36.1\%) occurred in subjects who were currently drinking water containing concentrations of arsenic less than 50 µ g/L.

    The risk for skin lesions in relation to the exposure estimates based on urinary arsenic was elevated more than 3-fold, with the odds ratios for the highest versus the lowest quartiles being 3.6 (95% confidence interval, 1.2 to 12.1) for urinary total arsenic and 3.2 (95% confidence interval, 1.1 to 10.0) for urinary creatinine-adjusted total arsenic. The risks for skin lesions in relation to the exposure estimates based on arsenic in drinking water were less strongly elevated, with the odds ratios for the highest versus the lowest quartiles of exposure being 1.7 (95% confidence interval, 0.6 to 5.1) for drinking-water arsenic and 2.3 for cumulative arsenic index.

    The study suggests that arsenic exposure is associated with skin lesions in the Bangladesh population and that urinary arsenic may be a stronger predictor of skin lesions than arsenic in drinking water in this population.(Habibul Ahsan, MD, Mmed Sc, Mary Perrin, MPH, Atiqur Rahman, MBBS, Faruque Parvez, MPH, Martin Stute, PhD, Yan Zheng, PhD, Abul Hasnat Milton, MBBS, MSc, Paul Brandt-Rauf, ScD, MD, DrPH, Alexander van Geen, PhD, and Joseph Graziano, PhD, Columbia University Medical Center, 2000).

    ). These skin lesions have also been considered to be an indicator of high exposure, and to constitute a pre-cancerous condition. Advanced keratosis is painful and results in disfigurement that can lead to social isolation. The high exposure to arsenic poses a public health problem in Bangladesh that has only recently attracted interest from the world. This situation seems to be one of the largest arsenic calamities of the world, with 30-70 million people in Bangladesh currently consuming arsenic-contaminated water (Chowdhury et al.,2000; Smith et al., 2000).

    PROGRAM IN ARSENIC HEALTH EFFECTS RESEARCH

    Researches at the University California, PROGRAM IN ARSENIC HEALTH EFFECTS RESEARCH School of Public Health and Centre for Occupational and Environmental Health University of California, Berkeley (1998) provided the following accomplishment on arsenic studies:

    • Provided definitive evidence (from studies conducted in Argentina and Chile) that arsenic is a potent cause of human bladder cancer.
    • Provided definitive evidence (from studies conducted in Argentina and Chile) that arsenic is a potent cause of human lung cancer.
    • Demonstrated results which indicate that epidemiological and experimental human data do not support the methylation hypothesis.
    • Showed that with exposure to water containing around 600 µµg/L, 1 in 10 adult cancer deaths may be due to arsenic-caused cancers, the highest environmental cancer risk ever reported.
    • Identified a dose-response relationship between arsenic exposure and bladder cell micronuclei, a genotoxic marker of effect.
    • Identified a preliminary dose-response relationship between arsenic concentration in well water in India and the occurrence of keratoses and hyperpigmentation.
    • Studies currently underway in India, Chile and the US, will allow projection of cancer risks with individual exposure data.

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    TOXICOLOGICAL STUDIES

    NONMALIGNANT HEALTH EFFECTS OF ARSENIC EXPOSURE.

    This thesis comprises a series of studies concerning occupational and environmental exposure to arsenic and some novel chronic health effects of this element, namely diabetes mellitus and hypertension. Substantial prevalence of the well-known skin manifestations of arsenic ingestion was also found to occur as a result of environmental exposure through drinking water.

    Two case-control studies on diabetes mellitus and occupational exposure to arsenic included individuals employed at a copper smelting industry (Paper I) and in art glassworks (Paper II) in Sweden. Although the number of smelter workers involved was small (12 cases and 31 controls), a significant exposure-response trend was obtained (p = 0.03). The assessment of arsenic exposure among 888 glass workers was less detailed, nonetheless it revealed an approximately doubled risk (MH-OR = 2.1; 95% confidence interval 1.2-3.7) for the workers with occupational titles that suggested exposure. Overall, the results of these studies provide evidence that occupational arsenic exposure may play a role in the development of diabetes mellitus.

    Four cross-sectional studies were carried out in Bangladesh, where a fairly large part of the population is exposed to inorganic arsenic in drinking water. In the first study (Paper III), the prevalence of diabetes mellitus among subjects with keratosis (n = 163) was compared with unexposed subjects (n = 854); keratosis was considered to be a definite sign of exposure.

    A dose-response relationship was found between categories of time-weighted arsenic exposure (mg/L in drinking water) and the prevalence of diabetes mellitus (p < 0.001), and the crude overall prevalence ratio amounted to 4.4. Despite the lack of detailed individual exposure data and information on potential confounders other than age, sex, and body mass index (BMI), the association seems strong enough to support a causal relationship, because the adjusted overall prevalence ratio was 5.9 (95% confidence interval 2.9-11.6).

    One of the other studies performed in Bangladesh (Paper V; 1481 exposed individuals, 430 exhibiting keratosis) showed a somewhat higher prevalence rate of skin lesions in males (31%) than females (26%) due to chronic arsenic toxicity.

    The crude overall prevalence was 29% in the studied villages, and there was a distinct dose-response relationship between arsenic concentrations in drinking water and skin lesions (p < 0.01).

    A clear dose-response relationship was also observed (Paper VI) between arsenic exposure and glucosuria for subjects both with and without skin lesions (p < 0.01). The possibility of using the skin lesions for initial screening for glucosuria was considered. However, the appearance of dermatological signs of chronic arsenic toxicity proved to be a poor marker in this respect, because glucosuria also occurred in the absence of skin lesions.

    A third Bangladeshi study (Paper IV) indicated a significantly increased risk of hypertension in connection with exposure to inorganic arsenic in drinking water (1481 exposed and 114 unexposed subjects). The overall crude prevalence ratio of hypertension amounted to 1.7, and the adjusted (for age, sex, and BMI) ratio was 1.9 (95% confidence interval 1.0-3.6). A significant trend in risk (p << 0.001) was observed between an approximate time-weighted mean exposure to arsenic, considered in milligrams per liter or milligram-years per liter, which strengthens the possibility of a causal association.

    (Mahfuzar Rahman , Akademisk Avhandling,Environ Health Perspect 1999 Sep;107(9):727-729 Department of Health and Environment, Faculty of Health Scien
    ces, Linköping University)

    Why is Arsenic Bad for Health?

    Arsenic dissolved in water is acutely toxic and can lead to a number of health problems. Long-term exposure to arsenic in drinking-water causes increased risks of cancer in the skin, lungs, bladder and kidney. It also leads to other skin-related problems such hyperkeratosis and changes in pigmentation. Consumption of arsenic also leads to disturbance of the cardiovascular and nervous system functions and eventually leads to death. These health effects – sometimes collectively referred to as arsenicosis – have been demonstrated in many studies. Increased risks of lung and bladder cancer and of arsenic-associated skin lesions have been reported for consuming drinking-water with arsenic concentrations equal to or greater than 50 parts per billion (or microgram per liter). (WHO Environmental Health Criteria, No. 224: Arsenic).

    Arsenicosis is recognizable from skin colour changes, blotches all over the face and body, hyper pigmentation on the chest and upper arms, hard patches on palms and soles of the feet, inability to walk, debilitating pain, watery eyes

    Arsenicosis, or arsenic toxicity, develops after two to five years of exposure to arsenic contaminated drinking water, depending on the amount of water consumption and arsenic concentration in water. Initially, the skin begins to darken (called diffuse melanosis). This happens first in the palms. Diffuse melanosis leads to spotted melanosis, when darkened spots begin to appear on the chest, back and limbs, although the latter is what is usual among people, and so is taken to be an early symptom. At a later stage, leucomelanosis sets in: the body begins to show black and white spots.

    Keratosis is the middle stage of arsenicosis. The skin, in portions, becomes hard and fibrous; it is as if the body has broken out into hard boils, or ulcers. Diffuse or nodular keratosis on the palm of the hand or sole of the foot is a sign of moderately severe toxicity. Rough dry skin, often with palpable nodules on hands, feet and legs means severe toxicity. This can lead to the formation of gangrene, and cancer.

    Arsenic poisoning brings with it other complications: liver and spleen enlargement and cirrhosis of the liver; myocardial degeneration and cardiac failure; peripheral neuropathy affecting primary sensory functions; diabetes mellitus and goitre; and skin cancers.

    Three types of skin cancers are observed: Bowen’s disease (form of squamous cell carcinoma); basal cell carcinoma and squamous cell carcinoma. These cancers develop primarily from keratosis.

    "Another unfortunate and complicating fact about arsenic poisoning," Hiroki Hashizume adds, "is that it generally takes from seven to 10 years, sometimes longer, for the disease to be recognized. When it finally is, it may be too late to treat." Professor Robert Goyer, who headed a nine-member commission of the US National Academies of Science, says its findings bolster a 1999 study by the Academy that found that men and women who drink every day water with 10 ppb of arsenic have an increased risk of more than 3 in 1000 of developing bladder or lung cancer during their lifetime. That risk rises to 7 in 1000 at 20 ppb.

    WHO reports(Sept. 8, 2000):

    Bangladesh is facing the largest mass poisoning of a population in history because of arsenic contamination of its drinking water supplies. The research by Allan H. Smith, professor of epidemiology at the University of California at Berkeley, said that between 33 and 77 millions of Bangladesh's 125 million population was at risk. Smith predicted a big increase over the coming years in the number of cases of disease caused by arsenic. These ranged from skin lesions to cancers of the bladder, kidney, lung and skin to cardiovascular problems. Bangladesh is grappling with the largest mass poisoning of a population in history because groundwater used for drinking has been contaminated with naturally occurring inorganic arsenic. The scale of this environmental disaster is greater than any seen before. It is beyond the accidents at Bhopal, India, in 1984 and Chernobyl, Ukraine, in 1986 (Smith).

    The Bangladesh Observer adds (editorial, 17. 02. 03):

    Though the mere mention of cancer brings the image of death, the fact is that in the case of children, around 70 per cent cases of cancer can be cured if treatment is provided at the right time. Ashic (A Shelter for Helpless Children) disclosed at a press conference that every year 2,50,000 children are affected by cancer and added that in 80 per cent of the cases, children are deprived of treatment as proper diagnosis is not done. We are also greatly alarmed to find that in the Bangladesh context between 5000 and 6000 children below the age of 15 become afflicted. A more searching look informs us that one child in 600 develops cancer before reaching the age of nine.

    Mass majority of the rural population does not have any alternative. While those problems remain unsolved, thousands of villagers in Bangladesh will never be able to recover from a condition that has ruined their lives. "For the last ten years I've had spots on my body," says one villager, Aleya Begum, "but it's only recently that it has become a lot worse. Now, it feels that my body is burning and a continuous itching which I'm told won't go away for the rest of my life."

    A neighbour, Iqbal Hossain, has a similar story. "In this village of ours, nearly three thousand people are living and about twenty-five people have been subjected to arsenic poisoning. Among them my condition is the most severe. Although the government had committed to supply arsenic free water two years ago, that commitment has not been fulfilled yet. The villagers didn't take notice of this problem at the beginning and now, although they are trying to stay free from arsenic poisoning, there is no way to resist it."

    While the number of arsenic victims is increasing, so too is the level of acrimony as to who is responsible for this humanitarian disaster. The British Geological Survey is currently being sued by a Bangladeshi non-governmental organization. It allegedly conducted a survey in 1992 which revealed large quantities of arsenic, yet failed to provide thousands of villagers with adequate warning (Sakil Faizullah, 26 September 2002).

    The regulatory regime in Bangladesh entangles in a number of governance issues... The rules as followed by the bureaucrats are, in most cases, outdated, complicated, ineffective and provide no scope for monitoring, transparency and above all accountability. (Patel, P. H., 2001).

    You can’t go into a village and just screen. Say, as it has happened in many cases, that you have 100% of the tube wells contaminated. So one day people are very happily drinking from what they think to be safe sources and the next day an organization like BRAC or any other NGO, goes over and paints all the tube wells red because they’re contaminated far higher than the WHO or the Bangladesh standards. And they, the people, are left scratching their heads, "Where do we drink water from?" (B. Kabir, The world Bank, 2001)

    50 cr people at risk of arsenic poisoning

    Experts and prominent members of the civil society on Wednesday emphasised the need to make the government and the lending agencies pro-active to provide safe drinking water across the country by reducing dependency on underground water to protect 100 million people who are at risk of arsenic poisoning. They also urged the authorities concerned to ensure the transparency and accountability of the organisations working on ways to stop or mitigate arsenic contamination. These observations and demands were made at an international workshop on arsenic contamination of underground water in which a 10-point Dhaka Declaration was adopted.

    The declaration included a call to update and implement the National Arsenic Mitigation Policy 2005 and its action plan, after taking into account the risk, affordability and sustainability. The other declarations include initiating large-scale programmes for rain-water harvesting at the national level, particularly for drinking and cooking; taking measures to ensure reliable access to water that is free of microbial, chemical and physical contamination; and asking the government and the lending agencies and countries and other support organisations to mobilise resources for treatment and rehabilitation of arsenicosis patients.

    'The government and the donor communities should become pro-active to ensure supply of safe drinking water to the masses by reducing dependency on underground water,' said the Dhaka Community Hospital's chairman, Professor Quazi Quamaruzzaman. He warned the audience that arsenic contamination would hamper the national economy and society as about 100 million people are at risk of arsenic poisoning. Urging the authorities concerned to ensure accountability in the field, he said, 'The big problem is that a huge amount of money has been made available here.

    Four billion dollars have already been spent for arsenic mitigation projects in the country. But the people are still suffering from arsenic contamination. We need to assess how much support we are really providing to the people who are at risk.' The Dhaka Community Hospital's coordinator, Professor Mahmuder Rahman, suggested that there should be third party audit of the quality of the water of all deep tube-wells installed by government and non-government agencies in all the high-risk upazilas.

    Dr Atiq A Rahman of the Bangladesh Centre for Advanced Studies suggested that a holistic approach should be adopted to address the problem of water contamination. Professor Mahmuder Rahman said that the World Health Organisation's approved level of arsenic contamination is 0.01mg/l, but Bangladesh is still maintaining the level at 0.05mg/l which is five times higher. It is estimated that 30 per cent of the 10 million tube-wells of the country are contaminated with a high level of arsenic. But if 0.01mg/l is the upper limit then the percentage may be about 70 to 100 in some of the arsenic-contaminated areas.

    Professor Feroze Ahmed of the Bangladesh University of Engineering and Technology emphasised the need for introducing the water safety framework of the WHO to improve the safety level of underground water. Professor Mujibur Rahman of BUET said harvesting rain-water could be a low-cost and technologically viable option for supply of safe drinking water in the arsenic-affected areas with the appropriate back-up of community sources of water for 2-3 months in the dry months of the year. The Daily Star's editor, Mahfuz Anam, emphasised the need for creating a social movement to make the people, in general, and the policymakers, in particular, aware of arsenic-related problems. He also suggested preparation of a time-bound work plan to tackle the arsenic problem. Professor Dipankar Chakraborti of the Jadavpur University, India, said that 50 crore people of the region, which includes Bangladesh and the neighbouring states of India, are exposed to arsenic contamination. Professor Allan H Smith of the Berkeley University, USA, said the real problem in addressing the problem of drinking water contaminated by arsenic is the level of awareness in the decision-makers. Dr Meera Hira Smith of the same university warned against faulty installation of tube-wells.

      Farida Akhter of UBINIG said the arsenic problem is a women's health issue as they are most vulnerable to contamination. Editor, Nurul Kabir, said the subsequent governments have failed to understand the level of arsenic contamination and the magnitude of the problem. Emphasising the need for making the people aware, he suggested launching of a concerted move by the electronic and print media — both Bangla and English. It was the seventh international conference on arsenic contamination of underground water and its mitigation held at the Dhaka Community Hospital. (Bangladesh News, 15, February, 2008)

    Over 38,000 people affected with arsenic-related diseases

    khulnaKHULNA, June 24, 2008 (UNB): Over 38,000 people in the country were affected with arsenic-related diseases while water of 30 per cent tubewells contaminated with arsenic till 2006, according to a government survey. The number of patients may rise if the latest results of the division wise surveys are published, said a Health Department workshop here Tuesday.

    Arsenic Programme of the Health Ministry and Department held the monitoring and evaluation workshop on "Searching of Arsenicosis Patients and Management". It also said Water of some 1.44 million tube-wells in 270 upazilas of 62 districts were contaminated with arsenic while 66.0 million tubewells identified as vulnerable.

    Dr AKM Mujibur Rahman, NCD and OPHE Programme Officer, presided the workshop, addressed, among others, by Deputy Secretary (Administra-tion) of Health and Family Welfare Mahfuzul Huq, Divisional Deputy Director of Health Department Dr Zebunnesa Khatun and district Civil Surgeon Dr Maksuda Begum. In Bangladesh, arsenic contamination of ground water was first detected in 1993 by the Department of Public Health Engineering (DPHE) at Sama village of Baroghoria union in Sadar Upazila of Chapainawabganj district. After testing water in different districts, some eight arsenic patients were detected in 1995. The number rose to 23 in 1996 while 42 in '97 and 60 in 98. And the number stood at 38,412 in 2006. Some 5,120 arsenicosis patients were detected in Khulna division due to consumption of arsenic contaminated water. District-wise break up of patients are : Khulna - 420, Jessore - 1,537, Bagerhat - 490, Satkhira - 194, Narail - 107, Magura - 174, Jhenidah - 312, Chuadanga - 815, Kushtia - 637 and Meherpur - 373. The workshop was informed that the government has undertaken different arsenic mitigation programmes. Medicines have already been sent to different district and upazila health complexes through CMSD. The government has initiated to take rehabilitation programme for the arsenicosis patients. (The Financial Express, June 25, 2008).

    Arsenic Affects the Whole Body

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    Arsenic poses stroke risk

    Contaminated water has affected people in Bangladesh Arsenic poisoning through contaminated drinking water can lead to diseased arteries, which in turn can cause heart attacks and strokes, research shows.

    Scientists say they have identified a link between long-term exposure to arsenic and the accelerated development of atherosclerosis or progressive narrowing and hardening of the arteries leading to the brain.

    The findings, published in the Journal of the American Heart Association, strongly point to arsenic and possibly other pollutants, as risk factors for blood vessel disease throughout the body.

    Lewis DR, Calderon RL. US Environmental Protection Agency, Human Studies Division, USA, 1999:
    Human health effects potentially due to drinking water arsenic (As) are more frequently reported in other countries than in the United States (U.S.). The types of health effects reported in other countries, especially skin effects, are very different from outcomes observed in the U.S.

    Results of a recent cohort mortality analysis among a historic population of 4,058 Latter Day Saints in Utah and historic As concentrations have found significantly increased mortality for all heart disease (Relative Risk (RR) = 1.26, 95% Confidence Interval (CI) = 1.03-1.55), respiratory cancer (RR=3.55, 95%CI = 1.37-9.20), and prostate cancer (RR=l.98, 95%CI = 1.04-3.77) among males. Females had moderately increased mortality from cerebrovascular disease (RR=l.42, 95%CI=0.94-2.15) and hypertension with heart disease (RR=l.99, 95%CI = 0.82-4.81). A dose-response analysis of median drinking water As concentration by town and residence years showed an increase for prostate cancer with increased concentration.

    Similar results for these effects have been found in non-U.S, populations. Future directions for the examination of drinking water As and health effects in the U.S. include an assessment of data needs from areas representing different geology, metabolic studies, and epidemiologic studies of As exposure in populations in areas with moderate As. This is an abstract of a proposed presentation and does not necessarily reflect EPA policy.

    Low-level exposure to arsenic in drinking water is widespread in the United States and elsewhere. In New Hampshire, for instance, where 40% of the population's water supply comes from private wells, as much as 8% of the state (one-fifth of all private well users) may be exposed to arsenic concentrations between the U.S. Environmental Protection Agency's proposed standard of 10 parts per billion and the current standard of 50 parts per billion. At industrial sites and toxic waste sites--including over 70% of all Superfund waste sites--arsenic is usually found in combination with many other toxic chemicals, and it can leach into groundwater and find its way into drinking water.

    Statistics of Arsenic Calamity

    Total Number of districts in Bangladesh 64
    Total Area of Bangladesh 148,393 sq.km
    Total Population of Bangladesh      120 Million
    GDP per capita (1998) US$260
    WHO arsenic drinking water standard     0,01ppm
    Maximum permissible limit of arsenic in drinking water of Bangladesh   0,005pm
    Number of districts surveyed for arsenic contamination 64
    Number of districts having arsenic above maximum permissible limit 59
    Area of affected 59 districts 126,134 sq.km
    Population at risk of the affected districts  75 Million
    Potentially exposed population 24 Million
    Number of patients suffering from arsenicosis  7000
    Total number of tubewells in Bangladesh 4 Million

    Source: BBS, Dhaka Community Hospital, NIPSOM, DPHE.

    Affected tube-wells, 1999 Assuming 0.250 mg/litre as the mean content of arsenic in groundwater, a person who consumes 1500 ml of this water each day for 10 years will consume about 6 gm of arsenic only from water. It is reported in the literature that 3 to 25 grams of arsenic when consumed over 1 to 22 years produces hepatic damage in the form of cirrhosis and non-cirrhotic hypertension (Morris, et al., 1974). Considering the poor health situation of the majority of the population in Bangladesh and double the amount of water consumption it is very likely dose-response effects will be more severe and devastating.

    The development of atherosclerosis in the arteries

    Chih-Hao Wang of the National Taiwan University and colleagues studied 463 people living in an area of Taiwan with high rates of arseniasis, or chronic arsenic poisoning. Scientists have tracked the amount of arsenic in well water in the region for more than four decades

    The team found that three indices of long-term exposure to arsenic correlated directly with the amount of atherosclerosis present in the carotid arteries. People with the highest arsenic exposure, they report, had three times the risk of atherosclerosis as seen in those who were not exposed to the element. "Our results indicate that long-term arsenic exposure may lead to the progression or acceleration of carotid artery disease and most likely generalized artery disease in humans," Wang notes. Because this study occurred in a region characterized by extremely high levels of arsenic in drinking water, the lowest level of contamination examined was 50 micrograms per liter (Journal of the American Heart Association, 26. 03. 02).

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    Arsenic Contamination in Rice(IRRI) growing Countries

    Now around these paddy fields a disguised evil has crushed the nation, a catastrophe that is more severe than flood or tidal storm, Chernobyl, Bhopal or any kind of disaster that human being has ever faced to a such large extent. Slowly, but severely, painful deaths are occurring and most of the rural population of Bangladesh do not know why! A poison that you cannot see or even smell in the drinking water is hardly thinkable for such a simple-minded nation. The decision to change (so called "improvement") their life-style comes from the luxurious offices of the richest capitals of the world. A modern agrochemical /technological based agricultural system was imposed on them about three decades ago but they were never consulted nor asked for their advice.

    Rice - IRRI High Yield Producing Countries in River Plain faceing Arsenic Contamination

    a patient

    Priya Harish Patel, Harvard University, USA,( 2001) describes, "Where are we going to land?" I thought, inwardly panicking as acres and acres of water drew ever nearer with each passing second. At that moment, I recalled that Bangladesh was in fact the most densely populated country in the world and that 35 million people in this watery wonderland were suffering from lack of safe drinking water.
    I ignored these distracting thoughts as my plane safely landed on a magically appearing island of hard ground. A week later, I was rudely awakened to the reality of Bangladeshi life when I visited a rural village.
    There, within the wetlands and rivers that are Bangladesh, millions of people had erected little huts held up by hardy strips of bamboo.
    And there, I saw my first arsenicosis patient - his hands and chest were discolored and three fingers had been cut off due to gangrene, a symptom of advanced, chronic arsenic-poisoning. Here, within this green haven, millions of people were and are still living in a kind of hell - a hell they cannot see, taste, or feel but which invades their bodies through the water they drink and will eventually kill them."

    Before the beginning of the century there were 15 countries in the world that had arsenic contamination in water.Four countries,Bangladesh,West Bengal —India, China,and Taiwan, had populations that were suffering seriously.
    In fact, in the time span of only two years (2000 –2002) six more nations have found significant ground- water arsenic contamination.These are Cambodia, Lao People Democratic Republic, Pakistan, Myanmar, Vietnam, and Nepal.The International Arsenic Conference at San Diego (July, 2002 ) brought out a new aspect of this debacle. For the first time the serious situation of Bihar (another state of India in Middle Ganga Plain), was confirmed. This new discovery reveals that a good portion of the Ganges Plain,with an area of about 530,831 sq.km.,may be contaminated with arsenic.This area has a population of about 450 million (including Bangladesh) (Chakroborti, 2003)

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    Inner Mongolian

    96% of Well Water is Undrinkable: Arsenic Concentration Found as high as 1.088 ppm

    Hetao region

    Many of the arsenic affected areas are located in the arid region (with the annual rainfall of 200-300 mm) of the Hetao Plain between the Yellow River on the south and the Inshan Mountains on the north. The Gobi Desert lies on the west.The Hetao region had been known as fertile farmland attracting immigration. However, in recent years, there are desolate villages here and there since the residents left having given up their houses and fields due to the prevailing diseases such as cardiopathy, the disorder of circulatory organ, or cancer.

    "The mortality rate is high here", or "Many people are suffering from cancer in this village". During the survey, two cases each of Bowen's disease and stomach cancer were confirmed by pathological diagnosis. In the arsenic affected Shengli village of the Haizhiyan district of Wuyuan county, 40 people passed away during the 11 years from 1986 to 1996 in the sixth, seventh and twelfth hamlets. (Villages consist of hamlets, each hamlet containing around 200-300 people). Among the 40 deaths, 15 were due to cancers. According to the various research reports compiled by the end of 1995, arsenic contamination in Inner Mongolia spreads in 655 villages of 11 counties and 1,774 patients were confirmed (Guo Xiao-juan, 2001).

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    Nepal

    Nepal is a landlocked country in southern Asia, between China and India, with a total land area of 140,800 square kilometres. Topographic variations are extreme and the terrain has a general southward slope. The topography ranges from rugged high Himalaya in the north, to the central hill region, to the lower-lying Siwalik Range (south-central) and down to the 'terai' or flat river plain in the south.

    Elevations range from greater than 8000 m (Mount Everest range) on the north border with China to 70 m (Kanchan Kalan, terai region) in the south. Nepal has eight of the ten highest mountains in the world.

    Many of the documented problems are related to pollution of both surface waters and shallow groundwaters from domestic, agricultural and industrial wastes. Much of the Nepalese population uses surface water for potable supply which is most vulnerable to pollution. Hence only 34% of the population are thought to have access to safe drinking water (NepalNet, 2001).

    Shallow groundwaters are also at risk from contamination: pathogenic bacteria, pesticides, nitrate and industrial effluents (urban and periurban areas) are likely to be the greatest problems encountered.

    Shallow groundwaters in the Kathmandu Valley in particular are reported to have been contaminated with industrial and domestic pollutants in recent years (Jacobson, 1996).

    The nature of the industrial effluents present is not known in detail, but the greatest sources are likely to be from the textiles and carpet-manufacturing industries. These may introduce effluents with high salinity and containing organic chemicals and some trace metals (from dyes and finishing treatments).

    The chemistry of shallow groundwaters in the terai region depends to a large extent on the lithology of the sediments: the shallow aquifers are vulnerable to pollution if surface sediments are sandy and permeable, but less so if a protective layer of low permeability (clay or silt) is present.

    As the shallow aquifer is reported to be largely unconfined, the vulnerability to surface pollution may be relatively high, at least in some areas.

    However, in some parts of the shallow aquifer of the terai, anaerobic conditions are observed as some shallow groundwater has high concentrations of arsenic iron.

    Arsenic in the terai groundwaters is a newly emerging problem and although no arsenic-related health effects have been recognised in the region, sufficient concern has been raised among the government and NGOs to launch an arsenic and health testing programme. Deep groundwaters present in the Kathmandu Valley and the terai are also largely anaerobic and hence vulnerable to increased concentrations of iron, manganese, ammonium and possibly arsenic. However, to date, no high-arsenic deep groundwaters have been documented in these areas. Springs from the karstic limestone aquifers at depth in the Kathmandu Valley are reported to be of calcium-bicarbonate type with good chemical quality, although the amount of data is limited.

    Arsenic

    Of the aquifers present in Nepal, those potentially at greatest risk from contamination with arsenic are the recent sediments of the terai region. A number of surveys of groundwater quality have revealed the presence of arsenic in some samples at concentrations above desirable limits. The Department of Water Supply and Sewerage (DWSS) found 1% of water sources analysed had arsenic concentrations of greater than 50 µg/l (the Indian and Bangladesh standard for arsenic in drinking water).

    Highest concentrations were found in groundwater from the active floodplain of the River Koshi. The Nepal Red Cross Society (NRCS), from testing in 17 of the 20 terai districts, found some 3% of groundwater sources sampled had concentrations above 50 µg/l, the highest observed concentration being 205 µg/l and the worst affected districts being Nawalparasi (Western Region), Rautahat and Bara (Central Region) and Bardia (Midwestern Region). NRCS (2001) has listed these districts, together with Parsa, Rupandehi, Kapilbastu and Banke as priority areas for testing, water-supply mitigation and health screening.

    Finnida found 12% and Tandukar found 9% of samples analysed in their respective investigations had concentrations exceeding 50 µg/l.

    The highest arsenic concentrations observed by Tandukar (2001) were around 120 µg/l, most of the high-arsenic samples being from the River Bagmati area. The high concentrations appear to occur in anaerobic groundwaters and are often associated with high dissolved iron concentrations (Tandukar, 2001).

    From the available data, it appears that the arsenic contamination occurs in the shallow aquifers of the terai (tubewells completed at <50 m depth). Deeper tubewells appear to have lower arsenic concentrations (<10 µg/l), although it is stressed that the volume of available data for the deeper aquifer is so far very limited.

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    The largest mass poisoning, Bngladesh/India

    The largest mass poisoning of a population in history is now underway in Bangladesh. It is a terrible public catastrophe, asserts Allan H. Smith, Professor of Epidemiology at the University of California, Berkeley, and a WHO consultant who has investigated arsenicosis in Bangladesh on several trips. The number of people affected by this arsenic disaster is among the greatest of any disease facing the world today. "By virtue of its sheer size it is pushing the limits of our knowledge and capacity to respond to it," asserts Professor Hans van Ginkel, Rector of the United Nations University in Tokyo (WHO,Friday 22 March 2002)

    Why do people die in arsenic poisoning?

    The contamination of wells with arsenic is one of the greatest environmental disasters being faced today and must rank as one of the worst in recent times. At the request of contacts in West Bengal I researched the matter and found a technology that can get rid of all traces of arsenic. Since then I have tried to mobilise public opinion to find finance for implementation and have also talked to the West Bengal Government, people and authorities in Bangladesh, US AID, UNICEF, DIFID, SIDA and other aid donors

    My own estimate is that one person is dying every 15 minutes and millions are suffering in illness. But very few politicians and bureaucrats live in the affected villages and the people dying are considered to be of no consequence.

    Worse still, the token efforts of the World Bank and other aid agencies has added obstacles to solving the problem. If the captain of the Titanic broadcast a May Day message, most of these people would have commissioned studies on iceberg flows and common sense home spun ways of avoiding icebergs rather than sending ships to take the passengers off.
    My conclusion is that:

    • the problem is chronic,
    • the contamination is irreversible and worsening,
    • no other safe water sources can substitute the wells,
    • aid agencies helped produce the problem due to lack of care about environmental impact, and are today full of ill considered patronising solutions,
    • the solution must fit village culture, be robust and be commercially sustainable,
    • technology exists to solve the problem but it will cost a lot,
    • no one cares sufficiently since its is all theoretical for them.
    (V. Chand, UK, 2003).

    No body is willing to marry Rahima Khatun

    The reason: She is a patient of arsenic-contamination. Over the past ten years, she has lost her parents and other family members owing to the same disease. Presently, she has one widowed sister, Mina Bewa, and her (Mina’s) two little sons. Rahima has contacted various diseases following the effect of arsenic. She lives at Sheikhpura village in Manikchak block and earns her livelihood working in fields. At times she has to beg to fetch food for her family members. Villagers know Rahima is on the verge of death. Because like Rahima, more than 10 villagers have died owing to arsenicosis and she is waiting for the same fate. Her next-door neighbour, 68-year-old Abdul Hanif, is suffering from arsenic-contaminated diseases.

    But the plight of these villagers is that they do not get the scope to collect arsenic-free water from a distance point owing to irregular supply due to various technical reasons. Unfortunately, despite poverty they have one tube well at their house and still they are drinking under ground water.

    Though a section is aware of the name of PHE water after setting up of an arsenic-free water treatment plant spending Rs 50 crore at Mathurapur in Manikchak block, very close to the village, but there was no sign of campaigning by any NGO group to stop using ground water. Having no alternative, villagers are drinking “a drop of poison”, as it were, every day.

    But in the next village, another victim, middle-aged Soyeb Ali, who has lost his right hand, collects PHE water for drinking every day, according to the guidance of the state’s school of tropical medicine. Ali had to agree with Kolkata doctors to amputate his right hand and is tying hard to live a new life. Tafajul Hossain (40), a jobless man owing to arsenic-contamination, despite amputation of his right leg fingers is living an uncertain life with four children and wife at Sardaha village near Golapganj in Kaliachak III.

    At Bamongram village in Kaliachak I, where an NGO Chetana is working with the ‘Keratosis’ patients with vigorous toxicity, tested over 2,000 samples. The local youths are organising this clinic here every Wednesday and a group of homoeopathy doctors is doing its best applying medicines and advising safe drinking water to the patients. Dr Subrata Pal Choudhury and Dr Bidhan Mandal, doctors of the Chetana clinic, said: We are trying to find out how three-year-old babies are being affected by arsenic contamination. From this clinic we have several such babies who are affected by arsenic and its deposition is found in their hair and nail. Some babies are coming with genetic weakness with the effect of arsenic-contamination.”

    On the other hand, people of arsenic-affected areas are suffering from diseases like gallbladder, bronchial, diabetics and other problems. As a result, the former sabhapati of Kaliachak I panchayat samiti, Noor Mohd. Biswas, died following attack of arsenic few years ago, a local practitioner, Dr Samuel said. A section of people in mostly affected zones is conscious about using under ground water in Kaliachak III and I. Some NGOs are also spreading awareness (The Statesman, Calcuuta, 2005).

    Bihar wakes up to arsenic menace

    PATNA: In the past couple of years, Ojhapatti village in Bhojpur district has seen only a few "baraats" or marriage processions. Nobody wants to marry a woman born and brought up in this village. And families with grown-up daughters are increasingly moving out of the village to get them married. In Bihar's heartland, Ojhapatti is one of the most affected villages by arsenic. The ground water in this sleepy, impoverished village is said to contain very high amounts of arsenic, about 50 parts per billion (PPB) which is five times more than the permissible 10 PPB (according to WHO and Bureau of Indian Standards).

    Since the word has spread, men now hesitate marrying women brought up in this village for fear of having abnormal children. Even though the village has now a piped water supply system, which is rare in rural Bihar, the ostracism remains. Arsenic affects 11 of Bihar's 38 districts. It was first detected in Bhojpur district about four years ago after people began to pour into hospitals with symptoms of arsenic poisoning.

    They all had dark pigmentation on their body with lesions on the soles and palms. Some were also detected with skin cancer. Sources said the state government has estimated an expenditure of Rs 324 crore over the next decade to provide a permanent alternative water supply network in the affected areas. Arsenic is erratically present in ground water. One tubewell may draw up highly contaminated water and another, barely 10 metre away, may be totally free of arsenic. After a recent survey, 11 districts starting from Bhagalpur in the east of the state to Bhojpur in the extreme west, all along the Gangetic plains, were declared arsenic-affected by the state government (Times of India, 24 June, 2006).

    CSE finds arsenic contamination in Gangetic region

    NEW DELHI, OCT. 5, 2004: The Centre for Science and Environment (CSE) today claimed that it had detected high levels of arsenic in the ground water westward along the Gangetic plains, with the Ballia district in Uttar Pradesh being particularly affected. While the Ballia administration denied this and even sent a legal notice to the CSE saying it was working against "national interest," the CSE director, Sunita Narain, said she stood by the findings and wants immediate remedial action by the State Government, including better monitoring of ground water.

    The laboratory analysis of hand-pump water and the hair and nails of people living in the villages of Ballia has shown levels of arsenic much higher than what is considered safe, Ms. Narain said. Though there is no legal safe limit for arsenic in hair, toxicologists say between 80 to 250 parts per billion (ppb) is acceptable. The level of arsenic detected in human hair here was 4,800 ppb to 6,300 ppb.

    The content of arsenic in ground water ranged between 15 ppb and 73 ppb, while the guidelines describe 10 ppb safe. Similarly, the acceptable level of arsenic in nails is between 430 ppb and 1,080 ppb but tests showed it was close to 2,480 ppb. The tests were conducted at the Delhi-based Shriram Institute of Industrial Research Laboratory. Ms. Narain presented a UNICEF survey and studies conducted at Jadavpur University, which showed that, besides West Bengal, arsenic was found in Bihar, Uttar Pradesh, Assam, Jharkhand and Chhattisgarh. According to the two studies, scientists believe that arsenic is present naturally and brought down from the Himalayas.

    The CSE stumbled upon the possibility of the presence of arsenic in water when Dinanath, a resident of Ekwana Rajpur village in Ballia, came to the All India Institute of Medical Sciences (AIIMS) for cancer-detection tests. His sons and many other villagers were suffering from skin diseases related to arsenic poisoning. When the CSE team checked his hand-pump, the arsenic level was found to be 73 ppb as against 10 ppb set by the Bureau of Indian Standards.

    As of now, the Central Government says that arsenic contamination is found only in eight districts of West Bengal and Bihar (Bhojpur). "The CSE believes that the case of Ballia highlights a matter of intense urgency to understand the extent of arsenic contamination in the country; and on this basis create a clear policy and action plan to ensure that people are not forced to drink arsenic contaminated water," Ms. Narain said ( Aarti Dhar, The Hindu, India, 2004).

    Arsenic affecting Bangladesh crops

    Crops in Bangladesh are being contaminated with arsenic from water used for irrigation, according to research by Bangladeshi and Australian scientists. They found evidence of high concentrations of the poisonous substance in rice and vegetable plants. Contamination of drinking water affects around 20 million people in Bangladesh and the neighbouring Indian state of West Bengal.

    Arsenic in Bangladesh drinking wells may be linked to crop irrigation, MIT study finds

    ruthless killer in Bangladesh's drinking water is making millions of people sick and may be causing as many as 3,000 deaths each year. That killer--naturally occurring arsenic in the water drawn from family wells--appears to have been released through a process involving crop irrigation, at least in one part of the country. At a research site in the southern part of Bangladesh, scientists calculated that irrigation pumping, which began in the last several decades, has dramatically altered groundwater flow through the aquifer. They show that the resulting changes to the chemistry of the groundwater have the potential to either increase or decrease arsenic levels, in a paper written by an MIT-led team of scientists in the Nov. 22 issue of Science. "Our data indicate that the arsenic was mobilized largely by degradation of dissolved organic carbon by microbes. Some of the organic carbon appears to have been drawn into the aquifer by irrigation pumping," said Charles F. Harvey, assistant professor of civil and environmental engineering at MIT and lead author of that paper. "But the effects of irrigation are complex, probably lowering arsenic concentrations in other areas. Curtailing irrigation pumping is not a solution."

    Harvey is also an author of a research paper providing an epidemiological analysis of arsenic-induced illness throughout Bangladesh. That paper will appear next year in the Water Resources Research journal published by the American Geophysical Union. In it, the authors conclude that replacing 31 percent of the country's most tainted wells with deeper wells will eliminate about 70 percent of the illness, assuming that arsenic levels remain low in the deep wells.

    Arsenic poisoning, usually characterized by sores on the chest, or blackened knotty palms, and cases of skin, lung, liver, bladder and pancreas cancers have been linked to arsenic in the drinking water. In 1998 the World Bank agreed to provide Bangladesh a $32.4 million credit to develop a method of controlling the arsenic. But today, most Bangladeshis continue to drink arsenic-laced water. The World Bank describes the problem as one of the world's primary environmental challenges. The World Health Organization refers to it as "the largest mass poisoning of a population in history" in a fact sheet published in March.

    The mass poisoning began, sadly enough, with a well-meaning attempt to provide clean drinking water for Bangladeshis, who suffered from cholera and other diseases caused by bacteria in water taken from surface reservoirs. To remedy that problem, the Bangladesh government, with the help of international aid organizations, drilled between 6 and 10 million wells at depths ranging from 50 to 300 feet to provide clean, safe water for individual households. At about the same time, farmers in this largely rural country began irrigating land so that rice, the country's main food staple, could be grown during all six of the dry months when monsoon flooding abates. Cholera deaths dropped. But about 10 years into the use of the tube wells, villagers started displaying symptoms consistent with arsenic-related illnesses, and incidents of skin cancer and internal cancers became common.

    UNDERGROUND ACTIVITY

    It is widely believed that the arsenic was transported on sediment into the Ganges delta from the Himalayan mountains, which border Bangladesh on the north. What scientists don't know is how the arsenic is released into water in the aquifers in such great quantities. WHO's guideline for a maximum amount of arsenic in drinking water is 10 parts per billion (ppb). Many of the wells in Bangladesh measure more than 50 ppb, though arsenic levels vary from well to well. If the arsenic is in the aquifer only at certain levels, then digging even deeper wells might solve the problem. The Harvey research team selected a site 30 km south of the nation's capital city, Dhaka, and 7 km north of the Ganges River. They installed 17 research wells about 4 meters apart at depths ranging from 5 to 165 meters, and collected three sediment cores, determining that the sediment was typical of southern Bangladesh.

    They did not find peat, which has been associated with dissolved arsenic, but did find a fairly even distribution of solid arsenic in a variety of forms. To determine whether it was this arsenic that was mobilized in the aquifer, and figure out how that might have happened, the scientists injected test substances into their sampling wells, then took water samples to see how the water was affected. One such test substance injected through the tube wells into the aquifer is molasses, which is rich in organic carbon. In water samples taken over several months, they found that arsenic levels quickly rose, as the organic carbon or its degradation products mobilized arsenic from the sediment. Injections of nitrate and oxygen-rich water provided further data, showing that arsenic levels can drop quickly after introduction of an oxidant.
    What remained was to find the source of the carbon. Harvey's team used radiocarbon dating to determine the age of the carbon isotopes in the groundwater at various depths. They found that very young and very old carbon were mixed, and concluded that water had carried young organic carbon (probably derived from untreated waste on the surface) deep into the aquifer.

    The second research project was the first detailed statistical analysis of the epidemiology of the health effects of arsenic in Bangladesh's groundwater. Using geostatistical methods, the scientists constructed a map of arsenic concentrations that divides Bangladesh into regions and estimates trends in arsenic concentration at various depths. Using census data to estimate exposure distributions in the regions, and epidemiological data from West Bengal and Taiwan--countries where the effects of arsenic poisoning from drinking water have been well-documented--they estimated what dose of arsenic makes people sick. The scientists predict that long-term exposure to present arsenic concentrations will result in approximately 1.2 million cases of hyperpigmentation, 600,000 cases of keratosis, 125,000 cases of skin cancer and 3,000 fatalities per year from internal cancers.

    "These numbers are highly uncertain," said Harvey. "We put together available databases to see what they imply, but the dose-response models for Bangladesh remain very rough." The authors conclude that by replacing a selected 31 percent of the country's most-affected wells with deeper wells, arsenic poisoning and arsenic-induced cancers would be reduced by about 70 percent, assuming that arsenic concentrations in deep wells remain low. "If the arsenic levels remain low at greater depths, and I think they will, then deeper wells are a good solution. But this should be studied," said Harvey, who added that the best immediate solution is to filter the water.

    Solving the arsenic problem in Bangladesh could also help people in other countries, such as those along the Mekong River delta in Vietnam, Laos and Cambodia, where high arsenic levels in drinking water and crop irrigation are becoming common (Massachusetts Institute of Technology, November 21, 2002).

    Bangladesh has many health worries



    Over a decade ago, scientists in Bangladesh discovered that drinking water drawn from wells was contaminated with arsenic. The same wells provide the vast majority of the water which farmers use for irrigation. Now researchers have discovered that the arsenic is being absorbed by several crop plants. In rice, they have found high levels of arsenic in the stems of plants, though not in the grains.

    Massive problem

    Root vegetables are also contaminated. The scientists describe their findings as "preliminary" and stress that many questions remain to be answered. These include the impact on human health and over what area crops are affected. Another concern is that arsenic could reduce the yield of rice, even if it does not enter the grains which are used for food.

    Even a cup of tea could be unsafe



    While this research goes on, the scientists urge farmers to use surface water rather than wells if possible. The contamination of groundwater in Bangladesh and West Bengal is the biggest mass poisoning in history. The latest estimates are that around 20m people drink water with dangerously high levels of arsenic. More than 10,000 people are known to have arsenic-related diseases, but it is thought that many more cases have gone unreported (By the BBC's science correspondent Richard Black ,Wednesday, 16 January, 2002, 15:23 GMT )

    New report again highlights dangerous arsenic levels in Assam’s groundwater

    A recently released report draws attention to growing levels of arsenic pollution in Karimganj district, Assam, and the plight of the people who suffer the consequences The amount of arsenic detected in groundwater samples in Karimganj is 10 times higher than the all-India limit of 0.05 milligrams per litre (mg/l) says ‘Preliminary report on groundwater contamination in Assam: Latest findings in the Ganga-Meghna-Brahmaputra plain’, a report released by the School of Environmental Studies (SOES), Jadavpur University, in Kolkata.

    Water from 56 villages in Karimganj and Dhemaji districts was analysed by a team of researchers headed by India’s leading arsenic researcher Dr Dipankar Chakraborty from Jadavpur University. The preliminary results reveal that 19.1% of the water tested from 241 tubewells in the region had more than 50 mg/l of arsenic in it; 42.3% had more than 10 mg/l. This suggests that the groundwater contains arsenic elements much beyond the permissible level of 0.01 mg/l, as recommended by the World Health Organisation, posing serious health risks. The report brings to light the fact that around 236,302 impoverished villagers in Karimganj district suffer serious skin and kidney ailments. “Out of the 20-50 children I get daily from many villages in southern and northern Karimganj, at least 25 suffer from hair, nail and skin problems,” says skin specialist Dr N Chakraborty.

    The first visible symptoms of arsenic poisoning are dark spots on the skin known as skin lesions or melanosis, dark and light spots, or leuco-melanosis, followed by localised thickening of the skin and the formation of wart-like painful growths or keratosis, ulcers, gangrene and skin cancer. Over a long period of time, drinking arsenic-contaminated water causes skin, lung, liver, kidney and bladder cancers. “We have been drinking this tubewell water since the past five years. Only now we discovered that the water here has the highest concentration of arsenic in Assam -- 444 mg/l. We don’t know what to do now as there are no alternative sources of drinking water in our locality,” says Anulal Das of Kayasthagram village in northern Karimganj. Every member of his family of three is pockmarked with ‘raindrop pigmentation’ (the development of sporadic black and white patches on the back and chest).

    The team had earlier carried out water analysis of 1,35,000 samples in West Bengal and 55,556 samples in Bangladesh. The analysis revealed that about 60 million people were drinking arsenic-polluted water beyond the WHO recommended value, while 30 million people were consuming water with high arsenic contamination above 505 mg/l. This placed entire populations at risk. The villagers are now preparing to file a public interest litigation against the Karimganj public health engineer (PHE) in Assam’s Guwahati High Court for failing to take adequate measures to stop the mass poisoning (Source: The Statesman, June 26, 2004)

    81 pc Bhanga, Faridpur HTW's (Hand tube Wells) arsenic affected,

    FARIDPUR, June 8, 2003:–A day-long workshop on "Community based arsenic mitigation action research project" jointly organised by Faridpur District Administration and Department of Public Health Engineering in collaboration with UNICEF was held on Wednesday at Faridpur Zila Parishad conference hall, reports BSS. The workshop was organised to review the progress of arsenic mitigation activities in Bhanga Upazila of this district where arsenic problem is very much alarming. According to workshop sources, in Bhanga 91 per cent Hand Tubewell (HTW) is arsenic affected. Out of 21300 HTW, 19127 HTW are arsenic affected and its water consists very high rate of arsenic beyond human consumption (BSS, 2003).

    Smedley, P. L. and Kinniburgh (British Geological Survey, 2002) describes:

    The scale of the problem in terms of population exposed to high arsenic concentrations is greatest in Bengal Basin with more than 40 million people drinking water containing 'excessive' arsenic.

    "There is a serious concern," says Han Heijnen, a spokesman for the World Bank, "if we don´t take action now, in five to 10 years we will see a very strong increase of the number of people affected either by skin lesions due to arsenicosis or by cancers and other serious conditions. That will be a very serious problem for the socio-economic system of Bangladesh as well as for the health system."

    Among 64 districts of Bangladesh, 44 districts have arsenic contamination in groundwater (Mitul, 1998). There are reports of deaths and serious infection relating to arsenic poisoning. It is reasonable to believe that widespread areas of Bangladesh have been contaminated. Arsenic poisoning leading eventually to death,. as world-wide poisoning outbreaks are shown as follows (Pearce, 1995, Chakroborti, 1997):

    It is difficult to predict how many Bangladeshis will eventually die from causes related to the arsenic. Most researchers, including Dr. Smith, are shy with estimates. Richard Wilson, a Harvard physicist who is an expert in risk analysis, puts the number at one million. Dr. Sk. Ahktar Ahmad, a public health specialist with the government, predicts a total of three million to five million (New York Times (14. 07. 02).

    Chronic Effects of Arsenic (professor Wilson, Havard University, 1999::

    • <i>Melanosis</i>
      After a few years of continued low level of arsenic exposure, many skin ailments appears i.e. Hypopigmentation (white spot), Hyperpigmentation (dark spots), collectively called Melanosis and keratosis (breakup of the skins and on hands and feet).
    • After a letency of 10 years, skin cancers appear.
    • After a latency of 29-30 years, internal cancers - particularly bladder and lung. These all have been seen in Taiwan and in Chilie
    • The number of cancers expected in bangladesh from the exposure already undergone can be very roughly estimated by using "defalut" (lower exposure of 0. 05 ppm (Bangladesh standard) - the risk 1 %) there are 20,000, 000 to 70, 000, 000 exposed persons at levels between 0. 05 ppm and 0.5 ppm.

    India, West Bengal

    Arsenic in groundwater above the WHO maximum permissible limit of 0.05 mg l -1 has been found in six districts of West Bengal covering an area of 34 000 km2 with a population of 30 million. At present, 37 administrative blocks by the side of the River Ganga and adjoining areas are affected. Areas affected by arsenic contamination in ground-water are all located in the upper delta plain, and are mostly in the abandoned meander belt. More than 800 000 people from 312 villages/wards are drinking arsenic contaminated water and amongst them at least 175 000 people show arsenical skin lesions. Thousands of tube-well water in these six districts have been analysed for arsenic species. Hair, nails, scales, urine, liver tissue analyses show elevated concentrations of arsenic in people drinking arsenic-contaminated water for a longer period. The source of the arsenic is geological. Bore-hole sediment analyses show high arsenic concentrations in only few soil layers which is found to be associated with iron-pyrites. arsenic .- West bengal, India

    Various social problems arise due to arsenical skin lesions in these districts. Malnutrition, poor socio-economic conditions, illiteracy, food habits and intake of arsenic-contaminated water for many years have aggravated the arsenic toxicity. In all these districts, major water demands are met from groundwater and the geochemical reaction, caused by high withdrawal of water may be the cause of arsenic leaching from the source. If alternative water resources are not utilised, a good percentage of the 30 million people of these six districts may suffer from arsenic toxicity in the near future (Source, D. Das et al. 1997)

    Country  Number affected
    Taiwan       20 000
    Inner Mongolia   50 000
    Obuasi Ghana    Unknown
    Cordoba Argentina   10 000
    Antofagasta Chile 20 000
    Lagunera Mexico     20 000
    Cornwall Britain          Effect unknown
    W. Bengal, India      38, 000 000
    Bangladesh 50, 000 000

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    Arsenicosis In Bangladesh : Samta

    THE CURSE

    This is the story of Samta, a sleepy village in south-western Bangladesh- calm and quiet, and full of traditional natural beauty. A small river called Betna is flowing beside the village which is not extraordinary in nature, but has some certain reasons to be different from others

    Now, nobody wants to marry any girl of Samta, nobody wants to choose bridegroom from the village. The reason is that arsenic was found in the groundwater of the village at alarming level. Water of 97% tube-wells of the village is unsuitable for drinking due to arsenic contamination

    THE FINDINGS

    Symptoms of diseases caused by arsenic have been found in the bodies of 97% people. 16 people already died from arsenic-related diseases and some others are making their journey towards inevitable death. The people of Samta do not know to what extent they are responsible for the disaster or for which reasons they have become isolated from others and are deprived of the sympathies of their neighbours who preferred to keep themselves away from them.

    The village Samta is in Sharsha thana of Jessore district. Some 4,841 people live in Samta, in an area of 3.2 square kilometer. Dhaka Community Hospital carried out a survey and tested the water of 265 tube-wells out of the total 279 of the village. It was found that only 2% or 5 tube-wells are safe from arsenic contamination. Arsenic upto the maximum permissible limit was found in the water of 7% or 18 tube-wells while the water of the rest 91% or 242 tube-wells were found totally unsuitable for drinking

    Besides, Miazaki University of Japan, the Japan-based Asia Arsenic Network, and Bangladesh Institute of Preventive and Social Medicine also carried out survey at Samta. According to their statistics, there are 284 tube-wells in the village and only 10 of them are safe. Arsenic upto the maximum permissible level was found in the water of 13 tube-wells while the rest 92% or 261 tube-wells were found contaminated alarmingly.

    Ten years back, nobody in the village could understand the reasons behind the strange diseases which affected their skins, eyes, lungs, stomach, and intestines. When they found that their skin was pigmented and ulcerated, they thought that it might be leprosy. Some of them thought that these were symptoms of cancer. But the real reason of the diseases was detected in January,1997 when a team of experts led by Dr. Dipankar Chakraborty, carried out a study at the village. They found at least 330 people infected with skin diseases and identified arsenic pollution as the main reason behind it. They apprehended that the number of affected people is higher than the number detected

    While conducting preliminary survey, they collected the samples of hair, nails and urine of 334 people and found 99 people affected with arsenic-related skin diseases. The skins of 120 people were not found affected by arsenic. Some 88 children were found affected with skin diseases caused by arsenic while 27 were found safe

    But a disastrous picture revealed when the samples were tested in the laboratory. The presence of arsenic at dangerous level was found in the urine of 324 people (97%), in the hair of 284 people (85%) and in the nails of 321 people(96%), out of the total 334.

    Later Dhaka Community Hospital collected urine samples from 301 more people including children. 118 of them were suffering from skin problems caused by arsenic. The results of the laboratory tests of these samples were more disastrous. Arsenic was found at safe level in the urine of only 8 people (3%) while the presence of arsenic at dangerous level was found in the urine of the rest 293 people(97%). After completion of the study, the report apprehended that most people of the village were affected with arsenic. As a matter of fact, a good number of people of this village have died of arsenic pollution. Dhaka Community Hospital has records of their names, age and other particulars (Dhaka Community Hospital, June 2001).

    There are hundreds or thousands of such villages in Bangladesh that are not yet known but confronting the worst scenerio like Samta village.

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    Reported 100,000 cases of arsenic skin lesions: Bangladesh faces outbreaks of cancer (WHO)

    Arsenic is a classic poison with a broad spectrum of effects. Unfortunately, although the World Health Organisation (WHO) acknowledged early that arsenic in the groundwater of Bangladesh is a “Major Public Health Issue” which should be dealt with on an “Emergency Basis,” the global community has been slow to respond to the problem of arsenic exposure in Bangladesh, despite the enormity of the problem. But as arsenic is toxic to both respiratory tract and myocardium, long term exposure to arsenic can have erious effects on health and if left untreated, can lead to death.

    Far less known is its neurological consequences on people both young and old. However a study of 12,000 residents of Araihazar, Bangladesh threw some light on this aspect that indicated how exposure to arsenic from drinking water was, in relation to the quantity of arsenic found in the water, associated with reduced intellectual function. This study reported a strong association between arsenic exposure and intelligence that is important and tragic, and adds urgency to the need for effective remediation. In addition to the elevated arsenic concentrations found in Bangladesh groundwater, the British Geological Survey reported in 2001 that many of the existing wells in Bangladesh also have manganese concentrations exceeding the WHO standard of 500 µg/l. This is of concern as occupational manganese exposure has been associated with neurologic sequelae in adults, specifically Parkinsonism.

    According to WHO, there are at least 100,000 cases of skin lesions in the country caused by arsenic and in addition, the country has to brace itself for probable outbreaks of cancer over the coming decade as the dose of arsenic increases in positive progression for each individual. Estimates now suggest that, by then, one in every ten cases of cancer will be caused by arsenic. That is not a pretty picture, especially as, according to doctors, those suffering from arsenic poisoning are not receiving the care and attention they deserve. That being the case, it is high time the complexity of the situation is recognised and given the priority it deserves.

    The human body excretes arsenic at a rate that depends on the individual but if arsenic is ingested at a rate greater than can be excreted by the kidneys, it builds up in liver, spleen and blood. However, if it can be excluded from the diet, this build-up, with the exception of the portion sequestered in nails and hair, will be excreted within days or weeks. But few are lucky enough to look forward to an arsenic free diet because too many people are still drinking contaminated ground water. This worry is intensified by the fact that 63 per cent of tube-wells are contaminated with unacceptable concentrations of arsenic. But the possibility of arsenic poisoning is the most challenging of all the health problems facing the nation for one simple reason, no one can be sure where it will strike, or when, as it takes between 2 and 20 years for symptoms to emerge. And worse - without any external manifestation of arsenic poisoning, a person can still succumb to its consequences either in the form of cancer or due to acute renal failure. Empirical evidence suggests that some stages of arsenicosis such as Melanosis, are reversible, provided the consumption of contaminated water is stopped. In other words drinking arsenic free water can stymie the deterioration of the patient. But as unfortunately no data related to total recovery has been recorded, this statement cannot be supported with statistics. However this does not detract from the major challenge facing the nation - how to provide millions of people with arsenic free, bacteria free as well as chemically safe, aesthetically acceptable alternative source/s of drinking water. Unless an effective action plan on Health and the Environment is put in place, one that can identify the areas of concern and define all possible solutions, the country is likely to be swamped by this crisis because the average person’s understanding of what is called “the largest mass arsenic-poisoning case the world has ever seen” is not only limited but generally erroneous. As such, arsenic poisoning will continue to take its toll on the people of Bangladesh.

    Many people have lost a limb to amputation but under the current programme for screening patients, no provision has been made for surgical intervention, nor is there a plan for rehabilitation. Although the Dhaka Community Hospital Trust is doing a good job, their resources are limited. However, DCH doctors have gone out into the field to train Government and NGO health workers in an effort to improve identification and treatment of cases of arsenic-poisoning as patients with severe acute gastrointestinal signs and symptoms may pose a diagnostic challenge. However ingestion of arsenic is the most common cause of poisoning and in consideration of this, diagnosis is essential, because acute arsenic poisoning can be fatal if it remains undetected.

    Acute respiratory failure can occur due to severe weakness of the respiratory muscles. Bronchial pneumonia and upper respiratory tract inflammation commonly develop. Central nervous system changes are found, including sudden altered mental status, seizures, toxic delirium and encephalopathic Numbness and tingling of the hands and feet are quite common. Patients may develop an unusual posturing of the hands, brought about by intense dysesthesias in the hands and feet. Severe peripheral neuropathy following several days of exposure to arsenic has also been noted. Dermatologic findings include flushing of the skin, hyperpigmentation and brawny desquamation, as well as dermatitis and folliculitis. Hyperkeratosis, especially of the palms and soles, has been described. White transverse bands across the fingernails and toenails may be observed four to six weeks after exposure.

    Diagnosis of acute arsenic intoxication should be considered in any patient with gastrointestinal complaints as the hallmark, including epigastric burning, esophageal pain, colicky abdominal pain, and persistent vomiting and diarrhea, which may be bloody. The vomiting and diarrhea frequently manifest as profound dehydration, leading to cardiovascular collapse and possible seizures (Sylvia Mortoza, The Bangladesh Observer, March 21, 2005)

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    Arsenic warning on 'sacred' water

    zam zam waterWater said to be from a sacred Muslim well has been taken off shop shelves, for containing high levels of arsenic. A complaint was made that bottles said to be Natural Zam Zam Water were on sale in central London. It should only be sold in Saudi Arabia. Analysis showed the water had high levels of nitrate and three times the permitted levels of arsenic.

    No other shops were found selling the product, but Westminster Council's investigation led to a national recall. Trading standards officers in Barnsley, South Yorkshire, have also received complaints from Muslims about the product being sold.

    Results 'a shock'

    The investigation in Westminster began with a complaint that the water was being sold in London. But the results of a sample sent to the public analyst came as a shock, a council spokesman said. The Food Standards Agency (FSA) said the arsenic "could contribute to increasing people's risk of cancer". There have not been any reports of anyone being taken ill after drinking the water, and no other samples were found for sale. Council staff also contacted the importers to stop them bringing more of the water in.

    The FSA has warned shoppers to be alert and report any incidences of Zam Zam water for sale to their local authority - particularly as demand increases during Ramadan.

    "This advice does not relate to the genuine Zam Zam water being brought into UK by returning pilgrims... as a personal import," a spokesman said. "As genuine Zam Zam water cannot be legally exported from Saudi Arabia for commercial sale, any product found in the shops would have an uncertain provenance and pose a possible safety risk" ,(Source: BBC, 21 Oct 2005).

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    Differences between West Bengal and Bangladesh

    There are major differences in institutional arrangements in the two countries. Bangla- desh has a highly developed and effective NGO sector, and the goverment has welcomed foreign assistance.

    West Bengal, being a ‘communist’ state, favors government intervention, and is less amenable to foreign assistance.

    For instance, both UNICEF and the World Bank are playing leading roles in arsenic mitigation in Bangladesh, but are doing relatively little in West Bengal. In Bangladesh, NGO projects currently cover about 75 per cent of villages, reaching a quarter of the population, and attracting more than US$ 500 million annually from foreign donors (Haq, 1997 in Hossain et al., 1999).

    The existence of these extensive NGO networks, and their close links with donors, has helped raise arsenic awareness and expand mitigation efforts more rapidly than has been possible in West Bengal.

    More than 9,500 field test kits have already been sold in Bangladesh (of which 90 per cent have been Merck kits), and more than 200,000 arsenic ests have been completed using field test kits. In May 2000, another 8,000 Merck kits were ordered by BAMWSP, and tenders for a further 50,000 kits are currently being evaluated. In contrast, sales of field test kits in West Bengal total only about 1,000 kits. The figures for Bangladesh look more impressive, but conceal the fact that both countries have only provided arsenic removal units to about one per cent of the affected household

    Another difference has been in the role of the private sector. In Bangladesh, the government owns 92 per cent of modern industries and privatization efforts have been relatively slow (Hossain et al., 1999). BAMWSP is coordinating closely with the NGO sector, and most stakeholders are waiting for BAMWSP to validate technologies before they consider large-scale implementation. Local manufacturers have limited research and development budgets, and are waiting to see which technologies are going to be validated before investing in production. Thus,innovation and experimentation by the private sector are being stifled.

    In West Bengal, there has been little coordination of arsenic mitigation efforts, and it appears that many in government favor the provision of alternative water sources over arsenic removal units. Despite this, there is evidence of genuine private sector participation, albeit at quite a small scale. Oxide (India) have developed and refined their own arsenic removal unit, built a network of seven dealers, made more than 500 private sales, and are actively engaged in marketing, including printing 5,000 leaflets for distribution through their dealers, and running a stall at a trade fair run by the Bengal Chamber of Commerce.

    There are also three local manufacturers involved in the production of field test kits. It has been suggested that longer awareness of arsenic contamination in West Bengal has contributed to this higher private sector participation, but there is little evidence to support this, and it seems likely that any differences have been created by the dissimilar institutional arrangements.

    Field test kits provide an example of technology difference. The imported Merck field test kit has become standard in Bangladesh, but has not been very successful in West Bengal, where AAN type field test kits are preferred. There are several possible explanations for this difference. Firstly, the smaller scale and seriousness of the arsenic crisis in West Bengal has combined with lower ESA involvement to result in less scrutiny of field kit performance than in Bangladesh. Secondly, local reagents and raw materials are cheap and freely available in India, while import duties are high (Merck kits are more expen- sive in India than in Bangladesh).

    Finally, anecdotal evidence suggests that groundwater sulfide levels are generally higher in India, so field test kits without a sulfide removal stage, such as the Merck kit, are less effective.

    Another striking difference is in the adoption of arsenic removal units using adsorptive media. There have been a number of field trials in Bangladesh, but few of them have been successful and there was no evidence of the adoption of adsorption units on a larger scale. In India, sales of the Amal filter are growing, and there are several community handpump units operating successfully. Again, there are several possible explanations. Most of the successful adsorption installations are based on activated alumina, which is manufactured in India, whereas manufacturers in Bangladesh have to import the media, and are hindered by import duties and bureaucratic delays. Another factor may be the aquatic chemistry. The areas of Bangladesh visited during this study had exceptionally high levels of iron in the groundwater, which created severe clogging in any sort of filtration unit, and severely limited the viability of single stage adsorption units (Arsenic Mitigation in West Bengal and Bangladesh Helping households respond to a water quality crisis, December 2000).

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