INAUGURAL SESSION
Chair: Dr. Maniruzzaman Miah
Welcome Address by
Dr. Mahmuder Rahman
Co-ordinator
Dhaka Community Hospital Trust
Distinguished ladies and gentlemen, friends and colleagues. Assalamu alaikum.
I welcome you all to this fifth International Conference on Arsenic. In January 1997, Dhaka
Community Hospital (DCH) in its first conference on Arsenic expressed serious concerns
about arsenic contamination in tubewell water. We called upon all concerned, particularly the
public sector to look into the matter more carefully. Moreover, UN agencies, development
partners were also asked to consider the issue of arsenic contamination of ground water as a
matter of great urgency. Since 1997, Dhaka Community Hospital has continued its crusade
against arsenic. We have already staged four international conferences in Dhaka and traveled
round the globe in order to demonstrate the plight of the people suffering from arsenicosis.
Some forty years ago, with the massive input from UNICEF and other donor agencies and
with the support of the government of Bangladesh and NGOs, the people of Bangladesh
switched to groundwater extraction by tubewell as a safe source of drinking water. It was a
great success story and naturally, it took time for the government and agencies to react to this
problem of arsenic in tubewell water. There are considerable pecuniary interests attached to
tubewells and the beneficiaries of tubewell business are so powerful and strong that any
move to change from tube well to other sources is obstructed by them. Change from tubewell
to alternative sources of water will require massive financial support that the agencies are still
hesitate to provide it. It will also need a national motivation strategy to shift the community
mind-set away from tubewell towards alternative safe water supplies. In spite of these
obstacles, public and private sectors and international agencies are slowly moving forward to
confront this crisis. However, Scientists and workers from the countries of these region came
together in various forums to exchange their experiences in order to combat the arsenic
problem. Arsenic crisis struck the nation with deadly silence. Poor coordination and conflict
of interest between various stakeholders obstructed the progress of arsenic mitigation
programs. In order to counter this problem, the government formed the Secretaries
Committee involving the relevant ministries and also a National Expert Committee on
Arsenic to lend technical support. Secretaries committee came to realize that to coordinate
and implement a sustainable and an effective mitigation program, a sustainable national
policy and action plan is needed. The National Experts Committee on Arsenic was entrusted
to formulate this major task. The committee presented a policy and action plan to the
government for approval. We hope that this policy and action plan will help to resolve the
conflict of interest and help the various stakeholders to act with full understanding of this
problem.
Let me now turn to issue of the management of water resources. Arsenic contamination of
groundwater is not only a problem of safe drinking water, it is also a problem of irrigation.
We should also be aware of the fact that almost 95% of the groundwater is used for irrigation.
According to some experts, over-extraction of groundwater for safe drinking, particularly for
irrigation may be the triggering factor for aquifer contamination of arsenic. Bangladesh is
2
inundated and blessed with surface and rain water. Unfortunately, because of ever decreasing
capacity to hold this gift of nature most of the surface water are wasted. Investment for
storing surface water and conserving it is negligible. The rivers, the canals, the lakes are
silted up. If we can invest judiciously in surface water management and digging canals,
excavating rivers, then the dependency on groundwater and its extraction will fall
considerably. This is not a very easy task for a resource-poor country like Bangladesh but
considering the massive health, economic, social and environmental consequences of arsenic
contamination on the people, society and food chain, we have to turn to nature and make use
of its gift. I hope this particular issue will be highlighted in the conference in great detail.
Bangladesh like other countries in this region gets water from rivers flowing through
different countries. The water flows in these rivers are the lifeline of the people of
Bangladesh. Naturally, diverting the flows will tremendously affect the life and economy of
the people of this country. The availability of surface water from these rivers also helps to
recharge groundwater aquifers along with enrichment of the soil. Arsenic problem and
mitigation activities are also directly and indirectly related to sufficient water flow through
these great rivers.
I will now focus on alternative water options as a mitigation option for arsenic contamination
of ground water. It is true that groundwater in some parts of the country may be safe but the
majority of the densely populated areas remain unsafe. So, tubewells, both deep and shallow,
need to be tested regularly for arsenic and other contaminates. Therefore, it is necessary for
us to go for alternative water sources with active community participation. The alternative
sources are mainly dug wells, the water from rivers, ponds, and also rain water harvesting.
Here I must tell the critics that it is not going back into history to use the old methods, it is
rediscovering and reinforcing the old technology with new knowledge and skill and making
the water sources affordable and safe for the communities. Experiences with safe alternative
water sources will help the development partners and the government agencies to consider
the various possibilities and act positively and decisively for safe water option.
Now about the patient management and arsenic related health issues. In the past, very little
initiative was taken in the field of arsenicosis patient management. Dhaka Community
Hospital is inundated with arsenic patients. There are poor people with very little means. The
costs of medical and surgical management are beyond their reach. We hope this conference
like the previous ones will again discuss this issue more constructively and try to convince
agencies, both government and donor, to support patient management and patient
rehabilitation program. Arsenicosis is a disabling disorder. Arsenic affected families need
considerable support. The community needs to be informed and armed with knowledge and
resources to rehabilitate such victims of Arsenicosis. Without the communities active
participation, it will be impossible to manage and rehabilitate arsenicosis patients.
Arsenicosis due to arsenic poisoning is an unknown problem confronted by health deliverers
throughout the world. In our last conference in Bangladesh health professionals working in
this field, after much deliberations, formulated a case definition on Arsenicosis along with a
management protocol. Later on WHO arranged a regional workshop where these protocols
were incorporated into WHO case management protocol and case definition. I am happy to
say that some of the scientists who were pioneers in this field also present here today and
their deliberations and comments will enrich our understanding about patient management.
Research in the treatment of arsenicosis and understanding of its symptoms and systemic ill
effects are also an important and demanding issue. Selenium, Vitamin A, C and E and high
protein and mineral rich algae are said to have therapeutic values. We need in-depth scientific
research in this field as it is still difficult to say that any of the abovementioned remedies
definitely helps to cure this disorder. Research in the field of genetics and molecular biology
3
is also needed to understand this process. Support from the countries and academic centres of
the developed world is necessary in this regard. We hope that this conference will attract the
attention of rich and resourceful countries to work with us so that we can help the millions of
people who are at risk from this enormous health hazard.
Now a few words about environment and food. Serious question is raised about
contamination of irrigation water with arsenic. At present, almost 95% of groundwater is
used for irrigation. Arsenic in irrigation water may pollute the irrigated soil and may also
enter the food chain. It may also adversely affect the food chain. This conference is going to
discuss the issues mentioned above and the scientists working in the field will exchange their
views and findings.
Let me now end by saying once again, on behalf of the Dhaka Community Hospital and the
School of Environmental Studies of Jadavbpur University of West Bengal, India, thank you
to the participants in this 5th International Conference on Arsenic focusing particularly of
developing countries perspective on health, water and environmental issues. Some of us may
feel frustrated with the slow progress with various mitigation activities and patient
management programs. We must realize that to confront a crisis of this magnitude and
complexity takes time and needs multidisciplinary coordination. We shall not falter and shall
continue to work together with faith, determination and spirit of understanding. And shall
successfully combat this natural as well as national and regional disaster.
Thank you all very much.
4
Mr. Morten Giersing
Country Representative
UNICEF- Bangladesh
First, I would like to congratulate Dhaka Community Hospital for organizing this conference
and bringing all of you here for the fifth time for some of you. I like to also congratulate
Dhaka Community Hospital for all the good work that they have done from the beginning on
this issue. UNICEF has worked with Dhaka Community Hospital in 45 upazilas in
Bangladesh in the area of case identification including the establishment of the case
management protocol and also with safe water options. We are happy for their continuous
effort in this area. I would like to start by mentioning two perhaps personal reflections and
background before coming to this issue. One is the fact that Bangladesh had one of the
biggest successes in providing safe water to its people in rural areas through tubewells. About
95% of its population received safe water during the 1990s. That was a unsurpassed success
anywhere. That success was encouraged by UNICEF as well as other agencies but it was
implemented by the people of Bangladesh themselves. A large number of tubewells were
sunk by the people themselves. My point on this is to say that the people of Bangladesh want
safe water. For this, they want to invest themselves whatever resources they can get together
to do it. That is not true for a lot of development issues. For this, a great motivational job is to
be done. My other reflection is that I have found it frustrating to come Bangladesh and revisit
this issue with which I had been acquainted also in Vietnam. And even when I worked in
New York before UNICEF. But I had been frustrated to come in and look closely and see
how many things are not known. Why a poor country like Bangladesh should have arsenic on
top of a lot of other things and why a country like Bangladesh seems to have to pioneer a lot
of research. If I look through the various issues from impact on health to relationship between
the levels of contamination, the impact on the food chain whatever it is nutritional
coexistence, what does that do? It seems like that Bangladesh has to pioneer a lot of research.
I will limit myself to three points or three issues. I would like to go back first to the testing of
wells. And I recall the overall agreement on testing as it was done sometime ago. In that
agreement, if I am not mistaken, we had a situation where out of 460 upazilas in Bangladesh,
268 were identified as hotspots. We agreed that we would do blanket testing in these 268
hotspots. Out of 268, 188 upazilas were allocated to BAMWASP for testing, 45 to UNICEF
and its partners, 13 to WATSAN partnership, 8 to DANIDA and 14 to World Vision. I go
back to that because I want to insist on the importance of blanket testing. I shall not detail
what was done by the other organizations but I would like to recall what UNICEF did.
Sometime ago we have concluded the testing of one million seventy-three thousand wells in
45 upazilas which were allocated to us. Seventy per cent of those upazilas and in those
upazilas around 750 thousand wells were found to be below 50 ppb. Thirty per cent were
above the ppb level. We also identified 14,619 patients with arsenicosis in these 45 upazilas.
We were also done sample testing of 51,000 wells across the country. This provided the first
general picture where are the hotspots and what is the situation. In addition, we were then,
after the 45 upazilas, given the additional task of sample testing of wells in 192 non-hotspot
upazilas. In these 192 upazilas we tested 1,64,000 wells and around 98% of these wells were
below 50 ppb. Only couple of percent had above 50 ppb level. However, there were four
upazilas identified as non-hotspots, which were reinstated as hotspot upazilas and now
blanket testing is underway in these four upazilas.
There was an additional 19 upazilas which had more than 5% of wells in the red category and
we have been requested by APSO also for blanket testing in those areas. Now why am I
5
insisting on that? I am insisting on that because it is important to me that all the wells in the
hotspot areas in Bangladesh are tested. If I look at this as a public health problem, I would
claim and you may contradict me because you are the scientist but I would say that the public
health approach, needs to go first to those people who are drinking the most contaminated
water and how do I find those wells which have the most contaminated water? I only do that
by blanket testing. So why UNICEF has tested 1.3 million wells over these years. I know that
other people have tested also but I do not know that data has been quality checked and that
has been publicized. So my first urge in this meeting is that the testing should be completed
and that those data should be made public in a quality controlled way. Because otherwise, I,
as a public health person, find it unacceptable. I find it unacceptable to invest my money if I
do not know that I reach the people who are most at risk first.
My second point relates to how do we get back to a situation with safe water for the vast
majority of the people in Bangladesh. We have, with partners including Dhaka Community
Hospital, been involved in finding alternative ways of providing safe water. Mr. Rahman has
addressed a number of them in his opening speech such as rain water harvesting, surface
water and constant filter, shallow and deep tubewells. We know that these have opportunities
and difficulties. We have also had a number of removal technologies that are tested. Some of
them are costly, imported, some of them are ingeniously indigenous to Bangladesh. But as far
as I understand what is coming through all of them is that they are all only in a pilot phase.
How come we can be in a pilot phase? How come we can be in the pilot phase when you
have spent so many years on this? How come we do not have a simple thing, which is
approved? How come we can take out the arsenic but that this is all in a pilot phase? Can we
not push and urge the government and its partners to move beyond the pilot phase and have
some removal technologies approved including the environmental evaluation of the impact of
these removal technologies? Obviously, we can take out the arsenic but what do we then do
with the arsenic? We need to know about that also. But I think that is indeed going very
slowly. So that is my second point or urging.
The last one may also be the most difficult one and the one which ,to a large extent, is
beyond UNICEF’s reach. Because it is not our issue as it were. This is the uptake into the
food chain. There are other agencies that are better placed than UNICEF, because other
agencies within the UN system like FAO, WHO also have responsibilities of water quality
within the UN system. We are also interested in this issue because it impacts also on our
primary customers- the children. What happens in the food chain? My concern is that if we
have a serious problem in the food chain and if that turns out to be serious, what does that
imply for the drinking water option, which is the UNICEF’s immediate concern. Say that we
were going for rainwater harvesting solutions in a number of upazilas and that people were
very motivated for this. The rainwater can probably not be used for irrigation purposes. So
they need that than wrong technology. I speak as the layman but I think there must be some
kind of correlation between what is the seriousness of the food chain problem and how do
you overcome that, and the drinking water option which can be provided. Lastly, there would
presumably be quiet a number of economic consequences for the government and for the
farmers of Bangladesh if there is a serious problem in the food chain. It’s not just a scientific
problem, it is also a problem of perception. It maybe that things maybe okay for you to eat
but it maybe that you would not want to eat if you can avoid eating it. So there is also that
things to be managed from the point of view of the government of Bangladesh and the
business side. These are my three issues. I hope I have not spoken too much out of context
but yet could we have all the blanket testing result is done so that we can evaluate our
situation and get close to those people who are most at risk first? That I raised as the first
6
one. Second one could we have some removal technologies approved so that they can be
taken to some kind of scale and certainly could we have some attention on a somewhat
prioritized based on the food chain issues.
I wish you all a very good conference. I hope that researchers will provide us with some of
the answers, which we do not have Thank you very much.
7
Mr. Tapan Chowdhury
Managing Director
Square Pharmaceuticals Ltd.
Honorable chairman, distinguished panelists, ladies and gentlemen. I am greatly honored to
speak in front of this august gathering. Professor Quamruzzaman, in fact, had asked me to
speak not only exactly on this subject but to speak on the private sector contribution to the
health sector and also sound success stories of this sector. Everyday whenever we open our
newspaper and especially all over the world what we see and hear about Bangladesh all the
negative stories. Though there are few success stories but these success stories have not been
always projected positively. I think these success stories, particularly in this sector need to
be projected rightly. I strongly feel that it is my responsibility to share few of these
experiences with you that the country has gained over the years.
Significance of water for the life and death is probably the most viewed in Bangladesh. Our
economy and our health are greatly influenced by water. In Bangladesh water means death
and destruction in the form of flood, cholera, malaria and now arsenic contamination. Non
government initiatives in handling common afflictions in Bangladesh are significant.
Bangladesh private sector played a commendable role in the health care management with an
annual turn over of Tk. 30 billion equivalent to US$ 500 million. Bangladesh pharmaceutical
industry is a unique success story. In the land of 130 million people with frequent natural
disasters, poverty and many other negative aspects, the pharmaceutical industry has grown
rapidly since the independence of Bangladesh in 1971. The industry is now producing quality
medicines at an affordable price to the millions of people. Among the 49 LDCs, Bangladesh
is the only country which is nearly self-sufficient in producing pharmaceutical products.
Bangladesh pharmaceutical industry now cater to 96% of the country’s needs of
pharmaceuticals. The remaining 4% comprise of insulin, vaccines, high and anti cancer drug,
etc. The production of these products is very capital intensive and therefore is not
economically feasible for Bangladesh. Some major achievements of Bangladesh
pharmaceutical industry includes affordability of medicines to substantial portion of the
population in Bangladesh, mortality and morbidity from the major epidemics like cholera,
typhoid malaria, etc., has been reduced significantly over the years. Increased affordability
and availability of medicines has contributed to this achievement. Bangladesh has an average
life expectancy of 61 years which is the highest in the Indian subcontinent.
Over the years, local companies have gained strong footing. In 1982 there were about 10
multinational companies which occupied about 80 % of the domestic market. Now local
companies cater to more than 80% of the domestic market. They have continued their efforts
to upgrade their facilities to the international level. After meeting to the country’s needs,
pharmaceuticals are now exported to 52 countries of Asia, Africa and Europe. All major
companies comply to the WHO GMP guidelines. As a result, Bangladesh is now able to face
competition from countries like India, China, Brazil, Turkey, etc., in its export market. A few
of the top level companies are going beyond WHO GMP with an aim to enter regulated
markets like US, EUA, etc. They are putting up manufacturing facilities of US FDI and UK
MHRA standards. Pioneer among them is Square Pharmaceuticals Ltd. It’s state of the art
international GMP standard pharmaceutical manufacturing facility has gone into commercial
operation in 2002. The Square has set many examples and standards. The major beneficiaries
of its achievement are Bangladesh economy and its people. We have now expanded our
business from pharmaceuticals to various challenging fields. We are now a major player in
8
toiletries, food products, textile and garments as well as in the IT and hospital business. Our
business objectives are to provide international quality products and service at an affordable
price. Square is recognized as an example of good corporate citizen of the country. As a
group, we are always very active in the matters of social significance and some of our social
activities are sponsoring sports and cultural programs of national and international
significance, helping disadvantaged women of Bangladesh to make them self-sufficient
through generating employment, increasing mobility, supporting to improve the quality of
their life, etc. It is also working with volunteer organizations in making health care facility
available to disadvantageous population. At last but not the least, our main contribution is
that we are trying to develop a transparent and professionals corporate culture in the country
which encourages professionalism. Since the independence of Bangladesh, we have received
substantial help from various countries and agencies in the form of aid and donation. Making
available the Internet support to the targeted population is a massive task. Private sector
enterprises handle the job efficiently and its outcome is very prominent in the areas of health,
education and micro-credit, telecommunication, etc. As the international support has
dwindled in recent years, efficient use of this increasingly scarce support is important for our
fragile economy. I believe that the private sector should have a greater role in negotiating the
support in their final utilization. At this stage of our development, the government should
limit its role as a facilitator and should allow the private sector enterprises to work.
We greatly appreciate the role of Dhaka Community Hospital in mitigating arsenic related
“scourge” .We are also happy to be associated with Dhaka Community Hospital in its efforts.
We wish all the activities of Dhaka Community Hospital a great success and at the same time
I wish the conference also a great success. Thank you.
9
Dr. Willard Chappell
Professor, Environmental Science
University of Colorado, USA
Honorable chairman, ladies and gentlemen. It’s a great pleasure to be here today. First, I
would like to thank the organizers of this conference and also the staff of this conference
who worked hard to make the conference success. Organizing a conference needs a great
deal of work. I first learned of the arsenic problem in this part of the world in 1994. In 1995
when I came to a conference that Dr. Chakraborti organized and a part of the conference
was involved a two-day field trip in the affected areas of West Bengal. We saw hundreds and
thousands of arsenic affected people. We were extremely moved by the patience, their
concern for themselves and family members and appalled by the size of the problem. I didn’t
know that there was a problem moving in Bangladesh. As time went on we learned about
problems elsewhere in Vietnam and Nepal. We had scientists from there describe the
problems in those countries and it seems that every year there is s new country added to the
list. Of those, South and South East Asian countries have high arsenic in their drinking
water. Recently, Cambodia appeared on the list with problems in the Mekong delta in
Vietnam. The Red River has been affected and a very little has been done in this regard.
Looking at health effects in those countries at this point, we can be certain that there will be a
health affect. But Bangladesh is still the most tragic of the situation. Once again we had a
field trip in 1997 at the first conference. We went to some villages and saw hundreds of
affected people and we once again were very moved by that experience. In the past years, I
have been somewhat disappointed by the slowness of the progress in dealing with this
problem. This year from this conference we are going to see a good step forward although
not enough in terms of delivering safe water to people. Although there is, as was mentioned,
a lack of work on patient management, I think it is urgently needed. I am concerned about
irrigation water and the soil of Bangladesh, which are important natural resources. Continued
application of arsenic rich water to these soils should be an urgent concern. Because there is a
possibility of food chain problem. Moreover, there is another possibility perhaps more likely
of toxicity to the crops themselves. Rice is relatively sensitive to arsenic which would, in the
early stages, start to lead to decrease in production that could have a very serious impact on
Bangladesh. It’s very difficult and very expensive to remove arsenic from soil. So I can’t
urge strongly enough for rapid action to get to the point where you are no longer using those
arsenic rich waters as irrigation water. Though you got lots of surface water, there is, of
course, storage problem that is going to be very difficult to address. But this resource must be
protected. I hope that the efforts to do this will be coming very quickly. Thank you very
much.
10
Dr. Maniruzzaman Miah
Chairman, TWEDS
Very distinguished guests, learned scientists and researchers, experts on arsenic from home
and abroad, other distinguished guests present here, ladies and gentlemen. I am afraid I could
not write-out of my speech which I should have normally done but then I think for this type
of conference I may not need that because more things will come out of scientific
deliberations that will follow. My task is only to say that the meet is open. Anyway, at the
very outset I should like to thank the Dhaka Community Hospital and other organizations of
this international meet who chose me to speak here as a chairman of this inaugural session.
Back in 1993 I was my country ambassador abroad. I used to get some newspapers that were
sent to me. And I came across one news item which horrified me because the first case of
arsenic was detected from a tubewell of my own village. Fortunately, of course, none of us or
our siblings whom we left that place long time ago after the demise of our parents. But then I
was thinking about the other people who are living there. Anyway, I had nothing to do but it
really horrified me. At that time much was not known but the horrors that might follow could
be guessed. Back home in 1996, I saw that some people here in Dhaka Community Hospital
along with Dr. Dipankar Chakraborti of the University of Jadavpur combined hands to study
this problem. By this time I came back, quiet a few things were known but even then some of
the major issues or rather the debates used to raise in the scientific community here. One was
very important whether arsenic is really from the groundwater by reduction or by oxidation.
That was one of the debates.
Another debate was whether there was any regional distribution of this arsenic contamination
of groundwater or not. Both these debates seemed to have receded in the background now
because although I won’t say that we have found the right as well as final answer to all this
but in Bangladesh situation it appears the first one that it is through reduction of groundwater.
The second one also was that we have also found the answer, perhaps the final answer in that
occurrence is there of arsenic only in the hollow sand sediments meaning the most recent
ones deposited more or less over the past ten thousand years or so. Or in other words, the
areas of old alluvium like say Dhaka and around this Modhubpur track, Barind tracks etc.
The sub-surface water of those areas seems to be free from any arsenic occurrence. In a way
that sounds logical also, those who know about the geology, surface geology and also about
the river behavior of this country, the morphology of the river, etc. What was most painful
about this arsenic contamination is that in our country child mortality was a big factor that
reduces the average life expectancy of the people. A number of ORS came around at one
time that reduced it barely. But UNICEF came in a big way to provide groundwater to
children by setting wells. Unfortunately, within a few years we came to know that it was a
source of arsenic. So, we were caught between the fires. Some of the success stories we used
to publicize on the reduction of child mortality in this country, the raising of life expectancy
at birth, the raising of literacy, etc. And partly UNICEF had something to do with this. But
when this news came that this groundwater contains arsenic, we were really caught between
the fires. The problem has not yet been solved in that what are the choices? Certain points
have been raised in Dr. Mahmuder Rahman’s opening speech, what are the choices of water
management then? First, we cannot do without water that is known, but where to get the safe
water- from the surface or from the ground? What are the choices left to the rural people? Do
they have enough money to go to some technological devices to free their water from
arsenic? These are some of the issues and very big issues which are still agitating the minds
of the decision-makers and also the experts. But at the same time, there is always a silver
lining along the clouds as they say. Scientists and our researchers or experts haven’t sat idle,
11
both in the university of Dhaka and the BUET. Some people of these institutions have
engaged themselves in research on arsenic being helped by people from outside like
Columbia University, London University, other universities of the United States. In any
case, the point that I am trying to make that there is a problem no doubt and it is a very big
problem indeed. I do not know of any other problem confronting almost the entire population
of the country than this arsenicosis . If we go by the WHO standard of arsenic contamination,
about 50% of the people are exposed to this danger. If we go by our own standard, which is
lower than the WHO, then about a third of the population is under threat.
Definitely, we have to find a solution to that. This is one of the international meets in Dhaka
Community Hospital. In the past several such international conferences were also held. I am
sure that many things will come from the deliberations that are going to follow right after this
over the next two-three days. The present government, when came to the power, put this on
their agenda to be taken up at least initiated within the first hundred days of their governance.
But two and a half years have passed since then. Some progress has been made no doubt but
at the same time I have a feeling that the decision makers of the governmental level do not
always invite the experts from outside the government. But the experts are actually outside
the governments. One has to accept that bureaucrats are not experts. Experts are inside the
university and outside the government. More and more of them have got to be involved.
Dhaka Community Hospital has engaged itself in most accusative part of the aspect that is
very important no doubt. But at the same time, the most important task is where should we
find the safe water? They cannot wait just for an even a day to give the people safe water.
That is the most important task. I am told that some devices have been found of late to free
contaminated water of arsenic. How effective they are, how costly they are, how expensive
they are? I really don’t know but definitely people are working on that. I look forward to
seeing fruitful deliberations over this issues. I am sure more things will come out from the
deliberations. I wish you all a good stay in this capital although right at the moment we are
passing through a politically charged situation but then we have learned to put up with that.
And we have learned to put up with cyclones and floods and all that. Arsenic is a new
menace, natural hazard. Thank you very much.
12
Vote of Thanks
Professor Quazi Quamruzzaman
Chairman, Dhaka Community Hospital Trust
Honorable chairman, distinguished guests, friends and colleagues.
Before I give you vote of thanks, I’d rather thank Professor Aynun Nishat who was suppose
to explain what we are doing for this conference. So I’ll start from there. First I apologize for
Dr. Kamaluddin Siddiqui. Truly, he was great inspiration for one of the ideas of this
conference but unfortunately this very morning he has to leave the country . So on behalf of
us we regret his absence, but he has promised and given his assurance that all the findings of
this conference will be put to him and as a chairman of the National Arsenic Mitigation
Committee of the Secretaries’ Committee he would give a serious consideration. Also.
Taleya Rehman, unfortunately, could not come because one of her relations expired, and she
has to go that place. The program of this conference will be three day long. Today is
inauguration and after then we will be a working session on arsenic health issues. Then there
will be lunch. The lunch will be at upstairs. Then second session will be on contamination of
arsenic health issues, then there will be tea at 3.45 and after that we will have a third session
which will be on update of safe water options. That will be the end of today.
Tomorrow we had a session of field visits to two areas . This is very interesting because
UNICEF, DCH and different NGOs all are working there. So it will be nice to see. What has
been happening in regard to options around there. The stories are all not bad. A lot of good
things are also happening. A lot of future hopes are there. But very unfortunate that tomorrow
there is a hortal. Many participants asked us what is hortal. It is very difficult to them. I think
they are experiencing themselves. What we want to do is that if enough people want to visit,
we can do that before the hortal time. The local people are very much eager. They have
already made lots of arrangements to receive our foreign visitors and the visitors going. I’ll
request you if you come, some one will collect you and provide all the transport. I am very
happy that the police department is very happy to help us with the security. If you want to
stay during hortal time in Dhaka is the kind of a experience you already got yesterday. I think
it will be a good experience for you to see the better side of Bangladesh. Then on third day
we’ll have a very interesting session on water availability and rational use of available water
sources. It is from 9 to 11 a.m. Where some very interesting papers will be presented by the
people of government, people from the research.
After this presentation we will invite the political leadership of this country not only from the
country’s two major parties also from other parties as well and members of parliament of
different political parties, activists, and people, editors of some newspapers and some
journalists as well who will react and give their reaction on this problem, both globally,
regionally and nationally. I hope most of these political people still remain conscious to
participate on that day. After that session there will be another working session on health and
environmental hazards encountered with extraction of groundwater and management of water
resources. And then there will be lunch and we try to be innovative in our teas. We try to put
some pithas but yesterday’s hortal got some problem but I hope we will manage it today. And
in lunch also with a bit of Bangladeshi touch. And I promise this is all good, many of the
foreigner people come here and suffer from tummy problems and we have taken enough
advice that you will not suffer that and as you know there is an international cricket
competition is going on. And all of them held their head fit, playing well, I hope Bangladesh
do well against them and we will try to keep that standard here.
13
The last session will be a working session on Health, Environmental Hazards Encountered
with Extraction of Groundwater and Management of Water Resource. Then there will be tea
again in the last stage but there is another interesting session on closing from 3:30 on 17th of
February. This session will also be chaired by Professor Muniruzzaman Mia. There we want
to invite the guests who are policymakers like members of planning commissions, editors of
different newspapers, national experts committee on arsenic members, secretary of the
LGRD, secretary of the environment, World Bank country representative and activists who
are working abroad for Bangladesh and other media. We will put forward to them the
findings and recommendations of this conference and we will ask them and ask the reactions
what will be their programs for the next few years. So we hope that you all will join there and
give your opinion and ask them the questions. After that a kind of declaration, which we will
call Dhaka Declaration, will be given. This Dhaka Declaration is very interesting because in
1998 Dhaka Declaration, we said Bangladesh needs safe water management policy and at the
fifth international conference we are happy that that some works have been done though not
100% but some ideas being thrown about and both the policymakers and different political
parties have some commitment to them. So we consider that DCH and Jadavpur University
have some success in motivation in political and bureaucratic circles. What we want from
this conference? We want to assess what has been achieved, what are the success stories,
what are the weaknesses, what are the mistakes we have made and also share our ideas with
our research people working in abroad who came here. So together we can develop a kind of
idea and information for all of us.
Arsenic is not only a Bangladesh problem, it is now in 129 countries and regionally it is from
Vietnam to Pakistan. Every country has affected by it. We hope that this conference will
play a big role. As you know organizing of a conference is a very difficult task. First you
have to find a financier and usually you do it in Sheraton Hotel or Sonargaon. But with our
attitude and our way of life, we try to be much more down to earth and cost effective. So we
try to do it here. All foreign participants came all the way with their own expenses and it is
very expensive now to travel to come here and they are all very business persons and they
have second time to come here. I must say that we are really grateful to you . I will put the
name of you Dr. Peter Nadebaum, he is from JSD Australia, Dr. Alison Baker, she couldn’t
come because of a family problem. She will be arriving this morning or tomorrow morning,
Professor Richard Willson, he is just arriving. He is from Research for Physics, he is a
Professor of Harvard University. Professor David Christini ,Professor of Medicine and
Epidemiology, Harvard University, Dr. Dewarat Kawsik, Regional office of Delhi WHO,
Phillip Crisp ,School of Critical Engineering Industrial Chemistry, University of New South
Wales, Mr. Choudhury, a Ph. D student, University of New South Wales, Professor Bill
Chappel ,University of Colorado, Denver. Also Professor Alan Smith, Professor of
Epistemology at the University of California-Berkley, Dr. Dipanker Chakraborti ,School of
Environmental Studies, Jadavpur University. Professor S.C Mukharjee, Department of
Neurology, Medical College, Kolkata, Professor Browse , Edinburgh, UK, Mr. Ray Burton
Butler,Australia, Mr. Michael Rook,Australia. Mr. Peter Robson, JSD Australia, Khristen
Collins,JSD Australia, Professor Moona Cage, my apology if I cannot pronounce rightly,
Kochi University, Japan, Professor James Bosom , People’s Republic of China. They are all
in their own rights. We are grateful to them for coming here on their own expenses and
giving their time. Thank you very much.
Now, I’ll thank Minister for Health and Family Welfare. It is not for only because we having
putting the name they are really kind and help us to organize and we got financial help from
14
Ministry of Foreign Affairs, Ministry of Home Affairs. They have provided us access to the
security in the airport, provided air support. So it is grateful for them similarly Minister for
Health and Welfare, Minister for LGRD. Minister for Environment and Forestry, Barrister
Nazmul Huda, Ministry of Communications, Advocate Sigma Huda, Department of Public
Health Engineering (DPHE), Sectaries Committee National Arsenic Mitigation, National
Experts Committee, Pabna Community Clinic, World Bank, UNICEF, WHO, Australian
High Commissions, Local AUSAID branch, all are very kind and always encouraged us to do
many of the work we are doing now. Actually, we are very grateful to the newspaper. Most
of the editors are always not only infrom us, they also ring up and encourage us to work on
arsenic. Mr. Joinal Abedin from Sirajdikhan Upazila and Mr. Chonchol from Dohar upazila
are the ones who are hosting our field visit. And few of the organizations such as Square
Pharmaceutical, Renata Limited, Singer Bangladesh, Duncan Brothers provided us help to
organize this conference. But certain individuals I must thank them. Mr. Tapan Choudhury ,
Managing Director and President of Metropolitan Chamber of Commerce and Industry,
deserves special mention for giving us moral support, advice and suggestions.
I also thank Mr. Ruhul Amin. He is a Deputy Inspector General of Police who is one of the
founders of Dhaka Community Hospital and we always have a support from him. Professor
Ahmed Kamal, he is a Professor of Dhaka University. Professor Aynun Nishat, as you know,
is one of the specialists on Water sector in regionally and in the world. He has taken a keen
interest on this conference and help in developing topics, sorting out papers. Unfortunately,
he couldn’t be here this morning but he’ll be here later on. Dr. S K M Abdulla, he is now in
the National Expert Committee and in formulation of many of the policies in Bangladesh
government, he played a very positive role in the interest of Bangladesh. We thank him
Our relationship with Mr. Paul Edwards and Shafiqul Islam of UNICEF is for beyoned the
working relation with UNICEF. The commitment and inspiration they do feel for Bangladesh
is really an example for us. And many of the works in Bangladesh have been possible
because of his inspiration and active participation, we thank him. Dr. Dipanker Chakraborti is
an example of himself and we thank him. And I do apologize for the many mistakes that we
have committed in this conference. They are few. Many names maybe printed wrongly. We
do not have much excuse for it, but I can give you one excuse, there is a virus called my
doom and actually doom does because many times the computer went differently and we
could not do. So there might be delay in giving this things. Anti virus didn’t work and we
have to go for different areas to get the correct anti virus? Then also late arrival of our
abstracts, actually yesterday we got some abstracts. A lot of people we could not provide
them. I would do apologize for the time constraint, accommodation constraint and in future
we hope that we will be able to provide them and be together. Then also I thank the staff,
volunteers and friends of the DCH who work tirelessly to make this conference possible. And
at the end, I wanted to make one or two points.
In 1998 we organized first conference and through this we got involved in arsenic issue.
Actually, community hospital is a hospital, its agenda should not be arsenic what we are in.
Even if we want to get out of it, we find it difficult. And I will tell you why patient
management is at this moment still with the patients who are going through chemotherapy.
Unfortunately, arsenic has struck at the rural areas and it is the rural poor who are most
affected. There was only one rumor that there was arsenic in Gulshan, and do you know for
one week the headlines of the newspaper are on arsenic. Unfortunately, there was no arsenic.
I hope that there is arsenic and this problem would have been solved because of the rural
poor. There are a lot of patients here if you want to see them, you just tell our people they
15
will take you and show them and talk to them. Few days ago, a young girl came to us and we
really seriously thinking should we be in this arsenic or not. Because we identified this girl,
she is about 22, as an arsenic patient in one of the north Bengal districts village. Now she was
about to get married. When they get to know that she has got this arsenic problem, the
marriage broke down. And four times then they moved that girl from that village to another
area but the news traveled and four times the marriage broke down. She was the youngest
girl. The father of this girl lost all his property because of the erosion of the river. She came
to us to withdraw her name from our register as she thought it is going everywhere .She said I
don’t need your treatment. Just tell everybody that I don’t have a arsenic. It makes you
wonder are we doing a good thing? We are identifying people but what are we doing? We
might giving some tablets or some medication but we talk big about social rehabilitation and
all sorts of things but economically and socially what we are doing? It is very good to paint
some tube wells or holding this conference, publishing a good proceedings but at their cost. I
think we should do this work as an integrated way and by identifying a patient we are causing
more problem, because the stigma started. We cannot do anything. Donors are not interested
about the health or patients. There are reasons for it. The government is also doing something
but we are not realizing what is actually happening to them. So maybe here we will be
discussing, the molecular level of the arsenic work. We’ll be discussing how, what is the
medication is going to help, we’ll be discussing what nice work is done by somebody, we’ll
be discussing Dr. Zaman, Mahmuder Rahman really organizing a good conference, very
cheaply with good food but what is happening to these people. I hope some suggestions,
some ideas will come from you in this conference regarding how we are going to work for
this rural poor of Bangladesh. Thank you very much.
16
Working Session-1 on Arsenic Health Issues
Chair: Dr. S.K.M. Abdullah
Arsenic Exposure, Diet and Skin Lesions in Pabna, Bangladesh
Dr. David Christiani
Professor, Occupational Medicine and Epistemology
Harvard Medical School
Boston, USA
I would like to thank the convenors of the meeting for their kind invitation to attend this
conference. I am going to present some preliminary data of an epistemology study that we
began three years ago in collaboration with Dhaka Community Hospital. I would like to
acknowledge both the team of Harvard Medical School and DCH. The data I am showing
today is part of a study done by Ms. Katie McCarty along with Dr. M.Rahman, Dr.
Quamruzzaman, M. Rahman, G. Mohiuddin, Ascheris, M. Kila ,Dr. E. Gonzalez and Dr.
Houseman.
Inorganic arsenic exposure has been associated with a number of conditions including the
malignancy of internal organs, spleen and bladder but also non malignant skin diseases that
are felt to be in the pathway to skin cancer. Also, a number of other non-malignant diseases
specially diabetes, cardiovascular diseases. We are going to focus today on skin lesions. The
region where we have been doing this survey is Pabna.
Skin lesions are a hallmark of arsenic exposure. The characterization of these lesions has
been done by colleagues West Bengal and Bangladesh and we are going to give you the
classification we use for the study. One is developed in West Bengal and Bangladesh, so that
characterization of melanosis, including the hyper pigmentation of the chest, arms, and legs
as well as keratosis. Melanosis and Keratosis are the two main health outcomes. These are
examples of the kind of skin diseases we have been talking about. This takes the upper chest
spotted in melanosis. This is a much more severe version. This is the hands and soles of the
hyperkeratosis as well as maleness, much more severe.
In this paper I am going to discuss the hypothesis whether diet protein, fruits and vegetables
intakes are protective in the relationship between arsenic exposure through drinking water
samples and the development of skin lesions.. This is a case-control study. It involves nine
hundred people, 2o % of the samples were constantly collected from the areas that have
greater arsnic and 80%from the areas that have lower arsenic We used a questionnaire but
which is simple enough to get the information relating to diet and exposure. We had 450
cases and 450 controls that were stratified on age and gender, and were collected at DCH.
Water samples were analyzed for arsenic by using EPA method 200.8. Our characteristics of
individuals of cases and controls those have complete data is close to 422 to 423 for cases
and controls. Beef intake, fish intake and bean intake as well as fruit , juice intake are all in
the crude analysis associated with the decrease in arsenic lesions.Bread was in thr opposite
direction becuse not many people were bread eaters.This is an unstable varable.The intakes
of chickens, eggs, vegetables,canned goods are relatively rare. Rice and milk have no effect
in one way or the other way.
17
In multivariate analysis we use logistic regressions . In this analysis it is seen that the log
linear relationship between the odds of having skin lesions and arsenic exposure measure by
toe nail Drinking of well water arsenic levels above 50 was associated with quiet a large
chance of having skin lesions drinking from a previous well In the adjusted analysis we have
the variables everyday in this case food intake. Beep intake is crude and more importantly
this is adjusted and what we mean by adjusted for is that we look at beep intake after taking
into account a gender, feed issues of well to well, well for the arsenic concentration, daily
liquid intake, smoking status, chewing tobacco use, beetle nut use and skin, socioeconomic
status. So we have adjusted for just about everything we could adjust for including arsenic
exposure and then we looked at the chance of the odds of having skin lesions with the
consumption of beef. In this case if you look at the adjusted analysis those that are consumed
beef are greater than three times a month were protected, relatively protected. . Fruits ,juice
intake was also relatively protective. Although not strong in slightly. Bread was a slight
increase but very few people eat more than three times a month so this is an unstable variable
and foul again no relationship and egg protein, canned goods, we only use rarely, again no
relationships and milk no relationships, vegetables also no relationships, and same with bean
and bean protein. Fish maybe somewhat protective.
The developing of skin lesions in this population in a case controlled study increases with
arsenic exposure through drinking water as measured by single well water or by toe nail. fruit
and beef maybe protective although the effects are relatively moderate. And compare to
arsenic exposure which is a very strong relationship for the development of these lesions,
inverse relationships by the intake of these relatively good food is too modest. I think to need
too specific treatments by diet proteins although we would all say that a better diet is better
for the people. Lepitpal control of arsenic associated skin disease is ,of course, reducing
arsenic exposure. I would like to acknowledge our funders in the national institute of health
and in particular national institute of environmental health sciences and Dhaka Community
Hospital, Pabna Area and Harvard laboratories for their cooperation across such long
distances. And Professor Richard Wilson ,who will be later here today, who is the first
individual to introduce our colleagues of DCH. Thank you.
18
Health Impact of Arsenic Contamination in the South-East Asia Region
Dr. Deoraj Harry Caussy
The Environmental Epidemiologist
Department of Evidence and Information and policy
World Health Organization, South East Asian Region, India
South East Asia region includes eleven countries and they are different from each other in
terms of their language, their culture, economic development, level of education. Arsenic is
found throughout the world but if you look at the South East Asia region, you will find
clustered epidemic contamination. Actually, all the hotspots of contamination are between
the Gangetic and Deltaic Plate. If we look at these hotspots, we find a larger number of
people are exposed to it. About 80 million people are at risk. This covers 65 million people
are exposed in Bangladesh alone, another 5 million in West Bengal, 5 million in Nepal and
about 5 million in Myanmar and some thousand in Thailand. About one million people are
exposed to skin lesion and about 20 thousand people recorded with various cancers. Are
those numbers correct? How do we get these numbers? This is all estimate but lets asses the
situation first.
We are approaching from using the classical which consists of two main sets. One will assess
the risk and then to manage it. When we manage the risk we take into account legal
considerations and other socio-economic factors and technology. We might find and we
should reduce arsenic from 100 to 10. But do we have the technology to measure?
Socioeconomic constraints and the work done by the Columbia University show, for
instance, well switching is a viable option to give clean water. But that was not socially
acceptable because well switching meant you had to go to the village of the next person’s
bath or the next person to get the water. And it was not culturally acceptable at least. So we
might find the solution, and might find the government is not doing anything In assessing the
risk through arsenic we are constrained because we don’t have a big database of people
exposed with accurate exposure and aggregate outcome. So we really cannot do much about
it. We have to get a lot. What types of people expose, what species, what concentration. Our
estimate is very wide also. What is the effect of the arsenic we don’t know. Most of the study
we’ll be using an ecological study. We have limited epidemiological strength to come to a
conclusion. We cannot generalize from that we need more systemic epidemiological study.
Now the implications of wrong analysis. It’s like keeping the balance. In holding the balance
you really got to be careful. If you make the wrong implication, say everybody is dying from
arsenic, you can raise fear -psychological and all kinds of fear. If you say it’s not a problem
when it is a problem you can ignore the problem and end up with a bigger catastrophe. So in
the case of assessment we have to use judgments all the time and reassess the situation. We
did a analysis.We see what arsenic is like. We found in India, Bangladesh and elsewhere
there is a lot of variation in the prevalence of arsenic disease.
Now, why the variation? You can say it’s the very duty of the population. That I agree. It’s
variation because we have made inheritance because it is in our gene for from Joh Harvey
and explain some of the variation. Or you can also have discussion with an error where you
have measured the arsenic improperly, measured the outcome improperly, you have used
science and you can come to wrong conclusion .We have some of the potential pitfalls where
you can make errors. If the lab method we are using is not defined we will not going to have
a correct result. If your clinical outcome is not defined again you are going to quantify them
19
wrong. You cannot generalize the whole universe and that’s what’s many of us have been
doing. That is where pitfall lies. So we should rectify this . We know arsenic is not just found
in drinking water but also in the food chain, in vegetables, in pulses, in seafood. You can
have various scenarios with go back to tipping the balance,. Where is the intake more. Is the
intake more in the water, more in the food than in the water? Or a bit equal. Or a bit less. We
can only do that if we do an integrated exposure. What we did? We developed a case study
together with the ADSD or from the CBCC in Atlanta. Where we did an integrated exposure
of arsenic from various sources. I and we developed the skills in Bangladesh. and what we
saw? We have completed a study here with the Dhaka University with Dr. Amir Khan and
Khalekuzzaman. The preliminary results show that the intake for food at the present, the level
is given, is not a threat to health although we need to defer the work a little because the
quantity is more and also we have to speak a bit more. So it is just preliminary but that the
water intake is the most substantial contribution presently. Then the food intake.
The biggest contribution of WHO for risks management is the tools for case definition. We
need to have a consistent case definition. That was developed over a long period of time, in
the year 2001, and last year we feel that the protocol went through to hold committees,
experts of national level, international level, regional level. We developed protocol, we field
tested them and now we have a protocol that does not look like this. Actually, we simplified
further ,we have a newer one. It allows us to do consistent surveillance and diagnosis in
training of healthcare workers. When we talk in the arsenic case we all talking the same
thing. And also when we have a objective in evaluating other we cannot improved but in
what criteria .One is risk management ,We have procured vitamins and medicines for in the
effort of capacity building in affected upazilas under the UN foundation in Bangladesh and
we are doing a feasibility study for arsenic.
We have seen only about 30% get the disease, if you take all of these into account, do we
explain how these variations happened? There are are many challenges. We lack of evidence
based guide patient management and risk assessment. We currently have no cure for arsenic.
We have the options for safe waters which are expensive. Scarcity of resources are so we
must forge an alliance. We have to forge all this together .. Thank you for your time.
20
Arsenic Neuropathy from Groundwater Arsenic Contamination in India
Dr. S.C. Mukherjee
Assistant Professor, Department of Neurology
Medical College, Kolkata, India
Chairperson, ladies and gentlemen. I thank organizers to include this particular topic. It is not
very clear to many of those who are interested in the clinical aspect of arsenicosis I am going
to present study findings on this particular topic. The problem of arsenicosis affected many
blocks in West Bengal, and many districts in Bangladesh and more recently two districts in
Bihar and one district each in UP and Jharkhand. Most important sources are contaminated
ground water, air environment, because other uses of arsenic is now very limited. Now how
these arsenic toxicity can open. It is known that is a general protoplasmic toxin, it involves
multiple organs and systems of the body. We are concerned with the chronic form of
ingestion. Nutrition of cattle is very important deficiency of human is very important, high
alcohol consumption is very important and lastly the viability is determined by at the
molecular level you can say as well as genetic factors.
Neurological parts can be broadly divided into peripheral and central nervous system
involvement. The latter is less frequent than peripheral nervous system involvement. There
may be acute entepelopathy. In some cases we have seen the manifestation of chronic
entepolopathy in our patients. Coming to the cranial involvements. We have few cases
involved with this hiposmiasma that is a disorder of smell. There may be few cases with optic
nerve involvement. Some patients with perceptive hearing loss. These are very rare and has
muscle involvement in acute poison is seen. This peripheral nervous system which is the
topic I am presenting today. It is arsenical or arsenic neuropathy. It is the commonest form of
peripheral neuropathy due to any metal or metalloid for executing neuropathies caused by
lead, mercury or other metals.
Now coming to the types of arsenic neuropathy. What are the types? It may be acute, subacute or chronic. Sub-acute neuropathies maybe like bravery syndrome in the form of those
who are medical persons know that it maybe typical for recantation high. We have reported a
case of bravery syndrome in relation to neuropathy arsenic exposure. Now it may be sensory,
sensory motor or motor neuropathy; it may be symmetric or asymmetric, especially in the
early stages of involvement it may be asymmetric.
It may be somatic. Rarely, it is automatic but autonomic nervous system involvement. It may
be clinical, usually clinical and sub-clinical involvement. We have diagnosed clinical
neuropathy in few cases with electro-diagnostic studies. It may be late late involvement.
Coming to the electro-physiological studies. Overall involvement in our Electrophysiological lab includes sensory or sensory motor or rarely motor. Axilopathy, with or
without minolopathy. Axels inside the nerve is more important for the affection and in some
cases there maybe motor involvement as well. Laboratory diagnosis is very important. In
acute cases we can get help from the urinary arsenic estimation in our dischronic patients. In
sub-acute cases, and sometimes I told you, bravery syndrome, you can get raised protein and
normal cell and some arbitrary changes, but it’s the chronic arsenic neuropathy. Estimation of
arsenic in hair, nails, liver, skin, cells, and other investigations may help you.
Now coming to the pathology, it can involve the nerve. Very few autopsy studies are there
where it has been seen that it can involve the tarsal route, gandrial spinal cord and the neuron
cells, etc. Coming to the differential diagnosis because there are no typical specific signs,
21
symptoms of arsenic neuropathy. You have to stress on risk of exposure, clinical suspicion
and chemical analysis for arsenic. You have to differentiate arsenic into come to a conclusion
you have to differentiate other forms of neuropathy like diabetic neuropathy, alcohol
nutritional neuropathy, bravery syndrome, acute intermediate popery...tic paranosis, etc. All
this is very important. Especially, diabetic neuropathy in our population. Now, I want to
stress on the pathogenesis of arsenic neuropathy? The arsenic effects it combines with the
sulfide groups of proteins which is known to everybody and with this combination it forms
monothual or dithual compound. Once dithual compound is formed it is a very stable ring.
Once it is formed that is the main pathogenic factor it produces the in division of several in
the system. And of this the in division of pyrubet dehydrated system is the most important
thing not only that the recovery of the life way mine by which this pyrubet occurs that is also
affective. So ultimately, by this affection what happens is that the availability of the ATP is
low and there are several other changes from where you can see that maybe the hypoglasimia
is a peculiar thing. Diabetes has been reported in relation to arsenic and arsenic can cause
hypglasimia.. and there are other changes which can affect the RBC survival and arsenic
metabolism.
Now what is the affection of the nervous system? It is at the stage of cellular energy
metabolism and at that level when it affects in the peri carrion it can affect either the cell, it
maybe affect or there maybe distal Axilopathy directly these are treatment part is same by
forming with the dithual compound and dithual compounds forms as a stable bond and this
compound with the formation of a stable bond can eliminate arsenic but it has been seen for
this chronic neuropathy this compounds are not effective. We have seen DMPS has not found
to be good and this monothual are not at all helpful. So we have to depend on the
symptomatic management and health education and physiotherapy. We see most of the
patients affected are young patients you see here that the sensory motor neuropathy. Severity
in most of the neuropathy is mild and moderately less. Symptoms are mostly distal
parasthesia and limb pains and or the hypoesthesia and the signs by which you can diagnose
it is the distal hypoesthesia .Other symptoms of these patients are cough, dyponia, anemia,
skinitching. Homoptysis wrongly diagnosed as progressive tuberculosis. Moderate clinical
neuropathy abnormalities are higher than in the mild clinical neuropathy. out of the 154
patients of neuropathy, 74 were analyzed and it is not the matter of level in these water. In
fact 62 samples were of lower group of arsenic content. 37.3% had evidence of neuropathy
and in group three 86.8% had features of neuropathy.. Now coming to another group of
patient of 430. Again the distal parasthesia is more compared to other groups. out of 21 case
study, there are three cases of abnormal VP and there are two cases of abnormal brain
stimulatory noises. So these two cases -one is visual pathway and the other is the hearing
pathway. We found that after the secession of this arsenic consumption there was
improvement in 33%, vitreous 10% and static was really slow recovery in 57%. This is a
combination of the recently studied three groups, three states UP, Bihar, and Jharkhand, more
or less, similar the percentage of this affection is 49, 58.8 and 43 percent.
So coming to the conclusion from this work we see that arsenic toxicity from groundwater or
contamination may produce neurological complication . The periphery neuropathy is the
predominant and the common neurological complication of arsenic toxicity. We have
studying central nervous system involved, we studied that work even in children we have
studied that work, as we have undertaken that work but the outcome of that I cannot say now.
But definitely peripheral involvement is very important. Then electrophysiological of the
affection is sensory or sensory motor. Now patients with neuropathy persisting clinical
features need to be followed. We cannot say what is the outcome, how this neuropathy is
related to some other problems. This is a must for us. Thank you.
22
Susceptibility of Arsenicosis in Bangladesh and Management of Arsenicosi Patients
in DCH
Dr. Ainul Islam Joarder
Consultant, Dhaka Community Hospital
Per capita income is only 35O US$. Malnourishment is seen due to nutrition. Literacy rate is
only 46%. There is prevailing obsolete customs, superstitions and conservativeness. Then
dietary habit: here most of the population are living in rural areas. They don’t know about the
balanced diet. They used to take the low protein and low energy diets. Also, they have lack of
health consciousness, health education and health facilities. Where the doctor and population
ratio is only 1:4200. Due to loss of traditional sources of surface water that is dug well, pond,
etc., 20-25 years ago people here used to have their surface water but after the availability of
the tubewells, all these surface water sources have been dismantled and destroyed.
The magnitude and extent and effect: As a result of high population density that is 948.70 per
sq. km, the affected strength of the arsenicosis becomes alarming. 61 districts out of 64
covering the area of 1,25,133 sq. km are contaminated. Sixty Five per cent population live in
the arsenic affected zone. Eighty million people are at risk, 160 million people consume
tubewell water. About 56.05% tubewells supply water containing arsenic more than 0.05 mg
per litre. Total identified arsenicosis patients recorded is 13,333 as per DGHS 2002. Possibly,
by this time it has become more and more.
Toxicity of arsenicosis. After oral intake, the arsenic distributes to all tissues and the organs
of the body carcino-genicity: Arsenic interacts with the DNA and it inhibits the repair and
formation or synthesis of DNA producing chromosomal abnormality. And it produces
ultimately a mutagenic effect to produce carcinogenic effect in the human body. Noncarcinogenic toxicity is due to inhibition of cellular desperation at hepatic mitochondria. Now
I’d like to describe the management protocol of arsenicosis in DCH.
It includes general medication, which includes nutrition and high protein diet locally
available, vitamins, anti-oxidants that is vitamin A, C, E, multivitamins and others including
zinc, iron, copper, selenium and manganese and catalytic agents that is salicylic acid10-20%
and urea also.
Sillation Therapy: Though it is not being practised here, it can be considered if it is available
and cost involvement may be provided. It includes dimarchaprol DMSA penicillin.
Counselling and rehabilitation also fall under this medication.
Surgical Management: I myself have done so many operations as a result of the malignant
changes and formation of the ascending or advancing gangrenes. Surgical management
includes non-specific ulcer if it. We do wide excision followed by biosuper histopathology.
For malignant ulcers, chemotherapy or radiotherapy and for the disseminated malignancy
radical amputation followed by chemotherapy or/and radiotherapy. And in the case of
gangrene that is, a result of peripheral vascular disease, it may be early or may be late. In the
case of early cases we used to do the conservative trials that is immobilisation. We give the
oxypentifiline, aspirin, anti-platelet drug, clofidogrel, sclerotic block, nicotine nicotinomide,
noispabrotapherine, antivesarbic drug. In the case of late and advancing that is ascending
type of gangrene in the limbs, we used to do amputation. Following the surgical manoeuvre,
23
we refer these patients for their rehabilitation following physiotherapy. We got a treatment
for that patient, prosthetic orthosis and rehabilitation. Rehabilitation may be physical
rehabilitation and at the same time the financial rehabilitation. As part of these topics, I’d like
to request Dr. Shahjahan to say the clinical data and clinical management that we used to do
in DCH. Thank You.
Dr. Shahjahan
Consultant, Dhaka Community Hospital
Chairman, Co-chairman, Distinguished scientists and learned audience, thank you. My topic
is Medical Management of Arsenoicosis In-Patients in the Dhaka Community Hospital. .
Patients at the Dhaka Community Hospital: From January 2001 to June 2003, 99 patients
were admitted at Dhaka Community Hospital. Among the patients, 70 were males and 29
were females. Male is more affected than female. In the age group of 0-2 years and above 70
years, there is no arsenicosis patients at DCH. More affected patients are from the age of
group of 13-49 years (76.76%) and 3-12 years (9.09). The percentage of affected person in
the age group of 50-70 years is 14.14.
Melanosis: Out of 99 patients, 95 are affected with melanosis, 4 have no melanosis.
Keratosis are found in 94%. About 72% are affected with malignant ulcer and 22.22% are
affected with non-malignant ulcer. Out of this, cancer, I mean Squamous Cell Carcinoma, is
found among 17.17% and non-malignant ulcer is 5.05%. And peripheral vascular disease is
found among 6.06%.
As I should state the clinical stages of Arsenicosis, the clinical stage I like to divide it into
two groups, Pre-clinical and clinical. In our hospital, at the pre-clinical stage nobody is
reported. Even in our community no pre clinical stages are reported to the doctors at any
other hospital. I’d like to say that the pre clinical stage, one, that is the chemical face tangiest.
In which only if we test the urine then we can got the arsenic present. And there is tissue
phase that is the permanent tissue phase. In that phase if we test the skin and body tissue
tested if it’s positive no chemical apparently present. Only urine test presents positive clinical
stage. Clinical stage includes complications stage and the malignant stage. In the clinical
stage we can see the visible skin lesions, ulcer, melanosis, keratosis. And complications are
gangrene etc. But you got the maleness when patients are in malignant stages management.
In community hospital we used to practice counselling. We prescribe arsenic free drinking
water, diet and dietary supplement, female counselling, social rehabilitation and socioeconomic support.
As we know, no known curative treatment is possible for arsenicosis, but we are still trying
with the arsenic free drinking water, dietary supplement anti-oxidant. Vitamin A, E and C
and the salicylic acid 10-20% and the urea 10%-20%, surgery for, physiotherapy,
chemotherapy, radiotherapy, surgery for gangrene, oxidant, amputation, Thank you
everybody.
24
Skin Manifestation & Complication in Arsenicosis
Dr. Shahidullah Shikdar
Asstt Professor, Department of Dermatology and Venerology
Bangabandhu Sheikh Mujib Medical University, Dhaka
Honourable chairperson, co-chair, ladies and gentleman. My Paper is on Skin Manifestations
and Complications of Arsenicosis.
Introduction: The epidemic occurrence of arsenicosis among people who have chronic
exposure to arsenic. So domestic consumption of contaminated ground water has been
evidenced in Bangladesh. The problem is emerging very rapidly and the number of
arsenicosis patient is increasing alarmingly day by day. Though the dermatological
manifestation is very common, arsenicosis leads to many complications in other systems
including skin cancer. The appropriate information regarding the skin manifestations and its
complication is very limited. That is why the present study is, therefore, undertaken to find
out the skin manifestations and complications of arsenicosis.
Materials and methods: A total of 450 arsenicosis patients were selected randomly by
observing their typical skin presentation in the Department of Dermatology and
Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka and in the Upazila
Health Complex of Bhanga, Faridpur. The patients selected had history of consumption of
arsenic contaminated water. The relevant investigations like skin histopathology, ultra
sonogram of hepatobilliary system, liver and kidney functions test were done. Among them,
200 cases were taken for estimation of arsenic level in hair and nail. Which was revealed
positive. To find out the complications of ailment,careful examinations were done to exclude
any other possibility, which might be the cause of ailment.
Results: Skin Manifestations: The common Skin Manifestation is pigmentary change. It was
98%. On this pigmentary change, there are two groups. One is end of pigmentation and the
other is diffused pigmentation. We have got 91.83% as the end of pigmentation and diffused
pigmentation was only 8.16%. Another common pigmentation is keratosis. It was 84%.
Among these presentations, hyperkeratosis type was 85.18%, cracked was 9.25% and
diffused type was only 5.55%.
Site of skin, distribution of skin pigmentary changes. In trunk only range of pigmentation was
15.5% and diffused pigmentation was 25%. In the Palm and sole, it was only 5.5% and
diffused pigmentation was 50%. In palm and sole, trunk and other part of the body rant
pigmentation was 79% and diffused pigmentation was 25%.
The site of distribution of hyperkeratosis. On the sole, the discrete warty type was 3.4%,
crack type was nil and diffused type was 9.5%. On the sole, discrete warty type was 3.7%.
cracked type was 94.2% and diffused type was nil. On both palm and sole, discrete warty
type was 72.6% and crack type was 5.7% and diffused type was 90%. On both palm sole and
other part of the body, discrete warty type was 20.1% and cracked type was 0% and diffused
type was also nil.
The complications of arsenicosis. Skin cancer: it was 4.8%. Among these skin cancers,
squamous cell carcinoma was 1.5%, basal cell carcinoma was 1.1%, Bowen’s disease was
25
2.2%, chronic liver disease was 6%, breathlessness was 20%, cardiac disorder was 2.2%,
renal failure was 3.1%, neuropathy was 6%, abortion was .66%, leg adema was .66%.
Gangrene: This is an important complication and we are getting it as gangrene but the black
foot disease is very common in Taiwan. The skin colour of gangrene patients are also hyper
pigmented and ugly and we may also denoted this as black foot disease. It was 1.33%. The
nail changes were 9.5% and the carcinoma in other organ was 0.66%.
Bowen’s Disease on the palm with warty hyperkeratosis lesions. And this was the Bowen’s
disease.
Bowen’s disease on the left fora. These are the lesions of Bowen’s disease. The extent of
surface of the ear fora. This is the complication of chronic arsenicosis with unilateral leg
edema. This is the unilateral leg edema. This is the gangrene. Black foot disease. This is
photography of the same patient. Hyperkeratosis of the palm. Cardiac patient. That very
patient was admitted with cardiac complication in our hospital.
This is the photography showing the rant of pigmentation and different pigmentation over
front of the trunk. This is the photography showing the arsenicosis of a patient of bitilogo.
You know this bitilogo is a depigmented skin lesion. That very patient was suffering from
this bitilogo for the last twenty years. And recently he has developed this hyperkeratosis and
distinct end of pigmentation over skin due to arsenicosis.
This is the photography showing both palms and sole. Discrete warty type hyperkeratosis.
This is the hyperkeratosis on the sole. This is the crack type hyperkeratosis, This is discrete
warty and also crack type lesions over the sole. This is the photography showing the
squamous cell carcinoma on the left foot fingers of a female patient of 51 years of age
reported at Bhanga Upazila Health Complex, Faridpur. This is another squamos cell
carcinoma lesion on the left heel of a female patient of 56 years of age reported at
Department of Dermatology, BSMMU, Dhaka. These are the lesions. This is also the lesion
of Bowen’s disease. We have taken the biopsy material from here.
Conclusion: More fundamental research is in relation to the pathogenesis and clinical features
is important particularly in the case of prolonged arsenic intake. Because various reports in
Bangladesh demonstrated the existence of arsenic exposure, relationship between magnitude
of arsenic exposure, and precedence of skin cancer and other clinical manifestations
including hyperkeratosis and hyper pigmentation. Thank you.
26
Ground water arsenic contamination and suffering of people in Bihar, Uttar
Pradesh, and Jharkhand States of India In Ganga Plain
Mr. Sad Ahmed
School of Environmental Studies, Jadovpur University
Kolkata, India
In 20 incidents ground water arsenic contamination have been reported so far in different
parts of the world. The present groundwater arsenic contamination situation in India is like
this. During 2002, we first discovered arsenic contamination in groundwater in the Bhojpur
District of Bihar. The total area of Bihar is 94000 sq. km and total population of Bihar is 83
million. To date, we have analyzed 6800 hand tubewell water samples. Out of this, 42% of
the samples contain arsenic above 10 microgram per litre and 24% of the samples contain
arsenic above 15 microgram per litre, and 0.7% of the samples contained 700-1000 micro
gram per litre. The frequency distribution is like this. During 2003 we identified Chakani of
Buxer districts, Bihar. We have analyzed all the tubewells of this village. Out of 94
tubewells, 24 samples contain arsenic above 1000 microgram per litre. In this village we have
screened five hundred people for arsenical skin lesions (ASL) and we identified 164 patients
in this village with ASL.
Now I will present some dermatological features of a group of children who are exposed to
749 microgram per litre arsenic and their arsenic concentration in hair and nail. We have also
studied some obstetric outcome in Bihar.
Previously when villagers used dug well water, they had no complaint about the arsenical
skin lesions but presently they have arsenical skin lesions and they are using tube well water.
During October 2003 we identified Balia district of Uttar Pradesh arsenic affected. We have
analzsed 914 water samples by flow injection hydride generation atomic absorption
spectroscopy technique. The analytical results show that out of this, 40% of the water
samples contained arsenic above 50 microgram per litre. 17% of the water samples contained
arsenic above 300 micro gram per litre. Our last 16 years field experience in West Bengal
and 8 years in Bangladesh, we may expect patients who are exposed to above 300 microgram
per litre for a long time may get arsenical skin lesion. In Bihar, and Balia districts of Uttar
Pradesh, 17% people may have arsenical skin lesions.
The most interesting thing is that all arsenic affected villages of Ganga plain, mainly UP and
Bihar, are by the side of River Ganga. During December 2003 we identified Saifganj district
of Jharkhand, states of India also arsenic affected. We have analzsed almost 700 water
samples and out of this 25% of the samples contain 50 microgram per litre, 11% contain 300
microgram per litre. Out of 325, 73 people have been identified with arsenical skin lesion.
The total area and population of Ganga, Meghna, Brahmaputra plain are 55974 sq. km and
449 million respectively. All the population of the Ganga plain is at risk of arsenic. Thank
You.
27
Social and Economic Effects of Arsenic
Dr. Farida Akhter
UBING, Policy Research for Alternative Development
We are not going to present the social aspects of arsenic in a technological manner. Because
we are going to talk about social and economic aspects which are very much related to our
day to day lives. I’d like to thank the organizers and the DCH because they are the ones who
first actually talked about it and made people aware. In fact, the Pabna community hospital
has also given training to our people in Pabna and that made us really very useful. I’d like to
first introduce my colleagues who have been part of the study and they will present three case
studies in Bangla in the end. Unfortunately because they have to speak about the real stories
of people. As I’m going to give the main essence of the study so those who do not understand
Bangla I apologise to them. The three presenters are Alice Parvin, Rabiul Hossain and Nabi
Hossain who are working in Pabna and also in Chapainawabganj. These two areas are very
much affected. I also would like to refer to what Jaman said in the morning that even the
patients like women would not like to record her name as an arsenic patient. Because they
were fear of not being able to get marry. So this is what we have seen and the presentations
that you had seen before, all the Keratosis case, melanosis case are not just physical
problems,. They all have their social problem.
Our study is UBINIG. It’s a policy research organisation. And we wanted the study was done
in the context because we are running an agricultural program which is called Naya Krishi
Andolan–a Bio diversity based farming practice. But it’s important that we are only talking
about tubewells. But actually the use of pesticide, the use of fertilizers, the use of ground
water through deep tube wells for agriculture are also part of it.
I’d just say that we have seen in the context that the agricultural practices are also responsible
for arsenic contamination that needs to be seen more effectively and I think it is important in
this study we’ve found that there are severe social impacts. All these things that you’ve seen,
you know, the effects on the bodies. For example, a woman has to bring water from distance
places as the tube wells are all red in her area. If she has some indication that she is an
arsenic patient, people are not willing to give her water. She also can’t walk very long
distance. She is not even treated well in the family if she is known to have arsenicosis. If the
husband has it, she doesn’t divorce him but if the wife has it, then the husband immediately
divorces her or marries again. Also, the dowry problem has increased further because of the
arsenic. We also found that some people who died did not even get a funeral prayer after
what they were. There were also economic impacts. Treatment cost is very high. There is
discrimination in the family in getting the treatment first. Of course, men get priority and
women don’t. The other important thing is that arsenic is also becoming a cause of poverty
because people are selling cows, goats and even other assets for meeting the treatment cost.
I’ll show you two slides just to show that how the mitigation programs are not very helpful.
One is that even the well that is made, it’s not very safe. Women are afraid that in this kind of
broken and imperfect wells, their children might fall. The rain harvesting is also not very
effective.
I think this well is made but it is also marked red. So this is another problem. This well is also
made in a very hurried way and it is dry. So I’ll now request that they’ll speak in Bangla and
they’ll give you three stories.
28
I’ll tell you a case study about an arsenic affected family’s discrimination in treatment. Hasan
Tara Begum lived in Binatuli Babupara village under the Nawalabhanga Union of Shivganj
upazila of Chapainawabganj . There are five members in this family. Farmer Rahimuddin,
husband of Hasan Tara, is affected by arsenic. When Hasan Tara was affected by arsenic
there were white spots all over her body, pigmentation of skin below her feet and palms. She
was unable to do any housework. Well-known doctors in the Chapi Nawabganj District
Hospital treated Hasan Tara’s husband. And he said to his siblings and wife, ‘Let me get
better first, then I’ll provide treatment to you all.’ And thus Hasan Tara and her children are
waiting for Rahimuddin to get better treatment for arsenic.
The story I’m about to tell it happened in Charakpur Village of Isherdi thana of Pabna. I’ll
focus on the social problem that arsenic is creating by hampering marriages. Her name is
Tulki Begum, 19 years of old. She has been suffering from arsenicosis for the last 12 years.
After being affected by arsenic, her whole body is covered with spots and there is
pigmentation in her hand and foot. After being affected by this disease, she has become very
weak physically. Sometimes she gets dizziness. Fever and cough have never left her.
Sometimes she even loses consciousness. Her body is so weak that she can’t do any chores
around the house. Her mother and brother died from arsenicosis. Her father lives with another
wife along with her two sisters and a brother. People of the village said that her mother and
brother died from the same disease. She has it also. Who will marry her? Her brother, who is
looking after them right now, is also refraining from marriage. Because he fears that if he
brings in another woman she may not look after his sisters. Tulki Begum is now very
disheartened and lost her motivation to study. Thank You.
I’ll talk about arsenic affected people’s financial losses. I’m going to tell Begum Sufia
Kamal’s story who lives in Ruppur village of Ishwardi upazila under Pabna district. Sufia
Begum is 40 years of old. Her husband Amirul Islam is a carpenter. She has been suffering
from arsenicosis for 15 years. Out of the five members of her family, three are affected with
arsenic. Of the family of her husband’s older brother, 4 out of 5 members died from
arsenicosis. And ten of her close relatives have died from the same disease. After learning the
disastrous nature of arsenicosis, she has taken treatment from various doctors. She has
received treatment in Rajshahi Government Hospital ten times. She also went to each and
every doctor or kobiraj where she heard about treatment for arsenicosis. But she is yet to
receive any good results. She has spent almost 2,10,000 taka in various places to receive
treatment. For her only son’s treatment, who is severely affected, she has even gone to
Kolkata. She had collected this money from various sources. She had six cows, goats, and
poultry. She sold it all and took loans from several banks and organisations. Now she is
living a very miserable life. When I spoke to her in her village, she said. “I’ve lost my land,
my cows, poultry but I’m yet to see some good results against this arsenic. Many
organisations and people came and took my hair, blood nails but they failed to provide any
good treatment and to cure me.” She also said, “I’ll probably die. But my soul will only rest
peacefully if someone cures my only son.” Thank you all.
Just to finish that, there are many stories. I’m sure all of you who are working know about it.
So arsenic is causing poverty, arsenic is causing social and economic discriminations and
above all arsenic is a cause of violence against women. So all those people, NGOs are using
millions of takas/dollars for poverty alleviation and everything. But I don’t think we are
doing enough against arsenic. So thank you.
29
Working Session-2 on Arsenic Health Issues
Chair: Dr. Deoraj Harry Caussy
Collaborative IRB Capacity Building
Lia Shimada
Department of Environmental Health
Harvard School of Public Health, Boston, USA
My presentation today is on International Collaborations in Human Research Subject
Protection. I’m going to begin with a brief introduction to human subjects’ protection. I’ll
continue with international applications of human research ethics. And I’ll then describe a
new project between the Institutional Review Board of Dhaka Community Hospital and
Harvard School of Public Health.
The twentieth century witnessed many incidents of highly unethical research studies
involving human subjects. In the US this led the government to regulate the use of human
participants in research through mechanisms of ethical review committees. In almost every
American University or research hospital today there is an ethics committee known as the
Institutional Review Board (IRB). An IRB is commonly referred to as a group of scientists
and non-scientists that is created for and committed to the ethical review of research
involving human beings as participants. An IRB has many responsibilities the most important
of which is to review research plans specifically as they relate to the use of human
participants. Members of the IRB work closely with the investigators to ensure that the
research studies comply with the federal ethics regulations. Also, an IRB has the power to
grant or to deny approval for a research study to take place. The American government has
vested these institutional review boards with tremendous authority. How does this relate on
an international scope? The US government through the office for human research protection
passed a regulation in the spring of 2002 that requires all institutions, whether in the US or
abroad, that collaborate on research studies that receive government funding to apply for
something called a Federal Wide Assurance.
A federal wide assurance is a document at any institutions that sign it to agree to follow the
guidance regulations laid out by the US government. In fact, this has led to the establishment
of IRBs at any institution that signs the Federal Wide Assurance. Since the spring of 2002.
we have seen an explosion of IRBs that are registering with the US government. In
Bangladesh there are four IRBs registered with the Office for Human Research Protection,
one of which is the IRB of the Dhaka Community Hospital.
There are two major operational challenges to implementing this regulation. The first type is
administrative. IRBs in developing countries receive very little guidance, thus often exists
only on paper. Second type of challenge deals with issues of cultural translation and
adaptation.
For administrative challenges, Federal Wide Assurance involves many rules that are difficult
to understand and follow. This problem is even more confusing for committees that exist
outside the US. There is a very real danger of IRBs in developing countries taking a rubber
stamp policy or feeling forced to follow the leads of the IRBs of their American collaborating
institutions.
30
Cultural challenges: The federal wide assurance regulations require many practices that may
be acceptable in the US but could be considered highly inappropriate in the other places. The
most prominent example is the issue of consent forms. Regulations require that each person
in a research study signs a consent form and this can be problematic in societies such as
Taiwan where the consent form requirement can be considered culturally insensitive. Another
problem might be in an area that have a high proportion of illiterate subjects. And on top of
this, American IRBs are increasingly rigid about the contents of these consent forms. I will
provide a visual example. This is the original consent form for the arsenic and human health
study here at Dhaka Community Hospital and I apologize for that orientation but now you
can see that the same consent form has expanded to three pages and where once there were
four main elements, there are now thirteen. This consent form actually represents a
compromise with our Harvard School of Public Health IRB. With the help of our colleagues
here at DCH, we have worked out a consent form that is actually a script. And the subjects
who are unable to sign their names will have this form read to them. They will then thumb
print it to use as signature. The researcher who read this consent form will sign as a witness.
This example really highlights the need for an IRB in a developing country to help mediate
this regulations coming out of the US government.
The DCH IRB was created in October 2002. The arsenic and human health study, as Dr.
Christiani mentioned earlier, receives funding from the US government and thus we were
required to register an IRB with the US government. The DCH IRB and Harvard School of
Public Health IRB project is a new three-year project between the established review board
of the Harvard school of public health and the new IRB at the Dhaka Community Hospital.
This project is designed to increase the outreach capacity of the DCH IRB. To fund these
programs, we have submitted a grant application, which is currently under review under the
US office of Institutional Research.
There are five major goals of this project. The first is to increase the capacity of the DCH
IRB to manage amendments and annual reviews of the research studies that fall under its
jurisdiction. The second goal is to serve as a resource for new ethics committees in
Bangladesh and its surrounding regions. The third is to educate committee members, research
staff and study communities in human research ethics protection. The fifth goal is for the
DCH to serve as a visible and accessible resource for its study participants. Finally, to serve
as a cultural resource for the western IRBs and research investigators.
This project has three major components. The first component is administrative, dealing
directly with the IRB of DCH. The second is more practical, focusing specifically on the
research staff. The third is an outreach component, which works directly with the subjects
themselves.
Project components include a baseline assessment of the DCH IRB’s needs and the
collaborative creation of a project plan. In years 1 and 2 of the project we intend to
implement a series of focused groups involving IRB members, researchers and community
workers. We also hope to implement consent monitoring by the third year. And finally, to
create collaboratively new education materials that are culturally relevant and appropriate for
training in human research subject protection. Through this project we hope to build the
administrative, educational and the outreach capacity of the DCH IRB and also to help
develop awareness both within the IRBs and the Government about the issues that are arising
from the implementation of IRBs in the developing countries.
31
Future challenges: in the US there is an assumption that IRBs will come to the same
conclusions. As IRBs in developing countries grow stronger, we predict that conflicts of
opinion will arise. We hope this leads to a healthy dialogue between the US and developing
countries.
I would like to conclude by saying that IRBs in developing countries have a pivotal role to
play in mediating the demand of the American regulations and ensuring highest standard of
research integrity and ethics including protection of human participants and research
protections. Thank you.
32
Respiratory Effect and Chronic Arsenic Exposure in Bangladesh
Dr. Ziaul Hasan Rumi
Technical Specialist, NGO Forum for DWSS
The honourable chairperson of the session, the co-chair and the ladies and gentlemen. I
welcome you all to the presentation. My presentation is on Respiratory Effect and Chronic
Arsenic Exposure in Bangladesh. Apart from me, the researchers who worked in this study
are Abul Hasnat Milton, who is from NGO forum as well as from Australian National
University and Prof. Mahmudur Rahman, NIPSOM.
The objectives of this study were to find out the respiratory effects among the respondents
exposed to arsenic above the permissible limit and among those who are not exposed to the
same. The specific objective of this study was to find out the prevalence of the respiratory
effects which include chronic cough, chronic bronchitis, difficulty in breathing among the
people neither with nor without chronic arsenic exposure. The second specific objective was
to determine lung volume of the individuals having or without having chronic arsenic
exposure. And also to see the relationship between the respiratory effects and chronic arsenic
exposure.
The key operational definition of this study is respiratory effects. What do we understand by
respiratory effects. A patient assume to be have been suffering from respiratory effects if he
has been suffering from any of the following clinical conditions which include chronic
cough, chronic bronchitis, difficulty in breathing. Reduced lung volumes, forced expiratory
volume in one second, forced vital capacity were examined by spyrolab. What do we
understand by chronic cough? A patient can be assumed to have been suffering from chronic
if he/she has been suffering from coughs in most of the time of the day for at least three
consecutive weeks for more than one year. Chronic bronchitis is almost the same but the
duration is almost two years. If he has coughed up most of the day for three consecutive
months for two successive years. A patient will have been suffering from difficulty in
breathing if he/she has a history of difficulty in breathing with the presence of bronchi and/or
cripidation on clinical examination. And forced vital capacity is the total amount of air
expelled out of the lungs forcefully after a full breath measured by spyrolab. This is a device
which we call spirometer. The forced expiratory volume in one second is the amount of air in
Litre expelled from the lungs in one second after a full breath into the lungs and then
breathing out fast. Trying to push all the air out of the lung measure with spyrolab. The
chronic arsenic exposure is measured if an individual gives a history of drinking arsenic
contaminated water uninterruptedly at a level above 50 PPB for at least six months. The
concentration of arsenic measured by testing the water with Flow Injection Hydride
Generation Atomic Absorption Sprectophotomet (FIHGAAS). So the period of time for
which an individual has been drinking from his/her last tube well source will be considered
as division of exposure. The emerging evidence in recent literatures and studies shows that
there is an association of respiratory effects with chronic arsenic exposure. Guha Majumder
et al. reported the prevalence odd ratio for cough was 7.8 in female and 5 in males and in the
case of hoarseness of breath, the prevalence odds ratio is 23.2 in females and 23.7 in males.
Put prevalence ratio for chronic cough, chronic bronchitis and respiratory stress to be 2.9, 2.9
and 2.1, respectively.
This is a cross sectional comparison study. We have conducted the study in two different
population. One is exposed to arsenic, this is population A as we have told and another is
33
unexposed to arsenic which is population B. In the case of population B inclusion criteria
were that all the individuals of this study were to be 18 years of old, living in the study area
and having the history of drinking arsenic contaminated water continuously for at least six
months.
For both the population, the exclusion criteria are those people who have been previously
diagnosed as having asthma by a qualified physician. By qualified physician we mean those
who have, at least, passed MBBS, graduation in medical science. We also excluded currently
suffering from TB as diagnosed by a qualified physician and people who have the history of
smoking within the last one year.
Two study area were selected. One was arsenic contaminated area and the other was arsenic
free area. The data was collected from the BAMWSP study survey.
The total number of sample required for statistical significance was 111 for each population.
The sampling technique was systematic sampling where the data regarding the number of
households were collected from the BAMWSP survey and we decided to recruit sixty
households from each study population so in the end we divided the number of households
with the required households which is sixty and this is the sampling interval and then we
collected the data from every interval. The results of the data were entered into SPSS and
analysed and partly by AP info. The mean arsenic concentration in arsenic exposed
population was 375.91 and in arsenic non-exposed population was 8.08 PPB.
The prevalence ratio for cough was found to be 20 with a 95% confidence interval .2 to 22.1.
In the case of chronic bronchitis, the prevalence ratio was found to be 3.6 with a 95%
confidence interval 1.2 to 10.5 which is statistically significant. The prevalence ratio for
difficulty in breathing was found to be 6.1 with a 95% CI. 0.7 to 49.5. It is not found to be
statistically significant. We have also measured the forced vital capacity between the arsenic
exposed and arsenic non-exposed, both male and female, population but there was no
statistical significance. Spyrometric examination of a subset of the total sample population
was done. In the case of forced expiratory volume in one second, there is also some
difference between the two populations (arsenic exposed and non-arsenic exposed
population) but they were not statistically significant. We also compared this large volume
with the south Indian reference population because the reference population for Bangladesh
was not available. And the per cent predicted was found to be in male and female separately
and there was no significant difference between these two. Mean FEV1 percent predicted was
also not found to be significant. Because we have conducted study in two populations and we
also collected socio demographic characteristics from both populations and there was no
significant difference between these two populations. We have found higher prevalence ratio
for chronic cough, chronic bronchitis and difficulty in breathing. However, we have found
significant difference only in chronic bronchitis. We have not found any significant
difference in lung volume and percent predicted for lung volumes. So the recommendation is
to establish a causal relationship between arsenic exposure and respiratory effects. To do this
we must do a stronger analytical study that may be a cross-sectional study. This is of utmost
importance that we must provide arsenic free water as soon as possible. The limitation of this
study is that the accurate duration of arsenic exposure was not possible to determine because
we do not know when this arsenic first came into their drinking water. Therefore, we used
duration of drinking from the last tube wells. The principal symptom of TB is chronic cough
so to exclude TB we should have done the examination but we could not do it. I must
acknowledge Mr. Dipanker Chakarabarti for analyzing the water in his lab. I also thank you
because I have taken a lot of time, forgive me.
34
Experiences of DCH Arsenic Clinic And Yahia’s War Against Cancer
Dr. Syed Nasrullah
Consultant, Dhaka Community Hospital
Respected Chair and Co-chair, ladies and gentleman. Good afternoon. Well my presentation
has two parts. The first part will be sharing of experiences of the DCH arsenic clinic. In the
second part I’ll be presenting the case history of a patient who is suffering from Squamous
cell carcinoma and which has been induced by chronic arsenicosis. We all know that
arsenicosis is a multidimensional and multiphase problem in Bangladesh with health, social
and economic implications. Bangladesh is a small country with a very little landmass and a
huge population that increases the whole magnitude of the problem. In our clinic a patient
primarily comes with skin manifestations which may be melanosis, leukomelanosis. In
melanosis it may be either diffused or spotted, may be mild, moderate or severe. In keratosis
it may be spotted or diffused and it may be mild moderate or severe. And sometimes a patient
also comes with a brain keratosis, which is a pre-cancerous condition. Around 27% of the
patients came with systemic complications like gangrene, skin ulcer carcinoma.
Let’s go for a short overview of diagnosis of a patient in the clinic. We diagnose the patient
by detailed water consumption history and by collecting biological specimens which are hair
or nails. Chronic arsenicosis has to be differentiated from other diseases like adisson’s
disease, idiopathic guttate, hypomelanosis, actinic hypermelanosis, PKDL, leprosy, and
hereditary palmoplanter and hyperkartosis, etc.
Now I’ll be sharing the experiences of the DCH OPD clinic. In four years from April 21 st
1999 to 2nd June 2003 we have documented 519 cases in our clinic. And in this study we have
considered 376 patients of which 219 are male (58.2%) and 147 are females (41.75%). In all
these patients the melanosis was present in 366 patients which is a little over 97% and it was
absent in 10 patients. Keratosis was present in 309 patients, which is a little above 82%.
Keratosis was absent in 67 patients. Systemic complications were found in 27% of the
patients and 33 patients came with chronic bronchitis and 3 with non-pittingoedema, 8 with
carcinoma, 2 with ulcer and 33 with peripheral neuropathy and 5 with enlarged lever and 2
with conjunctival congestion and 2 with vertigo and 15 with brain keratosis.
I’d like to present a case of Carcinoma. The name of the patient is Yahia Khan and he was
born in 1971. That might be the reason why he was named Yahia Khan. He was born in in
the Ramganj thana of Laxmipur and he has read up to fourteen classes. He has got three
brothers and three sisters. He comes from a family of school teachers. His father is a school
teacher and also his uncles. He drank water from a forty feet deep and forty years old shallow
tube well for 24 years. This was the only tube well in his locality. Twenty households shared
it. The number maybe more than two hundred people. So water was being constantly drawn
from that tube well. He developed melanosis and leukomelanosis in the trunk and the limbs
in 1989 and keratosis and hyperkeratosis of the palm and soles in 1992, and ulcer in the scalp
in 1994 and was operated in the DCH in 1997 and biopsy was performed and it was
diagnosed to be a case of Squamous Cell Carcinoma. But at that time it was not certain that
what was the cause of this Squamous Cell Carcinoma. Then he developed Squamous Cell
Carcinoma in other places such as in sole, in back, in thigh and in the puplitial faussa in 2
years from 1997 to 1999.
35
He came to DCH for the first time in the month of May 2000 with multiple Squamous Cell
Carcinoma in the sole, in the back of the trunk, in the thigh and the melanosis. At that time he
had melanosis of the whole body. He also had non-pitting oedema. At that time his weight
was 45 kg. His water consumption history was taken and all the tests were run and he was
diagnosed as a case of Squamous Cell Carcinoma, which was due to chronic arsenicosis. He
was operated upon and he also received chemotherapy and radiotherapy. In the last three
years he has been admitted to the DCH for more than ten times. And he received
chemotherapy and radiotherapy. Till now all his hospital expenses and his cost of treatment
are being borne by DCH. Now he is a bit better. His weight has increased to 51 Kg. But this
is a story of only one person. He is a young man. He is only thirty. But he could not complete
his education. He could not get a job, he could not get married. He could not raise a family.
And he could not lead a normal life. Everything was due to arsenicosis induced carcinoma.
In view of all these facts, we need to address the following issues and find out some
solutions. First and the foremost problem that who will bear all the expenses. I mean the
staggering cost of treatment. Is it DCH or some agency or some other people? There has to be
some compensation for the loss of health, education, work, wages and quality of life.
I’d like to make a few suggestions. There has to be more funds available for patient
management and there has to be improved nutritional status of patients. Because may only
the patients come from the rural area. They are either undernourished or malnourished. As a
long-term solution we have to improve the nutrition of the susceptible population, especially
the female children who are the future mothers. Because a malnourished or a sick mother will
always give birth to a malnourished child. Since huge population is our biggest problem we
need to have more rigorous population control. Thank you.
36
The Pattern of Clinical Manifestations and Practice of Alternative Water Options of 50
Arsenic Affected Patients of Sirajdikhan Upazilla, Bangladesh
Dr. Farzana Begun
Medical Officer, Public Health, Dhaka Community Hospital
Good afternoon. The title of my study is The Pattern of Clinical Manifestations and Practice
of Alternate Water Options of Fifty Arsenic Affected Patients of Shirajdikhan Upazila,
Bangladesh.
The objectives of this study are to find out the pattern of clinical manifestations of the arsenic
affected people among the 145 DCH identified patients of Shirajdikhan Upazila, to find out
their practice of safe water sources. The key variables are: socio-demographic indicators,
melanosis, keratosis, leukomelanosis, bone disease, Squamos Cell Carcinoma, Bissell Cell
Carcinoma, anaemia, hypertension, bronchitis, gangrene, neurological symptoms only,
Current practice of safe water options, arsenic concentration in current water and arsenic
concentration in nail.
The methodology: The study is a cross sectional study. The study population is 145 DCH
recorded arsenicosis patients of Shirajdikhan Upazila. The study period was from 15 to 28
September of 2003. Sample size was 50. I followed simple random sampling by just using
the random table. Study instruments were pre-tested structured questionnaires and merk’s
field test kits. Nail samples were analyzed at DCH arsenic lab by AAS method.
Major findings of this study are: 68% of the respondents are female and 32% are male. 90.2%
were educated ranging from primary to graduate and 9.8% were totally illiterate. 70.7% are
day labourers and non-agriculture day labourer. Majority of the patients lie in the income
category of Tk. 9500-12000 per year.
Now come to the pattern of arsenicosis skin lesions. At the palm, diffused melanosis is 4.1%,
spotted is 24.5%, leukomelanosis is 12.2% and 32.7% is spotted leukomelanosis. Among the
palm keratosis is 26.5% are diffused and 61.2% are spotted. And in front of the trunks, 38.8%
are diffused melanosis and 73.5% are spotted. The higher frequency lies with 89.8% are
spotted leukomelanosis, which lie in the back of the trunk. Keratosis of sole is showing that
49% are diffused and 42.9% are spotted. Gradation keratosis is done according to the WHO
criteria. The majority of the keratosis lie in the grade two keratosis, which is 36.8% in palm
and 47.6% in sole.
Let me now show the distribution of the respondents according to their clinical
manifestations. 62% are suffering from anaemia, 427 have jaundice which is only clinical
jaundice. And no meteorological tested has so far been done. 2.3% are suffering from
diabetic and 36% are suffering from chronic cough, 8% have gangrene. We found 54% of the
patients with different neurological symptoms. The distribution of the respondents according
to their skin malignancy shows that 25% are suffering from bowan’s disease and 6.1% are
suffering from Squamous Cell Carcinoma and none, among these 50 respondents, in
suffering from Bezel Cell Carcinoma.
37
Now come to the distribution of the respondents according to the duration of their drinking of
arsenic contaminated water. 37.4% of the respondents are used to take arsenic contaminated
water for 5-10 years. This is the highest frequency.
In the case of use of current water source it is seen that 66.7% of the respondents are using
deep tubewell, 28.2% are using shallow tubewell, 16% are using dug wells, 18.4% are using
rain water and 5.1% are using river and pond water. 27.3% of the respondents are still using
arsenic contaminated water with above .05 mg per litre.
In the case of arsenic concentration in nail it is seen that 67.3% lie in the 1.059 to 5.059 mg/
kg arsenic concentration in nail. The mean concentration of arsenic in nail is 3.44 mg./kg.
We can conclude the study by saying that most of the respondents are manifested with
leukomelanosis of the trunk. Those represented by keratosis, most of them are lie in grade 2
lesion. Most of the patients are suffering from anaemia, jaundice, chronic cough, cojunctival
congestion and neuropathies. Bowen’s diseases are increasing. Most of the respondents are
using deep tubewell. A portion of the patients are still using arsenic contaminated water. Nail
samples showed high concentration of arsenic.
Extensive research is needed in this regard. Health education is required to motivate the
people to use arsenic free safe water options such as surface water. Tube wells, both shallow
and deep tube wells are to be regularly tested for arsenic. Thank You.
38
Interaction of Ascorbic Acid and Iron in Arsenicosis patient
Abdus Zaher
Assistant Professor
Institute of Nutrition and Food Science, Dhaka University
Presented by Nanda Dulal Das for Abdus Jaher
Objectives: The objectives of the study are to get a clear idea of any beneficial effect of
ascorbic acid and iron in arsenic poisoning, to establish an idea about ascorbic acid as a
prominent anti-oxidant and co-enzyme of Dopamine Fi-Hydroxylase enzyme and to gather
enough information on ascorbic acid and iron for quick clinical diagnosis and treatment of
arsenicosis patients.
Methodology: Samples were collected from both arsenicosis patients and normal of
stadiumpara, Meherpur. Samples are nail 48, hair 43, blood 32 and tube well water 52.
Preparation of samples and methods. First water samples are preserved in nitric acid and
analyzed by Flow Injection Hydride Generation Atomic Absorption Spectrophotometer
Method (FIHGAAS). These samples were also sent to SOES for analysis by FIHGAAS
method. Hair and nail samples were also sent to SOES for analysis by FIGHAAS.
For arsenic patients, blood samples of 5 to 10 ml from each were collected by vanu panesa
and due to limitation of centrifuge machine, these samples were collected by parcel paper and
taken into a dry vial and stored in deep freeze under minus 20 degree centigrade. And for
control collected samples were centrifuged at 2000RPM for 10 minutes to separate the serum
and this was stored in the deep freeze -20 degree centigrade. The blood samples were
categorized into three groups. Nine samples were from the age group of 10-18 years, 14 from
the age group of 20-40 years, and nine samples from the age group 45-70 years. Blood
samples were also analyzed for estimation of ascorbic acid by Dinitrophenylhydrogen
method with modification by lauritale.
Findings: major findings are the level of arsenic in the tube well water of Stadiumpara,
Meherpur. Next slide please.
At first, tubewell waters were collected from Stadiumpara Meherpur. Here 52 samples were
collected and among them, nine samples contained less than 0.01 mg per litre arsenic, 16
samples contained 0.01 to 0.049 mg per litre and 27 samples contained greater than 0.05mg
per litre. Which are over the WHO standards.
Now level of arsenic in the nail and hair samples of the arsenic patients. In the case of nail,
the normal level of arsenic is 0.3 to 1.08 mg per kg.
Out of 48 samples, 8 samples contained less than 1mg per kg, and 37 samples contained 1-5
mg per kg, and three samples contained more than 5mg per kg. 37 samples and three samples
are in jeopardy. More than 1 mg per kg concentration of arsenic in hair is toxic. Out of 43
samples, 8 samples contained less than 1 mg per kg of arsenic, 28 samples contained 1-5 mg
per kg and 7 samples contained more than 5 mg per kg arsenic. 28 samples that is 65% are in
risk or danger.
39
Now ascorbic acid content in the serum of normal and arsenic patients. From the age group
of 10-18, nine samples were taken. For normal patient, the range is 1.07 to 1.63. But in the
age group of 10-18, patient, arsenicosis patients, contained 0.63 to 1.15 mg per decilitre
ascorbic acid. It is found that ascorbic acid content in-patient with arsenic is too low than the
normal. Mean value is also 1.29 and here it is 0.92. And in the age group 20-40 mean value
1.64 and mean value here it is 1.11. In the age group 40-70, mean value is 1.13 and 0.83. It is
clearly seen that arsenicosis patients contain lower ascorbic acid than normal.
Conclusion: It is found that ascorbic acid concentration in the serum of patients with arsenic
is lower than the normal. Since there is a biochemical relationship between the ascorbic acid
and debase activity, decrease in ascorbic acid may cause neurological disorders. It may be
useful as one of the parameters to diagnose saus disorder. It is also important to find out
whether the decrease is due to a decrease in the substrate dopamine or other co-factors. For
example, the deficiency of dopamine in Parkinson’s disease is treated by eldofa. And
dopamine deficiency in other neural disorder may be treated similarly.
Some recommendations. Our aim should be to establish a clear relationship between debase
activity and each specific neurological disorder. We also hope that this study will contribute
to quick clinical diagnosis of arsenic patients in future. So the present results will be helpful
to the further research with the arsenicosis patients. Thank you every body.
40
New Approach on Managing Non-Healing Ulcer
Mr. Abdus Salam
Consultant on Physiotherapy
Dhaka Community Hospital
Assalamu Alaikum. Respected chairperson and co-chairperson, and audience. My paper is on
New Approach on Managing Non Healing Ulcer. Really, it is a new dimension for
arsenicosis.
Arsenicosis toxin is a multi-dimensional problem in Bangladesh affecting the skin, GI tract,
renal system, cardiovascular system, nervous system, haematological, respiratory system,
endocrine system. According to the Directory of General Health Services, there are 13,333
arsenicosis patients in Bangladesh. It is one of the major health problems at present facing in
Dhaka Community Hospital. There are 109 arsenicosis patients admitted at DCH, out of 519
reported OPD patients at DCH from different places of Bangladesh. No major effort has been
undertaken not to find out the way to reduce this menacing problem. Non-healing arsenicosis
ulcer is one of the complications. So far conventional treatment has failed to heal this ulcer.
Therefore, we look for new dimension and new approach.
Document of arsenicosis patients. From March 2001 to September 2003, the total number of
OPD patient was 519, of which 109 were admitted. Among them, Arsenicosis ulcer is 22 and
others are 87. Among arsenicosis ulcer, Squamous cell carcinoma ulcer is 17 and arsenicosis
non-Squamous cell non-carcinoma ulcer is 5. So I gave therapy only five patients. As part of
conventional treatment, special dressing, and antibiotics were given. if it is failure, then the
biopsy test is done and if biopsy test result is Squamous cell carcinoma ulcer, then
radiotherapy and chemotherapy are offered.
Problems: Socio-economic problems include economic, social, education, population,
women, long term treatment, awareness, communication and not able to do activities of daily
living. Clinical symptoms are soiling, coflexure surround the joints, anaemia, pain, noisy
vomiting and gangrene.
Why non-healing? Factors impairing healing are tissue tension, haematoma formation,
necrotic tissue, local infection, foreign body, poor blood supply, faulty techni wooleraza
closure, reacantrauma, local radiation, and general cause of ageing like nutrition, anaemia
and diabetes also.
New Approach. New approach is Biobeam 660 non-therapy. What is biobeam? It is a new
dimension of length after ultra violet ray and laser therapy. It’s manometer is 660. It is
specially designed for physiotherapy and it is maintained by electrotherapy modality as high
frequency current. Wave length is extremely straight and narrow band. All beams are straight
and parallel. That is affecting directly on chronic non-healing wounds that is why it is
working. And also it is giving to reduce the inflammation.
Technique: Ulcer was cleaned by the padadon solution. Measurement of ulcerated area was
taken by sq per cm. Those should be calculated according to the machine as well as patients
sore area. One watt/joules per sq. cm. Continuous of length for ten minutes. Pulse of length
41
for five minutes. The total length of the treatment per day should be fifteen minutes or less
than of it or more.
How it is healing? : In the human body there is powerhouse. That is latocian in the human
cell mitochondria is responsible for the production of DNA and RNA and other metabolism
related substances and releasing histamine mouths substance. And breathing oxygen and
nutrition to the wound area. That is replacing the injured tissue and another viable tissue,
which is similar or dissimilar. That character is filling quickly. That is called healing process.
Results: As I have deals with five patients, the result is good and it is producing in the wound
area because it is releasing metabolism as well as they are producing their oxygen and
nutrition. And also it reduces the septic wounds and also allergic action there.
Conclusion: There are thirty sets of treatment of 15 minutes per day, which indicates that
Biobeam therapy effective augments tissue repair and reduces the treatment cost of
arsenocosis dermal ulcer.
42
Arsenic Contamination Problem In CHINA
Dr. Jheng Baosham
Professor, State Key Laboratory of Environmental Geochemistry
Institute of Geochemistry, Chinese Academy of Science, Guiyang Ghizou Province, China
Thank you chairman. And ladies and gentlemen, good afternoon. It’s my great pleasure to
come to Bangladesh and give our research on the endemic arsenicosis in China. China and
Bangladesh are same developing country. So we face the same public health problem and I
want to introduce Arsenic troubles in China. Next one please. This is endemic arsenicosis in
china in different area. And this is first part for this arsenicosis. This is first report in Taiwan
in 1950 and in the mainland the first one is in 1964. I’d better continue. Because 15 minutes
to push-off. So I roughly pretty. In Taiwan, you know, famous case for the arsenic research in
the 1954, the first to report. About in the 1970s people stopped drinking high arsenic water.
Continue. This is a patient before 1946-54. After that every year about 200 patients are
affected with arsenic and after this time it’s down and not so much. But the highest
prevalence is seen during 1970 to 1990. Next one please. This is a land view of the diseased
area of China. It is similar with Bangladesh and India. This is ocean segment and very new
segment. Arsenic water severely high organic. It’s similar. And this high arsenic water is still
used, fortunately not for drinking. This is an arsenic patient. Next one. Now this is a hospital
for special treatment for arsenic. This is a new patient in Taiwan. This is in a hospital. And
you can find some arsenic patients with arsenicosis symptoms. There are new patients. High
arsenic in drinking water for many Chinese patients. In 1983 the first survey was done in
sinxiang autonomous region. This is very deep water. In 1990, the first survey part in Inner
Mongolia. This case of high arsenic water is from high arsenic mineral deposit. Water comes
near the high arsenic mining then leaching arsenic into the water and go down to the ground
water. So the people who is drinking got trouble. But not too much people. Only few. Not
more than 30%. In 1994 we got big trouble in the Mongolia. We just have carried out an
investigation for the whole area in China. So, in the Mongolia it’s 2000 patients and in the
Shansei it’s 4000 patients. And another area is Chirin but arsenic is not too much. In total,
10000 patients are with arsenicosis. This is Sinya autonomous region. In this immigration
village they dig very deep well. Then after one year a lot of people got disease. So we close
this area and move the village to another place. Now this stops the trouble. This area is very
dry. It’s like a desert area. We take samples of these locals. The professor and the scientists
are from Taiwan. This is Finktu, a professor from Taiwan. He is an expert on organic matter
research. These are patients after 30 years, stopped drinking the high arsenic water but their
symptoms are still present. And this brings cancer. And here is in the Mongolia from the
mountain go down and go to the underground and in this area high arsenic is in drinking
water. This is kandong. We take samples to identify arsenic in kangdong. This is me. This
brings cancer. Now we come to the special arsenicosis in china. This high arsenic is coal, so
indoor combustion. So gets trouble. About 100 years ago in Kudo province in southwest
China there is lot of wood it is forest. So the people didn’t use the coal. But in 1950. The
forest is cut off. So the local people have to use the coal mining. Then in 1953, the first
patient was found. But at that time nobody know that it was from arsenic. From 1960 to
1965, 75 arsenicosis patients were found. In 1976, more than 800 people got arsenic
poisoning. The coal contains arsenic of 9600 PVP. That’s very high. This is different area.
This is like the arsenicosis villages. Next one. This is high arsenic coal. This is very very
small coal mining. Some coal mines take only 2-3 labours to dig the coal. The coal which is
produced is not very high, but in arsenic is high in it. You see, all the high arsenic coal is
43
surrounded by gold mining. Here is a leaching from the gold mining after leaching the gold
this is a waste of rock. And here is a waste of rock after the coal mining. So all the high
arsenic coal is around the gold mining. This is a little bigger coal mining with high arsenic.
Next one. There is local people who yearly take the coal. It’s very easy. After the fieldwork
they take the coal home and to use. Next one please. And the indoor combustion is ________
outstanding. And the arsenic emission to the air and float indoor air. And then float it coals in
the air. And there is a chilli. The local chilli can have very serious arsenic and this is the
patient with pigmentation. Next one. This is typical arsenicosis. I think very similar is the
Bangladeshi patients. Next one. And this is skin cancer. Next one. Skin cancer after two
years. When I take the pictures, the skin cancer is to the leg. Then cut the leg. After half, a
year he died with inner cancer. Next one please. This is 30 years ago they used high arsenic
coal but the symptoms still present. Next one. Similar. This baby was born in high arsenic
drinking water area. So high arsenic exposure gives him more serious risk for the cancer.
Next one. Thank you.
44
Working Session-3 on Update of Safe Water Options
Chair: Mr. Paul Edwards
The One-year Monitoring Programme Updates of Shallow Dug Wells to Provide ArsenicSafe Water in West Bengal, India
Fr. Xavier
Lecturer, Department of Environmental Science
St. Xavier's College, Kolkata, India
Good evening. honourable chairpersons, distinguished guests, ladies and gentleman. I am
very grateful to the organizers, the convenors, and to Dr Chakrabarti for giving me this
opportunity. This is actually a platform that I have come to share the hard work of a few
scientists who have got together, though of different branch of sciences, sharing the same
platform, doing something to the people that doctor asked in the morning whether we were
only busy with analyzing the problem or whether we were busy with giving something in
return to the people. So here is an aspect we have decided to give something to the people –
the arsenic safe water by shallow dug wells.
Where have you started? In the district of North 24 pargana. Our work had started there. In
fact, when we entered the para of Kandakati, Koishur, Shimulpur, Chondipur these have the
few sufferers, silent sufferers I’d say. Mrs. Kamala Devi, 45 years old, with the dosel
kerotosis. Her hands almost reaching to gangrenous stage. Her legs already reached these
particular conditions. Another individual – Aditya Paul, known by the whole para as an
arsenic patient. He was amputated twice for the gangrenous condition on his right hand. By
profession, he is a rajmistri that is mason. He was the breadwinner of the family. So he is
returned to the use of this dug well water. It is a project well first in the year 2001.
There is another patient in Kandakati area with spotted kerotosis. Now the question is : are all
these silent sufferers in spite of whether the surface water being disinfected and treated
consumed by them? Are they sufferers still after all these multi-crore filter plants being
implemented by the government? If this is so. Is this providing safe arsenic free water? It’s a
question mark. The condition of the multi-crore power plants is that where the backwash is
very prominent. Where the whole thing is backwashed back into the field where later on,
again the same thing will come into the vicious circle. That’s a field. Different depths
showing different concentration of arsenic. If this is what going to happen, high ground water
exploitation will lead to this aspect of leaching even to the deep tubewell. So with this aspect
we are gone to an aspect of whether the faulty construction of the deep tubewells even
leading to this particular leaching. A proper construction of the deep tube well, where this
casing can be done – a double casing type where the whole leaching process can be blocked
so that arsenic free water can be achieved even from the deep tube wells. To maintain these
particular standards by WHO standards. Now as a ray of hope, this is where we start. The dug
well is looking towards a sustainable remedy. Now what are the salient features of the dug
well that we are proposing. It is an age-old practice. Age-old traditional source for drinking
water. Through tin roof human intervention is blocked as much as possible. The another
hygienic aspect is whether outside elements cannot get into the water medium. So that’s how
the dug well looks even in the scorch of summer time. In the monsoon what is the condition?
45
Actually there are about 26 dug wells in that particular blocks that I talked about. We took
five dug wells for our pilot study. So this is the condition for water available throughout the
year for us. It’s a one-year study from last July 2002 to July 2003. The condition of summer,
which is leading to the drop in the water table. Even it happens into a pond medium. So how
do we carry out this particular digging work – dug well work? The initial investigations are
done. In the area where we want to do a dug well, we choose particular two tube wells for
arsenic contamination test. We do it in a reliable laboratory work. There are so many NGOs
in that area collecting 15 rupees for water testing and giving them arsenic safe result. There is
a reliable laboratory. Out of 50 tube wells that we did, almost 46% were declared unsafe and
we collected about 10 tube well waters for quantitative arsenic test in the SOES lab. After
doing this, then we start digging in the month of May. Then comes sediment analysis for
arsenic. How does it appear, what is the arsenic quantity?. That’s our second research. So,
sediment analysis. This is how it looks after the dug well was being prepared. Then second
aspect is to keep it away from the lavatory. So there is no bacterial influx off to the dug well
water. Third is to take the geo-code of the dug wells of the deep tube wells of the different
plants existing. Then create maps. This is how our study has started. The arsenic quantity is
far below the Indian Bureau Standard. The problem was with one dug well which shorted up
in the months of April and May. So this is how we did the analysis. We collected the raw
water, then we kept the water decanted for 24 hours. Then we filtered at the source itself, did
the arsenic test. We doubted may be there were some errors in the collection of sample. But
then we verified it. Then the research is on to find out the source of arsenic. Then we do the
bacteriological testing in a pre-sterilised bottle. Then the bacterial content has been
communicated to people. So this is during the monsoon season. And then depending upon the
bacterial quantity, depending upon the water available to us, we do the disinfecting process
with sodium hypochloride theoline.
So this is the standard-American public health standard we follow for the infection process –
disinfecting process. Then common people will be able to know whether they can drink or
whether it is with arsenic or whether it is without bacteria. Public awareness becomes very
much important. It is done through distribution of information and instrument pumplets such
as leaftlt of awareness, conducting puppet shows to communicate to the peoplemaintaing of
water cards to record the monthly contribution, monthly bacterial count, arsenic count. This
is beneficiary committee meeting, often held once a month. This is school children even
coming to the level of awareness about the water, and doing drawing. The public health
survey being completed every month on basic questions like diarrhoea, typhoid, dysentery, or
amoebic dysentery.
We have to go a long way. Should safe water becoming a distant dream for us and for the
future generations? So with this question to the audience, I acknowledge in gratitude to Dr.
Mira Smith, Dr. Allen Smith, Dr. Dipanker Chakrabarti and all my companions for helping
me out in this little effort towards giving arsenic safe water. Thank you so much.
46
Dug well and it’s Use as Sustainable Alternative to Ground Water
Nandini Sabrina
Environmental Engineer, Dhaka Community Hospital
Hon’ble chair, co-chair, ladies and gentlemen, good afternoon. I am here to present the paper
– Dug Well and Its uses as a Sustainable Alternative to Groundwater in Combating Arsenic
Crisis. We all know that arsenic contamination of ground water in Bangladesh is a major
public health problem. Already millions of people in Bangladesh are at risk of arsenic
toxicity. So we need to provide something to save these lives. The best treatment for arsenic
affected people is to provide them arsenic free safe drinking and cooking water. Dug well can
be a useful tool in combating this crisis. This technology has been used for hundreds of years
in this part of the world. It’s a known technology for this sub-continent. DCH has been
implementing its arsenic mitigation activities since the beginning of this crisis. It has already
provided several alternative water options in arsenic affected areas. So far it has installed and
renovated more than 500 dug wells in over 300 villages. We carried out a short clinical
survey during December 2003 on 50 dug wells constructed by DCH in Shirajdikhan and Bera
Upazila. A total of 661 families are served by these 50 dug wells. Of them, we have
interviewed 184 family-heads. The clinical survey result shows that all the dug well water is
arsenic safe and germ-free, and also during the survey period, we found no diarrhoea attack
among the consumers of the dug well water. In the of the taste of dug well, when we asked
the question, 98.4% respondents said that the taste of dug well water is good to them. About
96.2% said that the water is odourless. The small percentage of people who said the dug well
water is odorous or the taste is not that much good. It has been found in the survey that these
people lived in the place where the dug wells are newly installed. So they are not quite
adapted to this type of water. They are still not much adapted. So may be this is the cause for
their response.
About 83.7% of the respondents said that they face no problem in collecting water from the
dug well. However, some people face some kinds of problems in collecting water. When I
summarized the problem of collecting water, we found out there are mainly two problems.
One is distance of the dug well from the house they lived in and another is sometimes they
have to collect water from the households, which is owned by the other persons. So they
faced hesitate. Sometimes they hesitate to collect water. These are the main problems. Hence,
here is my recommendation. If we can provide household water supply through pipeline
network, these problems can be solved. In the end, you see it’s a very short clinical survey.
So in the end, I can say from the results I got that people are quite willing to accept this
source as for their drinking and cooking purpose. Thank you all.
47
Effectiveness and Usefulness of Arsenic Removal Plants: An Experience in West Bengal,
India
M. Amir Hossain
School of Environmental Studies
Jadavpur University, Kolkata
Hon’ble chairman and co-chairman, respected participants The title of my paper is
‘Effectiveness and Usefulness of Arsenic Removal Plants and Experience in West Bengal,
India.’ As we all know, arsenic ground water contamination is the biggest health hazard
nowadays in Sub-continent all Asian countries. We have already heard that the total GangesMeghna-Brahmaputra plain is arsenic contaminated. About 450 million people dwelling in
this area are at risk of arsenic contamination. All of the people of this 450 million are not
drinking arsenic contaminated water but they are at risk of arsenic contamination. The
problem of arsenic contamination came into the surface in 1983, in west Bengal, 1995 in
Bangladesh, and we SOES, Jadavpur University, identified arsenic contamination in Asaam
in January 2004. Since arsenic contamination is a great problem so all government as well as
national and international organisations come forward to combat the situation.
How to overcome this problem? Two-fold programs were initiated. First of all, to detect all
the contaminated tube wells, whether they are contaminated or not and then to provide safe
drinking water. The field testing kit was the device to screen tubewell whether tube well is
arsenic contaminated or not. But after the publication of effectiveness and reliability of
arsenic field testing kit, million dollar had spent for arsenic affected and we found that the
field testing kit was not actually able to detect arsenic contamination from the tubewell water
properly. So UNICEF, West Bengal already stopped using this field testing kit to screen the
tube wells and WHO also planning to decide banning this arsenic field testing kit for
screening project. Now providing safe drinking water. Since a lot of population is at risk of
arsenic contamination water and it is going to be blooming market to produce safe drinking
water to the people of this region. For this, particular for providing safe drinking water, the
arsenic removal treatment plants were installed in different areas of West Bengal and
Bangladesh. The objective of my study is to asses the usefulness the effectiveness of arsenic
removal plants and to asses. The usefulness in terms of user-friendliness – how the treatment
plants are user friendly, accessibility, whether the treatment plants have access to all the
population of the affected areas and operational continuity, while we are installing a plant in
a particular area whether this plant is going all over the period, whether it is functioning
continuously and justify our installation. There are a number of good proportions of the
treatment plants were installed with a tube-well, which had hardly any arsenic in the raw
water. So there is not at all any justification to install arsenic removal plants in those tube
wells. The second objective is to asses the effectiveness of particularly the chemical
performance – whether the plants are able to reduce arsenic and iron from tube well water.
The first study started in 2000. We studied the effectiveness of seven installed treatment
plants in Betai, West Bengal and as you see we have one treatment plant which is
continuously giving us the good quality water without any problem and all other six plants
have some problems related with it. Then we study 49 plants in Murshidabad District and out
of 49 plants we found 15 defunct plants. That means they are not at all working. In terms of
iron concentration, we have found out of the plants only 8.85% were able to work and arsenic
up to 300 micrograms per litre mark and 29% were above 1000 micro gram per litre. Then
we go for a larger study. We study 249 treatment plants.
48
The Role of Bangladesh Arsenic Mitigation Water Supply Project in Fighting Arsenic
Crisis of Bangladesh
Mr. Khoda Bux
Project Director, BAMWSP
Project period is 1998 to 2005. Executing agency is Department of Public Health
Engineering, sponsoring ministry is Ministry of Local Government Rural Development and
Cooperatives, donor agency is World Bank and SDC. The project is now carrying out its
activities. The major objectives of the project are improved understanding of the arsenic
problem through a national survey, identification of households and tube well, awareness
building and motivation and patient’s identification. The next one is strengthening local
Govt. institutions. The third one is onsite mitigation- that is water supply through different
options. Screening was a major task under this project. We have already screened 189
upazilas and data processed in 156 upazilas. Total tube wells screened were 2.5 million. Safe
tubewells found 1.77 million, contaminated tubewells found o.77 million. Percentage of
contaminated tube well is nearly 36%. Population covered 41.3 million, households screened
7.75 million, and patient identified 23000. Eighty upazilas have been screened by other
stakeholders like UNICEF, World Visions and other NGOs. Here, the data is: total tube well
1.08 million, safe tube wells found 0.77 million, contaminated tubewells 0.33 million and
percentage of contaminated tube well is 29.67. Upazila wise contamination status screened
154, UNICEF 44, and Asian Arsenic Network 1. These are the upazilas screened by different
organizations. And different colors reveal the ranges of contaminated tube wells. Mitigation
work. I would like to elaborate on this point. This is the first phase through come out the
action plan. Total options planned 490. Among these options, deep tube well is 96, dug well
382, pond sand filter 12. 338 different options Completed. Among them, deep tube well 36,
dug well 230, and pond sand filter 12. Under phase two, total options planned 1630, among
which deep tube well 757, dug well 874, pond sand filter only 1. Among the completed 664
total options, deep tube well 398, dug well 301 and pond sand filter 1. Well, ladies and
gentlemen, I would like to elaborate on these points. We have so far planned two options,
two major options. One is tube well and another is dug well. But we have encountered some
limitations in these two options, especially dug wells. A large number of dug wells have been
found to be contaminated by bacteria. When we talk about dug well, we should not forget
that for dug well, we extract water from the shallow aquifer. And that shallow is very
vulnerable to different types of pollution, especially bacteria. Another problem regarding dug
well is that we draw water from the very shallow … and every year water table of our
country is going downward. And during dry season, most of the dug wells get little water.
This is experienced that during the dry season, our dug wells have found to have little water.
Another problem is that we nowadays use a large quantity of chemicals like fertilizers and
insecticides for our agricultural purpose. You know a considerable part of these chemicals
reach directly to the shallow aquifer. And this may pollute shallow aquifer water. Another
problem regarding dug well is that people’s acceptability. Nowadays people have advanced
much. They do not like to use dug well at this moment. They want sophisticated options.
Well, it is possible to supply water for a small community through dug well. As for example,
for a single village it is possible to supply water through several dug wells. But what about
urban population? About 40% of our population now live in urban centers. It is not possible
at all to supply water through dug wells in urban towns like Faridpur, Pabna, Jessore. And
urban demand is very high. That demand also includes commercial uses. So it is a big
problem to supply water through dug wells in urban centers. These are the limitations of dug
49
wells. Now I will talk about the limitations of deep tube wells. Yes, people say that there is
every possibility to be affected by arsenic if we install deep tubewells. Well, if there is clay
layer above the deep then it is safe. But if there is no clay layer, then there is every possibility
of deep to be contaminated. As for example, there is no problem in sinking deep tube wells in
coastal areas. We are now sinking deep tube wells in coastal areas. But in non-coastal areas,
we are trying dug wells that we encounter with the problems I have already cited. In 7 coastal
upazilas we are now installing deep tube wells. These upazilas are Bhandaria, Gouronodi,
Kotalipara, Jhalkathi shadar, Agoilijhara, Debhata and Digholia. We are installing these tube
wells through community-based organizations. And more than 525 community-based
organizations have already been informed and total tube well planned 1439, total deep tube
well already completed 219. No deep tubewells are going to be constructed at this moment.
Next please. Under the project, arsenic mitigation project, there is one center. It is National
Arsenic Mitigation Center. That is a very important center keeping all records regarding
arsenic problem in the country and water supply options. Next page please. Major activities
of Management of 189 upazila survey data of collection and management of arsenic related
information from different stakeholders, preparation of priority areas for mitigation,
publication of project newsletters, publication of data and distribution of information website,
etc. Partnership programme with health sectors, partnership program with GHD, Bangladesh
Water Development Board and partnership with Bangladesh Council of Science and
Industrial Research Organization. We are working with these organizations and carrying out
different activities. Next please. Strengthening of DPHE laboratory. DPHE has got four zonal
laboratories and under this project we have upgraded these laboratories and we are going to
upgrade the BCSIR laboratory for better work regarding arsenic mitigation. Now apart from
the conventional system, conventional options say deep tube wells, dug wells, we are now
trying to construct village pipe water system at this moment. We are going to pilot six water
supply systems, pipe water in village areas. If these pipe water supply systems for village
areas are found to be successful, then we will go for pipe water supply system. Thank you
very much.
Thank you. Again I apologize for the shortness of time, but it does apply to all the presenters.
So otherwise we will be here until the hartal starts tomorrow. So I think our final presentation
is now Philip Chris who will be talking on the assessment of options for safe water in arsenic
affected areas of Bangladesh.
50
Safe Water Options in Bangladesh: Piped Water Supplies
Paul Edwards
Chief, Water and Environmental Sanitation
UNICEF - Bangladesh
Piped water supplies are increasingly mentioned as one of the so-called ‘Safe Water
Options’, which might be considered as an alternative to an arsenic-contaminated
tubewell. This paper examines what piped water supplies have to offer in this respect and
the key issues which need to be considered when promoting them as a potential safe
water option for rural communities in Bangladesh
A piped water supply can be defined as a system which moves water from its source to
one or more distribution points. These distribution points are located so that it is more
convenient for the consumer to collect from a distribution point than directly from the
source itself.
Prior to the discovery of arsenic in the groundwater in Bangladesh, access to safe water in
Bangladesh was estimated at 97%. In rural areas this is largely due to the high number of
tubewells fitted with handpumps which were installed over the last 25 years or so. It is
estimated that there are between 8 and 10 million of them in the country. With such a
large coverage. Most people had access to a water supply within a very short walking
distance from their home. Indeed many tubewells are located within the family
compound.
Now with some communities facing the situation of having many, if not all of their
tubewells contaminated with arsenic. The convenience of a nearby safe water source has
gone and they are faced with having to fetch water from much further away. Piped water
systems offer the potential of bringing back the convenience.
However it should be remembered that piped water systems, in themselves, are not
necessarily a safe water supply. It all, of course, depends on the source of water which is
feeding into the pipe system. That source could be a dug well, deep tube well, pond sand
filter, rain water harvesting system, etc. All the issues concerning the use of those options
still apply. The pipe system simply brings the water to a more convenient point for people
to collect. Nevertheless, in doing this there are two particular spin-offs. One is that by
increasing the potential number of users of a source it may become more worthwhile to
invest in the required technology to enable the source to provide safe water. The second
is that by bringing water closer to the consumer, the per capita consumption is likely to
increase, which can bring health benefits.
A typical piped water system in Bangladesh might consist of a source, a low-level water
storage tank, a pump, a high-level header tank and the pipe distribution itself. The
distribution points could be public tap stands or, indeed, individual household
connections. Such a system seems, on the face of it, relatively simple, but if it is
compared with the former system of tubewells, a number of complications can be seen. A
tubewell is normally used by just a few users, often with a single individual or family
being responsible for installing and maintaining it. A tubewell is relatively simple to
51
maintain and repair. A piped water system, on the other hand, is used by many people
and requires a high level of management in order for it to operate successfully. It requires
not only high capital investment but also running costs, such as the cost of providing
power to the pump and carrying out the more complicated maintenance of the various
components. A system is required for collection of funds for operation and maintenance.
So the question arises: are people willing to invest their money and time in a piped water
system? In rural Bangladesh the question is quite different to many other countries where
piped water systems are used. In many countries, piped water systems are proving
convenient water supplies to communities which had never experienced such a thing
before, where the alternative for any water at all is a walk of several kilometres. In
Bangladesh, however, the tubewells are still there, providing water for all requirements
except drinking and cooking. So a lot depends on people’s perception of the value of a
convenient safe water supply. And that perception can only be expressed by the people
themselves and is likely to vary from individual to individual, community to community.
Therefore the first requirement of any successfully piped water system is a clear
expression from the community that they really want it, that they are prepared to put the
time. Money and effort into constructing it, operating it and maintaining it. Facilitating
agencies, such as NGOs, DPHE, need to develop the skills required to assist communities
through this decision-making process. There are too many experiences in the world of
water systems which are handed over to communities and later found to be abandoned,
because they were not what the community wanted. Nobody can afford the waste of
resources that this entails.
Piped water supplies do have a role to play in providing convenient safe water to
communities in rural Bangladesh. Indeed there are an increasing number of examples to
be seen around the country. However communities need to be fully aware of what is
involved in opting for one, so that they can decide for themselves if it is worth it. The
success of piped water supplies in Bangladesh lies not in the hands of the engineers but of
the communities.
52
Assessment of Options for Safe Water in Arsenic-Affected Areas of Bangladesh
Dr. Phillip Crisp
Senior Lecturer, School of Chemical Engineering and Industrial Chemistry
University of New South Wales, Australia.
I would like to describe to you the work we’ve been doing to assess the various options. I am
very pleased to acknowledge all of our supporters and co-workers in Australia. The work was
originally funded by Australian government through AusAID and in Bangladesh, Dhaka
Community Hospital has provided a huge amount of logistics and support and information of
every kind for us. In Australia, staffs have been provided from GHD Proprietors Ltd., and
from the University of New South Wales like myself to assist with the assessment, the design
and the construction of various safe water devices. And it’s been organized through the
Bangladesh-Australia Centre for Arsenic Mitigation; known as BACAM. The starting point
is: you go to a village and you ask “what do we do?” Suppose you take us there and you ask
us very simply, “how do you solve the problem?” You see the tube wells, you see the people
with the black hands. Oh, what are we going to do? The first step must be to consult with the
people in the village. There must be meetings, discussions, more meetings, more discussions.
The villagers must understand and support the effort. Otherwise it will fail. It is simple as
that. We have all seen examples of systems that have failed for that reason. The first is to
look at is the history of the area. Are there already existing safe water systems? Are there
perhaps dug wells that have been used historically? Is there perhaps a sand filter? Or is there
a clean pond or a clean river where you might be able to put one? Also, are there any deep
tube wells that have been used quite possibly for agricultural purposes which are able to
provide safe water? Obviously, if there is already a safe water source, it is possible quite
likely that you can provide, use more of those and you might be able to improve upon the
design. The next step is to look at the geography of the area. Are you near the sea, for
example? If you are near the sea, then dug wells will most certainly fail because the water
will be too saline. What is the structure of the village? Is there a central area and an outlying
area? That is important. Where is the high land available where you might be able to install a
system so that people can get to it even in times of flood? Whether the locations are
acceptable to the people in terms of their social structure, the village clusters of families? The
logic is to start, I would say, in the central village areas. This is where you can do the most
good for the most people. And to begin with, people will just have to carry water from the
central areas to the outlying areas and hopefully we can design things for these outlying areas
later on. But this is really a race against time. It’s not a matter of doing whole lots of years,
another 5 or 10 years of thinking about it. I mean, these people will die soon unless
something is done. The next item is we want to look for a high volume water source. This can
be, at the moment, a dug well, a sand filter or a deep tube well. They are really our only three
choices. If a dug well fails, then a sand filter has a good chance if you have a clean pond or
river. If there is an ___ below where you can extract safe water, then this is also a good idea.
There are possibilities that we might be able to improve upon the design of very shallow tube
wells, which are dug, to the same depth as dug wells. We might be able to improve on us to
provide water. There are possibilities of improving the chemistry of the basic three kalshi
system that is been used in households for generations to make large scale systems like three
kolshi patro. That might later be able to provide a high volume source. Once you have a high
volume source, there is the opportunity to pump the water to an elevated tank and reticulate
the water to a number of families. The advantage of reticulation is that if you install
reticulation, it will cost twice as much to build the system, but you will be able to provide
53
many more than twice as many families. So the cost will decrease. Rainwater collection at
the moment is really an option for a single household. And it is very expensive option at the
moment unless there are improvements as in tank design and other aspects.
Now the reticulation system. I give just as an example, the one that we’ve put in at the
BACAM dug well in Lakshsm. We have built a very good dug well taking extreme care with
the design and the construction details. It has a floating intake. It has a screen around it. It’s
been cemented nicely on the inside. It is working very well. And there are no problems with
the choliform bacteria. The water is pumped to the elevated tank and then goes to eight taps
in the village. And this is the collection of kolshi around the tap and people are just filling
these and are using every drop of the water. It is pumped twice a day, two cubic meters per
day to the elevated tank. Now there are improvements we can bring about even in our own
work and we are in the process of doing this. We are extending the ___ around the dug well.
You can see how water can wash in underneath there and go into the poorly compacted soil
that is around the outside of the dug well tube where the hole was filled. That we believe is
the major source of contamination by choliforms in the dug well. It must be controlled. We
want to extend this to 1.5 meters so it seals around the soil. Secondly, we want to improve the
electrical safety. We should bring it up to Australian standards. If Australia is involved in
doing this, we should meet our own home standards. Thirdly, we want to have a manual
backup. What happens if there is an electricity strike or failure in the area? Then there will be
fifty families and another fifty families who are also getting some of their water will not have
a supply. It’s very important to have a manual backup system, either a hand pump or
preferably a bicycle type or a pedal pump. Pedal pump might be better because the leg
muscles are stronger than the arm muscles. There is also a problem possibly with the vacuum
limit. We can only pump water by this sort of means with a vacuum-driven pump from a
depth of about 7 meters. Already in Bangladesh, in some of the locations, the level is
descending below the vacuum limit. What improvements can we bring about for sand filters?
The standard design, this is a pretty good design. This is the one that has been built at
Shirajdikhan. In the case of the inlet tank, the problem is the water just quickly goes in and
floods all these upper chambers. And it then rushes very quickly through the pre-filter section
and you don’t give the pre-filter much of a chance. We believe that you can improve on the
design by having an elevated tank that acts as an inlet tank and which allows a constant slow
flow of water to go through the system so that you get optimum removal of silt in the prefilter and it will also provide generally better separation in the sand filter as well.
At the moment we are building a sand filter like that. It will be a BACAM pond sand filter
that will be incorporating these design improvements. And we hope that it will work better
than the existing ones deep tube wells. We’ve already heard about problems of sealing
between and are fundamentally costly because they require deep heavy drilling equipment.
We can improve on rainwater collection. There are many problems with the existing system.
In particular, we need bigger tanks, larger roof area, automatic first flush, better screening,
overflow from the bottom, durable tank, and above all, it has to be made cheaper. The system
that we are looking at is that education, hygiene, water are completely interconnected. Every
safe water system can be contaminated. We must look to a holistic approach for solving the
problem. And we recommend a dug well, if possible. Not always will it be possible.
Whatever high volume water supply you can obtain, we think that reticulation, if possible, is
a good idea. You will gain more uses than you will lose in terms of the additional cost.
Otherwise, a deep tube well if there is a suitable known or a sand filter if there is a clean
pond or river, rain collection if you are wealthy, very shallow tube wells, three kolshi patro,
and may be there are some other options coming along. And every system must be tested and
monitored to ensure that it is safe. Thank you.
54
Working Session 4 on Water Availability and Rational Use of Available
Water Sources
Chair: Dr. Ahmed Kamal
Water Supply in Arsenic Affected Rural Areas of Bangladesh –The Institutional
Challenge
Chowdhury Mufad Ahmed
Senior Assistant Secretary, Ministry of Environment & Forest
Honorable chairman, distinguished guests and participants. At first I would like to make a
small correction because I don’t have anything to do with the policy support unit because it
was in the local government division where I used to work before. Now I am the Senior
Assistant Secretary of the Ministry of Environment and Forest. But the presentation which I
am going to make is purely of academic nature and it does not reflect the official position of
the government in any way.
I would like to start with a success story of the government of Bangladesh in providing rural
water supply. I would like to highlight this success. This success is because of the dominant
role of the private sector. We estimate that 870 wells are in the private sector now,
particularly in the shallow water areas. What was the reason of this tube well becoming so
popular a technology. Because it is affordable, user-friendly and sustainable. People used to
know that once they get a tube well, maybe it will cost them 5 thousand taka, but the water
supply problems have been solved once and for all. This is why the willingness to pay was
very high and in most part of the countries the yield was sufficient because of the adequate
recharge and wind cost is insignificant.
But Arsenic contamination in the ground water changed this whole situation. Almost 80% of
the country, we have shallow tube well and two hundred and sixty upazilas are affected with
arsenic that means the range is 1% to 99%. We have upazilas where only 1% of the tube
wells are contaminated while we have upazilas where 99% of the tube wells are
contaminated. We have hundreds of villages with all the tube wells contaminated and
thousands of patients. Here I did not put any specific figure because we are still processing
the final data.
What is the consequence of this arsenic contamination in water supply? The first thing is
ineffectiveness of the hand tubewell in the arsenic affected area. And this is the demise of the
family and household base water supply system. I would like to give one example, suppose in
one small area all the people have bicycles so they depend on that. They don’t need any
public transport or anything. Suddenly, all the bicycles become ineffective, so they are
compelled to go for some public system and here the challenge, that is why there is a sudden
sharp decrease in the rural water coverage. You cannot say that we can provide 95% water
supply in those areas. In many areas it is almost no water sources-hundreds of villages with
no water sources. That is why we are compelled to reintroduce this community based water
system and there is a need for subsidy on the capital cost. There is huge burden on the
government because now the government should come and provide the lifeline supply of
water. The private sector cannot play that role which they used to play and the government
55
can play that dominant role. In 67 upazilas more than 80% of the tubewells are contaminated.
You see earlier that there one hand tube well for 18 persons. Now one hand tube well for 204
persons. But I would like to emphasize there are hundreds of villages where there are no safe
water sources.
The earliest distance covered was 84 feet and the time spent for collecting water was 9
minutes, now it is 556 feet and time spent is 27 minutes. There are many areas where the
situation is much worse. Now we have the rural water supply system, we call it point source
basis. There is no pipe water supply. There are private tube wells, government facilities, and
NGO supply facilities.
Private tube wells are mostly in shallow water table areas. On an average, for every three
household there is one tube well. Government and local government have no role to play, and
have no information about these private tube wells. Government facilities in most part, it is in
deep tube well areas; in the low water table areas where they supply “Tara” pump and in hilly
areas they need ring wells and in saline areas PSF has to be the option, these are supplied by
the government. There is very little role of the private sector. There are almost no private
facilities, and all are government facilities. DPHE also supplies tube well in shallow water
table areas.
The institutional arrangement is DPHE and NGOs, whatever it is. They supply subsidized
hardware and local government or union “parishad” selects side. This is the only role that
local government at the grassroots level play. Users are to bear a part of the capital cost. It is
around ten percent, and DPHE just selects contractor and supervise work. There is no role of
the DPHE or NGO or whatever institutions after the facilities are installed. So this is the
scenario which is prevailing in the country.
Now, in the arsenic affected areas these are the alternative water supply options:
a) dug well;
b) pond/rivers and filter, this is basically slow filtration technology;
c) deep hand tube well in certain areas where it is safe;
d) rain water harvesting;
e) arsenic removal technology.
Experience with rain water harvesting indicates that it should be purely household based and
it should be done by the private sector. The government cannot and should not subsidies this
facility. We are yet to know a lot of about this arsenic removal technology and proponents
are yet to prove that their technologies are equally effective in various areas. So these
technologies are basically suitable for community water supply, and they are much expensive
compared to a hand tube well and required regular and delicate maintenance. Which is very
important compared to tube well. There is a maintenance cost involved. There is need for
community based institutional arrangement and organizational management. The government
is expected to provide these facilities, not people are doing it themselves. They are expecting
the government to come and do something.
Now we need an institutional arrangement to address those facilities. But the inadequacy of
the present institutional arrangement is that DPHE is an engineering organization and it is
oriented to take responsibility of the community based institution and there is no presence of
DPHE below the upazila level, now that we are talking about the village level or the ward
56
level. There is no mandate to be involved in O&M activities in rural water supply because
our policy states that O&M should be borne by the users. So they cannot play this role.
It is very important that NGOs work are very project based. They are good at mobilizing the
community and developing community-based organization but the problem is that they work
under certain projects and once the project is over they are no more there. They cannot ensure
sustainability and there activities do not look beyond the project period. During the project
period they work very good but after the project is over things fall apart. They also lack the
necessary mandate, because the local government and other can ask question, can they take
the responsibility of water supply beyond the project period. The private sector’s role is –
institutional role- yet to develop in the rural water supply. We are talking about the union
parishad which is the grass-root level institution and recently we have the “Gram Sarkar”.
Their present role is insignificant, and water supply is not among the mandatory
responsibilities of the union “porishad”. It is an optional responsibility. If the government
wants to compel them to do, the government should provide some additional fund in very
problematic area because we are talking about building capacity but this an area we should
look into. Inadequate mandates cannot levying water rates as if now we are talking about
introducing piped water supply and it is also a very good option but if the question of
levying water rate comes, in that case they don’t have the mandate because the modern tax
schedule does not say anything about collection of water rates. So this is one problem.
Now to develop the new institutional arrangement. We think it must be this institution. We
don’t have any other alternative but to develop a community based system at the grassroots
level. There must be some effective linkage between these organizations and the local
government. It is from our experience, also some experience in India. First, the World Bank
with this project tried to copy a project from UP and it failed. It did not work without the
involvement of some permanent institutions and that is why we linked the local government
with all these activities. There should be a mechanism, we should work on that, for a
productive interaction among local governments and community, DPHE, NGOs, and the
private sector. So the challenge is how to develop this mechanism and make it work
Tax schedule should be devised to include water rate. So that if we think of any pipe water
scheme then they can play that role and measures should be taken to build a necessary
capacity at the union level. At this moment we have only one secretary, is the only permanent
staff at the union “porishad” levels that is very important. The NGOs should focus on
capacity building at the community instead of acting on behalf of the community. This is also
something very important that NGOs should not go to the community and do work on their
behalf rather they should build their capacity so that they can take care of their affairs by
themselves. The rural water supply project should have vision beyond the project period and
sustainability should be built into within the project. Thank you.
57
Arsenic Safe Water Supply: Potentials of Surface Water Sources
Professor Firoze Ahmed
Professor of Civil/ Environmental Engineering, BUET
Thank you Mr. chairman, distinguished participants. I have been asked to make a
presentation on the surface water, actually the potential of surface water in arsenic mitigation.
Well the title is Arsenic Safe Water Supply: Potentials of Surface Water Sources. We know
that Bangladesh is blessed with huge quantity of surface water and definitely it has got a big
role in arsenic mitigation. As we know that surface water is free from arsenic but it contains a
very small amount of arsenic, and under the condition the surface water prevails that is
hardly. There is possibility of having any arsenic in surface water. Now if we look into the
water availability in Bangladesh we get water mainly from cross border flow. In Bangladesh
about one thousand ten billion cubic meter of surface water is available each year. This
amount of water comes from other countries by cross border flow. And then about 340 billion
cubic meters of surface water is generated by rainfall. So we have got about one thousand
three hundred and fifty billion cubic meter of surface water each year. Out of which one
hundred and ninety billion cubic meter of surface water is evaporated. As you know that
surface water is subject to evaporation due to atmospheric reasons. And then ground water
reserves in turn around twenty billion cubic meters into groundwater. Therefore, the net
surface water available is one thousand one hundred and forty billion cubic meter. Per capita
availability of surface water is eight thousand four hundred million cubic meter which is the
second highest in the world.
For water supply, we need a very small quantity of water. In rural context, about eighteen
cubic meter of surface water is needed a year for drinking purpose. In urban context, we need
about sixty-five cubic meter of water per person against a availability of eight thousand and
four hundred million cubic meter of surface water. Definitely a very huge quantity of water
is available for per person. Our main surface water sources are 230 rivers, having about 22/55
km length and then 1922 square kilometer of major standing water bodies and about 1.2
billion ponds having an area of .1114 ha, Per pond, 21.5 ponds per mouza. The total length
of the pond is 1475 square kilometer. According to the BBS, about 17% of these ponds are
derelict. The other ponds have got water throughout the year. Now what are the problems in
surface water development? One of the problems is the pollution of surface water from
domestic, industrial and agricultural sources. There are many pollutants that are entering into
surface water. Then contamination of the pond water by semi intensive fish culture because
whenever there is water people try to do some fish culture there. Nowadays almost
everywhere fish feeds are applied and that really causes some sort of contamination. Then
high-suspended solids and algae green and bacterial count interfere with low cost treatment
processes. The water quality is such that now we cannot very easily treat it for surface water
supply and then presence of syno bacteria in some is a concern. This is some sort of toxin
produced by some algae, blue green algae. Then non-availability of perennial surface water
sources in some areas in the dry season. Because in the dry season we find that there is
scarcity of water, because we do not have any scope to reserve ponds water for us, then all
the water that comes in the country usually discharged in the sea.
These are the main problems that we encounter in surface water as a source for domestic
water supply. Now we have got several technologies for treatment of surface water for
drinking purpose, so we need some sort of treatment. The first treatment is slow sand filters.
58
It is called as Pond Sand Filter (PSF) in the country because this was originally developed for
coastal area. In the coastal area due to high salinity people prefer to use this pond water
which has of low salinity. Basically, slow sand filter made the water become clear and
significantly free from microorganisms. And it has got limitations. Limitations are that the
turbidity should not exceed 30 ntu. Most of our pond sand filters are not functioning because
of high turbidity, and of high algae gloom in the ponds. Within a short time it in two or three
days becomes clogged and people are not willing to maintain it or wash it quiet frequently.
That’s the problem. If turbidity and this slow colored it should have low color because this
system does not have the capacity to remove color. Then low faecal coliform counts should
be less than 100 because it has a capacity of removing microorganism, faecal coliform about
99.9%. According to the guideline value, it is not really acceptable for water supply. If the
bacterial count is very low, then only can remove 100% bacteria from the water. Then very
low sign of bacteria should be less than 1 microgram per liter, which is very low
concentration. In a recent study it has been found that syno bacterium is present mainly in the
northern part of the country and the central part of the country to some extent. But in the
coastal area practically there is no sign of bacteria in the water. This is a toxin and usually in
the case of bacteria, if you can kill it and remove it, it is fine, but in the case of syno bacteria
if you kill it then it become more dangerous. Because it releases the toxin from bacteria itself
in the water. We should be very careful about that. This blue green algae which may be
present in some of the ponds are not really suitable for pond sand filters.
Now the second option for a relatively inferior quality of water is the multistage filtration,
which is involved with combined roughing filtration and slow sand filtration. For up to a
turbidity of 100 ntu low color Faecal Coliform (FC) concentration should be less than 200
100 ml. This system works because it has the capacity to pre-filter the high suspended solids
and that’s why where turbidity is fish this system works. And then is the small scale
conventional treatment. If the contamination is high, then we have to go for an extensive or
comprehensive treatment of surface water which involves pre-settlement, coagulation,
sedimentation filtration and disinfects. This is the third option, which is conventional surface
water treatment, but in small scale it becomes relatively costly and it can take care of high
turbidity, high color and high FC count. Where the water is very polluted, this system can be
used. The pond sand filter is a very low cost. Slow sand filter has got a usual technology life
of fifteen years and then capital recovery cost of Tk. 3.00 and operation maintenance cost of
taka .5 per cubic meter and it becomes Taka 3.5 per cubic meter. In the case of multi stage
filter, the cost is a bit higher about taka 6 per cubic meter and for small scale conventional
treatment the cost is very high which is about taka 20 per cubic meter. This is the usual
costing that we have done. But significant amount of that cost is the capital recovery cost and
usually for comprehensive treatment it is rather not affordable in the village level and we
have to subsidize it and probably subsidize the capital cost and then the operational
maintenance can be borne by the people and it is within the affordability of the people. Thank
you very much.
59
Aquifer concept and withdrawal of safe ground water from the deltaic plain of
Bangladesh
Md. Nehal Udidn
Deputy Director
Geological Survey of Bangladesh
Honorable chairman, distinguished guests, ladies and gentlemen. I am going to address a
paper on Aquifer Concept and Withdrawal of Safe Ground Water form the Deltaic Plain of
Bangladesh. The co-author of this paper Mr. S K M Abdullah is sitting here. We know we
have this serious arsenic problem and we have sunk millions of tube wells in the delta plain
for the safe groundwater but these tube wells are now producing arsenic rich water. We know
that 61 districts out of 64 are producing contaminated water and most of these wells are
within the depth of 10 to 50 meters. From a satellite image of the Ganges-BrahmaputraMeghna drainage basin taken by NASA about six months ago, we can see the position of
Bangladesh and the position of Bhampautra river and the Ganges river, this is the confluence
and the forming of the Meghna. This drainage basin, these river systems have been carrying
huge amount of sediments annually and have been building up these delta systems.
The Bengal delta is composed of mainly sandy silty sequences with interventions of clay
layers. These sandy silty clay sequences vary in thickness from 100 meters to thousands of
meters. These sequences were deposited about 65 million years from the myosin age to the
present time. Because of the nature of the climatic conditions of this region, abundant water
remained in this sandy silty sequences of Bangladesh. People of Bangladesh have been
abstracting this water for drinking, irrigation, domestic purposes by sinking million of tube
wells both hand/shallow and deep. Now we have a concept on deep tube well and deep
aquifer. What does this mean? The word deep tube well is used from different perspectives
from diameter of the well, pumping system and depth. Similarly, it was a concept that any
aquifer below 150 meter is called deep aquifers without considering the age or geological
parameters of the sediments. From the geological point of view, the depth connotation for
deep aquifer does not bear any significant meaning because the so called shallow middle or
deep aquifer all can be from the same geological age or same geological formations.
The tube wells withdraw water from the Pleistocene sediments are arsenic safe. This is
known now. The area where the Pleistocene red clay formation is at the surface tube wells
can be used as the best source of water for all purposes and will probably remain sustainable
for a long time. For example, we have been abstracting Dhaka City Water for a long time but
it is not contaminated. Because this Dhaka City water is below the red clay and the water is
coming from the dubidila sand stone. The modhubpur and barined areas, the hilly areas, in
the east and north east and the Himalayan areas of Panchogor and Thakurgaon districts
belong to these areas, the red clays, and this constitutes approximately 30 % of Bangladesh.
In addition to the above areas, these dubidilas sediments probably will be found within the
depth of 200 and 250 meters and can be increased by another 10 to 15% of the country area.
Tube wells producing water in the flood plain or deltaic plains of Holocene sediments are
severely affected. In Bangladesh the thick semi-consolidated to unconsolidated flurio-delta
sediments of miocene to the present have many aquifers. Because the base of the holocene
sediments is not a uniform surface, it is very much undulated. As a result, the depth of the
arsenic safe aquifers varies from place to place and the deep aquifers considering only the
60
depth perspective are not always arsenic safe. Moreover, in parts of the coastal areas it has
salinity problems. UNDP has divided the aquifers as upper aquifers, the main aquifers, the
deeper aquifers, the BGSDP as the upper shallow and deep aquifers, Dagargall and others as
first, second and third aquifers. As per the geological divisions of the aquifers. We have the
upper Holocene aquifers, we have the middle Holocene aquifers. These two upper and
middle Holocene aquifers are severely contaminated. We have the Pleistocene and the
plyoplisotcin to the formation aquifers. These are arsenic safe. If you go below 500 feet depth
or below 1000 feet depth, the tube wells are arsenic safe, but this is not true and here is an
example of the Sharsha upazila of Jessore District. Theses tube wells are financed by the
JICA, and they have been surveyed in 1998 and in 2003, A number of deep tube wells are
below 500 feet’s that is about 15% of the tube wells are contaminated within these five years.
So the deep wells are not safe from arsenic. Work done by the UNICEF, DPHE on 15
upazila, these are the test tube wells, below 500 feet to thousand feet at is seen that in
Bancharampur about 76% of the deep wells are contaminated. In Borura, 31% of the deep
wells are contaminated and that a number of wells that is about 23 wells are below thousand
feet but here 15 of the wells are contaminated, so more than 60% of the wells are
contaminated. In Homna upazila 48 are contaminated. Six wells of Muradnagar upazila of
Comilla district are contaminated and these wells are below 500 to 1000 feet. So we cannot
say that the deep wells are safe rather we can say that this data suggests that deep wells are
not always arsenic safe rather geologically controlled wells are arsenic safe. It means that
from which formations we are taking out the water, from which rocks are taking the water,
the rock will say whether it is safe water or not.
Now there is a case study at Srirampur of Kochua upazila in Chadpur district. The work of
GSB-BWDB-USNF shows that there is a safe aquifer below the 10 m thick clay at about 300
in deep tube wells, but high content of iron is there. DPHE has put a well in here about .50 to
100 feet, and in that well they have set a arsenic removal plant but if they could go below
this clay layer about 1000 feet, this layer has no arsenic and no iron and this is potable water.
Therefore the geological consideration should be taken into account and we must have to
give importance to this on installation of tube wells. How the tube wells should be installed.
In our country, local mechanics and the local people are installing the tubewells without
having the proper technology. The annular space between the pipes and hole should be sealed
properly, with impervious materials so that the upper contaminated water cannot percolate
through the bottom aquifers. And this is very important for sinking tubewells.
Now I am coming to the conclusions. The deep wells are not always arsenic safe rather
geologically controlled ways are arsenic safe. Pleistocene and older aquifers are safe. Water
can be withdrawn from these aquifers after investigation of the proper aquifer parameters.
Over withdrawn of water should not be allowed in any case. Spacing between the wells
should be maintained strictly. Wells should be designed and constructed with proper care.
Annular space between the hole and pipes should be sealed with impervious materials like
beutonita clay. Proper monitoring, preferably annually, of the wells is essential. All the above
should be incorporated in a proper ground water act which should be enacted as soon as
possible. Thank you very much.
61
Impact of River Link Project
Mr. A N H Akhtar Hussain
Managing Director, Dhaka WASA
Mr. Chairman, honorable guests, distinguished participants, ladies and gentlemen. Assalamu
alaikum.
I will give a presentation on the impact of the Indian River Link Project on Bangladesh. The
history, economy, society, culture and ecosystem of our country evolved round the water
from time memorial. What the Indian leaders think Prime Minster Atal Bihari Vajpayee told
in the last Independence Day, that we have to execute the Inter-link Water Project. NRI is
working for mobilizing the fund for this project. Actually, India started work on this project
since the early fifties and now they are going to give it a permanent shape. The Indian water
policy doesn’t take into account the sharing of the water of Trans boundary rivers, there is
nothing mentioned about. They consider all the waters in the Indian Rivers as their own
wealth. So actually recently, some developments have taken place. There was a case in the
Indian Supreme Court and the immediate past Chief Justice of the Indian Supreme Court, P
M Tripal, gave an order to instruct to the Indian government to implement the project as early
as possible by 2012. According the Indian government has set a timeframe, formed a Task
Force on 16th December 2002, just following the supreme court’s direction. They are
planning to implement this project by 2016 and now they are doing preliminary works.
What’s their plan? Actually, they are planning to withdraw one-third of the Bhrahmaputra,
Tista, Dhorla, Korotoa, Mohanonda water, and it may be more. The plan has two
components. One is the Himalayan component and the other is peninsular component. They
want to divert the water from the Ganges and from the Brahmaputra. From the Ganges to the
Gujrat, Rajasthan and from Brahmaputra to the Deccan in southern India. The benefits they
have accrued the Himalayan component are 14 links, 22 million hectares additional area they
can irrigate, and 30000 megawatts of hydroelectricity they can generate and they are planning
to divert 200 to 250 billion cubic meter of water in the peninsular component that there is 16
link, 13 million hectares irrigation will be provided and 4000 megawatts of power will be
generated. These will cost around USD 112 to 200 billion and they want to implement it by
2016 which will account 25% of the Indian national budget. They have made substantial
progress so far which was unknown to us recently and when I went to the last World Water
Forum then we came to learn the progress. They have already completed feasibility study.
Bangladesh receives water from the Ganges and Bhramaputra. Bhramaputra contributes
around 60% of the water in Bangladesh. They are planning to divert the water from Manosh
and Sankosh , two of the main tributaries of the Bhramaputra, especially in the dry period, to
Farakka and then they will divert it to the southern India. Now they are planning to conserve
water tributaries, which come from Nepal. What will be the affect if they draw water from
the Ganges. Actually, if they start withdrawing them from October, the Ganges will become
dry. This is a very critical period, because the Aman crop, that is the flowering stage, starts at
this stage. So Aman crop is going to be affected. If Bhramaputra water is withdrawn, there
will be no water from October in the Bhramaputra. So how the agriculture is affected?
Actually, this is the very critical stage, and there will be no water neither in the Ganges nor
the the Bhramaputra. Aman crop will be severely affected. If the water is withdrawn then the
salinity fringe will move forward in the ground water. You will see destruction of mangrove
forest, increase in ground water salinity in these areas and coastal marine ecosystem will be
affected, our fisheries also, then everything, then rivers will get dry. All these tributaries, the
62
Bhramaputra, old Bhramaputra, Dhaleshori, Gorai rivers will get dry. Rivers flow flush
industrial, agricultural, municipal pollutants into sea. Reduction of river flow will increase
the concentration of pollutants in the river water. And there will be ground water reversal.
What happens if the river water is here actually then there is a replenishment of the ground
water. If the river water falls, then there will be reversal from ground water. Actually there
will be a problem with the ground water availability also. Other problems include lowering of
the ground water, sreduction of the water yield, increase in the cost of abstraction, increase in
the cost of water supply, increase in the cost of irrigation, agriculture production. And impact
of aquatic life. Withdrawal of floodwater may create two types of problems: shortage of
nutrient supply as upland flow will be reduced, resulting in lower growth of phytoplankton,
this may reduce fisheries production including hilsha. Besides, in urban areas electrification
problem would intensify. Actually, algae boom will increase this. Hilsha will be going to
reduce further. And this increased salinity will impact on shrimp culture, agriculture,
Sundarbans, drinking water, sanitation, everything. So this is actually the society,
communication, economy, environment of Bangladesh that is everything is going to be
affected through this project.
Now the national water management policies is in the draft form and it is going to be passed
by the national water council any time. If the Indian River Link Project is executed, then 67%
of the NW investment will become redundant. There are some international laws regarding
the sharing of trans-boundary waters. Actually, the international law is not obligatory or
compulsory. The country which follows they can follow it, the country that contravenes they
can contravene.
India took this project since the early eighties but they didn’t inform Bangladesh that they are
going to study it. Now they are almost at the fag end of their feasibility study, even they are
telling it is in the conceptual stage, we are not going to do it, when we will go to do it we will
discuss with you, I suspect how far it is correct because already Indian government has
declared that they are going to implement the link project from this year or next year. They
are going to undertake another project from Sankosh and Mankosh marosh, because there is a
fall in Farraka water level, which is needed for Bihar and West Bengal. Upstream withdrawal
in the Ganga could not meet the water demand at the Vagirathi. They are surely going to do
the transfer from Tista, Manosh-Sankosh. Then what we do?
India’s policy on sharing water resources is to be redrawn based on the United Nations
convention, law of international water courses. Cooperation between the states for
sustainable water management includes all relevant dimensions of water use and
management-social, economic and environmental, Scientific investigation and data
collection, analysis and planning, optimum water resources in the region, increase in
horizontal ties among the profession. What we want to do? We want to sensitize the publics
at large in Bangladesh, the politician, the economist, the social scientist, environmentalist.
Equally all these people in the surrounding countries of India, Nepal, then china. I think we
have to develop a kind of inter-linking. I strongly feel that Indian people never warn, they do
something that will actually harm the people of Bangladesh. So we should move very fast
because we will be the worst sufferer. We have to develop inter-linking and also mobilize the
public opinion nationally, regionally and internationally. Thank You.
63
The Present History of Surface Water in Bengal: A Cautionary Note
Mr. Sallimullah Khan
Consultant
Honorable chairman and members of the audience. Good news is that I would not be using
any of the overhead instruments. What I will be doing is partly read from my paper and make
oral presentation. Hopefully, make three points: Firstly, about solid scientific information. I
would argue that not enough explanation has been provided about the scientific facts of the
arsenic crisis. Second question is which has been made even less in the recent literature, by
recent I mean the literature of the last ten years, about the possible conflicts of interest in
finding out a solution to the problem. If this word is still permissible I would even use the
word even “classed struggle”. Just not conflict of groups, it is a wider concept. And thirdly, I
will make a point about the ethics of science or the ethical responsibility for the crisis There
is a very clear attempt at evading the past responsibility while we create a kind of anxiety
about the future. So what is the desire of the scientist and what is the anxiety about. I will
make these three points: conflict of interest, ethical responsibility of science and the
explanation of the crisis itself. So within the precious ten minutes let me try to do justice to
the first one of them. What is the conflict about? A recent study supported but without taking
responsibility of by the World Bank is now trying to promote a program of selling piped
water to the rural people. They make it very clear in this study, published just last year 2003,
that there is now a visible increase of rural income to certain groups of people. The project of
supplying piped water to the rural population has got nothing to do, it is their considered
opinion with arsenic crisis. But it reflects, they argue, a desire of the rural people to have
piped water like the urban areas. Therefore, whatever surplus is being accumulated in the
rural areas due to accumulation can be siphoned off to the urban areas. Let me read from my
paper a little bit; “This they call the unraveling of the water miracle. It has been claimed that
the postcolonial order in Bangladesh in the course of the five decades since 1947 has
succeeded in creating a water miracle in this country. A recent study, supported unfortunately
without taking responsibility by the World Bank claims that 95% of the rural households in
the country had not been able to access clean drinking water. These, in other words, were
called a water miracle. The miracle was attributed to three different factors; namely : 1. the
shallow water aquifers of the country, 2. a sustained public sector campaign encouraging
people to shift from pathogen contaminated surface water to ground water sources, and 3. the
introduction of hand pump technology.
Since 1972 in this country hand pump technology or shallow tube wells or deep tube wells
have been promoted vigorously by international organizations including the World Bank in
their sector policy papers. Now they are trying to completely erase their moral responsibility
by saying that we had got nothing to do with it or we could not predict it. The question is
arsenic has not recently been discovered in Bangladesh alone. It was known. The question is
that it was known in Taiwan, it was known for other parts of the world and of course it was
not impossibility. The question is when you are sinking tube wells, they are saying that this is
one of the great successes of the private sector. The story itself is no less miraculous. The
miracle is claimed to be the largest private sector supported safe drinking water program in
South Asia if not in the whole developing world.” This is a quote from the paper written by
this World Bank people. With the gradual discovery made since 1993 that the shallow
aquifers are contaminated with arsenic, the miracle has begun to unravel. Bangladesh is now
presented with the new need to find another miracle now called, not uninterestingly, I quote,
64
“effective, acceptable and sustainable solutions”, to address the problem of arsenic
contamination. The post colonial alliance by which I mean bilateral and international
agencies, the government and NGOs, I am quoting from them only. But the word post
colonial they don’t use it by which you sometimes say de colonialism, de-colonization. Now
the preferred term in the international literature is postcolonial, one word by the way. The
post colonial alliance is now involved in arsenic research, testing and mitigation services.
Research has mainly been conducted on as the World Bank supported study reports the
engineering aspects of arsenic mitigation technologies to assess whether the technology is
effective or on the hydrological properties of alternate sources of water and their potential to
become contaminated in the future. This is all so well and good. This is what is called solid
scientific information.
Now, the postcolonial alliance with the World Bank as a key player new proposes to promote
a new set of technologies and proposes to ensure household access to safe drinking water. It
is interesting as a case study to observe how a special interest, this is what is called special
interest in the United States, makes use of a crisis to advance its own preconceived agenda
and its own program. The abovementioned World Bank study team does make an attempt to
understand, “peoples preferences for arsenic free drinking water” and they use of the
discredited economic theory of revealed preference, once presented by Paul Sam Wilson,
Bank of Sweden prize-winner in economic sciences and says if people really are willing to
pay for the water services, then it reveals that they do have a preference and therefore it has
higher utility. This kind of which does not even stand the elementary test of reasoning a
circular theory has been utilized here to justify their study. By preference the bank people
mean if Bangladeshi people would be willing to pay for the new arsenic mitigation
technologies. Not surprisingly their answer is yes, they do. The study no less unsurprisingly
finds that households strongly prefer piped water systems, a system preferred by the World
Bank researchers themselves. Why? Plainly the reason is that these systems are more
affordable as well as more convenient. Convenience alone, however, they argue, could not
have explained the household preferences. Affordability is the key concern. Why aren’t
ponds and dug wells preferred by the households? They say, these alternative solutions are
reported to be not only to be less safe but even less convenient. Now the World Bank study
predicts that a rural piped water system by public authorities in Bangladesh is likely to
encounter a high failure rate. If the government initiates this system, they say, it will not be
successful. So it will have to be given to the private sector. But within the private sector
whom? They say to organizations like BRAC, to Grameen Bank. Why? Because they have
experience in micro-credit. They have experience in non-formal education. So they should be
given the contract to supply the rural areas in Bangladesh with water supply. Amazing
reason! World Bank studies are important to assess the potential of delivering network
systems through independent and non-public service providers. These are metaphors for
private capital.
Bangladesh’s experience with rural cooperatives managed by the Rural Electricity Board and
service delivery through the NGOs in areas as diverse as education and micro-credit suggest
that Bangladesh has local organizations that can play the role of such service providers. This
is the essence of their argument. I will not have to elaborate on that. What I am trying to say
now they say how shall we disseminate the information among the people. They say this
should be done at public cost because information is a public good but water is a commercial
commodity. This fundamental contradiction in their philosophy has never been resolved.
Neither theoretically nor empirically. And they don’t have even the minimum ethical
common sense that it has to be resolved with the people because they think everybody is a
65
fool. This is what they have done. But the situation has not been created yesterday – I don’t
want to say that. This is not the most likely place to make a quotation from Karl Marx but I
will do it nevertheless as the conclusion. This is what Karl Marx wrote in 1853, about the
public work system in India during the colonial role. Marx says, “there have been Asia
generally from immemorial times but three departments of government that of finance of the
plunder of the interior”, Marx was a 35 year old journalist so don’t mind the language, “that
of war of the plunder of the interior, and third, finally the department of public works. The
British in East India accepted from their predecessors the departments of finance and the
departments of war and they have neglected entirely that of public works. Hence, the
deterioration of an agriculture which is not capable of being conducted on the British
principle of free competition of Les Affair and Les segale.” This is Marx but long after Marx
wrote I can sight hundreds of British bureaucrats who corroborate him and as late as 1930 Sir
William Wilcox lecturing in Calcutta University on the ancient system of irrigation in Bengal
makes the same point. The natural irrigation system of Bengal had been destroyed by these
policies of malign and benign neglect both for railway construction and other reasons. I
would argue that to this date the social and political order in Bangladesh without which you
cannot cope with this problem, remains a direct and uninterrupted continuation of the
colonial policy. In that sense it is highly metaphorical use of the term independence that we
use.
Now comes the question of contamination of surface water with regard to India. Now the
Bengal, I will make this my last point. Germany is a divided country, so is Korea and there
are many other parts of the world. And we know more problematic countries like Palestine
and Kashmir. The Bengal remains a divided country, including the water problem, many of
our under development problem are related in the partition of India in 1947 of which a
consequence is the Farakka and today remains less discussed. I would like to draw the
attention of this August conference, to history if you want to understand the present as
history. My concept of history is that history is never the past, it is in so far as it is
remembered in the present.
66
Special Session
Mr. Mirza Fakhrul Islam Alamgir
State Minister, Ministry of Agriculture, PRB
Bismillah hir Rahman ir Rahim. Honourable Chairperson, distinguished participants, ladies
and gentlemen Assalamo Alikum and Good Morning.
I take this opportunity to express my gratitude to the organizers of the fifth international
conference on Arsenic for inviting me and giving me an opportunity to take part in the
discussion. I would also like to congratulate the distinguished paper presenters for their
presentation. I believe these papers would immensely help in the formation of
recommendations.
Ladies and gentlemen, arsenic pollution and contamination of underground water has already
posed a serious threat to our health and environment. The country having a population of
more than 130 million and a comparatively small land area is facing the challenge of food
security, safe water supply, adequate medical facility and efficient education system.
Unplanned introduction of underground irrigation has also aggravated the situation.
Thousands of people are being contaminated with diseases relating to arsenic poison.
Ladies and gentlemen, we must find out ways through which we can avoid arsenic pollution
and contamination. Use of surface water for irrigation can be a very positive step towards
these ends. We could have achieved considerable success in this respect if we could have
continued the program of canal digging introduced by the late president Ziaur Rahman.
Recently, government has given priorities to these problems and has already taken quite a
number of programs to combat this problem. NGOs have also come forward in lot of areas to
support these programs. I am afraid Indian plan to withdraw water from Padma, Ganges,
Bhramaputra, Meghna, and other rivers, which flows from across the border, will be
disastrous for agriculture and environment of Bangladesh. United effort is required to
persuade India to refrain from this project. Recently the world is passing through a critical
phase politically. Unfortunately, the priorities have changed, the suffering of poor and
common people and poor nations have increased. War against nations has replaced war
against poverty, disease and hunger. International communities seem to be more engaged in
political problems than human and social problems. Arsenic problem in Bangladesh needs
international support.
In this context, I must congratulate, Dhaka Community Hospital for organizing this
conference. They have not only taken initiative to create social awareness about the hazards
of arsenic and its treatment. They have also gone a long way to organize a relentless war
against this menace for mankind. Once again, I would like to thank and to express my
gratitude to DCH for hosting this type of international conference which would certainly
create an impact on the overall struggle for better health, safe water and environment. Let us
not mourn for the past and divide ourselves over the issues which do not help the suffering
of humanity. Let us unite to wage a war which helps the millions in combating arsenic.
Thank you all. Allah Hafez.
67
Mr. Shafiq Rehman
Editor, Jai Jai Din
Eminent visitors, prominent dignitaries, members of the press core, ladies and gentlemen
good morning to all of you. First of all I would like to thank Dhaka Community Hospital for
giving me this chance to speak to you and I would also like to congratulate Honorable
Minister here who set his priorities right, i.e. he did not make himself absent here in trying to
disorganize the hartal or organize the hartal. Thank you Mr. Minister I wish the other MP’s
take a lesson from you. Well water for many countries in 21 st century is now both
international and national issue. Bangladesh is unfortunately one of them. This morningworking session is on the subject water availability and rational use of available water
resources. As a conscious citizen of Bangladesh, I am more concerned about its availability
than its rational use. If water is not available, then the question of its usage will not come. So
what is happening to the water availability in Bangladesh today. Back in the days of British
Raj, when we used to travel by train from Calcutta to East Bengal we used to wait eagerly for
the time when our train will approach and cross the Hardinge Bridge, which still is one of the
largest railway bridges in the subcontinent. It used to span over one of the largest rivers of the
subcontinent, i.e. Ganges-Padma. Today the Hardinge Bridge is still there but the river
Padma does not have much water below. In fact, in winter months you may be able to cross
the river by walking. This has to be seen to be believed. I will appeal to the Dhaka
Community Hospital to take some of the visitors here with the cooperation from the minister
here. If they could be taken to the site, they will understand the real problem there. The water
is not there in one of the mightiest rivers of the subcontinent. Poet T. S. Elliot wrote I do not
know much about Gods but I think the river is a strong brown God sullen, untamed and
intractable. Well, obviously, T.S. Elliot was wrong. God’s don’t die. In Bangladesh not only
river Padma is dying, many other rivers are dying, they are becoming tame and of course
tractable. Water flows in over fifty rivers are being threatened by the neighboring state
India’s own water planning. The Central government of India’s water planning is not only
threatening us but threatening its own eastern states including West Bengal. That is why we
should involve the people of eastern Indian states including West Bengal and exchange ideas
with them. As I said before this is both a national and international issue. We should involve
Nepal, India and world bodies to solve the problem of the rivers of Bangladesh.
Engr. Akhter Hossain before me has explained this in detail. Thank you Mr. Akhter Hossain.
So I urge you to unite and educate the people of Bangladesh, appeal to the world community
at large and save the rivers of Bangladesh. Do not let the Gods die because if the creator itself
dies then what chance have we got for the creatures. Thank you.
68
Mr. Rashed Khan Menon
General Secretary
Workers Party of Bangladesh
Chairperson, honorable participants, I thank Dhaka Community Hospital and School of
Environmental Studies of Jadavpur University, Kolkata for their continued effort to make
people, our policymakers aware of the curse of arsenic contamination in tube well water and
also the crisis it caused in our health and environment and its continued crusade against
arsenic. Unfortunately, at first it didn’t make much impact on the policymakers rather the
Dhaka Community Hospital was made a villain by the Ministry of Health that they are
creating a panic and also causing embarrassment for the country for getting foreign aids from
the donor agencies. Later on due to the acceptance of the World Health Organization and
other agencies that arsenic is really causing problems for us, the government has become
aware. Also, the international donor agencies are trying to get rid of the own miss doings and
again they are coming up to help our people. But in the fight against arsenic their effort to
help the people of Bangladesh is not in that way genuine. Unfortunately, if it had been in the
west the governments in those countries would have asked from these international donor
agencies compensation for what they have done for our country. Because from 1972 when
they started digging tube wells in our country telling us that this will give us safe water. They
didn’t make us aware of the effects of those tube wells digging our people though they were
aware of the whole situation. Now they are not telling much about that. Still our policy
making, our Finance and Planning Minister is telling that the talk about the arsenic is causing
panic to the people, to the donor agencies and making a bad image of our country. At least I
heard about this telling in one of the meetings. But fortunately for us, there are many
organizations still here who are working for it. As far as the political arena is concerned, in
the political arena the arsenic problem has not as yet made much impact. But we in the left
front do make it an issue and try to make it one of our programs in our political activities. But
we could not do much about it because you know fighting this sort of menace needs a
definite support. Here in this conference I saw some very good papers, particularly appreciate
the paper of Dr. Salimullah Khan which really pointed out the approaches made by the donor
agencies towards this problem. About this problem I would like to make one suggestion only
that the arsenic problem and its fighting should not be made only matter of discussion among
the expert, professionals rather it should be made into a movement so that our people become
really aware of the whole thing and they can themselves fight this menace. About the other
issue, the issue of this river linking project, I would like to point out one thing that when
Moulana Bhashani in 1976 from his sick bed called for the Farakka march many raised their
eyebrows and his political opponents keeping criticize for whipping up the anti-Indian
sentiments. The following years Bangladesh had to go through the hard experience of
withdrawal of water from Ganges at the Farakka barrage point, lowering of the ground water
level, desertification of the river areas, increase of salinity, the Sundarbans was even. The
Farakka issue also became the main contention in the neighborly relation between India and
Bangladesh. It also became the main issue for political propaganda in our internal politics but
no government came out with the solution. In my own experience, in several of the second
track dialogues where we found Indian teams very prepared about the whole issue.
Unfortunately we found our policy makers, our experts not even prepared with the data so
that we can fight the Indians on these questions. I still remember if Mr. Aynun Nishat would
have been with me that our foreign secretaries, ex-foreign secretaries while presenting papers
in those conferences could not come up with even the relevant arguments for the sharing of
the Ganges water. We could come to an agreement with India on the question of Farakka
69
water sharing, at least we could achieve one thing that we have a claim on the international
water in the Ganges. Now when the river linking project has come up again we find the same
sort of un-preparedness of government, policymakers. I remember that I handed over the
news of this river linking project to our water minister, even before I gave him the paper, he
didn’t know about it that there is something going on in here. But Mr. Akhter Hossain here
presented that it is from the 1950s that the Indian’s are in the whole thing. But unfortunately,
our water experts, our policy makers are not aware of the whole thing. But this time one thing
is favor people are quite aware of the whole thing and fortunately for us in India there is a
strong movement against destroying of this environment by this river-linking project.
Particularly in the last World Social Forum this has become a real issue and many people
came up in our support and I think that we should take advantage of the situation and we
should make, we should unite with the Indian democratic forces and Indian professionals,
Indian intellectuals so that the Indian policymakers change this policy of river linking project
which would definitely harm Bangladesh in such a way that the whole ecosystem of
Bangladesh, the environment of Bangladesh and even the whole river system of Bangladesh
could be destroyed. I think that this should be the way which we go, and we should make the
politicians, the social workers, the professionals unite to make it one of the main issues for
Bangladesh people. Thank you very much.
70
Dr. Naila Zaman Khan
Professor, Child Neurology & Development
Bangladesh Institute of Child Health
I would like to thank the speakers for their excellent presentations. I am a child neurologist
and I work on child development. I would like to comment on what I learnt from this session,
and then I would like to end with presenting the state of child nutrition and child
development, vis-à-vis the problem of nutrition and water in Bangladesh. Now I would like
to first say that indeed what Mr. Salimullah Khan said it is a question of the underprivileged
versus the privileged, the arsenic vs. the water question. It is a question of class, and one
example that comes to mind is : from our department we had made public the whole lead
problem in Dhaka city. Because it affects every child of every social class. Within two weeks
the government banned lidded petrol and even now a lot of money is being spent to improve
the quality of air, but the arsenic problem which is affecting millions of people and causing
so much of diseases and cancers has not been dealt with in terms of mitigation. So the issue is
a people issue, it is a political issue. People who will be affected by the river linking project
should all join hands to counter the move of river linking project. There are (jal sangsad)
water parliaments that are now being conducted across the border in different areas of India
with people and the local government. We can learn from their experiences and what Mr.
Feroze Ahmed said about water is the second richest in per capita availability . We know that
water is going to be important, valuable than oil. Foreign companies are coming to take over
Dhaka WASA and all our water supply systems. There are lots of public interest meetings
which have been conducted in India and there are instances where the judges have actually
given the verdict for the people. So the foreign companies, the French companies, American
companies had stopped withdrawing waters from those rivers. A lot of legal activism is
needed in this area. Now I would come back to my own subject because I would like to say
the issues of malnutrition and lack of water have been taken over by private sector, NGOs,
donor agencies, not by people. No people actions are there. We know that 60% of our
children suffer from some degree of protein energy, malnutrition. The World Bank and the
Bangladesh government have spent millions of dollar in doing the national nutrition project
but what they have done . They have introduced micro-nutrients in terms of zinc, iron, folic
acid, vitamin A instead of saying that children need these more. According to published data,
the poorer, lower income families, the children in Bangladesh have very little access to meat,
eggs, fish, milk, pulses. Instead of saying that we the privileged send our children to school
not giving them zinc or iron, we send them to school giving them a banana or milk. That is
what is lacking in. We know that the water has also been destroyed by the so called green
revolution. We have pumped in millions of tons of pesticides, insecticides, chemical
fertilizers into our water systems. As a result, there is no fish, there is no common food for
the people who needed most. We know in our old system of agriculture there was common
food, common water systems and now all our studies options seem to be that we should go
back to those kinds of common community based water systems, food systems that have
ecological farming, have eco-water systems. I want to end by saying that the children of
Bangladesh are in a very precarious situation. We know that our height and weight is falling
every year unlike other countries. In the case of height and weight , an increasing trend is
seen in Japan and other places. We know that our children are highest in the world in the
school drop out rates, 15 – 30% of children drop out from primary school. Our IQ levels are
71
dropping. Our children are basically famished, they are hungry, they show very poor social
behavior, their language communication is poor. There are lots of evidences that mild mental
retardation which is the 9–4 retardation where they cannot go beyond class three-four, is very
high among lower income families. I would urge all of here that let us make it a political
issue, a pro-people issue. Let us make water your and my issue, not only the underprivileged.
Thank you.
72
Mr. Atiqur Rahman Salu
Member, International Farakka Committee
Mr. Chairman, learned audience, distinguished guests and dignitaries, Good Morning.
Before I go to the depth of the topic, I want to introduce myself. I am the Chairman,
International Farakka Committee, incorporated in New York, USA. This organization is
basically a non-profit, non-political, trans-boundary water rights and environmental watch
group. It mainly deals with arsenic pollution, other water related burning issues and
problems which severely burning our biosphere and the country as a whole. In this seminar
we are talking about Indian River Inter link project. If it is implemented, the very survival of
Bangladesh will be at a stake. We have three major rivers: Padma, Ganges and Bhramaputra .
Out of total consumption of water, we are getting 9-10% from the Ganges, 1-5% from the
Meghna and 80-85% from the Bhramaputra. India authority already finished six studies and
other eight studies are going to be completed. The World community must, at now, stop this
mega plan before it is completed. As an environmental organization, we have our own
proposal in a very nutshell. Water experts and related scientists and environmental
organizations can play a vital role to stop this mega project. The World Bank, ADB, and
other financial organizations must stop funding for those mega projects which can harm to
lower riparian countries like Bangladesh. Bangladesh must get help to be recovered from
damages already done by Farakka dam. Scientific approach with technically sound project
can help Bangladesh and her neighboring countries in a big way like Mekong river
commission or Danube commission. Bangladesh India, Nepal, Bhutan and China must be
included in this proposed project. It needs immediate attention and assistance from the ENO.
Actually, we need the regional cooperation. Now it is very important for Bangladeshi
environmentalists, politicians, policymakers or environmental organizations. Another
question is coming from the different corner. What is the solution? Ganges barrages or
should we proceed for the cross bay dam?
I want to say clearly that this is absolutely our choice which one best fit to Bangladesh. But
before that I emphasize and I must say we want to mention categorically that we want our
proper share from all those international rivers on the basis of mutual cooperation and
understanding and not depriving others. We value the friendship with our neighboring
countries. So we urge upon India to realize that we are always ready to raise our hands for
friendship. We know lot of things and we have to be learned lot of things. We know what
World Bank is doing. We know what other financial organizations are doing. But I am
action-oriented people. But our organization is not a aggressive one like a CRA club in
America. But Dr Salimullah, I always appreciate, mentioned something. I don’t know the
meaning of classless people. To me, classless people means those are the where place
people. When millions of people are suffering right away so we cannot stop. Struggle is
already started for the very survival of our country. We are action- oriented environmental
organization. We just finished our national water conference which was held in the
Bangladesh-China Friendship Conference center. Two congressmen came in their seminars
and I bring some of policymakers over there. I know there is a lot of criticism why those
ministers doing nothing are sitting over in this national conference?. Why we bring them?
They have to make the policy right now. When they criticizing other political parties was in
the power …last time by passing the parliament they just go for and sign the so called
treaties. We are not allowing this government to do that. So in that national conference we
had lot of proposals. Two vital proposals were: one is parliament must take a decision that it
73
should be and must be discussed in this session of the Bangladesh parliament. The second is
there will be a long march for our existence by may of 2005. In this regard we need help from
all corners. I know lot of things are involved in it .
Within one minute I will finish. We are doing an excellent job, we are putting our own
pocket money. We look like NGO, but we are not getting or going for any funding from other
organizations . I know what is going on in the name of mitigation. I say this is the only
national documentation without any government advertisement. Thank you very much for
giving me an opportunity to speak. As I am people-oriented people, I guess all you are
attending this conference are also people- oriented. Some time we have to act very speedy or
otherwise we cannot survive. Thank you very much.
74
Working Session-5
Health and Environmental Hazards Encountered with Extraction of Ground
Water and Management of Water
Chair: Dr. Richard Wilson
Water Quality Characterization of The Bhairab-Rupsha River System of Khulna
City and The Management of This Water Resource Through Environmental
Biotechnology
Mr. Nando Dulal Das
Biotechnology Discipline, Khulna University
Respected chairperson, co-chairperson and fellow audience. I welcome you all. Here my
topic is on Water Quality Characterization of the Bhairab- Rupsha River System of Khulna
City and the Management of the Water Resources through Environmental Biotechnology.
Objectives are:
 To describe the values of different parameters of water sample collected from the
Bairab, Rupsha river of Khulna.
 To find out the interrelationship between the water quality parameters of
collected water sample for two seasons, mainly winter and rainy season to gather
enough information on water use and contamination to alloy deepen and pretreatment and declamation system.
Methodology: For sampling points
 Samples are collected from different places of river systems and different
industries.
 The sampling points are Goalpara Power Station, Crescent Jute Mills, Newsprint
Mills, Hardboard Mills, Forest Ghat Salt Processing and Jahanabad Fish
Processing Industries.
 Parameters are temperature, electrical conductivity total dissolve solid, PS, Total
Alkalinity, bio-chemical oxygen demand, chemical oxygen demand.
Methods:
Standard methods are followed. The water samples were observed carrying high
concentration of VOD, COD, TDS, Alkalinity, Electrical conductivity's and low
concentration of DO, in comparison to control the cause of water pollution and the affluent,
the discharge from the industry was not properly treated.
Some comparison of polluting. Parameters during the winter and rainy seasons first
representation of PS value for PS standard is 6.829. It showed that the lowest PS value is 4.91
from hardboard sample and highest PS value is 8.6 from fish processing industries. Because
of selluzical materials realized from hardboard sample these are harmful for aquatic
environment. Highest TDS values observed 862.4 PPM from hardboard sample during rainy
seasons and the lowest 231 PPM from power station during winter season and it can lead to
the development of slash deposit and anaerobic condition. When untreated wastes are
discharged in the aquatic environment and 862.4 PPM hardboard samples were discharged
75
and these samples containing sellugic materials and supposing of wood the lignin discharge
here this cause high tidies in that reason. Represent shows the total alkalinity value. Here
total Alkalinity 182 mg per litter also from hardboard samples and lowest value 79 mg per
litter from crescent jute mills. And when alkalinity wastes are discharged into the water
courses combined with free carbonizeoxide in natural water it then further increases
alkalinity of the water. Represents of DS value dissolve excess value here. According to
Department of Environment, critical level of DS is only 4 mg per litter. But here lowest value
is 3.9 mg per litter from hardboard samples and also critical level is 4.2 in newsprint mills
during winter season. The critical level of DS towards sample for survey in the living
organism in river and here 4.2 in newsprint. Because newsprint ,here pulps and sellugic,
materials also contain lingual that is Biodegradable also but for bio-degradations too much
oxygen is required that's why physical level is in that regions. Represents show BOD value
that is Bio- chemical oxygen demand. Here industrialize standard demand is only 50 mg per
litter for surface water. But highest BOD value is observed for hardboard mills 180 mg per
litter during winter season. and BOD is too high. DO contain of the water becomes too low to
support all the life in water and high BOD value negatively impact on aquatic life. And here
also 158.7 and 166 for newsprint and crescent jute mills, respectively. In the case of crescent
jute mills when chemicals are used for processing of jute and that's why here 158.7 mg per
litter for BOD value. Represents of COD (chemical oxygen demand). Industrial standard is
150 mg per litter and here 260 mg per litter from hardboard and 250 from crescent jute mills.
And, from the above discussion it is shown that the highest polluting effect shows around the
hardboard mills and lowest in the power station. Here in the case of power station all samples
different parameter are low because power station mainly discharge hot water and hot water
is responsible for mainly water causing heat and that heat is responsible for deteriorating the
aquatic life in the case of feed.
The major value mostly crossed the industrial standards. Value of different parameters
mightily varied with changes of season. In rainy session the pollution effects on the basis of
different observed value are lower than winter season. Because you all know Bairab- Rupsha
river is one of the tidies river in our country and that's why during rainy season most dilution
effects causes the value, cause the parameters lower than the winter season. For this reason,
proper treatment, especially biological treatment like acne slash process, treatment filters are
necessary before discharging to contract the pollution effects.
Recommendations:
 develop a proper pollution control system, continuously maintaining of water
body and information about new compounds that can be discharged into the water
body.
 investigate the long-term effects of the industrial pollution. The human health
assessment should be considered and for the control of the pollution effective
management of the water resource are necessary and education, training about the
concerned subject is also necessary to develop technical person. Thank you all.
76
Status of Ground Water Contamination & Human Suffering in Murshidabad One of
the Nine Arsenic Affected Districts of West Bengal, India
Mohammad Mahmudur Rahman
School of Environmental Studies
Jadavpur University, Kolkata, India
Honorable chairman, co-chair, distinguished guests and friends. The tittle of my lecture is
Status of Groundwater Arsenic Contamination and Human Suffering in one of the Nine
Districts of West Bengal, India. Officially groundwater arsenic contamination was identified
in 1983. We started our survey in the arsenic affected villages in 1988. For the last 16 years
we have been working on groundwater arsenic contamination in West Bengal under the
supervision of Dr. Dipanker Chakraborti. When we started our survey we knew only 22
villages were arsenic affected. The present status is like this. Total arsenic affected districts
are nine. Total arsenic affected blocks are 85, total villages where groundwater contained
arsenic above 50 micro gram per litter are 3200. To-date, we have analyzed 30,000 water
samples with flow injection hydried generation atomic absorption spectrometry. Out of this
,half of the samples contained arsenic above 10 micro gram per litter and 26% samples
contained arsenic above 50 microgram per litter. We have analyzed 28000 Biological
samples like hair, nail, urine and skin from the arsenic affected areas of West Bengal. On an
average, 85% samples contained arsenic above the normal level. To-date, we have screened
92000 people from arsenic affected village of which around 9000 patients have been
identified by our medical team. About 9 million people drinking arsenic contaminated water
in nine arsenic-affected districts above 10 microgram per litter and 6.5 million people are
drinking arsenic contaminated water above 50 microgram per litter. Approximately 300000
people may be affected from arsenical skin diseases. This is on the basis of umbara hand
tube-well having arsenic above 300 microgram per litter.
To better understand the magnitude of arsenic ground water contamination and its impact on
health, we carried out a study in Murshidabad one of the nine arsenic affected districts of
West Bengal. The area and population of Murshidabad are 5300 square kilometer and 5.3
million, respectively. There are 26 blocks in Murshidabad district. We have collected water
samples from all the blocks. The Number of blocks where water contained arsenic above 50
microgram per litter is 24. The number of villages where ground water contained arsenic
above 50 microgram per litter is 990. We have registered 4800 patients from Murshidabad
district.
Now come to the water distribution from Murshidabad district. After working for two years
in Murshidabad district we could not cover the whole district then we decided to cover one
block and we have taken jolongi block. From Jolongi block, we have analyzed 1900 water
samples and we have registered 1600 patients . Seventy nine percent samples contained
arsenic above 10 microgram per litter and 50% samples contained arsenic above 50
microgram per litter. Then we had taken a gram panchayet ,cluster of villages, equivalent to
union in Bangladesh. We have analyzed almost all tube-wells from the gram panchayet of
sagarpara. We have analyzed 565 tube-wells in sagarpara. In sagarpara there are 21 villages.
The number of samples contained arsenic above 10 microgram per litter is 86.2% and 58.8%
samples contained arsenic above 50 microgram per litter. In all 21 villages, we have found
arsenic patients. We have registered 679 patients from sagar para. We also tried to estimate
the probable number of population suffered from arsenical cancer in Murshidabud district
77
comparing with international database. From the observation it is seen that regular drinking
of water with 100 microgram per litter leads to arsenic toxin, in some cases skin cancer. On
this view, we can estimate 0.6 million people may have suffer from Murshidabad district.
WHO reports drinking of thousand microgram arsenic per day may give rise fish skin disease
within a few day, few years. On this view from Murshidabad district 0.22 million may have
arsenical skin lesions, 15 thousand people may have arsenic skin reason. This is just on
estimation. Due to awareness and alternative safe water sources, we have found in some areas
where tube-wells were safe earlier, at present tubewells are arsenic contaminated. So, We are
not sure about the time period of arsenic contamination in this tube-wells ,from when the
villagers are drinking the contaminated water. Nutritional status is also play an important
role. During our survey at Jolongi block ,we found a family where all 9 adults have arsenical
skin disease and bounce. In our four day field survey in Murshidabad we have identified
1000 arsenic patients all of which are suspected cancer and 72 have bounce . From the study
in Murshidabad we reveals that the magnitude of arsenic calamity in Murshidabad district is
severe. Around 2.5 million people are drinking arsenic contaminated water above 10
microgram per litter and 1.2 million are above 50 microgram per litter. Seventeen million
people may suffer from arsenical skin lesions. Plus analysis of biological samples indicates
that many villagers in the affected villages of Murshidabad are sub-clinically affected.
Cancer patients are increasing among those who are suffering from severe arsenical skin
lesions. Children are more susceptible to arsenic toxite. This may be addressed. We need to
study all arsenic-affected districts separately to know the magnitude of arsenic calamity.
Thank you.
78
GOB-UNICEF Arsenic mitigation program in Bangladesh
Shafiqul Islam
Team Leader, Arsenic Unit
Water and Environmental Sanitation
UNICEF-Bangladesh
Thank you session chairperson, co-chairperson and distinguished participants. This is a
presentation with Paul Edward's and he did his presentation in the first day on the village pipe
water system and I will deal with this DPHE, UNICEF-NGO community based arsenic
mitigation project in Bangladesh from 1993 to December 2003. I am sorry that I really shared
this with my soft copy, as electronic copy did not come therefore as a back up I took my
transparency’s. So, I am doing with the transparency. UNICEF did work with this four part
integrated strategy which includes : first one is screening of tubewells, second is awareness
building, third is identification of patients and management and last one is providing
alternative options for safe water. And every the year the UNICEF really did test about 1-2
million tubewells all over Bangladesh in the assigned area.
Now come to the magnitude of this problem. A total of 45 out of 268 upazillas were
assigned to UNICEF for screening. The screening result shows that the tube-well of 600
villages identified as 100% contaminated, in 20 upazila contamination level is greater than 50
ppb. In 25 upazila contaminated level is average 9% and no village was found with 100%
contamination. In 5-upazilas average contamination level is 56% and 944 patients were
identified. In 15 upazilas average contamination level is 60%.
National committee for Arsenic headed by the Ministry of Health and Family Welfare was
established in 1996. Secretaries Committee headed by the principle secretary with 9concerned secretary was established in 2002 . National committee of Experts for arsenic was
established in 2002. District, Upazila, Union and Ward arsenic mitigation committees were
formed in 2000. Preliminary study identified the need for screening of all tube-wells in
arsenic affected upazilas as well as identified the patients and conduct awareness building. In
the year 2000 cabinet division issued a circular to form arsenic mitigation committees at
ward, union, upazila and district levels. The coordination committees at the national level and
the district level, upazila level and union committee and ward committee these are the
systems for controlling this thing. And as part of operational mechanism at each ward for
screening the tube-wells one female and one male person are selected for testing water, they
also do the awareness building activities and there are eight stakeholders at upazila level We
have been trained health and family planing workers, block supervisors, school teachers,
imams, tube-well mechanics and union parishad and local NGOs for awareness building
activities. Local level planning for implementation work plan was developed and followed.
Arsenic Mitigation policy aims at providing a guideline for mitigating the effects of arsenic
on people and environment in a holistic and sustainable way and supplement the national
water policy 1999 and national policy for safe water supply and sanitation 1998 in-fulfilling
the national goals of poverty alleviation, public health and food security. Arsenic mitigation
policy and implementation plan included water supply, health aspect, agriculture, cross
cutting issues. In all the cases research and development and institutional arrangement have
been considered. Emergency, medium and long-term measures have been proposed.
identification of the nature and extent of the problems, public awareness, provision of
alternative arsenic safe water supply, diagnosis and management of patients, collaboration
and cooperation between government and other agencies .All shall work within the
79
framework of the policy. In the water supply sector, total screening of tube-wells in the
arsenic affected areas will be done as an emergency measure. One water supply option for 50
families will be provided in the areas having more than 80% of contamination as supply
given delivery system. The service level will be increased in medium term and long term
measures with community participation. Deep tubewell protocol guideline for dug well, pond
sand filter, river sand filter , guidelines for slash disposal, for arsenic removal technologies
will be followed during implementation. The arsenic removal technology is under validation
test. We did not receive the result yet. In the health sector, case definition, case management
and national prevalence of arsenicosis patients are included. The protocol for case definition
and case management will be followed. In the agriculture sector as no major work is done,
scope of work in this sector is proposed to improve understanding of impact of arsenic on
agriculture, environment and food chain. Various researches will be done at this stage in
crosscutting issues, awareness, groundwater acts, linkage of sanitation and need of support
unit, and co ordination of activities has been proposed.
Strategy to be followed in arsenic mitigation . First, Identification of problems. Villages with
100% contamination, villages with 80-99% contamination, villages with 80% contamination,
villages with 40% contamination- these are the priority areas will be considered for
providing. Dug well, in dug well successful areas pond sand filter, river sand filter, rain water
harvest, where feasible deep hand tube-well in coastal belt land areas. Where other option
will fail, village piped water system using surface and ground water sources, arsenic removal
technology with flood management with other options will try to provide dug well. This is a
deliberation. I do not need to really go sand ponds and filter, everybody is aware of that. The
rain water harvest, I think all participants are aware of this system. Deep-tube-well is the last
option. Deep-tube-well within the depth of 200 meter or more is a feasible option at the
coastal belt area. This will be tried with cautions, simultaneously rain water harvesting and
pond sand filter will be promoted. This is a surface water, ground water source will be used
in existing irrigation well, which is arsenic safe, and can also be used where feasible, you say
village pipe water supply. We have provided arsenic removal technology on RND basis in
four upazilas that are all working well. What more we need to do in many parts of the
country. Where moderate deep irrigation tube-wells are still arsenic free but village hand
pumps are building arsenic contamination in water, small water system could be introduced
utilizing the irrigation tube-well. We have tried one which is functioning at Barura.
Simultaneously, the people should be motivated and sensitize to have their own water supply
system ,safe with regard to arsenic. The present water supply projects may be required to
meet the technological options to provide arsenic and other chemical harmful to low.
Consecutive use of both ground water and surface water should be tried out. A ground water
monitoring network needs to be established to avoid future threats from any other hazards as
contamination in drinking water. Laboratory ,under revenue, at district, upazila levels should
be set-up considering magnitude of the water quality issues. Reference laboratory at control
level should be established. Institutional arrangement should be made which includes
implementation through GOB, Donor, and other development partners involving local
government institution with support from other agencies and other institutions . Thank you.
80
Social Impact of Arsenicosis Patients in Bangladesh
Md. Jabed Yousuf
Project Director, Dhaka Community Hospital
Honorable chairperson, distinguished participants. I am going to present a paper on Social
Impact of Arsenocosis Patients: A Case Study. Arsenic is not a health problem, it is also a
social problem . My case study responded is Rekha. Rekha asked me to tell you about her.
She is 20 years old. She is living at Ahammedpur village of Pabna district. While she is
taking preparation to appear at the S.S.C examination at that time her father died . So she
could not appear at the examination. After her father’s death, her relatives and neighbors
advised her mother to give her marriage. She got marriage at the age of 15. During her first
year of marriage symptoms were identified in 1999 by DCH clinical manifestation.
Symptoms’ like burning sensation over the body, spotted erupted in hand and soars, black
spotted on front and back of the tunge , weakness. During her first year of marriage life the
social problems came .Misbehavior started in father-in-law’s house. She was prevented from
doing household work like cooking and food handling. She was thrown out from husband’s
house after 5 years of marriage along with her two years old son. Her husband got marriage
again. Rekha stated that when first identified her symptoms, many local doctors examined
her. But could not diagnosis the disease. One local doctor advised her not to give breast to
her son. This doctor pushed her 10 injections. Rekha does not know what these injections
were. Now come to the rehabilitation. She was first identified by DCH team in 1999. She got
admitted more than 4 times at DCH and got every necessary treatment. Now she is physically
well, symptoms are reducing. She is earning her livelihoods by teaching.
In order to mitigate arsenic patients and to rehabilitate them, we need more research on socioeconomic issues, need continuous awareness program, training of the doctors and field
workers for the mitigation of arsenic crisis. Thanks a lot.
81
A plan of Action
Dr. Richard Wilson
Professor, Department of Physics
Harvard University, Boston, USA
In 1998 DCH held their first conference on arsenic problem in bangladesh. By this time six
years have passed. But the progress is painfully low. There are several potential solutions
which may be house hold purification, Well reaching dug-well, pond sand filter and rain
water collection to attract the lower scale purification to avoid the arsenic. Feroze Ahmed
discussed it in 2002, probably in char conference, that each one has problem. It needs to
strong community involvement for successful implementation.: Household filter proposed 5
years ago particularly by DCH abandoned because household unable to manage them to solid
waste. Wells switching. we have optimism as best on poison. I think early optimism 70%
tube-well arsenic. We must be able to switch arsenic free wells. That does not work some
villages.. The deep-tube-wells are cheap. They must be built properly and properly
maintained . I should be said tube-well would have handed elaborately ,dug- well also. Pond
sand filter I do not know much about them or the expenditure. I have the record of expensive
experience by group. Rainwater collection is same to all solution them .This is the case of
expensive when nine month storage and must be maintain to keep it to storage for nine
month. Large-scale purification from arsenic limes water may be use for large community
and cost can be reduced. Piping water house to house can be done. If do it from river water it
actually cheaper than the doing arsenic lime. Less complex getting with arsenic and therefor
cheaper. We have dug wells, each NGO should do this. System knows best in the places,
which one is work best . Now the government must to work on the large scale unite for largescale community.
We need community involvement.. DCH has example for strong community involvement.
They provided fresh water for thousand people. Some people to houses. They want to expand
this activity which will probably saturated DCH capabilities but there are other NGOS. If
one NGO provides pure water for 350 thousand people with the 20 NGO 7 million people
can be provided safe water. The government to comply large-scale purification system. It is
task of all others. So, how do you support NGOs?. Should act for fund money direct to NGO.
World Bank asks other agencies to give money. Funding agency can give money to NGO.
World Bank is one to provide fund for social and. economical development. NGOs should be
transparent in their activities. Thank you.
82
Sludge Management In Arsenic Removal Plants in Manikganj and Faridpur
Ms Sharmeen Murshid
Chief Executive Officer, Brotee
First let me introduce to you my colleague Manjur Kader,who has been assisting in this
program and he is also responsible for preparing of this presentation. We talk about the
sludge management in arsenical removal plants in Manikganj and Faridpur. There are seven
arsenic and iron removal plants under DPHE urban areas. In 2003 I decided to visit three
sludge plants two in Faridpur and one is Manikgonj. I went Manikganj to observe how sludge
is being disposed of and managed. Being this is a report based on this investigation, our
objectives were to see the existing groundwater filtration practice, to observe the sludge
management and disposal practice in operation and to understand the level of awareness of
operators of the danger of sludge. The Methodology was simple which includes observation,
documentation and interviews. Two observers were sent to fields to see the process
documents. Whatever sees and happening in the field, short video and written documentation
was made. Plant operators were available for interview. Operators were unwilling to talk, to
show the premises to the outsider, or to talk to outsiders as their management told them . Of
course, we are able to get whatever information we got only because of our persistence. The
Manikganj arsenic removal plant provides drinking water to about a thousand family. . How
does it effect her environment? This is a unit . we look at the waterish pump at top ,the blue
pipe which has two chambers through a sand bed iron and arsenic are separated from the
water. The water is then pumped into an overhead tank, then distributed for drinking through
pipe water network connected to about a thousand family. In the mean time, what happened
to the sludge. It is removed from the filter through backwash and it channeled through orange
pipes. How sludge is characterizing this thing pour into the sedimentation pond. Waste water
is separated from the sediments and it flows up to the pipe and top level waste water is then
disposed of into the river. Unfortunately, our cameraman did not get picture of the river
which is just beyond the wall. Picture one shows the clear view of the sludge tank and picture
two gives the interior view of the sludge tank. The operator informs us women are employed
to collect the sludge from the sludge tanks in bamboo basket. This sludge is then carried for
dumping onto with ditches . According to the operator, women get into the sludge tanks they
are put in and it is paid and their hand collected sludge for further disposal. Now this is called
income-generating project. This is the poverty alleviation and income generating components
of the project for the poor women. The second plant in Faridpur at Goalchamant water is
treated here and passes through sand bed as usual and filter water is passes through
distribution pipe. The plant has no sludge sedimentation or sludge storage tank. This plant
disposed backwash sludge to this drain, which is an under ground that goes through this
slum and straight into the Kumar river. And every 24 hours during each back wash huge
amount of sludge and wastewater is poured into the river. Case three is Faridpur Plant at
Jeocheeri ,a hundred year old repaired plant greatly reduced the amount of arsenic in supply
water but left over sludge which contained iron oxides are directly disposed of the low land.
The process of filtration is the same as in the other plants. Only it has two additional stages UB disinfecting and colonization process. It is found that the arsenic level is greatly reduced
in the supply water. The specified iron oxides are disposed of the low land without
precautions. The operator informed us that the sludge is consumed by fish that is cultured in
the sludge tanks for consumption. The sludge became very healthy and tasty. What is
discovered in these three investigations that we made. Finally, we like to bring to your notice
the lack of good sludge management too have advantages. I would like to mind you the
83
expertise identified the disadvantages because we identified the advantages. Arsenic removal
plants are great poverty alleviation projects for the poor women. These plants make sure that
Pouroshava has a good role to play. Good slag management means that we can now exposed
of healthy and tasty fishes. No sedimentation or sludge tank is a quick and efficient way to
dispose of waste. And finally, if there is a beautiful river flowing by who need to manage
sludge at all and that is my presentation .
84
Safe Water for Agriculture: Treatment System Using Air and Scrap Iron (3-Kalshi Patra)
to Remove Arsenic from Tube Well for Growing Arsenic –Sensitive Crop
Mr. A.H. Chowdhury
School of Chemical Engineering and Industrial Chemistry
University of New South Wales, Australia
I would like to discuss what we are doing for safe water for agriculture in the arsenic affected
areas using air and scrap iron based on the three Kalshi Patra. The university of New South
Wales in Australia carried this out. I would like to thank Australian government for the
financial support university through CRE and for the waste management and through all the
way at the last stage of the project. There is no system invented for purifying water from
tube-well and deep tube-well for agriculture. We have been working on air and iron scrap
system with the hope that it may be possible to develop this system for agriculture water
,eventually for drinking water. What I am proposing? Imagine a pond sand filter constructed
within a large concrete tank .There are different components: oxidation-precipitation tank,
absorption bed with scrap iron, charcoal beds and reservoir from there we get purified water.
From the elevated tank water come through to the oxidation- precipitation tank. These
oxidation-precipitation tanks have several different chambers. The water goes down to up,
then down to up, then down to up. So here it is repeatedly force to the surface and have
oxygen from the air can dissolved any iron (ii). Also oxidant from iron (iii) three, and
specified form to hydroxide particle. Some of the arsenic also dissolved with this particle of
this chamber then water goes to the observation bed and it is flow down through the
observation bed. So, the remaining arsenic can absorbed in the separation iron with iron free
hydroxide particles. Then water goes through the charcoal bed, up through the charcoal bed.
If there is any remaining organic compound such as pesticides might be removed. After that
the water goes to the reservoir. I am showing the laboratory scale model just like this one.
This laboratory system model is operating for two years. It has elevated tanks, oxidation
tanks, absorption beds with water logs to level the water and reservoir for purify water. Eight
litter per day the tube well water continuing 200 PPB of arsenic free though every day for
two years. The water was emerging less 4 ppb, which is below than 7 ppb in Australian limit,
10 ppb in WHO and below less than 50 ppb in Bangladesh. Why the design of 3 kalshi patra
is so efficient? The reason is that it has complete removal of iron soft and there is water flow
easily go through the bed. So it never dries out. And this allowed maximum use of iron.
Another important thing is that the scrap iron bed will be last many for years. We will
surprise when we pull the pieces of scrap iron in the absorption bed we found that only
(approximately) 5% of the scrape iron was rusted. The reason is the iron bed is always
covered with water ,only dissolved oxygen can rusting the iron. So, we estimate that the
three-kalshi patra can operate at least ten years without any changing of the iron bed. Why
we are considering this system? People should be comfortable with this three-kalshi patra.
Because it is the similar concept as household three kalshi that is 3-kalshi system for
domestic water purification.. We have proposing to build in a three large tanks like a pond
sand filter, This system can never be patented since its principles have been described by the
authors in the open scientific literature. All materials are available cheaply in Bangladesh.
We do not need any thing from overseas. Waste disposal is not a problem because the iron
bed system it means absorption bed will last long at least ten years and iron is consumed very
slowly. Eventually, the rusted scrap iron can be disposed of by mixing with concrete.
85
Surface water option is the best option for agriculture purpose and also drinking water
purpose. Air iron systems are methods of a last resource. Surface water option will fail when
agriculture field is far from a river or a permanent pond and when soil is unsuitable for
digging a dug-well and a clean pond or a river is not available. To provide safe agriculture
water the option is remove arsenic from irrigation water that is dig deep pond. So the water
can available in dry seasons. For drinking purpose, only few options are left. One is rain
water harvesting which is currently very expensive. Another one is household three kalshi
methods. It may be cheaper and more convenient to remove arsenic from tube well water on
a large scale like ponds. At the end, I want to say there are no difficulties in testing a threekaishi patra for agriculture. At the best new agricultural water source will be available and
this three-kalshi patra may be developed to provide safe water as a last source when other
options will fail. Thank you.
86
Increasing Trend in Hand Tube-wells and Arsenic Concentration in Affected Areas of
West Bengal. India: A Future Danger
Mrinal Kumar Senguta
School of Environmental Studies, Jadavpur University
Kolkata, India
Good afternoon everybody. Respected chairperson, honorable dignitaries, colleagues and
friends. Today I am going to present the increasing trend of arsenic in hand tube-well. More
cancer patients are happening from arsenic skin disease. In 1983, we have recorded first
arsenic case in two blocks under North 24 Pargana and South 24 Pargana districts of West
Bengal . In 2004 Nine districts are found affected with arsenic. A total of 85 blocks, 3285
villages and 1,28,303 water samples have been covered by us. So, it was very difficult for
our group to survey these entire arsenic-affected districts in West Bengal. I had chosen North
24 Pargana one of the severely arsenic affected districts of West Bengal. The School of
Environmental Studies of Jadavpur University has surveyed in North 24 Pargona in 1990.
The red mark is showing the severely affected areas. From the one red it has turned to four
reds. The red zone increased from seven in 1994 to eleven in 1996. During 1996-98 the
number of red blocks increased further. I have now selected one of the blocks. It is
Begumgaon which is very much arsenic affected block in West Bengal. In 1997 we have
surveyed all the tube-wells that is 1197 and in 2003 we have surveyed again all the tubewells that is 1574 using the same instruments that we were used in 1997. We found that the
affected samples increased by 25%. In 1997 29.7% water samples have arsenic less than 10
in 2003 it increased to11.1%. This indicates that more safe tube-wells are getting
contaminated. In 1997 about 71% samples have arsenic above 10, it rose to 87.8% in 2003
that indicates the increasing trends of the severity. Now I will tell you about another study.
We had surveyed in different areas of West Bengal in 1997 , there were arsenic affected areas
and also arsenic safe tubewells .We had surveyed those again with the same instruments and
same techniques. See this is a photograph of irrigation. For agriculture purpose we are
extracting ground water and we have found that arsenic is growing 6.4 times in agricultural
fields. What happens then? Automatically arsenic will come into the food chain. Now I will
take 2 minutes more. Six years ago tube wells those were safe are now getting arsenic.
In conclusion, I want to say in West Bengal there is huge surface water resource. Here annual
rain fall is above 2000 mm .We need proper watershed management with people participation
to combat the situation. Now I will see you a photograph of the youngest arsenic patients in
Bangladesh . His name is Master Jamil, who is 18 months old. It is my just honest request to
scientists, medical personals, Bureaucrats, technocrats to come forward to solve this problem.
And this is today so that cannot become future danger. Thanks.
87
Community Demand Drinking Water From River Sand Filter
Mr. Ariful Islam
Assistant Program Officer, Dhaka Community Hospital
Honorable chair, co-chair, friends and colleagues. We know lot of people are involved in
arsenic mitigation activities. Here I am going to present some of our experiences on it. As we
know working in arsenic affected villages includes go to the villages, identify arsenic patients
and find out arsenic tube-wells and people ask what they need to do, where they should go
for getting arsenic free water. This is happening for last few years. We could not actually
offer them any option. Then the question of deep tube well came but we found that it is also
not a safe option and then along with UNICEF many NGOs came forward with options like
dug well ,rain water harvesting, pond sand filter . But we found in villages we are drinking
safe tube-well water because the tube-well water is still fresh. There is no smell. We tried to
find out why people preferred to drinking tubewell water even they know about this arsenic.
One of the biggest things we found that tube well is much more convenient than any ponds or
any other sources. So, we started having a dialogue with the people and we found that water
is actually used much more by women than men. For them, carrying water from distance
places is difficult . As the tube-well just is near their home, near their room, so they prefer
tube-well. That culture we have developed for the last 20 years. We tried to find out that if
we bring the water near their home, near their using points may be it will be more acceptable
and more convenient. Now I am bit afraid because in the morning whatever Mr. Salimullha
khan tell that how the World Bank is proposing about deep tube-well and the private
business. Actually, we are not gone for that; we went for the convenience of it. I will try to
talk to the engineer and different persons who are capable experts. We found another
problem, because experts are to offer sort of two-lakh taka just to design a program. And it
was not possible for us to do that as it is not cost effective. Then we tried to do it ourselves. I
must thank specially Professor Wilson and also thank the Government of Bangladesh and
some of the Bangladeshi experts who supported us to do that which we are now doing all
over the country. We are pursuing UNICEF very pleased that Paul Edward actually has a
commitment now for pipe water from the surface water. So, what we did is that we use dugwell in the beginning and it is not a normal dug- well. It is a improved version of dug-well
and is still in experiential stage because unless we go through few seasons you do not know
how much water actually in the dug. Well, What is actually happening? How much they can
give, how much it cost acceptability to the people. These sorts of thing are still going
through experimental stages. Similarly, we did with river water, because 38000 miles of river
is available in Bangladesh. In terms of per capita availability of surface water in the world
Bangladesh position is second. So, started experimenting on it.
Now we can put in front of you some experience what we did. We not only give the water,
we share the cost and it is gone through the community itself. People have participation and
ownership and cost sharing as well. With cost the present one we did river sand filter is
costly. But we think it can be done by sixty thousand taka. A Sixty thousand taka project can
supply more than two thousand people. So the cost of water is about six taka per person. For
capital cost, maintaining cost ,we are charging 20 taka per family . I think we are doing test
every month for bacteria and other toxin .Professor Firoze is very kind enough to organize
testing in BUET and our results are very good. But I must tell you it is not distilled water, it
is a safe water and also we do clinical observation if anybody getting any diseases out of that
.So every family got a card, pay for it and also testing. The person who actually deserves
88
credit for this, he is Mr. Arif. He is not an engineer. He can answer your questions- right and
wrong. I must say many NGOs came and talked to him. This gives us much more strength
that committed to do something probably achieved better.
Actually, the safe drinking water means you must have more or less all these things arsenic
free, must be bacteria free, must be toxin free. Sharmeen has very nicely said that you know
that the toxin is a factor now in rural areas, you should be accepted this part also important
because we put something there and people does not take it. It should be affordable because
in a DCH survey with Dipnaker we found eleven medium tube-wells and 99% are private.
So, we have to provide affordable option which will be convenient, user friendly and
sustainable. Another interesting thing is that there are lot of works on sari filter .Actually we
like to go for sari filter. Six layers of sari can clear 95% bacteria. I do not go their boiling in
household filter, these all things are available. We used this, this is river and that is a thing
we are using. We did area map without doing GPS. In the beginning we did not have GPS.
Thanks to Professor Philip Kays as he donated some GPS instruments. We are doing it now
.From there we pump the water where their is a electricity otherwise we use a tube-well and
reticulate to different households. These are usual staff in a very nicely told by many NGOs.
There is a thing that there is a different chamber there is a brick goes through. If you ask any
questions later will be answered. And sizes of chips those are all added usually there, not
there. But I think with the experience we added different types of chips and different types of
chambers. Now the water is actually very very good. I think I do not know that one of our
experts on surface water and he said it is called '' A'' one system. We got tremendous support
from the village and we are giving more than 1000 people from in one. We said moderately
safe not it is distilled water, it is safe water. DCH is not only provide we also provide health
clinic for arsenic patients and provide medicine for which we thanks to UNICEF and do
quality check regularly .We employed one of the people to see pipe is going all right, there is
no leak in the pipe. Those ponds are filled we are digging. Many dug-wells are now named
after Professor Wilson, they called Wilson dug well. And we are doing bit more after the
check and people really think that it is a God gift and this is a arsenic water, arsenic affected
tube-well and that is what is our presentation . Thank you very much.
89
Working Session 6
Health and Environmental Hazards Encountered with Extraction of Ground
Water and Management of Water Resources
Chair: Dr. Imamul Huq
Appropriate Technology in Action: Experiences in Arsenic Mitigation at Micro-Level
Ali Ahmed Ziauddin
Shobuj Shena Centre, Sibaloy, PRISM
Bangladesh
Mr. chairman, distinguished scientists from home and abroad, ladies and gentlemen. Good
afternoon.
I am trying to make a presentation, which will draw your attention. But before going to the
presentation, I have to confession to me. First I am not a scientist myself. I am a management
guy. Second mostly by using the result of fields’ kits bases the findings of this investigation.
We are sure and aware that they are not entirely dependable. But we see the results are very
encouraging. I am talking about the fisheries project,. Which has a fish hatchery and for
sweet water fish hatcheries we need huge amount of iron free water, otherwise the sponge
coagulates very rapidly. As you see this is the Iron filtration plant, which installed in the
project in 1993. This one is the pump house and that one is the Iron filtration tank, top one is
the overhead tank. Now it can take about 2 feet of Sylhet sand, which is coarse sand, locally
called as Sylhet sand, 9" of gravel and 10" of 1-1/2 diameter stones. The second and third
layers are mostly to retain the sand at a particular level. This proved to be a very successful
method of removing iron. In 1993 we are not aware of the arsenic problem, So our main
concern is to remove iron. Then in 1998 after the floods in connection to another project, we
checked the arsenic contamination of the tubewell. One tubewell contained arsenic around
100 mg per litter. And plus 100 micro gram and another one was about 6.7 micro gram per
litter.
The plant we are talking about is Hatchery Tepra. It had iron in ground water 9.6 mg per litter
and after treated there was no iron at all. Before treatment arsenic contained about 100 ppb
and after treatment it was nothing. Now between 1995 and 1998, lot of people in the adjacent
villages developed their own models. And it had a demonstrative effect. People use their
own models. Please goes to the earlier one.. It does not need three-kalshis; it needs only two
kalshis. And all these models are removing both iron and arsenic. They are using sylhet sand
as the main agent. I agree this has been monitored from 1998 onward. During 1999 – 2001
the monitoring was not so intensive. Then in 1993 DPHE had a project of checking each and
every tube-well in the locality Manikganj. High concentration of iron is found in most of the
ground water available there. So, This model is also removing iron plus arsenic. Out of
several models we had randomly checked about 7-8 and house of Moinuddin using kalshi
filter. The results came more or less same. This was done in June 2003. Again it was done by
the DPHE. Then we asked another environmental scientist engineer Dr. Nazim Khondokar to
do a second test, which was done in January 2004. The result was more or less similar. Now,
my point is I am aware that this was not tested in laboratory. We used, as I said before, field
kits, hack field kits. I do not know how much they are reliable. What the issue is, it needs
dodge or envisage the attention of the scientist, That head of the one sector which needs to be
90
explore much further. Because if it is at all removing arsenic both iron and arsenic. Then per
unit cost would come down to TK.50- TK.60. It requires only two kalshies, one cft of Sylhet
sand and that's all. Bamboo’s in most cases are available in each household and labor they
provide themselves. And total unit cost for removing arsenic from their homestead tube-well,
hand tube-wells would not cost more than TK. 60. For Irrigation purpose, we can again go
back to the same old design as I showed you before, The first one. For irrigation purpose, this
design can be used. So I invite the scientific community to make further investigations into
these models. This model as we have worked for the last several years, witnessed and
observed for the several years, we think it needs to be explored about the waste sands. We are
using the waste sands as concrete or rather as a construction material. I am also aware it
remains in the environment, yes it is true. But let us, I mean, resolved the problem once at a
time. Let us also think about the probable use of that waste or how we dumped it better in a
much more scientific environmental friendly way. But if it does really removed arsenic and
iron, then these need to be exploring further. That’s why this presentation. Thank you.
91
Arsenic In Drinking Water and Recent Knowledge on food chain Contamination
Prof. Imamul Huq
Department of Soil, Water and Environment
University of Dhaka
I will be talking on Arsenic in Irrigation Water and Recent Knowledge on Food Chain
Contamination. Well, much has been talk about the problem of arsenic in drinking water. I
am not going to deliberate on this. But one thing you must keep in mind that so far in our
country there is still some discrepancy about the arsenic contained in drinking water and the
number of arsenicosis patients. This has pointed out in my study. Is there any relationship
other than arsenic in drinking water? You know that in our country more than 40% of the net
cultivated areas are under irrigation. During the boro season we cultivate boro rice, wheat,
and other vegetables with irrigation water. And definitely about more than 60% of irrigation
water need is met from ground water and in many cases this ground water is contaminated
with arsenic. So there is a possibility of entering the arsenic in the food chain through crop
transfer. Arsenic contamination in the ground water is different in the different geological
origins. In our study we have also found similar results. Old blasts seminal soil area is
relatively less affected because of its geological formation but other alluviums are more or
less affected but tista alluviums is more less affected compare to gangatic alluviums and
meghna alluviums. The concentration of arsenic in soil is much higher in those soils than in
this soil. Actually, what happened when we collected contaminated soil sample and
uncontaminated one. For the same species there is lot of difference in the concentration of
arsenic in them. But gives an indication that differently there is an uptake of arsenic, which is
present in the system. There are crops such as arum and onion. Arum from gangatic
elevation soil the water is highly charged and the concentration of arsenic is very high
compare to other same plants collect from other areas. The plants collected from gangatic
alluvium area contain more arsenic than the other areas. And, this has a relationship with the
arsenic in water. We have found that there is a co-relation between arsenic in soil and arsenic
in plant, in some time they have negative correlation. But when we tried to calculate the
arsenic in water and arsenic in plant, it is very highly correlated. For arum, the slope of the
regression line is found to be more than one and there are other crops which have exceed.
This gives us a Medication. Even from our green house experiment, we have found that
arsenic in water goes directly to the plant. Even from soil the water solution action is
available to the plant.
Now when we calculated the arsenic concentration from different areas from different crops,
the minimum allowable level is about O.2mg per kg dry weight. So here the red ones it
shows if you take more than 10mg per day we exceed the maximum allowable daily level
limit like this. There are some crops, for example arum. We have found arum is an
accumulator. Although we know that for combating this arsenicosis, it is better to prescribe
nutrition. In rural area green vegetables are good source of nutrition. Arum is a special crop,
which is consumed totally that means we eat their leaf, we eat the roots, and we eat
everything. But unfortunately these crops when growing with arsenic contaminated water
accumulate this element. We have found that if the transfer factor that means the arsenic in
plant and arsenic in soil exceed the value of point 1, it means the plant has an affinity towards
this element. We have found many vegetables have an affinity towards accumulation of
arsenic. For wheat and arum the value is more than 1. We also analyzed rice collected from
arsenic affected areas as well as from under grown and small conditions. In rice the
accumulation is mostly in the roots followed by stem and small quantity is accumulated in
92
the grain. For wheat, the situation is same. This means that these two crops when receiving
arsenic contaminated ground water as irrigation, they are accumulating it, but they are
sequestrating them mostly into the roots and the stem. Small quantity is transferred to the
grain. The accumulation of different plant parts, roots contained the highest amount whereas
the grain husk and leaf contained very smaller amount. Amount of rice consumed per person
depending on the area where arsenic concentration is high. In Jessore area about 32% of the
population are at risk of arsenic, which is more than allowable daily limit. But in Rangpur
area the contamination is very low and only 2% population are above in D.I and for
Bangladesh it is about 19% on an average. Now there have been questions about the arsenic
in plant bacterial. Many have put the questions even if it is there, is it be available. That
means whether how much of it is available to the body. We had an experiment, Not here but
in Australia. It was done with pigs because we cannot use human model. The pitch layer fade
with vegetables there were silver bit and rice cooked with arsenic contaminated water. It was
found that from silver bit the viability was around 27%. But from rice the viability was 82%.
So, definitely the viability depends on the nature of food also.
Before I finish I must give one the conclusion. There is evidence of arsenic in irrigation water
enters the food chain. Now what is the way out? Can we go for alternative source of
irrigation water; I put a big question mark, going to surface water. But in some areas surface
water is not available for irrigation. What is the option? There is one option .We can go for
crop diversification. We choose the crops, which do not accumulate arsenic and other option
for rice because we have to live on rice. We have to find novel methods of rice cultivation.
Thank you very much.
93
The WHO Water Safety Framework Approach to Arsenic Mitigation
Dr. Guy Howard
International Specialist
Arsenic Policy Support Unit (APSU)
Good after noon, Ladies and gentleman I am going to describe WHO guidelines to Arsenic
mitigation. The new guidelines can be used when thinking about arsenic mitigation. To give
This guideline will be published in next couples of months. This guidelines are developed
through experts taken from all over the world and which are very widely consulted, Why do
we study this?. We study because this is new guideline shows a significant departure from
previous editions of the guidelines, particularly for mocrobial aspects, becuse they place an
emphasis on risk management and risk assessment approaches and place less emphasis on the
analysis of water quality.
The new guideline have five key steps: health base targets based on an evaluation of health
concerns, system assessment to determine whether the water supply chain can deliver quality
water, identifying effective management process control to develop management plan, how
to control safety under normal and incident conditions. And in particular to focus monitoring
on very simple surrogates. Where you get all most immediate information you can take
action upon. You do not need to wait any length of time for water quality result before you
take action, independent verification through surveillance program. So step two could be
integrated because of water safety plan. This draws on the principles of. Analysis a critical
control points approach which is being applied in the feed industries since the early 1970.
This approach basically emphasis's controlling in the processes. Well if you look at the
Australian drinking water guideline New Zealand public health management plan, Swiss
drinking water regulations they have been apply this concept for a number of years. The
AEU last year seminar on drinking water directives accepted the risk assessment, risk
management approaches. Experience from European countries showed that they preferred it
as water safety management. There are some experience in Africa in Uganda to apply this
approach Why would be thinks about this in terms of arsenic mitigation. Because we talk
about safe drinking water .Arsenic is the important issue.. We should be trying to leave a safe
drinking water not just arsenic free water. We also have to recognize the pragmatic Asian
program for goers. We after applying in change of water sources. May be that will be in
addressing arsenic potentially introducing new rest? So, we need to think about it about how
we control in advance. So that concerned have obviously included pathogen bacterial viral. It
may include things like soil bacterial toxin. We know in some areas in Bangladesh you do get
toxin in saw any bacteria that approach the toxicological effects now. It may be other
methods may be other organic chemicals. So why we are trying to do this? What's those the
arsenic policy support unite we are doing at present its under taking a risk assessment study
to try this kind of water safety frame work approach to understand what are the kinds houses,
state. We are progressing in two phases which first -one is a dug-well and deep hand tubewell. With the second phase surface water and rainwater. Anything, both primary and
secondary data from water supplies. And includes development constructive household
models. We are looking for the assessment to understand what scale of risk is implied by
shifting to new options. But the more importantly have we controlled this risk is not say.
There is another problem. We prevent the coming to rise of problems. We need to understand
what supporting training may be required to manage these risks. We want to understand
acceptability about whole process study. Most importantly this whole process is not designed
94
exclude options. I went through the field study on safe with water quality testing and social
acceptability assessment. We have statistically representative number of community.
I always try to get arsenic study is to inform the policy environment about how water safety
can be developed. How we can developed a system of water safety plans We need to get at
the moment,. I think, overall understanding of public health will be associated with water
which will significantly help for investment planning as well. Thank you very much.
95
Arsenic Mitigation at The Village Level: The Araihazar Experiences and a Draft
Framework for a National Strategy
Dr. Kazi Matin Ahmed
Department of Geology
University of Dhaka
Thank you Mr. Chairman. Before I start I would like to acknowledge my co-authors from
Columbia University. And what I will be presenting here is the based on experience from our
ongoing activities at Araihazar Thana under Narayanganj district. We have been working
there for some time now and we are doing a number of things. We conduct our activities in
three different areas- earth science, health science and social science. But I will be presenting
here is based on our activities in the earth science areas. Most of you know Araihazar is very
closed to Dhaka. In Araihazar almost half of the wells are contaminated and 50% of the wells
have arsenic above the Bangladesh limit. This is one thing, which we are found very useful, a
good map of the area. We tested all the 6000 wells within our study area. And, we do an
accurate mapping using hand held GPS and overlaying the positions on satellite images. This
is mainly a medical study funded by NIEH of United States. We thought we could also
provide them some mitigation. First, after the mapping we told people to switch well from in
the areas if you have green well and red well near by. We tell people this one is good one,
doesn’t go that one. And, we found a good response of that. Our experience have been
published in the WHO bulletins in 2002. We are installing a series of community wells in
safe aquifers. And, this is the kind of things, which we are following. First, we map the
contamination then we estimate safe tap at each village level. Then we select side on the map
then we go for discussion with the community and we have a suitable side we go for training.
We install tube-well after testing the arsenic on the spot during drilling. We install tube-well
if it is within Bangladesh standard. Most of our wells so far we have been installed comply
with the WHO current provisional guidelines and we keep monitoring all these wells. In that
case what we do first. We identify probable areas where we can start installing. We go to
areas where most of the existing wells are red, which water is still above the Bangladesh
standard. We determine safe tap for each village. We are not driven by a pre-conceived tap
like if you compare our area with the national data presented at the BGH, DPHE report. We
can have safe water at depth deeper than 100 meter. Whereas in most cases at deeper than the
100 meter. For each village we determine that and in some villages we have found that we
can have safe water at 30-meter depth. Some villages at 60 meter or even in other areas
deeper than that up to 120 meter or 200 meter.
In the case of well drilling we do a number of things. We analyzed the sediments for total
arsenic content .We also study the color of the sediments. We have seen that there is a good
co-relation between color of sediments and arsenic contents. We have seen that gray
sediments have got high arsenic, dark sediments, bleak sediments also got high arsenic. On
the other hand, radish brown sediment has got low arsenic. We also try to test the rate of
release. We have seen that gray sediments released much higher amount of arsenic than the
red sediments. This red sediment does not release arsenic at all. We have developed one
technology, while drilling we can take sample from a target depth what we called needle
sampler, using this needle sampler we can take sample from the target depth while drilling.
We can take water sample, we can analyze on the spot and for these analyses we used the
hack kits. So far we have developed about forty of this community wells and most of them,
except one or two, are within the WHO limit 10 micro gram per liter. We have only two, of
96
which one have got 25 and the other one has got 18 micro gram per liter. We are thinking of
re-installing these two so that we can comply with the WHO limits. We are monitoring all
these wells. We have the bore locks, we have the well fixture of each one. We monitor
arsenic, we monitor water level, and we can see for most of wells except one arsenic
concentration is not change at all. Only one well, which is well number 4, this was not
developing at target depth. This is one of our experimental wells where we can see some kind
of fluctuation in the arsenic level. Otherwise there is no change in arsenic level for the two or
three years. We are also monitoring water level from the different technofers. And, we have
another equipment that we used to log the wells to get the lithology, In Bangladesh there are
many wells, but we don't have the sub-surface information. We can use this login tool to
investigate the sub-surface geology. We are doing isotope study to know the residence time,
rate of recharge. We can see the clear difference in age from the upper aquifer and lower
aquifer. We are trying to estimate the recharge rate and thus to ascertain the sustainability.
We have seen that there are variations in the rate of re-charge in the upper aquifer and the
lower aquifer.
We have seen the installation of community wells has helped in reducing the arsenic
exposure to the local community. We have urine arsenic analysis results from our health
group and we have seen that arsenic in urine has reduced by half over the last two years while
we provided these safe options. This is the urine analysis from the first analysis and this urine
analysis is from the second analysis, see almost reduced by half. Based on this experience,
we think we can develop a strategy for arsenic mitigation and there is background for this
when the Columbia University president and the Director of Earth Institute visited
Bangladesh last year. They met the honorable Prime Minister and she requested them to
provide a kind of strategy for arsenic mitigation in Bangladesh. So, this is the background for
providing this. The main points what we think from our experience in Araihazar that special
variable of arsenic requires evaluation to mitigation at village level scale. So, we need village
level planning and then we can have low arsenic aquifer beneath every village. Then
household response to information about arsenic and status of their wells, we have found as
very good. When we tell them this well has got high arsenic, they don't take water from that
one. If there is a well near by which has got low arsenic, they go to that well. This means we
need to disseminate the data and based on this we think that strategically located well can
provide sustainable option for arsenic safe water. This is the draft strategy developed by
colleagues from Columbia University and involved many people in United States, in
Bangladesh, in UK and this is what they have presented. I think this strategy is now with the
expert committee. We have seen that when we have compared our data with the DPHE,
BAMWSP field testing data what we are seen. Only 12% have got discrepancy otherwise the
field-testing has mapped the red one correctly. We think that approach can be used
nationally. What we need first of all a map, an accurate map and then for each village we
need to determine the safe tap. For doing this, we can use these kind of things like GPS
receiver, a computer, field kits and we can train the people of village workers, volunteers
how to use this and then we can map the arsenic contamination accurately. For each village,
we can develop safe community well, one or more strategically located safe wells, which can
provide arsenic safe water. For this, we need a national plan. Like this starting from village
and data generated at village level can be transmitted to the union, from union to upazila,
upazila to district level and up-to. We can build up a national surveillance program
accordingly.
In concluding, before designing any mitigation we need to map accurately and community
wells are seen to be a successful in reducing arsenic exposure. Community wells can provide
97
safe drinking water not only safe from arsenic. This is one important issue. We are talking
about arsenic safe water but this is the time when we should talk about safe water. There are
many contaminants such as in-organic and organic contaminants. We should consider this
entire thing. Surveillance and resource monitoring is very important after installing any kind
of new options. We should monitor that. Other safe water sources can be used in conjunction
with community wells. Involvement and participation of community is also very important.
If we don't involve them, we cannot ensure the sustainability. Last one, much time we are
told that ground water is tables water, actually it is not that. This is a god gift for us. If we
don't use it properly, then we bring all sorts of problem. . There are many versions in Holy
Quran, which tell about the origin of the ground water, use of ground water, management of
ground water. If we manage our ground water properly, we can use it for long, long time.
Thank you very much.
98
Dr. Dipanker Chakraborti
Director & Head
School of Environmental Studies, Jadavpur University
Kolkata, India
You know that I decided not to give any lecture to this conference any more. That’s why in
the first day I am not delivered any lecture. What make me to come to the floor? I am telling
you about that the last lecture, placed by Professor Matin, is a very good lecture. You see
how scientific, how accurate, how precious it is. What they are doing is unique. Side by side
see the ground reality. On 16th, today is 17th, we went to field -Urine, Laksham, Comilla
district. When all of you are sleeping our full team went. That makes me today to say
something different .
The Urain Village is divided as North Urain, Middle Urain, South Urain, East Urain and
West Urain. It has 735 households with about 5000 people. I asked them what can we do? I
immediately decided to take a small area so that we can finish. We took middle Urain village.
The population is around 2000, which is the densely populated area. Our medical team
includes Selim, Tanzia, Professor Mukhrjee, me as a helper, since I am not a medical man,
and rest of the people. As usual ,I asked them how many people do you expect in this area.
Whatever the information I wanted they told me you can expect 100 patients from there, 100
patients from middle area. We continued and with time I am getting mad. It is unbelievable.
In last 18 years in India, West Bengal, Bihar, UP, Jharkand, 8 years in Bangladesh I never
saw this. In the same Urain village I went in 1996. I went in 1998 the same Urain village.
They remember me; they recognized me, they asked me. They asked my friend Asutosh that
you have done in Laksham. The place were we sat near there is a ground water tank that
means under ground water. The water is going to the tank and people are getting the skin
lesion. No, this is recent. How do you know recent? 17 years girls, 8 years boy all have the
skin lesions. I could not believe it. I asked them deeply what shall we do only one dug-well?
This time they have no water for three days. They are getting one hour water, and they are
drinking from the same contaminated tubewell. A boy told me that last one month they have
a new tube-well and that water as soon we started drinking, you see whole body becoming
black. And I saw their tongue, membrane maleness. I asked it is neocuss membrane
Maleness. Well, the people who were severely affected earlier, I saw these patients. I am
seeing them after some time, carcasses is another thing it should decrease if the water taken
was good water. But no there is increasing that he has suspected carcinoma. The same patient
I saw he remembered me. At that time I did not see that but by this time it is increasing. We
have seen very few such symptoms passed positive. He has all the symptoms possible. he is
an idle example for as an arsenic patient.
Now by this time millions and millions dollar came. But whether they got something. No,
they donot. A little girl told me that her face will not tell me, she has insight. I requested her
much more open; yes I want to see you. She has all the skin lesions. If they still continue she
will be lost. This is not a single child. Another child with all maleness and keratosis on hand.
My neuropathy professor Mukharjee is here. Professor Mukharjee saw altogether 146 arsenic
patients with skin lesion and 60.5% of them are with neurological affects. He told 7 children
with neurological affects below 11 years old. People says don't give lecture, we become
emotional. Can you feel if she is my own daughter of my own blood, what I would have
done? She lost. She is an arsenic patient. They are two sisters. These two little girls lost their
mother and father within last two years. And all died with SIT with full arsenical skin lesion.
99
They are orphanages. Shall I ever forget to see this face again, shall I even a human being can
forget this face. She is an arsenic patient. Yes, will forget her, and I know next time when we
will come I will not be able to see this face, because this face will be finished.
Selim is not here, he is newly married. But I have Tanzia with me. On the 8th of this month
she told me Sir I want to go with you. Let me tell her experience, what she she has seen..
When I just go for the field trip I was very much excited. It was my first field trip for
arsenic. I was very much exited but when I go over there and see the patients. I just can't help
it. There is like commingle flood. All are patients of a family. A girl, Sultana Parvin, touched
my hand and I see her it was so full of fear because all upper surrounding there three or more
persons died of arsenic. There was ulceration over the area and she told that her mother also
infected. But I can see her cause. That very moment in the house I reach over there. She
touched me and tried to tell me please help me. I don't know what I can do but I will try to all
of you .Please safe them, help them before they die.
That’s all. I will finish with only one word if you go to that village ask how may died during
last 8 years. In each family there is loss and the all died with the heavy arsenical skin disease.
Many of them died cancer. I am not co-relating arsenic with cancer but they are telling when
they died they had severe arsenical skin disease. What shall we do, what million dollars will
do?. We will get more scientific data. But to me useless, useless, and useless until we can get
the people help for the people.
100
Professor Quazi Quamruzaman
Chairman, Dhaka Community Hospital Trust
Before I conclude I would like to give my opinion on what we are doing and what should do.
Definitely do for arsenic safe water, at the same time the water should be safe from other
problems. At the same time I think now we have to look at the genetic level of human
biochemistry. As day before yesterday and today also Dr Dipanker was talking about
neuropathy and all this thing. Recently, I came to a report done is our country that the in
arsenocosis patients dokaminbeta hydrocogilar activities slow down and that is responsible
for neuropathology and also in that finding here shown that some low molecular proteins are
absent in arsenocosis patients, particularly the 24 kilo. Deton protein which is absent there.
At the same time, glucose level is higher in arsenocosis patients. That scorboric acid and
other things. So, with all this option that we are trying to mitigate arsenocosis, your answer
that what you have presented today emotionally even we supply safe drinking water the food
chain is there. So, we must now act on the genetic level that means how to mitigate from the
other end that means we have to find whether we can use recently developed gene technology
to cure people. So, this is my feeling and I thank to audience for the patience hearing Thank
you very much.
101
Closing Session
Chair: Dr. Maniruzzaman Miah
Dr. Ahmed Kamal
Professor, Department of History
University of Dhaka
Good afternoon, ladies and gentleman. Let me welcome you all to this closing session of the
fifth international conference on arsenic organized by Dhaka Community Hospital and
Jadavpur University, Department of Environmental Studies. By no means I am Professor
Moniruzzaman Miah Incarnation or replacement nor I man to be. I am just holding the chair
till such time when a returns, and takes the chair to continue the session. So, pleased bear
with me till then and let me start the session today. We have among us who are already
present Mr. Badiur Rahaman member of Planning Commission who is sitting right beside
me. Mr, Abul Kasem I don’t see him, say Tanvir Hossain I don't see him. I see Dr. Richard
Willson very much from Harvard University. I see Mr, Mahfuz Anam, Editor, Daily Star,
Miss Khushi Kabir, Co-ordinator, "Nejera Kori" yes very much she is there. Mr. Mortien
Gearshing right there. I don't have eyes behind me. So could not see people sitting behind,
And then Kristina Walech behind Mr.Atiqur Rahman Salu, yes and he is there. Mr. Musud
Kamal. So, without wasting any time let me asked Mr. Badiur Rahaman to make little
presentation or comments on the arsenic situation of Bangladesh to what extent government
is really responding to whatever is happening in an around the country and may be ten
minutes. There has been a little change in my understanding of the program, not really in the
program. Professor Aynun Nishat is supposed to present the finding and the recommendation
of this conference. I see him getting ready.
102
Conference Findings and Recommendations
Prof. Ainun Nishat
Country Representative, IUCN
Mr. Chairman distinguished participant. It is my privilege to present to you the
recommendations and the findings of the 5th international conference held over the last three
days. A number of points are made and what we have done by siting with the rappotiur, we
have picked up the some of the very important points. I mean we have been able to pick up
all the points. But we tried to pick-up some of the important points and may be three or four
points from each of the session and three or four recommendations from each of the session.
As you can see the 5th international conference started on 15th and today is the concluding
day and started with an inaugural session which was chaired by Mr. Moniruzzaman Mia and
there were other speakers also. During the sessions a number of points are made and first
point was coordination among all party working on various aspects of management of arsenic
related problems and this should be strengthened and streamlined and these are very common
questions even during lunch time a gentleman asked me that there is no coordination. I said
to Sir what are you working on and he is a doctor. I said in all the meetings we have the
secretary of health, DG health presents, that is the way we can achieve coordination. But
possibly they do not go back and transmit and communicate. This is true about every sector.
Then every body is talk about an arsenic policy and this we heard that this arsenic policy
emphasize on coordination and this policy documents ones approved by the cabinet should be
circulated. Like other policies of the government this is a document which should be
available to all. This was a point made on the inaugural session. Emphasis should be given to
use of surface water in water supply project. This is again we are talking in every meeting
every session but nothing is happening. What is happening in arsenic in the food chain?
Seventy per cent of the irrigation in the country is based on ground water, if ground water is
contaminated by arsenic, there is a possibility of arsenic going into the food chain that must
be controlled and towards that we will come in a minutes.
People are saying, the researchers are saying that we should really going to surface water for
irrigation also. The conference was divided into six working sessions on four themes. We
clustered them around four: arsenic health issues, safe water supply options, water
availability and rational use of available water resources. In one of the sessions a number of
papers were presented followed by comments from special guest, chair, co-chair and the
main observations and recommendation were made in each session and summarized below.
Now let me make a clarification the young persons who helped me in putting of this
comments. They picked up all the points but in the process I have picked up few. If you have
a point is left out, please blame me, not to the rappotiurs and the people who have covered
the sessions. It is not their faults, I take all the blame. Having said that on health and
management issue. The first observation is the number of arsenocosis patients is on the rise in
Bangladesh as well as in neighboring countries, especially in Bihar and West Bengal.
Medical complications from drinking arsenic contaminated water are now being manifested
through bronchitis, lung cancer, neuropathies and gangrene of limbs. I mean we heard about
gangrene of limbs and that was quite known phenomenon but neuropathies and other these
are also coming up. Various interventions in management of arsenocosis lack improve
nutrition along with anti-oxident, perulina, Cellerium etc. are on trial. So, this is an
observation, Not all the exposed person of arsenic contamination develop arsenocosis. Why?
103
Possibly nutritional or possibly genetic factors affect bio accessibility of arsenic. Now if
these are four major observations on that theme then the four recommendations are already
developed. Arsenocosis patients identification protocol should be strictly followed, research
activities on the effect arsenic health and diseases such as cancer, bronchitis, neuropathies,
etc., are recommended. treatment agents like anti-oxident, selenium and other micro nutrients
should be recommended to patients with backing of proper scientific evidence of their
effectiveness. We are very polite in saying that these are still not proven facts, therefore we
should be careful about it. And, finally nutritional support that is available protein sources.
By available we mean fish or anything that is available, vitamin rich vegetables and fruits by
vitamin rich we also indicate the processing of the vegetables, should be given to all exposed
as well as to the affected patients.
Moving on to the social and economical impact we have two major observations. One, social
discrimination is prevailing among arsenicosis patients. Affected females are discriminated
most in terms of marriage and social relationship and I personally was horrified to find their
discrimination in collection of safe water. In other words, they are not allowed to collect safe
water. Because of this improper understanding economic suffering of the affected families
are on increased. Therefore, the number one recommendation is health education is needed to
remove the misconception that arsenicosis is a contagious disease, which is not. And this is a
big thing that should be achieved. Social and economical rehabilitation of physically
handicapped persons, especially the female should be organized. Moving to the third theme,
which is surface water as a source of safe water, our observation is dug-well water is safe in
terms of microbiological contamination, if it is constructed properly and kept covered. Now
by constructed properly, means not only the construction procedure but also is location with
respect to the nearby latrine or contaminated ponds or whatever wetland that could be there.
Improved dug well is well accepted and affordable, and can easily maintain by the
community. The second observation is Bangladesh has huge volume of surface water in
monsoon months. With proper investment and appropriate management efforts surface
sources can provide safe water to all, Now we need to have investment to conserve the
monsoon water so that it can be used in the dry water period. The proposed diversion of
water in the upstream reaches would adversely affect the availability of surface water could
be even in the monsoon month. Obviously it would affect in the dry months, but could even
in the monsoon month. We don't know what is going to happen over there. Then the third
observation. Water from protected ponds and also from rivers can be a source of safe
drinking water if treated by the slow sand filter like pond sand filter or river sand filter.
Finally, people in small urban area, semi-urban areas, rural areas can be served through pipe
network that could be based on dug-wells, pond sand filter and river sand filters. So, the
recommendations are traditional dug-wells can easily be improved by providing cover and
lining of clay or concrete ring or brick work and if fitted with a hand pump could be manual,
could electrically operated. Through that process, we can distribute the water among the
selected people. Improve dug-wells and river and pond sand filters should be introduced with
management of the community. We cannot have outsider to go for manage it for their. One
pond should be provided in every village as per as practicable. As a source of water minimal
treatment of pond sand filter should be required for drinking purpose. If the pond is protected
from contamination for other domestic uses no treatment would be necessary. So the main
point here if the pond is protected from contamination and therefore there is a strong linkage
between sanitation and water supply. Similarly, river sand filters are recommended as a
major source of safe water because in a majority parts of the country we do have river water
round the year.
104
Now moving to the fourth area, which is safe extraction of ground water and related health
and environmental issues. The observation from this conference is depth of arsenic aquifer
varies from place to place. And, deep aquifers considering only the depth perspective are not
always arsenic safe. There is a general idea in the country that such and such depth is safe
which is not true, it is a variable all over the country. It is a function of age of the sediment,
etc. Number of arsenic contaminated tube-wells is increasing in Bangladesh as well as in
neighboring country that is India, including so called deep tub-wells. The third point is sludge
from arsenic removal plant may cause severe environmental hazards over the years because
the sludge removal or disposal protocol is still not very clear. It s not practiced properly. It is
observed that arsenic contaminated irrigation water from tube-well is a matter of concern for
food chain contamination.
Therefore, the recommendation number one is further research and performance of arsenic
removal plants and sludge management is required before their long-term environmental
effects are understood. The second recommendation is re-testing of the present green
tubewells as well as deep tubewells be done periodically to find out their arsenic level. In
other words, a tube-well may be green today, may not be found green tomorrow because
there could be movement of water from one aquifer to other one and this is true also for deep
tube-well. We do not know how safe this deep-tube-wells are. And, finally research on food
chain contamination and contamination of the soil from arsenic ground water should be
undertaken. So, these were some of the important findings which are slightly improvement
upon the research of the comments that were made up to the 4 th conference. I am not saying
these are not known but theses are kind of the points on which emphasis was given over the
last two days and these are the recommendations. Thank you.
105
Discussion by Special Guest
Mr. Badiur Rahman
Member, Planning Commission
What I am going to speak not fully as a member of planning commission also as a citizen
with my little background working in local government division which is the focal Ministry
of government for arsenic. If you allow me to the freedom of speaking and speak my mind. I
am happy these recommendations have come and if I recall the previous seminar and similar
recommendation were also made. But ,of course, this is much more emphatic on crucial
issues as we pointed focus on the important aspects of the various issues and topics dealt
with. Since time is short, I would like to make a brief comment because if arsenic is a
problem which is affecting ,if I understand at least in by number of district and upazilas, half
of Bangladesh, then a missing link I find in the discussed topic is that the people at the
grassroots level, the villages, must be involved in decision that they fix their life and
prospects. So you should be as good at a topic along with other topics like arsenic issues,
water availability, health care arsenic, and the role of people or if you add the role of people
in the affected persons, arsenocosis patients in particular, how to involve them and how to
develop their ownership in this problem. Unless we do, this remains always partial and
inadequate attempt at any discussion on arsenic related problems. And this has been a
problem not only on arsenic but any way it is being said the heads of State of SAARC
countries are recognizing this in a SAARC seminar also. The missing link in all the
development strategy in general is that the people don't participate in the decision that affects
their life and prospects of people at the grassroots. Having said that I am happy to report and
I find, I am very happy because during our previous tenure in the local govt. Secretary, we
went to the national experts on arsenic and related problems. I find one Mr. Abdullah is here
and I recall there we spent 3-4 days under the leadership of Aynun Nishat. They gave us an
outline on the action plan, national plan or policy whatever you say. The outline of that and a
framework what is to be done. There were three main stakeholders, One was government
itself, because arsenic was an issue encompasses about 8 or 9 ministries at that moment. So,
we had a meeting with 9 secretaries, with local govt. was the focal ministry ,focal point of coordination among the nine ministries, to take up a coordinated plan. Number two was, of
course, going to national expert and come out with a solution or with suggestions which are
cultural relevant, which can be grafted in the system not like something coming from outside
indigenous. So, we focused on that and I am happy as you find that those recommendations
which are available in the retreat or formulated by the experts ultimately went as inputs to our
national policy which is pending the cabinet discussion. The third stakeholder as I found at
that time of the local govt. secretary was a development partner. We had a meeting with them
similarly, like the efforts at the governmental level going on uncoordinated and disjointed
fashion: Same was the practice going around the development partners in most disjointed and
less coordinated fashions the efforts for tackling the arsenic problem all over the country.
Here I must say I felt it is not total my failure because at that time I got transfer from local
govt. and I found a feeling of uneasy. The donors along with the coordinated efforts of the
government and the national policymakers at the national experts committee which gave us
the outline. So, I don't know whether after the submission of these recommendations and the
policy to be decided at highest level. Once it is own, this role still will continue. The
coordinator role of the government means 8-9 ministry relevant to the arsenicosis problems
and its solutions. The involvement continued and active involvement of the national experts
106
so that they continue to give advise which is culture relevant, which is indigenous with can
be grafted in the system. And the third last but not the least the coordinated not the disjointed
efforts of the development partners coming out as support and creating the removing the
problems and bottom access by the govt. or the people what ever you say. These are the few
points I wanted to say if you want to have a full proof, satisfying sort of satisfactory policy
and implementation plan, these must go together, otherwise if there is imbalance between the
three main stakeholders, it will not work. I also would like to say with a ray of hope that this
comes out of my experience from temporary dropout from bureaucracy working five years
that we have been too long treated the people as object receiving and beneficiary. Let us treat
them as part of our concise plan of taking them as subjects. So, they day own this fully once
they treated as subjects. I am sure this gigantic efforts of tackling the arsenic issue will much
easier, much relevant and I think it to be sustainable too. These are the few comments I had
to make. Thank you very much.
107
Mr. S. K. M. Abdullah
Member, National Expert Committee
Mr. Chairman, ladies and gentleman I don't know what have been put here. My name was put
here. I am talking for last three days. Yesterday there was a hartal day, so we organized an
emergency meeting in the afternoon from 2 p.m. or 3 p.m. to till 5.30 p.m. But here I let be
mentioned we start from Dr. Aynun Nishat’s summary. The summary was quite good. It’s
summarized the recommendations of the proceedings of the conference quite well. And Mr.
Badiur Rahman has already started the discussion. So, what happened after we came back
from Gazipur. Mr. Badiur Rahman was transferred from the local govt. ministry. Some other
changes also took place. But ultimately the secretaries committee decided to prepare a
national policy and a national implementation plan, and it was came on my shoulder to took
this convenor of a member of a committee expert of twelve persons. We spent few months, I
think, almost two days a week to prepare that policy and implementation plan. And for the
donors present here this was also given to the donors. They sent a four-page reaction to this
national policy that was drafted by us. We try to incorporate as much as possible the
recommendations, these comments and it was finalized to sent to the national expert
committee for approval. Then we are waiting for last four-five months to get a cabinet
approval. I think it will be approved may be in the next few month. But there to continue Mr.
Motiur Rahaman’s concern the policy gives a lot of emphasis on the local govt. institutions
and local level responsibility for water supply. The people should decide what type of system
they want, what they can maintain and what they can afford. This policy and the
implementation plan’s whole heart is people’s participation at the local level. In the mean
time initiatives were taken. There are arsenic committees in the ward level, union level,
upazila, level, district level. We want the people to keep them informed, people should be
told these are the options, what you can afford and this will be the maintenance cost and they
will also urge to share around 10% to 20% of the capital cost. So that they feel that it is a part
of their project. They should supervise the implementation of the project. This is the heart of
the implementation plan that is now waiting for the cabinet approval. Last 3 days have
brought up a lot of new information from all over the country including West Bengal and I
think these 3 days were very fruitful. Because we got a lot of new information that we can
use, but still my concern is that we have talking lot. We are talking in last 7 years but doing
very little. Now it is a time to go to the field and start doing something. This is my advice and
request to the donor's. That's all come together to try to solve and help people. Dipankar gets
very emotional when start talking because he meets the patients. Here, if you go to the
arsenic ward at the 3rd floor. I think, you are also become emotional and you will understand
what are facing thousand and thousands of people.
108
Dr. Richard Wilson
Professor, Department of Physics
University of Harvard
Boston, USA
Scientists are said for century if animals don’t get cancer why should people. And not only
took people long time to realize people get cancer but also took long time to start doing
something about it. And you should start it 20 years ago. The urgency is there. I just want to
emphasize the one of ways of getting round some urgency is the government to ask big
funding people like the World Bank, the UNICEF in a sense and also Kuwait fund to fund
directly some of the NGOs for doing something. Unfortunately, a number of NGOs who are
doing something visibly small and DCH has demonstrated in several places they can do
something in a modest cost. The important thing I want to say not only, if my
recommendations are accepted, NGOs to be funded directly. It should not cut out the
Columbia group from the being supported. Because then talking deep-tube-well rather than
surface water which is in the national plan, Because deep tube-well recently means interim,
in some place are adequate options and cheaper than pond sand filter and Columbia people
have demonstrated that Ahmed explain they are doing all the pre-cautions to make sure they
are working. They properly granted adequately tested and lasted for ten years. So, that is the
last thing I want to say support the people what is doing things. Which is do not cut the
nearly because they are medium term as well long-term national policy. I think the national
policy is right. I think I will prefer the surface water but to somebody thinks they can do good
job and are doing good job, do please support. Thank you all.
109
Mr. Mahfuz Anam
Editor, The Daily Star
I suppose among all the participants here I am the most illiterate on the topic and the
discussion. So, you kindly pardon my comments if really it sound very foolish. I am here
more by my enthusiasm and less by knowledge of the subject. I am a journalist. My
enthusiasm is based on the fact that I realized that this is immensely important issue it is a
crisis that faces Bangladesh and I would like to contribute as a journalist through my
newspaper in helping the people on this. My common sense says that if justice delayed is
justice denied. Then delay in providing medical assistance to people it is to denial of their
rights to live. And it is in this rather dramatic terms that I would like to place this issue of
arsenic. I am absolutely depend on the fact that in spite of immense research and scientific
knowledge and even suggestions of how to fight arsenic being available, we still after almost
7-8 years of this problem. We do not have a national policy. I understand that after lot of
deliberations there is a policy almost in the final stage. But having come to that stage
suddenly it has gone issue like out of the agenda. We do not hear much about it. We have no
idea, what is in the policy. May be some experts have, but people do not. And we also have
no idea about when it is going to be announced. Now this is the first stage government takes
7-8 years just to formulate a policy. Now we all know about how good we are in announcing
laudable polices and how absolutely bad we are in implementing them. So, the whole story of
implementation is even in the future. The story of policy formulation has not even ended. So,
what we are talking about. I find it is a case of an immense or a case of irresponsibility on the
part of the policymakers. They should take almost half a decade or even more to just
formulate a policy now if it was the fact that scientific research was absent or sufficient
knowledge is not available in this field, I can understand that policy formulation has becomes
difficult. But we are not really in that stage.
So, my first comment today is that through this meeting here I would like to add my voice to
the rest of urging the government to formulate a policy and announce it to the public as soon
as possible. Because after its announcement I think there will be a further debate on the
policy at the public level and it will go through the further process of amendments all that.
So, there is really a time need in the finalization of the policy. And, then, of course, the whole
story of the implementation. Obviously, following the policy announcement, we will face the
challenge of who will have to bell the cat, in other words who implements it. My comments
against my little knowledge indicate there are eight ministries involved. Now believe me if
you have one ministry doing something we know how difficult it is if it is eight ministries
then God help us. So, my suggestion would be that simultaneous with the announcement of
the policy there should be also an announcement of the implementation structure. Now being
journalist I am attempting to make sweeping comments. One of my sweeping
recommendations would be to create a ministry of arsenic mitigation. Why I am suggesting?
Simply because enormity of the problems and number of people involved it in. I can foresee
that it will take it not several decades but at least one decade. I am being very optimistic that
we take one decade. Why don't so make a ministry for a decade. What does it with means (a)
that it tells the whole world, how much important the government attaches to this issue? It
brings in the whole machinery of government under one head to implement the process. I
think when we have a problem that involved 50% of our population, I think the problem
deserves a separate ministry for its mitigation. Therefore, policy on the one hand, and
simultaneously declaration of structure to implement on the other and that structure, in my
view, should be a separate ministry of arsenic mitigation. Thank you.
110
Ms Khushi Kabir
Chief Executive Officer, Nijera Kori
I think the issue is quite serious and want to thank the Dhaka Community Hospital, in
collaboration with the School of Environmental Studies, Jadavpur University, who have right
from the beginning consistently tried to get citizens of this country to be really aware of
what is the situation and seriousness and the gravity of the situation is, and the need to act
upon of it I think I may be biased because I am a great fan and supporter of the Dhaka
community hospital and work they do. And I have seen right from the beginning this is the
fifth international conference but right from the beginning when the first started at Jadavpur
University. Dr. Chakroborti is here, he may not remember me. I remember having seen him
right then, who have continued to bring this information at every level possible, not just to
conferences? And bringing in experts but also at the smallest meeting possibly they even
come and speak. Because we want to understand what arsenic issue is all about. They have
never said No. So, I really do admire the sustainability and the thing of continuing despite the
facts that all speakers differentiate how the government has been taking years to even just a
policy in place. How it’s being taking long and there has been little action on the part of
NGOs. And in terms of bringing the situation into every ones mind right of the front. It has
not come out same ways as many other situations and health issues do come out.
I am sorry I could not be here for the other days of the conference and that's my own loss.
But really I want to thank Aynun Nishat for having given us a summary because it gives
those of us who are not present an idea of what the major issues are and some trend about
where to go and what we need to do. What ,I think, we need to work at different levels. One
is, of course, continuing to pressurize the government in every ways. We know how to do
best some times not very usefully and some time not very successfully. But still continue to
do that to ensure that the government does have a policy and does have an implementing
system. I am not sure of a ministry work. I have not seen really many ministries they do
work. But at least an implementing system that allows people to go somewhere and insist on
the implementation, ask for accountability, ask for something to be done. I don't know, do we
have a lot of government representative at the seminar, quite enough. But at secretary and
policymaking level not that many. I said that's telling. We have had one who spoke more as a
citizen of this country. And, the others who have not whose names are there who are not
present. And, I don't know why it could be telling that they are not very sure as to what the
position of the government should be regarding this. I think this is the role of citizens of this
country to ensure that a government do take upon take notice and I think here Mahfuz has to
get all his friends together not just daily star, But all his friends together to ensure to keep
question. I think the more you keep writing, the more this thing can discuss, the more all of
us thus get activated and start working. The other thing I think that is very important is at the
participation level that the Mr. Badiur Rahaman had mentioned. Now the participation level
is not just getting people from different sectors of societies to come and talk and then say we
get the participation. To me, the participation level is much more at the action level and being
much more aware. So, the whole question of disseminating the information, Because I think
the conference is like this which brings in valued scientists, researchers, people who spend
here for works on this issues. Having brought out this entire people to gather and getting their
information together. To then disseminate to every level possible and I think here is
something's that all groups who work directly with people whether they be teaches, whether
they be NGOs who are working at the grassroots levels, whether they be any other media
which ever every different sector of the community who has direct contact with the public
every thing has to be involved and trying to get the information approach. People will then
111
start demanding and acting. People will then start demanding the whole question because I
think there is lot of confusion in awareness about arsenic. But confusion is to what should I
do the tube-well is green today but it may not remain green and how do, how we are sure that
this testing was genuine or not. Because of lot of debate do bring out some confusion in the
mind of the average citizen. So, I think the whole question of the kind of information that
was put forward today. As the result of you know the recommendations was put forward that
kind of recommendations or that kind of information to be put together and which should be
distributed among everybody. So, that then the sensitizing once that happens then the people
will start demanding and acting. I think community in our country, our culture have acted
before and will acted once of their total information and know what to do I think the
technical part of it is something that again needs to be put forward much more and you know
some time many of us start getting very confused just to what should be done and what
should not be done.
There are lots of debate, debates are healthy but I think people on ground really want solution
now. Not solutions as much as direct action and I think the main question is regarding the
social practices. This is something that all have to keep working at in trying to sure as we
have a lot of other work that somebody being a women is not negative, being a women with
disability is not negative, being a women who is disabled and poor and with arsenicosis is not
negative All those kinds of issues are something we need to continue to keep on working
about. Lastly there is a lot of debatable for arsenic programs but very few of it is actually
very targeted towards the whole questions of what to do in an area and with patients, very
little as far as I know fund is available for the treatment of a part of people who have suffered
from arsenic and I think that treatment is absolutely required and unfortunately even in the
health sector there is a lot of prevention, there is lot of system delivery etc. But the whole
question of peoples right to health care. Also demands right to health care demands, right to
health care regarding treatment of patients of arsenic. I don't want to go much further I just
want to end here by saying that when we sit together and when we hear, everybody speak, we
all get very committed with feelings towards the program and we need to do something. I
hope that we can all go back and start working in our own way, and working together trying
to meet that extremely problematic situation that is existing. We just not really wished up
rather sadly we found that we were infected with and to know that this work is to continue to
be challenged, the problem is to be challenged and work continue to work. At last I want to
say that very often we are aware of many issues but we continue to create the same kind of
problems. We are aware of the kind of pesticide poisoning that can happened through the use
of pesticide on vegetables In the name of development we continue to promote very
unsustainable and unhealthy processes which are extremely problematic for human being. I
think that paradigm continues to be needed to be debated all the times so that we can soft
talking of people-oriented system. Where this kind of problem is not something that we need
to deals with in future. Thank you.
112
Mr. Morten Giersing
Country Representative
UNICEF- Bangladesh
Thank you very much. I think I would ask Mahfuz how comes from having eloquently
describe all the inefficiencies of the ministries so proposed another ministry and this comes to
me also because I earlier today listen to the proposal to create a ministry to prevent accident
and injury. I think the seriousness of that is we come through that proposal because of so
many things which need coordination, which are not happening in Bangladesh. And to me
one of the earlier speakers he closed to home by saying that if this has to happen closed to
home and it has to happen in the decentralized level in Bangladesh. We cannot do this at the
level that we are talking about in the ministry. We need devaluation of power, we need to
come close to the people who are in this case exposed to arsenic. They are exposed to lot of
other problems also. If we cannot get planing down to top level, determination of money
flows to a level which is closed to the people, then we cannot do it. I think that needs to be
there, need to be open about it. UNI want to talk about the rights to information and what
more issue could you use to claim that right to know whether I am getting poison by the
water I am drinking. So, I mean there is the level where we need for the people to know what
is a situation. For the people to know what kind of money is available to mitigate at least to
know then I can act it. If I don't know, how can I act. I think the first thing is to get all the
information of the testing available to people. That would be quality control, So that we
know exactly who has what contamination in their wells so that we can go through those
people. First that those people can know but also those who can provide some kind of
assistance can get those people first to hard to reach. I think there is an important
recommendation I would like to see was that all the data are quality control made available
for everybody to work not only state people who are involved in it. Adding also to the urge to
conclude the national policy as soon as possible. I would add to finalize approval of some of
the removal technologies. Finalized that process there all stages in the process of being pilots.
And this is very difficult to take thing any scale and removal if not approved by the
government. Any thing that's another thing I would like to add picking up from the
perspective of my organizations from the recommendations I would stop with the very first
one on coordination which was emphasized by other people later on also. And perhaps they
are sitting next to me. I could propose that list on donors’ side that the World Bank, UNICEF
together tries to bring more donor coordination. That has been over there last preceding
years. In particular that area of donor collaboration so perhaps we could do offer, she was act
that could from donor side. I think there has been disagreement on reason that I think there is
largely behind those. I think it would be good if we choose that step, so step is
straightforward donor collaboration, which is happening in so many other areas in
Bangladesh, also in this area. Strike me also in a we have had people here all along. I had not
been here al along but I have been people for UNICEF all along. There is one issue that you
brought up which is issue of stigmation. I think it is one area where UNICEF staffs have
advantages which we support a lot of communications program and I think we could do more
stigmation that we have done in the past. We also offer so pick-up on that recommendation
and I think we can include that in a number of other activities we are doing. Otherwise, I
think, I said I wanted it at the outset we are going to repeat that just like me assure you that
UNICEF will stay with this issue is not an easy issue, is not an easy issue to funding for
other. So, I check very much your point that the NGOs should also be continued to be funded
and funded directly. But I also raise the point that it is not easy to get funding. So, who ever
can help on that I thing should be urge to do that, But I cannot commit UNICEF that we will
stay with this issue. I think we have worked hard over the last seven or eight years.
113
Ms Christine Wallich
Country Director for Bangladesh
The World Bank
Thank you very much. My no area with arsenic is also quite recent. But I had a wake-up call
on the issue latter on the day. I was offered the job as Country Director for Bangladesh,
because on that day the Washington Post had a front page story on arsenic contamination in
Bangladesh and that was a very thought provoking and quite freighting story about the
problems that face the country. After getting that offer, the first thing I thought how I
convinced my family to move out here. Had them having just read the newspaper. And
indeed it was very much part of those reflections. I told you this story only because of explain
how arsenic came to the center of my readers very reliant. Not only personal perspective but
also beyond that perspective of what we can support measures and mitigation in around of
programs. I like to start by arguing strongly what about saying by donors’ coordination. I
think we had a second wake-up call on that. I am very much appreciating that in many sectors
such as health and education and perhaps also now in the power sector donors are working in
a more coordinated, sector wide framework. They agree on a common policy framework with
the government and then ensure that the overall sector financing needs to meet in a
coordinated way. And I think you’re called to coordinating action areas. I take very much to
hear. I think well very much follow up on that area. I will be very brief to share with you.
Firstly, I was involved in this task in 1997 when we were involved in some strategic planning
in this sector and more recently we have underwent the development of two projects. One,
which is specifically focused on providing pipe water supply to villages which have been
identified having large arsenic concentration and also in villages where there is demand for
rural pipe water services. The second project focusing on strengthening the local government.
We very much agreed that local level is the place for action here. Local govt. can be used to
deliver services including pipe water supply. But not limited pipe water supply. These are
both projects that the govt. has identified for fast tracking in our program. I think that does
gives some sense that there is a sense of urgency. The other thing I would like to add the
notion of communicating on information. It strike me that there is a lot more we can do
communicate creatively on issues, do social marketing, do speak on issues that effect on daily
life and I am wondering beyond the newspapers what can television and radio media do any
creative way in the country. I come from, I see advertisements everyday on televisions
telling me not to smoke, telling me do wash your hands, warning not to eat cholesterol related
fats, telling me to do all sorts of things. One public health message, one teenage violence
massage one after another comes across my spring and they are highly effective in terms of
promoting behavior change and awareness. So I would say that the challenge is how you can
use media effectively to disseminate this kind of information. But also the mitigation
messages that people need to understand to protect them from this problem. Thank you.
114
Mr. Atiqur Rahman Salu
Representative, International Farakka Committee
Mr. Chairman, Good evening. There is no need to introduce myself again. I am an activist.
As an activist we have disadvantage. We don’t know lot of things. We have advantage too.
We can tell anything whatever we wish. We have accountability to the people, not to others.
To me, a scientist cannot tell lie on his findings, recommendations whatever he comes from
his research or recommendations from these kinds of seminar or from any finding. It must go
to the people. If anything goes wrong, for this they have to be accountable to the people. I am
not totally happy or satisfied with those recommendations. I don’t know why? Because we
are talking about the issues and giving prescriptions but we are not going to diagnose the
cause of main diseases quite happening which is very much related. I think issues we are
talking about the arsenic to me and we have all finding that it is very much related with the
low water flow for long time. UNICEF cannot judge by passed their responsibility, when
they setup millions of tube-wells in the rural areas. However, I am requesting the organizer to
keep their mind to include those things in a nutshell in recommendations. Now I coming to
that main point which is very related with the very survival of the country. Just in one time
we have the problem of River linking. It is not sufficient, I think. We are, as an activist
organization, doing excellent job. We have our own recommendations. I already handed over
but please allow me 2-3 minutes to read it out. A national conference on the impact of up
stream water diversion from the international rivers, Ganges, Brahmaputra, Meghna, was
organized by international Farakka Committee on 12th January 2004 at the BangladeshChina friendship conference hall. The Honorable Minister for LGRD and Cooperatives Mr.
Abdul Mannan Bhuiyan was present as the Chief Guest, the honorable representative of US
Congress Mr. Joseph Kowli, Chairman of the Bangladesh cocus in congress and Congress
Representative Mr. Gravery Mist, Member of US congress of cocus for Bangladesh were
present as Guests of honor. And other concerned ministers were there and I am not going to
that.
Engr. Akhter Hossain presented the keynote paper as you saw in the morning session. I am
opening those. So recommendation was like that the following were drawn and finalized after
a thoughtful discussion by the participants. One because the matter is the highest of public
interest, the role of Bangladesh government needs to be well defined, made clear and action
oriented. Special session of the Bangladesh Jatiya Sangsad, national parliament, should be
convened to discuss the issues and formulate a national policy on all relevant aspects. The
U.S congressmen were requested to make arrangement of the US congressional hearing for
the issue to start diplomatic persuasions to stop the process of linking of 54 up stream rivers
for diversion of water that has devastate effects on Bangladesh economy and environmental
ecology. Indian policy on sharing of international river needs to be revised in line with
international practice and UN convention on the navigational uses of international
watercourses 1997. Cooperation is urged between the riparian countries for sustainable water
management including all relevant dimensions of the waterish uses and management.
Horizontal ties among professionals, border access to data information by the public should
be facilitated. A long march will be mobilized in April or May by 2005. This is our now goal.
And the national awareness be created and make it public movement. A feasibility study for
construction of cross-dam should be carried out for overall disaster and environmental
management. We don’t know which one is the best fit the country –the cross-dam or Ganges
River. But this is absolutely our choice and this is not related with the Indian River inter link
project. Rational views of the experts and stakeholders should be promoted. The international
community may be asked to contribute and convince for conflict discoloration and resolution
115
by creating a congenial environment for dialogue. A regional commission should be formed
comprising of all riparian countries. Water resources planning organization under the
Ministry of Water Resources should be formed and expert committee should continuously
study in details the impact of the Indians river link project and advise GOB. National water
plan implementation of Bangladesh should include the impact of the diversion of water in the
upper catchment and necessary monitoring, evaluation and action program to safeguard the
rights of the people of Bangladesh. One more line then I will finish. I have own criticism for
media with all due respects when we go for some for any things we are doing; sometimes I
find not even a single line in the newspaper. For I feel in my heart that we are putting our
own money doing this entire thing day and night, it is not there. So, we need media support,
particularly I need the support of media individuals such as editors and big journalists, I
requesting to do that because the country needs your support .If we get your support then we
can go further. Thank you again for giving me a chance to place my recommendations.
116
Ms Taleya Rehman
Chief Executive Officer
Democracy Watch
Thank you for giving me this opportunity. Respected chairperson and respected guests and
the participants. I was supposed to speak in the inaugural session but I am glad that at least I
could catch the concluding sessions. I just want to make two comments. One is that I myself
did not know anything about arsenic and until I saw the advertisement on the sort clippings of
how arsenic is hazardous for health on the television program. There were short clippings,
which went on for sometime. But it has chopped –up as if we all know about it. I think it is a
donor-funded thing, which is no more there. So, awareness is not to because the fund is not
there. Govt. is not doing anything. I totally agree and I am very impressed that Christine
Wallace also said that media, television so important in this respect. Another thing, which
Khushi Kabir mentioned, is monitoring. Yes, the green and red markings have been done.
But I know there was incident in one of the local areas that we working. Where there was
one green one, which was safe and one tube-well in the areas, which was safe to drink, but it
broke down. So people who are compelled to use they want which are marked in reds. So, I
think this is very important to have it monitor again. I don’t know how long ago these were
marked. I have no idea but this should be monitored from time to time. Because there were
someone from my organizations that who was working who reported about it? So, that I want
to say that it has to be and one more thing is that we have been talking about it as Mahmudur
Rahaman and Dr. Moniruzzaman they are all saying that we have been talking about it. We
must start working on it. It has been said it is an enormous problem you can’t install it any
more. We have to start and I am very glad that Mr. Mahfuz Anam said that he would initiate
this in his newspaper. Thank you very much for giving me a little chance to say few things.
117
Dr. David Christiani
Professor, Occupational Medicine and Epistemology
Harvard Medical School
Thank you Mr. Mia .Thank you the organizers of this conference. I was getting late. DCH is
in the forefront right from the beginning. The second was one Wilson said that as an NGO
made laudable contribution to the nation I think that is true. They brought science and active
spirit together spirit of the all the community unite round the issue. I very much appreciate
the part of this process in collaboration a scientific work and so that I am optimistic and other
problem we heard and described the last few days. We also see the recognize kind of energy
in this room. Organizations are representing here that there is a reason with persistence in
activism to be optimistic for the future, not to give up. Thank you very much.
118
Vote of Thanks
Professor Quazi Quamruzzaman
Chairman, Dhaka Community Hospital Trust
Honorable chair, distinguished guests and participants. Occasionally I have a dream over
arsenic since we started working in 1996 and today is 2004. When Dr. Dipanker presented
paper we could see how much progress we have made. The dream is that when the mightiest
of the nation with their wealth and technology looking for weapons of mass destruction, why
they are missing arsenic, which, at this moment, is killing at least 300 million people at risk
all over the world and that is the tragedy of the present day world. This week in Dhaka is
very eventful week. Dhaka has become a global capital. We are having four international
conferences, one about the arsenic accident and emergency, one about the micro-credit, one
about the health related another international conference and even the just a international
conference and along with it we had to hartals in one week. Within this context, organizing
an international conference is very difficult. Many of the participants are same people. Many
of the guests are same people; many of the policymakers are also the same people. But I
thanked them all. They all came and not only contributed to the conference but also inspired
us and showed their commitment. I thank all the participants who, over the last two days,
were presented all the time, participated, contributed, criticized and given their ideas. I thank
the paper presenters as they presented excellent papers on very thoughtfull issues and certain
areas they have given tremendous information, which will be beneficial not only for
Bangladesh but also for other people. I thank the chair, co-chair, facilitators and reporters
who made it possible to finish this conference within a limited time. My special thanks to Dr.
Dipanker Chakraborti and his team, who always encouraged us, contributed and participated
with a very hard work, which made this conference worthwhile. I specially thank the media
journalists, newspapers who took interest and publicize. I think due to untiring effort of the
media and newspapers arsenic is still an issue in Bangladesh. I thank UNICEF, World Bank,
Ministry of Health and Welfare, Ministry of LGRD, Ministry of Environment and Forestry,
specially Barrister Nazmul Huda, MP, who is also Minister for Communications, Advocate
Sigma Huda who hosted some of our teams in the rural areas, DPHE, Secretaries Committee,
National Arsenic Mitigation Committee and Expert Committee, Pabna Community Clinic,
WHO, Australian High Commission and specially two gentlemen ,Mr. Jainul Abedin of
Sirajdhi Khan and Mr. Chanchal of Dohar upazila, who in their upazilas provided support for
our visitors. I do apologize for the inconvenience to have an international conference in this
sort of venue and in traffic jam. I apologize for any inconvenience or any mistakes that we
have committed. I especially thank the Square Pharmaceuticals and Duncan Brothers for their
support to this conference and for their help in many of our arsenic work in the field. At the
end, people of Bangladesh are always facing disasters. They face disaster, cyclone, flood,
hartal and inadequacy of the system. We hope if we work all together, we can provide the
support for this people so that they can exercise their rights to live, safety and happiness.
Thank you all again.
119