Million dollar arsenic. …… from 1997-2005
People involved in this Study:
Dhaka Community Hospital (DCH)
Bara Maghbazar, Wireless Rail Gate, Dhaka -1217, Bangladesh.
Sibtosh Roy (Pediatric)*, Salim Morshed (General Physician), Md. Zabed Yousuf (Project
Director), Md. Golam Mostofa (Program Officer), Md. Ariful Islam (Asst. Program
Officer), Tanzima Islam (General Physician), Farzana Begum (General Physician), Esarat
Ali (Medical Officer), Ms. Marjina Begum (Incharge Training), Md. Selim (Project
Assitant), Md. Gias Uddin (GIS Expert), Md. Wakar Hossain Tapan, Mr. Mosharaf
(Driver), Md. Selim (Field Attendant), Sarker Sahid Atanu (Field Attendant), Sarker Sahid
Santanu (Field Attendant), Mr. A. Razzak (Volunteer, Arsenic Project), Mr. Nurunnahar
Begum (Volunteer, Eruani), Ms. Sadia Afroj (Volunteer, Family Planning
HealthWorker),M. Mahmudur Rahman (General Physician), Quazi Quamruzzaman
(Pediatric Surgeon)
School of Environmental Studies (SOES)
Jadavpur University, Kolkata – 700032, India.
Sad Ahamed (Chemist & Ph.D. Student), Mrinal Kumar Sengupta (Chemist & Ph.D.
Student), Md. Amir Hossain (Statistician & Ph.D. Student), Bhaskar Das (Civil Engg. &
Ph.D. Student), Bishwajit Nayak (Chemist & Ph.D. Student), Dilip Lodh (Computer Expert
& Microbiologist), Mohammad Mahmudur Rahman (Post Doctoral Student), Subhas
Chandra Mukherjee (Neurologist), Shyamapada Pati (Gynecologist), Ratindra Nath Dutta
(Dermatologist), Amitava Mukherjee 9Research Associate & Metallurgist), Dipankar
Chakraborti (Environmental Chemist &Environmentalist).
* He was present during 1997 & 2000 field survey. He died in a car accident during his arsenic field
his arsenic field survey in 2001.
DCH-SOES,JU
Million dollar arsenic. …… from 1997-2005
Arsenic history of Eruani village of Laksham P.S.
of Comilla district, Bangladesh
Preamble:
The International arsenic conference held during 6-9 Feb, 1998 in Dhaka
was jointly organized by Dhaka Community Hospital (DCH), Bangladesh and School of
Environmental Studies (SOES), Jadavpur University, Kolkata, India [DCH-SOES, 1998].
Chandipur village of P.S. Ramganj, Lakshmipur district and Eruani village of P. S.
Laksham, Comilla district were surveyed by SOES-DCH team during Dec 21, 1997-Jan 6,
1998 field visit and recognized as severely arsenic contaminated. So, these two villages
were chosen for the participants’ field visit to show them the ground reality of arsenic
affected villages in Bangladesh. Though during the conference participants visited
Chandipur, due to time constraints could not visit Eruani village. The visit to Chandipur
proved shocking to the participants due to considerable suffering of people from arsenic
toxicity. At the end of the conference on 9th February it was declared in Dhaka
Declaration, “There should be no village like Chandipur suffering from
arsenic toxicity in Bangladesh.”
Arsenic situation at a glance in Chandipur village can be seen in our earlier report (SOESDCH, 2000).
Arsenic situation in Eruani village during our survey on
30th December 1997
During our arsenic survey in Bangladesh (21st Dec 1997- 6th Jan 1998) we surveyed Eruani
village on 30th Dec with our medical team and analyzed 110 water samples collected from
the village. All of them contained arsenic above 50 µg/L while 40% had arsenic above 300
µg/L (at this concentration we expect patients with skin lesions if ingested for a couple of
years) with the highest concentration recorded at 2160 µg/L. At that time we identified 40
patients with arsenical skin lesions screening only 200 people who came to our camp. We
spent only half a day in this village. At the end of the survey we realized that we have seen
the tip of the iceberg.
1
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Arsenic situation as we saw in Eruani village on 13th
February 2000
On 13th February, 2000 we again went to Eruani village and spent a day during our arsenic
field survey in Comilla district. We reported the grave arsenic contamination situation,
suffering of children from arsenic toxicity, pregnant woman drinking arsenic contaminated
water in Eruani village in our report, “Groundwater arsenic contamination in Bangladesh:
(A) Summary of 239 days field survey from August 1995 to February 2000 (B) Twenty
seven days detailed field survey information from April 1999 to February 2000” published in
April 2000. We wrote in that report, “Comilla district’s Eruani village of PS Laksham was
surveyed. Eruani is a very big village. It has 6 parts1: Madhyapara, Purbapara,
Paschimpara, Uttar Para, Dakshinpara and Telibari. We could survey only Madhyapara
and for a while Paschimpara. Normally, we do not find arsenical skin lesions in children
unless the arsenic concentration in drinking water is quite high (around 0.75 mg/l and
above) or the nutrition status is very poor, in which case a moderate arsenic concentration
of around 0.5 mg/l can cause skin lesions in children. But in some villages of Bangladesh
also in Madhyapara of Eruani village we have found children like Tahamina (F/8), Pravin
(F/11) and Saiful (M/10) have arsenical skin lesions. All the children in Photograph-56 of
Eruani village have elevated level of arsenic in hair; nail and a few have arsenical skin
lesions.
Paschimpara of Eruani is highly affected too. Here children are also affected – like Hasina
(F/10), Nargis (F/8) (Photograph -57).
Even a pregnant woman, Phulnar (F/23), who had arsenical skin lesions, was drinking
contaminated water (Photograph-58). However, the worse arsenic affected man of the
village is Wahidur Rahaman (M/36). He has severe keratosis (Photograph-59).”
We concluded in that report “Eruani village needs a detailed survey to know the magnitude
of the calamity”.
Purba Para, Paschim Para, Madhya Para, Uttar Para and Dakshin Para are also known
as East Para, West Para, Middle Para, North Para and South Para, respectively
1
2
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Analyses of nail samples for arsenic during November
2003
Arsenic concentration in nail samples is an indicator of arsenic body burden. While arsenic
in urine is an indication of recent arsenic exposure, nail arsenic can be obtained even a few
years after the exposure is discontinued. However the concentration of arsenic in nail
depends on concentration of arsenic ingested and duration of exposure.
We had analyzed 164 nail samples from Eruani villagers with or without arsenical skin
lesions during November 2003. Our analysis (Table A) clearly shows that the burden is
quite high (98.8% samples had arsenic above the normal level) to most of the population
though about 50% of the subjects had no arsenical skin lesions. In case of differential
diagnosis, confirmation for arsenical skin lesions is possible through nail arsenic analysis.
Table A: Parametric presentation of arsenic in nail from Eruani villagers (with
or without skin lesion).
Parameters
Arsenic in nail (g/kg)
No. of samples (n)
164
Mean
5779
Median
4736
Minimum
1014
Maximum
25346
Standard Deviation
4256
% of samples having arsenic above normal level*
98.78
*Normal level of arsenic in nail ranges from 430-1080 g/kg .
3
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Arsenic situation of Eruani village as we saw on 16th
February 2004
During 5th International Conference (February 15-17, 2004) on “Arsenic: Developing
countries perspective on Health, Water and Environmental Issues” in Dhaka, Bangladesh,
jointly organized by DCH, Dhaka and SOES, Jadavpur University, Kolkata. February 16th
was scheduled for field visit of the participants in Eruani village. Unfortunately on that day a
12-hour strike (6 AM to 6 PM) was declared all over Bangladesh forcing the organizers to
call off the field visit. Nevertheless the medical team of DCH and SOES along with field
team and Ph.D. scholars decided to go to the village and left Dhaka on 16th at 3 AM so that
they could reach Eruani village before the strike commenced.
Total area and population of Eruani village are 2.2 sq. km and 6690, respectively. During
the whole day study, the medical team screened 700 people and out of them 210 (30%)
was identified with arsenical skin lesions. Altogether 97 water samples were collected from
hand tubewells people were using for drinking and cooking and analyzed. Arsenic
concentration above 10 µg/L, WHO guideline value was found in 94 (96.9%) of them while
92 (94.8%) had arsenic above 50 µg/L (Bangladesh standard value), and 80 (82.5%)
contained arsenic above 300 µg/L. All of the 200 urine samples collected from the villagers
contained arsenic above normal level (normal level 5-40 µg/1.5L). Details about this study
have been stated in a report [SOES-DCH, 2004] on July 2004.
4
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
The
study
report
on
groundwater
arsenic
contamination and its health effects in Eruani
village during 16 Feb 2004- 18 April 2005
After February 2004, DCH and SOES decided to conduct a detailed survey on arsenic
contamination situation and suffering of people in Eruani village. The present report
describes the findings of the study from February 16, 2004 - April 18, 2005 (along with nail
collection from villagers during November 2003). This report will cover the following
aspects:
A) Reply of our questionnaire by villagers (n=100)
1)
Groundwater arsenic contamination situation in hand tubewells of Eruani
village:
1.1)
Number of people drinking arsenic contaminated water in different
concentration ranges
1.2)
Total population in Eruani village that may suffer from arsenical skin
lesions and cancer comparing with international data
1.3)
Concentration of As (III) and As (V) in hand tubewell water samples
(n=15);
1.4)
As and Fe concentration with depth and correlation of arsenic with iron
in tubewell water.
2)
Clinical survey to the population of Eruani village (on the basis of 23.3%
of the total population screened)
3)
Arsenical skin lesions including Bowens, gangrene and cancer
4)
People subclinically affected in the village
5)
Children at risk
6)
Arsenical neuropathy
7)
Pregnancy outcome
8)
Multisystemic features of arsenic toxicity
9)
Arsenic in rice, straw and arsenic in irrigated water.
10)
Social problem
11)
Water resources for drinking and cooking in Eruani village
12)
How to combat the arsenic calamity in Eruani village and as such arsenic
affected areas of Bangladesh and west Bengal.
5
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
A) Reply to our questionnaire by the villagers
We asked few questions to the villagers (n=100) to get more information about their
awareness on arsenic problem. The replies are shown below.
Questions asked
Reply
Do villagers know about the groundwater More than 95% know about it.
arsenic contamination in this village?
Do they think it is a serious problem?
How many
tubewells?
people
drinking
20% yes; 60% No; 20% No idea
from
the Around 95% villagers said that they
know their tubewells are not safe, but
they do not know how dangerous these
are. They do not drink from a fixed
source. They drink from hand tubewells,
which taste good.16 families drink from
DCH dugwell.
Do they consider arsenical skin lesions as Melanosis is very common to villagers
serious problem?
and they do not consider it as a problem
due to less suffering. Keratosis is
considered as a problem.
Do they consider that their children will be Most of them told that they never
affected like them and arsenic contaminated thought in this way
water may be harmful for the pregnant
women?
Do they consider domestic animals drinking They have no idea.
arsenic contaminated water; rice and
vegetables
irrigated
with
arsenic
contaminated water would harm them.
1) Groundwater
arsenic
contamination
situation
in
hand
tubewells water of Eruani village
Eruani is a big village constituted of six localities. Table 1 shows the area, population, and
other details of this village. Altogether there were 193 hand tubewells in Eruani village
during our last water collection, March 2005. Figure 1 shows the present groundwater
arsenic contamination situation in Bangladesh on the basis of 52,000 hand tubewell water
samples analysis from all the 64 districts by FI-HG-AAS technique; Comilla districts and
arsenic affected Eruani village. Figure 2 & 2(a) show the GIS map and the arsenic
contamination situation of all the localities of Eruani village. Table 2 shows the distribution
6
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
of arsenic concentration in all the six localities in Eruani village. From Table 2 it appears
that 5 tubewells are safe to drink according to Bangladesh standard (50µg/L) though none
is safe by WHO guideline value. Out of these 5 hand tubewells people do not use 3
tubewells because of bad smell and high iron concentration in water and rest two are used.
But the question remains how many villagers know that these two tubewells are safe and
are drinking from the safe tubewells. Table 1A (in page 34) shows name and address of
the owners of these five tubewells along with arsenic and iron concentration.
Table-1: Some of our findings in Eruani village during survey.
Physical parameters
Total area & population in Eruani village
Total adult patient screened for arsenical skin lesions by our medical
team
Total adults having arsenical skin lesions
Total Children screened for arsenical skin lesions (below 11 years)
Total Children identified with arsenical skin lesions
Patients having diffuse melanosis (both adults and children) on trunk
Patients having spotted melanosis (both adults and children) on trunk
Patients having Bowens (suspected)
Patients identified with suspected cancer
Death incidents to those who had arsenical skin lesions (we have
name & address)
Patients showing burning sensation when exposed to sunlight
Eruani village
of Bangladesh
2.2sq.km &
6690
1580
395 (25%)
186
16 (8.6%)
301 (73.3%)
390 (95%)
40 (9.73%)
2
 100
280 (68%)
Table 2: Distribution of the tube wells by arsenic concentration range (g/L) in
Eruani village of Bangladesh.
Location
Total
sampl
es <10 >10 1050
analy
zed
Arsenic concentration range (g/L)
>50
5199
100- >300 300299
499
500699
700- >1000
1000
East Para
42
-
42
1
41
1
13
27
12
12
1
2
West Para
10
-
10
-
10
-
3
7
2
1
2
2
South Para
35
-
35
1
34
-
4
30
7
11
9
3
North Para
52
-
52
3
49
-
5
43
21
15
1
7
Middle Para
46
-
46
-
46
-
5
42
3
19
10
9
Telibari
8
-
8
-
8
1
2
5
2
1
-
2
193
-
(Total)
193 5
188
2
32
154
47
59
23
25
(100 (2.59 (97.40 (1.03 (15.58 (79.8 (24.35 (30.56 (11.91 (12.95
%) %)
%)
%)
%)
%)
%)
%)
%)
%)
7
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Figure 1
Figure 2
8
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
8a
Figure 2(a)
DCH-SOES,JU
Million dollar arsenic. …… from 1997-2005
1.1 People
drinking
arsenic
contaminated
water
of
different
concentration ranges in Eruani village
Total population of Eruani village is 6690 and all were drinking from 193 hand tubewells
(except 16 families drinking from a dugwell and when there is not sufficient water in the
dugwell, they drink from their hand tubewells). So the number of people drinking from each
tubewell is around 35. In fact during our field survey of 1997 and 2000 we had information
of about 693 hand tubewells in this Eruani village. In 2004 it was about 250. As the
villagers now know about arsenic contamination in their hand tubewells many removed the
pipes and not willing to install new ones. Table 3 shows approximate number of people in
Eruani village dinking water with different arsenic concentration ranges. From our last 18
years arsenic experience in West Bengal, Bihar, UP, Jharkhand and 8 years in Bangladesh
we believe those drinking arsenic contaminated water above 300 µg/L for a couple of years
may get arsenical skin lesions. From Table 3 we observe that in Eruani village 5303 people
are drinking above 300 µg/L, hence may run the risk of getting arsenical skin lesions.
Table 3:
Number of people* drinking arsenic contaminated water at different
concentration range in Eruani village of Laksham P.S Comilla district.
Total
No of
No. of people drinking arsenic contaminated water (g/L).
population samples
analyzed <10 >10 10-50 >50 >100 >125 >200 >250 >300 >500 >1000
6690
193
- 6690 173 6516 6447 6308 5996 5719 5303 3708 866
(100 (2.58 (97.4 (96.36 (94.28 (89.62 (85.5 (79.26 (55.4 (13
%)
%)
%)
%)
%)
%)
%)
%)
%)
%)
* People drinking dugwell water has been included in this study as they also sometimes
use hand tubewell water and their urine analyses show more than normal range of arsenic.
DCH-SOES,JU
Million dollar arsenic. …… from 1997-2005
1.2 Total population in Eruani village may suffer from arsenical skin
lesions and cancer (comparing with international data)
Table 4: Probable estimation of population may suffer from arsenical skin lesions
and cancer in Eruani village when compared with international data.
Study
(authors/year)
Country/region
Health effect studied
No. of cases
expected for
Eruani village
Astolfi et al
(1981)
Cordoba,
Argentina
Regular intake of drinking water containing
above 100 µg/L of arsenic leads to clearly
recognizable sings of arsenic toxicity and
ultimately in some cases to skin cancer.
6400
Tsuda et al
(1995)
Nigata, Japan
Exposure for 5 years to a high dose of arsenic
(>100 µg/L) can cause skin sings of chronic
arsenicism
and
subsequent
cancer
development
6400
USEPA
(1992) NRC
(1999)
-
Chronic intake of 10 µg/kg arsenic per day or
higher may result in dermatological and other
sign of arsenic toxicity. 10 µg/kg per day is
equivalent to 125 µg/L of arsenic in tubewell
water considering from our field study, average
50 kg body weight for adults and 4 L of water
consuming per day .(Choudhury et at 2001)
6300
Chakraborty
and Saha
(1987)
West Bengal,
India
The lowest arsenic concentration in drinking
water that produce dermatosis was found to be
200 µg/L.
5900
Oshikawa
(1998)
Thailand
The prevalence of arsenic dermatosis in areas
with 200 µg/L of arsenic in drinking water
5900
WHO (1981)
-
Several years of exposure of approximately
1000 µg of arsenic per day may cause skin
effects within just a few years. In arsenic
affected areas of West Bengal , adults drink an
average 4 L of water per day (Chowdhury et al
2001) So 1000 µg of arsenic is equivalent to 4
L of 250 µg/L of arsenic containing water.
5700
Morales et al
(200)
Taiwan
The life time risk of death is 1 in 100 from
consuming 50 µg/L of arsenic in drinking
water.
65
NRC (2001)
-
Cancer mortality risk to be about 1 in 100 at 50
µg/L of arsenic.
65
Smith et al
(2002, 1992)
Chile
Lifetime risk of dying from cancer while
drinking 1 L of water per day with 50 µg/L of
arsenic is 13 of 1000.
84*
Smith et al
(1999)
Chile
Lifetime risk of dying from cancer while
drinking 1 L of water per day with 500 µg/L of
arsenic is 13 of 100.
482*
Chakraborti
et al (2002)
West Bengal
India and
Bangladesh
Ingestion of 300 µg/L of arsenic in drinking
water for couple of years may cause arsenical
skin lesions
5300
*Since in arsenic affected areas of West Bengal, adults drink an average 4 L of water per day
(Chowdhury et al 2001). So we expect the number to be 4 times higher.
10
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
On the basis of the data generated in Table-3 on the population drinking arsenic
contaminated water at various levels in Eruani village and from the information available in
literature we have tried to estimate the population in the Eruani village that may be
suffering from arsenical skin lesions and cancer.
a) In a study in Cordoba (Northern Argentina) [Astolfi et al. 1981] observed that a
regular intake of drinking water containing above 100 g l-1 of arsenic leads to
clearly recognizable signs of arsenic toxicity and ultimately in some cases to skin
cancer. Based on this view, around 6400 people in the Eruani village may have
recognizable signs of arsenic toxicity.
b) Tsuda et al. (1995) also claims that exposure for 5 years to a high dose of arsenic
(>100 g l-1) can cause skin signs of chronic arsenocosis and subsequent cancer
development. In Eruani village, there is a possibility of chronic arsenocosis in the
skin and subsequent development of cancer among a section of 6400 people, who
are continuing ingestion of arsenic above 100 g l-1 for 5 years at least.
c) In an EPA report which calculates for a reference dose (RfD) and drinking water
equivalent level, it is stated that chronic intake of about 10 g kg
–1
per day or
higher may result in dermatological and other signs of arsenic toxicity (NRC, 1999,
2001; USEPA, 1992). 10 g kg
–1
per day is equivalent to 125 g l-1 of arsenic in
tubewell water considering the average body weight from our field study for adults
was 50 kg and water consumption per day per adult was 4 l (Chowdhury et al.,
2001). On based on this, around 6300 people in the Eruani village may suffer from
arsenical skin lesions.
d) According to a study [Chakraborty and Saha, 1987] in 14 villages of West Bengal,
the lowest arsenic concentration in drinking water that produced dermatosis was
found to be 200 g l-1. A report from Thailand also indicates the prevalence of
arsenical dermatosis in areas with 200 g l-1 of arsenic in drinking water [Oshikawa,
1998]. On the basis of these two reports, it can be calculated that in Eruani village
around 5900 people may have arsenical dermatosis.
e) In a 1981 report, WHO stated that several years of exposure of approximately 1000
g of arsenic per day may cause to skin effects within just a few years (WHO,
1981). In the arsenic affected areas of West Bengal, adults drink an average 4 l of
water per day [Chowdhury et al., 2001]. So 1000 g of arsenic per day is equivalent
to 4 l of 250 g l-1 of arsenic containing water. In view of this argument it can be
11
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
stated that in Eruani village around 5700 people may suffer from arsenical skin
lesions within a few years if they continue drinking at the same concentration level.
f)
While analyzing arsenic data from a study in an arsenocosis endemic area of
Taiwan [Chen et al., 1988, 1992; Wu et al., 1989], Morales et al. concluded that
although the shape of the exposure response curve is uncertain at low levels of
arsenic exposure, over a lifetime, one out of every 100-300 people who consume
drinking water containing 50 g l-1 arsenic, may suffer an arsenic related cancer
(lung, bladder, or liver cancer) death [Morales et al., 2000]. They also suggested
that the lifetime risk of death is 1 in 100 from consuming 50 g l-1 and 1 in 50 from
consuming 100 g l-1 of arsenic in drinking water. The assessed risk for 50 g l-1
and 100 g l-1 of arsenic in drinking water would be about 65 and 129 people,
respectively in Eruani village if they would continue drinking contaminated water for
lifetime
g) It is reported that the lifetime risk of dying from cancer while drinking 1 l of water per
day containing arsenic at a concentration of 50 g l-1 could be as high as 13 per
1000 people exposed (Smith et al., 2002, 1992). Using this same method, the risk
with 500 g l-1 of arsenic in drinking water is 13 out of every 100 persons (Smith et
al., 1999). The assessed risk for 50 g l-1 and 500 g l-1 of arsenic in drinking water
would be about 65 and 482 people in Eruani village if they would continue drinking
contaminated water for lifetime.
h) From our 18 years of field experience in West Bengal and 8 years in Bangladesh
and last three years in Bihar, UP and Jharkhand states in the GMB plain, we have
screened more than 100 000 villagers and registered 12 195 patients with arsenical
skin lesions. From our field experience, we may expect that 300 g l-1 arsenic in
drinking water for couple of years may cause arsenical skin lesions (Chakraborti et
al., 2002; Rahman et al., 2003). On the basis of our study we expect around 5300
people may have developed arsenical skin lesions in the Eruani village provided
they consumed for a couple of years.
In all these calculations we have assumed that arsenic in contaminated hand tubewells
was present in the same concentration from the very beginning when the villagers began
using them. Our study showed that within a span of 3-10 years in some villages tubewells
which were safe previously (<10 g l-1) are contaminated now (>50 g l-1) and arsenic
concentration in many tubewells has increased by as much as 5-20 fold (Chakarborti et.
al., 2001). Therefore we are not sure of the time period of arsenic contamination in these
12
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
tubewells or how long the villagers have been drinking arsenic contaminated water.
Possibly due to this reason we are observing the size of the affected population to be much
smaller than expected from the above calculations.
From the information we received from the affected families during our survey of the
arsenic affected Eruani village, it appears that about 100 people who had arsenical skin
lesions died and many of them were young. Also from the preliminary survey and
information received from the villagers, we discovered that at least 10 to 15 people may
have died of cancer in this village. From our survey of the Eruani village, we have identified
22 patients with suspected Bowen’s disease and 2 patients with non-healing ulcer
(suspected cancer).
1.3 Concentration of As (III) and As (V) in hand tubewell water
samples
For chronic toxicity there should not be any difference between effects of As (III) and As (V)
species and people from Eruani village are affected from chronic toxicity. The arsenic
species of 15 hand tubewells from Eruani village were measured for As (III) and As (V)
(Table 5). From the results it appears that arsenic is present in both the forms and the
average ratio was of As (III): As (V)= 2:1.
Table-5: Concentration of total arsenic, arsenite and arsenate in tubewells (n=15)
water collected from Eruani village of Bangladesh.
Sl.
No.
Sub region of Total arsenic Arsenite Arsenate
Arsenite
Eruani village
(g/L)
(g/L)
(g/L)
/Arsenate (g/L)
1
East Para
342
200
142
1.40
2
Telebari
1030
650
380
1.71
3
Telebari
286
180
106
1.69
4
Telebari
338
220
118
1.86
5
South Para
371
260
111
2.34
6
South Para
720
320
400
0.80
7
Middle Para
754
500
254
1.96
8
South Para
600
440
160
2.75
9
South Para
542
360
182
1.97
10 South Para
731
550
181
3.03
11 Middle Para
1017
650
367
1.77
12 Middle Para
457
280
177
1.58
13 Middle Para
1025
750
275
2.72
14 Middle Para
1031
650
381
1.70
15 North Para
300
200
100
2
13
Average
arsenite/
arsenate (g/L)
1.96
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
1.4
As and Fe concentration in tubewell water
Usually tubewell water all over GMB plain is rich in iron. Table 6 shows iron concentration
in 193 hand tubewells of Eruani village and Figure 3 shows poor correlation between
arsenic and iron concentration. Figure 4 shows relationship of arsenic concentration with
the depth of tubewell. Usually the arsenic contaminated hand tubewells high concentration
of iron correlates with high arsenic concentration but this may not be true for all the samples.
Table 6:
Iron concentration in hand tubewells water samples from Eruani village of
Bangladesh.
Parameters
Iron concentration (g/L)
No. of samples
n =193
Mean
3291
Median
2435
Minimum
503
Maximum
48773
Standard Deviation
3928
14000
R=0.241
n=127
p=0.006
Iron concentration in (ug/L)
12000
10000
8000
6000
4000
2000
0
0
200
400
600
800
1000
1200
Arsenic concentration in (ug/L)
Figure 3: Correlation between As and Fe concentration from Eruani village in Bangladesh
Arsenicconcentration (ug/L)
2000
1500
1000
500
0
0
50
100
150
200
250
300
Depth (ft) of tubewell
Figure 4: Arsenic concentration with depth
14
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
2.
Clinical survey of Eruani village for arsenic toxicity
and arsenical skin lesions
The villagers are affected from chronic arsenic toxicity not acute. With our long experience
we have noticed that arsenic toxicity may develop insidiously after six months to couple of
years or decade depending on: i) arsenic concentration in the drinking water ii) amount of
arsenic contaminated water ingested. iii) How long ingested, IV) health status. We have
noticed in general that ingesting arsenic contaminated water above 300 µg/L for a couple
of years may result in arsenical skin lesions.
Dermatological symptoms in Eruani village affected population including children are
shown in Figure 5. During our survey our medical team identified all possible arsenical skin
lesions and toxicity symptoms of the patients. These are:
Darkening of skin: diffuse melanosis, Spotted pigmentation: spotted melanosis, White and
black spots: leucomelonosis, Mucus membrane melanosis, Palpable nodules: spotted
keratosis, Palpable nodules in dorsal of hand, feet and legs: dorsal keratosis also diffuse
keratosis were noted.
Other symptoms found: i) conjunctional congestion ii) non-pitting swelling (oedema) of feet
iii) hepatomegaly, spleenomegaly, ascites, Bowens (suspected),
gangrene,
Dermatological symptoms in Eruine village of Bangladesh
SB
12%
DORSUM
18%
DKS
62%
SKS
59%
Symptoms
DKP
n = 411
53%
SKP
55%
WBM
44%
LEU
76%
DMP
32%
SMP
21%
DMT
73.30%
SMT
95%
0%
20%
40%
60%
80%
100%
% of prevalence
Figure 5:Dermatological symptoms of arsenic affected people in Eruani village, SMP: spotted
melanosis on palm; DMP: diffuse melanosis on palm; SMT: spotted melanosis on trunk: DMT:
diffuse melanosis on trunk; SKP: spotted keratosis on palm; DKP: diffuse keratosis on palm; SKS:
spotted keratosis on sole; DKS: diffuse keratosis on sole; LEUCOM: leuco melanosis; WBM: whole
body melanosis; SB; suspected Bowen’s.
15
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
3) Arsenical skin lesions including Bowens, Gangrene
and Cancer
Table 7 shows arsenical skin lesions of 22 patients from Eruani village having suspected
Bowens, two of whom had suspected cancer. Photographs 1, 2, 3 show suspected
Bowens, suspected cancer, Gangrene, respectively and photographs 4, 5, 6 & 7 different
types of skin lesions.
Photograph 2: An arsenic patient with suspected cancer
Photograph 1: An arsenic patient with
suspected Bowens
Photograph 3: An arsenic patient with Gangrene Photograph 4: An arsenic patient with
spotted melanosis
16
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Photographs 5: an arsenic
patient with spotted & diffuse
Keratosis on palm
Photograph 6: An arsenic patient
with spotted &diffuse keratosis on
sole
Photograph 7: An arsenic
patient with diffuse melanosis on
palm
17
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Table 7: Dermatological features of a group of people with severe arsenical skin lesions of Eruani village
Name of the
patient
Sex/
Age
Firoza Begum
Ranju Miya
Abdul Karim
Surya Babu
Fulmoti
Joyanan Unnisha
Abul Hossain
Wadur Rahaman
Lal Mati
Ulfatunnesha
Noor Banu
Fatema Khatun
Khurshida Begum
Asmotunnesha
Shajeda Begum
Hoormoti
Suruj Jahan
Jobeda Khatun
Jahanara Begum
Sayera Begum
Ayesha Khatun
Amena Bibi
F/50
M/45
M/45
M/42
F/50
F/50
M/30
M/40
F/60
F/40
F/40
F/40
F/35
F/70
F/35
F/30
F/60
F/65
F/60
F/60
F/45
F/40
Palm
S D
Melanosis
Trunk
Leu WB
S
D
++
+ +
++
+
+ +
++
+
++
+
+ +
++
+
++ ++
+ +
++
+
++ ++ +++ +++
+
+
+
+
+
+
++ ++
++ ++
+
+
+
+
+
+
+
+
+
++
+
+
++
+
+
+
+ +
++ ++
++
+
++
++
+
++
+
+
+++
+
+
+
+
+
+
+
+
++
++
++
+
+
++
+
+++
+
+
++
++
++
+++
-
Keratosis
Palm
Sole
S
D
S
D
++
+
+++
++
+
++
++
+++
++
++
+
+
+
+
+
+
+
+
+
+
+
+
+
++
++ ++
++
+
+
+
+
+
+
++
+
+
++
+
+++
++
+
+
+
+
+
+
+
+
+
+
+
++
+
+++
+++
+
++
++
+++
+
+
+
+
+
+
+
+
+
+
+
+
Bownes Arsenic concentration
Dor
Water Urine
Nail
sum
g/L g/1.5L g/kg
+
+
+
+
++
+
++
+
++
+
+++ ++
++
+
+
+
+
+
+
+
+
+
+
+
++
++
+
+
+
++
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
526
589
619
619
689
N/A
120
pond
242
844
904
962
962
N/A
120
N/A
489
304
580
384
360
770
200
300
290
N/A
153
75
220
N/A
150
N/A
84
335
153
230
460
822
529
N/A
94
141
169
279
2275
4059
N/A
800
4012
1864
2631
N/A
2721
2259
N/A
18084
1428
N/A
3634
12970
N/A
N/A
2252
13073
5152
4871
Abbreviations: +, mild; ++, moderate; +++,sever; -,not detected; S,spotted; D,diffuse; F,female; M,male; Leu,leuco; WB,whole body.
N/A= not available.
DCH, Dhaka-SOES, JU, Kolkata
19
Million dollar arsenic. …… from 1997-2005
Photographs 8 & 9 of Md. Wahidur Rahman was taken during Feb 2000 and Feb 2004.
His health deterioration is noticeable. His skin lesions during February, 2000 and 2004
February, is presented in Table 8.
Photograph 9 (Wahidur Rahman):
February 2004
Photograph 8 (Wahidur
Rahman): February 2000
Table 8: Dermatological features of Md. Wahidur Rahman in 2000 and 2004.
Md. Wahidur
Rahman
Age-40 years
In 2000
In 2004
Melanosis
Palm
Trunk
S
D
S
D
-
-
++
+
Keratosis
Leu WB
Palm
S
+
++ ++ +++ +++ ++
+
D
Sole
S
+++ ++ +++
Dorsum
Suspected
Bowens
D
+
++ +++ +++ +++ +++
+
-
++
+
+, mild; ++, moderate; +++,severe; -,not detected; S, spotted; D, diffuse; Leu, leuco; WB,
whole body.
According to villagers (one of them was Md. Abdur Razzak, known as Arsenic Razzak) the
following persons died and had severe arsenical skin lesions with non-healing ulcer (may
be gangrene/cancer): Md. Ali Miah, Md. Abu Miah, Kamal’s father, Doctor Siraj, Siraj’s
mother, Hazra Begum, Hasina Khatun, Azun begum are a few them.
21
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
4) People subclinically affected in Eruani village
(Arsenic content in biological samples of patients and non-patients)
We had collected 122 nails and 161 urine samples from patients who had arsenical skin
lesions. Urinary arsenic denotes recent arsenic exposure and high arsenic burden in nails
indicate that they have not stopped drinking the contaminated water. Table 9 shows
around 97% of both the nail and urine samples contained arsenic above the normal level
proving that still they were consuming arsenic contaminated water.
Table 9: Parametric presentation of arsenic in nail and urine form Eruani village those who
had arsenical skin lesion.
Parameters
No. of samples (n)
Mean
Median
Minimum
Maximum
Standard Deviation
% of samples having arsenic above normal level
Arsenic in nail
(g/kg)
122
5351
4330
1020
18084
3542
97
Arsenic in urine
(g/1.5L)
161
457
291
29
4863
575
97.54
Arsenic in 311 nail and 194 urine samples from villagers of Eruani
village:
During our survey we had collected and analyzed 311 nail and 194 urine samples from
villagers with arsenical skin lesions (60%) and villagers without skin lesions (40%) (Table
10). The results indicate that the persons with and without skin lesions both have elevated
levels of arsenic in nail and urine. Thus many villagers may not show arsenical skin lesions
but have high arsenic body burden and may be sub clinically affected. Arsenic
concentration in urine and nails of both patients and non-patients from Eruani village show
elevated levels (around 97% each of nail and urine samples above the normal level),
indicating that both are consuming high arsenic contaminated water.
Table 10: parametric presentation of arsenic in nail and urine of the villagers with or
without arsenical skin lesions in Eruani village.
Parameters
Arsenic in nail (g/kg)
Arsenic in urine (g/1.5L)
No. of samples (n)
311
184
Mean
5427
576
Median
4362
332
Minimum
659
15
Maximum
25436
4863
Standard Deviation
3921
740
% of samples having
arsenic above normal level
99.67
98.36
22
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
5) Children at risk
Infants and children are often considered more susceptible to the adverse effects of toxic
substances than adults (NRC 1993). EPA study states that “when considering wateringestion rates in units of milliliters per kilogram of body weight per day, this analysis
shows that the mean per capita ingestion rates for babies younger than one year are
estimated to be three to four times higher than the mean rates for the population as
whole.”[EPA, 2000].
This increased exposure (on a body weight basis) indicates that
children and infants may be at a greater risk. Secondly, it is noteworthy to consider whether
the children are intrinsically more susceptible than adults. Differences in metabolism of
arsenic in infants, children and adults could be responsible behind differing susceptibilities
between these subpopulations. In one of our studies on an arsenic affected population in
Bangladesh we have found that second methylation step in arsenic metabolic pathways is
more active in exposed children in comparison with exposed adults [Chowdhury et al
2003]. Another study on effect of arsenic exposure on children’s intellectual function in an
affected region in Bangladesh concluded that arsenic in drinking water was associated with
reduced intellectual function in a dose response manner [Wasserman, G. A. et al., 2004].
From our study in Eruani village we have found children are also exposed to high arsenic
and many of them have arsenical skin lesions. Table 11 shows a few children with
arsenical skin lesions and arsenic in their drinking water and in nails. A considerable nail
arsenic body burden can be noticed. Photographs (10a) show another group of children
with arsenic in drinking water.
Table 11: Dermatological features of a group of children and arsenic concentration of their
drinking water and nail from Eruani village of Laksham police station of Comilla District.
Name
Melanosis
Sex/
Age
Palm
Trunk
S
D
S
D
Keratosis
Leu WB
Arsenic
concentration
Palm
Sole
S
D
S
D
Water
(µg/L)
Nail
(µg/kg)
Sabuj
M/9
+
+
+
+
-
-
-
-
-
-
1320
N/A
Shamur
M/11
+
+
+
++
+
+
+
+
+
+
N/A
10488
Kabir
M/11
-
+
+
+
-
-
-
-
-
-
1429
10371
Setara Begam F11
-
-
+
+
+
-
-
+
+
+
N/A
2123
Nasrin Sultana F/11
-
-
+
+
+
-
+
+
-
+
N/A
5185
Shirin Akter
-
-
-
+
++
-
-
-
-
-
1202
1818
F/10
Abbreviations: +, mild; ++, moderate; +++, sever; -, not
D,diffuse;F,female;M,male; Leu,leuco; WB,whole body.N/A; not available.
23
detected;
S,spotted;
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Photograph 10(a). A group of children were drinking arsenic contaminated water
24
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
6) Arsenical neuropathy
Neurological examination was generally undertaken in patients with chronic arsenicosis
whose skin lesions were already diagnosed. Neurological observation was recorded for
items considered consistent with peripheral motor and sensory neuropathy and for other
neurologic abnormalities as well. Pain history and pain specific sensory examinations were
stressed. Based on the criteria previously stated (Feldman et al. 1979; Kreiss et al., 1983;
Galer 1998) clinically neuropathy was diagnosed. The diagnosis of arsenic neuropathy in
the patients was ascertained by the presence of skin lesions and analyses of arsenic in
hair, nail, urine along with water they were drinking. The cases were further categorized
depending on type of neuropathy into sensory, sensorimotor, or motor types and according
to severity into mild, moderate or severe types. Other possible causes and alternative
explanations were also excluded such as diabetic, alcoholic, nutritional deficiency
neuropathies; Guillain Barre syndrome; intermittent porphyria; tick paralysis; diphtheria;
paralytic shell fish poisoning; paraneoplastic syndrome; amyloidosis; dysproteinemias;
uremia; pharmacologic agents; toxins including metals.
The total number of patients included for neurological studies was 166, comprising of 104
females and 62 males, age ranging 9-80 years. There were 12 children up to 15 years. The
range of arsenic in water, nail and urine was 300-1584 µg/L, 2200-18084 µg/kg and 3104863 µg/1.5L, respectively. The number of males was less as many of them could not
report to us for their places of work like cultivation. Most of the patients (54.21%) were in
the age groups of 21-40 years. As shown in Table 12, Of the 166 subjects (male: 62;
female:104; children 12) examined, neuropathies from arsenic toxicity were identified in
100 (60.24%) of these, 86 (51.80%, males 45.16% females 55.77 %) had sensory
neuropathy and 14 (8.43%, males 12.90%, females 5.76%) had additional motor
components (sensorimotor neuropathy). There were 10 patients (6.02%, males 4.84%,
females 6.73%) with evidence of moderate neuropathy. This was based on rigorous criteria
of neuropathy (Galer 1998) and included cases with impairment of at least two sensory
modalities and reduced deep tendon reflexes. Mild (predominantly sensory) neuropathy
with subjective complications such as paresthesias, pain, hyperpathia, and objective
findings of single abnormalities such as decreased pinprick, vibration, or position sense
were diagnosed in 76 cases (45.78%, 40.32% males and 49.04% females).
25
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Table 12: Prevalence, Severity, Type of arsenic neuropathy in Eruani village of Comilla district, Bangladesh.
A. Prevalence
Subject
No. of patients examined
No of patients neuropathy
Female
104
64 (62.65 %)
Male
62
36 (58.06%)
Children (up to15)
12 {female 1, male 5}
4 (33.33%)
Total
166
100 (60.24%)
B. Severity
Mild neuropathy
Moderate neuropathy
Female
104
54 (51.92%)
10(9.62%)
Male
62
30 (48.39%)
6 (9.67%)
Children (up to15)
12
4 (33.33%)
-
Total
166
84 (50.60%)
16 (9.64%)
Sensory
Sensory motor
C. Type
mild
moderate
total
mild
moderate
total
Female
104
51 (49.04%) 7 (6.73%)
58 (55.77%)
3 (2.88%)
3 (2.88%)
6 (5.76%)
Male
62
25 (40.32%) 3 (4.84%)
28 (45.16%)
5 (8.06%)
3 (4.84%)
8 (12.90%)
Children (up to15)
12
4 (33.33%)
-
4 (33.33%)
-
-
-
Total
166
76 (45.78%)
10 (6.02)
86 (51.80)
8 (4.82%)
6 (3.61%)
14(8.43%)
27
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Of the 166 subjects examined (Table 13), majority presented
with sensory features of distal paresthesias (57.23%), limb pains
(18.67%), and distal hypesthesias (46.98%) that out number
motor features of distal limb weakness or atrophy. Over all
prevalence of neuropathy was 60.29% of which mild cases were
50.60% and moderate 9.64%, even 4 out of 12 children
examined
(33.33%)
revealed
features
neuropathy.
The
neuropathy was predominantly sensory (51.80%) compared to
our observation in chronic arsenicosis patients of West Bengal
or Bihar. The prevalence of neuropathy was higher in the
patients of Eruani village of Bangladesh. Thus the activities the
daily living was found to be considerably affected due to the
presence of neurological involvement.
In these we further noticed other disturbing associated
neurological
features
(Table13),
which
included
Tremor,
Fatigue, Headache, Insomnia and abnormal sweating.
Photograph 10: An arsenic
neuropathy patient
Table 13: Presenting features of arsenic–induced peripheral neuropathy in Eruani village
of Comilla district, Bangladesh.
Total number of patients examined (n = 166)
No. of Patients
Percentage
Distal paresthesias
95
57.23
Limb pains
31
18.67
Hyperpathia / allodynia
13
7.83
Distal hypesthesias
78
46.98
Calf tenderness
19
11.45
Distal limb weakness/ atrophy
14
8.43
Diminished or absent tendon reflexes
21
12.65
Associated neurological features (n = 166)
Tremor
15
9.04
Vertigo and dizziness
22
13.25
Headache
21
12.65
Insomnia
14
8.43
Increased sweating
19
11.45
Diminished libido
5
3.01
Diminished vision ( ophthalmological cause
excluded )
6
3.61
29
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
7)
Pregnancy
outcome
from
Eruani
village
who
were/are drinking arsenic contaminated water
The study of pregnancy outcome in village level of West Bengal, UP, Bihar, Jharkhand and
Eruani village in Bangladesh is a considerably difficult task. During our survey in Eruani
village with medical group, the first day when we approached the families to enquire about
pregnancy outcomes they refused to talk to us. We realized that they did not want to speak
about it. The village leader Mr. Abdur Razzak and his wife Nurunnahar Begum told us that
they were unwilling to disclose the matter to outsiders because if they did so the elderly
people of the family will be unhappy. Finally Mr. Razzak suggested that at least we can get
some patients with the help of Ms. Saida Afroz, the family planning health worker of this
village. As she works with all pregnant women of the village and advice them with
medicines and anticontraceptive tablets etc. she knows them better. So we traced Saida
Afroz and she agreed to help us. With her help we could interview 40 women to study their
pregnancy history and 6 women during their first pregnancy. According to Saida, we were
lucky that 40 women came to us to disclose their pregnancy history.
Arsenic exposure during pregnancy can adversely affect several reproductive endpoints.
Several studies have examined the association between arsenic exposure and adverse
pregnancy outcome, including spontaneous abortion, preterm birth, stillbirths, low birth
weight and neonatal and perinatal mortality. The recent studies observed that arsenic
readily crosses the human placenta, giving rise to arsenic concentrations that are about as
high in cord blood as in maternal blood. We have already reported arsenic and pregnancy
outcomes in Bihar [Chakraborti et al. 2003]. From our field experience in Eruani village and
discussing with villagers and analyzing their drinking water, we feel that except a few most
of the pregnant women were drinking arsenic contaminated water.
Table 14 shows arsenic concentration in drinking water of 6 women during their first
pregnancy. During our field survey with medical team we studied 26 women who were
drinking arsenic contaminated water and suffered from obstetric problems. We also
analyzed arsenic in their drinking water and arsenic in urine, hair and nail.
30
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Table 14: A few women drinking arsenic contaminated water during their 1st pregnancy.
Sl
No.
Name of the patient
(years)
Duration of
pregnancy
As Conc. in drinking
water (g/L)
1
Fatema Akter
18
14 weeks
195
2
Kamrunnahar Shima
28
26 Weeks
233
3
Khodeja AKter
17
28 weeks
773
4
Rashida Akter
28
20 weeks
661
5
Parul
22
25 weeks
706
6
Hasina Akter
22
12 weeks
94
Age
In Table 15 below the arsenic concentration in drinking water along with arsenic in hair,
nail, urine of the respondents for pregnancy out come study are shown. Photographs 1116 show some women we studied, who were drinking arsenic contaminated water and had
high arsenic in urine. Analyzing the data on obstetric history of these women along with
arsenic in their drinking water, hair, nail and urine (n=26), our gynecologist opined that
incidences of Preterm birth, Low birth weight, Spontaneous abortion, Still birth, Neonatal
death in Eruani village is quite high. A detailed report will be published soon comparing
with an area where arsenic concentration in groundwater is in safe level.
Photograph 12
Photograph 11
31
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Photograph 13
Photograph 14
Photograph 15
Photograph 16
33
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
Table 15: Obstetric problem of 26 women from Eruine village of Comilla district, Bangladesh
Patient
ID
Name of the
subject
P0
Selina begam
Age
(Yrs
)
29
P1
P2
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
P13
P14
P15
P16
P17
P18
P19
P20
P21
P22
P23
P24
P25
Parul
Bokul
Rahima
Sahana
Janobi
Rawsan Ara
Ful Nahar
Parvin Akter
Nazma Akter
Firoza Khatun
Mehrun Nasa
Srimoti
Samsun Nahar
Rashida
Alya Begam
Ferdosi Begam
Mahinur Begam
Nargis Akter
Amena Begam
Feroza Begam
Parul Akter
Rina Akter
Julekha Akter
Hasina Akter
Hasina Akter
25
25
30
30
24
30
22
33
18
30
26
30
45
23
22
20
32
25
35
45
20
17
30
20
22
Order of severity of skin Type of water
lesions (mild / moderate/ drinking and cooking
severe)
moderate
Earlier drinking Tw water now
(1 yr.) drinking from pond water ( after
boiling)
moderate
At present drinking Tw water
moderate
At present drinking Tw water
moderate
At present drinking Tw water
moderate
At present drinking Tw water
moderate
At present drinking Tw water
moderate
At present drinking Tw water
moderate
At present drinking Tw water
moderate
At present drinking Tw water
Nill
TW , some times DCH dugwell
Nill
DCH dugwell
moderate
At present drinking Tw water
Nill
At present drinking Tw water
Mild
Rain water/pond water
Nill
At present drinking Tw water
Nill
At present drinking Tw water
Mild
At present drinking Tw water
Mild
At present drinking Tw water
Mild
At present drinking Tw water
Nill
At present drinking Tw water
Nill
At present drinking Tw water
Nill
At present drinking Tw water
Mild
At present drinking Tw water
Nill
At present drinking Tw water
Nill
At present drinking Tw water
Mild
At present drinking Tw water
35
Arsenic conc. As in urine
in drinking
(g/ 1.5L)
water (g/L)
1200
15
As in
hair
(mg/ kg)
3.730
As in
Parity
nail
(mg/ kg)
4.615
3
1584,605
1121
350
1009
748,1005
748,1005
301
915
Dugwell
Dugwell
685
272
1.481
4.684
3.076
1.008
0.567
N/A
0.867
3.492
0.757
2.404
1.084
N/A
0.540
1.157
1.001
1.143
1.292
1.072
2.109
7.889
1.436
0.691
0.491
1.358
2.229
3.537
12.914
6.440
2.635
1.202
N/A
1.010
4.117
1.001
2.945
2.645
N/A
1.224
3.841
1.269
3.087
4.025
3.141
4.682
8.605
2.051
1.008
2.186
2.666
5.757
773
550,661
550,661
550,661
550,661
1019
1019
1019
1019
201
530
1113
3563
2334
3157
2693
1276
1240
2455
1016
62
N/A
860
57
384
760
2619
741
450
N/A
1103
1289
760
591
3892
N/A
2
3
4
6
3
3
2
3
1
5
3
3
7
3
2
3
5
6
5
4
1
1
5
1
3
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
8) Multisystematic features of arsenic toxicity
Multisystemic nature of chronic arsenocosis due to groundwater arsenic contamination was
obvious in the studied subjects (Table 16). General manifestations included weakness and
fatigue, anemia and weight loss. Respiratory system involvement was of common
occurrence with presence of chronic cough and dyspnea (the letter being present in early
stages), chest pain and hemopthesias, gastrointestinal symptoms like loss of appetite or
dyspepsia were also observed. Skin itching specially on exposure to sunlight was an
important and peculiar symptom of arsenocosis. Similarly conjunctiva ingestion and
burning or watering of eyes was common findings. Arthalgia including backache and even
arthritis were evident. Although less common Pedal edema ulcer of Gangrene of foot were
also noticed. Thus chronic arsenic toxicity involves several system and organs of human
being in addition to presence of skin manifestations.
Table 16: Nonneurological multisystemic features in patients (n=166) with arsenicosis in
Eruani village of Comilla district, Bangladesh.
Sl. No.
Parameters
No. of patients (n=166)
1
Weakness and fatigue
94 (56.62%)
2
Weight lose
47 (28.31%)
3
Anemia
65 (39.16%)
4
Chronic cough & dypsnea
68 (40.96%)
5
Chest pain
13 (7.83%)
6
Hemoptysis
3 (1.81%)
7
Skin itching ( in sun light)
81 (48.81%)
8
Conjunctival ingestion
45 (27.12%)
9
Burning and watering of eyes
14 (8.43%)
10
Arthalgia / Arthritis
23 (13.86%)
11
Backache
11 (6.62%)
12
Loss of appetite
40 (24.10%)
13
Dyspeptia
26 (15.66%)
14
Pedal edema
6 (3.61%)
15
Ulcer of foot
3 (1.81%)
16
Gangrene of foot
1 (0.60%)
37
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
9) A preliminary study on arsenic in rice, straw and
arsenic in irrigated water
The findings from a preliminary study on arsenic in irrigation water, straw and rice from 5
fields in Eruani village of Comilla district, Bangladesh and control area of Medinipur district
(not arsenic affected), West Bengal, India are reported below.
During our survey in April 18th 2005, we collected straw and paddy samples from 5 fields in
Eruani village and irrigated water from the same fields. Since April being harvesting time
irrigated water was not available, we hired a pump and collected the irrigated water
samples. This was the ‘Boro’ cultivation i.e., using groundwater.
Samples collected from contaminated area Eruani village, Laksham, Bangladesh.
Sl.
No.
Arsenic concentration
in water sample (mg/L)
Arsenic concentration in
straw sample (mg/kg)
Arsenic concentration in
Paddy sample (rice) (mg/kg)
1
0.185
4.365
0.310
2
0.671
5.062
0.247
3
0.326
4.860
0.274
4
0.190
3.437
0.309
5
0.307
6.487
0.266
Samples collected from control area Bhupatinagar village, Medinipur, West Bengal
SL
No.
Arsenic concentration
in water sample (mg/L)
Arsenic concentration in
straw sample (mg/kg)
Arsenic concentration in
Paddy sample (rice) (mg/kg)
1
<0.003
0.238
0.088
We also collected soil samples during 18th April 2005 survey from these 5 fields but the
analysis results are not being reported here since for about last 2 months no arsenic
contaminated water was used in these fields. From our previous studies we have noticed
that under humid and damp conditions soil arsenic decreases with time. We have analyzed
SRM - water, soil, rice and leaves to verify our method.
The overall study indicates higher arsenic in paddy and straw compared to the control
samples. However the arsenic in rice from all the fields are less than the maximum
permissible limit of rice 1.0 mg of As kg -1. [National Food Authority. Australian Food
Standard Code; Australian Government Publication Service: Canberra, March 1993]. But
the straw arsenic concentration is quite high and when a cow eats about 5 Kg of straw, the
arsenic body burden may be expected.
38
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
10) Social problems
The common social problems due to arsenic toxicity as we have noticed from all over the
GMB plain are as follows:
1) Affected wives are sent back, sometimes even with their children, to their
parents.
2) Marriage of people of either sex from the affected villages has become a
serious problem.
3) It has been noted that jobs/service have been denied/ignored to the arsenic
affected persons.
4) It has been observed that when a husband or wife has been singled out as
an arsenic patient, the social problems crop up and destroy the social fabric.
5) Due to ignorance, the villagers sometimes view it as a cue of leprosy and
force the arsenic patients to maintain an isolated life and avoid him socially
wherever possible. It is social curse and human tragedy.
In Eruani village there are no exceptions. A few incidents narrated by tubewell owners are
described below:
GIS Code 59:
Nurul Mian is an arsenic patient and his daughter Selina Aktar too. Sirajul Islam married
Selina as he required money to go to USA. After some years he returned to the village and
divorced Selina and married again. Even during our survey all the family members were
drinking their hand tubewell water [As concentration= 542 µg/L] .
GIS code -71:
Sakina Aktar is of 12 years age. Her mother had sever arsenical skin lesions and died at
the end of 2004.Her father married again. Sakina is also an arsenic patient and she studies
in the fifth standard in a school. During our survey the members of their family were
drinking arsenic contaminated water [As concentration= 638 µg/L].
GIS code 73:
More than 20 people were drinking arsenic contaminated water from this tubewell. Md.
Hasmot Ali told us that his daughter Taslima Aktar is an arsenic patient and he is worried
about her marriage. He requested us for supplying the safe water. [As in tubewell water=
533 µg/L]
These are few examples out of many.
39
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
11) Water resources for drinking and cooking in Eruani
village
According to the information received, altogether there are 193 hand tubewells and two
dugwells and two TARA pumps (around 675 feet) in Eruani village. Our water analyses in
Table 2 shows that out of 193 hand tubewells, two shallow tubewells and one 250 feet and
another 270 feet deep tubewells have arsenic below Bangladesh permissible limit (but
none below 10 µg/L).
Owners of 2 shallow tubewells do not use it for drinking and cooking due to bad smell and
high iron. Two deep tubewells 250 feet and 270 feet are not available for public use.
Tara pumps: out of two TARA pumps (around 675 feet), one people do not use (but during
our survey it was defunct) due to bad smell and high iron. The other one is not available to
the public.
Table 1A: The safe tubewells in Eruani village according to Bangladesh arsenic standard
Sl.
No.
Name of the
tubewells owner
Address
As conc.
(μg/L)
Iron conc.
(mg/L)
Remarks
1
2
3
4
5
Md. Abutaher
Md. Abul Kalam
Md Amir Hossain
Md Samsul Haq
Md Abdur Razzak
East para
South para
North para
North para
North para
12
29
16
11
15
1.107
0.785
4.487
10.724
8.773
Reddish color
Reddish color
Bad smell &high
iron
Dugwells:
There are two dugwells (1) the one installed by BAMWSP but people do not use it.
Villagers said i) often sand comes out with the attached tubewell with the dugwell; ii) they
get smell; iii) this dug well is not properly maintained.
2) DCH dugwell is maintained by the villagers and people contribute to the maintenance.
Its arsenic concentration 20 µg/L and 16 families can use this dugwell and they use every
drop cautiously. However due to small diameter of the dugwell (≈ 4 feet dia) quantity of
water during summer is not enough for 16 families.
40
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
12) How to combat the arsenic calamity in Eruani village
and as such arsenic affected areas of Bangladesh and
west Bengal:
1)
Creating
awareness
about
the
danger
of
arsenic
and
remediation approaches:
The concept of community participation though a new paradigm is now become integral
part of any successful social venture. A proper awareness exercise should be integral part
of any arsenic remediation program. The villagers need to be properly educated about:
a)
b)
c)
d)
the danger of arsenic in drinking water
the necessity of arsenic removal
role of better nutrition
safe water options available at their disposal
The various processes for initiating community participation may follow take the following
steps:

In-depth discussions with key persons/clubs or groups

Social mobilization through discussions

Equality in Gender participation

Improve the community’s understanding about the participatory approach

An agreement with the community to share the expenses.
The community should treat the problem on a collective basis and try to find out a solution
together.
2) The safe water options
Dugwells: The use of Dugwells in Asia
was known even during the Mahenjodaro
[Photograph
17]
and
Harappa
civilization more than 4000 years ago.
Prophet Hazrat Mohammad was known
to use a dug well named “Jam-Jam”
[Photograph 18].
The culture of dug
well however died down due to induction
of
tube
wells,
which
proved
more
Photograph 17: Well in Lothal, Harappa
convenient
41
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
s far as bacterial contamination is concerned. With advent of technology the
bacterial problem in dugwell is no longer a serious problem. So far
we surveyed around 700 dugwells in Bangladesh and West
Bengal for arsenic and bacteria. 90% of them were found safe
with respect to arsenic (< 3-35 g/l, average 15 g/l). There are
few areas where we found arsenic contamination above 50g/l
(maximum 330 g/l*).
Phtograph 18: Old fashion of
taking water from Zamzam well
Arsenic contamination of dugwells depends on a few factors:

Depth of dugwell

Construction of dugwell

To take care of particles with water and if particles are
present we need to settle them before drinking

Due to arsenic being particulate, after collection when we add acid undissolved
particles may dissolve hence contaminating the water.
A properly managed dugwell from village Dangapara, Block Betai, Nadia District, West
Bengal is shown in Photograph 19.
Rainwater harvesting: In many states of India and southern parts of Bangladesh, the
harvesting of rainwater is still a common practice. In present scenario if rainwater is
harvested through clean roof top collection into storage tanks, and precautions are taken
against bacterial contamination, the stored rainwater can be used for at least 4-5 months
per year. In arsenic affected areas of Thailand this is a common practice. English people
during their stay in Kolkata, used to drink freshly collected rainwater.
Deep tubewells: It is well established that in the Gangetic plain As contamination in hand
tube wells has been observed to decrease after a certain depth but in unconfined aquifers
there appears to be no depth guarantee, even if the construction of tube well is done
properly. No doubt deep tubewell is a source of arsenic safe water and possibility of
arsenic contamination is less if the deep tube well construction is done properly, the aquifer
tapped is underneath a thick clay barrier, and periodical testing is done to check the water
quality. The water should strictly be utilized for drinking and cooking purpose not for other
requirements like agriculture. Our about 4000 deep tubewell analysis from Bangladesh and
42
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
west Bengal show in many parts of arsenic affected areas greater than 300 meter deep
tubewells are safe to drink.
Photograph 19
A proper watershed management: Upto early 20th century the main sources of drinking
water in West Bengal and Bangladesh, were ponds, lakes etc. and people would drink
untreated water. However at that time proper technology was not available to treat water
but there were separate ponds for drinking water and washing and bathing purposes. So
with proper treatment against bacterial and other contaminations and proper management
of available surface water may hold the key to safe potable water for Bangladesh and West
Bengal where per capita available surface water is huge (11,000 cubic meters in
Bangladesh and about 7,000 cubic meters in West Bengal), average annual rainfall in
these regions is about 2,000 mm and the land known as “land of rivers”. Below we present
a specific instance of how surface water resources lay unutilized which could have been
managed with proper planning.
43
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
A
Canal
named
‘Dead
Padma’
(Photograph 20) popularly known as
Mara (dead) Padma is one of the
examples of vast unused water
bodies of West Bengal, India. It is
believed that once it was part of river
Padma which is now in Bangladesh.
Stretched over a span of around 90
kms, this canal is flowing through
Photograph: 20
Nadia and 24 Parganas (North) districts and ultimately meets river Jamuna in 24 Parganas
(North). A significant part (around 20 km) is situated in Deganga block. The canal is
covered with water hyacinths. Throughout the year water is present in this canal. When
water declines during winter, local people connect the canal with river Jamuna and
cultivate “Boro” rice. There are several water bodies along side the canal, some privately
owned. In absence of proper plan and management the canal lays almost unused except
sporadic fishing by some localites. A proper plan to utilize this surface water resource in
the following ways could help overall economic development for the people living on the
banks:
(a) In Deganga block out of 15,886 tubewells we analyzed 9949 tubewells for arsenic and
found, 57% and 37.3% had above 10 and 50 g/L concentration respectively. In this
block out of 234142 people an estimated 7726 were drinking contaminated water
having arsenic concentration above 300 g/L. With our medical group including expert
dermatologist, obstetricians and neurologists we examined 11,780 people and 786
(6.6%) people were identified as patients (Rahman et al. 2003). In these circumstances
the water from this canal after proper treatment can be supplied to nearby areas. This
can serve as a safe water option for the poor affected villagers.
(b) A planned fish culture program and duckary can be undertaken.
(c) The water can be used for irrigation also.
What we need is proper management of huge land-water body with people’s participation.
44
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
3) Role of better nutrition:
We must understand that so far there is no available medicine for chronic arsenic toxicity;
safe water, nutritious food, vitamins and physical exercise are the only preventive
measures to fight the chronic arsenic toxicity. Plenty of seasonal fruits and vegetables are
available in Bangladesh round the year. A large percentage of villagers are not aware that
they can get better nutrition from local fruits and vegetables. Most villagers cook
vegetables in such a way that their nutritional value is lost. They have to be trained how
they can get nutritious food using local fruits and vegetables. It is not necessary to eat
expensive food items like fish, meat, eggs, apples and grapes, which poor villagers can’t
afford. The elephant is the strongest animal and the gorilla is the strongest mammal and
both are vegetarians.
4) Involvement of all strata, including women:
Last but not least, a socioeconomic upliftement of rural mass with proper awareness about
arsenic calamity will help along way to lessen the problem. Women should play a crucial
role in the combat against the problems. As the proverb goes, “The hand that rocks the
cradle rules the world.” Unless the fight begins from inside the homes, superficial measures
may not be fruitful in the long run.
45
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
References
1.
International Conference on Arsenic Pollution of Groundwater in Bangladesh:
Cause, Effects and Remedies, Jointly organized by School of Environmental
Studies, Jadavpur University, India and Dhaka Community Hospital, Bangladesh,
Dhaka, February 8-12, 1998.
2.
Groundwater arsenic contamination in Bangladesh: (A) Summary of 239 days filed
survey from August 1995 to February 2000 (B) Twenty seven days detailed field
survey information from April 1999 to February 2000” April 2000, SOES, Jadavpur
University, Kolkata, India & Dhaka Community Hospital, Dhaka, Bangladesh.
3.
Many million dollar projects for arsenic issue in Bangladesh: For Eruani village of
Laksam Police Station under Comilla district, the condition deteriorated from 19982004.” July 2004, SOES, Jadavpur University, Kolkata, India & Dhaka Community
Hospital, Dhaka, Bangladesh.
4.
Astolfi E, Maccagno A, Fernandez JCG, Vaccara R, Stimola R. Relation between
arsenic in drinking water and skin cancer. Biol Trace Element Research
1981;3:133-143.
5.
Tsuda T, Babazono A, Yamamoto E, Kurumatani N, Mino Y, Ogawa T, Kishi Y,
Aoyama H. Ingested arsenic and internal cancer: a historical cohort study followed
for 33 years. Am J Epidemiol 1995;141 (3):198-209.
6.
National Research Council. Arsenic in Drinking Water, National Academy Press,
Washington DC,1999
7.
National Research Council. Arsenic in Drinking Water 2001 update, National
Academy Press, Washington DC, 2001
8.
USEPA. Draft Drinking Water Criteria Document on Arsenic Submitted by Human
Risk Assessment Branch, Health and Ecological Criteria Division, Office of Science
and Technology, Office of Water, US Environmental Protection Agency,
Washington, D.C., 1992.
9.
Chowdhury UK, Rahman MM, Mondal BK, Paul K, Lodh D, Biswas BK, Basu GK,
Chanda CR, Saha KC, Mukherjee SC, Roy S, Das R, Kaies I, Barua AK, Palit SK,
Quamruzzaman Q, Chakraborti D. Groundwater arsenic contamination and human
suffering in West Bengal, India and Bangladesh. Environ Sci 2001;8(5):393-415
10.
Chakraborty AK, Saha KC. Arsenical dermatosis from tubewell water in West
Bengal. Ind J Med Res 1987;85:326-334.
46
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
11.
Oshikawa S. Re-examination of a cohort of subjects with arsenical skin lesions ten
years after inception. M.Sc. thesis. Prince of Songkla University, Thailand. 1998.
12.
World Health Organization. Arsenic: Environmental Health Criteria 18, Geneva,
Switzerland. 1981.
13.
Chen CJ, Chen CW, Wu MM, Kuo TL. Cancer potential in liver, lung, bladder and
kidney due to ingested inorganic arsenic in drinking water. British J Cancer
1992;66:888-892.
14.
Chen CJ, Kuo TL, Wu MM. Arsenic and cancers (Letter). Lancet 1988;2:414-15.
15.
Wu MM, Kuo TL, Hwang YH, Chen CJ. Dose-response relation between arsenic
concentration in well water and mortality from cancers and vascular diseases. Am J
Epidemiol 1989;130:1123-1132.
16.
Morales KH, Ryan L, Kuo TL, Wu MM, Chen CJ. Risk of internal cancers from
arsenic in drinking water. Environ Health Perspect 2000;108:655-661.
17.
Smith AH, Hopenhayn-Rich C, Bates MN, Goeden HM, Hertz-Picciotto I, Duggan
HM, Wood R, Kosnett MJ, Smith MT. Cancer risks from arsenic in drinking water.
Environ Health Perspect 1992;97:259-267.
18.
Smith AH, Lingas EO, Rahman M. Contamination of drinking water of arsenic in
Bangladesh: a public health emergency. Bull World Health Org 2000;78 (9):10931103.
19.
Smith AH, Lopipero PA, Bates MN, Steinmaus CM. Arsenic epidemiology and
drinking water standards. Science 2002;296:2145-2146.
20.
Chakraborti D, Rahman MM, Paul K, Chowdhury UK, Sengupta MK, Lodh D,
Chanda CR, Saha KC, Mukherjee SC. Arsenic calamity in the Indian subcontinentwhat lessons have been learned? Talanta 2002;58:3-22.
21.
Rahman MM, Mandal BK, Roychowdhury T, Sengupta MK, Chowdhury UK, Lodh
D, Chanda CR, Basu GK, Mukherjee SC, Saha KC, Chakraborti D. Arsenic
groundwater contamination and sufferings of people in North 24-Parganas, one of
the nine arsenic affected districts of West Bengal, India: the seven years study
report. J Environ Sci Health 2003;A38(1):25-59.
22.
Chakraborti D, Basu GK, Biswas BK, Chowdhury UK, Rahman MM, Paul K,
Chowdhury TR, Chanda CR, Lodh D. Characterization of arsenic bearing
sediments in Gangetic delta of West Bengal-India. In Arsenic Exposure and Health
Effects, Chappell, W.R.; Abernathy, C.O.; Calderon, R.L., Eds.; Elsevier science: New
York, 2001;27-52.
47
DCH, Dhaka-SOES, JU, Kolkata
Million dollar arsenic. …… from 1997-2005
23.
NRC (National Research Council). Pesticides in the diets of infants and children.
Washington, DC. National Academy Press, 1993.
24.
EPA, 2000. Estimated per capita water ingestion in the United States: Based on
data collected by the United States Department of Agriculture’s (USDA) 1994-1996
Continuing survey of Food intake by individuals. EPA –822-00-008. Office of Water,
Office of Standards and Technology, US Environmental Protection Agency
25.
Chowdhury, U.K., Rahman, M.M., Sengupta, M.K., Lodh, D., Chanda, C.R., Roy,
S., Quamruzzaman, Q., Tokunaga, H., Ando, M., Chakraborti., D., 2003. Pattern of
excretion of arsenic compounds (arsenite, arsenate, MMA (V) and DMA (V) in urine
of children compared to adults in arsenic exposed area of Bangladesh. Journal of
Environmental science and Health,. A38 , 87-113.
26.
Wasserman, G.A., Liu, X., Parvez, F, Ahsan, H, Factor-Litvak, P., van Geen, A.,
Slavkovich, V., Lolacono, N.J., Cheng, Z., Hussain, I., Momotaj, H., Graziano, J.H.,
2004. Water arsenic exposure and children’s intellectual function in Araihazar,
Bangladesh. Environmental Health Perspectives, 112, 1329-1333.
27.
Feldman, R.G.; Niles, C.A.; Kelly-Hayes, M.; Sax, D.S.; Dixon, W.J.; Thomson,
D.J.; Landau, E. Peripheral neuropathy in arsenic smelter workers. Neurology 1979,
29: 939 –944.
28.
Kreiss, K.; Zack, M.W.; Feldman, R.G.; Niles, C.A.; Chirico-Post, J.; Sax, D.S.;
Boyd, M.H.; Cox, D.H. Neurologic evaluation of a population exposed to arsenic in
Alaskan well water. Arch. Environ. Health 1983, 38:116 –121.
29.
Galer, B.S. Painful polyneuropathy. In Neuropathic Pain Syndromes; Backonja,
M.M., Ed.; Neurologic Clinics; W.B. Saunders Co.: Philadelphia, 1998, 16(4): 91 –
811.
30.
Chakraborti, D.; Mukherjee, S.C.; Pati, S.; Sengupta, M.K.; Rahman, M.M.;
Chowdhury, U.K.; Lodh, D.; Chanda, C.R.; Chakraborti, A.K.; Basu, G.K. Arsenic
Groundwater Contamination in Middle Ganga Plain, Bihar, India: A Future Danger.
Environ. Health Perspect. 2003, 111 (9): 1194-1201.
48
DCH, Dhaka-SOES, JU, Kolkata