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ASSAM: PUBLIC HEALTH
Struck by fluorosis Of 62 million Indians suffering from fluorosis, more than six million are children and young people. Among these young, nearly 20,000 are in Assam alone, and in Karbi Anglong, well known for its scenic beauty and thick forests, a tenth of the population is afflicted with dental or skeletal fluorosis. Nava Thakuria reports. 
09 January 2007 - Eminent Assamese filmmaker Manju Borah came to Diphu, district headquarters of Karbi Anglong, to make a docu-feature on a Karbi legend. The script was written by Basanta Das, a Diphu-based writer who also selected a Karbi girl, Kadam, for the lead role. Borah wanted to interact with the girl at least two days prior to the location visit; but he was shocked when he saw her. Not only was she not as beautiful as her character demanded, but her teeth were discoloured, her neck was braced, her face wrinkled. Then Basanta Das walked in - and was equally taken aback. "But," he sputtered, "Kadam was really beautiful when I met her three years ago!" Kadam is suffering from hydrofluorosis (or fluorosis), a waterborne disease that affects at least 100,000 people, more than half of them women, in Assam. Hundreds of villages in Karbi Anglong, Nagaon and Kamrup districts have been identified as fluorosis prone. According to statistics, of 62 million Indians suffering from fluorosis, more than six million are children and young people. Among these young, nearly 20,000 are in Assam alone. Well-known for its scenic beauty and thick rainforest, Karbi Anglong is by far the worst affected, with 10 per cent of its population of 800,000 - or 70 per cent of Assam's fluorosis patients - hit by either dental fluorosis or skeletal fluorosis. The first fluorosis case in Assam was discovered during a study, the first in the northeast, by the state Public Health Engineering Department (PHED) in May 1999 in the Tekelangjun area of Karbi Anglong. Fluoride levels there were found as high as 5-23 milligrams per litre (mpl), whereas the permissible limit set by the World Health Organization is 1.5 mpl. Says Amalendu Bikash Paul, then additional chief engineer in the state PHED, who was instrumental in unearthing the rampant disease, "Severe anaemia, stiff joints, painful and restricted movement, mottled teeth, loose muscles, kidney failure, premature death and physical disability are manifestations of fluorosis." He adds that women and children are more prone to the disease as they are generally homebound and, thus, in contact with contaminated water for a longer time. Furthermore, malnutrition during childhood renders the women more vulnerable.
Fluorosis has no cure: it can only be prevented from deterioration if diagnosed at an early stage. Fluoride replaces hydroxide in the bones, leading to chronic skeletal fluorosis. Meet Gita Deb, 49, a resident of Tekelangjun (about 90 km from Diphu), who has been suffering from the disease since 1995. Now paralysed and confined to her bed for the past three years, Gita feels severe pain in her waist, legs, hands and, lately, her finger joints. Earlier, she could move with the help of a stick, but now she can barely sit up on the bed for a half hour.
The nearby government health centres don't supply her any medicines, leaving her husband, who used to run a small shop in Baghpani Bazaar, as her sole caretaker. Not having a bedpan, the family of three lays a plastic sheet on the bed, which is washed twice a month and reused. This is when Gita has to be carried outside. Their only son, a school student, is also slowly getting affected with dental fluorosis. Two of the Deb daughters, who married and left for distant villages, have also begun complaining of severe joint pains and semi-paralysis. Gita and her husband had migrated from Tripura to Karbi Anglong about 25 years ago. In the early days, the family used springwater. In the early 1990s, the state PHED launched a drinking water supply scheme in the locality. The family then started using groundwater and continued till fluorosis was discovered in 1999. The PHED immediately abandoned the supply scheme and warned people against using groundwater for drinking and cooking purposes. It arranged to transport springwater into the village from a nearby hillock. Today, harassed into desperation, many families in the villages prefer to use water from wells about 10 ft deep.
Statistics reveal that fluorosis is endemic in at least 20 states in India, and dozens of other countries have noted incidences of the disease. Serious efforts had been made to eradicate fluorosis in India after the launching of the Rajiv Gandhi National Drinking Water Mission in 1986. Now the Union government is said to have decided to set up a Fluorosis Mitigation Centre for referral, documentation and validation. UNICEF and some local NGOs like the Jirsong Asong, the Lions Club, and the Nehru Yuva Kendra are running health awareness drives in the affected areas. There is no denying the connection between flurosis and poverty. Almost 80 per cent of those affected in Assam are acutely poor, illiterate and socially unaware. Addressing fluorosis would obviously mean minimising socioeconomic deprivation first. While healthcare might mitigate the crisis in the short term and awareness in the medium term, the economic independence of the people is the only long-term solution. Skeletal fluorosis, which can cripple a working individual, directly affects earning capacity. Dental fluorosis, on the other hand, doesn't restrict a patient's movement but, because it looks devastating, adversely affects the matrimonial aspect of girls and boys. Even after marriage, repeated quarrels between wives and husbands can cause serious problems in their conjugal life. The disease also gives rise to an inferiority complex among its victims. Kadam, thankfully, got over her complex when Borah told her that she would be working in Borah's next venture. Till then, Borah told Kadam, she should take care of her health. How, is another matter altogether. (Women's Feature Service) ⊕
Nava Thakuria
Nava Thakuria is a journalist based in Assam. 
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Comments (6)
The situation is very grim not in Assam but in many parts of the country such as Andhra, Rajasthan, Gujarat, even in Delhi. There is an urgent need to implement the possible schemes to supply at least fluoride free drinking water to the affected areas. Some filters are available which are not very costly they can deflouridate the water. Govt. has to see how these can be distributed or reach in needy families. Some local NGOs may play the lead role. God help us. High fluoride content is more common in some districts of Yemen and mostly of geological origin. In most deep wells, the fluoride content is above 3mg/liter (23mg/liter is found). Therefore, Government asked UNICEF/WHO for technical support to prepare urgent action plan for increasing awareness among the affected communities to stop drinking from the fluoride contaminated sources and using other alternative water sources (dug wells). They asked also for study tour to some of countries, which have a good experience of low cost technologies for treatment in households. I would be very appreciative for your help in suggesting some areas/projects to visit by GARWP staff (General authority of rural water supply projects in Yemen). Hi.. As the article stresses the situation in Assam I hope the information can be of some assistance. hi,the article have been very informative and tells the true story in karbi anglong.....only thing that is to be see is weather the preventive measures r implemented in a proper manner or not.... The above article is very informative and the respected Doctor had done a great job.
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This is a quick response to Kadam's condition. If she can drink fluoride free water that would be a beginning. How is that possible? Is the open well water fluoride free? If not then families like Kadam's should harvest rooftop rainwater, collect and store it and use that only for drinking and cooking. Many families in Karnataka, Rajasthan, A.P. do that. A 5000 or 6000 litre tank is usually enough to collect the rainwater for a year - of course depending on the catchment.
How does this message get to Kadam and fellow villagers?