5th International Conference on Arsenic:

Developing Countryís Perspective on Health, Water & Environmental Issues

 

February 15th -17th 2004

Dhaka, Bangladesh

 
Editors:

Prof. Quazi Quamruzzaman

Prof. Mahmuder Rahman

Quazi Habibur Rahman

Alison Quazi

Md. Jabed Yousuf

Md. Golam Mostofa

Md. Altab Elahi

Dr. Farzana Begum


 

Organized By:

Dhaka Community Hospital (DCH), Bangladesh

and

School of Environmental Studies (SOES), Jadavpur University, India

Sponsored by UNICEF-Bangladesh
Preface

     In recent years the Arsenic problem has surfaced as a mega health and environment problem for Bangladesh and in other South and South Asia countries. To understand various aspects of this problem and to plan and implement mitigation programs will obviously need uniform and coordinated activity of all national and international agencies including UN, bodies.

 

This conference helped them to come together and able to share their experiences and help to formulate ideas, which helps national and regional policy to formulate Arsenic Mitigation programmes.

 

One of DCHís major public health programme is arsenic mitigation and Arsenicosis case management. In its course of action DCH have developed partnership with UNICEF, WHO & UNDP. Different agencies of the Government of Bangladesh, engaged us on various mitigation activities in Health and Environment. Many donor agencies like World Bank, AusAid, DFID, and Canadian CIDA, also working with us.

 

School of Environmental Studies (SOES) of Jadavpur University and School of Public Health, Harvard University of USA are jointly working with us in various research activities.

 

This conference is the fifth one staged jointly by DCH and SOES and was actively supported by UNICEF. We are also acknowledging the kind support provided by the various government agencies of Bangladesh. The private organisations like Square Bangladesh, Duncan Brothers Bangladesh, and Singer Bangladesh also helped us all the way in organising the conference. Media, both print and electronic, helped and supported us from the early stage of our struggle against Arsenic contamination.

 

We hope that the Proceedings of this 5th International conference on Arsenic will help the policy planners and researchers and other agencies to implement programmes. We sincerely thank UNICEF, Square Pharmaceuticals, Duncan Brothers, DPHE and the members of the organising committee for their kind support and help.


List of Contents


Introduction

 Inaugural Session
Welcome Address by Professor Mahmuder Rahman
Co-ordinator, Dhaka Community Hospital Trust

Mr. Morten Giersing,  Country Representative, UNICEF- Bangladesh
Mr. Tapan Choudhury,  Managing Director, Square Pharmaceuticals Ltd.
Dr. Willard R. Chappell,  Professor, Environmental Science, University of Colorado, USA
Dr. Moniruzzaman Miah,  Chairman, TWEDS

Vote of Thanks:   Prof. Quazi Quamruzzaman Chairman, Dhaka Community Hospital

Working Session 1
Arsenic Health Issues


Arsenic Exposure, Diet and Skin Lesions in Pabna, Bangladesh
Dr. David Christiani Professor, Occupational Medicine and Epistemology
Harvard Medical School

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 Organigation, South East Asian Region, India

Arsenic Neuropathy from Groundwater Arsenic Contamination in India
Dr. S.C. Mukherjee
Assistant Professor, Department of Neurology Medical College, Kolkata

Susceptibility of Arsenicosis in Bangladesh and Management of Arsenicosis Patients in DCH
Dr. Shahjahan and Dr. Ainul Islam Joarder
Consultants, Dhaka Community Hospital

Skin Manifestation Complication in Arsenicosis
Dr. Shaihidullah Shidakar
Assistant Professor, Department of Dermatology and Venerology
Bangabandhu Sheikh Mujib Medical University, Dhaka

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 Social and Economic Effects of Arsenic

Social and Economic Effects of arsenic

Dr. Farida Akhter
UBING, Policy Research for Alternative Development

Working Session 2
Continuation of Arsenic Health Issues


Collaborative IRB Capacity Building
Lia Shimada
Department of Environmental Health, Harvard School of Public Health

Respiratory Effect and Chronic Arsenic Exposure in Bangladesh
Dr. Ziaul Hasan Rumi
Technical Specialist, NGO Forum for DWSS

Experiences of DCH Arsenic Clinic And Yahiaís War Against Cancer
Dr. Syed Nasrullah,
Consultant, Dhaka Community Hospital

The Pattern of Clinical Manifestations and Practice of Alternative Water Options of 50 Arsenic Affected Patients of Sirajdikhan Upazilla, Bangladesh
Dr. Farzana Begum
Project Officer, Public Health, Dhaka Community Hospital

Interaction of Ascorbic Acid and Iron in Arsenicosis patient
Abdus Zaher
Assistant Professor, Institute of Nutrition and Food Science
Dhaka University

New Approach on Managing Non-Healing Ulcer
Mr. Abdus Salam
Consultant on Physiotherapy, Dhaka Community Hospital

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

Working Sesssion 3
Update of Safe Water Options


The One-year Monitoring Programme Updates of Shallow Dug Wells to Provide Arsenic-Safe Water in West Bengal, India
Fr. Xavier,
Lecturer, Department of Environmental Science, St. Xavier's College, Kolkata

Dugwell And itís Use as Sustainable Alternative to Ground Water
Nandini Sabrina
Environmental Engineer, Dhaka Community Hospital

Effectiveness and Usefulness of Arsenic Removal Plants: An Experience in West Bengal, India
M. Amir Hossain
School of Environmental Studies, Jadavpur University, Kolkata

The Role of Bangladesh Arsenic Mitigation Water Supply Project in Fighting Arsenic Crisis of Bangladesh
Mr. Khoda Bux
Project Director, BAMWSP

Safe Water Options in Bangladesh: Piped Water Supplies
Mr. Paul Edwards
Chief, Water and Environmental Sanitation UNICEF - Bangladesh

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

Working Session 4
Water Availability and Rational Use of Available Water Sources

 Water Supply in Arsenic Affected Rural Areas of Bangladesh ĖThe Institutional Challenge
Chowdhury Mufad Ahmed
Assistant Secretary,  Ministry of Environment & Forest

Arsenic Safe Water Supply: Potentials of Surface Water Sources
Firoz Ahmed
Professor of Civil & Environmental Engineering, BUET

Aquifer Concept and Withdrawal of Safe Ground Water from the deltaic Plain of Bangladesh
Md. Nehal Uddin
Deputy Director, Geological Survey of Bangladesh I

Impact of River Link Project
Mr. A N H Akhter Hossain
Managing Director, Dhaka WASA

The Present History of Surface Water in Bengal: A Cautionary Note
Mr.  Sallimullah Khan,
Consultant

Special Session

Mr. Mirza Fakhrul Islam Alamgir
State Minister, Ministry of Agriculture, PRB

Mr. Shafiq Rehman
Editor, Jai Jai Din

Mr. Rashed Khan Menon
General Secretary, Workers Party of Bangladesh

Dr. Naila Zaman Khan Professor,
Child Neurology Development Bangladesh Institute of Child Health

Mr. Atiqur Rahman Salu
Member, International Farakka Committee

Working Session 5
Health and Environmental Hazards Encountered with Extraction of Ground Water and Management of Water Resources

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

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

GOB-UNICEF Arsenic mitigation program in Bangladesh
Shafiqul Islam
Team Leader, Arsenic Unit, Water and Environmental Sanitation, UNICEF-Bangldesh

Social Impact of Arsenicosis Patients in Bangladesh
Mr. Jabed Yousuf
Project Director, Dhaka Community Hospital

A plan of Action
Dr. Richard Wilson
Professor, department of Physics, Harvard University

Sludge Management In Arsenic Removal Plants in Manikganj and Faridpur
Ms Sharmenn Murshid
Chief Executive Officer, Brotee

Safe Water for Agriculture: Treatment System Using Air and Scrap Iron (3-Kalshi Patra) to Remove Arsenic from Tube Well for Growing Arsenic ĖSensitive Crop Mr. A.H. Chowdhury
School of Chemical Engineering and Industrial Chemistry University of New South Wales, Australia

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

Community Demand DSrinking Water from River Sand Filter
Mr. Ariful Islam
Assistant Program Officer, Dhaka Community Hospital

Working Session 6
Continuation: Health and Environmental Hazards Encountered with Extraction of Ground Water and Management of Water Resources

Appropriate Technology in Action: Experiences in Arsenic Mitigation at Micro-Level
Ali Ahmed Ziauddin
Shobuj Shena Centre, Sibaloy, PRISM, Bangladesh

Arsenic In Drinking Water and Recent Knowledge on food chain Contamination
Professor Imamul Huq
Department of Soil, Water and Environment,University of Dhaka

The WHO Water Safety Framework Approach to Arsenic Mitigation
Dr. Guy Howard
International Specialist, Arsenic Policy Support Unit (APSU)

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

Dr. Dipanker Chakraborti
Director and Head
School of Environmental Studies, Jadavpur University, Kolkata

Dr Quazi Quamruzzaman Chairman Dhaka Community Hospital Trust

Closing Session

Dr. Ahmed Kamal
Professor, Department of History, University of Dhaka

Prof. Ainun Nishat
Country Representative, IUCN

Mr. Badiur Rahman
Member, Planning Commission

S.K.M. Abdullah
National Expert Committee

Dr. Richard Wilson
Mallinckrodt Research Professor of Physics, Department of Physics, Harvard University

Mr. Mahfuz Anam
Editor, The Daily Star

Ms Khushi Kabir
Chief Executive Officer, Nijera Kori

Mr. Morten Giersing
Country Representative, UNICEF

Christine Wallich
Country Director, World Bank- Bangladesh

Mr. Atiqur Rahman
Representative, International Farraka Committee

Ms Taleya Rehman
Chief Executive Officer, Democracy Watch

Dr. David Christiani
Professor, Occupational Medicine and Epistemology, Harvard Medical School


Vote of Thanks

Prof. Quazi Quamruzzaman Chairman,
Dhaka Community Hospital

5th Dhaka Declaration

List of Participants
Introduction

With the aim of providing an integrated and sustainable health care delivery system at an affordable cost both in the rural and urban areas of Bangladesh, Dhaka Community Hospital was established in 1988. Besides its clinical activities it also runs various health related projects, conducts training programs with its individual research, training and  community-based project implementation divisions. Since its inception, Dhaka Community Hospital has been playing a significant role in focusing attention to the issue of arsenic contamination of water through its publication, conferences, seminars and workshops. DCH is the pioneer organization in the field of arsenic research in Bangladesh. In 1996, the doctors of Dhaka Community Hospital first detected some patients affected with diseases caused by arsenic contamination. By undertaking manifold activities DCH has been successful, over the years, in establishing the arsenic issue not only as a major environmental problem, but also a critical public health concern in Bangladesh. National and International conferences constitute an important part of the overall DCH activities. Through holding of conferences/workshops over the years, DCH has sought to highlight many problem faced by the arsenic that face millions of people of Bangladesh. To date, DCH has organized five conferences on various issues arising out of arsenic contamination. These conferences have resulted in enriched deliberations as well as wider dissemination of the issues at hand. The present one is the Fifth International Conference on Arsenic: Developing Countriesí Perspective on Health, Water and Environmental Issues held during 15-17 February, 2004 at the Auditorium of Dhaka Community Hospital, jointly organized by DCH and School of Environmental Studies (SOES), Jadabpur University, India.The major issues addressed in this 5th conference include health issues related to arsenic contamination, updated safe water options, water availability and rational use of available water and management of water resources, particularly surface and ground water. The present proceedings highlight the major findings from the papers presented as well as views expressed in the fifth conference on arsenic.  It is hoped that this proceedings will help all concerned in strengthening arsenic mitigation programmes as well as in creating more awareness about the magnitude of the hazard of arsenic and safe water options. It is also hoped that the proceedings will be utilized by researchers, planners, policy makers and all those concerned with arsenic issue, home and abroad.

INAUGURAL SESSION
Chair:
Dr. Maniruzzaman Miah

Dr. Mahmuder Rahman
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 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 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.


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 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 UNICEFís 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 UNICEFís 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. Itís 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 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.


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.

The 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 countryís 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 countryís 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. Itís 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 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 ďscourgeĒ .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.

Dr. Willard Chappell

Professor, Environmental Science

University of Colorado, USA

 

Honorable chairman, ladies and gentlemen. Itís 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 didnít 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. Itís very difficult and very expensive to remove arsenic from soil. So I canít 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. 

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.

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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 wonít 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 Rahmanís 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 havenít sat idle, 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 donít 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.

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, Iíd rather thank Professor Aynun Nishat who was supposed to explain what we are doing for this conference. So Iíll 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 Secretariesí 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 will have 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. Iíll 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 weíll 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 countryís 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 yesterdayís 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.

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 couldnít 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 , Peopleís 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, Iíll 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 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 couldnít be here this morning but heíll 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 didnít 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 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 donít need your treatment. Just tell everybody that I donít 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. Weíll be discussing how, what is the medication is going to help, weíll be discussing what nice work is done by somebody, weíll 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.     

Working Session-1 on Arsenic Health Issues

< style="color: rgb(204, 0, 0);">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. 


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.

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


The 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 personís 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 donít 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 donít know. Most of the study weíll 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. Itís 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 itís 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 itís the very duty of the population. That I agree. Itís 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 wrong. You cannot generalize the whole universe and thatís whatís 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
.

<>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 neurpotahy. What are the types? It may be acute, sub-acute 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 Electro-physiological 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 itís 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, 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.                 

 

Susceptibility of Arsenicosis in Bangladesh and Management of Arsenicosis 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 donít 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. Non-carcinogenic toxicity is due to inhibition of cellular desperation at hepatic mitochondria. Now Iíd 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, 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, Iíd 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. Iíd 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 itís 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 socio-economic 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.

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%, Bowenís disease was 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%. 

Bowenís Disease on the palm with warty hyperkeratosis lesions. And this was the Bowenís disease. Bowenís disease on the left fora. These are the lesions of Bowenís 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 Bowenís 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.

(Alas the slides with the  pictures are not avaialable)

 

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.

 

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. Iíd 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. Iíd 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 Iím 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. Itís 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 AndolanĖa Bio diversity based farming practice. But itís 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.

Iíd 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 weíve found that there are severe social impacts. All these things that youíve 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 canít 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 doesnít 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 donít. 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. Iíll 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, itís 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 Iíll now request that theyíll speak in Bangla and theyíll give you three stories. 


Iíll tell you a case study about an arsenic affected familyís 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 Taraís husband. And he said to his siblings and wife, ĎLet me get better first, then Iíll provide treatment to you all.í And thus Hasan Tara and her children are waiting for Rahimuddin to get better treatment for arsenic
.

 

The story Iím about to tell it happened in  Charakpur Village of Isherdi thana of Pabna. Iíll 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 canít 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.

 

Iíll talk about arsenic affected peopleís financial losses. Iím going to tell Begum Sufia Kamalís 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 husbandís 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 sonís 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. ďIíve lost my land, my cows, poultry but Iím 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.Ē She also said, ďIíll probably die. But my soul will only rest peacefully if someone cures my only son.Ē Thank you all.

 

Just to finish that, there are many stories. Iím 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 donít think we are doing enough against arsenic. So thank you.

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. Iím going to begin with a brief introduction to human subjectsí protection. Iíll continue with international applications of human research ethics. And Iíll 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.

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 IRBís 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.


   
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.

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 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.

<>Experiences of DCH Arsenic Clinic And Yahiaís 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 Iíll 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. <>

Letís 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 adissonís disease, idiopathic guttate, hypomelanosis, actinic hypermelanosis, PKDL, leprosy, and hereditary palmoplanter and hyperkartosis, etc.

 

Now Iíll be sharing the experiences of the DCH OPD clinic. In four years from April 21st 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.  

 

Iíd 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.

 

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. 

 

Iíd 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.


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 merkís 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 bowanís  disease and 6.1% are suffering from Squamous Cell Carcinoma and none, among these 50 respondents, in suffering from Bezel Cell Carcinoma.

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. Bowenís 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.
 

<>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.


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 Parkinsonís 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.


<>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, noisyvomiting 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. Itís 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 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. 

 

<> 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. Itís 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. Iíd 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 itís 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. Itís 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 itís 2000 patients and in the Shansei itís 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. Itís 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 didnít 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. Thatís 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 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. Itís very easy. After the fieldwork they take the coal home and to use. Next one please. And the indoor combustion is  bery polluting. And the arsenic emission to the air and the suspended indoor air. And then it is suspended 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. 

 

Working Session-3 on Update of  Safe Water Options

Chair: Mr. Paul Edwards

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 Ė 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 Iíd 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 Ė 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? Itís 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. Thatís 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 Ė 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 thatís how the dug well looks even in the scorch of summer time. In the monsoon what is the condition? 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. Itís 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 Ė 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?. Thatís 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 Ė 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.

 

Dug well and itís Use as Sustainable Alternative to Ground Water
Nandini Sabrina

Environmental Engineer, Dhaka Community Hospital

 

Honíble chair, co-chair, ladies and gentlemen, good afternoon. I am here to present the paper Ė 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. Itís 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 itís 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.

Effectiveness and Usefulness of Arsenic Removal Plants: An  Experience in West Bengal, India
M. Amir Hossain
School of Environmental Studies

Jadavpur University, Kolkata

<>Honíble chairman and co-chairman, respected participants The title of my paper is ĎEffectiveness and Usefulness of Arsenic Removal Plants and Experience in West Bengal, India.í 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 Ganges-Meghna-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 Ė 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 Ė 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. 

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 patientís 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 Ö 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 peopleís 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 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.


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 ĎSafe Water Optionsí, 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 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 peopleís 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.

Assessment of Safe Water options for 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 weíve 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 itís 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 ďwhat do we do?Ē Suppose you take us there and you ask us very simply, ďhow do you solve the problem?Ē 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. Itís 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 a level 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 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 weíve 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. Itís 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 apron 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. Itís 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 donít 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 pre-filter 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. Weíve 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.


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 ĖThe 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 donít 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 donít 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 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 ďTaraĒ 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 ďparishadĒ 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 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 sectorís role is Ė 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 ďGram SarkarĒ. Their present role is insignificant, and water supply is not among the mandatory responsibilities of the union ďporishadĒ. 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 donít 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 donít 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 ďporishadĒ 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.


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.
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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. 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. Thatís 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.

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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 thatís 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. 

Aquifer concept and withdrawal of safe ground water from the deltaic plain of   Bangladesh

Md. Nehal Uddin

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-Brahmaputra-Meghna 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 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 feetís 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.

 

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
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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 doesnít 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 courtís direction. They are planning to implement this project by 2016 and now they are doing preliminary works.  Whatís 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 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 didnít 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?

 

Indiaís 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.

 

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 ďclassed struggleĒ. 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; ďThis 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.Ē 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, ďeffective, acceptable and sustainable solutionsĒ, 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 donít 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, ďpeoples preferences for arsenic free drinking waterĒ 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 arenít 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.


Bangladeshís 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 donít  have even the minimum ethical  common sense that it has to be resolved with the people because they think everybody is a fool. This is what they have done. But the situation has not been created yesterday Ė I donít 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, ďthere have been Asia generally from immemorial times but three departments of government that of finance of the plunder of the interiorĒ, Marx was a 35 year old journalist so donít mind the language, ďthat 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.Ē 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.

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. 

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 MPís take a lesson from you. Well water for many countries in 21st century is now both international and national issue. Bangladesh is unfortunately one of them. This morning-working 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. Godís donít 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 Indiaís own water planning. The Central government of Indiaís 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.

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 didnít 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 didnít 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 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 didnít 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 Indianís 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.

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-ŗ-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 Ė 30% of children drop out from primary school. Our IQ levels are 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 9Ė4 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.

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 donít 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 Ölast 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 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.

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 pre- treatment 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 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.

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 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.

 

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 transparencyís. 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%.


The 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 9-concerned 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 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.

 

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 fatherís 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. Symptomsí 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-lawís house. She was prevented from doing household work like cooking and food handling. She was thrown out from husbandís 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 socio-economic issues, need continuous awareness program, training of the doctors and field workers  for the mitigation of arsenic crisis. Thanks a lot.

 

<>A plan of Action (a full paper is available)

Dr. Richard Wilson

Mallinckrost Research Professor of Physics

Harvard University, Cambridge, MA USA 02138

In 1998 DCH held their first conference on their arsenic problem in Bangladesh. By this time six years have passed. But the progress is painfully slow. There are several potential solutions which  may be used.  Household purification, to purify the water by removing the arsneic and sanitary  dug-well, pond sand filter and  rain water collection to  avoid the arsenic. Feroze Ahmed discussed ithese options in 2002, in the WHO conference,  and noted that each one has a problem.  Each one needs strong community involvement for successful implementation.  Unfortunately the household filtersthat were strongly urged 5 years ago in these conferences and particularly by DCH,  have beem abandoned as a general solution because households have been  unable to manage them; and in additio there is a p[otentail long term problem of solid waste. Well switching was also proposed  Early optimism noted that 70% of the tube-well were arsenic free (as Professor McArthur constantly points out).  The suggestion was to switch to arsenic free wells. But that does not work some villages.


Another alternate we discussed 7 years ago was deep tube wells.  The deep-tube-wells are (relatively) cheap. They must be built properly and properly maintained.   The same is true of dug-wells amf pond sand filter.    I do not know much about the realtive cost and the capital expenditure needed. I fortunately do have the record of expensive experience by the DCH group. Rainwater collection is a potentuial solution in all areas.   But it is more expensive than in a European country because nine month storage is needed.  Moreover it must be well  maintained to keep it bacteria free in  storage for nine months. Large-scale purification and removal or arsenic may be useful for large communities where the cost may be shared and therefore reduced. Piping water house to house can be done. If do it from river water it actually cheaper than the removing  arsenic.  It is less complex than arsenic removal and therefor cheaper.


DCH has demonstrated that they can produce sanitary have dug wells.  I would like each NGO to copy this and demonstrate clearly their proposed solution.  Bu a community commitee must discuss wahta is best in their location;  which procedure works  best .   This leaves the government to work on the large scale arsenic removal units for a large community.

 

We need community involvement. DCH has set an example for strong community involvement. They provided fresh water for ten thousand people. Some people have piped water in their houses. DCH want to expand this activity three fold.  A threefold expansion  will probably saturated  DCH capabilities  but there are other NGOS. If each NGO provides pure water for 350 thousand people;    7 million people can be provided safe water by 20 NGOs. The government can then supply the large-scale purification systems for the others.


So the fundamental question arises, how and when do the big donors support NGOs?  They should send  fund money direct to NGO.  UNICEF and World  Bank asks other intermediate agencies to give money. Only then can the funding agency give money to the NGO.   Some procedure must be found for the World Bank to directly fund those  NGOs which are transparent in their activities and have shown by talks at these meetings that they know what to do.  


So my suggestion is very simple. Support any, and all,  NGOs which has or have shown that it or they can provide arsenic - free and bacteria free water at modest cost.  They should be  directly funded by World Bank, other UN agnecies, Kuwait fund and other international agencies.   Criteria might be peer approval in these meetings and  WHO approval.


Thank you.

 

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 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 .


Safe Water for Agriculture: Treatment System Using Air and Scrap Iron (3-Kalshi Patra) to Remove Arsenic from Tube Well for Growing Arsenic ĖSensitive 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.

 

Surface water option is the best option for agriculture purposes 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 three-kaishi 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.

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 tube-wells 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.


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 dug-well 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 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.


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 fieldsí 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 Ė 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 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. Bambooís 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. Thatís why this presentation. Thank you.

 

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 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
 

.

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 tube-well. 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 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.
 

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, doesnít 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 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 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.

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. Thatís 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. 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.

 

Thatís 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.

 

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.

 

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 donít 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.  <> 

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? 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.

 

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 4th  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.

 


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 co-ordination 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 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.                           


Mr. S. K. M. Abdullah

Member, National Expert Committee

Mr. Chairman, ladies and gentleman I don't know why I  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 Nishatís summary. The summary was quite good. Itís 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 Rahamanís 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 planís whole heart is peopleís 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.

 

Dr. Richard Wilson

Professor, Department of Physics

Harvard University,  Cambridge MA, USA


 Scientists have said for a`century that if animals donít get cancer why should people get cancer?. And it took scienists a to realize that people get skin cancers and internal cancers  but also it took a long time to start doing something about it. And we  should have started  20 years ago. The urgency is there. I just want to emphasize the one of ways of getting round the lack of urgency is the for government to ask big funding organizations like the World Bank, the UNICEF in a sense,  and also Kuwait fund to fund directly some of the NGOs for doing waht the can to get pure water to the people. Unfortunately,  the  number of NGOs who are doing something effective is small.   But 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 that NGOs be funded directly, bypassing the government, it should not cut out the Columbia/University of Dhaka group from the being supported merely because they are talking about deep-tube-well rather than the surface water which is in the national plan.   Even if deep tube-well is merely an interim solution in some places   They  are adequate options and cheaper than pond sand filterand dugwells.  Professor Ahmed explained to us that  they are taking all the pre-cautions to make sure the wells are working well. They properly grout the wells and they will be  adequately tested for ten years. So, I repeat, plesase support finacially the groups which are actively doing something and have a track record.   Do not cut out a solution that is working because it is only a medium term solution and not in the long-term national policy. I think the national policy is right. I think I will prefer the surface water in the long term.  But if some group thinks they can do a good job, ask them to show you.  If they are doing a good job, do please support them. Thank you all.

 

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.
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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 itís 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 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.


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 donorsí 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.
       

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 donorsí 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 youíre 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.

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 donít 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 donít 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 Bangladesh- China 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 donít know which one is the best fit the country Ėthe 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 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.


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 Ėup 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 donít 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 canít 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.  

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.

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.

 


The 5th Dhaka Declaration

Date: 17.02.04

 

We, the Participants of the 5th International Arsenic Conference, note that while certain achievements been reached so far regarding the supply of arsenic free safe water to the people of Bangladesh, concrete and long-lasting efforts remain to be implemented. We were, however, pleased to note that a national policy and guidelines is under the process of approval by the Government of Bangladesh regarding the supply of safe drinking water to the arsenic affected population. We understand that major initiatives have started. but considering the severity and magnitude of this human tragedy, the efforts are still too slow. As such. We continue to urge upon all concerned, irrespective of their nationality or affiliation, to come forth to help the people of Bangladesh on an emergency basis.

 

We have heard and noted the progress achieved in mitigating the arsenic crisis from the 1st International Conference in 1998 till the 4th Conference in 2002. While we appreciate that efforts are more significant than in the previous years, we cannot but stress the need for placing greater emphasis on patient care and development of an approved protocol for the treatment of arsenic patients. In this strategy, the interests of the people of Bangladesh should be given utmost priority.

 

More specifically, we the Participants do hereby declare that:

 

In matters relating to patient management, It is important to develop both an acceptable and affordable form of treatment, keeping in mind that many of the patients will not be able to afford costlier forms of management.

 

In matters relating to water resource management, all stakeholders are earnestly requested to adhere to the National Arsenic Mitigation Policy and the Implementation Plan under the process of approval by the Government of Bangladesh. As mentioned in the Policy, priority must be given to exploiting perennial sources of surface water, which is found in abundance in Bangladesh. Bangladesh being endowed with abundant surface water and rain water, all agencies must consider the use of surface and rain water before any suggestion of ground water withdrawal is made, except in unavoidable circumstances

or in known safe areas.

 

Before recommending extraction of ground water from deeper aquifers, the safety of the deep aquifers must be ensured and adequate understanding of the geological parameters developed to ensure that these aquifers would not become contaminated in the future.

3rd party audit and analysis of all the deep tube-well both Government and Non-Government installed from 1997 onward should be undertaken immediately to monitor the quality. This has become very urgent from the experience of the Sharsha Upazila

More understanding is required to quantify the impact of arsenic contaminated irrigation water on the food chain and food production.

 

We, the Participants of this Conference, Recommend that:

 

All activities related to arsenic mitigation or research in Bangladesh should be significantly increased and expedited after scientific evaluation.

 

All mitigation activities must be undertaken to ensure the full participation of local communities and local government institutions before, during and after implementation to ensure ultimate ownership. We believe that without the involvement of communities and local government institutions all efforts will be unsustainable. Transparency and mutual respect should the basis for all future work.

 

All future mitigation activities should involve the private sector, forging a partnership and coordination between the public and private institutions.

 

Tests so far indicate that none of arsenic removal technologies works in all the hydrological regions. It is strongly recommended that more scientific scrutiny and public discussion should be held before validating any of the technologies for the purpose of marketing and large-scale use.

     

In conclusion, we re-iterate the seriousness of the situation in Bangladesh and urge all concerned to actively assist the people of Bangladesh in overcoming this crisis.



NATIONAL ADVISORY COMMITEE (Conference)

 

Dr. A. M. Shawkat Ali                       FAO

Dr. Abdur Rahman Khan                    DGHS

<>Dr. Ainun Nishat                                Country Representative, The World conversation Union (IUCN), Dhaka

Mr. Amanullah Kabir                          Amar Desh

Mr. Ashok Madhab Roy                     Ministry of LGED & C

Dr. Babar N. Kabir                           Programme Coordinator, SEMP

Mr. Borhan Ahmed                            Janakantha

<>Mr. Choudhury Mufad Ahmed            Ministry of Environment & Forest.  GOB, Bangladesh Secretariat, Dhaka

Ms. Christine Wallich                         World Bank       

Dr. Feroze Ahmed                             Professor, CE, BUET

Mr. Han Heijnen                                WHO

Ms. Janet Donnelly                             AusAID 

Mr. K.M. Minnatullah                         World Bank

Dr. Kayode Oyegbit                           UNICEF

Dr. M. Moniruzzaman Miah                TWEDS

Mr. Mahbub Jamil                              SINGER

Mr. Mahfuz Anam                             The Daily Star

Dr. Maidul Islam                                BSNMU

Mr. Matiur Rahman                            The Protham  Alo

Mr. Nurul Kabir                                 The Weekly Holiday

Mr. Paul Edward                                UNICEF

Prof. Quazi Quamruzzaman                Chairman, DCH

Mr. S.K.M. Abdullah                          National Expert Committee

Mr. Shafiqul Islam                              UNICEF

Mr. Shajahan Sarder                           Reports Unity, Dhaka

Ms. Sharmin Morshed                        BROTEE

Ms. Taleya Rehman                           Democracy Watch

Mr. Tapan Choudhury                        SQUARE

 

INTERNATIONAL ADVISORY COMMITTEE (Conference)


Dr. Alan H. Smith                              USA

Dr. Alison Baker                                AUSTRALIA

Dr. D.N. Guha Mazumder                  INDIA                                                                

Dr. David Christiani                            USA

Dr. Deoraj Harry Caussy                    INDIA

Dr. Gary Owens                                AUSTRALIA

Dr. K.C. Saha                                    INDIA

Ms. Kristen Collins                             AUSTRALIA

Dr. Peter Nadebaum                          AUSTRALIA

Mr. Peter Robson                               AUSTRALIA

Dr. Phillip Crisp                                  AUSTRALIA

Dr. Ravi Naidu                                   AUSTRALIA

Dr. Richard Wilson                             USA

Dr. S.C. Mukherjee                            INDIA

Dr. Shyamapada Pati                          INDIA

Dr. Tony Fletcher                               UK

Dr. Willard Chappel                            USA

Dr. Y. Munekage                               JAPAN

 

  CONFERENCE ORGANIZATION

 

Conference Convener                                    Dr. Mahmuder Rahman 

                                                                        Dr. Dipankar Chakraborti

Organizing Committee

Chairperson                                                      Dr. Quazi Quamruzzaman

Member Secretary                                            Mr. Wakar Hossain            

Member                                                            Ms. Alison Quazi

                                                                        Mr. Quazi Habibur Rahman

                                                                        Mr. Jalaluddin Khandaker

                                                                        Mr. Golam Mohiuddin

                                                                        Mr. Abdur Rahman

                                                                        Dr. Capt. (Retd) Md Shahajahan

                                                                        Dr. Ainul Islam Joardar

                                                                        Dr. Abdus Salam

                                                                        Dr. Sayed Nasrullah

                                                                        Dr. Farzana Begum

                                                                        Ms. Nandini Sabrina

                                                                        Dr. Fazle Rabbi

                                                                        Dr. Fazana Aziz

                                                                        Dr. Probir Banerjee

                                                                        Mr. Sukumer Chakraborti

                                                                        Mr. Jabed Yousuf 

                                                                        Mr. Golam Mostofa

                                                                        Ms. Hasmat Ara Parul

                                                                        Mr. Altab Elahi Sohel

                                                                        Mr. S. M. Basit

                                                                        Mr. Ariful Islam

                                                                        Mr. Selim Reza

                                                                        Mr. Ziaul Islam

                                                                        Ms. Marzina Begum

                                                                        Ms. Tithika Chakraborti

                                                                        Mr. Nazrul Islam

                                                                        Ms. Jannat Ara Irine

                                                                        Mr. Mihir Banerjee

                                                                        Mr. Mahbub Morshed

                                                                        Ms. Sabitri Roy

                                                                        Ms. Afroza Parvin

                                                                        Ms. Afroza Begum

                                                                        Mr. Kawser Alam Manik

                                                                        Mr. Anamul Kabir

                                                                        Ms. Shamima Alam Ranu

                                                                        Mr. Sakila Afroz

                                                                        Mr. S.M.A. Samih Hasnat

                                                                        Mr. Bivash Chandra Barmon

                                                                        Mr. Shafiqul Islam

                                                                        Mr. Salim

                                                                        Mr. Alam

                                                                        Mr. Wayazed

Reception Sub-Committee

Chairperson                                                      Dr. Quazi Quamruzzaman

Member Secretary                                            Mr. Saidur Rahman

Mamber                                                            Dr. Mahmuder Rahman

                                                                        Mr. Quazi Habibur Rahman

                                                                        Dr. Sabera Rahman

                                                                        Mr. Jalal uddin Khandaker

                                                                        Mr. Golam Mohiuddin

                                                                        Dr. Capt. ( Retd) Md Shahjahan

                                                                        Dr. Ainul Islam Joardar

                                                                        Dr. Abdus Salam

                                                                        Mr. Jabed Yousuf 

                                                                        Mr. Golam Mostofa      

Finance Sub Ė Committee

Chairperson                                                      Dr. Quazi Quamruzzaman

Member Secretary                                            Mr. Sukumar Chakraborti

Member                                                            Mr. Jabed Yousuf

                                                                        Ms. Jannat Ara Irine

                                                                        Mr. Nazrul Islam

                                                                        Mr. Jakir Hossain

 

Press and Publication Sub-Committee

Chairperson                                                      Mr. Quazi Habibur Rahman 

Member Secretary                                            Dr. Farzana Begum

Member                                                            Mr. Mihir Banerjee

                                                                        Ms. Nandini Sabrina

                                                                        Mr. Jabed Yousuf

                                                                        Mr. Golam Mostofa

                                                                        Mr. Shafiqul Islam

                                                                        Mr. Mahboob Morshed

                                                                        Mr. Aqlasul Momanin

                                                                        Mr. Alam

 

Accommodation Sub-Committee

Chairperson                                                      Mr. Quazi Habibur Rahman

Member Secretary                                            Mr. Ziaul Islam

Member                                                            Mr. Shafiqul Islam

                                                                        Mr. Aqlasul Momanin

                                                                        Mr. Anamul Kabir

                                                                        Ms. Morzina Begum

                                                                        Ms. Sabitri Roy

 


Food and Catering Sub Ėcommittee

Chairperson                                                      Mr. Jalal Uddin Khandaker

Member Secretary                                            Mr. Wakar Hossain

Member                                                            Dr. Abdus Salam

                                                                        Mr. Nazrul Islam

                                                                        Mr. Kawsar Alam

                                                                        Ms. Nighat Khanam 

                                                                        Mr. Ali Hossain

                                                                        Mr. Rahman

                                                                        Mr. Alam


Publicity and Media Sub-Committee

Chairperson                                                      Mr. Quazi Habibur Rahman                    

Member Secretary                                            Mr. Ziaul Islam

Member                                                            Mr. Mihir Banerjee 

                                                                        Mr. Golam Mostofa

                                                                        Mr. Ariful Islam

                                                                        Mr. Shofiqul Islam,

                                                                        Mr. Aqlasul Momanin

                                                                        Mr. Anamul Kabir Khan


Transport Sub-Committee

Chairperson                                                      Mr. Jalal Uddin Khandakar   

Member Secretary                                            Mr. Wakar Hossain   

Member                                                            Mr. Enamul Kabir Khan

                                                                        Mr. Abdul Mannan

                        Mr. Zamal

                                                                        Mr. Mosharaf Hossain

                                                                        Mr. Abdul Hamid

                                                                        Mr. Ali Hossain


International Relations Sub-Committee

Chairperson                                                      Ms. Alison Quazi

Member Secretary                                            Dr. Farzana Begum

Member                                                            Mr. Jabed Yousuf

                                                                        Mr. Golam Mostofa

                                                                        Ms. Hasmat Ara Parul

                                                                        Ms. Afroza Pervin        

                                                                        Md. Ziaul Islam

                                                                        Ms. Afroja Khatun

                                                                        Ms. Morzina Begum     

Scientific Session Sub-Committee

Chairperson                                                      Dr. Mahmuder Rahman

Member Secretary                                            Ms. Alison Quazi

Member                                                            Dr. Farzana Begum

                                                                        Ms. Nandini Sabrina

                                                                        Mr. Mahboob Morshed

                                                                        Mr. Jabed Yousuf

Field Visit Sub-Committee

Chairperson                                                      Dr. Quazi Quamruzzaman

Member Secretary                                            Md. Jabed Yousuf

Member                                                            Md. Altab Elahi

                                    Md. Golam Mostofa     

                                                                        Md. Ariful Islam

                                                                        Dr. Farzana Begum

                                                                        Ms. Nandini Sabrina     

                                                                        Mr. Shafiqul Islam Shohag

                                                                        Dr. Selim Morshed

 

Auditorium & Venue Sub-Committee

Chairperson                                                      Md. Zalal Uddin Khandokar

Member Secretary                                            Dr. Abdus Salam

Member                                                            Ms. Morzina Begum

                                                                        Mr. Mahboob Morshed

                                                                        Md. Wakar Hossain

                                                                        Ms. Sabitri Roy

                                                                        Mr. Kabir Hossain

                                                                        Ms. Tithika Chakrabarti

                                                                        Mr. Salim

                                                                        Mr. Alam                                                                                             

 

Registration Sub-Committee

Chairperson                                                      Ms. Alison Quazi

Member Secretary                                            Ms. Marzina Begum

Member                                                            Ms. Sabitri Roy

                                                                        Ms. Hasmat Ara Parul

                                                                        Ms. Afroja Parvin

                                                                        Ms. Jannat Ara Irin

                                                                                               

 

Patient Mobilization Sub-Committee

Chairperson                                                      Dr. Nasrullah

Member Secretary                                            Dr. Farzana Begum

Member                                                            Mr. Altab Elahi

                                    Mr. Shafiqul Islam

                                                                        Ms. Tanjila Khatun

                                                                        Ms. Rashida Akter

                                                                        Ms. Masuma Akter

 

Volunteers Sub- Committee

Chairperson                                                      Dr. Abdus Salam

Member Secretary                                            Md. Khandakar Jalal Uddin  

Member                                                            Ms. Mujrat Tanjib Laboni

                                                                        Ms. Shama Rahman

                                                                        Dr. Farzana Begum

                                                                        Ms. Nandini Sabrina

                                                                        Dr. Fazle Rabbi

                                                                        Dr. Farzana Aziz

Medical Sub- Committee

Chairperson                                                      Dr. Ainul Islam Joorder

Member Secretary                                            Dr.  Fazle Rabbi

Member                                                            Dr. Salina Sultana

                                    Dr. Probir Banerjee

                                                                        Ms. Kajal Kater

                                                                        Ms. Rabeya Khatun

                                                                        Ms. Tapoti

                                                                                               

Exhibition Sub- Committee

Chairperson                                                      Ms. Sabitri Roy

Member Secretary                                            Mr. Mahboob Morshed        

Member                                                            Ms. Marzina Begum

                                                                        Ms. Tanjila Khatun

                                                                        Ms. Anna Parvin

                                                                        Mr. Sudipta Bayddha

                                                                        Ms. Shakila Afroj  

                                                                        Ms. S.M.A. Shami Hasnat

                                                                                               

Photography Sub- Committee

Chairperson                                                      Ms. Marzina Begum

Member Secretary                                            Mr. Ariful Islam

Member                                                            Mr. Wakar Hossain 

                                                                        Ms. Shova Akter

                                                                        Ms. Anjuman Ara

                                                                        Ms. Bina Rani Mollik

                                                                        Ms. Shakila Afroj  

                                                                        Ms. S.M.A. Shami Hasnat

                                                                        Mr. Alam           

 


Audiovisual Sub- Committee

Chairperson                                                      Dr. Abdus Salam

Member Secretary                                            Mr. Wakar Hossain   

Member                                                            Ms. Shahina Sultana

                                                                        Ms. Kajal Akter

                                                                        Ms. Anjuman

                                                                        Ms. Anjuman Ara Begum

 

Social Evening Sub- Committee

Chairperson                                                      Mr. Quazi Habibur Rahman

Member Secretary                                            Mr. Kawsar Alam

Member                                                            Mr. Wakar Hossain   

                                                                        Md. Golam Mostofa

                                                                        Dr. Farzana Begum

                                                                        Md. Jabed Yousuf

                                    Mr. Mihir Banerjee

                                    Mr. Bivash Chandra Barmon

                                                                        Mr. Ziaul Islam

                                                                        Mr. Altab Elahi

                                                                        Mr. Kabir Hossain

 

Conference Secretariat

Chairperson                                                      Ms. Alison Quazi

Member Secretary                                            Dr. Farzana Begum                

Member                                                            Mr. Mahboob Morshed

                                    Mr. Mihir Banerjee

                                                                        Ms. Nandini Sabrina

                                                                        Dr. Farjana Aziz

                                                                        Dr. Fazle Rabbi

 

 

List of Participants

National

 

 

A B M Anwarul Haque

Duncan Brothers

 

Ali Ahmed Ziauddin

Shobuj Shena Centre, Sibaloy

 PRISM, Bangladesh

 

 

A F M Anisur Rahman

Government of Bangladesh

 

Aminul Islam

Duncan Brothers

 

 

 

 

 

A H M Abul Quashem

Government of Bangladesh

 

Aminur Rahman Shah

DG Health

 

 

 

 

 

A N H Akhter Hossain

Managing Director, Dhaka WASA

 

Babar N Kabir

SEMP-UNDP

 

 

 

 

 

A Z M Maidul Islam

Bangabandhu Sheikh Mujib Medical University

 

Mr. Badiur Rahman

Member, Planning Commission

 

 

 

 

 

Abdul Motin Khan

Pabna Community Clinic, Pabna

 

Choudhury Mufad Ahmed

Senior Assistant Secretary

Ministry of Forest & Environment

 

 

 

 

 

Abdul Wadud Khan

NIPSOM

 

Christine Wallich

Country Director for Bangladesh

The World Bank

 

 

 

 

 

Abdur Rahman Khan

MOHFW

 

Fahmida Shabnam

Program Officer, AusAID, Dhaka

 

 

 

 

 

Abdus Jaher

Assistant Professor, Institute of Nutrition and Food Science

Dhaka University

 

 

Farhad Hossain

Pabna Community Clinic, Pabna

 

Abu Shahajalal Azad

UNICEF

 

Dr. Farida Akhter

UBING, Policy Research for Alternative Development

 

 

 

 

 

Dr. Ahmed Kamal

Professor, Department of History University of Dhaka

 

Faridunnin Akhter Khan

BAMWSP

 

 

 

 

 

Prof. Ainun Nishat

Country Representative, IUCN

 

Farid Uddin Mia

SDF

 

 

Professor Firoz Ahmed

Professor of Civil/ Environmental Engineering, BUET

 

Dr. Kazi Matin Ahmed

Department of Geology

University of Dhaka               

 

 

 

 

 

G N M Shawkat Hayat Khan

Dhaka WASA

 

Khoda Bux

Project Director, BAMWSP

 

 

 

 

 

Dr. Guy Howard

International Specialist, Arsenic Policy Support Unit (APSU)

 

Ms Khushi Kabir

Chief Executive Officer, Nijera Kori

 

 

 

 

 

Haroon Ur Rashid

Asian Development Bank

 

Korshed Alam

DPHE

 

 

 

 

 

Hossain Zillur Rahman

PPRC

 

M. Nuruzzaman

APSU

 

 

 

 

 

Ihteshamul Huq

DPHE

 

Mahbub Jamil

Chairman & Managing Director

Singer- Bangladesh

 

 

 

 

 

Prof. Imamul Huq

Department of Soil, Water and Environment, University of Dhaka

 

Mr. Mahfuz Anam

Editor, The Daily Star

 

 

 

 

 

Jahangir Hossain

CARE Bangladesh

 

Makammel Hasan

PSTC

 

 

 

 

 

Jalal Ahmed Chowdhury

Zia International Airport

 

Dr. Moniruzzaman Miah

Chairman, TWEDS

 

 

 

 

 

Janet Donnelly

First Secretary, Australian High Commission, Dhaka

 

Mashuda Khatun Shefali

 

 

 

 

 

 

Jiptha Bairagi

Coordinator, Arsenic DASCOH

 

Md. Bazlur Rahman

Dhaka WASA

 

 

 

 

 

Kazi Ali Azam

Dhaka WASA

 

Md. Harunar Rashid

 

 

 

 

 

 

 

Md. Moniruzzaman Howlader

Karsha Community Clinic, Madaripur

 

Md. Siddiqur Rahman

Alt Medicine

 

 

 

 

 

Md. Monjur Kader

Brotee

 

Mirazul Hossain Tara

Pabna Community Clinic

 

 

 

 

 

Md. Mustakim Sabuj

Pabna Community Clinic

 

Mohammad Humayun Kabir

Zia International Airport

 

 

 

 

 

Md.Nehal Udidn

Deputy Director

Geological Survey of Bangladesh

 

Monirul I. Khan

Professor

Department of Sociology

University of Dhaka

 

 

 

 

 

Md. Owaliur Rahman

Ranaping Community Clinic, Sylhet

 

Mr. Morten Giersing

Country Representative, UNICEF

 

 

 

 

 

Md. Ruhul Amin

DIG, Bangladesh Railway

 

Mostafijur Rahman

 

 

 

 

 

 

Md. Saiful Islam

RRD

 

Dr. Naila Zaman Khan

Professor, Child Neurology & Development

Bangladesh Institute of Child Health

 

 

 

 

 

Md. Salim

CARE-Bangladesh

 

Mr. Nando Dulal Das

Biotechnology Discipline

 Khulna University

 

 

 

 

 

Md. Sekendar Ali

Pabna Community Clinic

 

Nasima Akhter

NGO Forum

 

 

 

 

 

Md. Seraj Uddin

Dhaka WASA

 

Nayeem Chowdhury

 

 

 

 

 

 

Dr. Md. Shahidullah Shikdar

Asstt Professor, Department of Dermatology and Venerology

Bangabandhu Sheikh Mujib Medical University, Dhaka

 

Nishith Ranjan Bindu

Pabna Community Clinic

 

 

 

 

 

Md. Abdur Rahman Khan

DG Health

 

Nurul Islam Khan

BAMWSP

 

 

 

 

Nurul Kabir

The Weekly Holiday

 

Sanat K. Bhowmik

COAST Trust

 

 

 

 

 

Paban Ritcil

HEED Bangladesh

 

Sayed Tanveer Hussain

Secretary, Ministry of Forest and Environment

 

 

 

 

 

Mr. Paul Edwards

Team Leader, Water and Sanitation Program, UNICEF

 

Selina Zaman

Duncan Brothers

 

 

 

 

 

Quamrunnahar

 

 

Mr. Shafiq Rehman

Editor, Jai Jai Din

 

 

 

 

 

Ramdulal Bhowmik

Pabna Community Clinic

 

Mr. Shafiqul Islam

Team Leader, Arsenic Unit, UNICEF

 

 

 

 

 

Mr. Rashed Khan Menon

General Secretary, Workers Party of Bangladesh

 

Shafiul Azam

World Bank

 

 

 

 

 

Rejaul Karim

COAST

 

Shahidul Huq

Bhanga THC

 

 

 

 

 

Rifat S. Khan

Program Officer, AusAID, Dhaka

 

Shahnewaz A. Khan

Concern

 

 

 

 

 

S.K.M. Abdullah

National Expert Committee

 

Ms Sharmeen Murshid

Chief Executive Officer, Brotee

 

 

 

 

 

Dr. Salek Ahmed

UBINIG

 

Sharmina Banu

 

 

 

 

 

 

Salimullah Khan

Consultant

 

Siddiqur Rahman

Begum Setara

 

 

 

 

 

Samsunnahar

Shaptadinga

 

Siddiqur Rahman

DG Health

 

 

 

 

 

Samsur Rahman Shimul Biswas

Chairman, BIWTC

 

Sylvia Islam

CIDA

 

 

 

 

 

 

T. Otsuko

JICA

Tapon Kumar Nath

 

 

 

 

Tahmida Banu

 

Tarik Hasan Protik

Pabna Community Clinic

 

 

 

 

Ms Taleya Rehman

Chief Executive Officer

Democracy Watch

Dr. Ziaul Hasan Rumi

Technical Specialist

NGO Forum for DWSS

 

 

 

 

Mr. Tapan Choudhury

Managing Director

Square Pharmaceuticals Ltd

Zakir Hossain

DG Health

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  <>

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


List of Participants

International  

 

 

 

 

 

01

Mr. A.H. Chowdhury

School of Chemical Engineering and Industrial Chemistry

University of New South Wales, Australia

09

Kristen Collins

Project Manager Ė Social Infrastructure

International Development

GHD Pty Ltd, Level 12, 390, St Kilda Road, Melbourne Vic 3004, Australia

 

 

 

 

02

Dr. Alan H. Smith

Prof. of Epidemiology, School of Public Health, Eart Warren Hall University of California, Berkley California 94720 USA

10

Lia Shimada

Department of Environmental Health, Harvard School of Public Health

Harvard University, USA

 

 

 

 

03

Dr. Alison Baker

Senior Project Manager

GHD Pty Limited, 380 Lonsdale Street, Melbourne Vic3000, DX 611 Melbourne Australia

11

Michael OíRourke

Health Management, Planning & Development Consultant

46, Knowles Avenue, North Bondi

NSW 2026, Australia

 

 

 

 

04

Prof. David Christiani

Prof of Occupational Medicine and Epidemiology

Harvard School of Public Health,

Boston, MA 02115,USA

12

Md. Amir Hossain

School of Environmental Studies

Jadavpur University, Kolkata, India

 

 

 

 

05

David Garman

Executive Director, CRC for Waste Management & Pollution Control Ltd

Valentine Annexe (H22), Gate 11, Botany Street, UNSW Sydney NSW 2052, Australia

13

Mohammad Mahmudur Rahman

School of Environmental Studies, Jadavpur University, Kolkata, India

 

 

 

 

06

Dr. Deoraj Harry Caussy

Environmental Epidemiologist, Department of Evidence for Information and Policy, World Health Organization, South East Asia Region, Indraprastha Estate, New Delhi, India.

14

Mrinal Kumar Senguta

School of Environmental Studies, Jadavpur University, Kolkata, India

 

 

 

 

07

Dr. Dipanker Chakraborti

Director, School of Environmental Studies Jadavpur University, Kolkata, India

15

Dr. Peter Nadebaum

Senior Principal ĖEnvironment

GHD Pty Ltd, 380 Lonsdale Street Melbourne Vic3000 DX 611

Melbourne Australia

 

 

 

 

08

Dr. Jheng Baosham

Professor, State Key Laboratory of Environmental Geochemistry

Institute of Geochemistry, Chinese Academy of Science, Guiyang Ghizou Province, China

16

Phillip Crisp

Senior Lecturer

School of Chemical Engineering and Industrial Chemistry, University of New South Wales

 Sydney NSW 2052 Australia

List of Participants

 

International

 

 

 

 

 

17

Rhett Butler

Chairman, Sky Juice, Sky Juice Foundation

3 Bardwell Road, Mosman NSW 2088

21

Prof. Willard R. Chappell

Chairman Arsenic Groundwater Committee, Campus Box 136, University of Colorado at Denver, PO. Box 173364, Denver, Colorado 80217-3364, USA

 

 

 

 

18

Prof. Richard Wilson

Mallinckrodt Research Professor of Physics

Cambridge, MA 021238

Harvard University, USA

22

Xavier Savarimuti

Lecturer, Department of Environmental Science

St. Xavier's College, Kolkata, India

 

 

 

 

19

Mr. Sad Ahmed

School of Environmental Studies, Jadovpur University, Kolkata, India

 

23

Xue Wang

Guiyang Ghizou Province, China

 

 

 

 

20

Dr. S.C. Mukherjee

Associate Prof. Dept. of Neurology, Medical College, Kolkata, India

 

24

Yukihiro Munekage

Kochi University, Japan

 

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