I had some basic idea about Arsenic contamination of groundwater and Arsenic poisoning in Bangladesh but the problem was so severe and widespread and the challenge to solve this problem so daunting and huge, which I could realize only after coming to Bangladesh and interacting with AAN staff and visiting the Arsenic affected villages. I met a team of committed AAN workers, equipped with required skills and expertise and over and above all a deep sense of commitment to take the menace head-on and provide as much relief as possible to informed but helpless people who are forced to drink arsenic laced water. I am deeply pained at the plight and helplessness of the arsenic affected people but satisfied that honest and sincere efforts are being made by the NGOs like AAN in unison with government and donor agencies like JICA to combat the problem. This seems to be a long intractable battle which will keep the arsenic mitigation agencies engaged for many years to come. The problem being underground and therefore hidden from the naked eyes and difficult to access and widespread in terms of geographical area, thus seeking more efforts and resources makes the solution difficult and relief to one and all in terms of safe water and healthy life a distant possibility. However, I appreciate the efforts of AAN and other agencies involved in arsenic mitigation. Their honest efforts are laudable and inspiring.

I reached AAN office Dhaka at 7 PM, met Sachie, AAN Country Manager. Had a look at the office and the infrastructure. Briefly talked about the Arsenic problem and work plan during my stay. Had delicious dinner at a nearby restaurant. Retired to bed around 11.

May 4-Rotary seminar

I and Sachie discussed about the Arsenic problem and AAN activities. I had a look at various reports on arsenic and water and sanitation related literature. Sachie gave me a map of Bangladesh and got two booklets on water and sanitation photocopied for me. We left for Jessore around 5 PM and reached Jessore AAN office around 6:30. We rushed off to Rotary office where a seminar on “Arsenicosis disease and prevention” was being held jointly by Rotary Jessore and AAN. The seminar was very illuminating. There were two lucid presentations on arsenic, one by Aklima Choudhury (AAN) on Arsenicosis patients’ management and the other one by Dr. Akhtar Ahmad (an Arsenicosis expert) on History of Arsenic.

I learnt for the first time that 30% of the 5 million screened tube wells had arsenic in excess of Bangladesh standard of 50 microgram per litre. More than 60 districts out of total 64 were arsenic contaminated. There was a possibility of arsenic contamination of 17% of all the tube wells. Dr Akhtar informed that southeastern parts of Bangladesh were most affected and roughly 50 million people were exposed to arsenic contamination. 38,000 arsenicosis patients had been identified so far. I also learnt about various symptoms of hypo- and hyper- melanosis, keratosis and arsenic related cancers and other non-dermal health problems. The most important information he gave was that the only cure for arsenicosis was arsenic free water, supplemented with nutritious food.

May 5-Meeting with AAN staff and fun

I was introduced to AAN family. It was nice talking to AAN staff and learning about the great work they are doing in various parts of Bangladesh. The meeting lasted for roughly 3 hours, during which I could learn about the individual and collective responsibility of the AAN team. Each one seemed to excel in its field, be it awareness, patient identification or management, setting up of safe water supply system or administrative work. They seemed to be very impressive as a team. We also worked out the itinerary of our field visit during the meeting. The meeting was presided over by Abu Shamim Khan.

A progress review was done for an ongoing Panjia Project Phase II. Mainly issues regarding TW screening, awareness program and Rotary DTW installation and safe water option monitoring came up for discussion. Aklima Choudhury updated about the income generating schemes like making of handicraft items with the participation of women of arsenicosis patient families launched in the project area. 

The evening was reserved for some fun. The AAN team organized a mock marriage ceremony for a Japanese couple and we all celebrated the event with great interest. It was a fun loaded evening inclusive of marriage rituals as per Bangladesh Muslim culture, dinner party and cultural activities.

May 6-Site visit

We visited the villages (Khalsi, Rajganj and Kanaikhali) of Putkhali Union of Sharsha Upjila where a piped water supply system has been put up to supply safe drinking water to the arsenic affected villages. A nearby baor, or oxbow lake, serves as the intake for the raw water. The water is treated through Slow Sand Filter system and then supplied to villagers by pipes. When I visited the pipeline system the raw and treated water contained a high amount of salinity. The water usage is mixed, therefore; some people use it for drinking, some for drinking and cooking and some are not using the water at all, and instead they rely on their old system like arsenic-contaminated shallow tube well. Most of the users complained about the quality of water. There was an intrusion of marine water in the freshwater lake thus making the raw water saline. I also heard that the use of fertilizer in the lake for fish culture occasionally makes the water a fertile ground for algal bloom. The growth of algae in the lake and sand filter bed gives the water a bad taste and smell, rendering the water unfit and unsafe. Also there is a problem of O&M costs of the system. There is difficulty in realizing the users’ shares which puts the sustainability of the system in question.

Then we went to Samta village of Bagachara Union in Sharsha Upazila. I was told that this was the first village AAN conducted various fact-finding surveys and mitigation in Bangladesh. Samta village has become a synonym for arsenic contamination, I was informed. I saw the PSF there but unfortunately there was no water in the pond. The seasonal variations in the water levels of the surface water bodies make the PSF a less reliable water option. We also met some arsenicosis patients. We met two affected people who had undergone operations and others who had obvious symptoms of arsenicosis but were unable to access the treatment. Most of the people cannot afford going to Dhaka where the treatment is available.

Finally we visited a DTW site in Keshabpur Upazila. The DTW drilling was difficult at this site and a 600 ft drilling exercise had already failed once.

May 7-Site visit

I learnt a few things about arsenic chemistry by Shamim Khan. We visited Marua village of Chowgacha Upazila. We saw a DTW with sand filter system which had been installed by AAN. There was another filter system installed by Miyazaki University, called Gravel Sand Filter, which removes arsenic in shallow tube well water. We also saw a RWH system but the container was empty. We met two arsenicosis patients. One of the patients who was hospitalized in Dhaka for treatment was feeling better and recovering. He was being treated for lung cancer. He was very grateful to AAN for the support he received for his treatment.

We also visited Sampdar 2-Andharkota, Nogorborni-Sukpukuria, and Jhawtala-Narainpur, where a JICA/ Bangladesh government arsenic mitigation project is being carried out. I was informed that the DTWs which had been installed recently at these places were contaminated. The arsenic concentration ranged between 200-300 ppb. The chemists working for the project tested the DTW water with Wagtech field test kit and I learnt the procedure to use the FTK. Water samples from 4 DTW were tested and only one DTW was found to be within the Bangladesh norm. Water samples were also collected for further validation by AAS in the project lab. I was also informed that though the shallow tube wells were not contaminated with arsenic the water level dipped during the summer, thus making the water availability difficult. Every village has been provided with one DTW as per government plan. But the DTW water is not necessarily arsenic safe. This shows the complexity of the problem.

May 8-Site visit

It was an action packed day for me. First with AAN staff I visited Bhabanipur village of Bidyanandkati Union in Keshabpur Upazila. Field workers appointed by AAN carried out the screening of shallow tube wells by using NIPSON field kit. The contaminated tube wells were painted red. Two tube wells were found inactive.

A nutrition program was organized in Panjia Union. Roughly 100 villagers, mostly women and kids, assembled at one place where they were given Khichuri (rice, lentils, vegetables cooked together). This was a part of an awareness program which is intended to send the message across that arsenic safe water and nutritious food were the only means to ward off the threat of arsenicosis.

AAN staff held a very interesting awareness program for the villagers. Day long preparations were made; announcement regarding the cultural program was made through loud speakers in the nearby villages. Approximately 200 spectators, again mostly women and kids, assembled to listen and watch an interesting dialogue between a grandfather and a son regarding arsenic. This is an hour long play which is called Gambhira. The actors were dressed up and conversed in such a way that viewers remained glued to the play throughout. It is an effective way to communicate the message of arsenic, its adverse impacts and ways to deal with it. The villagers, especially kids actively participated in the program. Some of the young boys and girls sang songs. One of the AAN staff members, Manjuara Praveen, explained as how to keep safe from the adverse impacts of arsenic. She used the flip chart to explain various aspects of arsenic. The viewers, again the kids, flocked to the AAN staff once they were asked to come forward to get checked if they had any symptom of arsenicosis. It was great fun and learning experience for each and every one.

May 9-Aborted site visit

We left for Srimontokathi village of Jalalpur Union of Tala Upzila in Satkhira district. We had planned to visit the PSF (3) installed there by AAN. But our visit proved to be a futile exercise due to heavy downpour. It started raining by the time we reached Srimontokathi and continued till we came back to Jessore. So the day was wasted in traveling uselessly. I and Sachie left for Dhaka by the evening flight. We had dinner in the same Indian restaurant where I and Sachie ate the first evening. We were joined at dinner by two JICA members. I briefly talked about my work to them.

May 10-Left for India

I wrote some part of this report in Dhaka office before leaving for airport in the afternoon.

My observations:

Arsenic contamination is a huge and complex problem in Bangladesh. Though sincere efforts have been and are being made to provide safe water to needy people, a majority still lacks access to safe water and treatment facilities for arsenicosis. Massive efforts and resources are needed to provide safe water and health to people. It seems to be a never ending engagement. Local government, NGOs and people need to be strengthened so that they could be prepared to deal with the problem through their own resources.

Though several safe water options have been installed, DTW seems to be most feasible and sustainable option. But there is every possibility that DTW may start spewing arsenic contaminated water over a period of time. Therefore DTW water quality monitoring at regular interval is mandatory. Some effective monitoring mechanism needs to be evolved. If a DTW becomes contaminated, some arsenic removal mechanism can be added later.

I could not get a chance to meet any other NGO working for arsenic mitigation nor did I meet government officials, so I cannot comment if the various agencies involved in arsenic mitigation are working in a coordinated way.

People are aware about the arsenic problem but at some places they are helpless and forced to drink the contaminated water. There are people who have arsenic related diseases, even cancers, and they are well aware about it but can not afford either safe water or appropriate treatment. Such areas having high concentration of diseased people should be identified and some special package consisting of safe water and treatment facility should be worked out for these areas.

The Integrated Arsenic Mitigation Program consisting of awareness programs, safe water options, treatment facilities, and income generating schemes is a comprehensive and all inclusive program. It is a very impressive and effective program and is being implemented by a highly dedicated team of youth. This team of young people developed by and under AAN should be made sustainable. Though some of the team members have graduated and have been rehabilitated by other agencies like JICA, still a practical and feasible exit policy needs to be developed so that the team does not lose its relevance and continues to render the valuable service even after outside support has been withdrawn. I wish the AAN team the best.

Answers to the questions regarding proposed integrated arsenic mitigation project in Uttar Pradesh, India

Patients identification and management

Eco Friends will conduct a door to door survey using questionnaire. Eco Friends’ trained personnel (having basic idea about the symptoms of arsenicosis) will identify the potential patients which will later be referred for confirmation to an expert team of doctors (local or Japanese) visiting Hariharpur and other villages. We will prepare the list of people with any symptom of arsenicosis. The expert doctors will diagnose and decide the level or severity of the disease and suggest treatment accordingly. We will help patients in getting proper treatment and keep monitoring the progress.

DTW installation and users committees

Installation of deep tube wells will depend on the depth of drilling. Once the depth at which safe water is available is decided, the drilling and installation of DTW should not be difficult. We may have to start works for many DTW simultaneously. Users committees will be formed in the beginning, before the work starts. The number of committees, composition, and terms and reference of the committees will be worked out after completing the baseline survey.

Peoples’ participation and sustainability

We will mobilize the residents to participate actively in the project. We will make a Core Group comprising the key people in the village and other stakeholders. This Core Group will work out the level and ways of participation. The residents may be asked to contribute financially and physically so that they have a sense of belongingness to the project. We will make the residents feel that it is their problem and they must contribute towards solution. We will try our utmost to make the residents feel responsible. We will play the role of facilitator and catalyst. We will not give the impression that we have come to dole out largesse, instead support them in finding the solution to their problems.