Before cancer: Treating arsenic early
First comes the wheezing. It happens decades before the skin lesions appear – the tell-tale signs of arsenic poisoning. It is the first symptom of a life-story that ends for many in cancer of the lungs, among others. For some, it happens before they learn to walk.
That is what had happened to all of Sajeda Khatun's three boys. "They used to have very frequent bouts of asthma. They had to try so hard to breathe that their stomachs would flatten out beneath their rib cages," says the mother of six who lives in Matlab upazila in Chandpur.
"No doctor would test for arsenic poisoning in a case of respiratory distress," says Dr Parveen Shaheda Akhtar, department head of medical oncology at National Institute of Cancer Research and Hospital, "yet I have many cancer patients who have arsenicosis. Early screening could have prevented this."
That is what had happened to all of Sajeda Khatun's three boys. "They used to have very frequent bouts of asthma. They had to try so hard to breathe that their stomachs would flatten out beneath their rib cages," says the mother of six who lives in Matlab upazila in Chandpur.
The asthma dissipated by the time they had left toddlerhood, but other symptoms customary of arsenic poisoning have started to appear. Her youngest is 11-years-old – although stunting makes him look three years younger – and has been consuming arsenic-laced water since he was a foetus. A thick tough layer of skin – almost like hide – tops his palms. It is called keratosis and this is one of the very first signs of advancing arsenic poisoning.
"This is nothing to worry about: all three of my boys have palms like that. It's probably because they are boys," laughs Khatun. That Sajeda Khatun thinks all boy children have coarse palms shows how arsenic poisoning has been entrenched in her family. Because of her long history of exposure, her boys are a part of a study by ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh). "We have been following a cohort of 650 children from early childhood—many of them from their time in their mother's uterus," says Dr Al Fazal Khan, one of the principal researchers of this study, "this cohort is unique in that way." Their aim is to observe the development of arsenic poisoning in cases of early childhood exposure, and perhaps also identify places of intervention.
For example knowing that Sajeda Khatun's children have arsenic poisoning, even though they haven't developed the customary black skin lesions, means that treatment can start early. This finding is important at a time when plenty of tube wells still remain untested and Human Rights Watch has estimated that 20 million drink water with arsenic.
Sajeda Khatun's children's poisoning can be managed with treatment and arsenic withdrawal. The symptoms will reduce.
The Human Rights Watch report came out last year, after the fear over arsenic had died down. The last time the government did any nationwide study on drinking water was in 2013, when 12.4 percent of the samples exceeded the state-mandated safe limit of 50 micrograms per litre (WHO argues that only 10 micrograms per litre is safe). Unfortunately, this did not reflect any improvement; levels were almost the same as the 2006 study of drinking water at people's homes where 14 percent were found to be at risk, the report argues.
Human Rights Watch itself analysed 125,000 green tube wells installed by the Department of Public Health Engineering and found around 5 percent had become contaminated. They provide a caution however – this is not reflective of the true scenario since a majority of the wells were installed in areas where more than half of the people had access to safe water to begin with.
Sajeda Khatun has access to one of these green-marked deep tube wells but does not use it, choosing instead her old tube well. "Our tube well was marked red a long time back and we even had another safer one installed. We keep on using it because the green (safe) one smells," she says.
Locals explain that the green-marked tube well is a deep tube well set up by the government. Since these pipes are installed to draw water in from deeper places, the workers used a slurry of cow dung to soften the clay. The slurry makes the water smell.
That the water from her tube well has been tested as having 30 times the safe limit by ICDDR,B makes little difference to Sajeda Khatun. The numbers go over her head. "We've always had water from this. Our children's school has a red-marked tube well. My paternal home – their grandfather's house – has a red-marked tube well. Nothing has happened to us yet," she says. She does not regard the symptoms that her children experienced in childhood as effects of poisoning. The only person who could have made an impact would have been their doctor, but he diagnosed their chronic respiratory problems as the common cold, thus perpetuating the belief that the family is not actually poisoned. Her belief proves the necessity for doctors to keep up with recent research and prescribe solutions accordingly.
"No doctor would test for arsenic poisoning in a case of respiratory distress," says Dr Parveen Shaheda Akhtar, department head of medical oncology at National Institute of Cancer Research and Hospital. "Yet I have many cancer patients who also have arsenicosis. Early screening could have prevented this."
"This is nothing to worry about, all three of my boys have palms like that. It's probably because they are boys," laughs Khatun... That Sajeda Khatun thinks all boy children have coarse palms shows how arsenic poisoning has been entrenched in her family.
They are mostly all in their forties, she says, "People do not get lung cancer at such a young age, unless there was an external factor like arsenic."
That doctors recognition of early symptoms and intervention do make a difference can be seen from Sefayat Ullah's case. Unfortunately he only got help when he got skin lesions. He knew then that he had to change his water source. And in good time too, since all of Sefayat Ullah's children have been exposed to arsenic in the uterus.
His family now uses a safe tube well, but not until years after his water source was marked red. "It is expensive to install a deep tube well. My eldest son got a job in Oman cutting tiles, and we finally saved enough money to repair the house and install a different tube well two years ago," he adds. The water of that tube well is yet undergoing tests the results of which he'll get to know soon. Anecdotally, the villagers said that a deep tube well can cost anything from Tk 50,000 onwards, while Human Rights Watch put the figure at $850 and up.
From outside Sefayat Ullah's house is the gleaming picture of health and hearth. The walls have had a fresh coat of paint, the beaten earth floor has been covered with a jute mat, the ceiling is adorned with do-it-yourself chandeliers that his daughters made out of soda-bottle caps. Livestock runs about and his yard is heaped with piles of glittering yellow corn. He is definitely better off than many of his neighbours whose homes can be blown away by a storm. Yet, the fact that installing deep tube wells is an expenditure that even the better-off households can find difficult to provide out-of-pocket shows how inaccessible safe water actually is – and what a big public health disaster is being ignored.
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