The poor pay twelve times more for water

The poor in the developing world pay on average 12 times more for water than people connected to municipal systems, according to an ongoing study by the World Commission on Water for the 21st Century. While the rich benefit from subsidized treated piped water, water vendors charge the poor up to 100 times more for water of doubtful quality in some cities such as Port-au-Prince, Haiti and Nouakchot, Mauritania. The World Commission presented its preliminary findings, which are part of the World Water Vision process, during its second meeting on 9-11 August 1999 in Stockholm, Sweden. The US$ 8 million (EUR 7.7 million) study is being funded mainly by Sweden and the Netherlands (World Bank Press Release, 11 August 1999 ; UN Wire, 9 August 1999).

Effects and Treatment of Arsenic Poisoning (Arsenicosis)

There are several effects of arsenic poisoning from drinking water but these are imperfectly understood in India and Bangladesh. WHO (2000) reports:

Between five and 10 million tube wells in Bangladesh may be contaminated with arsenic, according to conservative estimates. As a result, at least 25 million people may be at risk from drinking arsenic contaminated water throughout Bangladesh. Long term consumption of arsenic contaminated water leads to serious health effects, often referred to as arsenicosis. The symptoms of arsenicosis manifest themselves after several years initially as skin lesions, and progress to localized gangrene and eventually cancers of the skin, lung, bladder and kidneys

Arsenic can be absorbed from the gastrointestinal tract following the ingestion of arsenic-containing food, water, beverages or medicines, or as a result of inhalation and subsequent mucociliary clearance. The bioavailability of ingested inorganic arsenic will vary depending on the matrix in which it is ingested (i.e. be it food, water, beverages or soil), the solubility of the arsenical compound itself and the presence of other food constituents and nutrients in the gastrointestinal tract. The human health effects of arsenic have been comprehensively reviewed by several leading national and international bodies including, WHO, IARC and the US NRC (IARC, 1973, 1980, 1987; ATSDR, 1993, 2000; NRC 1999; WHO, 1981, 2001).

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Non-cancer health effects

According to the National Research Council report (p89, 1999): "Arsenic exposure interferes with the action of enzymes, essential actions, and transcriptional events in cells in the body, and a multitude of multisystemic non-cancer effects might ensue." The most widely noted non-cancer effects of chronic arsenic consumption are skin lesions. The first symptoms to appear after initiation of exposure are hyperpigmentation (dark spots on the skin) and hypopigmentation (white spots on the skin).

Some physicians collectively refer to these symptoms as melanosis. Hyperpigmentation commonly appear in a raindrop pattern on the trunk or extremities, but also on mucous membranes such as the tongue (Yeh 1973). Over time arsenic exposure is associated with keratoses on the hands and feet. Keratosis is a condition where the skin hardens and develops into raised wart-like nodules. These nodules become more pronounced over time, sometimes reaching 1cm in size (National Research Council 1999).

Tseng et al. (1977) noted that skin cancers often appear at the sites of existing keratoses. The time from exposure to manifestation is debated in the literature (see National Research Council 1999). It is likely that differing exposures to arsenic accounts for the heterogeneity in observations. The youngest age reported for patients with hyperpigmentation and keratosis is 2 years (Rosenberg 1974). For Bangladesh, Guha Mazumder et al. (1998) suggests a minimum time gap of five years between first exposure and initial cutaneous manifestations. The distinctive appearance of these skin lesions has meant they have been used as indicators of arsenic exposure, when it has not been possible to ascertain arsenic concentrations in well water.

Arsenic has been associated with a multitude of other non-cancer health effects. Arsenic is associated with peripheral vascular disease (blackfoot disease) in China (Province of Taiwan) (Tseng 1977). This condition results in gangrene in the extremities and usually occurs in conjunction with skin lesions. Other cardiovascular problems such as hypertension (Chen et al. 1995) and ischemic heart disease have been found to be associated with arsenic (Tsuda et al. 1995).

Burden of hypertension in Bangladesh

The silent killer is active in Bangladesh but works very silently. It's a big problem. We have done an analysis in 1999 of all published data that appeared in indexed journals, and observed that 11% of Bangladeshi adults suffer from hypertension. A more recent study (2001) also reported by us indicated that about 13% of Bangladeshi rural adults suffered from hypertension. Ninety-nine percent of the hypertensive people did not know that they had hypertension (Dr. M. Zaman, 2003).

Research into organ damage has concentrated mainly on the liver. Guha Mazumder et al. (1988) found evidence of liver enlargement and non cirrhotic portal fibrosis among a small sample of severely affected arsenic patients in West Bengal. In a later study, Guha Mazumder et al. (1997) also suggested pulmonary health effects. They found restrictive lung disease among 53% of a small sample of severely affected arsenic patients in West Bengal.

In terms of haematological effects, anaemia is commonly cited (National Research Council 1999). Another widely suggested health effect is diabetes mellitus. Rahman et al. (1998) found a significant dose response relationship between arsenic exposure and diabetes mellitus among those suffering from keratoses in Dhaka, Bangladesh.

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Cancer health effects

Hutchinson (1887) identified arsenic as a carcinogen because of the high number of skin cancers occurring on patients treated with arsenicals. The International Agency for Research on Cancer (IARC 1980) classified inorganic arsenic compounds as skin and lung (via inhalation) carcinogens. In the period following this classification, concerns have grown over the possibility of arsenic in drinking water causing a number of other cancers.

A series of studies from BFD-endemic parts of Taiwan have clearly demonstrated the existence of an exposure-response relationship between the magnitude of arsenic exposure and incidence of skin cancer and other manifestations including keratosis and hyperpigmentation. Tseng et al. (1968) found that ascending rates for skin cancer, keratosis and hyperpigmentation corresponded with increasing arsenic content of well water in a study population comprising 40,000 "exposed" and 7,500 "comparison" individuals; a dose-response relationship for arsenic concentration and black foot disease prevalence was also reported. The studies of Chen et al. (1985; 1988), Chen & Wang (1990), Wu et al. (1989) and Tasi et al (1999), which found evidence of links between mortality from cancers of the lung and bladder and arsenic exposure (see previous section), all report similar associations for cancers of the skin.

In Bangladesh, Tondel et al. (1999) examined a total of 1,481 subjects (aged 30 or over) residing in four villages were arsenic concentrations in drinking water ranged from 10 to 2,040 ug/L. Almost one third (430) were found to have skin lesions (i.e. pigmentation changes or keratois). A statistically significant exposure-response relationship was also demonstrated; the age-adjusted prevalence rate of skin lesions increased from 18.6 per 100 in the lowest exposure group (< 150 ug/L), to 37.0 per 100 in the highest exposure category (> 1000 ug/L) for males and from 17.9 to 24.9 per 100 in females. Again, when the exposure was considered by dose (in ug/L per kg body weight) there was an increase in the age-adjusted prevalence rates of skin lesions for males and females across dose groups.

The strongest epidemiological evidence on skin cancer effects comes from studies of arsenic contamination of drinking water in China (Province of Taiwan). Villages in south-western China (Province of Taiwan) switched from surface water to arsenic contaminated well water for drinking in the 1920s.

An early study by Tseng et al. (1968) found evidence of a dose response relationship between concentration of arsenic in drinking water and prevalence of skin cancer. IPCS (1981) estimated skin cancer risk from life-time exposure to arsenic in drinking water at 5% for 0.2 mg of arsenic per litre, based on the findings of Tseng et al. (1977).

Based on the increased incidence of skin cancer observed in the population in China (Province of Taiwan), the US Environmental Protection Agency (1988) has used a multistage model that is both linear and quadratic in dose to estimate the lifetime skin cancer risk associated with the ingestion of arsenic in drinking-water. With this model and data on males, the concentrations of arsenic in drinking-water associated with estimated excess lifetime skin cancer risks of 10-4, 10-5, and 10-6 are 0.0017, 0.00017, and 0.000017 mg/l respectively.

Considering other data and the fact that the concentration of arsenic in drinking-water at an estimated skin cancer risk of 10-5 is below the practical quantification limit of 0.01 mg/l as well as a view to reducing the concentration of arsenic in drinking-water, provisional guideline value of 0.01 mg/l is recommended (WHO 1996). The guideline value is associated with an excess life-time risk for skin cancer of 6x 10-4 (i.e. six persons in 10,000).

High levels of arsenic in drinking water are also associated with a number of internal cancers. However, it is difficult to quantitatively establish risk in many of the studies, due to problems in measuring exposure to arsenic. Chen et al. (1985) calculated standardised mortality ratios (SMRs) for a number of cancers in 84 villages in south-western China (Province of Taiwan). Mortality from 1968-1986 was compared with age and sex adjusted expected mortality.

Significantly increased mortality was observed among both males and females for bladder, kidney, lung, liver and colon cancers. However, the authors were not able to directly estimate arsenic concentrations in well water.

Chen and Wang (1990) were able to use data on arsenic concentrations in 83,656 wells in 314 precincts and townships, collected from 1974-1976 in China (Province of Taiwan). The authors used a multiple regression approach to control for socioeconomic confounding factors, and compared age adjusted mortality rates with average arsenic concentrations in each township. They found a significant relationship with arsenic concentration and mortality from cancers of the liver, nasal cavity, lung, bladder and kidney for both sexes.

Hopenhayn-Rich et al. (1998) examined SMRs for bladder, kidney, lung, liver and stomach cancers for 1986-1991 for 26 counties in the Cordoba Province in Argentina.

The authors stratified counties into low, intermediate and high exposure groups based on arsenic levels in their drinking water. The authors defined the low and intermediate exposure counties. Data for arsenic levels in the two high exposure counties were given. These levels ranged from 0.04 mg/l to 0.43 mg/l. SMRs were calculated using age and sex specific national rates for Argentina. Significant exposure-response relationships were found for the cancer in the bladder, lung and kidney. It is unlikely that smoking is a confounding factor, as deaths from chronic obstructive pulmonary disease (indicative of smoking) were not related to arsenic concentrations.

The above-mentioned studies all utilised an ecological design and are thus susceptible to bias from confounding factors. However, the bladder and lung cancer results of these studies are also confirmed by cohort studies which may be less susceptible to this form of bias. These studies are also useful in providing data on the latency period of internal cancers. Cuzick et al. (1992) studied a cohort of patients treated with Fowler's solution (potassium arsenite) in England from 1945-1969. In the follow up until 1991, a significant excess of bladder cancer mortality occurred. In addition, a subset of patients had exhibited skin lesions when examined in 1970. It was found that all patients who subsequently died of bladder cancer had also suffered skin lesions. Even after stratifying this subset according to dose group, the finding that all cases had skin lesions was highly significant. The authors suggested this provided evidence that skin lesions are a useful biomarker for susceptibility to internal cancers. The period between first exposure and death from bladder cancer varied from 10 years to over 20 years.

Tsuda et al. (1995) followed up a cohort of 454 residents in Japan who had used industrially polluted water for five years. The authors separated the cohort into low, medium and high exposure groups, based on arsenic concentration in local wells. The low group was exposed to less than 0.05 mg/l, the medium exposure group 0.05-0.99 mg/l and the high exposure group greater than 1 mg/l.

A significant excess of cancers occurred only in the group exposed to an arsenic concentration greater than 1 mg/l. This finding may be because the small sample size is unable to detect significant excess deaths in the medium exposure group.

There may also be underestimation of the effect due to the relatively short period of exposure. Significant excess deaths from lung cancer (nine deaths) and urinary tract cancer (two from bladder cancer and one renal pelvis cancer) were observed in the high exposure group.

In contrast to the findings of Cuzick et al. (1992), the authors found excess cancer mortality among those both with and without skin lesions present: "The results demonstrate that negative skin signs are no assurance of low risk for cancer development." (Tsuda et al. p207, 1995). The authors note that the period from first exposure to death from lung cancer varied from 11 to 35 years, with a mean of 26.7 years.

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Findings in India and Bangladesh

Treatment of arsenic related diseases are rare in Bangladesh. We visited several arsenic affected villages, where doctors treat arsenic patient as skin disease. We investigated drinking water of several patients and found a dangerous level of arsenic (12 to 8 times higher than WHO standard (0.010 µg/l). A very few studies are known so far.

Arsenic affects the whole body An Asia Arsenic Network (AAN) survey team visited the State of West Bengal, India, and Bangladesh, from February 5 through 12, 1996, and carried out medical and environmental surveys in the arsenic affected areas in the two countries.

The number of residents examined for clinical manifestations excluding the skin was 153 (86 male and 67 female), and the ages ranged from 3 to 80 years. Details are given in Table1 Dr. D. N. Guha Mazumder, Professor and Head of Department of Gastroenterology, Institute of Post Graduate Medical Education & Research in Calcutta, reports many cases of hepatomegaly, splenomegaly and non-cirrhotic portal fibrosis (NCPF).

The reason why those three diseases appear at a higher rate in West Bengal than other cases of arsenic poisoning elsewhere is unknown, but many patients of hepatomegaly were found in our survey, too.

Disturbances of respiratory and digestive systems are often observed as the first sym-ptoms of chronic arsenic poisoning caused through drinking water contaminated at this level (2 ppm).

Neither Dr. K. C. Saha nor Dr. D. N. Guha Mazumder mention cases of disturbances of the circulatory system. Such disturbances mainly appear at later stages of arsenic poisoning as an arteriosclerotic change. It is not clear how much arsenic has acted on the circulatory disturbances observed in our survey. However, it is recorded here as one of the symptoms found among the arsenic-affected residents in West Bengal.

Of the 167 people on whom the AAN survey team were able to conduct skin examinations, 163 (97.6%; 3-80 years of age) were found to have skin lesions related to arsenic (Table 1. ):

Table 1: Dermatological Findings


Trunk Diffused
160 (95.8%)
114 (68.3%)
Palm Diffused
127 (76.0%)
71 (42.4%)
Sole Diffused
4 ( 2.4%)
15 ( 9.0%)
Mucosa Bucca
27 (16.2%)
26 (15.6%)
21 (12.6%)
32 (19.2%)
2 ( 1.2%)
Depigmentation: 68 (40.7%)


Palm Diffused
33 (19.8%)
> 84 (50.3%)
Sole Diffused
142 (85.0%)
> 108 (64.7%)
Dorsal hand and foot ( 0.6%)
Tumor: Bowen's disease
3 ( 1.8%)
> 2 ( 1.2%)
> 1 ( 0.6%)
1 ( 0.6%)
Others: Leg edema
Dupuytren's contracture /td>
1 ( 0.6%)
> 5 ( 3.0%)
> 1 ( 0.6%)

*)=Squamous cell carcinoma
**)=Basal cell carcinoma

Polyneuropathy, a peripheral neurological disturbance, is often found among patients with arsenic poisoning, but only 3 cases, all at light levels, were found during AAN survey.

Table-2 : Clinical manifestations except skin

Disturbance of respiratory system including bronchitis: 39 25.4 %
Hepatomegaly: 27 17.6 %
Disturbance of digestive system: 22 14.3 %
Disturbance of circulatory system: 16 10.4 %
Heart disturbances 10 6.5 %
Cerebral infarction 3 1.9 %
Gangrene in the extremities 3 1.9 %
Neurological symptoms: 37 24.1
Superficial sensory disturbances 17 11.1 %
Hyporeflexia and areflexia 16 10.4 %
Polyneuropathy 3 1.9 %
Auditory disturbances 8 5.2 %
Muscular atrophy 5 3.2 %
Psychiatric symptoms: 14 9.1 %
Depressive state & hypochondria 10 6.5 %
Apathy 2 1.3 %
Dementia 2 1.3 %

Increase of skin cancer is feared

With regard to skin tumors, Dr. Saha found six cases (0.5%) of SCC (squamous cell carcinoma) among 1214 people he examined during 1983-87, but he did not observe any other ma-lignant neoplasms like Bowen's disease. The survey, however, found three cases of Bowen's disease, two SCC's, one BCC and another undiagnosed case; altogether seven cases (4.29%) of malignant skin tumour.

One of the reasons for the small number of cases of skin tumour in Dr. Saha's reports is probably that his surveys were made after only a relatively short period of exposure to arsenic. Generally speaking, arsenical cancers appear, symptomatologically, first on the skin followed by cancers on the internal organs.

Suppose the arsenic contamination began 16 years ago in 1980. It may then be inferred that it would take some further years for internal cancers, such as lung cancer, to appear. However, as reported above, there are unmistakable signs of the occurrence of skin cancer. What is required therefore, is a systematic examination for internal cancers at the time of medical check-ups of the residents in arsenic affected areas in the future.

Prof. Richard Wilson of Harvard University, USA (2001) recently describes:

"In Bangladesh 30 million people are exposed to arsenic at levels higher than EPA presently permits(>50 ppb in the water). I have been quoted many times, without ever being contested, that the Bangladesh catastrophe makes Chernobyl look like a Sunday school picnic. Some thousands have already died from secondary effects of the skin lesions and there are estimates by responsible scientists that a million people will die eventually."

Her further adds:

The effect of arsenic in water at a level of 500 ppb (only 10 times the present EPA-allowed level of 50 ppb) is producing a catastrophe in Bangladesh that exceeds in magnitude the Chernobyl disaster by a factor of over 10 and maybe 100.

Animals do not develop cancer led toxicologists and almost everyone else, including myself, to believe that the limited data on humans was consistent with the idea that people who ingest only moderate doses of arsenic do not develop cancer.

But in a paper that shocked everyone, C.J. Chen and collaborators from Taiwan described cancers of the bladder, kidney and lung attributable to ingested arsenic. That ingestion of arsenic, as distinct from inhalation of arsenic, causes lung cancer seemed bizarre and was widely disbelieved. But scientists from Argentine and Chile and by Dr. Lu and collaborators from Inner Mongolia supported the link between ingested arsenic and cancer. Until recently animal experiments supported their beliefs: arsenic did not cause cancer in animals and therefore was unlikely to cause cancer in people. But recent studies show that a metabolite of arsenic, DiMethylArsenic Acid (DMAA) does cause bladder cancer in rodents

Guha Mazumder (1996) outlines a treatment regime for those suffering from arsenicosis. It is suggested that the first stage in treating those with arsenicosis should be the immediate cessation of consumption of arsenic contaminated water. But in Bangladesh most of the arsenic patient does not have access to arsenic free water.

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Once this has been achieved the emphasis should be on the provision of a diet high in protein (preferably meat) and vitamins, to aid the methylation of inorganic arsenic in the body.

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In humans, the liver methylates inorganic arsenic that is consumed in drinking water. The resulting arsenic metabolites are excreted in the urine. Differences in methylating efficiency may be the reason for variations in arsenic retained in the body, and thus susceptibility to arsenic poisoning. Variability in arsenic metabolism appears to be important in understanding the human response. There is evidence that methylating capacity differs among individuals and population groups. Different capacities would result in variations in tissue concentrations of arsenic. Also, environmental factors, particularly diet, might be important in explaining susceptibility (National Research Council, p193, 1999).

Evidence suggests that the role of nutrition may also be important in determining methylation efficiency and toxicity to arsenic retained in the body. Yang and Blackwell (1961) studied nutritional factors in the blackfoot endemic region of China (Province of Taiwan). Their results indicated that residents of this region consume a diet low in protein, and in particular the amino acid methionine. Vahter and Marafante (1987) found that a low amount of methionine or protein in the diet decreased methylation of inorganic arsenic in the rabbit. In addition, insufficient vitamin intake, in particular vitamin B 12, might reduce the ability of the body to methylate arsenic (Buchet and Lauwerys 1985).

For these reasons, women, whose nutritional levels are frequently deficient in South Asian countries for reasons linked with cultural norms and reproductive function, may be at particular risk

The chelating agents DMPS (dimercaptopropane sulphonate) and DMSA (dimercaptosuccinic acid) are recommended as treatment drugs. DMPS is considered more efficacious than DMSA in aiding the elimination of arsenic from the body, but DMSA is preferred for wide spread application because of its lower risk of side effects (Angle 1995). However, Guha Mazumder (1996) notes that these drugs are very expensive.

Chelation therapy has been demonstrated to be effective in the treatment of acute arsenic poisoning. Its value in treatment of chronic poisoning remains undemonstrated. Palliative care may be the only affordable treatment in rural areas of Bangladesh, where expensive drugs and protein-rich diets are unlikely to be available to the vast majority. In the case of keratosis, application of ointment containing salicylic acid can help to soften the skin and ease the pain of the patient.

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Poor suffers Arsenicosis

Why do people die in arsenic poisoning?

The contamination of wells with arsenic is one of the greatest environmental disasters being faced today and must rank as one of the worst in recent times. At the request of contacts in West Bengal I researched the matter and found a technology that can get rid of all traces of arsenic. Since then I have tried to mobilise public opinion to find finance for implementation and have also talked to the West Bengal Government, people and authorities in Bangladesh, US AID, UNICEF, DIFID, SIDA and other aid donors

My own estimate is that one person is dying every 15 minutes and millions are suffering in illness. But very few politicians and bureaucrats live in the affected villages and the people dying are considered to be of no consequence.

Worse still, the token efforts of the World Bank and other aid agencies has added obstacles to solving the problem. If the captain of the Titanic broadcast a May Day message, most of these people would have commissioned studies on iceberg flows and common sense home spun ways of avoiding icebergs rather than sending ships to take the passengers off.
My conclusion is that:

  • the problem is chronic, ·
  • the contamination is irreversible and worsening,
  • no other safe water sources can substitute the wells,
  • aid agencies helped produce the problem due to lack of care about environmental impact, and are today full of ill considered patronising solutions,
  • the solution must fit village culture, be robust and be commercially sustainable,
  • technology exists to solve the problem but it will cost a lot,
  • no one cares sufficiently since its is all theoretical for them.
(V. Chand, UK, 2003).

It was a great shock to read an editorial of renumated British Medical Journal , Rhona MacDonald BMJ 2001;322:626-627 ( 17 March, 2001):

If a developed country was cursed with the geology of Bangladesh it would have mechanisms in place to deal with it and its people would not be drinking poisoned water. Water problems tend to disappear when a country becomes rich.

Population of the poor developing countries have to die just because lack of effulent to pay high tech. Now it is understandable why the scientists from the west quickly concluded natural origin of arsenic in Bangladesh.

Jalil Miah a sugercane farmer at village Norshinia Faridpur seriously affected by arsenicosis says, "Look we did not have this probleme before. Since we use toxic agrichemicals, we see that our end has come". He begins to cry and holding his daughter tight, "Allah has punished us! "

Former Ofwat boss attacks "excess profits" in South

Private sector companies working in water have made excessive profits in some of the poorest countries in the world by exploiting the twin evils of corruption and lack of knowledge. Alan Booker, former deputy director of Ofwat (the regulator in the privatized water industry in the United Kingdom), draws this conclusion based on his review of the working of water utility contracts in different parts of the world. Through the lack of knowledge of host governments in the developing world the contracts are often biased towards the contractor, Booker wrote in a column "Talk Back" in the May 1999 issue of Water and Environment International. "The examples are drawn from Latin America in particular," he adds in a short reply by e-mail to a few questions

In general such contracts have been negotiated with institutions incapable of supervising the performance and behaviour of the contractors. European companies in particular have developed robust marketing techniques, often playing on the endemic corruption in the host country and the influence greed can have. Even where the contractor is known to be generating levels of profit of around 50 percent greater than comparable contracts in Europe, it is impossible for the host country to share in out-performance, because of the terms of the concession contracts which last 25 years or longer. (October, 1999, International Water and Sanitation Centre, Netherland).

The Asia Arsenic Network conducted a demographic survey of Samta Village in the Jessore District of Bangladesh in 1998 (Tani,1999). A graphical representation of household income data versus arsenicosis prevalence, using data collected in this survey, showed a negative relationship. In an attempt to further quantify this relationship a regression analysis was conducted using the same data. Prevalence of arsenicosis was based on evidence of skin lesions in the surveyed population. Household income was measured on an annual basis.

There were no arsenicosis patients in any of the income classes above the 140,000-150,000 Taka household income range. The regression indicates the negative relationship between arsenicosis and household income. Increasing levels of household income are associated with a lower prevalence of arsenicosis. The burden of arsenicosis falls mainly on those living in low-income households (Tani, 1999).

Usually it is found that the affects of arsenic pollution become visible on the skin after 8-14 years of taking arsenic contaminated water regularly. This is why symptoms of arsenic poisoning are not found in the bodies of children below the age of 10 years. But there are some The children affected with arsenic are from poor families and deprived of nutritious food. The symptoms found in their bodies included spotted melanosis, spotted keratosis and defuse melanosis on palm, feet and other parts of the body.

We have shown, using econometric analysis, that the poorest suffer the most from arsenicosis in Bangladesh (WHO, 2000).

Most arsenic patient of Bangladesh is still drinking arsenic contaminated water and can hardly afford any medical treatment.

Sulekha, Shakti, Mubarak, Narayan Shiel and thousands or millions of arsenic patients in Bangladesh displaced from their professional life can hardly afford arsenic free water, healthy food and have no access to expensive treatment or proper medical care. In Bangladesh almost 50 or more percent of population is landless farmers. Jasim Uddin writes about a young landless girl:

Field after field run along
Green winds sway tender paddy shoots
That spreads like open hair
In it butterflies ornamented with wings…
Mother earth smiles at her fertile pride.
In this harvest Asmanis (landless people) have no claim.
As worn out ribs hold together their stomachs
They burn with hunger.

Forest after forest run along
This fairyland of flowers and fruits….

In this forest Asmanis (landless people) have no claim.
They are hungry.

River after river run along
They flow through nameless wharfs…
In this river the Asmanis (landless people) have no claim.
Worn out ribs hold together their stomachs
They are empty.

(Source: Selected Poems of Jasim Uddin)

Shakti an eighteen years young girl possibly suffering from liver cirrhosis from drinking arsenic contaminated water. Many days her pain is so forceful that she has lie in bed. Her parents cannot afford any medicine. But I was surprised to her noble thinking. Shakti with full of tears whispers, "All she wants, nobody suffers as she does…."

What may we know of the secret sorrow
Of the shepherd in the field?
In vain we search in our joy and our pain

Yet I may try to fathom this pain
To the earth if I press my ear
The voice of the soil speaks to me
Its heartbeats I can hear.

(Source: The Field of the Embroidered Quilt by Jasim Uddin)

Source: Jamal Anwar, "International workshop on arsenic mitigation", Dhaka 2002

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Last modified November 1, 2004)