Mitigation of Arsenic Contamination
in Rural Areas of Bangladesh

-- The Current Status and Problems --

Kazuyuki Kawahara
JICA Expert (Arsenic Mitigation Adviser)

Three months have passed since I came to Bangladesh as JICA's long-term expert (Arsenic Mitigation Adviser). Now I would like to summarize the current status and problems of mitigation measures to combat the arsenic contamination in rural areas in Bangladesh based on the findings of my own surveys and daily collection of information.

I. The Current Status

1. Safe Drinking Water

In highly arsenic-affected villages various projects have been gradually undertaken to supply safe drinking water by DPHE, BAMWSP, UNICEF, DANIDA, both national and local NGOs and others. I have observed the following methods as their mitigation measures.

A. Household Options

1) Rainwater Harvester (Photo #1; Chowkiderbari, Chandpur Dist., 8/12/00):

This is a round tank of about 1.8 metre high with a diameter of approximately 2 metre. The tank is made of concrete and connected with a gutter which collects rain water from the tin roof of a house. A few neighbouring families are using the rainwater harvester (RWH).
In Chowkiderbari, UNICEF bore the whole cost of the installation of the RWH without any cost-sharing from the beneficiary families. Whereas, in Achintyanagar, Jhenaidah District, a similar RWH (3,200 litre, Taka 9,000) was installed with 20% of the cost borne by community people and 80% financed by NGO Forum.

The weakness of this system is that people can use it only a few months after the rainy season. In Achintyanagar, two families are using this 3,200 litre RWH. If ten people of the two families drink five litre each per day, the water runs out after 64 days. After that, they have to look for another source of drinking water.
The tap of the RWH in Chowkiderbari was tied up with thin bamboos in early December 2000 so that people do not use it.

2) Arsenic Removal System No. 1 (Photo #2; Chowkiderbari, Chandpur Dist., 8/12/00):

This is called "Four Pitcher System". In the second pitcher there are charcoal and brick chips, and in the third sand. Tubewell water put into the first pitcher is oxidized while it flows down to the second pitcher, and filtrated through charcoal, brick chips and sand. Thus arsenic- removed water is kept in the fourth pitcher. The system is based on the property that arsenic is adsorbed to iron by oxidization. Therefore, much effect cannot be expected unless groundwater is iron-rich.

The unit is a traditional system used for removing bacteria at a time when people used to drink pond water. After the source of drinking water was switched from a pond to a tubewell, the system has been utilized to remove iron and reconsidered as an effective way to remove arsenic also since two and a half years ago.

The system does not require any chemicals. It is cheap (Taka 100) and simple. It has all the factors that can be accepted by villagers. DPHE is currently undertaking the test about the effectiveness of the system for arsenic removal.

3) Arsenic Removal System No. 2 (Photo #3; Durbadanga, Jessore Dist., 10/11/00):

This is called "Two Bucket System", implemented by DANIDA. To the tubewell water poured into the red (top) bucket, potassium permanganate (oxidizing agent) and aluminium sulfate (coagulant) are added to remove arsenic from the water. The tubewell water is then filtrated through the sand in the green (bottom) bucket. The arsenic concentration of 0.5mg/L of the original tubewell water was lowered to below 0.02mg/L in this system by the measurement of a field arsenic testing kit.

B. Community-based Options

1) PSF No. 1 (Photo #4; Doaty, Chandpur Dist., 8/12/00):

This pond sand filter (PSF) was installed by UNICEF's full support in July 2000. Nearby there was also a deep tubewell (DTW) sunk by DPHE. On visiting a household, I found that DTW water was kept for drinking and PSF water for cooking in separate kalshis in the kitchen.

Here, water is taken from a relatively large pond (80 x 50 metre) for the PSF. However, villagers were using the pond for bathing and washing. It is my opinion that any pond for PSF should be kept hygiene for drinking purpose and not be used for any other purposes.

2) PSF No. 2 (Photo #5 ; Samta, Jessore Dist., 3/00):

This is a pond sand filter constructed by the Asia Arsenic Network (AAN) in January 1999. The pond for the PSF is protected by bamboo fencing and any use of the water other than drinking is prohibited. All the cares are taken to prevent bacterial contamination by removing a lavatory to a place more than 15 metre away and by sterilizing the processed water with chlorine in the last chamber of the PSF (Photo #6). A doctor of Samta Health Centre checks coliform and other bacilli once a month (Photo #7).
The construction cost was Taka 1,50,000 for the PSF itself and Taka 2,00,000 in total inclusive of other expenses incurred for re-excavation of the pond, fencing, and the removal of a lavatory. The cost was paid with the grant given by the Toyota Foundation.
The PSF has the capacity for 150 households (750 people). The Samta Arsenic Prevention Committee is in charge of the maintenance and management of the pond and PSF. Since the pond water dries up toward the end of the dry season, they consider bringing water from the Betna River approximately 500 metre away to the pond. The collection of water rate is yet to be considered.

The medium-size PSF that AAN is currently promoting can supply water to 100 households (500 people) and can be constructed at a cost of Taka 1,00,000. The other expenses for re-excavation of a pond, fencing and maintenance are to be borne by the community people.
The condition for the installation of a PSF includes the replenishment of a pond of a suitable size free, the establishment of a solid group of community people for operation and maintenance, and the availability of pond water throughout the year.

3) Arsenic Removal System No. 3 (Photo #8 ; Rajnagar Bankabarsi, Jessore Dist., 19/12/00)
This is an arsenic removal system with aeration and sand filtration combined. In Rajnagar Bankabarsi, The JICA Study Team on the Groundwater Development of Deep Aquifers was testing the effectiveness of the unit.

4) Arsenic Removal System No. 4 (Photo #9 ; Rajunagar Bhangabarsi, Jessore Dist., 19/12/00)
This is an arsenic removal system with aeration, gravel and sand filtrations and adsorption by activated aluminium oxide combined. In Rajnagar Bankabarsi, The JICA Study Team was testing the effectiveness of the unit.

5) Iron Removal System (Photo #10 ; Baraipur, Chuadanga Dist., 17/11/00)
This is an iron removal system installed by NGO Forum at a cost of Taka 8,000 (Taka 1,600 was borne by community people). Since the system removes arsenic as well as iron at the same time, it is being introduced for arsenic removal in other affected areas. The arsenic of 0.5mg/L in the original groundwater was removed with iron and lowered to 0.02mg/L when tested with a field arsenic testing kit.
The sand of the filtration tank is backwashed once a week, but the drained water is disposed on to the ground from the back of the unit (Photo #11). The arsenic of 0.4mg/L was detected from the drained water that was still on the ground. It is necessary to examine the disposal of drained water.

6) Deep Tubewell No. 1 (Photo #12 ; Rajnagar Bankabarsi, Jessore Dist., 3/11/00)
The JICA Study Team is conducting a monitoring research on the water quality of the three deep tubewells (222 metre deep) installed in Rajnagar Bankabarsi with different types of sealing technologies; namely, cementing, nice-sealing and mechanical method. They plan to evaluate the cost, effectiveness of each sealing method, the feasibility of transferring the technologies, and other factors. Since no arsenic was detected in the pumped up water, villagers started collecting water from the deep tubewell for drinking (Photo #13).

7) Deep Tubewell No. 2 (Photo #14 ; Gopinatpur, Chuadanga Dist., 17/11/00)
This is a deep tubewell (120 metre deep) installed in Gopinatpur village by DPHE. Measured by a field arsenic testing kit, it was found that the water contained arsenic of 0.3mg/L. Depending on the places, arsenic is detected at high concentrations in deep tubewell water. It cannot be said that a deep tubewell is always safe everywhere.

When I visited Dourbadanga village in the Jessore District on 10 November 2000, I saw a deep tubewell (220 metre deep) sunk by DPHE. The water sample was checked with a field arsenic testing kit and the arsenic concentration was only 0.01mg/L. However, due to the salinity, villagers were not drinking the water. A deep tubewell, as an alternative source for the mitigation of arsenic contamination, requires careful pre-installation assessment and post-installation monitoring.

2. Medical Treatment

The mitigation of arsenic contamination has so far been stressed on the supply of safe drinking water as a preventive measures, and only a few organizations are engaged in treatment of arsenicosis patients. I would like to consider the medical problems that people in arsenic-affected areas are facing through the cases studied and taken care jointly by AAN and NIPSOM(DOEH).

1) Seriously-affected Patient who Recovered his Health

Mr. Rezaul Morol of Samta village, Jessore District, was walking with an aid of a stick when a doctor of NIPSOM examined him in December 1996 (Photo #15) . His whole body was covered with hyper-melanosis, he had hyper-keratosis on the palms and soles, and he was suffering from bronchitis, enlargement of the liver and peripheral neuritis. Following year he was hospitalised in Sharsha Thana Health Complex and took arsenic-safe water, nutritious food, vitamins A, C and E, and chelating agent. When he left the hospital three months later, his symptoms were so substantially improved that he could start working as rikishaw-van driver (Photo #16) .

NIPSOM doctors say about medicines for arsenic poisoning: "Safe water first, safe water second, safe water third, and then nutrition and vitamins as the fourth".

2) Skin Cancer Patient No. 1

Mrs. Fulslat of Samta village, Jessore District, was found to have had skin cancer of 4 x 5.5cm size on the parietal region of the head (Photo #17) during the medical examination survey conducted by AAN and NIPSOM(DOEH) in February 1998. She had an operation at the Yamagata Dhaka Friendship Hospital in May 1999 and her skin cancer was removed (Photo #18). She was very much pleased and said that her second life had begun.

In December 2000 a doctor of AAN medical team from Japan found six skin lesions on her scalp which were suspected to be of cancer (Photo #19). All of them appeared afresh after the operation of one and a half years ago.

3) Skin Cancer Patient No. 2

Mr. Ijjat Ali (Photo #20) of Mazdia village, Jhenaidah District, had skin cancer on the palms of both hands (Photo #21) and on the left groin. He had an operation (Photo #22) at the Yamagata Dhaka Friendship Hospital in October 2000 and returned home early December. However, since the cancer under the artery of the left groin had not been removed, he is now receiving chemotherapy since December 2000.

†4) Skin Cancer Patient No. 3

Mrs. Rokeya Begum (Photo #23) of Marua village, Jessore District, had skin cancer on the right palm (Photo #24). She had an operation at the Yamagata Dhaka Friendship Hospital in December 2000 and returned home early January 2001.

3. Community Participation

Arsenic mitigation activities by international organizations and major NGOs are generally undertaken jointly with a local NGO active in one particular village. The local NGO encourages villagers to form a committee so that the committee may act as the principal body to organize mitigation work.

According to AAN experience, members of such a committee are decided among the village leaders. One of the main functions of the committee is to collect funds to operate and maintain a newly installed option of alternative source of safe water. The running of the fund including the management of money is under the supervision of the local NGO during the initial stages. The committee needs some experience to become an independent running organization.

II. Problems

1. Safe Drinking Water

As reported in I.-1., various systems to supply safe drinking water are being introduced in highly arsenic-affected villages. There are systems that are accepted by the community straightaway whereas for the implementation of some other systems contractors and/or villagers may have to be properly trained beforehand.
The former is a system that is cheap in cost, necessary materials of which are easily obtained, and that is simple in operating and maintaining. Such systems are to be replaced in future by highly advanced systems. The latter has some difficulties in cost, construction and operation/maintenance aspects. However, such an option is feasible by improving the abilities of contractors and/or villagers, which will, in turn, be a basis of installing a permanent measures such as a piped water supply system.

In the planning of measures for safe drinking water, concerned people often quote the necessity of "emergency" and "permanent" measures or "short-term", "mid-term" and "long-term" measures. However, those classifications are not clear with respect to the division of "emergency" and "permanent", or "short-term", "mid-term" and "long-term". It would be necessary to form a public understanding in this respect as to what condition allows the move from emergency to permanent, or from short-term to mid-term and long-term measures. Here I would like to investigate from the viewpoints of the effectiveness of systems implemented as alternative sources of safe drinking water, their costs, and the development of villagers' ability, taking the above-mentioned cases into consideration.

1) The Effectiveness of Systems

The first requisite of any system for arsenic contamination mitigation is to be able to supply safe drinking water. The "safe drinking water" means the water that meets the Bangladesh standards set for coliform and other bacilli and any hazardous substances as well as arsenic. When applying arsenic or iron removal equipment, it is important to dispose sludge properly to prevent the second contamination. When using of chemicals, cautions are to be taken so that no such chemicals remain in the processed drinking water.

The more advanced, the more technology the system requires to solve the problems of meeting water standards, sludge disposal, residual chemicals and so on.

2) The Cost

For an alternative source of drinking water, both the installation fee and the operation and maintenance expenses are required. The villagers' willingness and ability to bear a part of the cost largely depends on not only their economic condition but also on their understanding of the importance of taking safe water. In case the installation fee is high, financial aid may be required from international organizations, ODA funds of advanced countries or major international NGOs as well as from the Government of Bangladesh. In principle, all the costs incurred for operation and maintenance should be borne by beneficiaries.

It is assumed that the more advanced the system is, the higher cost is required for construction, operation and maintenance. Therefore, the change of villagers' consciousness and the increase of their income are the conditions essential to the installation of such systems.

3) The Development of Villagers' Ability

Villagers are required to have the ability to manage a system installed as an alternative source of safe drinking water. The ability is required in two aspects; namely, (1) to maintain and check the system technically and (2) to manage the fund collected from beneficiaries and run the fund. It is difficult to imagine that villagers will keep on making use of any system that requires technical and managerial abilities beyond those of their own.

It is also difficult to introduce any system widely unless such a system is constructed with locally available materials and by the hands of local contractors. The contractor's ability is an important factor when considering whether any system is acceptable or not.
The more advanced a system is, the more important such development of abilities will be.

2. Medical Treatment

In consideration of the cases introduced in I.-2. and others, I would like to summarize the medical side of mitigation in terms of medical knowledge, cost, and the development of villagers' ability.

1) Medical Knowledge

First, the knowledge to identify arsenicosis patients and to classify them into certain groups of symptoms is called for. In highly arsenic-affected areas, there are some patients with skin cancer, and the knowledge to confirm skin cancer at initial stages is important.

Arsenicosis patients with mild symptoms may improve by taking arsenic-safe water and nutritious food. Those with moderate and severe symptoms should receive treatment with medicines in addition to arsenic-safe water and nutritious food. All of nutritious dietary, effective medicines and the treatment of arsenicosis patients will be the target of future studies and developments.

For patients suffering from advanced cancers require surgical operations and chemotherapy.

2) Cost

Skin cancer at an initial stage (Photo #19) can be easily removed if a surgeon and simple facility are available. The cost in this case is not much. However, if patients have to bear the cost, only rich people can receive medical care and the poor cannot, which will create discrimination. In case of the medical care for moderate and severe patients, too, there may occur similar discrimination unless some assistance is available.

The medical expenses incurred for the operation of skin cancer patients introduced in I.-2. amounted to several times of their families' annual income. It was not possible for them to pay, and AAN paid the bills. It is hoped that some public insurance system be established to reduce economic burden on the patients' side. Until then, it would be difficult for a cancer patient to receive an operation and/or chemotherapy without any assistance.

3) The Development of Villagers' Ability

Among the patients with hyper-keratosis on the soles, there were many cases that bacteria got through the cracked skin and the part became festered. In another case, a patient had to stay on in hospital after the surgery of cancer since it was not possible for him to disinfect the wound at home. It is required to develop the concept of health and sanitation among villagers and to spread simple medical knowledge. It is also important to further develop the abilities of local health workers.

3. System-making

As explained in I.-1., in arsenic-affected areas various types of systems are being introduced as alternative sources of safe drinking water, with each having a problem. Those systems will vie with one another in the rural area of Bangladesh for a long time. Who is going to coordinate this complex development and where? To carry out permanent mitigation measures, the development of villagers' abilities as well as the improvement of effectiveness of systems and medical knowledge is dispensable condition.

I feel that some social system is required to implement mitigation measures effectively in the rural area. It is a comprehensive mitigation system under which the extent of arsenic contamination will be clarified, safe drinking water supplied, and medical care and awareness education undertaken. The system will develop the abilities of community people and will prepare the basis for permanent mitigation measures.
I will discuss more about the system in III.-3. below.

áV. Japan's Cooperation

1. Safe Drinking Water

The JICA Study Team has been conducting a survey on the development of groundwater in the three districts of Jessore, Jhenaidah and Chuadanga on the southwestern region of Bangladesh. One model village is set up in each district and there they supply water from the arsenic removal plants and deep tubewells. Among villagers the improved (= sealed) deep tubewells are most popular.

It has become clear that there are some problems to the improved deep tubewells (150 to 200 metre deep). For instance, there are areas where there is no clay layer (which is essential to do the sealing) along the way to the deep aquifer, there are places which deep groundwater is saline, it is likely to take some time for the sealing technologies to be learnt, and so on. Accordingly, the number of sealed deep tubewells to be installed in a year will not be large.

AAN completed the construction of a large-size PSF (for 150 households) in Samta, Jessore District, in January 1999. Currently, two middle-size PSFs (for 100 households) are being constructed in separate villages. AAN plans to install some kind of options as a means of supplying an alternative source of safe drinking water in 20 villages per year.

Both sealed deep tubewells and AAN-type PSFs can be implemented only with the improvement of construction skills of contractors and the technical and managerial abilities of villagers. As such, it will be difficult to construct many such facilities within a short period of time. Priority for mitigation should be given to severely affected villages by identifying them through a screening survey.

On the other hand, it is also important to plan mitigation measures for safe drinking water in mid- and long-term perspective. While trying to improve the construction skills of contractors and the technical and managerial abilities of villagers, it is also required to prepare for permanent measures.

2. Medical Treatment

When AAN have found patients in arsenic-affected village they visited, AAN provide moderately and severely affected patients with medicines and give support to those with skin cancer.

Dr. Nobuyuki Hotta of AAN paid his third visit to Bangladesh in December 2000 and called at various affected villages. Before returning to Japan, he commented: "I am afraid that the number of skin cancer patients will rise enormously in Bangladesh if the arsenic contamination continues as it is. To find them at an early stage it is important to educate medical personnel so that they can distinguish skin symptoms. Since cancers on the internal organs are likely to increase, it is necessary to start the mitigation in this respect, too".

It is my opinion that Japan can contribute a great deal toward the training of dermatologists, the establishment or enrichment of facilities for the surgery of early skin cancer, and the provision of a system for treatment of cancers. These will be the cooperation that can be undertaken with medium- and long-term prospects.

3. Arsenic Centre

As stated above, in highly arsenic-affected areas various types of options to supply safe drinking water are being introduced on an emergency basis. In villages a comprehensive approach is required not only to obtain another source of safe drinking water but also to provide patients with medical care and to promote community participation. It is important, therefore, to establish a social system to coordinate these activities and proceed with mitigations of high-degree. I myself have a plan for an "Arsenic Centre" to function as the nucleus of such a system.

At the Arsenic Centre a group of experts (medical doctors, chemists, civil engineers for the supply of safe drinking water and social workers) is posted, necessary apparatus and materials are equipped, medicines are kept, and simple treatment and surgery will be undertaken. The Centre will promote comprehensive mitigation measures in the locality, give guidance to the people of affected villages in respect of skills and management, and help village-level committees become independent. Through these activities all the mitigation measures undertaken will be firmly established in the community, which, in turn, I think, will become the basis to prepare permanent measures for drinking water such as a piped water supply system in the future.

The source of revenue of Arsenic Centres and the running bodies will be the subjects for me as JICA long-term expert (Arsenic Mitigation Adviser) to study further.

4. Selection of an Area for Cooperation

I think it necessary to make Japan's plan clear at an early stage as to which area of Bangladesh and what kind of cooperation they are going to offer.
Japan's cooperation currently promoted is the survey on the groundwater development of deep aquifers by the JICA Study Team and the grass-root activities by AAN. The former is working in the three districts of Jessore, Jhenaidah and Chuadanga, whereas the latter targets the ten districts of the Khulna Division that includes those three districts. Japan's mitigation measures will achieve great results when it is carried out comprehensively in coordination with these two attempts on a mid- and long-term basis.

I think it preferable to select an area for Japan's cooperation in the Khulna Division avoiding the duplication of work in the places where BAMWASP, UNICEF, DANIDA and NGOs are already present. I would like to consider that in the area an Arsenic Centre will be set up as an experiment, and then the Centre will undertake comprehensive mitigation measures while preparing for a water supply system of higher level and an appropriate medical care system.

(1st February 2000)