The Daily Star April 05, 2002 Fending off the silent killer Shafiqul Islam Arsenic is a multidimensional problem. Scientists, researchers, planners, medical professionals, engineers, executives and media people need to work together to guide the nation. Their collective efforts can contribute to the development of a framework that will ensure provision of safe water for all DETECTION of arsenic in groundwater has aroused widespread concern among the people in Bangladesh. It occurs in different forms, organic and inorganic, with different toxicity. Humans are exposed to arsenic mainly through ingestion and inhalation. The World Health Organisation (WHO) has set a provisional guideline value of 10ppb for total arsenic in drinking water. The Government of Bangladesh (GOB) has set a provisional water quality standard of 50ppb for drinking water. In 1978, the first tube-well waters with greater than 50ppb were found in West Bengal. In 1983, the first arsenicosis patient was diagnosed in West Bengal. In 1987 the first arsenic patient from Bangladesh was identified. In 1993 the DPHE confirmed arsenic in tube-well in Chapai Nawabgang in the Rajshahi division. The arsenic issue was internationally recognised in 1995, when the first international conference on the subject was organised. Two hundred and sixty-five out of 463 upazilas in 59 out of 64 districts are affected by arsenic. There are six to 10 million tube-wells in the country. At the current pace, by the end of 2002, half of these will have been tested. It is estimated that between 26-60 million people are at risk of contacting arsenicosis. About 14,000 patients have been reported and this is just the tip of an iceberg. Possibly two million people are now in pre-arsenicosis stage. Countrywide situation is not yet fully clear five years after the government has recognised this as a public health problem. In order to address this issue the government sought World Bank loan and got US$40 million for national response. The Bangladesh Arsenic Mitigation Water Supply Project (BAMWSP) has been established to carry out emergency screening programme. It was given the responsibility to co-ordinate with other agencies willing to carry out arsenic mitigation work. On the basis of this it has allocated 268 hot-spot upazila to the following organisations to complete the screening programme by June 2002: BAMWSP (188), Unicef (45), WATSAN Partnership (13), DANIDA(08) and World Vision (14). The five-thana Community-based Arsenic Mitigation Action Research project implemented during 1999-2000 developed a four-part integrated strategy: communication for awareness, blanket testing of tube-wells, patients identification, and safe water options Although the above is a DPHE Project that was implemented with large NGOs such as BRAC, GB, DCH, ROTARY/ISDCM thus able to implement with speed. It became necessary to have interface with DPHE, NGOs and the local government so that the initiatives become sustainable. Communication for awareness: A strategy for communication campaign was developed involving the eight concerned government departments under the DPHE leadership. Those materials were pre-tested before production for large-scale use. This package was formally launched by the then minister of health and family planning along with the UNICEF EXD in December 1999. The objectives were to inform without creating panic-factual, inter-personal approach; establish trust-use credible and familiar figures in mass media materials; promote active role for women in decision making; and promote role for adolescents. Blanket testing of wells: In order to carry out the blanket tube-well testing, testers were selected within the community and they were trained to test tube wells using field kits. They conducted blanket testing of all tube-wells to identify safe as well as contaminated sources. On the basis of the test results mark red, if arsenic is detected: green if tube well water is safe for drinking. Patient identification: As arsenic is a new phenomenon, medical professionals are not fully aware of the treatment procedures for arsenicosis. As such a training programme for medical professionals and workers of the DGHS has been taken up and a treatment protocol has been developed by a qualified agency. Patients are being diagnosed by trained physicians in house to house survey or by health camps. Provisions for palliative ointment were made. Referral for advanced cases is encouraged. Safe water options: Traditionally, surface water, ponds are used. Ponds are still abundant, but many given over to fish culture and thus unsuitable for drinking purpose. Bangladesh enjoys a good rainfall, average 1,500 to 3,000 mm per year. Besides arsenic, other issues with groundwater exist, such as manganese, boron, uranium. During the first five upazila Community-based Arsenic Mitigation Action Research during 1999-2000 Rotary in Bangladesh came forward and joined hands with the Unicef to provide safe water options to the suffering people of Manikgang upazila. The basis of that work, out of the four-part integrated strategies, the Unicef would do the screening, awareness building and arsenic patient identifications and Rotary would provide financial supports for providing safe water options keeping in view of the GoB Water Supply and Sanitation Policy 1998. Under that scheme Rotary spent about US$50,000 on alternative safe water options. With that fund 28 deep tube-wells, four-continuos arsenic removal filters (SIDKO), one iron-cum-arsenic removal filters, 50 DPHE-DANIDA Bucket Filter, nine family size surface water treatment units, four RWH and other home-based filters were provided which showed the actors in arsenic mitigation a way to address this gigantic problem. In the implementation process three Rotary Clubs in Dhaka and the Rotary Club of Manikganj were involved in the selection of arsenic testers, safe water option sites, quality control of the options, and cross checking of tube well screening. In addition to that the Manikganj club was involved in the motivation and training activities at local level along with ISDCM a NGO that implemented the project. Lessons learnt in Manikganj may be used as reference to other Rotary initiatives for mitigation of arsenic problem. Strategies have to be developed for encouraging the private sector involvement. For practical challenges, attempts have to be made to develop long term community led approaches to safe water provision, develop emergency approaches for heavily affected communities, collect reliable information to base advice on ground water chemistry, option performance. Last but not least is to stay abreast of and develop the mitigation programme based on new information on water, food chain, etc. Shafiqul Islam is team leader, arsenic unit, WES Section, Unicef, Dhaka.