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Mahfuz Anam: I would like to invite BRAC to tell us what they are doing and how it can benefit us.
Zakaria: We have done very little on the arsenic programme. We first decided to work in a collective way. We selected a small thana, Hajiganj of Chandpur district. In 157 villages, 12,000 tubewells, 11,096 tubewells were arsenic contaminated, that is almost 93 per cent.
We have tested all the tubewells of BRAC offices in different parts of the country, almost 900 offices. About 94 tubewells were arsenic contaminated.
Khushi Kabir: What is your follow-up programme, since BRAC has such a far outreach?
Zakaria: We are informing the people through our health forum about hat to do if the tubewells are arsenic contaminated. We advise then to use the safe tubewells if there are any in the village. If they not, they are to boil the surface water. If that is not possible, they let the water stand for 12 hours, the collect the upper two thirds. More than 50 per cent of arsenic is removed by this process of sedimentation, according to an article.
Quamaruzzaman: I don't know what article you saw, arsenic is a trace element. It does settle down but there is another problem. Water-borne diseases form when water to kept like this. We stopped advising people about this. Before we would use alum, but this causes more problems. There is a packet of NIPSOM but that caused chlorine poisoning.
Zakaria: NIPSOM produced a report where they mentioned this specifically,
Quamaruzzaman: Perhaps you should check this with a scientist. Certain things have been one about arsenic in Bangladesh which is worse than quacks.
Ashiqul Hasib: BRAC is just is a state of finding out about why arsenic is in ground water and there remains a lot of uncertainty regarding the occurrence. SO BRAC decided just to check the tubewells for possible arsenic contamination. We are still in a state of knowing where arsenic is present.
Quamaruzzaman: There are guidelines to be followed. One organisation can validate the kits to be used. The government has this provision.
Mahmudur Rahman: About the kits, we have had a lot of problems when we went to test the water. There is a very big question mark about the results of the kits.
Alex Redekopp: There are three kits in use at the moment and there are some doubts about the accuracy of some kits. One groups doesn't believe the other and so on. This raises all kinds of questions regarding the validity of the data collected. WHO plans to look at the kits being used in Bangladesh and India. We will have this team of Indian experts come here and share with everybody interested in field testing the basis of their investigations. As a result of their evaluations, they will hopefully come up with a generic step-by-step procedure which can be used.
The idea is not to import things from outside. They are expensive and so on. To have them done here is better, in collaboration with UNICEF, to form a user-friendly procedure. Steps will be put into effect to see how they can work.
Mahfuz Anam: What about the kits being used now?
Redekopp: The one being used by the Dhaka Community Hospital is available in the local market. I believe its being made in Germany or Austria. Another kit is made in India. Some kits are imported by UNICEF and the NIPSOM kit initially began as the Asian arsenic network kit, it came from Japan and has been modified by the NIPSOM people.
Redekopp: In terms of the water quality guidelines of WHO, these are not standards. Standards are provided by countries. The guidelines are through a task force or consultative type meetings where experts gather around and discuss and come up, by consensus, with a guideline. This is how things are done in WHO.
This is a reasonable guideline for Bangladesh. If you aim for.01, you may as well discard the majority of tubewells that you are talking about. I think.05 is a reasonable guideline that has to be adopted by the Ministry of Health.
WHO does not issue standards, it issues guidelines.
In terms of WHO consultants, a comment was made that one of their reports was rejected. It is not true. Professor Darby (?) was here to do some of the initial investigations, prepare the report which I believe has been the basis for a lot of thinking in the Ministry of Health and the World Bank, etc. His report along with that of Dr. Alan Smith was discussed at some length at the India-Bangladesh consultation along with other reports. What he did was the beginning of the whole process. It takes a lot of thinking initially to get things moving.
We have copies here. These were recommendations for action. They are available in my office and anybody may have a copy. This has been used by the World Bank and others to formulate. WHO is not a funding agency. It is simply a technical support agency. This is the way things are done in WHO. Consultants are selected for their expertise.
About what is done in the US, Canada and elsewhere, the first choice is the use of ground water, because it costs money to clean surface water. It is very expensive. In Canada or the US, people can pay for the cost.
In smaller communities across the countries is to drill a tubewell, a deep one. There they consume ten times as much water per capita than we do here in Bangladesh. I would discourage to discard ground water because of this issue. The first point is to determine arsenic-free sources of ground water. Let's not go overboard and look at surface water unless in extreme cases where uncontaminated ground water is not available.
Mahfuz Anam: Are you in a position to give us some sort of overview, like ideal town planning. Does one go first for ground water?
Redekopp: In terms of water supply in Canada, yes. I cannot speak for other countries.
In countries of North America, the volume required is rather excessive, so you frequently wind up having to go to surface water with the expensive treatment it requires, chemicals, operations and maintenance. This is a problem here.
Mahfuz Anam: Is there any thumb rule for the first choice of water?
Redekopp: For small cities and towns in Canada would be to consider ground water because it requires less treatment.
Dr. Iftekhar Hossain: The government situation is no the same as the NGOs or CBOs, that is Community Building Organisations or SOs, that is Support Organisations, and others.
The problem with the government is that it is accountable to the people, not the NGOs, the CBOs or the SOs. So the government is very careful of any step it takes. It is not that the government is not doing anything. I congratulate the NGOs when they bring the issue of arsenic to attention. It triggers the action of the policy makers in the government. But we don't have any solution at the moment at any point. We don't know how the water is being contaminated. We don't know the solution. We don't know the treatment. The government cannot come forward with anything is such a dilemma. People look to the government for a solution. So we are taking into consideration all recommendations by all agencies and the government has formed a focal point for the arsenic problem and that is formed by the Minister of Health. This was constituted in 1996. In that steering committee, all people working with the arsenic problem are being involved.
The government has decided to make intensive survey. That is an immediate need.
It is not true that we overthrow the view of the consultants because we pay for them. We take heed of good suggestions and work is carried on these suggestions.
We are doing an epidemiological survey, finding out the patients, how many there are and we have health indicators to determine how many people are suffering from arsenicosis nation-wide. It is a pilot study now. From the experience of the study, we will expand it using our health infrastructure nation-wide.
We are now handling two projects, one funded by the government, that is for one year, the other by UNDP, that is for six months.
We are carrying out a Geological Information Survey, GIS, and are trying to map out the high risk area, the low risk area. We are also trying to standardise the kits because it is a problem. Actually the formula of all the kits are similar, perhaps there is some change in the methodology.
Mahfuz Anam: Can you give us an overall picture of the country? Dr. Mahmud said 76 million are at risk. Do you agree?
Dr. Iftekhar Hossain: We will not differ. For example, if one tubewell in an area is at risk, we can say the entire population of that area is at risk. The government's view is that 44 districts are affected by arsenic so far.
About 19,000 tubewells are being treated and we find nearly 4000 are contaminated. We have identified 2000 patients so far in our project. We found 139 patients in a two-day survey in Jamalpur which is not in our project area. So, in that way, we can say the whole country is at risk. We are doing an intensive survey using our infrastructure. We cannot simply wait for donor support. I think it is possible. Then we can determine the magnitude of the problem.
We are also validating some of the initiatives of different agencies who are coming up with different methods for removing arsenic. Everyone says that their technology is the best as ask for financial support. We are taking care of some of the reputed organisations. These are the immediate measures.
We try to examine all the options and suggestions and depending on that, we take this immediate action to provide safe water by treating surface water, or deep tubewell. In Bangladesh people have a negative attitude about storing rainwater for drinking.
Mahfuz Anam: What are the immediate tasks and long term vision.
Badiul Alam Majumdar: Say, I am an ignorant villager and have come here and have learnt a lot of things about arsenic pollution. I have learnt that it's a disaster in the making. My tubewell is not affected now, but it may be affected tomorrow. It's a pervasive problem and I may be at risk. I have also learnt that there is no solution. We are still finding the extent of the problem and the solutions. Can you tell me, as an illiterate farmer, what can I do?
I also want to make an offer. In Bangladesh we have used social mobilisation for poverty alleviation. That can be used here. In Gaibandha district we have to deal with the problem of iodine deficiency. We involved a district-wise campaign involved in going to every village, every person in the district with a brochure, causing awareness and a solution by the way of using iodised slat. Can you prepare a page which will be understandable to the villagers and I will take up one district and deliver it to every person in the district. I will mobilise thousands of volunteers to do that. We can say that we don't enough, but we need to do something about it. If you can give us some information the poor villagers can use, we will take it to them and create a mass awareness campaign where villages will do something to protect their own health.
Mr Farooq: At Rotary, we are involved in safe drinking water programmes and at the moment we are in a fix whether we go ahead with our tubewell sinking programme or not. We have 300 tubewells right now.
We are looking for an appropriate message to take to the people.
Dr. Iftekhar Hossain: In our government programme, carried out by DPHE and the Community Hospital, we are testing the tubewell and when we find tubewells contaminated by arsenic, we mark it with red. The good one is labelled with green. If you don't find any green tubewell in your locality, go for a deep tubewell, if the cost can be borne by the local people. This is an immediate option.
The next option is, treat the surface water and consume it.