Fluorosis still exists in various forms in Mundargi town and its villages due to lack of awareness on preventive measures especially groundwater consumption
In Kalkeri life stirs early. Out of the many lone figures trudging their way along the tree-lined roads of this little village, Patte Khan can be seen doing the same but with halting steps.
Farmers need to be up at the break of dawn to begin work in their land. Irrigating, fertilizing, tilling and repeat. Patte Khan too has to do the same to earn his measly monthly income of Rs. 1250. But for him, each step is painful.
Life doesn’t come easily in this parched village roughly a kilometer away from Mundargi town of Gadag District in north Karnataka.Skeletal fluorosis has left both his legs peppered with bony spurs.
“It is part of my life now. I don’t think about the pain anymore. If you have been living with it as long as I have, it doesn’t bother you as much,” says Khan smiling, picking up his 4-year-old grand-daughter.
Fluorosis: A persistant peril for the people of Mundargi
People in the Mundargi Taluk and its surrounding villages have been dependent on groundwater which showed an average fluoride level ranging from 4.0 to 10.5 ppm in a study published in the Indian Journal of Public Health. Many are afflicted with fluorisis. But the authorities think that the problem is over after the construction of the Singtlaur-Hammige Dam and providing river water to these settlements.Its consumption through drinking water and food products can cause dental and skeletal fluorosis. NCBI states that more than 60 million people in India drink water having more than optimal required concentration of fluoride. The available data says that more than 15 States in India are endemic for fluorosis (fluoride level in drinking water >1.5 mg/l), and more than 60 million people in India suffer from fluorosis. The most seriously affected states are Andhra Pradesh, Punjab, Haryana, Rajasthan, Gujarat, Uttar Pradesh, Tamil Nadu, Karnataka and Maharashtra.Mundargi and the nearby villages, some 54 of them are situated over what is called the Fluoride belt in India. Of the 14 essential elements required for the normal growth of human body, fluoride is one. National Center for Biotechnology Information (NCBI) reports that in its ionic form, fluoride is found abundantly in a wide variety of minerals, including fluorspar, rock phosphate, etc. Thus, a fluoride belt is a region on earth where the concentration of fluoride is in excess. This leads to fluoride leaching into the ground water.
Manjula Sajjan, Mundargi Block Health Education Officer and a resident of Mundargi says, “The Dam has been providing Tungabhadra water to the taluk and its villages for more than a decade. We do not see skeletal fluorisis in the people anymore. Dental fluorosis is still prevalent but very less.”
The Ground Reality:
In Kalkeri, a kilometer away from Mundargi, skeletal Fluorosis may not be visible in the young generation but the people in their 50s exhibit signs of skeletal fluorosis worsening with age.
“I go to the hospital every week. The doctor just tells me to take the pain killer. I have had this since childhood,” says Shankramma Baligar, 65, pointing to her swollen knees and thin legs, “but now I can’t even walk without the pain crippling me.”
The Primary Health Centre (PHC) in Kalkeri doesn’t have any records of patients with dental or skeletal fluorosis. “We do not keep records. There is no cure for this. The elderly are given pain killers whenever they complain. And we try to educate the people about a healthy diet including green vegetables and calcium laden food,” says Dr. S.S Patel, medical officer at Kalkeri PHC.
The painkiller available at the PHC is Aceclofenac Tablet 100 which sells for Rs. 10 for 10 tablets.
If Skeletal Fluorosis can be seen in the elderly then Dental Fluorosis is evident in children as young as 8-years-old who showed various stages of dental fluorosis, from teeth stained with yellow to dark brown, irregular surface and noticeable holes. “Despite river water (Tungabhadra) being provided long back people still drink ground water; you can’t stop them from doing that,” adds Dr. Patel.
He points to a group of children walking from the direction of the village school. “Ask them to show you their teeth. Go ahead. The girls especially get conscious because of it. It is alright as long as you are in Kalkeri. It becomes a talking point when you go to other places,” he continued while lining up the 7 kids for a picture. Arvind, a 19-year-old who holds a diploma in ITI said, “I am here for holidays. I work in Mysuru and face a lot of comments on the state of my teeth. It is embarrassing to talk to my seniors. But here in my village, it doesn’t bother me as most of my childhood friends have it,” talking about the dental fluorosis he suffers with.But it seems that gap of information from the health centre to the villagers is not really the culprit here. “Why would we drink ground water and give it to our children when we know it is bad for us? We drink it because there are days in the week when we do not get water. If we ask, then we are told that the RO machine is faulty,” says Tugappa Badyappa Lambani, 65 with a severe case of Skeletal Fluorosis in the form of twisted and curved legs.
Government Intervention:All the smiling faces had one similarity; the deteriorating state of their teeth due to excessive fluoride.
It goes to explain why Patte Khan doesn’t rely on government supplied water. “I don’t drink that water and neither do I allow my family to do so. We filter our own water on yearly basis,” so saying, Khan showed the system of roof top-rain water harvesting (RRH) and filtration that many houses in Kalkeri now use for drinking purpose.
This is part of Sachetna Drinking Water Project, a joint initiative of government of Karnataka and Bharatiya Agro Industries Foundation (BAIF-K) Institute of Rural Development Karnataka, where RRH systems were installed in many villages of districts of Gadag, Tumkur and Kolar (with high fluoride content in drinking water).
Mundargi is part of the semi-arid region of Karnataka with an average rainfall received in Mundargi is 489 mm. Where the family of Khan uses tube-well water for other purposes, for consumption, they depend on the RRH system.
In addition, H.K. Patil, Minister of Rural Development and Panchayat Raj, for the state set up the ShudhaNeeru project where in the initial stage 200 Reverse Osmosis water purifiers were installed across the Karnataka to provide pure drinking water to the rural populace.
The current status of the project shows that 13, 765 RO purifiers have been installed across the state and Gadag District has 445 units installed with one in Kalkeri. However, problem persists even now.
The district status report for National Programme for Prevention and Control of Fluorosis shows that for the years 2016-17 till January ’18, out of 6416 school children surveyed for dental fluorosis, 66.24 per cent cumulatively tested positive. Not only that, for skeletal fluorosis, out of 200 suspected cases, 16
“Water has reached the villagers. We have been doing a lot of Information, Education and Communication (IEC) activities and fluorosis related cases has gone down significantly. But people still use ground water and we need to target that,” says D. H. Kabadi, District Health officer, Gadag.were tested positive. This figure shows that the reach of fresh water is still limited in many villages of the 333 villages of Gadag district.
The status report from the District Health Office, however showed that IEC activities like articles, press releases, spot interviews, nukkad-nataks etc. for the last two years have been nil in the villages of Gadag.
“We have a seminar planned for Kalkeri. We will be doing more. People need to be told about diet and what food they should eat. Normally pulses, rice and sometimes meat is widely eaten, we need to make them aware that calcium rich food and green vegetable intake should increase among the villagers,” says Dr. RR Hossamani, District Fluorosis Consultant.
“This is a very old problem. It cannot be cured. IEC activities have increased since last couple of years to which we send yearly updates on the activities and fluorosis mitigation works,” he added.
The Possible Solution:
For Fluorosis-related diseases to be completely eliminated, IEC activities can prove valuable. Alternative methods of fluoride reduction in ground water where fresh water is unavailable can help too. A team of scientists of IIT-Hyderabad used carbonised Jamun seeds to reduce the concentration of fluoride in the water less than the WHO-approved level of 1.5 mg/litre, making the water safer for consumption.
This experiment may prove a boon to villagers who have not able to harvest rain water and cannot get access to river water.
Despite the government’s efforts to provide safe drinking water to the rural masses, fluoride-rich water is still being consumed by the villagers. Patte Khan may have access to fresh water through rain water harvesting, it is imperative to bring in more people into the know-how of how devastating the excessive concentration of fluoride can be in the human body.
The youngsters are perhaps the luckier ones; perhaps. They may have been saved from the horror of skeletal fluorosis, yet the blight of dental fluorosis still persists among the younger populace. Patte Khan shows gumption in the way he has accepted his pain as a part of his life, yet the many elders who haven’t been able to embrace the pain still feel abandoned by the government.However, Khan is skeptical. “I have had too many surgeries over the years to make me think that this problem can be so easily solved. Pain killers are the only relief given to us by the PHC. That too works only for some time,” says Khan.
Fluorosis is irreversible. It needs implementation of awareness from the school level. The problem of fluorosis and preventive measures should have been made a part of syllabi long ago which sadly hasn’t been done.
A generic medicine shop was conspicuous due to its absence in the village where so many suffer with the curse of fluorosis. If the disorder can only be prevented instead of being cured then informative street plays, distribution of pamphlets and brochures and insurance for children to get free dental replacement could have been planned by the government.
Sadly, Kalkeri is still a long way to rid itself of the monster lurking underground.
