RESIDUE OF A REVOLUTION

RESIDUE OF A REVOLUTION

Bhola Singh is dead...

Bhola Singh was a farmer from village Balloh, district Bhatinda, Punjab. He is part of a story with a beginning and an end. But it has no middle. Thus what follows is a fragment. But it is not fiction.

Punjab practices intensive agriculture that needs pesticides. Industry says that, compared to the developed world, we use little pesticide in India. That is true, perhaps even in Punjab. But what industry does not tell you is that we find much more pesticide, compared to the developed world, in our food, our water, our soils. And now, our blood. As you will find, in this story that has no middle.

We know pesticide use in Punjab is one of the highest in the country. We also know there are residues in the food it produces. But what else? Do we know what pesticides are doing to people there? Whether cancer rates there are higher, or of a correlation between growing disease burden and the use of toxins? No. We don't. Why? Because there is no definite evidence. So, industry says, don't ask hypothetical questions. So, this story has no middle.

But our colleagues have tried to understand the science and politics of pesticide regulation: a piece of the missing middle. Another piece: they travelled to two districts -- among the highest users of pesticides in Punjab -- and collected samples of human blood. This was in October, 2004: spraying season. Pesticides everywhere: in fields and storerooms of kitchens. Shops stocked to the rafters. Pesticides sold over the counter, like aspirin. You can mix, you can match, use as much as you can afford. There are no rules here. No corporate responsibility on educating farmers on right use. But the market works on marketing, not on telling the truth, right? Nobody is supposed to ask what is right. Because there is nobody to tell you what is wrong.

This story tries that. We found pesticides in the blood samples. All samples. A mixture of pesticides. At high levels. And at this point, the story falls apart again. For, what is a 'high level' in human blood? How much is safe in human blood? How much unsafe? We do not know. There exist studies in India, of human blood, for a range of what are called 'persistent' pesticides; they bioaccumulate. But such pesticides have been banned, at least on record. So are the residues we found a 'historical burden'?

No. Moreover today, says industry, they peddle Gen-next pesticides: these do not persist. They degrade. We beg to differ, strongly. Invented for chemical warfare during World War II, these Gen-next concoctions are less persistent but more toxic. We found the blood of people in Punjab contain these pesticides, which should have disintegrated into metobolites and excreted, as industry would have it. But they are there. We found them.

Industry is completely mum on what Gen-next pesticides do, in the human body, in the time they circulate there. And what about metabolites? What do we know about their impact on our bodies?

We know chemicals can suppress the immune system, in turn triggering disease. But since no doctor will give you a death certificate which says the cause is an unknown trigger, industry is safe. We cannot pinpoint blame. All stories of cancer will be dismissed as fiction. No truth. No connection. Certainly no liability.

But this is chemical rape. What we found in Punjab has no comparison. Still, we are not saying cancer in Punjab is because of the pesticide it uses. There is no proof. In this world of industry, the onus is on us to prove, our death, in the face of an evident murderer.

So, we ask you to read. Do read between the lines, the horrendous pain of cancer and no cause. We ask you to read so that we can jointly ask for change. This, we repeat, is not fiction. It is real life. About all of us. About our bodies. It cannot go unsaid. It will not remain denied.

-- Sunita Narain and Chandra Bhushan

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Evidence of Damage

 We also came to know another study that explored the high incidence of cancer in certain areas of Punjab and its linkage with pesticide. The Punjab Pollution Control Board had commissioned this study. We had sent one of our colleagues to visit the area and to ascertain the cancer incidence situation. She came back with data and names of a few places. In October 2004, the Pollution Monitoring Laboratory (PML) of the Centre for Science and Environment (CSE) decided to undertake a study in these areas of Punjab. A team of PML scientists visited Punjab, October 4-7, 2004. We visited four villages: Mahi Nangal, Jajjal and Balloh in Bhatinda district and Dher in Ropar district — agricultural fields surrounded these villages and

 

 

 

 

 

pesticide use was quite evident. We randomly selected 20 people from all the four villages. Venous blood (10ml) of these people was collected. Blood samples were collected in residue-free heparinised 20 ml glass vials containing 200 USP units of heparin in 0.2 ml solution with the help of sterilised syringe. The samples were transported in dry ice to the laboratory and stored at –20°C until analysed. The samples were analysed for 14 organochlorine and 14 organophosphorous pesticides using a Gas Chromatograph based on US Environmental Protection Agency methodology.

 

The picture is truly gruesome

Organochlorines

Mean total DDT in blood samples of Punjab was 0.0652

mg/l

   Mean levels of aldrin in blood samples were 0.0062 mg/l

and ranged from not-detectable (ND) – 0. 0159 mg/l  Mean levels of alpha and beta endosulfan in blood were 0.0044 and 0.0002 mg/l respectively. Mean total endosulphan in the samples was 0.0046 mg/l.  HCH was detected in all blood samples. Mean level of HCH in blood was 0.057 mg/l.

Organophosphates  Mean levels of monocrotophos in blood samples were 0.0948 mg/l in the range of ND – 0.4915 mg/l. Monocrotophos, a non-specific, systemic insecticide and acaricide is shown to cause delayed neuropathy.  Mean level of chlorpyrifos in blood was 0.0662 mg/l and ranged from ND – 0.4965 mg/l  Mean levels of phosphamidon in blood was 0.0366 mg/l and ranged from ND – 0.1282 mg/l  Malathion was detected in whole blood samples from Punjab at mean levels of 0.0301 mg/l and ranged from ND – 0.0753 mg/l

 

Major contribution to total pesticide concentration in blood samples from Punjab is of organophosphorus pesticides  Data also indicates that each person is exposed to and carries a body burden of multiple pesticides. The presence of higher levels of total pesticide residues in the blood of occupationally exposed population of Punjab might be due to direct exposure during application of pesticide and due to exposure through air, water, and food. Based on Centre for Science and Environment’s Pollution Monitoring Laboratory’s March 2005 report, Analysis of Pesticide Residues in Blood Samples from Villages of Punjab. Investigators: H B Mathur, H C Agarwal, Sapna Johnson, Nirmali Saikia.

 

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Chemical trespass

We found 15 different pesticides -- a cocktail of 6-13 pesticides, all different -- in the 20 blood samples we tested from four villages in Punjab. What does this imply for public health? Can such plural contamination supress the immune system, in turn increasing cancer and other ailments?

To understand this, let us find out how science estimates how much of pesticide in blood is 'safe'. Does a safety threshold level exist? If yes, how do scientists -- and the industry -- compute it? As we delve into such questions, it becomes clear that science claims more, but understands much less. This, too, comes horrifically out in the open: humans are also victims of a criminal trespass by the pesticide industry.

Measuring toxicity
Pesticides are toxins. But its makers say the exact dose differentiates between poison and remedy. So, regulators benchmark exposures into two types: short-term exposure which leads to acute-toxicity, and repeated or long-term exposure, which causes chronic toxicity; symptoms develop over time.

All pesticides are tested to establish toxicity -- a dose necessary to produce a measurable harmful effect -- usually established through tests on mice, rats, rabbits and dogs. Results are then extrapolated on humans, and safe exposure levels predicted.

The value commonly used to measure acute toxicity is ld 50 (a lethal dose in the short term; the subscript 50 indicates the dose is toxic enough to kill 50 per cent of lab animals exposed to the chemical). ld 50 values are measured zero onwards; the lower the ld 50 the more acutely toxic the pesticide.

To establish chronic toxicity, animals receive a pesticide-laced diet from a very young age. This continues till they show chronic adverse affects whether carcinogenic in nature, or mutagenic or with definite impairment in the reproductive system. Such experiments have a purpose: determine a no-observable-effect-level (noael) of pesticide exposure -- a level in the total diet that causes no effect on test animals as compared to others maintained under unexposed conditions. Sometimes, it is not possible to deduce this number. Then, the safety mark is established at the point where the first, minutest, adverse effect appears. This is called loael, or "Lowest Observable Adverse Effect Level". noael / loael is expressed as pesticide exposure in milligramme per kilogramme of body weight per day (mg/kg bw/day).

ld50 and noael values are then extrapolated to determine safety values for humans, known as acute reference dose (aRfD) for acute toxicity and acceptable daily intake (adi) for chronic toxicity. aRfD and adi are arrived at by adjusting ld 50 and noael values downwards; usually, by a factor of 100 respectively: a division factor of 10 is used to allow for the possibility that humans are more sensitive than animals; another division factor of 10 is used to allow for differences amongst individual humans.

Toxic but not persistent?
Toxicity apart, persistence is an important trait of a pesticide: this characteristic has compelled regulation. Older organochlorine pesticides, say ddt or bhc, were persistent: they are still found in water, soil and human blood even though their use was discontinued many years back.

To circumvent this problem, industry devised new pesticides: these degrade in the environment. For that reason, these have much less time to accomplish their job; so, they have to be far more toxic then their older, persistent, cousins. Contemporary pesticides kill pests with very small doses, and so are far more lethal.

Let's compare ddt -- most used in India up to the early 1990s -- with monocrotophos, currently most used. ddt' s ld 50 is 113 mg/kg; monocrotophos, 14 mg/kg. But let us never forget that lower ld 50 means higher acute toxicity. In other words, the acute toxicity of monocrotophos is eight times higher than ddt . Moreover, monocrotophos has an adi of 0.00005 mg/kg: it is 10 times more chronically toxic than ddt (see table: Gen-next pesticides).

Similarly, chlorpyrifos -- also widely used in India -- is five times more chronically toxic than ddt.

The body's burden
It is understood that once ingested, pesticides accumulate in the body fat or pass through. Organochlorine pesticides, for instance, accumulate in body fat and blood lipids. These fat-soluble chemicals persist in the body for many years. Research traditionally concentrated on such pesticides. Then the pesticides that were persistent gave way to the more toxic ones. But even now, scientist are merely beginning to fathom what happens when these latter-day pesticides circulate and pass through humans.

Acceptable levels?
The us- based Centre for Disease Control and Prevention (cdc) regularly conducts one of the most comprehensive biomonitoring programmes in the world -- the National Report on Human Exposure to Environmental Chemicals -- to aim to determine the chemical body burden of us residents and also investigate potential links to diseases. cdc's second report of January 2003 analyses blood and urine levels of 116 environmental chemicals. The sample population was studied from 1999 through 2000.

Five of the pesticides we tested for were those studied by the cdc. So, let's compare. To our horror we found the Punjab samples had far higher pesticide residues (S ee table: Horrific). For example, lindane residues in our samples were 600 times higher than the cdc study. Similarly, levels of dde and ddt in the Punjab samples were 35 times and 188 times higher than the us samples.

What does this mean? Are there any acceptable levels for these pesticides in blood? Says cdc's 2003 report: "The recommended limit value in blood for lindane has been established by various agencies and organisations. uk's benchmark guidance value is 35 nanomoles per liter (approximately 1,700 nanogramme/gramme of lipid)". The same lindane in Punjab villagers' blood samples was about three times this value.

These alarming results are only for 'persistent' organochlorines. Industry claims that the 'new' organophosphorous pesticides (ops) are low-dose, less persistent. It never mentions that low dose also means higher toxicity. Our tests also belie their claim that ops are less persistent. We found the supposedly low persistent op monocrotophos in 75 per cent of the blood samples. cse's pollution monitoring lab found another op, chlorpyrifos, in 85 per cent of samples, 70 per cent of which contained two more ops: phosphamidon and malathion. In fact, ops constituted more than 60 per cent of the total pesticide residues in the samples. Nothing unusual. After all, studies in the us and other parts of the world have found such pesticides in human blood. The point is: our study shows such contamination has reached alarming proportions.

Alarming situation
ops have both high acute as well as chronic toxicity. The level of ops found in the Punjab blood samples we collected could be the case of both acute and chronic poisoning. For example, the average monocrotophos level found was 0.095 milligramme per litre (mg/l). Considering about 5 litres of blood circulate in an average human, every sample contained 0.475 mg of monocrotophos, on average, only in their blood. The aRfD (short term exposure limit for humans as per the World Health Organization/Food and Agriculture Organization, who/fao) of monocrotophos is 0.002 mg/kg bw/day. This means an average adult weighing 60 kg cannot exceed the acute exposure limit of 0.12 mg/day (0.002 mg/kg multiplied by 60 kg) for monocrotophos.

Shockingly, the blood samples alone contained 4 times more monocrotophos than the aRfD. This is significant if we consider the "known" properties of monocrotophos, not supposed to persist in the body and so, ideally, excreted soon. For monocrotophos to be present in the high amounts found in the blood samples, the regular exposure must have been high enough, perhaps far higher than the aRfD. Our findings clearly point out to such exposure among the people studied. And this was not just for monocrotophos. The level of chlorpyrifos found in the blood samples alone was more than 3 times the short-term exposure usepa limit. Clearly, this kind of exposure is unacceptable.

Pesticides are commonly used in Punjab. Thus, we cannot rule out chronic poisoning by ops as well. It is relatively clear chronic exposures to ops occur as a 'circulating dose'. People so exposed may excrete these chemicals quite quickly. But since op s are used widely, people get re-exposed; they carry them as part of their pesticide body burden. If this is the case, the people we took samples from could have been exposed to similar levels of pesticides year around -- disastrous!

Why? Because the chronic acceptable daily exposure limit for monocrotophos is just 0.00005 mg/kg bw/day. This means an adult of 60 kg can be exposed to no more than 0.003 mg/day of this pesticide. But we found average levels of 0.095 mg/l of monocrotophos in collected blood samples alone, 158 times more than the daily long-term safe exposure limit. And we are talking of residues only in blood.

How unhealthy is this?
Very little is known about the link between pesticide body burden and health impacts. Biomonitoring studies -- measuring chemicals in blood, urine, breast milk, fat, hair or other tissues -- do reveal that large amounts of synthetic chemical residues have infiltrated our bodies. Yet, industry argues there is no evidence these chemicals cause harm. Having chemicals in our bodies is unavoidable in modern times, they contend. They take refuge behind what they call a lack of 'authentic' epidemiological studies correlating disease to the invasion by a pesticide. Industry also finds it useful that there are many pesticides and chemicals involved in the assault. It makes it difficult to pinpoint blame. The conspiracy of denial continues.

But toxicological impacts of individual pesticides is stark. There is also no evidence that proves the safety of carrying a chemical body burden; in fact there is growing evidence to incriminate such burden. Biomonitoring research suggests that the chemical cocktail in our bodies could be linked to a host of afflictions: developmental disorders, fertility problems, neurological disorders and cancer, with exact effects varying person to person. In addition, virtually nothing is known about cumulative health impacts of dozens of chemicals present in the body at the same time.

So it is that, now, it is widely recognised that finding the exact effects of the chemical body burden is not the issue at all: identifying the cocktail of chemicals in human bodies and setting up regulatory systems to reduce the chemical body burden is more significant. The general premise is that, irrespective of their impacts, synthetic chemicals should not be allowed to trespass human bodies.

Who is responsible?
As biomonitoring results confirm the presence of pesticides in even occupationally unexposed population, the industry is at pains to defend its standard argument: "safe use" of pesticides poses no risk. But increasing evidence proves that they are horribly wrong. Many researchers, scientists and ngos now believe there should be a paradigm shift in the way pesticides are regulated. It's no more about monitoring pesticides in food commodities only. It's about checking the body burden and then regulating these toxins.

Body burden studies hold the key to a fool-proof system to regulate the use of pesticides and other chemicals. This view is also gaining ground among policymakers in the West -- albeit slowly. For example, in 2003 the uk Royal Commission on Environmental Pollution stated, "where chemicals are found in elevated concentrations in biological fluids such as breast milk, they should be removed from the market immediately". In fact, policymakers in New Zealand and the state of Tasmania in Australia are now debating Chemical Trespass Bills which will render illegal the ingress of agricultural chemicals into the human body and also facilitate the recovery of damages.

Similar concerns are also driving action elsewhere. On April 27, 2003 the us Supreme Court affirmed the rights of consumers, workers and farmers to sue pesticide manufacturers when their product causes harm. The ruling strikes down the pesticide industry's persistent claims that registration of a pesticide under the us federal pesticide law automatically shields manufacturers from damage claims. The judgement also overrules the pesticide industry's claims that the Federal Fungicide Insecticide and Rodenticide Act, 1948 (thereafter amended many times) pre-empts local and state liability statutes

Assigning primary responsibility to pesticide manufacturers is an efficient way to address the problem of chemical trespass. So far, little penal action has been possible against these manufacturers, even when a clear link has been established between their product and its adverse health implications. To be effective, the modern regulatory system has to consider the chemical body burden and hold manufacturers of these toxins accountable.

What about India?
Biomonitoring has not yet been institutionalised in India; the government has no specific programme for it. However, a few public as well as private institutions have conducted tests to find pesticide residues in human blood, fat and milk. In the past, Indian researchers have found ddt and bhc levels in the blood of Indians to be among the highest in the world. For example, a 1992 study published in the journal, Science of Total Environment found ddt levels to be as high as 7.17 parts per million in blood samples. However, most Indian studies on pesticide residues in humans are restricted to older organochlorine pesticides such as ddt and bhc. We have not come across any research on the presence of ops in the blood of Indians.

Clearly the new burden that modern India is carrying -- as Punjab clearly exemplifies, in our study that could be called the proverbial tip of the iceberg -- needs to be examined by its scientists. Doing anything less would be negligent.

-- Kushal Pal Singh Yadav 12jav.net12jav.net

Multiple exposure

That's the surmise of the Punjab Pollution Control Board's (ppcb) final report of a year-long study to explore high cancer rates in certain areas of Bhatinda district, Punjab.

ppcb had commissioned the School of Public Health (sph), department of public health, Post Graduate Institute of Medical Education and Research (pgimer), Chandigarh to conduct the study. The institute's report, 'An epidemiological study of cancer cases reported from villages of Talwandi Sabo block, district Bhatinda, Punjab', compares cancer incidence in Talwandi Sabo (referred to in the report as the study area) with that in Chamkaur Sahib block (described by the report as the control area) of Roop Nagar district, Punjab. Farmers in Talwandi Sabo use canal water and cultivate cotton while their counterparts in Chamkaur Sahib use ground water and cultivate rice or wheat. The rationale for selecting areas with different irrigation patterns was to ascertain links between canal irrigation and cancer. The study also tried to find if cotton cultivation -- much more pesticide-dependant compared to rice and wheat -- could be linked to cancer.

183,243 people making up 39,732 families were surveyed in 129 villages of both the blocks. "The number of confirmed cancer cases were 103.2 per lakh at Talwandi Sabo, compared to 71 per lakh at Chamkaur Sahib", notes the study. Prevalence of histologically (based on tissue tests) confirmed cancer cases at Talwandi Sabo was 125.4 per lakh while it was 72.5 per lakh at Chamkaur Sahib. "The age adjusted cancer death rate of Talwandi Sabo is higher than that of Barshi in Maharashtra -- the only rural centre in India that maintains cancer data. However, cancer mortality at Chamkaur Sahib was lower than Barshi," says Rajesh Kumar, head, department of community medicine, pgimer . Significantly, 63.8 per cent of cropped area in Talwandi Sabo was under cotton while the crop was not cultivated at all in Chamkaur Sahib. More than half of all the pesticides manufactured in the country are used in cotton. The sph study shows that many more people sprayed pesticides at Talwandi Sabo as compared to Chamkaur Sahib.

Ubiquitous toxins
sph tested water (tap and ground) and vegetables from the study and control areas. For the month of March 2004 heptachlor levels in tap water of Talwandi Sabo were 0.00004 parts per million (ppm) -- higher then the permissible limit (0.00003 ppm); this pesticide was not found in Chamkaur Sahib tap water. The April samples for groundwater showed similar results: hepatchlor levels of Talwandi Sabo was (0.006 ppm); they were again not present in Chamkaur Sahib water. Malathion in Talwandi Sabo's tap water samples of April 2004 was 0.21 ppm: 420 times higher than the permissible limit (0.0005 ppm). The pesticide was within permissible limit in Chamkaur Sahib water (0.00009 ppm). "The levels of heptachlor, a known carcinogen that's banned in India, were higher in samples of tap water in Talwandi Sabo compared to Chamkaur Sahib," concludes the report. "The same holds for groundwater too," it states.

The results of tests on vegetable samples were akin to the water studies (see table: The toxins in food). Chlorpyrifos and ethion levels were above permissible limits in vegetable samples of Talwandi Sabo.

The report observes: "It's difficult to pinpoint a single cause for cancer...A multi-pronged strategy to provide safe water supply, discouraging indiscriminate pesticide use.. is recommended." The technical committee to look into the report has recommended "a comprehensive study of the status of environmental health in other cotton growing areas of Punjab".

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Cancer train

At 9.20 pm everyday, a passenger train leaves Bhatinda town for Bikaner in Rajasthan. "It's full of cancer patients," says Umendra Dutt of the ngo Kheti Virasat. The patients are bound for the Acharya Tulsi Regional Cancer Treatment and Research Center (rcc) -- one of the 19 regional cancer research centres in the country. A train full of cancer patients? How widespread could this killer disease be in Bhatinda district (it carries the same name as the town)? I head there. The initial foray reveals that the re is very little documentation to to show the disease's prevalence in the district. But that's no hindrance. For, the villagers I meet are full of talk of cancer-caused deaths in recent years, and of numerous co-villagers who suffer the disease.

37-year old Bimla Devi of village Mahi Nangal near Bhatinda town is one of them. She is battling cancer of the ovary. In January 2004, Bimla had jaundice followed by urinary problems. Several rounds made of doctors at Talwandi Sabo block and Bhatinda town were of no avail -- one even suggested that Bimla had contracted aids. Meanwhile, her pain intensified and she bled profusely. So, in June 2004 she did what most people afflicted with an 'unknown' aliment in the region do: head for Bikaner. At rcc, doctors confirmed the worst. She underwent a round of radiation therapy.

"There are about seven cancer patients in the village," says Harbans Singh, a registered medical practitioner who lives near Bimla's home. "I have been practising at Mahi Nangal since the last 10 years, but did not hear people here suffering cancer before the last 4-5 years," he adds. "We have never had any doctors because people did not fall sick, but now everyone seems to have medicines in their pockets," rues Gurcharan Singh, whose wife Mukhtiar Kaur died of cancer last year.

Back at Bimla's, a week later
The family is preparing for another trip to Bikaner. Bimla's second round of radiation therapy is due. The preparations become feverish once Sita Ram, Bimla's husband, returns: he runs a ration shop and had gone to Talwandi Sabo to seek permission to close shop for a few days. Bimla jokes with her children, Modka and Gursharan, while packing her bag: clothes, medical records and the all-important travel concession form; bedding, utensils and a gas stove had been left at Pardayatji Shri Dhuriji Dharamshala, a charitable resthouse near rcc she'd stayed in when she'd gone to Bikaner last. Though rcc runs a subsidised canteen, a meal for just five rupees, Bimla prefers to cook her own food.

Meanwhile Naseeb, her elder son, returns from school. He looks visibly strained. The prospect of looking after the household in his parents' absence seems to weigh heavy on the 15-year old: the next day he has to get labourers to spray the family's cotton fields with pesticide. At 5.30 pm he hefts his mother's bag onto his cycle and moves towards the bus stop. Boisterous Bimla is suddenly sombre; she hugs her children goodbye and with Sita Ram follows Naseeb.

The bus arrives at 5.45 pm. It takes about half-an-hour to Bhatinda, but over bumpy roads that has Bimla grimacing in discomfort. She tells me later of the blisters left behind by the first round of radiation. It's another jerky and uncomfortable ride -- this time on a rickshaw -- to the railway station. The Bhatinda-Bikaner passenger train is already in platform no 1. Though it's a good three hours for departure, Sita Ram scurries for seats. Of course, "Bimla will anyhow get a place to lie down, people on the train are usually helpful to cancer patients," he says.

Cancer patients can travel free throughout the country, but rcc has really made things easier for its wards: there are people in the hospital specifically to sign the travel concession forms. "Lots of cancer patients travel free on this train," says Rajinder Singh, supervisor (booking) at the Bhatinda railway station. He even shows me that week's records: they show that an average of six patients travelled everyday on the Bhatinda-Bikaner passenger mail, that week.

Family problems besides cancer
Getting a seat on the train is easy for Bimla and Sita Ram. The compartment is stuffy. Bimla takes her mind off the discomfort by relating her family's problems: the ration shop does not pay, taking leave requires bribing the inspector and their landholding is too small to be profitable. But she does not list her health -- and mounting expenses on it -- as a problem. However, the day has taken a toll. As the train judders into motion, Bimla falls asleep: next day will be taxing for her.

Meanwhile, Sita Ram tells me that treatment at rcc is cheap: the last time they spent around Rs 8,000. This brings to mind Dalip Kaur (Surjeet Kaur in rcc's records), also of Mahi Nangal: she spent Rs 30,000 in Talwandi Sabo and Bhatinda hospitals for chemotherapy for her breast cancer. Another resident of the village, Satya Devi, spent Rs 1 lakh for therapy on a cancerous growth on her lip. Both had to go to Bikaner anyway. Satya still visits rcc every six months for check ups. Though much better now, she rues not being able to tend the cotton and maize her husband grows on his 2.8-hectare (ha) farm. Dalip's joint family holding is even larger: about 13 ha. "We didn't use much pesticide till five years back. Now we spent Rs 10,000 per ha," she informed.

Indeed, my visit to villages in the area is a spiral of similar stories: there is Bhola Singh, a school teacher from Jajjal who had brain cancer. He is dead. "The entire village had grieved, for Bhola was one of the few educated here," said Gurmeet, Bhola's brother. He, too, has been spraying his 4 ha land with liberal doses of pesticides, since the last two years. Pesticides hold centrestage in another sorry tale: Gurbaksh Singh of Jajjal. He died of throat cancer in 2002. Gurbaksh's brother Sukhdev told me that in 1985 they sprayed a litre of fenvalerate over 8 ha. Now they spray the same dose over 1.2 ha. Gurcharan Singh at Mahi Nangal described the bane aptly, "We inflict poison on our land. We grew pulses earlier but now these don't even flower. This is because the soil is not rested. We suffer diseases for the same reason."

Memories of these conversations, all stories of suffering and separation, constantly come to mind. The train screeches to a halt at Bikaner.

Away from home
The sun beats down as Bimla and Sita Ram head for her doctor's residence, carefully picking their way over railway tracks and through pothole-rutted roads. This, it seems, is the norm: a preliminary check up is done at the doctor's residence and the patient is then directed to the hospital for further tests. The two then walk on towards the dharmashala. The guard here chooses this moment to insinuate that the survival rate of patients of the doctor looking after Bimla is quite low . T he two somehow manage to wriggle away and deposit their baggage with one of the resthouse residents. They would fix up a room only later: the physician's signature is required for this.

Bimla and Sita Ram make towards the nearest dhaba: not a dirty place, but ideally best avoided by those with reduced immunity such as Bimla. But she and Sita Ram have not had a morsel in the last 16 hours. They sip tea and munch matthis with relish.

At the hospital
Inside the hospital, Sita Ram points towards the Life Saving Medical Shop -- the biggest reason treatment is cheap at rcc . The hospital has arranged with pharmaceutical companies to make drugs available at wholesale price to patients. A radiotherapy consisting of 30 'fractions' or sessions costs just Rs 600 -- Rs 20 per cycle compared to Rs 600 per cycle in Punjab.

Bimla's medical records in hand, Sita Ram waits outside the doctor's room. It's still some time for treatment to begin: a few general checkups have to be conducted, it has to be decided if Bimla requires short cycles of radiotherapy, or if a long course would be needed. Bimla's blister might also affect the decision on her treatment. There is confusion because she is late for her second round of radiotherapy; doctors reprimand the couple. After much waiting, and whispered conferences about why the doctors were taking so long, the couple is told that Bimla's treatment would begin the next day. They trudge back to the dharamshala.

The next day, I visit the hospital again to get data on cancer patients visiting rcc ( see box: They do care). There is Bimla on a stretcher on her way to radiation therapy.

The bane
rcc is carrying out a study to find out the reason for increased incidence of cancer. "Pesticides could be a problem but it's too early to link the two conclusively," avers D P Punia, rcc's director. "We do know, however, that pesticides cause mutations. And significantly, lymphoma and leukaemia, which are linked to mutation, are on the rise. But cancer is a group of diseases and cannot have just one reason," he adds.

rcc 's experts will take time to complete their study, and might zero in on the relation of pesticide use -- or tobacco, or diet -- to increased cancer incidence. Villagers are sure of one thing. Pesticide use has zoomed. "20 different types of pesticides are used in our village, every year. They cost us more than Rs two crore," says Kewal Singh, Mahi Nangal panchayat member, evoking memories in me of the overpowering chemical stench invariably hanging around the fields. And cancer? "I cannot directly link cancer to pollution. But pollution has increased and so has the disease," says Harbans Singh. Adds Karnail Singh of village Mahi Nangal, "We read about pesticide use and cancer in local newspapers all the time."

Isn't it time this doubt is resolved?

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