Dinanath Singh has a cancerous wound on his left foot from which blood and pus continuously ooze. He has black and white spots (lesions) all over his body. The 61-year-old also suffers from skin cancer. Two fingers of his left hand had developed ulcers and had to be amputated. His ailments are many, but the cause is one: arsenic.
Dinanath lives in Ekawana Rajpur village of Ballia district, Uttar Pradesh. He came to the New Delhi-based All India Institute of Medical Sciences (AIIMS) in June 2004 for medical advice. While going through his papers, Neena Khanna, a professor in the dermatology department of AIIMS, and her colleague, Amit Malhotra, came across a startling bit of information. A blood report dated May 12, 2004, showed that Dinanath had 34.40 parts per billion (ppb) of arsenic, when the reference limit is a mere 1-4 ppb, as per leading toxicology manuals.
"The presence of such high levels of arsenic in blood can only be possible in case of chronic exposure," felt Khanna. She was particularly perturbed, as Dinanath belonged to Ballia, where arsenic contamination of groundwater was unknown. Worried, she called Down To Earth. She wanted to know what the possible cause could be of her patient's horrendous ailment. She, like us, had heard of arsenic in West Bengal and Bangladesh. "But he is from Ballia," she said. Why him? Where is this arsenic coming from?
We were also shocked. Maybe the source of contamination was industrial in nature, we thought. Down To Earth decided to check the story out with the doctor and her patient.
At AIIMS, when Down To Earth asked him about the cause of his disease, Dinanath's answer was surprising. He believed the handpump-drawn water he drinks in his village was laced with arsenic. "What evidence do you have to claim this?" we asked. "The doctors at the Banaras Hindu University (BHU) have told me that the water may be contaminated," he replied. We pursued with our questioning: "But is your well contaminated?" "No. Or rather, I do not know." His helplessness was evident. "Please tell me," he told Down To Earth, "if my well has a problem. My family drinks this water. I must know."
Something was strange
How had this person, from the invisible backwaters of India, made it all the way to Delhi? Dinanath had been an education instructor with the Indian army for almost three decades (since 1962). After retirement in 1991, he joined a charitable organisation based in Betul, Madhya Pradesh. But when his foot got injured in 1996, the wound would not heal. He went to the Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, where the doctors asked for a biopsy. The results showed that he was suffering from squamous cell carcinoma (skin cancer). Why? Nobody knew. If the doctors had investigated his blood, they could have worked out that the lesions were because of arsenic poisoning. But no.
From Madhya Pradesh, Dinanath went back to his village in 2002, without knowing that a handpump would seal his fate. His condition deteriorated. Two fingers developed ulcers. In June 2003, Dinanath started visiting the BHU hospital -- the nearest big medical centre to his village. The doctors at the hospital did not know what was ailing Dinanath. So, they amputated his diseased fingers.
But they suspected something strange, and referred him to the dermatology department of BHU. One look at the skin lesions was enough for Sanjay Singh, a doctor there, to ask Dinanath to get his blood tested for arsenic. But there is no laboratory in Varanasi that does such a test. The sample was sent to a private pathology laboratory in Delhi. The report, which Dinanath received in April 2004, confirmed arsenic in his blood. Dinanath believed that he would need money for treatment and came to his former employer in Delhi -- the army -- to get his social provident fund certificate, which would secure him free treatment at a government hospital. When in Delhi he decided to seek a second opinion. He visited AIIMS. Here doctors confirmed the diagnosis. Dinanath was suffering from skin cancer.
Still, something was strange. Dinanath had been posted in different parts of the country and could have picked up his ailment somewhere else. "What was the proof that his arsenicosis (arsenic toxicity) was because of his well water?" we asked. Dinanath introduced us to his son, 39-year-old Ashok Singh, who was accompanying his father. Ashok had never moved out of the village but also had skin lesions. Nobody had ever checked his blood. We at Down To Earth decided to pay for the blood test. The sample was sent to the laboratory where Dinanath's blood was tested. The result was startling. It confirmed that Ashok's blood contained 34.50 ppb of arsenic.
Now we wanted to know more. What about others in the village? After all, it could not only be affecting Dinanath's home. He also had a question for us: "Tell me if my well is poisoned. Tell me what I should tell my family?" Down To Earth decided to visit Ballia.
Ekawana Rajpur is about 16 kilometres from Ballia town, along the banks of the Ganga in the Belhari block of the district. It is situated away from the national highway. People here are farmers. The village has no roads, no electricity, no healthcare centre: poverty is evident. The Census 2001 says that this village has 1,800 people. When contacted, household after household had the same dreadful story to relate. All the 100-odd people contacted, many being above 35 years of age, had skin lesions (known as melanosis, the first stage of arsenicosis); in some, the skin of their palms and feet had become rough, dry and thickened (keratosis, the second stage) and a few suffered from breathlessness: doctors say this is the third stage of the disease; in addition to the outward signs, internal complications begin to occur (see box: What the poison does).
Visits to nearby villages -- Sughar Chapra, Tiwaritola, Gangapur and Choube Chapra -- showed the disease was well spread. In all these villages, there were people suffering from various stages of arsenicosis. In all these villages, something else was common. People depended on handpumps for drinking water, despite the river being at their doorstep. "Bringing water from the river is time-consuming. The handpumps are located in every corner of the village," explained Dinanath's wife, Basanti, who also has skin lesions. Nobody had told her that a walk to the river could make a difference between life and death.
It is precisely these handpumps -- bored to a depth between 27-36 metres below ground level -- that have introduced arsenic into their lives. "The handpumps were put in place in the early 1970s. After these were installed, we started noticing skin diseases. But nobody connected the two," said Ram Bhadhur Singh, a 68-year-old resident of Rajpur diagnosed with skin cancer at the Vineet Skin Institute, Varanasi. "We have stopped counting the number of people who die. Now the river is changing course. It may kill us even before arsenic does, " averred Kanti, his daughter-in-law.
Dinanath's own household is tragic proof of the arsenic menace. His two daughters -- Amita, aged 35 and Anju, aged 25 -- died in the past two years. Like Ashok, Arvind -- Dinanath's younger son -- has skin lesions.
Similarly, when Down To Earth spoke to R K Singh, the chief medical officer of Ballia district, he was quick to denounce the Jadavpur University's findings. "The report of the university is behind the commotion. But their report cannot be correct, because all its samples tested positive for arsenic, which is clearly not possible." His remarks only prove his ignorance, for the report found a wide variation in the samples checked. He was also not informed about the symptoms of arsenic poisoning.
For the administration, the situation was normal. When questioned by Down To Earth on July 28, 2004, district magistrate Vinod Kumar Malik declared: "There is no water contamination in my area." Malik went on to expound his theories: "The katav (river cutting) may destroy the villages, automatically solving the problem of arsenic. Moreover, in all probability this skin problem is due to parthenium -- a weed that plagues the entire district."
Murkier and murkier
Down To Earth is in possession of a letter dated July 31, 2004 -- soon after Malik was interviewed. It carries Malik's signature, and is addressed to the director, medicine and health, UP government, asking for a team to be sent to investigate the problem of skin cancer in the district. On August 13, 2004, the UP Jal Nigam, which had also adopted an ostrich-like attitude, wrote to the Jadavpur University, asking for a team to revisit the area to check the water again.
Clearly some wheels are beginning to turn.
We check for arsenic
But we had to be sure. We knew that the prevarication and denial game would continue. It is the favourite official pastime. Dinanath and his neighbours would be easily buried in the files of "lack of scientific evidence".
Down To Earth had already checked the laboratory procedures needed for collecting samples for analysis. Water samples from Dinanath's handpump, Ramsagar's handpump and Vishnu Gaur's handpump were collected. All these were people who were suffering from what was visibly arsenicosis. The fourth sample was from a handpump, believed to be "clean". We also collected nail and hair samples of people living in Tiwaritola, Choube Chapra and Rajpur villages. All these people had visible signs of the disease.
The results confirm what we already knew and the administration refuses to see.
Dinanath's handpump has 73 ppb of arsenic -- seven times higher than the permissible limit.
Ramsagar Singh, a 75-year old resident of Rajpur, is drinking water that has 47 ppb of arsenic. Because of the poisoning, he has ulcers in his mouth, which have killed the desire to eat. He has a cyst on his side, which may be cancerous. In 1988, he had a tumour-like growth on his thigh. With no access to even the most rudimentary medical facility, Ramsagar himself incised the abscess with a blade and put chuna on the wound. To date, it hasn't healed.
When Down To Earth visited Vishnu Gaur’s home in Tiwaritola he had said: “Please help me. If I die what will happen to my children?”
His death on August 1, 2004, should be a wake up call for the authorities to act before it is too late.
Vishnu Gaur is no longer with us. He died at the age of 42. He was drinking water that has arsenic levels as high as 129 ppb. He had a huge cancerous tumour on his throat. Being extremely poor, he could never visit a doctor.
The fourth handpump, at Tiwaritola, has a relatively low 15 ppb of arsenic.
Ram Bhadhur Singh of Rajpur has 6,310 ppb of arsenic in his hair. The so-called normal level for hair is believed to be between 80-250 ppb. Can the administration now relate his skin cancer to arsenic?
Janaki Devi, a 40-year-old resident of Choube Chapra, has 4,790 ppb of arsenic in her hair. She has skin lesions all over her body. Will the administration still continue to call this parthenium poisoning?
Mukheshwar Singh Pande, a 27-year-old resident of Tiwaritola, has 2,480 ppb of arsenic in his nail. The "normal" range is 430-1,080 ppb. He is too young to die. But with this level in his body, doctors will tell you his death by cancer is probable.
Unless. Unless something is done to change this. Something is done to explain to people which of their handpumps is poisoned, which is safe.
But for this the government must first begin to accept that the arsenic problem goes beyond West Bengal. It must begin to map the extent, mark the handpumps, inform the people so that they can secure alternatives to toxic drinking water. It is a huge task. But it is not impossible.
Perhaps Dinanath's lonely journey to AIIMS will change all this. Perhaps.