Arshad Ahmed
Arshad Ahmed
Arshad is an independent journalist, currently based out of Guwahati, Assam. He brings in-depth reportage on wide-ranging issues from the grassroots of Northeast, India.
Stories by Arshad Ahmed
 19 Jan, 2023

Deformed and distressed, fluorosis patients of Assam still await regular potable water supply

The schemes launched to provide fluoride-free water in Nagaon district not up to the mark; many patients not covered under the national programme on fluorosis; erratic distribution of medicines another hurdle Hojai, Assam: Unlike most others of his age, Tajuddin (18) does not like to be photographed. “I am sorry, I have posed enough... I have only been mocked and shamed because of my appearance,” says the teenager, who lives in Tapatjuri, along River Jamuna in the Hojai district of Assam. Tajuddin is one among many lives crippled by fluorosis, a medical condition caused by overexposure to fluoride in the water that affects teeth enamel to make them look crooked and results in bent legs due to skeletal deformation.“More than 1,000 children in the sub-villages of Tapatjuri 1, Haladihati and Niz Parokhawa coming under Akashi Ganga panchayat in Hojai district are affected by both dental and skeletal fluorosis,” claims activist Dharani Saikia of NGO Environmental Conservation Centre.In all, Tapatjuri has 1,422 (1,305 dental and 117 skeletal) fluorosis patients, according to Arundhati Deka, the State Nodal Officer of National Programme for Prevention and Control of Fluorosis (NPPCF). However, an official at Haldihati Health and Wellness Centre tells 101Reporters on condition of anonymity that the numbers are heavily downplayed. Saikia adds non-skeletal fluorosis patients are not even counted!Dental fluorosis plagues the personal and social lives of many in Tapatjuri (Photo - Arshad Ahmed/101Reporters)Fluorosis patients have to deal with the physical stress of the disease, besides facing mental trauma and social rejection. They feel they are a ‘burden’, with limited employment and marriage prospects. For Sadhini Kalita (50), her walking stick is her ‘life partner’. “I have never stepped out of Tapatjuri. There is no scope of marriage either,” she sighs.  Archana Malaker and three others in her family have skeletal fluorosis. She is the sole breadwinner of the household, running a shop selling daily essentials. Archana is 35, but looks much older. Her physical condition has been steadily deteriorating since she became afflicted with the disease at 15. Now she can barely move her neck. Malaker is unmarried, as are many other affected women in the neighbourhood.Imrana Begum (17) could only study till Class 10 as it was painful to walk to the school located 1.5 km away. Her brother Imran feels appearance is not a big issue for men with fluorosis. “I have bent legs too, but I will get a bride sooner or later,” he says, adding that men migrate for work and can opt for cosmetic treatments like teeth bleaching, which women cannot. “Earning money also makes it easier for me.”The story is different for Malaker’s brother Alek, who has been bedridden since the age of six. “Some in my family had recovered partially after taking supplements distributed by some organisations. But my son’s condition only worsened. As a result, when he reached adulthood, he fell into depression,” his mother Bhagwati tells 101Reporters.“He does not talk to anyone, is unmarried, and cannot get off the bed,” his eldest sister Khunmoni Malaker says, while showing his faded passport-size image. “That was the only time he agreed to be photographed… for some paperwork.” ‘They have forgotten us’According to the NPPCF, on-ground inspections and dispensation of micronutrients can help tackle fluorosis. The National Health Mission’s NPPCF 2020-2021 report says only 720 patients receive supplements in the Nagaon district, but Saikia contends at least 50,000 children in 285 villages in the Hojai district have fluorosis. (The NPPCF programme operating from Nagaon district covers both Hojai and Nagaon districts) Imran admits that appearance is not as big of a deal for men with fluorosis as with women. “I have bent legs too, but I will get a bride sooner or later,” he says, adding that men migrate for work and can opt for cosmetic treatments like teeth bleaching, which women cannot (Photo - Arshad Ahmed/101Reporters)Patients too complain that not much is happening on the ground. “No one visited us in one-and-a-half years… They have forgotten us,” says Noorjahan (70), a chronic fluorosis patient for 20 years. The general feeling of discontentment is such that many have stopped interacting with the officials. “They do not even accept medicines distributed by midwives as a sign of protest,” says auxiliary nurse midwife (ANM) Brinda Bora.According to Umesh Chauhan, a rural health practitioner at Haldihati centre, distribution of micronutrient tablets such as zinc and vitamin D has become random as “Hojai district drug warehouse does not ensure timely supply of the medicines we seek.”Even the Fluoride Mitigation Centre set up in 2015 at Nagaon Civil Hospital has stopped functioning in the last two years due to exigencies related to COVID-19 and maternity care, says a former district consultant AK Bora, who is a doctor. Saikia adds the posts of NPPCF district nodal officer, district consultant and lab technician remained vacant since the Coronavirus pandemic.Deka, however, informs that a new nodal officer has been appointed, but the district consultant’s post is yet to be filled as candidates with experience in the medical field are preferred. She also claims that patients are taken for physiotherapy from time to time under the NPPCF plan. (Left) Noorjahan (70), a chronic fluorosis patient for 20 years who was crippled in her youth; (Right) Dharni Saikia says it pains him to see his children lose on childhood (Photos - Arshad Ahmed/101Reporters)No fluoride history till 1987Until 1987, Tapatjuri residents mainly drew drinking water from two streams that have now dried up. The issues cropped up when they switched to drinking water from tube wells commissioned by the local panchayat under a government scheme the same year.Former Public Health Engineering Department (PHED) executive engineer AB Paul says regular intake of fluoride-contaminated groundwater made the population susceptible to fluorosis. Paul is credited with bringing the matter to UNICEF’s and the government’s attention in 2000.According to an official survey, over three lakh people in 11 districts of Assam are at risk of fluoride exposure. Saikia’s NGO had tested water samples from several tube wells and detected 10 mg/L of fluoride, which is almost 10 times the permissible limit of 1.5 mg/L, as per World Health Organisation standards.After the official detection of fluoride in 2002, the PHED built 18 new ring wells using UNICEF funds of Rs 75 lakh, and banned the use of the existing tube wells. However, indiscriminate drilling for hand pumps and borewells lowered the water table, reaching levels where mineral-rich rocks exist. Deep drilling released fluoride into the water leading to a second wave of fluorosis that gripped those born after 2002. Their kin now holds the PHED responsible. “My child became a victim for no fault of his. His childhood has been robbed,” Sukkurun Nesa, Tajuddin’s mother, told 101Reporters. Despite the gravity of the situation, the national and international media focus on Tapatjuri tapered away after 2017, leaving the patients to suffer even more.(Above) The Health team at the Haldihati Health and Wellness Center admits that the number of fluorosis patients are heavily downplayed; (Below; left) A comparative image of Tajuddin in his childhood and youth; (Below; right) A grown-up Tajuddin (18) is conscious about his appearance because he always been shamed for the same (Photos - Arshad Ahmed/101Reporters)Failed efforts  Touted as measures to end fluoride contamination, the PHED inaugurated Urdhaganga Water Supply Scheme and the Combined Dighaljaroni-Tapatjuri Water Supply Scheme in 2005 and 2012, respectively. But the second scheme, which sourced water from the Jamuna, prompted a drought. “We receive water for five minutes one day and then nothing comes out of taps for the next three to four days,” says Imran.A section PHED Engineer, Bipul Nath,  who supervises the combined scheme, however, claims “55 litres of drinking water is supplied to each person in a month.”Bhaven Bora (60) counters it, saying villagers still use water from tube wells. “My wife’s teeth are mottled. We are still drinking poison,” he says. Lending credence to his claim, a survey held in Haldihati by Chauhan and team had found 123 active tube wells in 141 houses. “Imagine the cumulative number considering the other villages,” Chauhan exclaims.The only way to prevent fluorosis is to ensure a regular piped water supply. However, only 174 households have piped connections under the Dighaljaroni-Tapatjuri scheme, while the Urdhaganga scheme caters to 265 households. One of the defunct ring wells built by the Public Health Engineering Department (PHED) using funds from UNICEF (Photo - Arshad Ahmed/101Reporters)While acknowledging the water crisis, a PHED official tells 101Reporters on condition of anonymity that the water supply project stands in an elephant corridor and is at an elevation. Elephants frequently vandalise the pipes, while topography also makes catering to all households a humongous task.Saikia alleges the PHED spent over Rs 7 crore on 16 piped water schemes in Nagaon district since 2003, but most of them are now defunct.Cover image is of Sadhini Kalita with her friend, both victims of skeletal fluorisis, as clicked by Arshad Ahmed/101Reporters.Edited by Tanya Shrivastava

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Deformed and distressed, fluorosis patients of Assam still await regular potable water supply

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