I suggest looking up the winning entries of the Grainger Challenge from the US National Academy of Engineering (NAE). It proposes relatively inexpensive point-of-use treatments for arsenic in water for the developing world. Here is the link: https://www.nae.edu/Projects/48083/page2007PrizeWinners.aspx .

As(III) is significantly more toxic than As(V) because As(III) is more soluble in water and it is widely believed to affect methylation chemistry during DNA transcription. The reduction in As oxidation state resulting in increased mobility happens in reducing zones (e.g., high carbon loading from fertilize/manure). Look up Charlie Harvey's (MIT) work on tracking arsenic speciation in aquifers in Bangladesh.

Arsenic is very toxic element. It is dissolved in water and contaminate the water easily. It is also present in various insecticides and pesticides. Because it gives health hezards, the following steps is needed to wards its prevention

1. If arsenic is more than 50 microgram/lit, the water can not be used for domestic purpose and in particular for drinking. Alternative water arrangement should be

supplied..

2. Green vegitables and fruits should be washed thoroughly.

3 attempt should be made for deArsenification and mass awarenes program in the effected area.

5 Periodic analysis of groundwater samples and its reports should be displayed for

clear information to people.

Dear Virendra,

I do agree that alternative water sources (perhaps rain water or safe town water), awareness and education and periodic analysis of groundwater samples would be required.

Golam,I appreciate your points. Thanks.

Dear Dr. Kibria,

The matter you raise has been the topic of research and development for decades. A good summary of the problem of arsenic pollution and most of the workable solutions can be found in an excellent book written by Peter Ravenscroft, High Brammer, and Kieth Richard, entitled 'Arsenic Pollution: a Global Synthesis; Wiley-Blackwell & Sons, 588 pages, 2009'.

On a narrower note, many regions that suffer from arsenic pollution of groundwater find it mainly in shallow groundwater (depths < 150 mbgl) and have deep aquifers that are low in As; these can be used to mitigate the arsenic pollution (see the attached).

Dear Prof John McArthur,

Many thanks for providing the references. I do agree that use of deep tubewells would be one of the most important migration options for safe water supply in the sub-continent since arsenic level is generally very low in aquifers >150m. In this perspective we have to protect/preserve the deep groundwater resource from any contamination so that future generations can utilise the resource safely

In addition to what others have said, reducing human exposure to arsenic depends on firstly identifying the sources of arsenic contamination in the environment. arsenic could be contacted via smoking/smoke inhalation, food, soil and water. It means avoid passive smoking, test drinking water and avoid water containing arsenic, reduce contact with soil containing arsenic and arsenic treated materials. do a thorough wash-up after outdoor gardening or other outside activities in arsenic contaminated environment.

In addition keep children toys away from arsenic contaminated environment and wash pets before bringing them into the home.

:

Dear Dr Egirani,

Many thanks for your inputs; yes we have to avoid arsenic contaminated water, one of the suggestions is switching from an arsenic unsafe well to an arsenic-safe drinking water source, or use deep tubewells (which are generally arsenic free).

The other measures could be using filters (arsenic filters and pond sand filters to remove arsenic), and not to irrigate crops and vegetables or grow fish with heavy arsenic contaminated water (which possibly reduce contamination and thus prevent accumulation of arsenic in food).

Furthermore, we may have to identify plants that are tolerant to arsenic and have a limited arsenic uptake. I also feel that the closure of highly contaminated tube-wells may prevent people from using As contaminated water.

Arsenic is generally present in drinking water in localities have a close proximity of industry specially tanneries and textile dyeing industry. The possible solution lies in that the industry people treat their effluents before leaving the industry and comply for the rules and regulation of effluents. In case Arsenic has already polluted the ground water, one can use the deep boring (more than 400 feet deep) for water source. This will surely improve the condition for drinking water.

Dear Asif, Thank you for your inputs. Do agree that deep boring would be one of the best solutions. In case of Bangladesh the British geological survey found that between 150-200 meter deep well are low in As

I do agree that reducing human exposure to arsenic depends on identifying the sources of arsenic contamination in the environment. Arsenic is widely circulated throughout Earth’s crust, and generally released to atmosphere and water by either natural activities (e.g., volcanic activity); human activities (e.g., metal smelting, mining, agricultural pesticide and fertilizers). Public health actions are needed to reduce human exposure, identify the source, and reduce the consumption of arsenic from drinking-water and food in zones with naturally high levels in the groundwater. Moreover, increase public awareness about how to avoid exposure and about the harmful effects of high arsenic intake is very important.

I suggest looking up the winning entries of the Grainger Challenge from the US National Academy of Engineering (NAE). It proposes relatively inexpensive point-of-use treatments for arsenic in water for the developing world. Here is the link: https://www.nae.edu/Projects/48083/page2007PrizeWinners.aspx .

As(III) is significantly more toxic than As(V) because As(III) is more soluble in water and it is widely believed to affect methylation chemistry during DNA transcription. The reduction in As oxidation state resulting in increased mobility happens in reducing zones (e.g., high carbon loading from fertilize/manure). Look up Charlie Harvey's (MIT) work on tracking arsenic speciation in aquifers in Bangladesh.

Arsenic has been used for more than 40 years in most first world countries as a feed additive for poultry. Arsenic controlled some pathogenic bacteria and increased feed conversion rates. Only in the last few years have countries moved to ban it use and application in poultry feeds. It raises the question if the second and third world countries are still using it as a feed additive.

Dear Said, Thank you for your inputs. Yes awareness of communities about threats and risks posed from arsenic would be vital. Similarly measures to prevent/reduce human exposures from As contaminated drinking water and As contaminated food would also be essential

Dear Faarukh,

I am aware of SONO filter invented by Prof Abul Hussam. It is like an advancement of traditional three pitchers technology traditionally used by rural people in Bangladesh to filter out their surface water? Are people still using this technology in Bangladesh?

Dear Cloud,

Thank you for your inputs

For water sources it is necessary to identify both the source of the arsenic and the mechanism by which it is mobilised into the water source. In groundwater As may be mobilised by a change in redox conditions brought about by lowering the water table and allowing it to recover. These are conditions typical of low yielding boreholes equipped with hand pumps used periodically, after which the water table is allowed to recover.

We did some work on this in South Africa, although not specifically focused on arsenic. Report at: https://www.researchgate.net/publication/262484220_To_Calibrate_and_Verify_a_Predictive_Model_for_the_Incidence_of_Naturally_Occurring_Hazardous_Trace_Constituents_in_Groundwater_Field_Sampling_Leaching_Tests_Geochemical_Modelling_and_Groundwater_Policy_Implications_Report_to_the_Water_Research_Commission_by_Hkan_Tarras-Wahlberg_Peter_Wade_Henk_Coetzee_Shane_Chaplin_Patrich_Holstrm_Tom_Lundgren_Nicolene_van_Wyk_Gabriel_Ntsume_Jaco_Venter__Karim_Sami?ev=prf_pub

Book To Calibrate and Verify a Predictive Model for the Incidence...

Dear Henk,

I read the abstract of your book and do agree that groundwater abstraction practices may facilitate movement of As from the bedrock and into the water. Also it appears that harmful levels of As (ASIII) detected in four boreholes (one in Giyani and three Beaufort West boreholes). Do the people use these borewater for drinking or agriculture?

The boreholes at Beaufort West were mainly old exploration holes dating back to a uranium exploration programme in the 1980s. I'll need to revisit the Giyani data as we've learned a great deal more about that area in the past decade. Giyani is located in an Archaean granite - greenstone terrane with gold deposits associated with arsenopyrite. Thanks for reminding me of this one.

There are four issues at hand, 1) reducing the sources of arsenic contamination in water, 2) reducing human exposure to the most contaminated water (however the water became contaminated); 3) reducing the uptake of arsenic by other food sources (crops and other animals), and 4) reducing the harmful effects to people exposed to arsenic.

One strategic solution is to attack the peak (1) and the base (2): (1) stop exposure to the most contaminated water and (2) reduce the levels of exposure/effects to the vast populations who live at the margins of the various effect levels.

I like several of the specific solutions provided above, including policies to reduce the sources of arsenic, engineering solutions to reduce the extent of contamination and allow for the recovery or mitigation of contaminated sources. Great US EPA resources are available at: www.epa.gov/safewater/ (where there are lists of cost and efficacy)

I offer that you can simply blend some water sources to reduce arsenic; and you can reduce plant uptake of arsenic by amending soils. And if nutrition was improved to the large number of people who are exposed to the serious adverse effect levels, we could mitigate many of these effects. These will take care of the vast populations who live with arsenic exposures(near the margins) that could be managed.

Of course it is convenient for me (with high access to resources) to make the suggestion of nutrition --which has beneficial effects to everyone. However, in many cases we could find greater benefit in providing these at risk populations with better nutrition.

Many public health laboratories in the US test for arsenic in water (http://bit.ly/SnVrjv). While the association that represents them in US (www.aphl.org) is looking for ways to work on water testing globally (let me know if you have ideas), I wonder how many field testing devices are available and how expensive they are. If communities are able to use them, one important consideration is to ensure some level of quality assurance so that they can be confident in the results.

Megan: The semiquantitative field test is very simple. I use it in the field down to a 10µg/l. Test kits are readily available, for example http://www.mn-net.com/tabid/10304/default.aspx, explained on www.sustainablefuture.se/arsenic/docs/how_to_detect_arsenic.pdf. This makes it possible to do a lot of screening in the field and focus attention on problem areas.

Gregory: Blending is only viable when there is no overall water scarcity. For decades, we have relied on large scale blending to maintain decent water quality in South Africa. We've recently reached the point where the cost - financial and environmental of more large dams in Lesotho can't sustain the need for clean water.

Thanks for the link Farrukh.

General Comment:

I find it interesting the focus of the discussion is on arsenic in water. Arsenic in food is far easier to control and has an immediate low cost impact on the health of the population. Science, and change, should start with the low hanging fruit instead of trying to figure out how to get to the top of the fruit tree to pick the fruit at the very top.

Dear Gregory,

I do agree with you about the four issues you identified in relation to As mitigation including reducing sources, reducing human exposure, reducing uptake from food and reducing harmful effects. Also preventing exposure to most contaminated water is very much possible via awareness and education plus avoiding plant food that accumulates higher level of As compared to other plants (e.g. Arum (Colocassia antiqourum) which was found to have higher accumulation of As compared to other plants grown in As contaminated soil and water

Dear Megan,

I know in the past the British Geological Survey, and Bangladesh Directorate of Public Health and Engineering tested As in Bangladesh water. In case of Bangladesh people are currently using deep tube well to avoid/ prevent exposure from Arsenic or buying bottled water. Yes we do need most affordable testing in poor countries. See a paper (reference below) which evaluated different kits for arsenic (ITS Econo Quick, Hach EZ, Wagtech Digital Arsenator, Merck Sensitive, Lyophilized Bioreporter Bacteria) and the paper recommended that an ideal As test kit would be the one which is light and compact, easy to use, require a short reaction time, generate minimum quantities of chemical wastes, and be able to accurately measure As concentrations relative to the World Health Organization guideline of 10 ug/L as well as the higher Bangladesh standard for As in drinking water of 50 µg/L

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653972/

George CM1, Zheng Y, Graziano JH, Rasul SB, Hossain Z, Mey JL, van Geen A. Evaluation of an arsenic test kit for rapid well screening in Bangladesh. Environ Sci Technol. 2012 Oct 16;46(20):11213-9. doi: 10.1021/es300253p. Epub 2012 Sep 25.

Dear Cloud,

Thank you for your inputs

Use of simple sand filters to remove arsenic in Vietnam

Arsenic concentrations in groundwater resources in Vietnam is reported to be >1000 μg/L. According to a Journal paper (see Robert Tobias and Michael Berg. 2011. Sustainable Use of Arsenic-Removing Sand Filters in Vietnam: Psychological and Social Factors. Environ. Sci. Technol. 45: 3260–3267) a simple household sand filters can remove 80% of arsenic, on average, from groundwater containing 1000 μg/L of dissolved iron or an iron/arsenic ratio of >50.

The operation costs with this sand filter is reported to be very low and the locally available construction materials can be used, which are available in Vietnam. This filters are operated without chemicals. They can treat a reasonable amount of groundwater within a short time, and easily be installed by the affected communities. One of the advantages is that the sand filters can treat large quantities of water therefore can be served for drinking as well as for washing and laundry needs

The sand filters comprise two superimposed concrete containers. The upper container is filled with locally available sand, while the lower stores the filtered water. Groundwater, which is pumped from the tubewell into the upper container, trickles through the sand into the underlying water storage tank. Arsenic removal is governed by the precipitation of iron (hydr)oxides on the sand surfaces. Arsenic then adsorbs to the iron (hydr)oxides and remains immobilized under ambient conditions.

Reverse osmosis filtration system but must be maintained. Also rinse rice before cooking and add extra water (6 parts water to one rice) to cook rice and drain off excess water.

Dear Ricky,

Thank you. Yes cooking of rice in excess water and removing tuber/vegetable skins can reduce As exposure

Ricky

Does this apply to Brown Rice or simply "white rice"?

Dear Cloud,

I think brown rice should have higher concentrations of arsenic than white rice!

Arsenic in brown and white rice (some research results)

I have done some research and found out the following info: As level is higher in brown rice than white rice (see point 1); the arsenic level within brown rice differs based on grain size (see point 2)

1.According to a study carried out my Meharg et al. (2008) (based on rice samples collected from field, supermarket, pot trials), brown rice had a higher level of arsenic than white rice (see Andrew A. Meharg , Enzo Lombi, Paul N. Williams, Kirk G. Scheckel, Joerg Feldmann, Andrea Raab, Yongguan Zhu and Rafiql Islam. 2008.Speciation and Localization of Arsenic in White and Brown Rice Grains. Environ. Sci. Technol., 2008, 42 (4): 1051–1057)

2.According to another study (Halder et al. 2012) short-bold brown rice has higher arsenic concentration compared to other sizes of brown rice in the following orders: short bold> medium slender> long- slender. The study found that the average accumulation of arsenic in rice grain increases with a decrease of grain size (see Dipti Halder,,Subhamoy Bhowmick,,Ashis Biswas, Ujjal Mandal,Jerome Nriagu, Debendra Nath Guha Mazumdar,Debashis Chatterjee, and Prosun Bhattacharya. 2012. Consumption of Brown Rice: A Potential Pathway for Arsenic Exposure in Rural Bengal. Environ. Sci. Technol. 2012, 46, 4142−4148)

Low As groundwater in palaeo-interfluvial aquifers of Bengal Basin

See a very recent paper (April 2014), which shows that low-As (

Golam

Thank you for being so informative, very much appreciated.

Hope this recent article about CKDU in Sri Lanka will add to your existing knowledge on arsenic . pl. refer

International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph

Glyphosate, Hard Water and Nephrotoxic Metals: Are They the Culprits Behind the Epidemic of Chronic Kidney Disease of Unknown Etiology in Sri Lanka?

Channa Jayasumana 1,2,*, Sarath Gunatilake 2,† and Priyantha Senanayake 3,

Dear Manjula,

Could you pls provide title of the article on arsenic published in International Journal of Environmental Research and Public Health ISSN ?

The U.S. Geological Survey is investigating the use of zeolite as an alternate filtration media to remove arsenic-containing iron/aluminum hydroxide co-precipitates.

http://water.usgs.gov/wrri/09grants/2009WI216B.html

Dear Tamara,

Thanks for the links the summary of results until now shows that sorption of arsenic on Fe-modified zeolite was strong with a sorption capacity of 100 and 50 mg/kg for As(III) and As(V). The optimal solution pH for As removal was found to be between 6 and 10.

Dear Golam:

(1) You might add non-ferrous metallurgy (copper mining and smelting, first of all) as a very important sourse of soils (and further on through food chains) contamination with As - here in the Urals, for example, it constitutes a significant health risk, carcinogenic included.

(2) One of the way to protect population is to try and increase its resistance to this harmful exposure (see on bio-prophylaxis in the "Contributions" on my ResGate profile).

Dear Boris,

Thank you for your comments. Are you referring to the following publication?

Role of biological prophylaxis in the framework of interventional epidemiology (a self-review) BA Katsnelson, LI Privalova, VB Gurvich, SV Kuzmin, EP Kireyeva, IA Minigalieva, MP Sutunkova, NV Loginova, OL Malykh, SV Yarushin, JI Soloboyeva, NI Kochneva

Yes, it is one of them. If you give me your e-mail address I'll send a somewhat revised version.

What consumers can do to reduce their own exposure:

1) Eat a varied diet and try out alternatives to rice such as quinoa, barley, grits/polenta, couscous or bulgur wheat.

2) Boil brown rice in a lot of water (as you do with pasta). Evidence suggests that can lower arsenic levels. White rice does not hold up as well to this method of cooking.

What parents can do to reduce children’s exposure:

1) For babies, try orange vegetables such as sweet potatoes and squash, bananas and avocados as first solid foods.

2) Buy non-rice baby cereals, such as oatmeal or mixed grains.

3) Do not use rice milk as a dairy substitute.

4) Limit fruit juices to a maximum of one-half to one cup a day.

http://www.ewg.org/release/reducing-arsenic-your-diet

Dear Jeremiah,

Yes research studies found brown rice can have more arsenic compared to white polished rice (if irrigated with arsenic contaminated groundwater), therefore boiling of brown rice with lot of water is one of the measures to reduce risks. Unfortunately in many Asian countries rice is the staple food, therefore there is likelihood of people being exposed to Arsenic is relatively higher if contaminated rice are eaten more often!

we can use adsorption method for the removal of contamination of arsenic metal by using a high adsorbent bed.Many studies are going out for the adsorption for many heavy metals using activated carbons prepared by agricultural waste.why cant we opt arsenic solution for these type of adsorption studies?

Dear Priya,

Yes I came across few papers related to removals of arsenic via adsorption (see below some references)

Sandip Mandal , Manoj Kumar Sahu, Raj Kishore Patel. 2013. Adsorption studies of arsenic(III) removal from water by zirconium polyacrylamide hybrid material (ZrPACM-43). Water Resources and Industry. 4: 51–67

T. Sumathi and G. Alagumuthu Adsorption Studies for Arsenic Removal Using Activated Moringa oleifera. 2014. International Journal of Chemical Engineering.http://dx.doi.org/10.1155/2014/430417

Le Zeng. 2004. Arsenic Adsorption from Aqueous Solutions on an Fe(III)-Si Binary Oxide Adsorbent. Water Qual. Res. J. Canada, 39 (3): 267–275

Arsenic is everywhere, when you think in all the sources it is a never ending story, water (drinking water, fish, shellfish, crops such as corn and so on), air, soil. In the other hand is about to witch of the 50 different spices of arsenic you are talking about.!so is not easy.

Thank Ramon, I have been thinking about the rice and brown rice having arsenic. So the next question is. "Do brown and white rice grown and processed in developed countries with standards for potable water contain greater than, equal to or less than level of arsenic grown and processes in non-developed countries?" Anybody have a null hypothesis?

Dear Cloud,

Let me do some research and see whether I can find out some relevant papers!

Dear Ghose,

Thank you for your short review on Arsenic highlighting (a) need for awareness and education of communities about arsenic (b) identify crops susceptible to As poisoning and (c) develop As resistant crop varieties etc

Just a Comment. There have been also contamination of Arsenic due to Gold mining processes. I am following the case of Paracatú-Brazil where Cancer incidents have exponentially increased since the mining activities of the canadian company Kinross. 

Dear Pablo,

Arsenic dust is produced during copper and gold smelting, and coal combustion. Arsenic has been classified as class 1 carcinogenic by IARC  

Matschullat, J. 2000. Arsenic in the Geosphere -- A Review. The Science of the Total Environment. 249(1-3):297-312. 

Taking Pulses containing methionine and or cystine, fruits and vegetables containing Anti-Oxidants in addition to arsenic safe water found as good measures to reduce human exposure to Arsenic in Bangladesh.

References:

1. Akhtar S A, Faruquee M H, Sayed MHSU, Khan M H, Hadi S A, Khan A W. Chronic Arsenicosis: Management by "Vitamins A, E, C" Regimen. JOPSOM, 1998; 17(1): 19-26.

Faruquee M H. Medical Observation, A comparison between 1997 and 2002. Samta, Coallition against Arsenic, JICA/AAN Arsenic Mitigation Project, Report-4, May 2004.

I agree with Ghose, the first thing is to raise awareness among people who facing the Arsenic pollution problems.

There are different human exposure pathway for Arsenic pollution in different area. If we want to reduce human exposure of Arsenic, the environmental risk should be assessed firstly. After major human exposure pathway identified, the treatment for Arsenic pollution can be done, such us drink water planning, soil remediation, etc. 

The various steps that could be taken : Make available drinking-water with arsenic concentrations below 10 µg/l in areas where the level is higher. Measures such as collecting rainwater preventing microbial contamination and breeding of mosquitoes; testing water for arsenic levels; installing arsenic removal systems, either centralized or domestic and ensuring appropriate disposal of the removed arsenic; discriminating between high-arsenic and low-arsenic water sources; general awareness; Monitor high-risk populations for early signs of arsenic poisoning, usually skin problems. 

Symptoms, treatment could be listed out for early detection of arsenic toxicity!

Dear Mahmud, please see my comments of June 10.

If your source of drinking water is a private well and you suspect that your exposure to arsenic is associated with the water you drink, you should have your well tested and use bottled water for drinking until the well is shown to be safe or until appropriate water filtration systems are put in place to remove the arsenic.

Dear Blessy,

Yes testing of water for arsenic in the contaminated areas, awareness and education would be needed

Raising "awareness" is a huge assumption regarding the people who are at what is perceived as risk.  Many of the contributors above are assuming the general population is not already aware of the risk.  A few factors impacting on the behavior of a person would be as follows: Deliberate Indifference, Selective Ignorance and Naive Understanding.  It is not correct for us to assume the general population is unaware.  They may have no alternative to the present condition.  Those possessing alternatives can make informed choices or utilize Deliberate Indifference or Selective Ignorance.  Those individual who would be considered unaware may be naive (not understanding the situation).  However deliberated indifference means the individual is aware of the situation/consequences but makes a choice, considered by some of the contributors, as irrational.  Smoking is certainly and excellent example of Deliberate Indifference.  Selective Ignorance is the ignoring of some facts within the situation and thus the avoidance of considering all the consequences.  

Individuals with only water to drink with elevated arsenic levels may have another alternative in gathering water from an uncontaminated well 10 kilo meters down the road.  They may choose to continue to drink from the well containing arsenic based on the lack resources (time, energy, physical health, etc.) available to them.  They understand the situation (not naive) but make a decision based on their Selective Ignorance or Deliberate Indifference.  

As people construct possible scenarios for changing individual behavior, it is important to recognize the three driving forces that motivate the individual decision.  Lumping everyone into a single category of motivation will not yield significant change in the general population.  The naive individual can be provided with information to facilitate "understanding the situation."  Once they understand the situation they may continue to exercise their right of Deliberate Indifference or Selective Ignorance.  This then posses an entirely different set of criteria for changing the behavior.

Read the Pirsig's trap thread for additional information on changing behaviors. 

Thanks Dr. Kibria to raise the issue to think about measures to reduce human exposure to Arsenic. Though arsenic has been detected in groundwater in 1993, a huge population is still exposed to arsenic poisoning despite of a number of arsenic mitigation programmes. In relation to this failure to reach a mass population with safe water access, proper implementation plan is important for arsenic mitigation in Bangladesh.

1. Introduction

Evidence thus far indicates concentration of arsenic above the permissible levels of 50 parts per billion (ppb) in the groundwater in many parts of Bangladesh. Ninety seven percent of

Bangladesh’s population relies on groundwater as source of drinking water. Most of this water comes from about 10 million tube wells, about 90% percent of them privately owned.

In 2000 it was estimated that 2.65 million hectares that is about 75% of the total land under irrigation are irrigated by ground water. Some estimates show that more than 95% of the ground water extracted are used for irrigation and less than 5% is used as drinking water.

Nation-wide studies reveal that the problem of arsenic is of an enormous magnitude engulfing almost the entire country. Arsenic contamination of groundwater is as much a health and environmental issue as it is a water supply issue. There is yet no strong evidence to suggest that arsenic in groundwater adversely impacts agriculture, crops and livestock.

Studies are underway to determine whether or not there is any impact of arsenic on agriculture and food chain.

The Implementation Plan to address arsenic must, therefore, be multi-sectoral with components on water supply, health and agriculture sectors. This Implementation Plan will be the overall framework for the related sectors. The relevant ministries and agencies may formulate and administer the sectoral components with the co-ordination taking place through the Secretaries’ Committee on Arsenic and with technical support and advice from the National Committee of Experts on Arsenic.

A. WATER SUPPLY

2. Present Status

2.1 Screening

There is a distinct regional pattern of arsenic contamination. The greatest contamination is in the South and Southeast and the least contamination in the northern most and in the uplifted areas of north and central regions of the country. However, there are several occasional highly contaminated hot spots in generally low contaminated regions of the country.

Variability of arsenic concentration within short distance makes it difficult to predict the level of concentration of a given well even when the concentration of the adjacent wells are known. These conditions make testing of each and every tube well essential before implementing or even designing any mitigation programmes. However the scarcity of water testing facilities including adequate field test kits with required efficiency made this task ever more complicated.

2.2 Mitigation

Provision of arsenic safe water for people after screening of wells has been the greatest challenge. So far the success in providing mitigation options has been limited. Uncertainty about the effectiveness of alternative water supply technology options; inappropriate institutional arrangements; and confusion over the service delivery mechanism inhibit progress on arsenic mitigation. Nonetheless the last few years yielded useful lessons on different aspects relating to arsenic mitigation that will help future programmes.

3. Plan for Implementation of Arsenic Mitigation Program

3.1 Screening and Monitoring:

Information about location and extent of arsenic contamination of ground water is the primary requisite for undertaking any mitigation initiatives. Screening of all tubewells in potentially arsenic contaminated areas is, therefore, an essential activity that should precede any mitigation initiatives. Lack of adequate information about the causes of occurrence of arsenic in ground water and the temporal variability of its the concentration in wells, necessitate a regular follow up screening of tube wells that have been presently identified as arsenic safe and marked green. Regular testing and monitoring of ground water of at least 2% of the green tube wells including the irrigation wells should be undertaken on a six-monthly basis and testing capacity must be built at the local level for the purpose. Laboratory facilities to cross check field results should be available at the upazilas levels and the private sector should be encouraged and promoted in testing of tube wells.

3.1.1 Test Kit Development

A Committee of Experts on Arsenic can advise a mechanism for evaluation of all existing test kits and recommend measures for development of local test kits through public/ private initiatives so that testing can take place at the community level without intervention of government agencies. Ultimate aim shall be the development of a digital or atleast an analogue arsenic meter.

3.1.2 Development of Laboratory Facilities

Laboratory at the Upazila DPHE should be upgraded to deal with water quality parameters including arsenic and bacteriological testing. Laboratory facilities must be developed at upazila levels through public/private initiatives and must be linked in a network with the seven existing DPHE laboratories and four DOE laboratories. Making arsenic-testing equipment tax-free may provide incentives for private entrepreneurs. The DPHE laboratories should be equipped with necessary instruments, chemicals and trained personnel.

Government should formulate and enforce effective regulatory instruments for certification and accreditation to assure that these laboratories meet the minimum standards of equipment and performance.

3.2 Technology Options

Arsenic mitigation programmes for safe water supply shall promote a range of options but shall give priority to surface water over ground water source. The programme shall follow the approved guidelines/protocols in installation of safe drinking water options. The relevant guidelines/ protocols shall be upgraded and made comprehensive enough to support construction, operation and maintenance of the different technological options. It shall endeavor to promote piped water system wherever feasible. While research to devise appropriate options are on, for the present the arsenic mitigation programme shall promote the following options:

3.2.1 Improved Dug well:

Improved dug wells with the introduction of flexible pipes with float wherever necessary to minimize the adverse effect of sand boiling will be given priority in rural areas. Facilities for entering air and sunlight and in the case of turbidity sand filter shall be provided with the dug well. The guideline recommended for construction of dug well by expert committee shall be followed. Dug well is a traditional technology for withdrawal of ground water.

The water of dug well is free from dissolved arsenic and iron even in locations where tube wells show arsenic. In arsenic affected areas dug wells have been proven to be safe, acceptable and popular source of alternative water supply. In many areas dug wells had traditionally been in use even in the recent past.

Improved dug wells can be constructed in almost all areas in the country except in areas with loose sandy soil, in areas with more than 15 metre consolidated clay layer, in the tidal zones of the coastal areas and in areas of stony hills.

3.2.2 Surface Water Treatment:

a. Pond Sand Filter

Given the presence of a large number of ponds in rural Bangladesh with water free of arsenic, construction of community based slow sand filters is a viable alternative water supply option all over the country where perennial rivers, canals, fresh water lakes and ponds of acceptable water quality is available. Therefore, treatment of surface water with slow sand filtration, popularly known as Pond Sand Filter (PSF)/River Sand Filter (RSF), shall be considered a suitable alternative water supply option for arsenic contaminated areas. PSF is low cost and efficiently removes turbidity and bacteria. Regular maintenance, particularly washing the filter media, is crucial for the effectiveness of PSF.

b. Larger Scale Surface Water Treatment

For large-scale water supply, surface water treatment from flowing rivers, large water bodies by appropriate treatment plant shall be encouraged.

3.2.3 Deep Hand Tube Well

Experts believe that mapping of the aquifers is an essential pre-requisite to any decision on the long-term development of ground water in arsenic affected areas. Where the shallow contaminated aquifer is separated from a deeper aquifer by substantially thick impervious layer, water from the deeper aquifer could be tapped for drinking water as a short-term measure. There are areas where water may be available in aquifers--deeper than the contaminated shallow aquifer. However there is no reliable data or information about the characteristics of the aquifers, or the existence of any impermeable layer separating the deeper aquifer from the contaminated upper aquifer. In these areas Pond Sand Filters and

Dug wells will be tried first. If these options are found to be technologically not feasible, deep hand tube wells could be tried in those areas. However, deep hand tubewell can be installed in the coastal areas of Bangladesh having proven safe aquifer.

3.2.4 Rainwater Harvesting:

Rainwater harvesting is basically a household-based technology. It has good potential for water supply all over the country especially in salinity affected areas. In areas where alternative water sources are not easily available the potential of rainwater harvesting as alternative source of safe water supply has good prospect. Some NGOs and with the help of

Unicef, DPHE have been promoting the development of various rainwater harvesting technologies in the country. In the context of arsenic problem and taking into account the cost and other limitations of long term storage of rainwater, the Local Government Division have been promoting a new approach to rainwater harvesting in arsenic contaminated areas. This approach aims at persuading people to drink rainwater at least in the rainy season.

Being a household based option it is recommended that the government’s role in rainwater harvesting should be limited to promotional activities.

3.2.5 Arsenic Removal Technology:

Many organizations, local and foreign are involved in testing and marketing arsenic removal options. The dearth of reliable technology for arsenic removal has made Bangladesh a fertile ground for testing and implementation. These technology options fall in to two main groups – household and community level. The difference is in the cost and volume of water treated.

While the marketing of the removal options should be through the private sector the government shall do the following:

Shall not allow marketing of any such technology without proper testing and validation from

Bangladesh Council for Scientific and Industrial Research (BCSIR). Before validation BCSIR shall submit all the technical and scientific data/information to a panel of experts for verification. This panel of experts shall be formed by the secretaries committee on arsenic from the national committee of experts on arsenic and from relevant experts in this field. For the purpose of validation BCSIR shall develop and follow necessary protocols approved by the National Committee of Experts on Arsenic.

Before permission is granted for marketing, proper legal procedures for consumers’ protection must be in place. All agencies/companies/manufacturers must be made liable for any kind of failure of the unit, adverse effect to any user and environmental damages caused by the technology used. An agreement ensuring consumer protection and legal liability of the proponent should be made between the proponent and the validating agency (BCSIR).

National Committee of Experts on Arsenic shall develop detailed protocols regarding sludge and spent media removal and continually monitor such removal options by the public sector agencies (DPHE, DOE, LGIs) shall be ensured.

Arsenic removal technologies should not be considered as appropriate options until there has been formal validation of the technology options. There are several issues relating to the safety of these technologies, in terms of chemical and biological water quality, and to the disposal of the liquid and solid sludge. It is best to wait until these issues are better understood.

After the validation of a given technology it is for the private sector to develop marketing and, distribution networks. The role of the government shall be limited to validation of the options and making provision of legal instruments for consumer safeguards against all adverse effect resulting from the use of the options.

3.2.6 Piped Water Supply System

The long-term goal should be to introduce piped water supply systems both in the rural and urban areas preferably based on surface water treatment plants. For the rural areas government shall facilitate testing and piloting of small-scale piped water supply systems based on improved dug well, Pond Sand Filter or other surface water and safe ground water sources.

3.3 Provision of Alternative Water Supply

Given the fact that any effective ‘treatment’ for arsenicosis is yet to be developed and supply of arsenic safe drinking water is the principal way of addressing the problem, the government shall ensure that the affected community have access to safe water. Those already showing signs of disease from arsenic exposure will get special attention.

The wide variation of arsenic contamination from one village to another makes a phased response to arsenic mitigation imperative. Villages with more than 80% of the tube wells contaminated are obvious hot spots that need immediate attentions. These areas shall come under emergency response. The villages with arsenic concentration between 40% and 80% shall be under medium-term response. The long-term response shall include the whole country and shall aim at providing long-term sustainable water supply options.

3.3.1 Emergency Response

The government shall focus on ensuring at least one safe source of drinking water within a reasonable distance on an emergency basis. This shall be termed as “Emergency Water

Supply Program in Severely Arsenic Affected Areas”. In upazilas, where screening has already been completed, the emergency water supply program should be commenced without any further delay. In other areas this program should start immediately after the screening is complete. For the emergency response improved dug well, pond sand filters will be tried first and deep tube wells following the protocols shall be adopted as the last option. The emergency response shall be completed in one year. The emergency response will take pressure off all stakeholders and time will be available to develop a considered and comprehensive approach to the supply of safe water to the people in the longer term.

Criteria

For the “Emergency Water Supply Program in Severely Arsenic Affected Areas” following criteria shall be followed:

Selection of Villages: Villages that have more than 80% of the tube wells contaminated shall fall under the emergency response. Pockets of high arsenic contamination or high number of arsenicosis patients in a village of otherwise low arsenic contamination may be allowed emergency response as exceptions. In villages, where more than 20% of the tubewells are safe awareness should be raised for drinking water only from safe tubewells.

Mitigation approach: The emergency response to arsenic mitigation shall be based on a supply driven instead of demand driven approach. The community and local government institutes will be actively engaged in site selection and will take responsibility of O&M of the facilities provided. Emergency response shall not subsidize to any individual household services.

Service Delivery: Speed is the essence of the emergency response and a demand driven approach, although good for long-term sustainability is usually time consuming. Therefore, in the emergency phase the delivery of facilities shall be supply based.

Service Level: Emergency response shall ensure at least one safe water source for 50 families taking into consideration the available safe hand pumps in a village and the new safe facilities installed. Emergency phase will deal with only community facilities. If feasible, supply of drinking water through pipes from improved dug wells, Pond Sand Filters or safe deep tubewells shall be considered on pilot basis.

Cost Sharing: It is a usual practice in the government to provide emergency response without any cost-recovery and the same principle has been followed for tubewells after floods, cyclones etc. Likewise, for the present emergency response there shall be no cost sharing for the capital cost of facilities. However the operation and maintenance cost shall be borne by the community and one of the nearest households will be selected as the caretaker family. It will also be the responsibility of the women member of the respective Ward of the Union Parishad to ensure that these public water sources are properly maintained.

Site Selection: Under the overall supervision of the women member for the respective Union

Parishad, the Ward Arsenic Mitigation Committee, which is responsible for overseeing the implementation of the screening program, shall produce a map of the villages under the

Ward, showing the location of red and green tubewells, safe government tubewells, wells with high arsenic concentrations and of patients. The representatives of the supply agency should then discuss the location of the safe source with the community, particularly the women, taking into account the information in the map and the technically feasible locations for the source. The location should then be agreed and the map sent to the supplying agency for final approval. During site selection, local conditions should be taken into consideration and it must be ensured that the water sources are easily accessible by women. Location of the existing safe water sources, distance from homesteads the facility means to serve, concentration of patients and access of poor to the facility shall be the considered in selecting the site for the new facility.

Institutional Arrangement: Different projects and agencies engaged in arsenic mitigation in different parts the country shall be required to accommodate their mitigation approach to this implementation plan. If any project becomes unable to accommodate the national action plan or implement the national emergency water supply program, DPHE shall implement the emergency program in the area.

Apart from implementing the emergency water supply component of its Arsenic Mitigation projects, DPHE, being the mandated government organization for rural water supply and having a countrywide network of personnel, shall be made responsible for coordinating the overall emergency water supply program at the central level. DPHE shall also monitor the progress of implementation against targets and hold regular review meetings. It shall also be the focal agency for providing necessary technical information and advice for implementation of the emergency program.

The Union Parishad, through the Union Arsenic Mitigation Committee and Ward Arsenic

Mitigation committee shall oversee and coordinate the emergency water supply program in the Union. It shall be the responsibility of the Union Parishad to ensure that the criteria for site selection are followed properly and to keep the Upazila Arsenic Committee and UNO informed about the updated status of the emergency water supply program.

Third Party Audit: There shall be provisions of third party physical audit to verify whether criteria for service delivery, site selection etc. are properly followed before installation of any safe sources in any given village. The local administration could be involved in this activity.

Random audits will be done by national level research and development organization like BIDS, ITN (BUET) and Department of Geology of Dhaka University.

Preparatory activities to be under-taken on an emergency basis:

• A quick review and collation of various sample survey and blanket screening results to determine the magnitude of the arsenic problem in the country in terms of number of contaminated districts/upazillas, percentage of contaminated tubewells, number of patients identified. A working group with representatives from DPHE, NAMIC, BAMWSP, DGHS, BWDB, WARPO, Dhaka University, BUET, NIPSOM, DCH and any other relevant organization could be formed for the purpose and be given specific time limit to prepare a report.

• All organizations/ projects engaged in screening program should be asked to prepare a data base of villages with more than 80% contaminated tubewells, showing number of families, number of safe tubewells (government and private). This database will be required to work out the number of safe water sources to be provided under the emergency program.

• An emergency support program to make the non-working dug wells working again. This will require some repair/improvement of the non- working dug wells (e.g. replacing the clogged suction pipe with a flexible pipe with a float, making provisions for sufficient aeration etc.), random testing of water quality, determining type and dose of disinfecting agent to be used and dissemination necessary information to the users of the dug wells.

Sustainable Environment Management Program (SEMP) under Ministry of Environment and Forest will provide assistance in this regard. This program will ensure supply of safe water to the community in question and provide valuable information and guidance for the emergency program.

• A quick appraisal of the locally developed field test kits to ascertain their effectiveness and if required recommending measures for further development of these kits. A small sub-committee of the National Committee of Experts may be entrusted with the responsibility.

• Preparation of an agreed package of messages for awareness campaign and ensuring that no contradictory messages are disseminated, particularly through any mass media.

3.3.2 Medium-Term Response

The medium term arsenic mitigation programme shall be completed within a period of three years and adopt the following criteria:

Selection of Intervention Areas: Villages that have more than 40% and less than 80% of the tube wells contaminated shall fall under medium term response.

Mitigation Approach: The medium term response to arsenic mitigation shall be based on a demand-based instead of a supply-based approach. Communities shall be given information on the sustainability and cost involved and choice of a range of technology options. The demand-based approach implies active involvement of the community in decisions that affect their lives and devolution of responsibility to the LGIs. Arsenic mitigation programmes shall not subsidize individual household services, but shall conduct social mobilisation and awareness campaigns.

Cost Sharing: Sharing of capital cost for community services shall consider the affordability of people and type and cost of the technology options. The total cost of operation and maintenance shall be borne by the users.

Service Level: Community facility shall be provided at the rate of one water point for a cluster of 25 to 30 households

Site Selection: The community that shall use the facility shall select the site for the installation of the facility. The site shall be such that it facilitates the access of the poor.

Institutional Arrangement: The local government institutions, particularly the Union Parishad, shall play more effective role in the medium term water supply program.

3.3.3 Long Term Response

The long-term response to arsenic mitigation shall consider the same criteria as under Midterm response. The difference being that in this phase arsenic mitigation programmes shall promote proven and sustainable technology options. This phase shall include many of the technology options promoted during the mid-term response. The activities towards long term response shall be initiated immediately.

The long-term response shall also include piped water supply systems for the rural areas.

3.4 Urban Water Supply

As per the Bangladesh Bureau of Statistics (BBS) there are over 500 urban centres. Except for the old pourashavas most of these urban centres have little or no urban attributes. Arsenic mitigation programme shall consider only those centres having municipalities as urban. In municipalities where production wells are safe but hand tubewells in the peripheries are mostly unsafe, pipeline network shall be extended to the affected areas.

In municipalities where production wells are contaminated the possibility of switching over from groundwater to treated surface water shall be actively explored and given priority. If surface water is not immediately available in adequate quantity, sinking of production tube wells at safe aquifer shall be considered. In case a safe ground water source is also not available; transporting safe water from distance surface/ground sources shall be considered. If none of the above options are technically feasible, as a last resort, treatment of arsenic contaminated water with proper sludge management programme can be tried. Pourashavas without Piped Water Supply Screening of all tube wells in potentially contaminated municipalities without piped water supply is going to be completed soon.

Piped water supply based on surface water treatment shall be a priority in pourashava areas.

Where surface water cannot be made available in adequate quantity, piped supply from improved dug wells on neighborhood basis shall be preferred option. In case safe ground water source is also not available, transporting safe water from reasonable distance surface/ground sources shall be considered. If none of the above are technically feasible, sinking of tube well at safe aquifer shall be considered.

The long-term goal of the government shall be to cover the whole areas of all municipalities through piped water supply from treated surface water source.

3.5 Research and Development

Research and Development (R&D) are of paramount importance in filling gaps in knowledge and information. The importance of arsenic demands that the government establish an Arsenic Information/ Resource Centre within DPHE that shall be the custodian of all data and information on arsenic in the country. The Centre shall keep abreast of all research on arsenic whether in the country or abroad. All research organizations or individual researchers undertaking research on arsenic in Bangladesh shall be required to share the research findings with the Centre. Local Government Division shall formulate necessary regulatory instrument to facilitate the work of the Centre.

National Committee of Experts on Arsenic shall identify institutions/ agencies for Research and Development activities in diverse fields of arsenic mitigation. Such activities shall be initiated, among others in the following fields.

Field Test Kit

• Development of an accurate and reliable field kit for measurement of arsenic at the village level.

Alternative Water Supply Options

• Improvement in Dug Well technology;

• Effect of sanitary protections and continuous withdrawal of water on arsenic content of dug wells;

• Improvement in Pond Sand Filters technology;

• Improvement in Rainwater Harvesting methods;

• Development of a combined roughing and slow sand filter for surface water treatment in Bangladesh;

• Development of cheap and affordable piped water supply methods;

• Small scale water treatment plants;

• Study on the existing water treatment plants in operation in Bangladesh; identification of problems in the design of appropriate water treatment technology;

Studies on Deep aquifer

• Investigation on impact of groundwater withdrawal on different aquifer;

• Research on protection of arsenic safe aquifer;

• Proper sealing methods in deep tube wells so that arsenic contaminated water from the upper aquifer cannot mix with the arsenic safe water of the lower aquifer of the deep tube wells;

• Mechanism of recharge of deep aquifers and possibility of contamination of deep tube wells in arsenic affected areas;

• Investigating into source and release mechanism of arsenic in groundwater;

• Mapping of arsenic safe aquifers in Bangladesh;

• The use of Isotope hydrology to investigate the source of arsenic, residence time and interrelation among water bodies may be continued as is being undertaken by BAEC;

• Research on possible in-situ intervention; Research relating to Arsenic removal Technology

• Development of effective, affordable and environment friendly arsenic removal technology for the use in rural areas of Bangladesh;

• Leaching characteristics of arsenic rich sludge under different conditions and possible contamination from arsenic rich effluents produced by arsenic removal technologies;

• Disposal of arsenic contaminated sludge and spent media.

Miscellaneous

• An evaluation of effectiveness, impact and replicability of arsenic mitigation initiatives in Bangladesh.

3.6 Institutional Arrangement

The rural drinking water sector in Bangladesh is set for a major transition. The arsenic contamination may force rural households to shift from individual to community based drinking/cooking water systems. This shift brings into question the existing institutional arrangements for and the role of different organisations rural water supply and in the management of local water resources. Institutional arrangement for implementation of the arsenic mitigation programme in the water supply sector shall take the following into considerations:

3.6.1 Local Government Institutions:

The local governments need to be directly involved in the arsenic programme and be partners in the scale-up and sustainability of water supply systems. There shall be a need to establish some minimum in-house capacity within Union Parishads in financial management and social mobilization.

The government has to define the nature and scope of these arrangements and provide a regulatory framework to involve the local government institutions to work in tandem with government agencies. The ongoing BAMWSP implementation procedure and other projects1 on local management of development would provide important lessons in defining the future role of local government institutions, government agencies, civil societies and communities in delivery of water and other services to the people.

The government shall review and evaluate these initiatives; analyze and synthesize the lessons and take steps to make the necessary changes in the roles, responsibilities and authority of local government institutions. These changes to address arsenic and provide arsenic safe drinking water will also have implication in delivery of other services as wells.

Role of Government agencies: Department of Public Health Engineering (DPHE) shall play its mandated role but develop and operationalize a mechanism to facilitate effective involvement of the local government institution in service delivery and ensuring pivotal role of the community in most decision making. DPHE shall also be developed into a resource center for promotion of safe water supply with emphasis on surface water system.

Role of Local Government Institutions (LGIs): Devolution of authority to the local level and an active role of the LGIs in water and sanitation service provisions shall be emphasized.

Role of Private sector: The private sector shall be encouraged and the government shall promulgate necessary regulatory framework.

Linkage with Universities and Research organizations: Linkage of research organization to universities and educational institutions will add value to research.

Human Resources Development: Development of expertise within the government ministries and agencies shall be emphasized. Trained personnel shall be allowed to continue and contribute in their fields of expertise.

B. HEALTH ISSUES

4.0 Present Status

The health hazard due to the contamination of arsenic in groundwater has raised serious concern for public health. Although survey results show that the prevalence of arsenicosis in the country is still very low, experts fear that patients so far identified might be the ‘tip of an iceberg’. Survey results also suggest that there are several pockets in the country where prevalence of arsenicosis patients is alarmingly high.

The implementation plan regarding the health sector issue shall include the following:

4.1. Case definition, case management and national prevalence of arsenicosis patients

4 .1.1 The case definition protocol to identify arsenicosis patients developed by the national expert committee and subsequently adopted at the WHO regional workshop in November 2002 that is now being field tested on a regional basis needs to be circulated and properly understood by doctors and relevant health workers at different levels. There shall be an action plan for national survey on prevalence of chronic arsenicosis and based on this baseline information the extent and nature of health problem caused by arsenic poisoning will be assessed and documented.

4 .1.2 The case management protocol developed by the national experts committee was later adopted at the WHO regional workshop in November 2002 that is now being field tested on a regional basis needs to be properly understood and uniformly implemented by the health deliverers from village to upazila and up to the district to national level hospitals.

4 .1.3 In order to train the health manpower at different levels, health workers and doctors will be identified for training.

4. 1.4 Training manuals has been developed in accordance with case definition and management protocol and a simplified draft Bangla version for use of the field workers has also been made that will be finalised. Organisations and individuals for training shall be identified and a TOT programme shall be introduced by the

Directorate General of Health Services.

4 .1.5 An action plan for different level of health workers training shall be developed nationwide by the Directorate General of Health Services with time frame and venue.

4 .1.6 Ministry of Health and Family Welfare through the Directorate General of Health

Services shall implement the training programmes for health service providers at different levels. NGOs/private sectors can also conduct such training programmes in co-ordination with the DGHS.

4.2 Identification and Management of Arsenicosis Patients

Similar to the provisions of the alternative water supply the health issues will also be dealt in the following stages:

4.2.1 Emergency Response

Directorate General of Health Services and other organizations under the Ministry of Health and Family Welfare, partners of the United Nations Agencies, Development Partners and NGOs will implement this progrmme. All activities of the emergency response phase will be completed in one year. For emergency response the following criteria shall be followed:

1. Selection of Villages: Villages that have more than 80% of the tube wells contaminated shall fall under the emergency response. Pockets of high arsenic contamination or high number of arsenicosis patients in a village of otherwise low arsenic contamination may be allowed emergency response as exceptions;

2. In the Upazilas of those villages health workers of all levels will be trained for case identification according to the approved protocol;

3. Detailed screening of the total population for case identification.

4. Ward, Union and Upazila arsenic committees will be responsible for referring all patients for proper at different levels of health centers where patients will be treated and managed according to the approved protocol and

5. Social mobilization and awareness campaign through all electronic and print media will done after scrutinizing all available materials and selection of those found suitable.

4.2.2 Medium-Term Response

The medium term arsenic mitigation programme shall be completed within a period of three years and adopt the following criteria:

Villages that have more than 40% and less than 80% of the tube wells contaminated shall fall under medium term response and in addition Upzila and District Hospitals will be further strengthened for patient management and rehabilitation by increasing the skills of all levels of health workers.

4.2.2 Long Term Response

This will consist of the same criteria as medium term response. At this time it is expected that new and improved patient management methodologies will be developed and will incorporated in the protocols for treatment, management and rehabilitation.

4. 3 Institutional Arrangement

4 3.1 Central and Regional Level: All the medical college hospital and national level hospitals will have separate units for management of complicated arsenicosis patients (cancer cases, vascular complicacy etc.).

4 3.2 District Level: All the district level hospitals will have arsenic units. The Arsenic Unit will be composed of Head of Dermatology, Head of Medicine, Head of Surgery and head of Gynaecology along with the Civil Surgeon. Apart from the management of complicated cases this unit will be responsible to maintain referred chain from Upazila to district level and district level to central/regional level including specialized hospital.

4.3.3 Upazila Level: There shall be an arsenic unit at the Upazila level involving trained Upazila Health and Family Planning Officer, Resident Medical Officer and Medical Officer Community Health. This unit shall be responsible for patient management and maintain a referral chain for union and village. This unit shall develop and maintain an information network involving all Upazila level Officials and other stakeholders.

4 3.4 Union Level: At the Union level there shall be the union health team with trained health workers. Union Parishad Chairman and Members will facilitate the activities of the health workers in patient management and rehabilitation.

4.3.5 Role of the Private Practitioners and health care providers: Private Practitioners and health care providers should also be part of patient identification and management programme and should provide information to arsenic units and should be encouraged to utilise the referral system.

4.3.6 Logistic Support: Procurement of medicine, procurement of and even distribution of medical supplies shall be established. Laboratory support will be in place to facilitate patient management at appropriate level of service delivery.

4. 4 Record Keeping and Monitoring

At all levels arsenic case records will be kept and updated. A monthly record of new cases/ complication shall be sent to the arsenic record cell at the office of DG, Health form union level to regional and national level hospitals. District arsenic team headed by Civil Surgeon shall develop monitoring system for case detection and case management at Upazila, Union and Ward level.

4.5 Development of Community Advocacy and Behavior Change Communication

(BCC)

At the Union level a community advocacy group with Union Parishad Chairman andMembers and field level health workers will be formed. They will be responsible to inform the community about the facts of arsenicosis, mitigation options and management and treatment along with facilities for management of complication with the help of the following:

• Simple BCC materials and information materials (Some already developed and some needs to be developed).

• Trained Health Field Workers and Volunteers for interpersonal communication.

• Mass communication of continuous information flow through mass media.

4.5.1 Help line will be established for social health. The above committee at union level will also be responsible for developing and maintaining the help line for physical/social rehabilitation of arsenic victims by organizing meetings to disseminate information, organize volunteers and try to mobilize of financial resource for rehabilitation of the victims in the community.

4. 6 Research and Development

• The National Committee of Experts will form a sub-committee as National Arsenic Research (Health) Co-ordination Committee. Chairman of the Scientific Review Committee of Bangladesh Medical Research Council (BMRC) will be the Chairperson of this committee and BMRC Director will be the Member-Secretary.

• This subcommittee shall identify priority areas in health for research (such as case control study on patient management, research on drugs including herbal/ traditional medicine (Ayurvedic, Unani and Homeopathic) dose regression study and also study to understand course and effect of arsenic in producing various systemic complication) and shall advice the Health Ministry and Directorate accordingly.

• This subcommittee shall identify and evaluate appropriate national & international institutes and individuals either singularly or jointly to undertake priority and need based research of arsenic related health issue.

• All agencies including the UN agencies and Donors shall be asked by the government to work in close coordination with this Arsenic Research (Health) Co-ordination sub-Committee in Health sector work.

• The committee will inform the National Committee of Experts and the Secretaries Committee on arsenic mitigation research activities in the health sector.

• All research findings will be properly documented for dissemination to all stakeholders.

C. AGRICULTURAL ISSUES

5.0 Objective

The objective of arsenic programme in the agriculture sector shall be to improve understanding of impact of arsenic on agricultural environment and food chain. The possible adverse effect of arsenic in groundwater on agriculture and food chain is under investigation.

In the near future arsenic related activities in the agriculture sector are likely to be on research and investigation. Professionals, researchers and institutions shall undertake research to study different phenomena.

5.1 Activities

To address the issues regarding the impact of arsenic in the agricultural sector the following activities shall be undertaken:

• Conduct research on arsenic in food chain;

• Conduct research on impact of arsenic on soil quality;

• Investigate into effect of arsenic in agri-chemicals such as fertilizer/ pesticide on agricultural environment;

• Investigate into the effect of arsenic contaminated irrigation water on agricultural product and

• Establishment of a national standard for arsenic in ground water used for irrigation and in agricultural products.

Bangladesh Agricultural Research Council shall prepare a prioritized list of studies and researches based on which all studies and researches in the country should be undertaken.

5.2 Institutional Arrangement

It is perhaps premature to talk about institutional arrangement for the implementation of the agricultural sector programme. In the long-term should arsenic prove to be a concern to agriculture the basic principle of the institutional arrangement shall be the same as for the other sectors based on partnership of local government institutions, government agencies, communities and civil societies.

D. CROSS CUTTING ISSUES

6.0 The Issues

Some issues such as creating general awareness on the arsenic problem, gender equity, and the rights of the poor, coordination cut across water supply, health and agricultural sectors.

The cross cutting issues should form integral parts of projects in the relevant sectors. The following cross cutting issues shall be given priority:

6.1 Awareness

6.1.1 Coordinated awareness programs shall be undertaken focusing on raising awareness about the following:

♦ impact of ingestion of arsenic contaminated water;

♦ alternative arsenic free safe water sources and other mitigation options;

♦ remedial measures against arsenic poising.

a. Communication Strategy: A national communication strategy shall be developed particularly focusing on the contents and methods of communication. The strategy will also identify partners to implement intensified communication campaign based upon agreed strategy

b. Implementation of MOHFW communications campaign.

6.2 Ground Water Act

Groundwater is a national resource and a suitable Groundwater Act should be enacted to control all activities regarding groundwater, exploration, extraction and management.

6.3 Linkage with sanitation

With the increasing emphasis on the use of surface water in arsenic affected areas promotion of health and hygiene achieves paramount importance. Neglecting it may not only undo the health gains from water sanitation programme but may also pose a health challenge of a different dimension. In the implementation of the arsenic program in the rural areas sanitation issues shall be given due consideration

6.4 Support Unit

Considering the complexity and uniqueness of the arsenic problem a specialized support Unit(s) will be established to provide necessary support to the government’s overall arsenic mitigation program. This support unit will primarily draw on the expertise available in relevant government agencies. Such experts shall be remunerated properly commensurate with experts working in such units in other sectors. The Unit will also emphasize on developing and sustaining necessary expertise in relevant ministries and government agencies. Trained personnel shall be allowed to continue and contribute in the field of expertise for a substantial period of time. To facilitate transfer of technical knowledge, the unit will draw on international expertise in areas where necessary local expertise is yet to be developed. The National Committee of Experts on Arsenic will identify such areas of expertise. In establishing such units, the DFID funded Arsenic Policy Support Unit (under process of establishment) may be taken into account and the terms of reference of the Unit may be revised in light of the implementation plan. The Danida funded Unit for Policy

Implementation (existing) under the Local Government Division shall provide complementary support to the Unit as per above criteria in the field of arsenic mitigation.

6.5 Co-ordination

Effective co-ordination of activities both within sectors and among sector is imperative. The sector level co-ordination shall be done by the relevant ministry while the inter sectoral coordination will be done at the national level through the Secretaries Committee on Arsenic.

A small inter-ministerial working group could be formed to ensure effective inter sectoral linkage at the working level.

Dear Mainul, 

Many thanks for your long discussion. I have the following further inquiries: 

Rainwater harvesting: How are you (UNICEF) promoting rainwater harvesting technologies in Bangladesh? 

Awareness: How do you do it? Do you produce leaflets about arsenic and distribute to local people? 

Food contamination: Is there any one conducting research on arsenic accumulation in the food chain since 95% of the ground water extracted are used for irrigation?

Any weblinks will be appreciable

control As content under 10microg/L for WHO standars and 1 microg/L for Switzerland

Dear Golam, may you kindly provide the references of Arsenic in different countries; infact i have finished a study on waterborne diseases in two different communities in pakistan, where arsenic is found in the ground water; thanks dear. 

Dear Munir,

I will send you the references within few days time 

why we perfer  well switching as compare to other mitigation measure aganist arsenic.any one please

https://www.researchgate.net/publication/317556575_High_Impact_Research_Achievement_of_Innovative_Artificial_Mussel_Technology_Extension_in_Bangladesh_to_Monitor_and_Assess_the_Risk_of_Pollutants_Trace_MetalsHeavy_Metals_in_Fresh_Brackish_and_Marine_W

Technical Report High Impact Research: Achievement of Innovative Artificial M...

Online Environmental Education to Help Developing Countries

https://www.researchgate.net/project/Online-Environmental-Education-to-Help-Developing-Countries

Use of least arsenic contaminated drinking water sources and cereals/vegetables containing low arsenic accumulation are the safest method to lower the risk of arsenic in human beings.