A Winter of Fear
--- Field Report on Arsenicosis Patients with Cancer
Sachie Tsushima Asia Arsenic Network House No. 57, Road No. 13 Block-E, Banani Dhaka-1213 Bangladesh Phone: (880-2) 9894493 E-mail: firstname.lastname@example.org
In Bangladesh arsenic contamination of groundwater is found in 61 districts out of the total 64. About 5 million tube wells were tested in arsenic-prone 271 upazilas out of the total 470, and more than 1.44 million tube wells (about 30%) were found with arsenic exceeding the Bangladesh permissible level of 50g/L. In 8,540 villages more than 80% of the tube wells were arsenic–contaminated. So far 38,430 arsenicosis patients have been detected, and it is estimated that 30-35 million people are at risk of arsenic toxicity through drinking contaminated water. It was in 1994, over twelve years ago, that the first group of arsenicosis patients was identified in Bangladesh. Since exposure to low level arsenic through drinking water for a long period, say, 2 to 10 years, may cause arsenicosis (with higher concentration the symptom may appear earlier), the number of patients will certainly go up unless alternative safe water sources are provided immediately. The Asia Arsenic Network (AAN), a Japan based NGO, has been conducting varies mitigation projects in Bangladesh with emphasis on protection of people against arsenicosis by providing safe drinking water devices. Its activities include the regular monitoring of arsenicosis patients by Patients Support Coordinator and periodical medical check-ups by experts. Those experts, having observed the changes in skin symptoms of the same patients for a several years now, fear that the
number of cancer cases will increase in the near future. A study recently carried out in 5 arsenic-affected upazilas revealed that more than two third of the arsenic victims were from poor families and more than half could not work as they used to do before development of arsenicosis.
The groundwater arsenic problem in Bangladesh was widely recognized after the international conference jointly organized by Dhaka Community Hospital and School of Environmental Studies, Jadavpur University, Kolkata, in February 1998. After this conference, two reports were published in the ‗Guardian‘, a London daily, featuring interviews of international funding organizations and arsenic experts. In that report, the World Bank‘s local chief said, ―Tens of Millions of people are at risk‖. In the same report, WHO predicted that within a few years, one death in 10 adults across much of southern Bangladesh could be from cancers triggered by arsenic.
●Abdul Aziz, Marua Village, Jessore District My mobile phone rang at midnight on 18 December 2005. It was from a friend of mine who was staying in Jessore as a member of a research team from Japan. She has been conducting various researches on social aspects of the arsenic contamination problem in Marua village of Chowgachha Upazila, Jessore district, for some years now. ―A brother of Rokeya‘s husband is suffering from lung cancer and hospitalized in Dhaka. He and his family are very worried since his three brothers died from lung cancer. Can you please help him?‖, she said. Rokeya had skin cancer on her right palm and it had been removed by amputation in December 2000 with financial support from the Asia Arsenic Network (AAN). Her husband, Altaf Hossain, too, had some Bowen‘s (pre-cancerous skin lesion) excised with AAN‘s financial support. They were cordial to receive visitors in Marua and told them their experiences and sufferings, emphasizing how dreadful arsenic poisoning is. Altaf Hossain died from heart attack in January 2004, but
Rokeya is commendably determined to relate her experiences to anyone who visits her, showing her half-sized right hand with no ring and small fingers. On 20th December I visited Abdul Aziz, ―the brother of Rokeya‘s husband‖, at Naznur Hospital in the Dhanmondi area. Dr. Ekhlasur Rahman, Director of the Yamagata Dhaka Friendship Hospital (YDFH), kindly accompanied me. Aziz‘s cabin was on the third floor. He was stitting on a mattress near the window, though there was a bed along the wall on the left. There were a several men in the room. I could not figure out who they were, but seemingly they might be his relatives or friends. As soon as we entered the room, more people joined in. I felt nervous about the atmosphere. With so many strangers it did not seem right to talk about some private affairs. However, Aziz did not care about those people and disclosed that he was suffering from lung cancer. He added that his three brothers had already died from lung cancer and he was scheduled to take chemotherapy from tomorrow. Dr. Ekhlasur said that he would like to see if chemotherapy was the best treatment for Aziz and asked him to show his X-ray film and other medical reports. Milon, Aziz‘s son, followed us to the outside of the hospital building to see us off. While he entreated us saying, ―Please save my father‘s life‖, I observed black spots on his chest. Milon, too, though still young, had arsenicosis symptoms. In the evening Aziz‘s X-ray film and various medical reports were delivered to YDFH. Dr. Ekhlasur examined them together with Dr. Asif, pulmonologist or expert of respiratory medicine. They came to the conclusion that operation was not possible. Cancer had infested the base of the lung and operation would only spread cancer. On the following day, we called at Naznur Hospital again, though reluctantly. Dr. Ekhlasur recommended Aziz to take chemotherapy as planned. Aziz agreed. Then he turned his eyes to me and said in English, ―Will you give me financial support?‖ I had anticipated that such a request would be coming forth, but without any concrete plan I shrank back. If chemotherapy were needed for a long time, the fund for medical support would run out quickly. The fund consists of donations of citizens in Japan. Some people may criticize me for allocating a huge amount of money to only one patient. In front of the patient shuddered with fear of lung cancer, however, it was difficult for me to utter a cold word. Dr. Ekhlasur told me that about Taka 50,000 would be necessary for a cycle of chemotherapy. I proposed that AAN would bear 50% of the medicine cost required for this cycle of chemotherapy. In middle of February 2006, we received a batch of receipts from Aziz. His medical expenses amounted to almost Taka 110,000, of which Taka 56,248 was spent for medicines. Dr. Ekhlasur kindly took the trouble of going through his medicine
bills and sorted out that the total cost of medicines for chemotherapy was Taka 41,689. AAN provided Aziz with Taka 21,000. ●Mafiqul Islam, Azagora Village,Chandpur District One late afternoon of a cold cloudy day in mid-December 2005, a man called at our office in Dhaka accompanied by a lock mechanic who had done some work for us a couple of months ago. The mechanic said: ―Having seen the photographs of arsenicosis symptoms on your wall, I thought you might be able to help him. He is from my village, Azagora, in Chandpur‖. The mechanic added that there were many patients like him in Azagora. On shaking hands with the man, I realized he was suffering from arsenicosis. His hand was warty. He, Mafiqul Islam, 35 years of age, showed us various medical reports, one of which was a radiotherapy completion certificate issued by the Dhaka Medical College Hospital (DMCH). Mafiqul explained that skin lesions started to appear five to six years ago. First he went to see a village doctor. The doctor diagnosed his symptoms as skin disease but could do nothing saying that he had never seen such symptoms. Having visited many doctors and hospitals, including DMCH, he came to know that he was suffering from arsenicosis and it was due to arsenic in tube well water. Then he switched his drinking water source to pond in the hope of getting better. The tube well water which he had been drinking since his childhood, was painted red a couple of years ago during the national screening. The Data Book Vol. 2, issued in October 2003 by the National Arsenic Mitigation Information Centre (NAMIC) under the Bangladesh Arsenic Mitigation Water Supply Project (BAMWSP), recorded 98.67 % tube wells in Tamata Union, where Azagora belongs to, were arsenic-contaminated. ―About two years ago‖, Mafiqul continued, ―tumor developed above the right heel. I underwent surgery at DMCH to have the tumor removed, but it was never cured. Rather it became larger and larger day by day.‖ This was why he held the radiotherapy completion certificate by DMCH. He showed us the affected part by lifting a piece of white cloth which he was using to protect it from infection from dusty air. I was trembled at the sight of the condition. The part was showing flesh, wet and red, in a circle of about 5 cm in diameter, surrounded by dry, blackened skin. I told him to visit Dr. Ekhlasur at the Yamagata Dhaka Friendship Hospital for consultation since he was a reliable orthopedic surgeon with the state-of-art operation skills. Mafiqul left our office hobbling with the right hand on the shoulder of the lock mechanic. Walking must have been giving him
pain. The following day, Dr. Ekhlasur called me and said: ―What I can do to save Mafiqul‘s life would be to amputate the lower part of his right leg and give him an artificial leg. Operation cost would be around Tk. 50,000.‖ Having heard the doctor‘s words, Mafiqul gave up the operation. Where on earth can I procure such a big amount of money? — he must have thought. He was a farmer with a very small piece of land and also ran a grocery shop in the village. In recent years, however, he was unable to do any farming work due to the pain from keratosis on palms and the tumor around the heel. The shop, too, was very small and his customers were only within the village. In January 2006 a TV director came with a cameraman from Japan. They shot Mafiqul and Noorjahan, his wife, in Azagora, and later followed him to DMCH in Dhaka when he needed further treatment. His doctor told the TV director that in fact Mafiqul was suffering from lung and lever cancers and those were at terminal stages. Their documentary film was broadcast in March in Japan and a DVD of the programme reached me in Dhaka in April. In a scene, Noorjahan was telling the interviewer: ―When I ask him how he is, he always says he is getting better. But I know he is getting weaker and weaker, and more serious. I am very worried indeed‖. Then she wiped her tears with her saree. ●Lutfor Rahman, Marua Village, Jessore District At a monthly staff meeting held at our Jessore office on 3rd March 2006, Aklima Chowdhury, Patient Support Coordinator, reported that Lutfor Rahman of Marua village was complaining of breathing problem with occasional pain on the chest. She showed a copy of his X-ray report, in which it was written that dense opacity was seen in the lower zone of the left lung. Is he, too, suffering from lung cancer as Aziz? Fear ran through my body with shiver. Marua is one of highly arsenic-affected villages in Bangladesh with many patients. Aklima records 164 names for the village as patients for her to monitor their health condition periodically. Lutfor Rahman was admitted at the Yamagata Dhaka Friendship Hospital (YDFH) for examinations on 14th March for five days. It was Dr. Ekhlasur‘s opinion that Lutfor needed some treatment on the lung, though he did not identify the cause of the water in the lung. It might be due to just a kind of inflammation, or tuberculosis, or fibrosis, or cancer. **********
●Spring 2006 Late April there came sad news that Mafiqul passed away in the evening of 24th. On 29th I visited his home in Azagora to convey condolences accompanied by Sayed Sunny, our Programme Officer, who had called on him a number of times while he was in the Dhaka Medical College Hospital. Noorjahan said Mafiqul had shown no appetite for more than a week prior to his death. At about 4 p.m. on 24th he started spitting up blood and then his consciousness seemed faint. A village doctor was called in but he just watched the patient after murmuring: ―The case is beyond my ability‖. ―My husband breathed his last breath at 8:30 p.m. that evening‖ – having said so, Noorjahan burst into tears. I just hugged her. While driving through the village to return to Dhaka, our car was stopped many a time. People now knew why we were here and wanted to show their skin problems. Yes, here too, there seem to be many, many patients. We found one male patient with seemingly squamous cell carcinoma (SCC) on the right foot. He said his name was Dural and he was 40 years old. We proposed him to go to Dhaka immediately with us for examination and then possibly for treatment. Being seen off by his family and neighbours, he got in the car. As soon as the car moved, Dural started crying and wailing. Probably he was fearful of the disease having realized that his symptom was similar to Mafiqul‘s. When we arrived at the Yamagata Dhaka Friendship Hospital (YDFH) that evening, Dr. Ekhlasur had just finished his surgeries on Nozrul Islam and Shajahan of Samta village, Jessore district. Nozrul has uncountable warts, normally known as keratosis, on his palms and soles. During the regular check-up in Jessore earlier in April, Dr. Ekhlasur noticed very small black dots on some of those warts which he suspected as a sign of SCC. Because of this change in keratosis, Dr. Ekhlasur has fear that the number of cancer patients will increase alarmingly among arsenicosis patients in future. Nozrul was lying on the bed with his arms and legs wrapped with bandages. Shajahan, who had two SCCs on the face removed, was also lying still unconscious due to the effect of anesthesia. At YDFH, Nozrul‘s wife, Rizia, was also hospitalized. She had tumor at the root of her tongue and was going through treatment with medicines. Lutfor Rahman, who had been in the hospital again since 11th April, complained that the doctor had done nothing on him. Having heard his complaint, Dr. Ekhlasur told me that the hospital was feeding him nutritious food since he needed to
strengthen his body condition for operation. Lutfor underwent surgeries twice in May with his left lung removed finally. Dural had his SCC excised from the right foot on 2nd May. ―It was a very difficult operation‖, said Dr. Ekhlasur. The SCC was at the inside bottom of the foot, below the ankle. ―Not only blood vessels but nerves and tendons run here‖, he explained to me. Dr. Ekhlasur also added: ―I did every thing I could, but micro metastasis may not be avoided. I would like to observe his condition regularly for a while.‖ Abdul Aziz of Marua was taking radiotherapy at the Cancer Hospital in Dhaka in May. On calling him at his hostel, he first thanked AAN for its support. He said: ―Both my son and daughter are still students and we need money for their education. All the savings, however, have gone for my treatment. I am really sorry for depriving them of happy future. I very much appreciate AAN‘s support since it gave me a belief that I would survive with your help. You see, my keratosis has improved after stopping drinking arsenic-contaminated tube well water. Why can‘t I recover from lung cancer?‖ He grinned reassuringly.