Recently, Uddhanam in Srikakulam, Andhra Pradesh, has once again received public attention, but unfortunately not much action later on seems to have happened. I did not visit the area. But, I have been monitoring this issue for long. Chronic Kidney Disease (CKD) as everyone tries to identify this with is reportedly found here in Uddhanam, Srilanka and Nicaragua.
In Srilanka, the problem was traced to glyphosate, a herbicide, which was banned promptly. Funny that India with all its scientific resources has not established the source of the problem. Just to allude, long back, in a village near Warangal, we found 12 women who had breast cancer. When we asked later a team of Doctors as to what could be the reason, we were told that it is due to unhygienic conditions. Only after I suggested if pesticide is a probability, they agreed that there are other possibilities. I am narrating this to buttress my point that often research can also go in wrong direction. Research, or study, is not happening in the right direction on CKD. And, I think it is happening in Uddhanam as well. From what I read, only nephrologists have done some studies, that too based on medical records of the victims.
Usually, research on environmental health conditions in the area should be able to identify the source. Nephrologists, or for that matter any medical specialist, have limited knowledge of a human body, and particular organ of the body. We need multi-disciplinary studies here. It should include socio-economic background of the CKD-affected persons and their families, food and nutrition practices, their occupations, water sources, possible contamination sources of food and water and food cycle chains. In Uddhanam, because of huge number of coconut trees, there is a strong possibility of pesticides being used. In Kerala, a local Doctor has identified endosulphan as a source of a mysterious spread of health problems in humans and animals.
Similar problems in Mondipalem, in Vishakhapatnam, are being reported indicating a wider area of incidence, than just one particular area. I realised health problems in rural areas are invariably linked to pesticides and fertilisers. In Vijayawada, also there are numerous kidney-related hospitals, indicating a problem probably linked to higher amounts of agro-chemicals in canal waters, which flow in and out of paddy fields.
There was a suggestion of shifting people from Uddhanam. It may not be the solution, if the problem is traced to human practices that contaminate water and soil.
In this regard, I feel the following needs to be done:
- Serious multi-disciplinary study of Uddhanam area, by Indian Council for Medical Research, with time-bound results. Primarily, focus should be on environmental health assessment, including investigation of local drinking water sources, food chain analysis, industries and manufacturing facilities, soil testing, crop and tree farming methods, and sociological survey.
- Immediate relief can be provided through rainwater harvesting (in problem areas)
- Ban, even if temporarily, on all pesticide usage.
- Adoption of ‘flush’ methods to remove water contamination through Reverse Osmosis water systems, groundwater recharging and stopping of borewell water usage.
- Organic agriculture practices should be encouraged in the area, through integrated, multiple crop systems, non-pesticidal management methods, mulching and food cropping.
- CKD-affected persons should have easier access to village-level dialysis systems, blood transfusion systems, medicines, a Dietician (local food) and local Doctors, in a clinic. Every village, depending on the population affected should have such clinics.
In addition, the problem of endemic fevers, Japanese Encephalitis (JE) and brain fevers in agency areas, especially in tribal areas, also needs attention. This is becoming a regular feature, and so far no party, politician has taken up this issue.
JE incidence moved into forest areas and tribal hamlets, almost a decade back and thus out of the media and government glare and focus. It was severe in some years in Adilabad. While I did not do any formal mapping, but was looking up media reports, whenever JE gets mentioned. However, I am certain incidence of JE, and related symptoms, can be seen in tribal areas, mostly. And, no longer in coastal, paddy lands.
As is the norm in India, especially in medical emergencies, the blame is always on victims and their lifestyles. However, no research institution in India has cared to study how JE, brain fever, and various forms of fever is affecting tribals, who live very close to nature, and have remedies offered by nature.
As a anti-pesticide activist, I feel the blame could go to pesticide usage and increasing adoption of conventional agricultural practices. Pesticides wreak havoc with natural food chains, killing, maiming various forms of life, randomly, and also impact on immune systems. Vectors might have changed, because of agro-chemicals, immunity might have decreased due to food habits, poisons in the food and hunger. And, all caused by conventional agriculture.
I tried to find answer to another question that popped up on my mind long back – how did JE, a phenomena of mosquitoes, irrigated areas and coastal lands, move into inland, dryland zones. It also seems to have crossed seasonal barriers, occurring in various seasons. Did agro-chemicals cause any mutation among JE strains? Indian health establishment is yet to take cognizance of these issues.
Ofcourse, importantly, we need to see what can be done in tribal areas to stop and prevent deaths and ‘unknown’ epidemic (if one can call that). Further, we need to start a epidemiological study to establish the pattern, causes, vectors, etc.