The worst mass poisoning in history, Bangladesh, Arsenic

1. Physicalprocess
Tube-well testing Site selection
Site selection
An installation site for
the water supply is
selected during a village
meeting. Informal talks
reveal whether the
choice is appropriate or
not. Landownership is
legally vested in the
community. This step is
crucial to avoid
monopolisation of the
water supply by the
landowner.
Installation of the
water supply
With the assistance of
the staff, a contractor is
selected. The
community provides
some material and
logistical support. The
installation process is
monitored to ensure
proper installation.
Setting up an
information centre
A simple shed is set up
and furnished with
posters and information
material. This will help
facilitate the dialogue
between staff,
committee members
and the community (see
social process).
Setting up homestead
gardening
As arsenicosis is
worsened by
malnutrition, affected
households are helped
to establish fruit and
vegetable gardens.
Data collection in the
working area
General geographic
information is collected
about a working area
(usually a union or sub-
district).
Tube-well screening
In several survey
villages, tube-wells are
tested for arsenic (and
marked) in order to
identify those most
seriously affected.
Technology
assessments
Previous and present
drinking water projects
are assessed. Villages
are selected where no
other programmes are
running, or where they
have previously failed.
Money collection and
savings
The committee opens a
bank account and
collects financial
contributions from water
users. The contributions
are not large, allowing
everyone to participate.
Some of the money can
be used to share in the
investment; some for
maintenance. The
committee is
encouraged to meet
once a month in the
information centre to
discuss operation and
maintenance issues, the
use of the bank
accounts, and so on.
Maintenance of the
water supply
Financial contributions
serve to buy and stock
spare parts. The
committee repairs the
water supply whenever
required. Since women
are usually first to signal
problems with the
operation of a water
supply, they have an
important role in the
committee. When
expensive repairs are
needed the committee is
encouraged to collect
more money from water
users.
Water users
Information centre
Tube-well marking Water supply installation
Handpump maintenance
Information centre
Studying existing water
supplies Water supply installation Platform in disrepairHomestead garden
Socialprocess
Household survey School programme
Consultation and
agreement
The implementation
process is discussed
and agreed upon with
the community. The
technologies assessed
during the surveys are
discussed. This leads to
the selection of a water
supply option.
Establishment of a
committee
In a village meeting, the
staff facilitates the
election of twelve
committee members -
both men and women.
With an understanding
of the local socio-
economic conditions,
the staff can better
assist the poor and
improve their
representation in the
committee.
Raising awareness
Information about
arsenic is initially
disseminated during
surveys. Later, meetings
are organised to reach
different social groups
(courtyard gatherings,
school programmes, tea
stall meetings and
information centre
meetings). As people
may be alarmed or feel
powerless, simple
nutritional tips are
suggested.
Treatment of patients
Regular treatment is
provided to arsenicosis
patients identified during
surveys. They are also
given seeds and support
for starting homestead
gardening (see physical
process).
Paramedic training
Orientation meetings
(Non-) Governmental
Organisations in the
working area are visited
to form an idea about
who is doing what on
arsenic.
Socio-economic
survey
In order to select the
poorest survey village,
data are gathered about
the social, economic,
educational and familial
status of households.
Arsenicosis patients
identification
Trained staff screens
possible arsenicosis
patients. This initial
investigation may reveal
more serious poisoning
in some villages.
Maintenance of the
committee
With increased
awareness of the
dangers of arsenic, and
interest in a functioning
water supply, water
users are more likely to
keep an eye on
committee members.
The staff helps to
motivate or replace
inactive members. This
is the beginning of
peopleʼs control over the
committee. To
encourage self-
monitoring in the long-
term, village volunteers
are selected to monitor
committee members
and their duties.
Follow-up treatment
Arsenicosis patients still
require treatment long
after having shifted to
arsenic-free water.
Better diets through
homestead gardens
may gradually replace
medical support.
Paramedic training will
help increasing people's
understanding.
People's
organisations
The committee is
encouraged to become
a 'peopleʼs organisation'
that will independently
establish access to
other public services
(such as sanitation,
education, or road
construction).
Courtyard meeting
Data analysis Committee election
Village volunteers
Patient treatment
Patient screening Committee New road in the villagePatient treatment
OrganisingSurveying Facilitating
Select and
analyse a
village
Establish drinking
water and public
health systems
Improve well-being
through sustainable
water and health
systems
Problem and aim: This action research programme is concerned with safe drinking water in rural
Bangladesh – a matter of grave urgency since the discovery of arsenic in the groundwater more than a
decade ago. Between 35 and 77 million users are exposed to dangerous levels of contamination, and the
implementation of solutions has been slow and inadequate. Few projects have been undertaken, and even
fewer have managed to develop suitable operation and maintenance arrangements, to bypass existing power
relations, and to extend services to the very poor. The aim is to understand these failures and to suggest a
more successful approach. The findings come out of a safe drinking water supply programme, implemented
by the Arsenic Mitigation and Research Foundation (AMRF) in several arsenic affected villages.
ARSENIC CONTAMINATED DRINKING
WATER IN RURAL BANGLADESH
Proposed approach, processes and phases: The diagram shows two basic processes: a physical and
a social one. The physical process relates to technological and ecological assets; the social process to
human and organisational assets. The processes run in parallel, and both roughly follow the three
phases of surveying, organising and facilitating. The first phase leads to the selection of a village. In the
second phase, AMRF assists the community with investments in new assets, such as a water option, a
maintenance committee, knowledge, skills, and so on. In the third phase, AMRF's direct involvement is
reduced, as it begins to support activities leading to the sustainability of the water and health systems.
The diagram represents work-in-progress, and will be elaborated as new findings emerge from practice.
"The Worst Mass Poisoning in History"
Author: Crelis Rammelt (PhD Candidate, Environmental Policy and Management)
in collaboration with the AMRF staff in Bangladesh.
Email: crelis@peopleandwater.org Website: www.peopleandwater.org
New York Times, 1998