Ground Report: Nalgonda Fluorosis victims wait for Shivannaguda project to disconnect from groundwater

Hyderabad: Amshala Swamy dreamed of being a soldier in the Indian Army. But for as long as he can remember, he has had crippled arms and legs. A resident of Shivanna Gudem village in Nalgonda district, Telangana, Swamy (37) is a victim of skeletal fluorosis.

He was diagnosed with fluorosis when he was only five years old. His condition, endemic skeletal fluorosis, is a disease caused by excessive ingestion of fluoride through water, food, or both.

Swamy's mother drank fluoride-contaminated groundwater in Shivanna Gudem village in Nalgonda when she was pregnant. It is possible that he ingested high levels of fluoride before he was born.

Sitting in front of his barber shop and speaking to NewsMeter, Swamy said he had two sisters. "They were both born crippled. They died within 2-3 years of their birth. My parents could not take care of them," he confessed.

"My mother never stopped drinking groundwater as there was no alternate source of water. Years later, fluorosis hit her as well," he said.

He's only one of the thousands of victims who suffer from fluorosis in the Nalgonda district. As per the 2011 Census, the population of the district is 1,618,416.

There is no exact figure as to how many persons are suffering from and have died due to fluorosis. Neither the most recent Census nor the National Family Health Survey mentions fluorosis.

"An informal survey conducted in 2019 or so shows that nearly 3,000 persons in Munugode constituency continue to suffer from fluorosis. The highest number (293) is from Marriguda mandal," said P. Subhash, a member of the Jal Sadhana Committee.

How does fluoride enter the body?

In addition to directly consuming fluoride-contaminated groundwater, Nalgonda residents here also use the water for irrigation purposes.

While many citizens no longer use groundwater for drinking, they continue to use it for irrigation. NewsMeter visited several villages and found that the water is also used for food crops such as rice and vegetables which the residents here consume daily.

Fluorosis is an age-old problem in Telangana's Nalgonda district. No proper or permanent solution has been provided to many citizens here. Political parties only pay heed to the problem during elections and use it as an election agenda.

Why is fluoride present in Nalgonda's groundwater?

The water in Nalgonda district has high contents of fluoride due to its rocky terrain.

"Rocks consist of minerals and the rocks in Nalgonda terrain have higher fluoride content than usual. This fluoride began dissolving in groundwater when the rocks were subjected to great pressure while digging bore wells," said Dr. Arjun Khandare, a retired scientist from the National Institute of Nutrition (NIN). He has extensively researched Nalgonda's fluorosis issue.

For several decades, the residents of Nalgonda have consumed the groundwater which consists of high fluoride levels.

"When we realised that the fluoride levels were high, we used to travel all the way to Hyderabad in buses to fetch Krishna water for as many people as possible," said Dusarla Satyanarayana, the president of Jala Sadhana Committee in Nalgonda.

WHO on fluorosis

Fluoride levels continue to be higher than the upper limit set by the World Health Organisation (WHO), according to Jala Sadhana Committees. It is also pertinent to note that Nalgonda district continues to be a part of the National Programme for Prevention and control of Fluorosis (NPPCF).

The upper limit of safe total intake of fluoride from food and water per day for an adult is 5 milligrams (WHO-2002).

"Fluorosis continues to haunt Nalgonda. Six months ago, I came across a man who has been partially affected with skeletal fluorosis," said Satyanarayana.

Satyanarayana says that the fluoride levels range from 1.6 to 4.6 in several mandals of the Munugode constituency.

As per a NIN survey in 2018, the fluoride levels in groundwater continue to be higher than the WHO permissible levels.

Marriguda mandal of Munugode constituency in Nalgonda district has the highest levels of fluoride. Vattipally, Ramreddypally, Nampalle, Waddepalle, Nerellepally and several other villages in the Munugode constituency have high levels of fluoride, according to the NIN study.

Mission Bhagiratha and Shivannagudem projects

Most citizens now do not drink groundwater. For the last eight years, most residents have been provided drinking water from Mission Bhagiratha.

"I am grateful to the government for everything. Water from Mission Bhagiratha has truly helped us. We get water for an hour a day. This water is sufficient for drinking and cooking. But we still continue to use groundwater that's contaminated with fluoride for agricultural purposes. We use it to grow our rice and vegetables," Swamy explained.

Satyanarayana further stated that animals, too, drink bore water. "The only solution to the fluorosis issue is the completion of Charlagudem and Shivanna Gudem projects," he said.

The completion of the projects, which are part of the Dindi Lift Irrigation project, will provide an alternate source of water completely free from groundwater in Nalgonda district.

NewsMeter visited the projects that were inaugurated in 2016 and found they were still being constructed. It seemed that not even half of the work for the reservoir was completed. The Rs. 6,500-crore project aims to supply drinking and irrigation water to Munugode and Devarakonda Assembly constituencies.

The project is spread across nearly 3.5 lakh acres. As many as four villages have been displaced for the project.

Prevention is better than cure

"There is no cure or medicine for fluorosis," said Dr. Arjun Khandare. "The only permanent solution to fluorosis in Nalgonda district is to prevent using groundwater," he said in a conversation with NewsMeter.

In addition to not using groundwater, dietary interventions can also help in eliminating already-consumed fluoride contents in the body. "For example, consuming tamarind will help in removing excess fluoride contents in the body. However, eating tomatoes will only keep the excess fluoride content in the body stagnant," Dr. Arjun added.

"Using aluminium vessels for cooking also aggravates the fluoride content. We have educated the residents of Nalgonda to not use them," he said.

He stated that there are multiple dietary restrictions that everyone should follow to avoid fluorosis.

Another eminent researcher and medical professional, Dr. D. Raja Reddy, said the groundwater can be de-fluorinated as well. "Defluoridation plants are based on adding aluminium compounds to the water containing high levels of fluoride. It may be noted that hundreds of crores of rupees were spent on erecting these plants in the 1980s and 1990s; not a single one is working now. Similar is the fate of household defluoridation units," he wrote in a research paper he published a few years ago.

Dr. Raja Reddy also said that even tea contains exceptionally high content of fluoride and each cup may add up to 2 milligrams of fluoride.

"A proper nutritious diet needs to be followed. There are three factors for the causation of skeletal fluorosis: water, food and nutrition. Water from the river Krishna needs to be provided for all purposes," he said.

Asara pension not enough

As part of Asara pensions, all fluorosis victims are to receive Rs. 3,016 per month.

"This amount is hardly sufficient for a nutritious diet and medicines. We hope the government considers increasing this amount to at least Rs. 10,000," Swamy said.