Fluorosis the Mystery Disease

Kavitha  Yarlagadda

Copyright 2018 by Kavitha Yarlagadda


Photo of children suffering from Fluorosis.

A quiet village, people going around their daily chores in a mundane way, all seems well, but as you go further into the village, we come across young children limping around, a crippled man dragging himself on the ground to move around and a stooped woman going about her work, this is the sight that greets us, as we enter Cherlapally, in Nalgonda District, a small village hardly 100 km from the famous city of Hyderabad, with around 1050 families. Around 50% of the people of this village are suffering from Fluorosis of both types dental and skeletal fluorosis.

Fluorosis is a chronic disease which is caused due to the presence of excess fluoride in water which causes mottling of teeth and if severe it causes calcification which results in damage to ligaments. The risk of fluoride is there in all ages, but mostly effects young children up to 10 years. As per the World Health Organization the permissible limits of fluoride in water is up to 1mg per liter but in some states in India, the fluoride limit in water is as high as 10mg per liter. Nalgonda district in Telangana, is one such town which has the highest presence of fluoride in drinking water, because of consuming such high fluoride content water since more than a decade, most of the people in Nalgonda are found to have mottled teeth, disfigured limbs, bent down stupor, crippled and stunted physical growth which has been the sad state since a long time. A 27 year old young man looks like a 10 year old, this is what fluorosis has done to the people of Nalgonda, and in fact many of the residents have to remain bachelors for the rest of their lives, as nobody is ready to marry them.

 Compared to dental fluorosis, people suffering with skeletal fluorosis apart from being crippled also face social stigma, wherein they are not accepted into the social circles in the society which is harder to deal than the physical inability. Skeletal fluorosis is caused due to the excessive presence of fluoride in the bones which does not have any initial symptoms but in later stages results in joint and bone pains, osteoporosis, fatigue, tingling, weakness and a reduced appetite. In fact the concentration of fluoride ingested by the person daily is known to be equal to around 20mg continuously for over 20 years, for him to be suffering with skeletal fluorosis.

Since many years both the Central and State government have been working with other NGOs and have invested a lot of money, by trying to solve the problem by setting up fluoride treatment plants, but all in vain as the problem still exists. The main reason for the sustenance of the problem is the delay in projects because of the siphoning off of money by the contractors thereby leading to incomplete projects. The requirement for Nalgonda district to overcome this issue is the quick restoration of the more than 4,000 tanks in the town out of which many are not operational. The major cause for fluorosis was found to be the excessive usage of bore wells in the recent times as compared to using water from open wells and lakes, the excessive digging of bore wells resulted in the penetration of sub surface levels where the fluoride levels are the highest resulting in the contamination of drinking water. Many schemes were launched by the State Government in a vain bid to tackle this situation but none of these schemes have been able to solve the problem of fluorosis.

Even after all these years the residents of this town do not have any choice but to drink the water which has fluoride levels of 1.5 to 3mg per liter, many school children in Nalgonda are forced to drink this water, when the officials on finding fluoride in this water stopped the supply of drinking water to these schools, and now these children are drinking water taken from the many hand pumps in the town which is not only unhygienic but also contains fluoride levels of 2.5mg and above. Fluoride if within the permissible limits is actually a required substance which helps in reducing tooth decay and strengthens our bones, but the excessive fluoride causes fluorosis and more than 10mg causes crippling skeletal fluorosis which is the situation in Nalgonda district.

It is usually very expensive and difficult to reduce the high concentration of fluoride in water, because of which we have to depend on other sources of water, but if that is also not possible like in the case of Nalgonda district, the best option would be to go for de-fluoridation of the water. The most common methods of removing fluoride are sand filtration, chlorinating the water and disinfecting the water using ultraviolet rays. Other expensive methods of treatment are the bone charcoal method which helps in filtering out the fluoride and later the charcoal is removed, another method is precipitation method in which Aluminum Sulphate and Lime are added to the fluoride water and later the sludge thus formed over the water which has high concentrates of fluoride is removed, a final method is using activated Alumina to filter out the fluoride. The water used for drinking and cooking purposes can be de-fluorinated using the above methods.  

Alternatively people of fluoride affected areas can opt for alternative drinking water sources like rainwater, which in fact is the best alternative source, wherein every household should have a rain water harvesting pit by which they can use this water for drinking and cooking purposes, as building reservoirs is a costly affair. UNICEF is working along with the Government of India and actively initiating the process of de-fluoridation in all the states affected by fluorosis. UNICEF is playing an active role since the past 5 years in India by monitoring the quality of water and helping in setting up fluoride treatment plants in households across India. Fluoride becoming a worldwide importance, UNICEF has been assisting the affected states with solutions like creating awareness among people about the impact of fluorosis on children, alerting the governments and the public regarding fluorosis and stressing the importance of monitoring the quality of water, importance of taking nutritious food, establishing certain effective projects which offer low cost fluoride treatment and helping the community and government in the prevention of fluorosis by monitoring regularly the health of people and quality of water.

The most responsive and effective move by the then Congress government was when they vowed to solve the fluorosis issue in Nalgonda and was committed to provide drinking water from the Krishna river, and accordingly the project of constructing tunnels and reservoirs to provide safe drinking water to Nalgonda started in 2006. In the meanwhile, safe drinking water is being provided many days in a week from a reservoir which collects water from the Krishna river basin. Even though drinking water is being supplied to some villages now, certain villages in Nalgonda district are still bereft of drinking water and depend on the ground water only for their daily needs which still consists of high concentrates of fluoride. With the Telangana government in power now, one can only hope that at least the future generation of Nalgonda District will be free of fluorosis.

Skeletal fluorosis apart from Nalgonda and neighboring districts in Telangana state is prevalent in other states of India like Chhattisgarh, Jharkhand, Madhya Pradesh, Tamilnadu, Bihar, Gujarat and Rajasthan. The worst affected states being Telangana, Rajasthan and Gujarat, the only way to prevent fluorosis is by creating awareness among the people regarding the necessity of using rain water, improved nutrition and proper health education.

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