Chronic kidney disease in Rajarata, worse than tsunami
Posted on November 26th, 2013

by Prof. Sunil J. Wimalawansa

Safe drinking water is a fundamental human right, but more than 2.0 billion people in the world still lack access to safe-clean drinking water and to sanitation; Sri Lanka is no exception. Contaminated water and poor sanitation claim more lives than any war or any single disease. Toxic chemicals or organisms affecting health cannot necessarily be seen, tested, or smelled. Provision of clean water and sanitary facilities can save over 3 million lives globally and about 10,000 in Sri Lanka, annually.

Geographical and other issues


A casualty with his head on mother’s lap

Chronic Kidney disease (CKD) primarily affects middle-aged farmers. The CKD of multi factorial origin (CKD-mfo) in Sri Lanka is geographically demarcated, but is spreading to adjoining areas around the North Central Province (NCP) and elsewhere in the country. The farming communities are predominantly affected; of which more than 90% live in rural areas with little access to medical or preventative health facilities. Currently, the CKD-mfo-prone areas cover approximately 20,000 km2, and potentially affecting about 2.8 million Sri Lankans.

The occurrence of CKD is likely dye to consumption of polluted water/food, or yet unknown and thus, uninvestigated cause. Adverse environmental conditions, recent environmental unfriendly irrigation and agricultural methods, excessive use of phosphate-rich (and perhaps contaminated) artificial chemical fertilizer and toxic agro-chemical, and mishandling of petrochemicals, all may play a role in causing CKD-mfo; but no causality is demonstrated. It is paramount to launch an island-wide campaign to reduce the usage of artificial chemical fertilizers and toxic agro-chemicals, which necessitates gradual reduction of agro subsidies. All available data suggests that the CKD-mfo is an “environmentally” acquired disease.

Causes and incidence of CKDu

The water and food in the certain affected areas is polluted with low levels of toxic heavy metals, cadmium, arsenic, and lead, as well as with flouride, and toxic agro-chemicals and petrochemicals. Although the specific cause for the CKDu is unknow, it is of multi-factorial origin, and is due to a combination of chemicals and toxins that are prevent in this area. However, CKD-mfo can precipitate in the presence of other pollutants and toxic components that have not yet been investigated. The exact incidence or the causes of CKD are unknown, but over 100,000 people are currently affected (up to 10 to 15% of people in certain villages); unfortunately, the incidence continues to increase. Therefore, an urgent, cost-effective solution is necessary.

The reality

Approximately 400% of the inhabitants in Sri Lanka have access to clean, pipe-borne water supply. It is the prime duty of the Water Supply and Drainage Board to provide clean water via the same system to the remaining 60% of the population. People live in

villages should have the same privileges of having clean potable water provided via centrally purified pipe-borne water supply, that enjoy by the city dwellers. However, this may take another three decades or more to materialize fully. Unless intervene now efficiently, by then an estimated 250,000 predominantly middle-aged farmers will be succumbing to CKD-mfo.

There are no curative measures for those who acquire CKD-mfo, thus, prevention is the only way forward. Other than providing centrally purified pipe-borne water or clean water via reverse osmosis method, there is no other sustainable way of providing clean water to the affected villages, most of which are located in remote areas.

However, this must be implemented systematically and based on scientific basis. None of the variety of commercial filters that has been introduced to the area seems capable of removing the potential chemicals and toxins efficiently.

Methodologies

The North Central region desperately needs a cost-effective way to provide safe and clean water for its farming populace. Our analysis indicates that the Reverse Osmosis method is the most cost-effective, sustainable and environmentally friendly system than can remove all toxic components from the brackish water in NCP. However, not all reverse osmosis units are the same. Thus, it is imperative to install the right reverse osmosis water purification unit in a given village to provide clean water. Depending on the water quality/turbidity, electrical conductivity, chemical constituents, turbidity, etc., a pre-filter is necessary for the RO units. Philanthropic organizations and the water board are currently installing pilot units in villages in the Anuradhapura district. However, the Rajarata area requires approximately 400 of these reverse osmosis unites to provide clean water to its inhabitants.

Education, awareness and pollution prevention campaign

It is utmost important to initiate a region-wide awareness campaign on prevention of environmental pollution. This educational program must include (A) consequences of drinking contaminated water, (B) the importance of using safe and clean treated water, (C) water conservations methods, prevention of pollution of water sources and the environment, (D)essential precautions to be taken by farmers when using agrochemicals, (E) utilization of locally available organic substances and compost for cultivation and for pest control, etc. We have an on-going village level educational cum informative campaign on this since 2008; however, this needs to be intensified.

Provision of clean water to Rajarata

1. Prioritisation of villages to provide reverse osmosis water purification units.

2. Identification of the right RO units for the right village: as cost-effective, practical and sustainable way to provide clean water – via water treatment technology (removing all potential pollutants).

3. Availability of sustainable sources of brackish-water and method for clean water distribution.

4. Set-up infrastructure for proper operation and long-term maintenance of reverse osmosis plants.

5. Awareness program to encourage people to use clean water for drinking and cooking.

6. Regular monitoring of water quality as an integral part of the operation and maintenance.

7. Long-term data collation and systematic assessments to eliminate health problems in the region.

8. Capital, operational, maintenance and distribution costs; and cost recovery method.

Cost of installation reverse osmosis plants

On average, reverse osmosis plants costs about Us $8,900 to install (cost varies from $4,000 to $25,000, each unit). An average reverse osmosis unit provides safe and clean water to approximately 1,500 people (one or a cluster of 2 to 4 villages). We estimate that the entire region requires approximately 400 reverse osmosis plants, at a cost of US $4 million (500 million Sri Lankan rupees).

Cost-effectiveness

The number of deaths secondary to CKD in the affected region currently approximates 5,000 year. In spite of the diagnostic underestimations, this amounts to deaths of 13 farmers a day. Thus, each $650 spent on this project will prevent one CKD death per year. Therefore, over the expected life span of 30 years of an RO pant, investment of US $24 will prevent one death in Rajarata. Therefore, the proposed region-wide intervention is highly cost-effective.

With an estimated rate of 1% CKD-mfo related deaths, each reverse osmosis plant prevents approximately 10 deaths in a village, per year. Thus, over a 30-year period, each reverse osmosis plant will save about 300 lives. There is no medical or any other intervention where one could offer a solution to this region that is more cost-effective in reducing diseases burden and premature deaths.

Expectation and the hypothesis

The provision and the consumption of clean water will prevent the new occurrence of CKD-mfo. It would also decrease other chronic diseases and diarrhoeal diseases prevalent in the region. In 2012, department of health spent 3.6% of its annual budget, 350 million rupees to treat patients with CKD-mfo, and this cost is escalating. We estimate that the implementation of this proposed broader project would save about 500 million rupees per year in the health department budget alone. In addition, improvements in health reflect with increase productivity. Especially paddy and other agricultural productions in the region. Therefore, a rapid capital cost recovery is expected after commencing this project.

Current priorities:

Commitments and raising funds

A) Regional island-wide educational campaign on prevention of water and environment pollution.

B) Provision of clean, safe portable water using RO systems to CKD-affected villages in Sri Lanka.

C) Broad-based, environmental and sociological research program for CKD-mfo affected areas.

D) Government to provide adequate funds, and to develop collaborations and private-public partnerships, particularly with the not for profit sectors to implement the project and its longer-term maintenance in the region.

Once funds allocated, the Consortium of Concerned Philanthropic Organisation will (A) launch a extensive awareness campaign on prevention of environmental pollution and encouraging farmers to use less agro-chemicals, (B) professionally install reverse osmosis plants in the entire region providing clean water to all affected villages within the next 18 months, and (C) carry out a truly multi-disciplinary, prospective, long-term geo-water, health and socio-economic research program that covers the entire region. In addition to providing clean water, proposed project will also embrace on the provision of sanitary and toilet facilities. We look forward to undertaking a firm commitment by the government, provides adequate funds for the Consortium to implement this sustainable and extensive plan.

13 Responses to “Chronic kidney disease in Rajarata, worse than tsunami”

  1. helaya Says:

    Sunil,
    I am from Rajarata and when went to my village during recent visit to Sri Lanka I observed that excessive use of agrochemicals. Now the young farmers never clean the NIYARA (the bund separating LIYADDA), instead they use weedicide to clean it. Also the import and export of agrochemicals do not have any quality control. Have known any cluster analysis of the prevalence of the CDK? I think it is worthwhile to have a sociological and technical investigation to go together and find some solutions, How did the conference go in Peradeniya.
    Thanks

  2. Fran Diaz Says:

    Dear Dr Wimalawansa,

    Thank you for your concern and write up re CKDu. We are truly grateful to you.

    ———–

    Two ways to treat CKD is use of homeopathy remedies (will at least mitigate symptoms) and use of Chelation Therapy (under doctor supervision with heavy use of supplement vitamins and minerals).

    There is no replacement for safe drinking water other than use of the Reverse Osmosis systems which are used in some parts of America to deliver clean water to even small cities.

    Herewith a website which deals extensively with the subject of CKD and natural approaches to cure or mitigate symptoms :

    carahealth.com/health-conditions-a-to-z/digestive-system/detox/409-naturopathic-approaches-to-prevent-treat-heavy-metal-toxicity.html

  3. Lorenzo Says:

    Truth hurts so some shoot the messenger hoping the truth will be buried with the messenger. But it doesn’t.

    CKD is much worse than the tsunami. Tsunami killed MOSTLY Tamils so no real IMPACT on SL. In fact it was a blessing in disguise as it killed LTTE in Mulaitivu, etc.

    But CKD kills ONLY Sinhalese. That is the problem.

    But there is NO HOPE. This govt. is NOT concerned about clean drinking water of Sinhalese.

    e.g. Weliweriya – govt. KILLED Sinhala people asking for clean dirnking water while PUMPING OUT all good water from Sinhala areas to Tamil areas in Colombo.

    So what hope for CKD!!!

    Govt can lay pipes and pump good water to these people which will save them from CKD, water bourne diseases, etc. But NO HOPE. This govt. will NEVER EVER give clean drinking water to Sinhalese.

    2006 was an exception.

  4. Fran Diaz Says:

    Lorenzo,

    It is still not established HOW the wells of Rathupaswela got contaminated. The glove factor is not the cause. This whole affair has other dimensions to it, not yet revealed. In fact, it is somewhat like the 1983 Riots …

    ————

    We await for ‘sleeping’ ignorant human beings all over the world to awaken to Truth/God/Allah.

    An enlightened organisation in Switzerland suggests that a basic allowance be paid to every citizen through their government, whether they are employed or not.

  5. Fran Diaz Says:

    P.S. : The CKDu problems started about 20 yrs ago and the present govt. wasn’t around then. Credit must be given to the present govt. for initiating action on the problem. The earlier govts took no notice of it, probably no thanks to ltte terrorism.

    We saw a media release that registration of persons suffering from CKDu is under way and the first event has already happened.

  6. Lorenzo Says:

    Fran,

    It does NOT matter.

    IF people demand CLEAN WATER give it to them as others are getting it!

    Why this double standards?

    Have NO doubt. This govt. will NEVER give cleandrinking water to CKD people because they are NOT Tamils.

    Contrast the GRANDPASS RIOT just a week later. NO SHOOTING!! Why? Because the rioters were Muslims!! Just like 1983 when the rioters were Tamils!! NO shooting.

    The rioters in Weliweriya have been SUSPENDED from their military work. A case will be filed soon against them. Good move. The govt. has decided who the wrongdoers are. We can argue but the govt. decision has been made!!

  7. Fran Diaz Says:

    Lorenzo,

    We went through all debate this before re Rathupaswella.

    The army ought to dig bore holes in Rathupaswella and prove that there is clean water. If not, then action
    must be taken. New wells should be dug if there is clean water in the bore holes.

    CKDu people in the other 3 provinces adjacent to the Central Province will get clean water once the Reverse Osmosis system is in place. If useless War Crimes charges were not levied against the GoSL, then what needs to happen in the country will happen. Civilians do die in wars, caught in X fires etc. Nearly 63 Million died in WW II. No questions asked about that one.
    In this world, Might is Right. No more wars is a better way to go. Birth control freely available – a must.

  8. Lorenzo Says:

    Fran,

    “If useless War Crimes charges were not levied against the GoSL, then what needs to happen in the country will happen.”

    I DISAGREE.

    Our enemies will ALWAYS try to destroy SL. That is their NATURE.

    We should do what is needed for SL regardless.

    Who really cares about war crimes? I’m sure less than 5% in SL. Look after the rest of the 95%.

    Birth control for Sinhalese – NO. They alwaready control their birth rate which is the LOWEST.

    Birth control for Tamils – YES.
    Birth control for Muslims – YES.

    Pipe water for ALL water related problem affected areas not just to Colombo.

  9. Nanda Says:

    Black dress has become the dress of 80% muslim women. It was 0% 20 YEARS AGO.
    I saw some special GONIBILLAs I have never seen before. Everything 100″ black, no holes to eyes. Hand also covered with black gloves. Old , bearded husband must hold hand to guide. Never seen in Middle East even.

  10. aloy Says:

    IFS also have done some useful work at last. They too are now working on CKDu. According to a news report today, they have discovered that the high level of phosphorous being used by upcountry farmers is causing algae bloom in the downstream water bodies in NCP and those algae releases poisonous substances that can cause CKDu. I thought it is Ammonia (nitrogen compounds) that gives rise to algae bloom.

  11. Fran Diaz Says:

    Lorenzo,

    I agree with you that clean pipe borne water should be available ALL OVER THE ISLAND, not just to main cities. Under the Basic Human Needs it is Food, Clothing & Shelter. Our bodies are 70% Water, and clean Water is more important than even Food. Water has to come under the Food header. Food can be grown only if there is Water.

    Our Survival Needs are surfacing, now that the ltte war is sort of over and the CHOGM is also over. Let us get together and sort things out.

    aloy,

    You are right. I saw the same article which I reproduce below. But I wonder as some other readers do, why it is that CKD is prevalent in the provinces adjoining the Central Province, but not in CP itself which uses fertilizers extensively for tea and vegetable crops.

    Thursday, 28th November 2013

    Daily News Online : Sri Lanka’s National News
    HomeLocalEditorialPoliticalBusinessFeaturesSportsWorldEntertainmentLettersObituaries
    Thursday, November 28, 2013 (All day)
    LOCAL
    Agri-Ministry to deal with high phosphorus levels in vegetable cultivations
    Ishara Mudugamuwa

    The Agriculture Ministry will take immediate measures to address the issue of high soil phosphorus levels in vegetable cultivations specially in the up-country, Agriculture Ministry Additional Secretary (Development) Nimal Dissanayake said.

    Addressing a media conference held yesterday presided over by Agriculture

    Minister Mahinda Yapa Abeywardane, the Additional Secretary said the Phosphorus content in farming fields in Nuwara Eliya has exceeded the limit due to the excessive additions of chemical fertilizer.

    According to the researches conducted by Agricultural experts of the Agriculture Department, most of the farmers in Nuwara Eliya continue to add large quantities of phosphate fertilizer to their farm lands. This amount is 5-10 times more than the amount recommended by the Agriculture Department.” the Additional Secretary said.

    According to scientists, the maximum amount of soil phosphorus required for agricultural crops (Agronomic Critical Level) is 30-40 ppm and in more than 70- 80 percent of farming lands in the up-country this limit has exceeded.

    Adding more phosphate fertilizer to these lands with high phosphorus content is only a waste of money.

    The recommended environmental level of phosphorus soil content (Environmental

    Critical Level) in most countries is 60 ppm. In more than 1,000 vegetable growing lands in the up-country, this level has been exceeded.

    The excess fertilizer addition has also badly affected the pollution of water bodies as the surface soil enriched with phosphorus can move out of the land by erosion and enter the water bodies.

    Most of the irrigation reservoirs in the North Central Province have been badly polluted with phosphorus. Water in these reservoirs cannot be used due to the algae bloom.

    According to researches conducted by the Institute of Fundamental Studies, Kandy, the algae releases various poisonous substances to the water. Some scientists say that these poisonous substances are injurious to health and it can be a reason for kidney disease that is prevalent in the North Central Province.

    – See more at:dailynews.lk/local/agri-ministry-deal-high-phosphorus-levels-vegetable-cultivations#sthash.OipjNNkr.dpuf

  12. Lorenzo Says:

    Fran,

    Sinhalese must play the VICTIM CARD always just like Tamils and Muslims.

    Otherwise they will be IGNORED.

    (Unless Tamils and Muslims STOP playing the victim card.)

    But I don’t think the govt. will resolve the miseries of CKD patients. NO BUDGET ALLOCATION anyway!!

  13. Senevirath Says:

    the govt will never do anything agaist Agro chemical companies I still can rememberhow govt used Hudson Silva to abuse Prof . Nalin de silva and others regargind their findings about arsenic in rajarata water. Even the president has said that the “”MEDITATION LADY”” who advised the kelaniya researchers was a lunatic.

    These “”PUSHPA KUMARAS””” WILL NEVER UNDERSTAND WHAT MEDITATION IS

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