An Overview of Arsenicosis

In an effort to eliminate mortality associated with water-borne disease in the 1970s in Bangladesh, a nationwide effort organized by UNICEF saw the installation of millions of shallow tubewells, widely replacing untreated surface water as a source of drinking water. Tubewells are used by as many as 97% of the rural population. At this level of the water table, carcinogenic inorganic arsenic compounds are prevalent, thus exposing millions to a host of health complications.

Tubewells scattered throughout rural Bangladesh are supplying the populace with arsenic-contaminated water. Consequently, an estimated 35 million inhabitants of rural Bangladesh are at elevated risk of developing complications associated with chronic arsenic poisoning. Chronic arsenic poisoning is defined as the effects of long term arsenic exposure from the consumption of contaminated water. The presence of excessive levels of arsenic in the body is known as arsenicosis—a condition that currently affects as many as 2 million individuals with varying degrees of symptomology.

Arsenicosis symptomology is classified into four distinct stages. The pre-clinical stage occurs within the first few years of exposure, and elevated arsenic levels can be detected in the urine and tissue. The second, clinical stage is characterized by skin lesions, gangrene, keratosis, and melanosis—typically on the hands, feet, and trunk—and tends to manifest itself between five and ten years of exposure. The third stage involves pronounced external expressions in addition to complications with internal organs. The final stage, occurring after approximately 20 years of exposure, is marked by the development of cancers of the skin, bladder, kidneys, and lungs. There is currently no known cure for the symptoms of arsenic poisoning, thus intervention efforts have been strongly directed at modes of prevention.

In addition to the physical complications associated with arsenicosis, there are myriad social implications as well. The poor dissemination of reliable information not only precludes awareness of dangers and consequences associated with drinking contaminated water; it also prevents rural Bangladeshi societies from recognizing and understanding arsenic poisoning. The early, visible symptoms of arsenicosis are mistakenly associated with leprosy. Even in cases in which symptoms are recognized as those of arsenicosis, the disease mechanisms are not well understood, and sufferers are consequently stigmatized and marginalized. Women who suffer from arsenicosis are considered unmarriageable; children of arsenicosis patients are excluded from schools. Arsenicosis is still, in many areas, perceived as a contagious disease. In some districts, superstition leads many to view affected persons as having been cursed by God or evil spirits.

While some studies have targeted the social and cultural aspect of arsenicosis, there is a great deal still to explore in that vein. There are several particular areas in which further anthropological analysis could be applied to work toward alleviating this public health crisis--more on this in an upcoming entry.