Reports of unusually high rates of chronic kidney disease and death due to kidney failure in a cluster of villages in Chhattrapur Block of Ganjam District have recently been covered by The Wire and a few Oriya-language newspapers.
Alarmed and disturbed at these reports, a group of concerned citizens constituted a fact-finding team and visited the area on 19-20 January 2018. Team members are all senior human rights workers who have written and researched extensively on public health and people’s health issues.
During the visit, the team met and interviewed over 25 affected persons, their families and local leaders in three of the affected villages (Badaputti, P-Lakhimpur and Baginipetta). The team also met the District Collector and IREL officials, district health officials and the senior Consultant Nephrologist of MKCG Medical College.
At a press conference in Bhubaneswar on 21 January, the team shared its main findings.
- The three villages show an unusually high incidence of chronic kidney disease. All the persons interviewed and cases cited were substantiated with diagnostic reports, treatment records and medical certificates.
- Records from local activists mention at least 200 cases diagnosed over the last three years, with at least 70 deaths, most of them of individuals of working age. This is significantly higher than the highest figure reported so far – 229 per million population reported by a national level study in 2006.
- The persons interviewed all spoke of how they have been completely impoverished by the disease. Most if not all of the persons interviewed are landless agricultural workers depending on seasonal work and collection of forest produce. In the absence of limited facilities at the MKCG Medical College, patients are forced to resort to private doctors and clinics. Average treatment costs are reported to be in the range of 5-7 lakhs over two years. Families have no alternative but to sell or mortgage their tiny landholdings land and meagre assets, and have been compelled to take loans from private sources at interest rates of 2-3% per month.
- With adult members of the household having to leave the workforce to take on the burden of caring for patients whose condition is deteriorating, the team noted with distress that children have had to leave school to join the workforce. The team met some young men who have left their education or, in some cases, jobs to support their families. Some young girls have sacrificed their hopes of higher education and professional careers and have migrated to work in factories in neighbouring Andhra Pradesh.
- The affected villages have been subjected to a form of social quarantine by neighbouring communities. The team was told that people are refusing to marry into these villages, and are unwilling even to buy their produce such as coconuts. As a result, the overall economy of the affected villages is spiralling downwards.
- The affected villages are also the locations where land was acquired on long-term lease by IREL, a PSU under the Department of Atomic Energy, in the late 1980s. These lands were thickly forested with cashew trees that provided a source of income for the villagers. Although compensatory afforestation has been carried out on the reverted land, the trees are not yet yielding fruit. This has caused considerable loss to the community.
- Morale in the affected villages is extremely low. There are several instances where people suffering preliminary symptoms have refused to go to a doctor since they are terrified of being diagnosed with kidney disease which they speak of as tantamount to a death warrant. There has been at least one incident of suicide of a man diagnosed with chronic kidney disease. The team was also told about the family of Gourango Sahu in P Lakshmipur) where all six members – Sri Sahu, his two wives and their three adult children – have all succumbed to kidney failure within a period of a few years.
- None of the persons interviewed have been able to access any entitlements available through government programmes such as health insurance (eg under Pradhan Mantri Swasthya Suraksha Bima Yojana) or work in the lean season under MNREGA. Many families seem to be surviving primarily on the cheap rice available under the 1/- kilo scheme.
- The local population holds the view that the high rates of kidney disease afflicting the area are a consequence of contamination of ground water with toxic by-products of monazite processing at the Indian Rare Earth facility located about one kilometer away from Badaputti village. The team was shown water drawn from local tubewells, with a thick sediment of some chalky substance at the bottom. Every single household in the area is purchasing bottled water or has installed expensive RO filters in their homes.
- The district administration and officials of IREL oppose this theory and offer the results of water testing conducted by the Regional Pollution Control Board, the State Public Health Engineering officials and a district medical official, which declared the water to be fit for drinking. However, the team noted that the tests tracked the presence of only two heavy metals (lead and cadmium) and did not test for the several other toxic by-products of thorium processing such as molybdenum, mercury and psyrium.
- Despite the clean chit given to the water from local tubewells by the above team, the district administration has taken up a scheme for providing drinking water via a pipeline from a new deep tubewell located about 2 km from Badaputti. This scheme is expected to be completed in three months.
- Dr Saroj K Panda, consultant nephrologist at the MKCG hospital in Behrampur, met the team. As the largest public hospital in the area, MKCG hospital has been the first port of call for a very large number of patients from the affected area. Dr Panda confirmed that dialysis facilities in MKCG hospital were limited as a result of which patients had to seek private treatment.
- Dr Panda expressed the view that the high rates of chronic kidney disease in the affected villages is a new phenomenon in the area and is definitely the result of one or more environmental factors, of which contamination of water and food are strong possibilities. Since there are several research studies confirming the association of heavy metal elements with chronic kidney disease, he agreed that this aspect should be rigorously researched.
- The team was able to access the report of a study undertaken by the district health department in 2015, following an intervention by the NHRC in response to a petition from a local person. The study report (a copy of which was shared by the CDMO’s office) speculated that likely causes could be contamination of water with heavy metals or pesticides, or inhalation of pollutants expelled into the air by the IREL facility. The report recommended evacuation and resettlement of the affected villages pending investigation and remediation of the problem.
- It is noteworthy that although this report was submitted to the State government three years ago (March 2015), no action whatsoever has been taken to follow up on the findings and recommendations.
The team finds that the inhabitants of the affected villages are not merely unfortunate victims of a deadly disease, but are also being subjected to denial of basic rights promised under the Constitution. For no fault of their own and merely by virtue of their location in this area, they have been forced to forfeit their rights to work, right to a safe and secure physical environment, right to health and most of all their right to live with dignity and security in their own homes. Whatever the cause of the disease that is stalking them, they surely have a legal and moral claim on the state for restitution and rehabilitation. The silence and inaction of the Government of Orissa on this issue is condemnable.
- Immediate investigation by a high-level expert team into the increasing incidence of chronic kidney disease in the villages surrounding the IREL facility, Chhatrapur, in order to conclusively establish the causal factors and recommend actions for prevention and remediation.
- Provide immediate relief to affected individuals through free treatment at MKCG or other government facility with adequate infrastructure and expertise to handle the large patient load.
- Urgently set up a system for preventive and promotive measures such as regular village-level medical camps for early identification and treatment of susceptible individuals and patients in the early stages.
- Immediate action by the State government to fulfil the right of the affected communities for clean and safe water for domestic consumption and use.
- Action to remove potentially toxic solid waste in and around the affected villages, in particular the waste dumps around the tailing ponds outside the IREL facility.
Dr Kalyani Menon-Sen, Dr Nisha Biswas, Basudev Mahapatra and Ranjana Padhi