Eminent Assamese filmmaker Manju Borah came to Diphu, district headquarters of Karbi Anglong, to make a docu-feature on a Karbi legend. The script was written by Basanta Das, a Diphu-based writer who also selected a Karbi girl, Kadam, for the lead role. Borah wanted to interact with the girl at least two days prior to the location visit; but he was shocked when he saw her. Not only was she not as beautiful as her character demanded, but her teeth were discolored, her neck was braced, her face wrinkled. Then Basanta Das walked in - and was equally taken aback. "But," he sputtered, "Kadam was really beautiful when I met her three years ago!"

Kadam is suffering from hydrofluorosis (or fluorosis), a waterborne disease that affects at least 100,000 people, more than half of them women, in Assam. Hundreds of villages in Karbi Anglong, Nagaon and Kamrup districts have been identified as fluorosis-prone. According to statistics (where are the stats taken from?), of 62 million Indians suffering from fluorosis, more than six million are children and young people. Among these young, nearly 20,000 are in Assam alone. Well-known for its scenic beauty and thick rainforest, Karbi Anglong is by far the worst affected, with 10 per cent of its population of 800,000 - or 70 per cent of Assam's fluorosis patients - hit by either dental fluorosis or skeletal fluorosis.
The first fluorosis case in Assam was discovered during a study, the first in the northeast, by the state Public Health Engineering Department (PHED) in May 1999 in the Tekelangjun area of Karbi Anglong. Fluoride levels there were found as high as 5-23 milligrams per litre (mpl), whereas the permissible limit set by the World Health Organization is 1.5 mpl.

Says Amalendu Bikash Paul, then additional chief engineer in the state PHED, who was instrumental in unearthing the rampant disease, "Severe anaemia, stiff joints, painful and restricted movement, mottled teeth, loose muscles, kidney failure, premature death and physical disability are manifestations of fluorosis." He adds that women and children are more prone to the disease as they are generally homebound and, thus, in contact with contaminated water for a longer time. Furthermore, malnutrition during childhood renders the women more vulnerable.

Fluorosis has no cure: it can only be prevented from deterioration if diagnosed at an early stage. Fluoride replaces hydroxide in the bones, leading to chronic skeletal fluorosis. Meet Gita Deb, 49, a resident of Tekelangjun (about 90 km from Diphu), who has been suffering from the disease since 1995. Now paralyzed and restricted to bed for the past three years, Gita feels severe pain in her waist, legs, hands and, lately, her finger joints. Earlier, she could move with the help of a stick, but now she can barely sit up on the bed for a half hour.

The nearby government health centers don't supply her any medicines, leaving her husband, who used to run a small shop in Baghpani Bazaar, as her sole caretaker. Not having a bedpan, the family of three lays a plastic sheet on the bed, which is washed twice a month and reused. This is when Gita has to be carried outside. Their only son, a school student, is also slowly getting affected with dental fluorosis. Two of the Deb daughters, who married and left for distant villages, had also begun complaining of severe joint pains and semi-paralysis.
Gita and her husband had migrated from Tripura to Karbi Anglong about 25 years ago. In the early days, the family used spring water. In the early 1990s, the state PHED launched a drinking water supply scheme in the locality. The family then started using groundwater and continued till fluorosis was discovered in 1999. The PHED immediately abandoned the supply scheme and warned people against using groundwater for drinking and cooking purposes. It arranged to transport spring water into the village from a nearby hillock. Today, harassed into desperation, many families in the villages prefer to use water from wells about 10 ft deep.

Statistics (from where?) reveal that fluorosis is endemic in at least 20 states. These include Andhra Pradesh, Gujarat, Rajasthan, Bihar, Punjab, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu, Uttar Pradesh, Assam, Kerala, Orissa, West Bengal, Uttaranchal, Jharkhand, Chhattisgarh, and Jammu and Kashmir. Countries such as Bangladesh, Pakistan, Sri Lanka, Thailand, Japan, China, Jordan, Iraq, Iran, Syria, Turkey, the United Arab Emirates, England, Italy, France, Germany, Spain, Portugal, New Zealand, Australia, USA, Mexico, Argentina, Egypt, Kenya, Tanzania, Ethiopia, and Uganda have noted incidences of the disease.

Serious efforts had been made to eradicate fluorosis in India after the launching of the Rajiv Gandhi National Drinking Water Mission in 1986. Now the Union government is said to have decided to set up a Fluorosis Mitigation Centre for referral, documentation and validation. UNICEF and some local NGOs like the Jirsong Asong, the Lions Club, and the Nehru Yuva Kendra are working with health awareness drives in the affected areas.

There is no denying the connection between flurosis and poverty. Almost 80 per cent of those affected in Assam are acutely poor, illiterate and socially unaware. Addressing fluorosis would obviously mean minimizing socioeconomic deprivation first. While healthcare might mitigate the crisis in the short term and awareness in the medium term, the economic independence of the people is the only long-term solution.

Skeletal fluorosis, which can cripple a working individual, directly affects earning capacity. Dental fluorosis, on the other hand, doesn't restrict a patient's movement but, because it looks devastating, adversely affects the matrimonial aspect of girls and boys. Even after marriage, repeated quarrels between wives and husbands can cause serious problem in their conjugal life. The disease also gives rise to an inferiority complex among its victims. Kadam, thankfully, got over her complex when Borah told her that she would be working in Borah's next venture. Till then, Borah told Kadam, she should take care of her health. That, is another matter altogether.