1. Solving the Largest Mass Poisoning in History: Metal-affected Drinking Water in Bangladesh, India, and Myanmar
S.H. Frisbie,
T. Bacquart,
C. Cole,
L. Grigg,
E.J. Mitchell,
D.M. Maynard,
J. Defelice,
C. Small,
B. Sarkar
R. Ortega,
K. Bradshaw,
H. Dustin,
G. Springston,
Copyright © 2018 Seth H. Frisbie, Ph.D. All rights reserved.

2. A History of Drinking Water
Since the beginning of human history until very recently, we have used only surface or dug well water for drinking.
In 1862 the tubewell was invented by Col. Nelson W. Green and deep well water became easily accessible for drinking.
Today billions of people use deep well water for drinking.
(Photograph by Peer
Water Exchange, 2006)
(Col. Nelson W. Green)

3. A History of Drinking Water (Photograph of Vibrio cholera
Surface and dug well water often has microorganisms that can make a person sick hours or days after drinking.
High dissolved oxygen (O2) and the removal of ions by leaching gives surface and dug well water low concentrations of arsenic (As), manganese (Mn), and other metals.
(Photograph of Vibrio cholera
by Jozef Rosinský)

4. A History of Drinking Water (Images by Theodore Gray)
In contrast, deep well water rarely has pathogenic microorganisms.
Low dissolved O2 and the accumulation of ions from leaching gives deep well water high concentrations of As, Mn, and other metals that can make a person sick after years or decades of regular drinking.
The diagnosis of chronic metal poisoning is made difficult by the 5 to 20 or more years of exposure needed to produce symptoms.
(Images by Theodore Gray)

5. A History of Drinking Water
This graph suggests that As is released from solids to deep well water by low dissolved O2.
Graph of As concentration (mg/L) versus oxidation-reduction potential (mV).

6. A History of Drinking Water in Argentina (Photographs by Ayerza, 1918)
In the 1880s tubewells were first used in Northern Argentina.
In 1916 Dr. Abel Ayerza found that both people and chickens had symptoms similar to pharmaceutical As poisoning.
Later, Ayerza checked things in common and found As and vanadium (V) in the drinking water.
(Photographs by Ayerza, 1918)

7. A History of Drinking Water in Bangladesh
Rivers, ponds, and dug wells were the only practical source of drinking water for about 3,000 years until the 1970s.
A massive cholera outbreak began in 1963.
(Photograph by Dhaka Hospital)
Many premature deaths were caused by drinking surface water.
The life expectancy during the mid-1960s was only 46 years.

8. A History of Drinking Water in Bangladesh
Approximately 10,000,000 tubewells have been installed since 1971 to supply safe drinking water.
Within 1 generation the population changed from drinking surface water to drinking groundwater.
By 2000, approximately 97% of Bangladeshis drank tubewell water.
(Photograph by Steven Brace, 1995)

9. A History of Drinking Water in Bangladesh
The symptoms of chronic As poisoning from drinking water usually take 5 to 20 years to manifest.
Chronic As poisoning from drinking tubewell water was first diagnosed in 1993.
Keratosis of the feet
Blackfoot disease
Keratosis of the palms
(Photograph by Dhaka Community Hospital and Richard Wilson, 2002)
Melanosis of the chest

10. A History of Drinking Water in Bangladesh
The first national-scale map of As concentration in Bangladesh’s tubewell water was made in 1997.
Approximately 75,000,000 Bangladeshis are at risk of death from skin, bladder, liver, and lung cancers caused by chronic As poisoning.
The source of As is geological.
Map of As
concentration (mg/L).

11. The Discovery of Other Toxic Elements in Bangladesh’s Drinking Water
Analyte
Independent
Standard Recovery
(Analyte Added to Distilled Water)
Sample Matrix
Spike Recovery
(Analyte Added to
Drinking Water)
Arsenic (As)
83%
89  11%
Ferrous iron (Fe2+)
93  10%
34  23%
Total iron (Fe)
95%
Not measured, at least 27% of samples developed the wrong color.
At least 27% of the drinking water wells in Bangladesh contain an analytical interference to the 1,10-phenanthroline methods for measuring ferrous iron and total iron.

12. The Discovery of Other Toxic Elements in Bangladesh’s Drinking Water
Locations of tubewells that contained interfering metals are labeled with the letter “E”.
This suggests that other toxic metals besides As are widely distributed in Bangladesh’s drinking water.
Map of Fe concentration (mg/L).

13. The Discovery of Other Toxic Elements in Bangladesh’s Drinking Water
In addition, the early onset of chronic As poisoning suggested that multimetal health effects are possible.
The problems measuring iron and the early onset of chronic As poisoning were the first evidence that other toxic elements are widely distributed in Bangladesh’s drinking water.
(Photograph by NGO Forum, 2002)

14. Map of Mn concentration (mg/L).
60% of Bangladesh’s area contains groundwater with Mn concentrations greater than the WHO drinking water guideline.
Manganese in drinking water is a potent neurotoxin, associated with violent behaviors and depression. It causes learning disabilities in children and Parkinson's-like symptoms in adults.
It causes liver and kidney damage, and is associated with hearing loss.

15. Map of lead (Pb) concentration (mg/L).
3% of Bangladesh’s area contains groundwater with Pb concentrations greater than the WHO drinking water guideline.
Lead is a potent neurotoxin, associated with IQ deficits and learning disabilities in children and dementia in adults.
It is also associated with kidney, liver, and heart disease, tooth loss, cataracts, hypertension, diabetes, and bladder cancer.

16. Map of nickel (Ni) concentration (mg/L).
< 1% of Bangladesh’s area contains groundwater with Ni concentrations greater than the WHO drinking water guideline.
Nickel is a potent carcinogen.
It is also associated with lung, heart, and kidney disease and can induce spontaneous abortions.

17. Map of total chromium (Cr) concentration (mg/L).
< 1% of Bangladesh’s area contains groundwater with Cr concentrations greater than the WHO drinking water guideline.
Cr(III) is the form most often found in drinking water. Chronic exposure inhibits DNA synthesis and the fidelity of DNA replication.
Cr(III) accumulates in the liver; persons with existing liver disease may be exceptionally susceptible to its toxic effects.

18. Estimated number of Bangladeshis drinking water with metal concentrations above WHO guidelines.
Carcinogenic Potential
WHO Guideline (µg/L)
Percent of Bangladesh’s Area Exceeding WHO Guideline
Number of Bangladeshis Drinking Unsafe Water a As Mn Pb Ni Cr
Known carcinogen
Noncarcinogen
Possible carcinogen
Probable carcinogen 10
400 20 50 49 60 3
< 1
75,000,000
92,000,000
4,600,000
< 1,500,000
a Assuming Bangladesh has 158,570,535 people (July 2011 est.) and 97% of its population drinks well water.
Tens of millions of Bangladeshis are drinking water that exceeds WHO health-based guidelines for As, Mn, Pb, Ni, and Cr.
Boron (B), barium (Ba), molybdenum (Mo), and uranium (U) have also been found above WHO health-based guidelines in Bangladesh.

19. REMEDY #1: Testing Can Provide Safe Water to Millions
Map of average As
concentration (mg/L).
Map of minimum As concentration (mg/L).
45% of Bangladesh’s neighborhoods contain groundwater with average As concentrations greater than the 50 µg/L national standard.
15% of Bangladesh’s neighborhoods contain groundwater with minimum As concentrations greater than this standard.
Therefore, 85% of Bangladesh’s neighborhoods have at least 1 tubewell that does not require treatment for As removal prior to drinking.

20. Testing Can Provide Safe Water to Millions
As a result of this discovery, groundwater testing has become a major component of an overall strategy for providing safe drinking water to the people of Bangladesh.
Tubewells are considered safe and marked with green paint if the As concentration is less than or equal to the 50 µg/L national standard.
Conversely, tubewells are considered unsafe and marked with red paint if the As concentration is greater than 50 µg/L.
(Photograph by The World Bank Group, 2005)

21. REMEDY #2: Drilling Deeper Tubewells May Access Safe Water
The vertical distribution of As in groundwater (mg/L) based on adjacent pairs of “very deep” (67 to 335 m) and “shallow” (less than 28 m) tubewells.
Drilling deeper tubewells can access water with markedly less As.
This approach should be used in the 15% of Bangladesh that cannot find drinking water with As concentrations less than the national standard from existing tubewells within their village.

22. Drilling Deeper Tubewells May Access Safe Water

23. REMEDY #3: Treatment Can Provide Safe Water
The quality of water entering and leaving a storage tank which supplies drinking water to 300 people.
Parameter
Influent
Effluent
Arsenic (µg/L)
Oxidation-reduction potential (millivolts) pH
Conductivity (microsemans)
Temperature (oC)
Total iron (µg/L)
Sulfate (µg/L)
Sulfide (µg/L)
Chloride (µg/L)
Phosphate (µg/L)
160
-38
7.06
514
27.2 NA
< 2 19
6.47
344
28.2
1,400
< 1,000
< 30
16,000
1,300
The As concentration is lowered from 160 to < 2 µg/L.
The O2 in air converts As(III) and Fe(II) to a solid which settles to the bottom of the tank.

24. Treatment Can Provide Safe Water

25. The Discovery of Multiple Toxic Elements in
West Bengal’s Drinking Water
The deep well water from neighboring West Bengal, India has unsafe concentrations of As, B, fluoride (F-), Mn, and possibly thorium (Th).

26. The Discovery of Multiple Toxic Elements in Myanmar’s Drinking Water
The deep well water from neighboring Myanmar has unsafe concentrations of As, F-, Mn, and U.
This rapid switch to deep well water is exposing hundreds of millions of people in south Asia to unsafe concentrations of metals.
This has been called the largest mass poisoning in history.

27. A Challenge for Drinking Water Scientists
Abundance of elements in the earth’s crust.
Elements with WHO drinking water guidelines are white.
No.
Ele.
ppm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 O Si Al Fe Ca Mg Na K Ti H P Mn F Ba Sr S C Zr V
455,000
272,000
83,000
62,000
46,600
27,640
22,700
18,400
6,320
1,520
1,120
1,060
544
390
384
340
180
162
136 20 21 22 23 24 25 26 27 28 29 30 31 32
33a
33b 35 36 37 38 Cl Cr Ni Rb Zn Cu Ce Nd La Y Co Sc Nb N Ga Li Pb Pr B
126
122 99 78 76 68 66 40
9.1 39 41 42 43 44 45 46 47
48a
48b 50 51 52 53 54
55a
55b
55c Th Sm Gd Er Yb Hf Cs Br U Sn Eu Be As Ta Ge Ho Mo W Tb
8.1
7.0
6.1
3.5
3.1
2.8
2.6
2.5
2.3
2.1
1.8
1.7
1.5
1.3
1.2 58 59 60 61 62 63
64a
64b 67 69 70 71
72a
72b 74
75a
75b Tl Tm I In Sb Cd Ag Hg Se Pd Pt Bi Os Au Ir Te Re Ru Rh
0.7
0.5
0.46
0.24
0.2
0.16
0.08
0.05
0.015
0.01
0.008
0.005
0.004
0.001
0.0007
0.0001
Only 14 of 76 (18%) elements in the earth’s crust have a WHO drinking water guideline. Many of the remaining elements are toxic and commonly found in groundwater. More guidelines are needed.

28. A Second Challenge for Drinking Water Scientists
50 µg/L
10 µg/L
7 µg/L
0.17 µg/L
0.004 µg/L
The maximum allowable concentration of As in drinking water set by the governments of most developing counties;
1 excess cancer death/80 people
The maximum allowable concentration of As in drinking water recommended by the WHO and set by the governments of most developed counties; 1 excess cancer death/400 people
The detection limit for measuring As in drinking water by the arsenomolybdate method; 1 excess cancer death/600 people
Causes an unacceptable risk of death from skin cancer, according to the WHO; 1 excess cancer death/20,000 people
Causes an acceptable risk of death from all cancers, according to the California Environmental Protection Agency; 1 excess cancer death/1,000,000 people

29. A Third Challenge for Drinking Water Scientists
The range of uranium concentrations in drinking water samples from various states, cities, and regions in India (Bajwaa, et al. 2015).
State, City, or
Region of India
Range of Uranium
Concentration (μg/L)
Delhi
Ghaziabad
Himachal Pradesh, Bilaspur
Himachal Pradesh, Chamba
Himalayas
Hyderabad
Jhansi
Kanpur
Karnataka, Kolar
Maharashtra
Punjab
Punjab, Amritsar
Punjab, Bhatinda
Punjab, Malwa
Uttar Pradesh
West Bengal
2.2 – 8.8
4.2 – 11.4
0.1 – 4.6
0.3 – 6.8
1.1 – 35.8
0.6 – 82.0
0.9 – 6.4
3.3 – 9.1
0.3 – 1,442.9
0.03 – 7.8
0.5 – 579
3.2 – 45.6
11.7 – 113.7
5.4 – 43.4
1.4 – 19.2
1.3 – 13.2

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