Sambhar: Two cousins, ages 18 and 6, who have stunted growth and malformed limbs, as well as other members of the extended family, including toddlers and elderly, who frequently experience joint pain despite knowing that their water consumption may be to blame.
This is the tale of not only the Singh family but also of other residents of the Rajasthani villages of Devpura and Moondwara, which are located around 80 kilometres from the Sambhar salt lake, the largest inland salt lake in India.
The villagers, many of them unlettered, blame the lake water that has contaminated the groundwater as the main reason for the high salinity and fluoride content in drinking water.
According to Om Prakash Sharma, head of the NGO Gram Chetna Kendra that works in the area, disability in the two villages about 50 km from Jaipur averages about 10 in 1,000. The national number is 5 in 1,000 people. That is almost double the normal average, he pointed out.
The disability is directly linked to high fluoride content in the area, a fact backed by studies, he said.
Long-term effects of skeletal fluorosis take place if the fluoride level in water is more than 1 mg/litre, said Dr Aman Dua, director, of joint replacement and orthopaedics, at Delhi's Fortis Escorts hospital.
"So there is widening of bones, deformities in joints and the symptoms are specially marked in the spinal column where they may lead to nerve compression and weakening of limbs because of long-term use," he told PTI.
According to a Central Ground Water Board (CGWB) report, high fluoride in groundwater in Jaipur district where the villages are located is a matter of great concern with fluoride concentration going up to 16.4 mg/litre in some places at Sambhar block against the permissible 1mg/l.In Sambhar lake itself, it is 2.41 mg/l.
The signs are there for all to see.
In the Singh household in Devpura village, Lalita, who is now 18, said she was just five when her mother noticed she could not straighten her hand.
The disability soon spread and her leg, too, got deformed over the years. Her speech also started slurring".
"Doctors were not sure what happened to me. There was something wrong with my bones and muscles," Lalita, who struggles to speak, told PTI. Her mother Shanti Devi points to the pump from where the family gets their water.
It looks clear, to begin with, but collect it in a container and the salt soon settles at the bottom.
"The drinking water we get here is saline. This is leading to pain in different parts of the body, hands, and legs. Our children are becoming disabled at different ages, some at six months, some at 12 months, some at five years," Shanti Devi said.
The government, she added, started a pipeline to connect them to a different source but did not finish work on it so they continue to be dependent on groundwater The joint family of 13 lives in Devpura, about 50 km from Jaipur.
And nothing has changed for them since Lalita's disability was first noticed 13 years ago. Like Lalita, her six-year-old cousin Monu has an inflated chest and suffers from bone deformities.
"He isn't growing, the chest is inflated. We have consulted doctors who attribute it to the water quality. Groundwater is the only source of water for us here and it has chemicals that cause our ailments," his mother Rashmi Devi said.
Not far from their home, Sakshi Singh, principal of the primary school in Devpura, echoes her despair. Of the 30 children in the school, five to six children suffer from disabilities.
"Fluoride content in the water is very high. This is a leading cause of disability in children here. There are no special teachers to teach such children," Singh said.
The many stories of Devpura find an echo in the twin village of Moondwara. Sonu, 20, is wheelchair-bound. He also suffers from full-body disabilities and his hands and legs are deformed.
"We don't understand what went wrong. The deformities slowly started and spread across the body, we showed doctors in cities and they blamed saline water for it," his father Ramesh Singh, a farmer, said.
The situation has worsened in the last two decades, said Harish Singh, a photographer whose two children suffer from disabilities.
"Our organisation has been working on the issue for the past 20 years. In many cases, we have seen that a single family has many cases of disabilities. We feel that this area because of salt lake Sambhar has high salinity and fluoride content in water. Groundwater is overexploited. The dipping levels have caused further contamination of water with fluoride," Gram Chetna Kendra's Sharma said.
According to the census 2011, there are 26.8 million people with disabilities in India, making up 2.21 per cent of the total population.
Controlling fluoride content in water can reverse non-skeletal symptoms but skeletal symptoms are irreversible, said Fortis Escort hospital's Dua. Non-skeletal symptoms start quite early and are seen as normal symptoms such as nausea and abdominal pain.
"But when you go deep into it, when skeletal manifestation starts kicking in then you understand it is fluorosis affecting all the system. It can also lead to nervousness and depression which also have long-term impacts. Muscle strength is affected, and the tendons, and kidneys are all affected. Water with high fluoride content is the most common culprit," he said.
Dr Amit Sharma, senior consultant, of rheumatology, at Jaipur's Fortis Hospital, agreed that fluoride contamination in drinking water is creating havoc in many parts of Rajasthan.
"Fluoride when ingested over a prolonged period of time gets deposited in our gums, enamel and bones. A molecule called calcium hydroxyapatite formed in our bones gets replaced by fluoride so teeth become ultra-white and bones become brittle. There is a late complication of joint stiffness, ligament calcification and that leads to deformities and pain in the joints," he explained.
Asked why some children get affected and not all in a village, he said malnutrition when combined with high fluoride content in water can worsen the condition.
The government's Jal Jeevan Mission has promised to provide clean tap water connection to the entire rural India by next year. But villagers say the mission is yet to reach these villages. The pipeline for clean water started long back but it's still not complete.
There is just 39 per cent coverage in the rural Jaipur district of tap connection till now, according to official data.
In 2019, thousands of migratory birds of about ten species were found dead around Sambhar lake with officials attributing water contamination as one of the reasons for the deaths.
With PTI inputs