Why hide the truth about CKDu?

By Dr PARAKRAMA WAIDYANATHA

An open letter to the new Minister of Health

The chronic kidney disease (CKDu) has been a major non-communicable disease prevalent essentially among the Rajarata’s agricultural communities in the last three decades that had, on average, killed several thousand people annually. The disease aetiology is now known, with a high degree of certainty to be hard water in dug wells on high ground contaminated with fluoride. Because it largely affected the farming families, agro-chemicals were justifiably suspected as the cause although without evidence; and many, especially the ignorant politicians, including several key ministers without knowing the facts of the matter, have blamed agrochemicals.

In fact, the term wasa visa krushikarmaya (toxic- agriculture) was coined on conventional agriculture largely because of the misinformation. Ridiculous boards displaying that fruits and vegetables sold in wayside shops are ‘toxin-free’ have been a common sight. The shopkeeper hardly knows the origin of the produce!

Then, there was the much-hyped ‘toxin-free agriculture” or organic farming drive of the Yahapalana government, led by the then President and Ven. Ratana, which again was on the premise that agrochemicals are the cause of the disease. It was, however, a total failure. And it would appear that the current President too, rushed to organic farming with the misinformed judgment that agrochemicals are the cause of CKDu, and probably also of other non-communicable ones, although there has been no evidence for it! He should have consulted the scientists and academics in the relevant fields before rushing to the decision.

However, the new Finance Minister has, in a recent gazette notification, dated 31st July 2021, claimed to be published in order to “regulate the importation of chelated minerals and micronutrients” which were previously banned, has also ‘surreptitiously’ reverted the Presidential decision; allowing imports of virtually all straight chemical fertilizers and mixtures thereof, but on license! So, hopefully, farmers should have access to chemical fertilisers for the coming Maha season!

Be all that as they may, the writer’s concern is that despite the overwhelming research, as also supportive numerical evidence the Health Ministry/Department has been generating on the prevalence of CKD, through a broad surveillance with nationwide sentinel sites that has also supported the observation that drinking water quality is the major cause of the disease, it has hitherto made no formal pronouncement on the disease causation. Regrettably, neither the former Health Minister nor the Agriculture Minister seem to be aware of this fact, from the utterances they have made recently in Parliament and outside. In fact, both of them were seen yelling in Parliament, some days ago, that the cause for the kidney disease is agrochemicals! Further, at a meeting with the farmers some weeks ago, the Agriculture Minister exclaimed that the government has rushed into organic farming to save the kidneys of farmers!

Mr. Minister, please be aware of the following facts and take necessary action to clear the myth in the minds of the President, ministers and other authorities, that agrochemicals are the cause of CKDu, the number one non-communicable in the country:

1.

The scientific and medical community have developed an understanding of the origins of this chronic disease. Steps to control it have shown increasing success as the numbers stricken by the disease have decreased since 2016, following supply of clean drinking water to the residents of the endemic areas. And it is now critically important that people of all affected areas are provided with good quality drinking water. Apparently, when the Yapahalana authorities then “flogging the dead agrochemical horse” came to learn that polluted water was the cause of the disease, rumour was doing the rounds, that the authorities did not want people told about it for fear of an outcry for quality water!

2.

Research by at least five groups and many individuals, local and foreign, have shown that the disease is caused by the consumption of water from wells containing hard water and fluoride, found in geological formations known as Regolith aquifers that hold the water in the relevant dry zone areas. People who were settled rapidly during the Accelerated Mahaweli Programme on higher ground in the late 1970s, had to dig shallow wells or tube wells for their water supply. Estimates reveal that there are some 176,000 such wells in the Rajarata! CKDu is found essentially in villages drinking water from such wells. Residents who get their water from agricultural canals, rivers or reservoirs DO NOT CONTAMINATE CKD, whereas one would have expected them to do so if agrochemicals were the cause of the disease. Please see the attached graph (Fig. 1) from a publication by none other than Dr Asanga Ranasinghe, Coordinator of the CKDu Programme, Ministry of Health and others (BMC Nephropathy, Aug 2019) that reveal a sharp drop in the number of patients in the two most CKD affected districts of Anuradhapura and Polonnaruwa. This was a consequence of provision of safe drinking water, and in fact the people themselves in the affected areas realised that polluted water was the cause of the disease, and not drinking it. Further, the Table 1 below compiled from the data of 2018 Annual Health Bulletin (page 70), also confirm a sharp decline in the increase in patient numbers from 52% between 2014 and 2016 to just 12% between 2016 and 2018, which should essentially be a consequence of drinking good quality water. There is no other evidence to explain this prominent decline.

Sadly, however, the 2019 Annual Health Bulletin does not carry any information on the CKDu status, despite there being a nationwide Sentinel Survey of patient numbers; and the 2020 Annual Health Bulletin too has not been published to date! Why are the health authorities so negligent about the number one non-communicable disease in the country! Table 1

3. There is CKDu in areas like Mullaitivu where no agro-chemicals whatsoever have been used due to the Eelam wars. So it is now amply evident that residents who drink hard water rich in fluoride contract CKDu, but not those who drink water from streams, reservoirs and wells in the planes.

4.

No CKDu is found in the Hill Country (vegetable and tea cultivation) and in most other areas such as Kalpitiya (vegetable cultivation) where agrochemicals are used much more heavily than in the Rajarata.

5.

The WHO Report, 2013, concluded, amongst other things, that some CKDu patients secreted pesticide residues above the reference (permissible) levels, but did not refer to the pesticide residue status in the urine of the control subjects (from Hambantota) in the trial! Our subsequent analysis of the pesticide residue raw data, revealed that the numbers of subjects with urine pesticide levels were two to three times higher from the non-CKD (Control) area than among the CKD patients (See Table 2). Why did the WHO Report omit this critically important control data? Referring to pesticides, the Report merely stated that some CKDu patients had residues of some pesticides above reference limits! Was it to give the impression that pesticides were probably the cause? However, an International Expert Consultation held in 2018 on CKDu in Colombo, concluded that there is no evidence to implicate agrochemicals in the causation of the disease.

6.

Several ministers and most importantly even the President of the GMOA, Dr Padeniya have been repeatedly claiming that Sri Lanka is the country consuming the highest quantities of agrochemicals in the world. However, the published data of the World Bank (see Table 3) reveals that in this part of the world, we are the country consuming the lowest amount of fertiliser and the second lowest amount of pesticide per unit area!

In conclusion, the disease is evidently caused by consuming naturally contaminated well water. It has nothing to do with fertilisers or pesticides. The disease is prevented by supplying clean water to the endemic villages. This has been done largely by the distribution of rain-water collection tanks, and by the installation of reverse-osmosis water filtration plants by benevolent donors. Moreover, people in the affected areas are now aware of the cause of the disease and are taking preventive measures themselves, as evident from the data.

Please bring this information to the attention of the President and other authorities, so that vital national decisions are based on facts, and not myths!