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It’s not just what you drink but what you used to drink...

For the last year, Nuevas Esperanzas has been investigating high levels of naturally occurring arsenic in water sources in the municipality of Telica, León.  Having recorded levels many times the World Health Organisation’s recommended limit (10 parts per billion, or ‘ppb’) the next step was to investigate the health impacts of the arsenic problem. 

Over six hundred patients from six communities not far from León were seen by five doctors over five days of clinics.  The team of doctors was led by Dr Alina Gomez, a specialist dermatologist who discovered the first cases of arsenic poisoning in Nicaragua in 1994 and has become an expert in this area through her on-going work with UNICEF and others on this problem.  She was supported by a second experienced dermatologist and three junior doctors.  The Nuevas Esperanzas team had conducted a census of the six communities in the weeks prior to the clinics.  On arrival, medical histories were taken and each patient was seen by a doctor.  The doctors examined the patient’s skin, particularly their hands and feet, looking for symptoms which may be consistent with arsenic poisoning.  These include ‘keratoses’, lesions of the skin, and ‘hyperpigmentation’, where black marks appear under the skin.

Thankfully out of the six hundred patients who were seen, the number of cases with suspicious symptoms is relatively small.  Those people who do have symptoms consistent with arsenic poisoning, however, were amongst those who have had the greatest exposure to arsenic contaminated water.  An older man, who displayed the most severe symptoms, had been drinking water from a well which has 250 ppb of arsenic for over twenty years.  Amongst others displaying symptoms were a woman in her forties from the community of La Unión who had been drinking water with around 300 ppb of arsenic for about ten years.  At first we were surprised by the number of suspicious cases found amongst people from the community of Bella Vista, where arsenic levels are only moderate, at 40-50 ppb.  However, it was discovered that this is a relatively new community and that many of the residents were relocated after Hurricane Mitch from a place called Paso Picado where very high arsenic levels have been recorded.  While there is no proof that this is the cause, the anecdotal evidence suggests that their symptoms may be related to historic rather than recent exposure.

Those patients who were identified as having symptoms consistent with arsenic poisoning, or other illnesses identified during the clinics such as skin cancer, were offered treatment and follow up at a specialist hospital in Managua.  During the clinics, one community where no arsenic is present in the water supply was used as a control sample.  At the second clinic, in order to gain further evidence of arsenic poisoning, hair samples were taken from the affected communities and the control community.  Samples were taken from sixty people crossing a range of ages and including men, women and children.  It was important to handle the situation sensitively as for women with long hair, this meant cutting off a lock of hair about the thickness of a pencil from close to the neck.  Of course for women this is less likely to show.  It was harder with the men and some needed a full haircut in order to provide enough of a sample to be tested!  The results will not be known until November but those who allowed their hair to be cut are understandably keen to know the outcome.  Workshops will be held with Dr Gomez to give them the results and consider what happens next for the affected communities.

The clinics went well and everyone is relieved to know that, while it is likely that some people have been affected by drinking arsenic contaminated water, the number of people with serious symptoms appears to be quite small.  Obviously early diagnoses can greatly increase the likelihood that affected patients can be given the medical care that they need.

The investigation will continue.

25/09/11