In Rajarata:

Action plan to avert kidney disease

By Ranil Wijayapala

The recent surveys done on the spread of Chronic Kidney Disease (CKD) in the North Central Province has revealed that around 17,000 people in the North Central Province have become victims of this disease within the past few years. It has therefore drawn the urgent attention of the Government towards taking precautionary steps to avoid the spread of this disease further.

According to Dr. Asanga Ranasinghe, director of the Provincial Renal Disease Prevention Unit of Anuradhapura General Hospital, around 17,000 people who have been affected with CKD were reported in the North Central province by the end of last year and the province's monthly death rate average as of the end of 2013 due to renal failure was 19.

According to him 3,194 patients of the CKD have been reported from Medawachchiya, 2,653 from Padaviya, 1052 in Kebithigollewa, 800 in Rambewa, 541 in Kahatagasdigiliya, 508 in Central Nuwaragam Palatha, 473 in Horowpathana, 351 in Nuwaragam Palatha East, 286 in Galenbindunuvewa, 274 in Thambuttegama, 253 in Thalawa, 248 in Nochchiyagama, 157 in Kekirawa, 141 in Thirappane, 108 in Galnewa, 248 in Mihintale, 117 in Rajanganaya, 90 in Ipalogama and 55 in Palagama in the Anuradhapura district by the end of last year.

In addition, 4,493 patients have been reported from the Polonnaruwa district with 1,114 from Medirigiriya, 966 from Hingurakgoda and 702 from Dimbulagala.

According to Dr. Ranasinghe, the annual increase in kidney patients in Anuradhapura is approximately 1,450, and 450 in the Polonnaruwa district.

According to Health Ministry statistics, the Ministry is spending some US$3 million annually to treat persons diagnosed with CKD while providing kidney patients receiving regular treatment with a monthly stipend of about near $4 and those on dialysis, $11.

Several agencies and individuals who have carried out research on CKD and have come up with varied presumptions. It is believed that the disease has been attributed to the heavy metal cadmium, pesticides, chemical fertiliser etc. connected with agriculture.

Some believe that this can be attributed to fluoride/ fluoride in combination with aluminium, mainly from cooking utensils. Since of late, arsenic, algal toxins have also been cited as possible reasons for CKD.

An extensive study was carried out by the World Health Organisation and the Ministry of Health to determine the causes of CKD and their latest report attributes the disease to substances such as cadmium which could be present in chemical fertilizers, weedicides and pesticides. It has also implicated high hardness in the drinking water.

Subsequent to the several studies and research carried out on CKD, it has been widely accepted that supply of good quality drinking water is one of the most important interventions for controlling the disease.

Therefore, President Mahinda Rajapaksa has instructed the relevant authorities at least to get the young generation protected from CKD spreading around the country by taking steps to provide them safe drinking water facilities while they are engaged in studies.

President Mahinda Rajapaksa initiated this program of providing safe drinking water for the school children after opening the new drinking water project at Rambewa Maha Vidyalaya in Medawachchiya electorate which records the highest number of CKD affected people in the North Central province and from the entire country.

To cater to this project Ministry of Water Supply and Drainage together with National Water Supply and Drainage Board and National Community Water Trust developed a strategy and work plans which include short term, medium term and long term plans to provide safe drinking water to CKD affected areas.

According to Water Supply and Drainage Ministry officials this work plans have been endorsed by the parliamentary subcommittee for CKD, chaired by Hon. Vidura Wickramanayaka member of parliament, of Kalutara district.

Since the majority of people living in those CKD affected areas, use groundwater obtained from tube wells, hand pumps and dug wells which are satisfactory for general purposes such as bathing, toilet, flushing, washing of clothes and utensils, it may not be suitable for drinking and cooking purposes.

"Only few areas have surface water based piped water supply. Thus it has been decided to provide the CKD affected areas with good quality water for their drinking and cooking purposes in which a per capita supply of five litres per day is considered as adequate", officials from the Ministry said.

The short term program of the Ministry covers the CKD affected areas in the districts of Anuradhapura, Polonnaruwa, Badulla,Mannar, Ampara, Trincomalee, Kurunegala and Matale.

Under these short term measures it has been identified to establish small treatment Reverse Osmosis (RO) plants to purify groundwater from wells or boreholes and supply the water to communities using water bowsers.

"These small treatment units are operated by the respective communities through Community Based Organisations (CBOs) and continuous technical support of National Water Supply and Drainage Board (NWSDB) is provided for operational and maintenance purposes", the officials said.

Apart from that bowsers will be supplied to affected areas which are in close proximity for bowser supply from existing water supply schemes while extending the services provided from existing piped water supply schemes to certain areas.

"Rain water harvesting is also promoted in areas where bowser supply is uneconomical to cater to these needs", the officials said.

As a part of implementing this short term program in Anuradhapura district the Water Supply Drainage Ministry has given priority for the Padaviya, Medawachchiya, Kebithigollewa, Rambewa and Mahawillachchiya DS Divisions to provide good quality water for cooking and drinking purposes.

According to officials in Padaviya DS division, one RO plant has been installed to cover Parakramapura and Track B. The RO plant for Bogahawewa and Ruwanpura is being installed while preliminary work on water supplies to the areas Sudharshanagama, Mahasenpura, Balayawewa, Maithreepura, Abhayapura, Buddangala, Bisokotuwa and Padaviya 18th Post are underway.

In Medawachchiya DS division, three RO plants have been installed in Mahadivulwewa, Periyakulama and Karmbankulama while rainwater harvesting is being also carried out in Thammanna Elawaka.

In Kebitigollawa DS division, rainwater harvesting is being carried out in Thammennawa, D4 Wahalkada, Thiththagonewa, H and agala, Kirimatiyawa and Halmillawetiya. Bowser supply is operated in Eethalwiddawewa, Thimbiriwewa, Samadhigala, Ihalausgollewa, Aiyanthigewewa and Kahatagollewa.

RO plants are to be installed under the proposed ADB project to cover the areas of Halmillewa, Thiriyaya and Thimbiriwewa.

In Rambewa DS division, a RO plant has been commissioned in Thambalagollewa-Wewalketiya while preliminary work on water supplies to the areas Wahamalgollewa, Sangilikanadarawa are underway. Rainwater harvesting is being provided to Ambagahawewa, Thalgahawewa, Kandewa, Ikirigollewa, Diviyaudabandawewa.

The short term program is implemented using the capital funds of Ministry of Water Supply and Drainage. The Ministry obtained Rs. 100 Mn in 2013 and that amount has been fully utilised. An additional Rs. 20 Mn has been transferred from savings of National Water Supply and Drainage Board.

Private sector, NGOs have also contributed approx. Rs. 7 Mn. for the program of safe quality drinking water for CKD affected areas.

The work program for 2014 has been developed based on the availability of Rs. 1,100 Mn. In support of this strategy, the President in his budget speech proposed to allocate Rs. 900 Mn for the year 2014 to install RO plants in the North Central province.

This program will include 126 RO systems, several rainwater harvesting systems, additional bowser supplies and several service extensions.

Eleven water bowsers obtained under the assistance of Japanese International Cooperation Agency were also handed over to Anuradhapura Water Supply Board last week under the patronage of President Mahinda Rajapaksa during his visit to the district.

Coca-Cola Beverages Sri Lanka Ltd (CCBSL) also joined hands with the Water Supply and Drainage Board to establish a Reverse Osmosis (RO) water treatment facility to thousands of beneficiaries who reside in the Padaviya division in Anuradhapura.

This unit can purify 30,000 litres of water per day and it will run on 20 hours per day on seven days a week basis to provide safe drinking water for the people in Padaviya.

As this program is carried out by the Ministry of Water Supply and Drainage Child Development and Women Affairs Minister Tissa Karaliyadda as a Minister representing Anuradhapura district has also launched a program to educate the people about safe drinking water habits to prevent spreading this disease further in the district.

Minister Karaliyadda also launched a program to provide set of clay cooking utensils for the people living in the areas mostly affected from the CKD in the Anuradhapura district as it has been suspected that the use of low quality aluminium cooking utensils as one contributing factor for the CKD. "The Government of President Mahinda Rajapaksa is committed to provide all the medication for the CKD affected people while taking steps to stop people becoming victims of this disease by providing them required safe drinking water and other facilities", he said.

"President Mahinda Rajapaksa has also taken initiative to provide safe drinking water for the schools in the areas mostly affected with CKD as he wants to protect the young generation from this disease", he said.