Focus on Madhya Pradesh: Chhindwara

Ramlal has a chance even now

Is there hope for Ramlal’s life ahead (Location: Chhindwara, MP)
Ramlal gets up from his chair outside his home in Mukhandak village of Chhindwara district, MP. The effort is painful, even for someone who watches it. He manages to stand, or make a pose that looks like standing. With effort, he pauses and remembers his past, trying to remember a time when he was “normal” like anybody else. There was a childhood of fun and play. When did it change? How did he turn into this helpless form at 25 years, with no idea given by anyone around, as to what happened. Maybe a curse.

Bone deformity from Fluorosis and Malnutrition (Location: Chhindwara, MP)
Ramlal is not alone. As we stand in the village centre, amidst thick forests, more and more such children, adolescents and adults turn up. As news spreads of a team visiting, more turn up by the minute. The phenomenon seems unstoppable. Fluorosis in Chhindwara is not well known to many in India. Yet there seem to be an endless stream of Skeletal fluorosis affected people in Mukhandak and nearby villages. What caused this? Nobody here knows, they just nod at what they are told. Look, dont drink this water, It will make you crippled. Eat good food .. and so on


A gallery of shame (Location: Chhindwara. MP)
Fluorosis in India, is a 80 year old history of shame and neglect. These neglected people of Chhindwara are not alone. The disease affects Millions of people in India, in varying degrees of severity. The easiest way to detect is to look at children’s teeth. Horizontal stains, yellow, to brown, are the best indicator. Testing water for high fluoride is also very simple. It just takes a minute to test and less than 5 Rupees per test (more than 10 tests per US Dollar). But why is the problem still spreading so fast?

1-y0zy1ywqzo_c87v2jxr27gWith such bent legs, this girl will not be able to walk soon (Location: Chhindwara, MP)
The root of this Malaise lies in two very different, but somewhat related reasons. One, is the high dependance and extraction of groundwater, increasingly even in remote tribal pockets. As we go deeper, there is lesser chance of rainwater recharging aquifers and more chance of Fluoride-like substances being released into water. So, often we find deep handpumps and borewells having more Fluoride than shallow Dug wells. The unlimited access of water for irrigation makes this problem worse by making people go deeper and deeper.
Secondly, is the Food problem. Though people are consuming Calories, what they lack is basic nutrients. Especially, something like Calcium is almost absent in many people’s diets. And since Fluoride disturbs Calcium in the body, it causes greater Fluorosis in Calcium deficient people.

Stunting from Fluorosis, with sword like deformity in legs (Location: Chhindwara, MP)
Coming back to Ramlal and Mukhandak in Chhindwara, we are told, around 42 Skeletal Fluorosis affected people are living nearby. They have been “discovered” thanks to the effort of District Fluorosis Officer, Dr Rahul Srivastava. Because of dedicated efforts by the Prime Minister Rural Development Fellow (PMRDF), Ms Vasundhara Dash, posted at Chhindwara, a team from Jhabua was able to visit these villages. The Forest Department has provided support in reaching out to these victims till now. The Jhabua team represented by Mr Sachin Vani and Mr Arvind Singh has prior experience in dealing with such extreme disability cases. They believe that at least a few children here could be saved such as some in Jhabua.


Chhindwara is just the tip of the Iceberg as far as such Malnourishment and Fluorosis nexus in MP is concerned. More than 15 Districts are highly Endemic to Fluorosis. Among these are Jhabua, Dhar and Ali Rajpur in the western side, and Mandla, Jabalpur and Chhindwara on the eastern side of the state. However, many villages such as Mukhandak are still unknown to people outside. Even public health workers who reach these villages are often not aware of the cause of the problem. Misdiagnosis delays early action and hence prevents these people from being saved. Beyond MP, 22 States of India have Fluoride affected areas.

Chakoda Bhaaji — Cassia Tora — a wonder leaf ?
Dr Tapas Chakma from the Regional ICMR Central for Tribal health in Jabalpur strongly advocates action of Nutrition improvement for such places in MP, along with Safe water. He discovered the value of Cassia Tora, known locally as Chakora Bhaaji which has 4 times more Calcium in dried leaves than Milk powder. Moreover, it has Magnesium and Vitamin C, which helps in detoxification of Fluoride from the body. Following such procedure, with help from Dr Raja Reddy, a Neurosurgeon from Hyderabad, the Jhabua team working under the auspices of a non-profit, INREM, was able to recover many such Skeletal fluorosis affected children. Nilesh here is one of them.

Communities across MP have also started coming together to collectively solve the problem. The effort in Dhar, of helping affected community to identify and protect Safe water sources free of fluoride, has helped many villages to sustain their Safe water programmes. Especially, in tribal areas where Dug wells are still in use, this offers one way to develop Fluoride free Safe water programmes.
As evening dawns, the visiting team reaches many villages — Gaighat, Sindarmau, Rampur … the story remains similar. More skeletal fluorosis cases appear. Some new.
Ramlal looks calmly as the visiting group takes pictures and promises for help. Resignation to your fate is one coping mechanism for such people. But does he have an alternative.
Could we script a different story for him and the children of this village?


Blog Courtesy: Sunderrajan Krishnan, Fluoride India Medium

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