Juttu Deshamma’s kidneys have shrunk to half the normal size, a telltale sign that they have been damaged. Sitting in a remote village in Srikakulam, her will to survive is weakening. The 57-year-old is among thousands affected by unexplained Chronic Kidney Disease that has gripped this district. Deshamma lives in Kusumapuram, an obscure settlement of 4,000 people in Andhra Pradesh, with two unmarried daughters who together earn less than Rs. 100 a day. The young women show their mother’s health records anxiously to visitors, hoping that they can offer some miracle cure.
Financial burden The verdict on the silent collapse of her kidneys came after her creatinine levels climbed steadily and settled at 8, compared to a normal level of 1.1. Renal failure brings with it chronic financial distress, and in the last two years, Deshamma has undergone several dialysis sessions for which she is forced to commute to Visakhapatnam, over 200 km away. The crisis has tested the daughters’ resolve to find a cure for their mother.
“Though free treatment can be availed by eligible beneficiaries, the commute to big cities even for a day is expensive,” says Niranjan Bishai, Kusumapuram’s community facilitator. “Nearly everyone gives up treatment.”
Stories like Deshamma’s are common in Itchapuram, Kanchili, Kaviti, Mandasa, Sompeta and Vajrapukotthuru mandals which form the Uddhanam region, although the majority of the known sufferers are men in the productive age group.
The six affected mandals are home to about four lakh people.
At least a couple of households in each of the village’s 15 streets has someone with the renal disease the origin of which is unknown. “We treat patients for minor ailments but cannot diagnose or treat kidney disease here due to lack of manpower and infrastructure. Blood samples collected are sent to district headquarters or elsewhere for testing,” says pharmacist Sumalatha at Manikyapuram’s Primary Health Centre, the only medical facility with some capability in the village.
Dr. Ramesh Naidu, who runs the PHC, says those with oedema of the feet and face are referred to the district hospital. Mild kidney disease is managed with diuretics and antibiotics while severe cases are referred for follow-up. Frequent administration of the painkiller, diclofenac, injections and tablets by private practitioners in the village is now under study.
A better understanding of the epidemic is likely to emerge when kidney biopsies of 50 patients are performed next month at Rajiv Gandhi Institute of Medical Sciences in Srikakulam.
There are several hypotheses on why a higher incidence of renal failures is being reported in Andhra Pradesh. One is the possible link to excessive levels of silica and heavy metals in groundwater. The water in Uddhanam region was tested by the Ground Water Department and ICMR in 2013.
Doctors, however, are not certain if the tests can confirm the silica and heavy metals link. It will take more research to see if abuse of painkillers, alcohol, genetic predisposition or other factors are also responsible. From traditional reliance on surface water, many dehydrated villages now consume groundwater in Andhra Pradesh. Only a few get treated water once a week.
A third affected
Whatever the cause, the outcome is devastating. Dr. T. Ravi Raju, Vice-Chancellor, Dr. NTR University of Health Sciences in Vijayawada, who is leading research on the issue, says a staggering 35 per cent of the population is affected in some areas.
New cases continue to be reported from across this coconut-growing region, and the disease profile is so clear that it is now called ‘Uddhanam nephropathy’. Concentration of silica in the groundwater could be a cause, but it could not be scientifically established, says Dr. Raju.
Dr. Gangadhar Taduri at Nizam’s Institute of Medical Sciences in Hyderabad says hard water, aggravated by alcohol, and rampant use of painkillers could be the culprit.
Killer cocktail
“After an exhausting work day, many men tend to take painkillers and drink alcohol. These and other factors, including dehydration, could be driving the disease,” according to Dr. Taduri, who thinks there could be an ongoing CKD epidemic in Khammam district of Telangana too.
Dr. Taduri and others reported last year that high levels of urea and creatinine, markers for renal diseases, were found in blood samples of inhabitants of Uchapally, which had higher mean levels of lithium, silicon and strontium, compared to residents of Pedarajupalem where the water has smaller amounts of these elements. Both villages are in Nellore district.
While researchers work to unravel the Srikakulam crisis, villagers have their own views. Sarpanch B. Krishna Rao of Kusumapuram thinks the number of kidney-related complaints have dipped after a reverse osmosis water plant was installed. In neighbouring Majhiputtuga, Dandapani Majhi believes that the physically active are spared 'the curse'.
The issue has attracted international attention and is now recognized as a key dot connecting similar phenomena seen in Nicaragua, Egypt and elsewhere. The CKD epidemic in Srikakulam and its likely dehydration link to global warming is to be discussed at a conference on ‘Health Impacts from Climate Change’ being held by the Aspen Global Change Institute in Colorado, U.S., next month.
