Education Brings Sectors Together to Address Fluorosis in Alirajpur

A new project from the Center for Sustainable Development and Lamont-Doherty Earth Observatory will use education interventions to try to curb fluorosis, caused by high fluoride levels in drinking water, in Alirajpur, India.

Guest Blogger
August 12, 2019

By Radhika Iyengar

When we think of education, we think of classrooms, teachers and teacher training. Our thoughts perceive education to be confined to schools and curriculum. However, sustainable development urges us to expand education into communities. Attempts should be made to understand the community’s developmental issues and use education as a lens to bring about sustainable development. Education should be used as a lever to raise concerns (about water, health, sanitation, etc.), communicate the problem, raise awareness about the problem and use the right institutions to boost integrated solutions. This process may involve nontraditional education interventions: a football match to improve school enrollment in Nigeria, school campaigns during a fertilizer distribution ceremony to farmers in Malawi, a banana plantation maintained by parents to supply a meals program at schools in Ghana. Many such community-based interventions helped to reap the benefits of holistic development in the Millennium Villages Project in 10 sub-Saharan countries.

Using such community-based education initiatives to improve awareness and communication of sustainability issues will help to meet the United Nations’ 17 Sustainable Development Goals, and not just SDG 4, Quality Education. For example, SDG 6, Clean Water and Sanitation, aims to “ensure availability and sustainable management of water and sanitation for all.” It is fair to assume that SDG 6 needs help from the education sector to meet its targets.

Let me take you to Alirajpur district in Madhya Pradesh, India. The district has one of the lowest literacy rates in India at only 32 percent, as per the Census of India, with women lagging at 26 percent. The district is counted among the bottom 10 districts on many development indicators. Increasing the problems for the district, the underground water in the region has high fluoride content, which is not unique in India. It is a problem in the many western Indian states that have a population larger than many African countries. A moderate amount of fluoride in water can reduce the prevalence of tooth decay, but an excess intake of fluoride over a long period will result in fluorosis, which can damage bones and joints. In this case, how should we educate people to avoid water that is high in fluoride?

Status of Fluorosis in India
Status of Fluorosis in India. Source: Factly

Smiling children are not a pleasant sight in Alirajpur, bringing pain to the people in the district. Their brown, rotting teeth bear witness to the high fluoride in their water. Timely intervention could easily avoid this, but once the rotting begins, it is irreversible. In an initial needs assessment, it was discovered that many hand-pumps in Alirajpur have more than the average level of fluoride (0.7 mg/liter). The government marks some of them blue, which denotes safe fluoride levels. Red color indicates a sign of danger. But the residents have forgotten why these hand-pumps are painted red and do not generally link their browning teeth with fluoride. The community conjectures that the brown teeth could be associated with children having tobacco, children not brushing their teeth regularly, or “germs”. These responses came from educated college students, village leaders and community-based nurses, who are usually responsible for vaccinations and disease mitigation efforts, yet none of these answers are correct.

Brown teeth due to dental fluorosis from high fluoride levels in water. Photo: Radhika Iyengar
Brown teeth due to dental fluorosis from high fluoride levels in water. Photo: Radhika Iyengar

The district’s water department is working hard to test all hand-pumps, and the health department is conducting training for all the community nurses. The water department is very good at conducting water tests, but may not be the ideal department to design effective and engaging training modules. They may not be experts in conducting workshops for college students to make them aware about water-related ailments. The government school curriculum does not include any module or information about fluoride, even though it is a serious health condition in the district. It does not matter if the student is a college or a primary school student: she is not even aware of the problem and is left conjecturing.

Here is a sustainable development problem that is not yet being addressed by education interventions. Therefore, water scientists at Lamont-Doherty Earth Observatory, social scientists at the Center for Sustainable Development, and India-based non-profits INREM and Pratham are joining hands to tackle this issue. The strategy will help everyone in affected communities to understand the results of water testing, even if they are not formally educated. It will involve community-based skits, posters, broadcasting through radios and other communication media that resonates culturally. It will integrate voices from the community, with local college students and middle and high school students who become aware of the issue working with the water department to develop solutions. The education interventions should be co-designed by the water department, health department and local government institutions, along with the community.

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Fluoride testing kit used by the water department in Alirajpur. Samples of water were tested at the Barnard College lab. Photo: Radhika Iyengar

Addressing fluorosis in Alirajpur requires avoiding the water sources with high fluoride, awareness on the issue, various government departments working together, cost-effective water treatment techniques, comprehensive testing of all water sources, and common community water filtration systems to be put in place. However, it also requires one sector — education — to bring all of these elements together. Residents need to be aware and sensitized to look for prevention strategies and solutions. It requires information dissemination at every panchayat (the village-level local government body). Educating people on the science of water testing and making the information easily digestible is the need of the hour. High fluoride is a perfect sustainable development problem that urges different sectors to come together and do their part. Is the education sector ready to be the leader in community-focused science?