CKDu or Chronic Kidney Disease of Uncertain Aetiology is perhaps the most serious non-communicable disease afflicting dry zone farming communities in six out of nine provinces of Sri Lanka. Only the western, southern and Sabaragamuwa provinces appear to be free from the disease according to available statistics compiled by Health Ministry. Despite 20 years of research carried out by scientists here and abroad, the exact cause of CKDu has not been identified to date.
Over 30 different hypotheses have been advocated to date, but there has been no strong evidence to support any one of them. Some leading scientists and medical specialists have observed a close association between the source of drinking water and the occurrence of the disease.
It has been pointed out that those drinking surface water from reservoirs (dry zone tanks), natural springs and river water appear to be free of the disease, while persons consuming well water tend to be afflicted. Recent investigations, carried out by this writer in Mahiyangana, provide compelling evidence supporting and linking drinking water as a key factor contributing to the disease. A summary of observations and research methodology adopted is enumerated below.
We have adopted a community-based approach to research with the active participation of village population in Ginnoruwa. The writer who serves as the principal researcher, has been in the village for 10-15 days each month directing and guiding his field staff drawn from the village itself or in close proximity to the area.
The research team maintains a close dialogue with the resident population engaging in participatory rural analysis, a process which encourages the villagers to discuss, analyse, and document their situation. Households identified as ‘CKDu-affected’, are visited personally by the researchers. Their hospital records (clinic cards) are examined, and further checked by referring to doctors attached to the Renal Clinic at Girandurukotte District Hospital, before they are plotted as CKDu households on a map of the village.
Technical assistance has been provided by the International Water Management Institute, The Rainwater Harvesting Forum (an NGO), medical staff attached to Renal clinics at Girandurukotte and Kandy hospitals, and the Department of Geology of the University of Peradeniya.
The project is funded entirely by the private sector- CSR division of the Commercial Bank of Ceylon and contributions from personal friends and well wishers. Project implementation commenced in December, 2015.
Learning from Ginnoruwa
For the past six months we have been engaged in carefully plotting the distribution of CKDu affected households in two villages (no more than one Kilometre apart) in the Ginnoruwa Grama Niladhari Division, Mahiyangana Pradesiya Sabha. In one village, Badulupura, over 25 percent of households have at least one CKDu patient. In the other, Sarabhoomiya, there is only one positively diagnosed CKDu patient.
He too had been living in Badulupura for about 10 years before moving to Sarabhoomiya. Residents in both villages had been resettled under the Mahaweli project in 1982. They are mostly from Badulla, Welimada, Passara, Etampitiya and Kandeketiya areas within Badulla District. Prior to the Mahhaweli project, the area had been covered in forest. Rice farming is the major occupation of residents in both villages. Both villages have their paddy fields located in the same tract (Yaya). They grow the same rice varieties, and use the same fertilizer and pesticides. Their farming practices and food habits are essentially the same.
The only obvious difference between the two villages is one of topography. Badulupura is located on the upper slopes of the rolling landscape, while Sarabhoomiya is on relatively flat land. These observations clearly point to some environmental factor in the homesteads of Badulupura residents as the likely culprit contributing to CKDu. Probing deeper, we learned that Badulupura villagers drank well water obtained from shallowly dug wells in their homesteads, while majority of Sarabhoomiya residents drank water from Mahaweli River nearby. Badulupura residents complain of hard water, ‘kivul vatura’, in their wells. River water has no ‘kivula’, say Sarahoomiya residents. Probing still deeper, we find that the Electrical Conductivity (EC), a measure of dissolved salts in the ionic state, of many Badulupura wells range from 300 micros to 700 or more. River water is rarely over 200 micros.
A few dug wells found in Sarabhoomiya have exceptionally good quality water, even less than 100 micros. One tube well in Sarabhoomiya registers 34 on the EC metre! This is almost as good as rainwater. People in Sarabhoomiya, living further away from the river, drink water from these wells. Chemical analysis of well water in both Sarabhoomiya and Badulupura, as well as river water, is currently being carried out with the assistance of geologists at Peradeniya University.
The above investigations carried out at Ginnoruwa clearly indicate that quality of drinking water may hold the clue to unravelling the CKDu mystery.
Affirmative action
Based on above findings, we have initiated a rainwater harvesting programme designed to provide Badulupura villagers with clean drinking water. This project, named the ‘Raindrops Project’ (Wehi bindu), has been providing clean drinking water to several households since early January this year. Beneficiaries love drinking rainwater saying that it reminds them of ‘soft water’ in their ancestral villages in Badulla. Many claim that since they began to drink rainwater, they no longer suffer from the burning sensation when passing urine which they had experienced while drinking well water. Limited funds enable us to provide rainwater harvesting facilities to only a limited number of households. Additional funds are urgently sought to provide more rainwater storage tanks to the rest of the village. This appears to be the most pragmatic way of preventing CKDu from spreading throughout the village.
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