Major interventions on chronic arsenic poisoning in Ronpibool District, Thailand - Review and long-term follow up

This study aimed to assess the outcome, impact and problems of the major interventions during the past ten years to control chronic arsenic poisoning in Ronpibool District, Nakorn Sri Thammarat, the southern Province of Thailand, in order to find better strategies to combat the illnesses. In early 1998, the principal investigator conducted four focus group discussions in the district. The results from the focus group discussions showed that the toxicity from arsenic contamination in natural water sources in Ronpibool District had been recognized by the Thai government and the residents of this district for more than 10 years. Since 1987, the government sectors have launched several interventions. Major measures include: providing of alternative water sources (e.g. distribution of big water jars to collect rain water, construction of deep tube wells, and construction of village pipe water systems), periodic monitoring of drinking water and environmental samples, case detection and supportive treatment for patients with severe skin manifestations. Also included were health education for the villagers; and site remediation to clean up the 3,000 tons of high-grade mine waste piles. However, the major interventions during these ten years show less success than expected. All four group discussions agreed that they still lack a good understanding of the situation and desire continuous communication with the government sectors. Villagers are concerned about their economic status and some old life styles inhibit their participation in solving this problem. The investigators conducted a survey of all households (approximately total 5,000 households) in the district. Information was collected on demographics, sources of water used and suspected cases of skin lesions. After the survey was completed, household mapping was done in a manner that the villagers could easily utilize for long-term follow up and design the appropriate interventions for the specific problem of each village. It is proposed that a well-planned, long-term study should be established in order to control the problem and to provide a rich source of scientific knowledge to help us understand the specific disease occurrence and changing pattern of illnesses in this area.