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When speaking with P.H., Dr. Chowdhury highlighted "three primary reasons" for the prevalence of arsenicosis among Bangladeshi poor. "One, malnutrition, which is experienced by the poor more and seems to aggravate and hasten the process of arsenicosis. Two, the poor can't afford to switch to other sources of arsenic-free water, most of which requires more spending. And three, once they have the disease, the treatment is expensive." The poor have few of the advantages that their wealthier counterparts take for granted. Normal interventions do not function as effectively. With lower body mass, fewer antioxidants, and dietary proteins, poor, malnourished individuals find it difficult to metabolize and detoxify the arsenic. They cannot afford bottled water or filtration devices nor can they locate or afford treatment for the diseaseÕs multiple symptoms, from cracked hands to cancer. Individuals of low socioeconomic status are also less likely to know about the dangers of arsenic.
Following infection, arsenicosis tends to make the poor poorer still. In addition to the associated health costs, infected individuals have a more difficult time at work and risk losing their jobs. Marked by lesions, boils, and other skin conditions, victims are often marginalized by those who fear wrongly that arsenicosis is contagious. Discrimination alienates and isolates the infected, especially women and children, reinforcing their economic poverty. As organizations begin to mount a response, they must construct their efforts in a way that considers the specific needs and realities of low-income populations.
Nearly thirty years after the UNICEF and World Bank project that brought water to 97 percent of the population, the illusion of "clean" water has been shattered. The cruel reality is that the poor have only two options: return to the contaminated surface water or continue to use the affected tubewells. At the time of the drilling, the government convinced most people that groundwater was their safest option and water from lakes, rivers, and ponds was forbidden. Not surprisingly, even those with knowledge of arsenic's deadly toll continue to drink from the contaminated wells.