![Page 1: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/1.jpg)
Environmental Pollution & Chronic Kidney Disease of
“Multi Factorial Origin” in Sri Lanka
Sunil J. Wimalawansa, MD, PhD, MBA, DSc Professor of Medicine
New Jersey, USA
![Page 2: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/2.jpg)
Environmental Pollution & Chronic Kidney Disease in Sri Lanka: Key sponsor:
Engineers Without Boarders/Sri Lanka
EWB-SL is volunteering to come up with solutions to the CKD problem
![Page 3: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/3.jpg)
Outline • Water, sanitation, pollution and diseases • Definition of Chronic Kidney Disease (CKD)-
of multi factorial origin (CKD-mfo) • What causes CKD-mfo • Engineering solutions for CKD: Clean water • Reverse osmosis method to overcome CKD • Sustainable solutions to overcome the
problem
![Page 4: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/4.jpg)
90% of these deaths occur in economically
poor countries
Why this disparity?
In Every 15 Seconds, a Child Dies from Water-Related
Disease (U.N.)
![Page 5: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/5.jpg)
How Does Water Get Polluted?
• Domestic: disposals, chemicals... • Industries: agriculture, manufacturing.. • Production: gasoline, chemicals, etc..
![Page 6: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/6.jpg)
Natural Disasters are Destructive and Lead to Water Pollution
Post-Tsunami environmental and water pollution
![Page 7: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/7.jpg)
Floods Lead to Water Contamination
Flood Causes Water pollution
![Page 8: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/8.jpg)
Main Causes of Water Polution “Microbial” contaminants ― bacteria and viruses:
– Contamination via sewage and septic systems
– Agriculture, livestock operations, and wildlife
“Inorganic” contaminants ― salts and metals: – Can be naturally occurring, or – Agrochemicals; storm water runoff
– Industrial or domestic wastewater – Oil and gas production, mining, and farming
![Page 9: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/9.jpg)
Preventable Water Pollution
![Page 10: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/10.jpg)
Poor Sanitation and Water Pollution
![Page 11: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/11.jpg)
![Page 12: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/12.jpg)
Toxins & Chemicals Affect The Whole Body
• Brain • Cardiovascular system • Intestine • Skin and eye/sensory system • Immune system • Liver and Kidneys
![Page 13: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/13.jpg)
Consequences of Drinking Contaminated Water
• Acute illnesses –Water-borne diseases –Diarrheal diseases –Dehydration and death
• Chronic illnesses –Fluorosis –Chronic liver diseases –Chronic kidney disease
• High morbidity and mortality
Chronic Kidney Disease
![Page 14: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/14.jpg)
Anatomy & the Functions of The Kidney
![Page 15: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/15.jpg)
Preferred Terminology for CKD • CKD of Multi-Factorial Origin (CKD-mfo) (the term, I have been using since 2007) • CKD-mfo is an “Environmental” Disease
that cause by - several factors • When the “conditions” are unfavorable
to kidneys, it begin to fail • It causes tubulo-interstitial sclerosis;
Thus, it is irreversible • Prevention is the only cure
![Page 16: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/16.jpg)
Rajarata Kidney Disease: Causes? • No one is certain what is going on • Too much speculations: Inadequate research
data to make meaningful conclusions • Multiple interactions escalate toxic effects • Unregulated / illicit medicine and alcohol • Role of NSAID, leptospirosis, smoking, and
others―totally neglected • Unforeseen, unpredicted, or neglected reasons • Combination of various unhealthful issues
![Page 17: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/17.jpg)
Prevalence of Chronic Kidney Diseases in NCR
• In certain villages in NCP, the prevalence of CKD is between 8 – 10 %, of the population
• Region-wide, the average prevalence is ~ 5%
![Page 18: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/18.jpg)
Geographical Distribution of CKD
in Sri Lanka
![Page 19: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/19.jpg)
CKD-mfo: Endemic Areas
Predominantly Affected Districts:
• Anuradhapura • Polonnaruwa • Badulla • Hambantota
![Page 20: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/20.jpg)
Distribution of CKD in SL
Also now in: Southern Wellawaya, Thanamalvila, Lunugamvehera, Tissamaharama, etc.
![Page 21: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/21.jpg)
Occupational Distribution of CKD Pts.
Category Number % Farmers (male) 174 56 [71%] House wife 29 9.4 Labors 15 4.9 Businessmen 05 1.6 Carpenters 05 1.6 Postman 03 1.0 Gramasewaka 02 0.6 Others 13 3.9 Missing data's 63 20
![Page 22: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/22.jpg)
Age Distribution AGE / YEARS NO %
0-10 00 00.0 11-20 04 01.3 21-30 29 09.4 31-40 57 17.4 41-50 73 23.6 51-60 73 23.6 61-70 51 16.5 71-80 10 03.2
Missing data's 12 03.9 Total 309 100.0
63%
![Page 23: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/23.jpg)
Multiple Aetiologies Leads to Development of Chronic Renal Failure
Potential Culprits: Lack of adequate hydration (chronic
dehydration) – GI absorption issue Heavy Metals: Cadmium /Arsenic /Lead Fluoride / aluminium / hard water Pesticides / herbicides / Nitrates NSAID / leptospirosis /illicit alcohol & drugs Unidentified toxins
NSAID / leptospirosis /illicit alcohol & drugs Unidentified toxins
![Page 24: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/24.jpg)
Rajarata CKD Epidemic
• Pathological feature of CKD-mfo is “interstitial nephritis”
• The aetiology of it is unclear • CKD-mfo is not an immune, congenital,
genetic, or an infectious disease • It is a disease that is acquired by
“environmental” exposure • Real time bio-surveillance is necessary
![Page 25: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/25.jpg)
Potential Water Pollutants in NCP that Cause CKD
Heavy Metals
Agro-Chemicals
Fluoride Heavy Metals
![Page 26: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/26.jpg)
Heavy Metal Toxicity
Cadmium
Arsenic
Lead Mercury
![Page 27: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/27.jpg)
Evidence on Toxins from Algae as a Cause
of CKD?
![Page 28: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/28.jpg)
War-related pollution and
bio-terrorism in previously
endangered villages are not
causes of Rajarata kidney
disease
![Page 29: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/29.jpg)
Water Hardness is Unlikely a Major Source for CKD
• Hardness of water is mostly caused due to presence of cations, Ca2+ and Mg2+ , prevailing across the island for hundreds of years.
• It may be associated the presence of Fluoride, Cadmium or Asenic.
• The natural ground water hardness does NOT correlates with CKD distribution
![Page 30: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/30.jpg)
Distribution of Ground Water
Hardness
Distribution of CKD Patients
![Page 31: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/31.jpg)
Role of Pesticides and Others Agrochemicals Causing CKD
![Page 32: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/32.jpg)
Paddy Fields Are A key Source of Water Contamination in NCP
Artificial fertilizers Pesticides, weedicides
& Fungicides
Excessive uses of
![Page 33: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/33.jpg)
Annual Chemical Fertilizer Consumption in South Asian Region 2012
Country Fertilizer consumption (Kg/hectare of arable land)
Sri Lanka 284.3 Bangladesh 164.5 Pakistan 163.3 India 153.5 Bhutan 9.0 Nepal 7.7 Source :http://data.worldbank.org/indicator/AG.CON.FERT.ZS
![Page 34: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/34.jpg)
Can We Control Pests Without Toxins? We Can Control Pests Without Toxins
![Page 35: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/35.jpg)
Ways of Purifying Water
![Page 36: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/36.jpg)
Ways of Purifying Water Need to develop an affordable
methodology to purify water applicable to:
• Domestic use: for less fortunate communities
• Community-based small local plants
• Filtration vs. chemical purification
• Predictable, easy to operate & maintain
• Household vs. larger scale purification
![Page 37: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/37.jpg)
What Works in the Field?
• The use of charcoal, sand, and brick (individually or in combination) do not meaningfully remove heavy metal or fluoride.
• Anything given free, people will consider worthless; hence some nominal amount should be charged to make them feel responsible and taking the ownership.
![Page 38: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/38.jpg)
We Have Tasted Several Commercial Water Purification Filters for Efficiency in the Lab
![Page 39: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/39.jpg)
Efficacy of the Locally available Filters in Removing Heavy
Metals, Fluoride, Agro-chemicals, and Bacteria
None of the filter material tested in the laboratory was efficient in removing potentially serious water contaminants in NCP region. We need a New Method.
![Page 40: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/40.jpg)
Real World Water Solutions (in order of long-term cost-effectiveness)
• Natural spring water • Rainwater harvesting • Wells, and deed tube wells • Provision of pipe-borne water • Water transportation • Boiled, cooled water
• Desalination • Bottled water (the most expensive) Reverse osmosis: The most applicable
![Page 41: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/41.jpg)
What is Happening Now
• Every month, over 400 people are dying of CKD-mfo in 2013
• i.e., 13 deaths per day! • Should we continue neglecting
those who are affected, suffering and dying form the CKD?
![Page 42: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/42.jpg)
Do We Really Need to Confirm Causative Factors Before Taking an Action?
• Over 10 years of CKD-related investigations, failed to come to a conclusion of the cause of CKD.
• No substantial actions have been taken.
• Yet people are dying every day.
![Page 43: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/43.jpg)
We Need Long-Term Solutions • Intense public awareness • Effective water purification methods • Prevention of water contamination
– (agriculture, waste, and sewage disposal) • Use of environmentally friendly
agricultural practices • Reverse osmosis methodology • Provision of centrally purified pipe-
borne water supply to every one
![Page 44: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/44.jpg)
Cost-efficiency of R/O Units • Deaths due to CKD in the affected region
approximates 5,000 per year (13 a day)!
• Thus, each $650 spent on this project will prevent one CKD death per year.
• Over the expected life span of 30 years of an R/O pant, investment of US $23 prevent one death
Cost of one restaurant meal !
![Page 45: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/45.jpg)
Educational Posters
![Page 46: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/46.jpg)
![Page 47: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/47.jpg)
Educational Posters
![Page 48: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/48.jpg)
![Page 49: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/49.jpg)
We Must Provide Clean Water for All
![Page 50: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/50.jpg)
Dialysis Units are not the Answer to Solve this Issue
Setting up Large-Scale Dialysis Units is NOT the Answer to This
Ongoing Problem: We Must Take Preventative
Actions: Actions Needed to Prevent
Healthy People Acquiring CKD
![Page 51: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/51.jpg)
Prevention of CKD in The NCP Region
![Page 52: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/52.jpg)
Functions and Failure of the Kidney
![Page 53: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/53.jpg)
• Recognition of the impact of different environmental conditions
• (In)appropiate continued spending on authorities like Mahaweli (and others)?
• Re-allocation of resources to: – Restoration of cascade of ancient tank
system, and – Village-level activities to re-vitalize the
rural societies
Focus Should Be on Prevention and Sensible Reallocation of Resources
![Page 54: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/54.jpg)
Solution to CKD Problem Must Include
Science & Research
Medical
Engineering Environmental
![Page 55: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/55.jpg)
Provision of Reverse Osmosis Would • Prevent new occurrence of CKD in healthy
farmers
• Also decrease other chronic diseases that prevalent in the region
• Clean water consumption should reverse the trend of sicknesses, and thus, enhance productive lives
• Installation of Reverse Osmosis plants are the best way to achieve these goals
![Page 56: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/56.jpg)
Focus Should Be on Preservation, Improve Access, and Prevention of
Water Pollution • Preservation of waterways, canals,
underground water, and tanks
• Regulation and maintenance of the quality of the water in tanks, wells and tube-wells
• Prevention of water pollution and alleviation of its adverse effects
![Page 57: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/57.jpg)
Key Missing Pieces
• Use of proper sampling techniques • Use of well-characterized
instrumentation for water analysis • Hazard identification • Risk assessment • Dose/response data • Risk characterization • Management and communication
![Page 58: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/58.jpg)
Practical Steps to Be Taken
• Explore alternative water conservation methods
• Empowerment of women & youth • Rainwater harvesting • Attention to sanitation
• Provision of sustainable drinking water and toilets in public places, schools, and workplaces
![Page 59: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/59.jpg)
Current Priorities: Commitments and Raising Funds • Regional and country-wide awareness
programs on prevention of water and environment pollution.
• Provision of clean, safe drinking water to all CKD-affected villages in Sri Lanka.
• Region-wide, geo-water-health study. • Obtaining funds, and corporation from
all stake-holders to rapidly implement this worthwhile project.
![Page 60: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/60.jpg)
What We Need to Do ? • SLGo to categorically authorize the CCPO, The
Consortium to carry our region wide: – Education on prevention of water and the
environmental contamination – Provision of clean water to all villages – Carryout region-wide geo-water study
– Allocate funds for the project
• In parallel, individuals, organizations, and corporations should raise funds for the project
• CCPO is READY to implement the project
![Page 61: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/61.jpg)
Overcoming The CKD Issue in NCP
• Never doubt what a committed group of people can do for the country
• When resources and expertise are inadequate, evolve & adapt to the situation
• Need to provide an economic viability to the region
• Change the fundamental • Need honest leadership and investments to
overcome poverty and diseases
![Page 62: Environmental Pollution & Chronic Kidney Disease of · PDF fileEnvironmental Pollution & Chronic Kidney Disease of ... “interstitial nephritis” ... contaminants in NCP region](https://reader031.vdocuments.pub/reader031/viewer/2022013014/5aa1424d7f8b9a07758b5654/html5/thumbnails/62.jpg)
Thank you………
Questions and
discussion
www.wimalawansa.org