The case of infectious diseases due to Yali Dam

Villagers in a remote Stung Treng’s Svay Rieng village living along the Sesan River reportedly appeal for health treatment assistant due to the infectious disease coming from dirty water flowing from the Yali dam in Vietnam. Majority of 200 families in this village are using the water from Sesan River in where dirty water, rubbish, and feces and water infiltrates from a red earth area are discharged from the Yali Dam located near Cambodia-Vietnam border.

This has resulted to different types of infectious diseases including diarrhea, itchy skin diseases, swollen limbs, typhoid, on the villagers; particularly the children. Over 20 children and adults have reportedly suffered from diarrhea and itchy skin disease since January 2010.

Notably, these kind of disease symptoms had never appeared in this village who always consumed the water from the river. The below video, in Khmer language, was reported by Radio Free Asia, where villagers were echoed their disease symptom and its root causes. Translation excerpt is available on the Mirror.

In fact, there have been much discussion and concerns by many stakeholders concerning the impact resulted from the building of the Yali Dam since 2000. The Vietnam’s $1 billion Yali Falls dam which was begun without prior Environment Impact Assessment (EIA) was later assessed by community-based groups who concluded that the dame has causes and is causing serious environmental and socio-economic impact to 20,000 people in 59 villages in the dam affected area, downstream on the Se San river in Cambodia’s Ratanakkiri and Steung Treng provinces.

The study conducted in 2000 further revealed that the dam is bringing death, disease and environmental devastation to Cambodia even before it is fully working. These mentioned impact has actually and continually occurred now. In 2000 report, five Cambodians were reportedly killed, crops destroyed, and fishing boats lost after the released water from the Vietnamese power station into the Se San river that cause a sudden surge in the volume and current downstream in Cambodia’s Ratanakkiri province.

There has been also much discussion on the quality of water which has harmed many livestock.

“According to the study, villagers claimed that more than 4,900 buffalo have died of unusual diseases since the water quality problem began in 1996. They also reported the similar deaths of more than 2,200 cows, 7,800 pigs, 1,600 ducks, tens of thousands of chickens, and more than 2,500 dogs and cats”

Regardless these reported cases, it seems there have been yet proper mechanisms being addressed and continued to impact to the community well-being where the social infrastructure including health care or risk reduction system have been yet well equipped. If this continued, it will be resulted into large social and economical cost similar to Minamata disease, where Japanese government had failed to taken any immediate risk assessment and reduction.

Background of Risk Management System Section:

This is a series of reflection on the risk of management system in Cambodia followed the study on Japan’s Minamanta disease; particularly, after a current IUJ‘s lecture seminar, “The Error shall not be Repeated,” by Mr. Katuhiko Bando, a key attorney for the lawsuits filed by the victims of the Minamata disease in Niigata and Kumamoto against the polluted companies since the late 1960s. Mr. Bando have kept legal fighting, regardless the recommendation by many other attorneys and judges to have political resolution, in order that justice and proper compensation for the victims can be prevailed. The Minamanta case reveals much failure of Japanese government in risk management system by putting more priority on industrial activity (after the post-war war II period and during competitive world market), and fails to involve stakeholders (who can be individuals, groups or organization that can affect, be affected by or perceived themselves to be affected) for risk communication and monitoring. This failure have great impact on the society; especially the victims who have been burdened for the legal battle and social respect.

The early reflection to Cambodia was on the current practice of the Cambodian government who neglects or bypasses the regulations in approving forest concessions or filling the lakes is not only harmful to natural resource depletion, but also to environment, to human life, and the whole community survival. This includes the case of 1) the Bokor mountain which have been authorized by the government to private company in the name of development project of palm oil and cassava plantations and livestock farms,and 2) the filling of Boeng Kok Lake, which the private company could start their land filling operation even before the Environmental Impact Assessment (EIA) had been approved. Though the company recently obtained EIA stated that the lake the Boeng Kok is “dead lake—no major impact on environment”, there is also remark that some flooding will occur in rainy season and they are unable to provide any specific estimation on severity of risk.

Relevant articles:

Another Failure of Risk Management System: a case of SMON

Reflection on the risk management system in cambodia

A failure of risk management system a case of minamata disease

I first became aware of prostitution in Cambodia when I was 10. On the way home from the Phnom Penh Airport, we drove down Tol Kork Street. I was puzzled to see so many ladies wearing short skirts and heavy make-up. They were standing in front of their small cottages and waving at us. It was explained to me that they were prostitutes. Yet, I became even more puzzled. Why did they choose to become prostitutes? Will I end up like them? Are there other choices?

The word for prostitute in the Cambodian language is, “Srey Khauch,” or, “Srey Phaka Meas.” The phrase indicates a bad lady who chooses to earn income by having sex with men. It does not acknowledgement the vulnerability of women to sex trafficking. Yet, the reality is that given a choice, they would not become prostitutes. Events, circumstances, and conditions force women into prostitution, and I prefer to call them victims instead of prostitutes.

The following items will be highlighted in my article:

• Factors that Make Women Vulnerable to Sex Trafficking and Exploitation
• The Suffering of Victims of Sex Trafficking
• Does the Current Economic Crisis make Females More Vulnerable?
• Hope and Motivation from Anti-sex Trafficking Activists

Read more @ http://bit.ly/bhg1qC

Another Failure of Risk Management System: a case of SMON
SMON (Subacute-Myelo-Optico-Neuropathy): is caused by the side-effects of an anti-diarrheal drug containing Clioquinol or Chinoform. It was firstly treated as a strange disease of unknown virus because the disease had a number of characteristics common to polio epidemic widespread in Japan. That made the virologists and other medical researchers kept concentrated in finding the virus instead of other root causes. More importantly the causes of the SMON were prolonged due to the fact that the doctors could not anticipate the disease was resulted by their medical prescription or simply the large doses of Clioquinol drug.

The symptom: it first appears abnormal symptoms such as diarrhea and pain. Then it affects the peripheral nerve, posterior and lateral columns of the spinal cord and the optic nerve, causes such neurological manifestations as strange sensation of paresthesia and pain, difficulty in walking, visual disturbances, recto-vesicle dysfunction and the like caused complete blindness and death in serious cases (GPSS, 1978).

Impact: The officially recognized victims were 11,000 though the actual number could reach up to 30,000. Beside the above mentioned symptoms of SMON, the victims not only physically suffered, but economically and psychically hurt because of discrimination, insult (that the victims tried to produce fake claims in order to get compensation), and marriage problem (some were divorced, denied to be married by the family, and forced to live alone).

Main responsible actors and implications: This disease indicates a failure of hazard identification and risk estimation by which three main actors involved: pharmaceutical firms, government regulators and doctors. Since 1933, there were reports abroad about the harmful effect of Clioqunol and risk prohibition measures: 1961—FDA in US listed Clioquinol as indication –needed medicine; 1965—use of the drug to cats and dogs banned in the UK; and 1968: prophylactic use of the drug prohibited in Sweden.

Yet, the Clioquinol, which came to be used in Japan by 1930s, gained the status of an “enteric drug” (use for diarrhea) on no firm ground that make it way for regulation-free marketing drug in 1939. By 1955 to 1960’s, the production started to increase sharply though other countries banned the drug use. This revealed a lack of risk management system and global communication on the risk impact. The failure of risk assessment is also due to the lack of feedback mechanism to monitor the adverse effects of drug. At the meantime, there was collusion between Ministry of Health and Welfare with the company (the Chief of Pharmaceutical and Supply Bureau of the Ministry was welcomed to a seat of the board of the Union of Pharmaceutical companies, GPSS, 1978). This clearly shows that corruption mainly contributed to the failure of this risk assessment. In addition, the “Health Insurance System” which granted people to free health care or partial payment was another factor to the disease outbreak combined with unprofessionalism of some doctors. People enjoyed that medical service and therapy, while the doctors also took it for granted as they could earned extra by the warranted payment whenever they practiced therapy and medical prescription. Consequently, with marketing promotion from the pharmaceutical company, unprofessional doctors kept giving excessive doses of Clioquinol to patients. That proves a business-oriented mind of the company and the doctors on the cost of people’s life.

Patients’ Struggle: Similar to Minamanta Disease, victims were burdened to prove the case and struggled to proceed with the court. At the end, all of them, except three patients, agreed to the conciliation agreement that the district courts recommended. It is difficult to justify whether the justice should be put more priority as they were burdened with prolonged legal procedure and continued legal fighting with the company and the government, while some of victims passed away. In spite of this justice compromise, there were two laws were consequently promulgated: The revision of the Medicine Law and the Relief Fund for Adverse Drug Reaction Victims Law (these are aimed to protect the health and safety of people on the drug policy and offers a more rigid criteria for drug approval).

The case of Ms. Yuriko Tanaka: she is currently the chair of Association of SMON Victims in Tokyo. She happened to be the SMON victims in her college life while she was the smart student and the only girl in her school. This disease did not only affect her study life, but her relationships with the family of her to be husband. Her husband’s parents rejected their marriage because she is SMON victims. However, they decided to get married without parents’ approval. Though she was lucky to deliver two healthy sons, she suffered much pain and being hospitalized for years (She spent one month in hospital and about one year in bed at home after her first baby delivery and another five months in hospital and two and half years in bed at home for her second baby). It took her much time to regain the strength of her normal physical condition as a SMON patient. Regardless her disease, she has been strongly struggling for her life and for other SMON patients. Her inspiring message to us is that: 1) Please deliver the SMON message throughout the world and help stopping any harmful effect including medical use or environmental harm; 2) Be hopeful:

“Please do not depressed,
Do not work so hard,
Please do not give up,
Forget your pain,
Believe in success in someday”

This SMON should be an influential case to relevant stakeholders including government, policy makers, doctors, as well civil society to be cautious about the safety and effectiveness of medical usage and other supplies which may result in harm. Also, adequate mechanisms can be taken so that stakeholders can reevaluate the hazard and its associated risks. There must be a mechanism for risk communication and monitoring with both government and civil society.

Reference:
Watanabe Shinichi (2009, winter) “Economic Development and its Risks to Life, Environment and Community: The case of SMON,” Risk Management under Globalization Class, International University of Japan.

GPSS (1978): “No More Yakugai SMON, Appeal from Japan, Tokyo,” (GPSS: group of plaintiffs of SMON Suit at Tokyo District Court).
SMON Lecture (March 03, 2009) by Ms. Yoriko Tanaka, the Chari of Association of SMON Victims in Tokyo. Ellison, B. and Duesberg, P. (1996): “The SMON Fiasco,” available at
http://www.virusmyth.com/aids/hiv/besmon.htm

2) the filling of Boeng Kok Lake, which the private company could start their land filling operation even before the Environmental Impact Assessment (EIA) had been approved. Though the company recently obtained EIA stated that the lake the Boeng Kok is “dead lake—no major impact on environment”, there is also remark that some flooding will occur in rainy season and they are unable to provide any specific estimation on severity of risk (Cambodia Daily, “Expert Dipute Boeng Kak Impact Report,” Thursday, March 26th 2009). This should recall to:
Precautionary Principle 15 of 1992 Rio Declaration on Environment and Development (one of the guiding principles of The United Nations Framework Convention on Climate Change (UNFCCC) of which the Cambodian Ministry of Environment has ratified this convention in Dec 13 1993) :
“in order to protect the environment, the precautionary approach shall be widely applied by States according to their capabilities. Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation”.

This precautionary principal places emphasis on the shift the burden of proof to proponents, not the victims or community who will be affected. However, most of the cases, the company is rarely demanded to proof the case, but the victims. Thus the government should take its responsibility to implement the convention that they had ratified.

Risk Monitoring and communication

The stakeholders need to be involved in determine and make decision on any tolerable risk and the access to information must be ensured as provided by the precautionary principle as well as the 1996 Cambodian Law on Environmental Protection and Natural Resource Management:
Article 11
The Ministry of Environment shall immediately inform concerned ministries whenever the Ministry of Environment finds that natural resources are not being conserved, developed, or managed [or] used in a rational and sustainable manner.

The procedures for public participation and access to information on environmental protection and natural resource management shall be determined by Sub-decree following a proposal of the Ministry of Environment.

This article is not raised to against the development project of the Cambodian government, it yet to provide the framework for the relevant stakeholders to take action on their assigned duties to serve the public interests and to avoid the future cost of risk management system failure. Also, in the case of weak social infrastructure, the poor and affected residents are more vulnerable and they deserved the rights to benefit from that so-called development dream.
Note: this article is interlinked to the previous articles:
Law needs to be enforced at Boeng Kak
Bokor National Park should be preserved
A failure of Risk Management System: a case of Minamata Disease

A failure of Risk Management System: a case of Minamata Disease
Minamata disease: is a form of methylmercury poison affecting the central nervous system. It is due to prolonged large consumption of fish and shellfish polluted with methylmercury compound produced by chemical plants’ dump wastewater flowing into rivers and seas, which then accumulates in fish.
Mercury is chemical element used in many everyday products, including shining lights and thermometers. Yet, Methylmercury is highly toxic, and if it absorbs into the blood and then to the brain, it will significantly damage to the human body. For the case of pregnant woman, the unborn baby could suffer brain damage.

The symptom: of Minamata Disease includes numbness (arm and legs), ataxia (loss of coordination), loss of equilibrium, vision narrowing, and loss of hearing. In sever cases, victims suffer dementia and unconsciousness, and it may lead to death due to acute fulminate form. The following is the statement of a victim who died shortly after saying:
I want to get better soon. Soon. Everything is numb…my whole body.
Everything is getting dark. Breathing is hard. Living is hard.
Origin of disease: The case of Minamata disease was firstly confirmed in Minamata Bay, Kumamoto Prefecture, in 1956. That is the reason why it is called Minamata Disease. Then, in 1965, it was found in the Agano River basin, in Niigata Prefecture. The government only made an official announcement of disease in June 1965, about 10 years after the disease notification. The number of the Niigata victims applying for certification alone was about 2,138, but only 690 victims were officially recognized. For Kumamoto victims, the number of official recognized victims was only 12,621 (out of 23,037 applicants). The disease was confirmed to be eliminated by 1978.

Causes: In Kumamoto Prefecture, the disease stemmed from the waste pollution of Chisso Minamata Plant, which had been a symbol of the area growth. Chisso produced acetaldehyde, the raw material for acetic and vinyl acetate (1932-May 1968).During this operation, the methylmercury was negligently dumped into the Minamata Bay. Though, the company argued that the explosives, amine, and other substances were the cause of disease, not the methylmercury.
For the case of Niigata Prefecture, the researchers found out that it was due to wastewater polluted by Showa Denko Kanose Plant. However, the company rejected the claim and offered “Agricultural Chemicals Theory,” holding that agricultural chemicals leak, during the Niigata earthquake, from a storage warehouse near the mouth of the Shinano River; then reached the Agano River.
These companies’ argument slowed up the process of harm identification, while the victims suffered and some died.

(source: Department of Health and Social Welfare (Mar 2005), “Outline of Niigata Minamata Disease,” Niigata, Japan)
Impact: The disease led to physical handicaps and impacts on their employment. Before, they were effectively hard-working homemakers or farmers. However, physical handicaps robbed their full capacity to work, and for some victims who hide their disease, were labeled as unskilled or lazy and they were forced to quit working. The disease also largely affected the fishing industry, which is the main income source of residents in these areas. Their sale was dropped due to the outbreak of disease (the total catch for the six fishing association in the Agano River fell by 23% for migrating fish, and about 65% for river fish). This income impact brought them into poverty and greatly changed their life as well as their family.

Beside, the victims also emotionally suffered from heartless discrimination, insults, and bigotry of the surrounding people (due to limited information about the causes of disease. It is like the case of HIV/AIDs that people previously prejudged that it can be infected by touching or speaking to that patients). Before the causes of Minamata Disease was not yet found, the disease was considered as a curse, or infectious disease that the victims were shunned by the community. Although after finding the cause of disease, there was still discrimination and the victims were laid off from their job, also their children could not find employment and marriage partners.
Implication: Though they were seriously affected by the disease, the legal procedure placed more burdens on the victims, including the responsibility to proof the case; applying for certification to be Minamata disease victims (some of them were rejected, so that they could not get any compensation or medical treatment and it was due to the strict certification regulation), and continuing effort to get stakeholders (the company and the government who neglected to prevent the second disease outbreak) accountable. Due to the delayed court process (about 10 years) and continued deny of the proponents, the victims were agreed to reach political resolution by the three main political parties: compensation and medical scheme by company and the government to those certified victims.

This story indicates the government failure in risk management system by putting more priority on industrial activity (after the post-war war II period and during competitive world market), and fails to involve stakeholders (who can be individuals, groups or organization that can affect, be affected by or perceived themselves to be affected) for risk communication and monitoring. Also, this experience can be the good lesson for developing countries whose social infrastructure and risk management system are weak.
Note: The reflection on Cambodia context is followed in the next article.

Reference:
Watanabe Shinichi (2009, winter) “Economic Development and its Risks to Life, Environment and Community: The case of Minamata Disease,” Risk Management under Globalization Class, Lecture Slide, International University of Japan.
Field visit (2009, Jan 27) at the Niigata Learning Center for Humans and Environment, meeting with Ms. Setsuko Kotake, a Minamanta disease victim.
Department of Health and Social Welfare (Mar 2005), “Outline of Niigata Minamata Disease,” Niigata, Japan
Ministry of the Environment Government of Japan (2002), “Minamata Disease: The History and Measures,” [online] http://www.env.go.jp/en/chemi/hs/minamata2002/