Bottlenecks to empowering and evolving fluorosis-affected communities, drawn from lived experience in stakeholder engagement

Ruth Wagatua


Fluorosis is a systematically marginalized health issue caused by consumption of water with high fluoride levels and presents itself in the form of dental, skeletal, and mental fluorosis (lowered IQ) among other effects depending on the dosage of fluoride consumed. Fluorosis-affected humans know what it feels like to have a health issue and not have proper medical explanation or a comprehensive health care plan that covers even that primary health issue. It is expensive to manage the dehumanizing effects of fluorosis, and the worst thing about this condition is that fluorosis-affected humans don’t look actually ill unless in extreme skeletal health problem cases. This creates the possibility of fluorosis-affected humans and communities being invalidated and provided with no fluorosis health care.

My project aims to defeat fluorosis and bring healing and empowerment to people born and living in fluorosis-affected communities through activities and lobbying for incentives that will promote their wellbeing. One of the project goals is to conduct fluorosis sensitization through community education sessions in order to provide the workshop stakeholders with water safety education and possible solutions, as the project convener picks on how the stakeholders process fluorosis. The ultimate hope is to be able to afford bone and dental health care for citizens through the nonprofit EmpoVolve.

Here are some of the concerns that came from community members during community health literacy sessions on fluorosis:

“People in fluorosis-affected communities go to school for everything else but not on how to deal with fluorosis.”

“Fluorosis sensitization is not in our basic school education.”

“We normally have to pack drinking water for our school going kids without much explanation as to why the kids bring water for drinking from home.”

“It is assumed that everyone automatically knows what water with high fluoride is, as well as the consequences of consuming it.”

“We as community members have not formed a water and public health association hence there’s no public channel for us to advocate for better water and public health care provision from the bottom – up. This background has been making it difficult to empower and evolve fluorosis-affected communities to deal with this complex and silent health condition that we will be having for a lifetime.”

“Being a fluorosis-affected human, I have really suffered, that rising above the fluorosis cycle has always been a serious family goal for the children I would bear. When pregnant, I really paid attention to what I was ingesting, in order to protect my unborn from my consumption habits regardless of the options I have in terms of the quality of our water. I wish every mother would be keen on what they expose to their children even from the unborn stage.”

Our government system like in Naivasha sub-county, Kenya is designed in such a way that it primarily collects revenues from the community resources, hence this becomes the root challenge of empowering and evolving fluorosis affected communities because, how can a system empower the community it collects revenues from? Giving back, in such a dynamic, is not the automatic reflex. The relationship between the communities and the government system is imbalanced. The regulatory body’s (Government) strict mandate makes it difficult to even identify and empower established groups of community builders who understand how they can empower their communities. Consequently, fluorosis persists.

The average monthly wage in Nakuru County is considerably low, and the available solutions for preventing as well as managing living with fluorosis are unaffordable. Some foundations or stewardship partners still prefer to fund initiatives that would have an overall communal impact rather than improving the quality of life of the individual community members. For example, some foundations would prefer to fund projects that are communal (like funding a good quality water project in a public hospital) than provide incentives that will impact the people individually (like household rainwater harvesting tanks). In order to defeat fluorosis, these mindsets and relationships require an effectiveness review and needs to be evolved.

Proposed solutions

In pursuit of providing the future generations with safe and good quality water as well as care for this systematically marginalized health issue, we need to encourage more evolved ways of thinking and interdisciplinary working.

Committed community members need to be given the best possible chance to contribute the unique perspectives they can offer, in a meaningful way. Capacity-building and incentives sponsorship that encourage proactive information sharing and action need to reach down to them. Practitioners and development partners in the water, ecosystem, and public health sectors and NGOs that support work around fluorosis share this common health challenge and therefore, in seeking wellbeing and liberation from the fluorosis cycle, they can all master fluorosis if only they face it together to understand their synergy and the resources they have, in equal and active stake holding, rather than individually trying to defeat fluorosis with limited capabilities. The recent Nakuru County climate resilient water management stakeholders’  dialogue meeting on Water Sources Protection is one of those platforms that encourages bringing together evidence and solutions from the community champions on fluorosis, the practitioners, and development partners. Such kinds of platforms will enable the parties involved to understand how they all process the challenge of fluorosis, and the findings need to be integrated into informed and sustainable decision-making.