Health Autobiography of a Fluorosis Affected Human: Good Quality water as Health Care

“Fluorosis has been a part of my identity even before I was born. I got fluorosis through in-utero exposure to fluoride because my mother consumed water with high fluoride when she was pregnant with me.  The only readily available water that the locals in Naivasha have access to is rainwater and groundwater. Groundwater in my community, as well as in several other counties in Kenya, contain high amounts of fluoride concentration. It is the reason many of my fellow community members and I have developed fluorosis.”

By: Ruth Wagatua

Fluorosis has been a part of my identity even before I was born. I got fluorosis through in-utero exposure to fluoride because my mother consumed water with high fluoride when she was pregnant with me.  The only readily available water that the locals in Naivasha have access to is rainwater and groundwater. Groundwater in my community, as well as in several other counties in Kenya, contain high amounts of fluoride concentration. It is the reason many of my fellow community members and I have developed fluorosis. In Naivasha, data on the quality of water and documentation on the number of people affected by fluorosis, how fluorosis presents itself and other diseases caused by high fluoride consumption, is not readily available and the local population do not have knowledge nor control of the fluoride concentrations in the water they consume. This is because water and public health information systems or surveys like population census do not capture this important indicator. Fluorosis affects not only people’s physical health, but also their socioeconomic status. As a victim of this illness myself, I want to champion reforms towards good quality water and a healthcare financing scheme that covers for dental and bone healthcare procedures in Fluorosis Affected Communities (FACs). I hope this will future proof the coming generations from fluorosis.

Fluorosis is an illness that comes about from the consumption of water with high fluoride concentration whereby the fluoride ions accumulate and diffuse into the enamel, skeleton, pineal gland, converting the hydroxyapatite (calcium) to fluorapatite (fluorosis). When the damage is done, it’s irreversible. Fluorosis presents itself in the browning of the teeth and however brown and damaged the teeth are, that’s how the internal skeleton of that particular individual also is. Fluorosis has also been scientifically proven to affect the cognitive abilities of the fluorosis affected human depending on how much fluoride an individual has consumed.

Our bodies are essentially soil and water and the quality of our soil and water determines the quality of our food, the health of our bodies, and the living condition of our lives. When you live within a fluorosis endemic zone, like Naivasha, you are not always conscious that you are different, and you go about life quite normally. You accept this as the norm. I only started becoming aware that I was different when my brother and I would visit our relatives in other regions of Kenya, and we would go through disrespectful and unsolicited dental scrubbing using natural sand and sometimes sandpaper. Neighbors would keep on asking our hosts why they didn’t take enough care of us and that’s why we have brown teeth. While the scrubbing was meant to be helpful, it left me with a lot of teeth sensitivity, and I had to eventually do dental masking which is a procedure that not everyone can afford.

Fluorosis is not only a cosmetic problem. It is socially isolating, it leads to bullying, it affects our minds and ability to learn, it can affect our long-term bone health, and keeps us from feeling confident and thriving. It has resulted in serious socioeconomic inequities as people associate it to poor oral hygiene and as an indication of poverty. Getting front office jobs and being recruited in the army is a serious challenge because we are discriminated against. We rarely speak about the invisible psychological cost of fluorosis.

While working for the former member of the national assembly for Naivasha Constituency, I started paying attention to our water and began to understand what fluorosis actually was. I noticed that Naivasha has a freshwater lake but the catchment community suffers from fluorosis, which didn’t make sense. This inspired me to pursue a masters in water policy and during my thesis research, I came across articles that said that the toxic effects of fluoride on human health when consumed in excess amounts (beyond 1.5 mg/L), for long periods, has been known for decades. Despite this knowledge, no one has been able to find a sustainable solution for this problem. It became my personal mission to find a solution. Through the research, I was able to observe how mount longonot’s volcanic activities poisoned the earth’s biosphere with high fluoride, how this volcanic ecosystem had made us sick, how I am the product of mount Longonot’s volcanic soil deep within my bone formation and how the fluoride had found its way into even my DNA.

From my thesis research work, I was able to piece together that Mount Longonot’s previous volcanic events were both a blessing and a curse to the geographical area. It is the reason for geothermal exploration potential and is also the generator of observed high fluoride aquifers of the area. The natural heat and steam from the vicinity of Mount Longonot has been harnessed to provide electricity to the tune of 699MW. Geothermal energy production has always required water in the form of steam to produce energy and therefore commissioning of a community water treatment plant and rainwater harvesting tanks through corporate social responsibility project partnerships is tenable.

To the rest of the world, I may come from a resources-rich sub-county, but our community is chronically underinvested in when it comes to public health infrastructure solutions. The system has failed us through neglectful care and neglectful provision. It also bothered me that I didn’t see a fluorosis affected human in the decision-making positions of water, ecosystem and public health sectors. How do we expect someone who doesn’t relate personally with fluorosis to be the one solving this challenge for us?

The most vulnerable populations are expectant mothers, children under the age of 8 years, caregivers, youth (the age seeking to be in a relationship and or employment because they get discriminated against) and the old with bone health issues. We need services like well-being checks on fluorosis affected humans. We need community education. We need infrastructure support that is actually led by the people of the community. There is a lack of depth in dealing with fluorosis because fluorosis is non-communicable and seemingly not life threatening. It is seen as a “lower priority”, and has been neglected on the global health and development policy agendas.

I now understand the depth of what needs to change and I want to be at the forefront of creating this change. I research on fluorosis because I need to understand and gain closure on what has happened to me. The process has been therapy for me and a voice to the victims of high fluoride consumption. Getting this fellowship means a lot, that ThinkWell institute sponsors and Samya Rose Stumo family acknowledges that the pain fluorosis affected humans have gone through is valid.

So how do we create change?

Fluorosis is a chronically underinvested issue. This is due to lack of affordable defluoridation technology, the insufficient awareness on water safety, high poverty rate, the lack of water safety coping strategies, expensive dental and bone healthcare procedures, and lack of water, ecosystem and public health policies on fluorosis.

Naivasha Sub County is a gold mine for resources such as geothermal exploration. It has a multimillion horticultural industry, and the Hell’s Gate national park and hotel industry promote conference tourism. We should be able to generate enough revenue that can go back into investments that enhance the quality of life in FACs. We should also create project partnerships on public health infrastructure solutions.

Lake Naivasha, Kenya.

Water (fluorosis) and energy (geothermal exploration) are very directly connected in Naivasha. The geothermal exploration company (KENGEN) is a major economic contributor and the biggest geothermal project in Africa. It is tenable to think and consider approaching geothermal energy exploration company in Naivasha Sub County to be a host partner in the investment of good quality water provision in Naivasha and all of Nakuru County. If a country invests in hydropower and geothermal power projects (that are dependent on water) then the same country should be able to invest in good quality water (rainwater harvesting and or water treatment plants) for their communities.

Community social enterprises need to be set up and empowered to take action towards ending Fluorosis in Naivasha. They should be channels of water safety community education, capacity building, and the demystification of fluorosis.

At the core of who I am, I’m still fluorosis affected. I wish people like me are seen as humans that require healthcare even if the healthcare that we need doesn’t look like the usual healthcare provided for in developing nations. I believe fluorosis issues should be covered by the basic Kenyan health insurance. People in FACs have been individually striving to manage this condition and well-being. We should make dental and bone healthcare procedures inexpensive and attainable to all.

Considering that borehole water in FACs already has high fluoride, dental fluorosis is not only natural but also provoked through the majority of the fluoride containing toothpastes provided for in the local stores. Education on toothpaste safety and a supply of fluoride free toothpaste or hydroxyapatite toothpaste is required for both caregivers and toothpaste suppliers.

The Fellowship is equipping me with funding proposal skills so that I’m able to develop funding proposals for rain water harvesting tanks and water treatment plants. With this I will be able to reach out to potential project partners and pursue investment partnerships in order to gain leads into securing funding for the public health infrastructure solutions.

Through the fellowship, I will be able to conduct quarterly targeted community public health education sessions with the aim of creating education spaces.  These will be platforms for a medium that improves health literacy and gives fluorosis affected humans spaces to speak and heal. With this channel we will be able to empower the vulnerable groups to be equipped with home grown policies and habits that ensure water safety.

The fellowship is a chance for me to lobby for the adaptation of healthcare financing into primary healthcare that covers dental and bone healthcare procedures in FACs. This is so as to minimize on out of pocket expenditure when it comes to managing living with fluorosis and to form a treatment plan for dental fluorosis and bone health issues that can be made affordable to all.

I look forward to setting up a social enterprise consultancy that will keep implementing defeating fluorosis activities/solutions even after the fellowship year.

My Call to Action:

I am a community builder, inviting visionary partners and helpers towards this vision of funding good quality water and healthcare financing for fluorosis affected humans. We need to have access and be able to afford the products and services we need to make managing as well as eradicating fluorosis easier. Empowering this initiative will mean empowering a healthy outcome for children born and living in fluorosis affected communities, just like me. Every child deserves white teeth, healthy skeleton, an intact self-esteem, and their rightful IQ. Help FACs grow and thrive by empowering us through investments in Public Health Infrastructure Solutions.

I look forward to the future of FACs which will be revamped communities, with revamped souls. I also look forward to taking this far beyond the community I am serving.