Daya Varma and Vinod Mubayi


More than twenty school children succumbed to death in the village of Gandawan in Bihar after consuming food contaminated by poisonous chemicals.  This unfortunate incident naturally caught the attention of national and international media. Speculations about the cause ran wild as was the case following the Bhopal disaster of 1984. This disaster has brought into question the desirability of the program of providing free meals to schoolchildren in India.


India runs the largest free mid-day meal to schoolchildren program in the world. India also loses a great deal of money through the petty corruption of the intermediaries involved in this vast program from schoolteachers and clerks to the heads of the village panchayats. Food meant for children is siphoned off into the illegal market. In UP, Sattu (ground flour which can be eaten or drunk after mixing with water), meant for school children, is sold by petty employees to feed livestock.


Of course, corruption at various levels of the economy from the highest to the lowest is pervasive in India as it is in many other countries. Construction contracts in Montreal, the second major city of Canada, were found to be under the control of Mafia. One of the largest construction firms of the world, Canada’s SNC-Lavalin, has been found to bribe influential persons with millions of dollars to obtain contracts.  Over the last few years, India has been rife with scams involving major contracts for coal, information technology, and construction at both central and state levels involving many major political parties, including Congress, BJP, DMK and others.


The world should be corruption-free. However, while big scale corruption is harmful to the national economy, petty corruption done by petty people in the day-to-day operation of civic life can have immediate, serious negative impacts on human health in a local area. The Bihar poisoning episode that occurred in a lunch cooked for schoolchildren is a glaring example of that; it is doubly ironic that suspension of the mid-day school lunch program due to this episode, if it were to occur, will be a bigger disaster for school kids as it will deprive them of an essential source of nutrition.


There have been two levels of criticisms about this disaster. According to one, it is proof of the incompetence of Bihar government and, by implication, of the central government, which instituted the free food program for school children in response to Supreme Court directives.


There are three ways the food program can become a part of corrupt practice. (1) A portion of the food provided is sold in the black market thus making it unavailable to many children; this probably is the worst case scenario; (2) The food is adulterated by lower cost products to become of lower quality than intended by the government; and (3) Food might get contaminated during storage and cooking. It is the last factor, that is the contamination of food by poisonous chemicals, which is acknowledged to be the cause of the Bihar incident.


Once children started falling sick and dying, the principal ran away instead of organizing medical help. Newspaper reports suggested all kinds of mismanagement in the running of the food program. One was that the food was never medically inspected. Another claimed that there were snakes, lizards and worms in the food. Doctors supposedly smelled phosphorus in the sick and dead children.  We are going to dwell on this because most readers of the INSAF Bulletin might not be informed about the technical aspect of this episode.


The claim that doctors could smell phosphorus is an absurd rumor. Phosphorus does not exist in free form.  The human body contains enormous  amounts of phosphorus in various states. DNA, RNA and many other constituents of the body contain phosphorus. Indeed the critical chemical in the production and utilization of energy in the body is ATP (adenosine triphosphate); as the name suggests each molecule of ATP contains three phosphate moieties. If phosphorus does have a distinct smell and if the doctors smelled phosphorus in the dead and dying children, they should walk with facemasks because all of us should smell, not of sweat, but of phosphorus. The poison that caused the death of children contained trivial amounts of phosphorus.


Snakes, worms and lizards should not be present in food. But they cannot kill any one. Indeed, in some cultures, they are items of consumption and there is a recent advocacy that worms should replace other items of meat as food; they are plentiful, they can be made tasty and they are ecologically the best. However, since cultural food habits in India do not allow consumption of snakes or worms as food, it is to cause a public scare that these food contaminants are highlighted.


There are only two situations in which stored foods can be harmful, though not in all instances fatal. Stored food in the Indian climate can deteriorate, losing its caloric content. Storage can lead to the growth of fungus, which can produce toxins; the most important is aflatoxin; in even minute amounts over time aflatoxin  may cause cancer but it cannot kill in the short term. The other situation, which is what most probably happened in Bihar, is contamination of the food by chemical poisons. The most likely poisons, which do exist in Indian villages, are pesticides.


A majority of pesticides and insecticides are collectively known as organophosphates. In these phosphate is attached to toxic chemicals like cyanide, fluoride and so on.  They were originally developed as war gases and indeed used both by the Axis and Allies during World War II. They are generally liquids and can be absorbed through any pathway, ingestion, inhalation, or absorption through the skin. Even minute amounts can be fatal.


The rumor that food was cooked in pesticides rather than in oil cannot be correct. Because the organophosphate pesticides are volatile and absorbed by every possible route, the cook should have died before he could finish preparing the meal. Besides, pesticides are far more expensive than cooking oil.


During the Sarin (methylphosphonofluoridic acid, a nerve gas) poisoning in the Japanese subway in 1995, the cause was suspected from the nature of the illness. Poisoning by Sarin-like poisons can be confirmed not by smell but by a simple chemical test. Organophosphates kill by irreversibly  inactivating a critical enzyme (acetylcholinesterase) of the body; the function of this enzyme is to destroy acetylcholine instantaneously.


Acetylcholine is essential for life and the sole chemical, which mediates the action of two of the three peripheral nervous systems (somatic nerves and  parasympathetic nerves).  Somatic nerves  control the functions of voluntary muscles  of  hand, legs, chest etc parasympathetic nerves control smooth muscles of the intestine, urinary bladder, etc. and secretions (e.g. saliva, wetness of the eye). However, the voluntary muscle must relax after contraction in order to contract again. This cycle is maintained because the effect is produced by acetylcholine and terminated by very rapid  destruction of acetylcholine by the enzyme acetylcholinesterase. The pesticides irreversibly inactivate this enzyme so that acetylcholine accumulates in the body causing excessive secretion in the lungs (preventing exchange of oxygen and carbon dioxide), and the paralysis of muscles including the chest muscles so the patient cannot breathe.


The standard treatment is injection of atropine to decrease secretions and provide artificial support of respiration. Atropine does not restore functions of skeletal muscles, like that of the chest.


During the terrorist attack in the subway in Japan, there were few deaths despite mass exposure to sarin, because treatment was rendered effectively and rapidly. Perhaps many children in Bihar could have been saved just by the injection of atropine, which is cheap and easily available. The fact that it was not done and the relatives had to carry the sick child from one hospital to another reflects the poor state of healthcare in India.


Most likely the poisoning was caused by the storage of food in containers previously used to stock pesticide. Because pesticides are the only source of poisoning, cooks and food distribution agencies should be educated about the danger of contamination of food by these chemicals. The fact that the food was never inspected by medical practitioners is of no relevance.  Food that every household consumes day after day is never inspected by health officials.


Sufficient modernization has taken place in India so that poisonous chemicals in the form of pesticide, insecticide, cleaning agents etc exist in the villages; some warning about the dangers of these should be made.

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