The Cost of Cheap Medicines: Antibiotic Pollution in Patancheru

(Note: The following story is the result of a series of interviews done with affected villagers, environmental activists, lawyers and other stakeholders along with visits to the affected areas by Anil Cherukupalli and Tushar Dhara in June 2009 as a follow up to news reports referring to a Swedish study that found extremely high concentrations of many drugs in local water sources in the Patancheru area of Hyderabad.)

The mantra that drives India today is development through industrialisation. Having missed the first wave of industrialisation India latched on to the emerging industries of the new millennium: Information Technology and Biotechnology. The precursor to biotechnology was the pharmaceutical industry which took root in Hyderabad from the late 1970s onwards. The succeeding decades saw Hyderabad emerge as one of the world’s largest centres for bulk drug production. The drugs were exported to major markets around the world including Europe and the USA and in lesser developed markets in Africa.

The rise of the Indian generics industry was made possible by a host of institutional and non-institutional factors: availability of a large pool of scientists; the Patents Act of 1970 that made a distinction between product and process patents which removed the legal constraints for manufacturing generics. In particular, the establishment of Indian Drugs and Pharmaceuticals Limited (IDPL) in 1961 by the government in Hyderabad led to the concentration of the generics drug industry in the southern Indian city.

The pharmaceutical manufacturing units are concentrated in the Patancheru industrial area, which lies 25 kilometres to the northwest of the city. Although a separate municipality before 2007 Patancheru became part of the newly constituted Greater Hyderabad Municipal Corporation that year. The newly constituted GHMC made it possible for the erstwhile suburban municipalities to access more funds for civic amenities and provided an integrated development plan for the Greater Hyderabad conurbation.

Though Hyderabad has become an important node in the global pharma industry, the environmental, human, economic and social costs have been overlooked. Although the benefits of providing cheap generic drugs are not in question the environmental cost is being borne by communities located in the vicinity of the drug manufacturing units in Patancheru. Since the early 1980s, when the pharma industry took off, these communities have had their water and soil polluted by the untreated industrial effluents. This has affected their livelihoods in the form of decreased agricultural yields. On the health front, although the evidence is anecdotal, abortion rates have increased; stunted growth has been reported in children, and increased incidence of skin diseases. The communities lack of the means to make their voice heard and along with willful disregard of existing environment laws and their monitoring by the regulatory authorities makes Patancheru a typical case of environmental neglect in a developing country.

A Swedish research team led by Joakim Larsson from the University of Gothenburg conducted a study on the levels of pharmaceutical drugs in the water discharged from a common effluent treatment plant in the Patancheru area of Hyderabad. The shocking results of the study, which was published in January and April 2009 in peer reviewed scientific journals, revealed the presence of very high levels of antibiotics such as Ciprofloxacin (up to 6.5 mg/L) and the anti-histamine drug Cetirizine (up to 1.2 mg/L). In one place, the levels were found to exceed human therapeutic blood plasma concentrations!

Moreover, it was not just Ciprofloxacin or Cetirizine that were found in the treated effluent. According to an Associated Press report, the supposedly cleaned water contained 21 different active pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments. Half of the drugs measured at the highest levels of pharmaceuticals ever detected in the environment!

The Chenchus XIII

The Chenchus XIII

November 2008, Nallamalla Forest, Andhra Pradesh.

With this the second part of the series on The Chenchus posted earlier comes to an end. You can follow the complete photo essay here.

The old man is the chief of the Chenchu hamlet Appapur which is inside a protected reserve forest. He was a very jovial person but behind his ever present smile I sensed a sadness caught as he and his people were between an overbearing government on one side and until recently far left radicals who used to threaten him and his villagers if they co-operated with the police.

The Chenchus XI

The Chenchus XI

November 2008, Nallamalla Forest, Andhra Pradesh.

This is the second part of the series on The Chenchus posted earlier. You can follow the complete photo essay here.

The house in the photo was actually built by the government for the Chenchus. But they prefe to stay in their traditional thatched huts. So the government built house is being used as a shelter for the calf.

The Chenchus-VI

The Chenchus-VI

November 2008, Kudichintalabayalu Village, Nallamalla Forest.

Kodala Bayanna contracted polio as a child. Both his parents passed away a few years back and he now lives with his old grandmother. A couple of years back the government had given him a tricycle but that soon fell into repair and he does not have the money to get it repaired. Now the only way for him to move is by crawling and sliding.

(To read this photo essay in sequence from the beginning please go here.) 

The Chenchus-V

The Chenchus-V

November 2008, Kudichintalabayalu Village, Nallamalla Forest.

Ramulu lives alone. His wife left him taking their kids with her. He only replied in monosyllables and sat outside his house staring into infinity. The doctor with us speculated that Ramulu might be suffering from depression based upon his behavior and his wife might have left him because he might have contracted AIDS. Apparently, going to prostitutes is another vice that the Chenchus pick up upon exposure to civilization and not being aware of safe sex practices inevitably suffer the consequences of unsafe sex.

(To read this photo essay in sequence from the beginning please go here.)