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A.K. SUSHEELA

India,

By encouraging awareness of fluorosis in both medical and local communities and by creating accessible low-cost preventive solutions, Dr. Susheela is curbing the spread of a crippling skeletal disease in India.

This profile below was prepared when A.K. Susheela was elected to the Ashoka Fellowship in 2003.

INTRODUCTION

By encouraging awareness of fluorosis in both medical and local communities and by creating accessible low-cost preventive solutions, Dr. Susheela is curbing the spread of a crippling skeletal disease in India.




THE NEW IDEA

Although there has been a growing awareness of fluorosis in the last three decades, little has been done to effectively contain the spread of the disease. Dr. Susheela has been a pioneering researcher-activist in the field of medicine in India. Through her own research, she has created simple, low-cost methods to prevent this disease. One of the first steps in this process is the creation of a greater awareness of fluorosis, and to achieve this, Dr. Susheela has initiated training programs for both the medical fraternity and the educational community. She has engaged both the government and the industrial sectors to increase efforts and investment in health-monitoring programs. Using these diverse channels of social impact, Dr. Susheela is educating India's youth, government, and medical fraternity on the causes, treatments, and solutions for this severely detrimental and easily avoidable disease.




THE PROBLEM

The disease fluorosis is caused by an element called fluorine. The 13th-most-abundant element in the earth's crust, fluorine is highly reactive and has a strong affinity to other elements that when combined, produce the compound fluoride. The presence of fluoride in drinking water above permissible limits (more than 1 mg of fluoride in 1 liter of water) leads to fluorosis. Depending on the level of fluoride intake, this disease can manifest in an irreparable and crippling deformation of the skeletal structure of the body. In India, 20 states have been identified as fluoride-endemic (with varying levels of fluoride of up to 48 mg per liter of water). It is estimated that 66 million people in India are seriously ill or at risk–of which 6 million of them are children. Although entirely preventable, little has been done to curb this endemic disease.




THE STRATEGY

As one of the country's foremost researcher-activists in the medical field of fluorosis, Dr. Susheela has created simple preventive and curative measures to remedy this crippling disease. She has adopted a multifaceted, holistic strategy to fight its spread.

In India, consumption of naturally fluoridated water is the most common cause of elevated fluorine levels in the body. Dr. Susheela is revitalizing existing government programs by training public works officials and water supply engineers on the defluoridation of the water supply. She has worked closely with the health ministry to train government doctors in the diagnosis of fluorosis at early stages and to create referral services in the fluoride-endemic regions.

Recognizing the important role of schoolteachers in society, she is bringing understanding and knowledge of fluorosis and its causes to teachers, creating the first link in a chain of learning that she believes will lead to greater social awareness. If detected in its early stages, fluorosis is totally preventable, and thus, Dr. Susheela emphasizes the need to educate doctors and other professionals who are most in contact with children.

People who work in smelting rooms in aluminum factories are at an especially high risk for fluoride poisoning. On this front, Dr. Susheela has persuaded the largest aluminum factory in the country to run a health-monitoring program that has drastically improved the health of workers. Such a program raises company moral and goodwill among workers. The management of the factory, on its own initiative, has undertaken the task of introducing the program to fellow factory-owners–a hopeful sign of interest in this new practice from the Indian industrial sector.

Medical colleges do not currently teach students how to diagnose Fluorosis and the disease characteristics. To remedy this situation, Dr. Susheela has documented the range of symptoms shown by a person affected by fluorosis and has organized extensive workshops to educate medical practitioners, especially pediatricians, on diagnosis and treatment. In addition, through publication of the dangers of this disease, Dr. Susheela hopes to evoke a change in the basic medical perception of the disease and eventually have such information taught in India.

At the policy level, she is educating governments that have failed to address this health problem adequately. Dr. Susheela hopes that in exposing the crippling effects of the disease and the simple measures needed for prevention, the necessity of immediate action will become clear. She has submitted a holistic report to the National Human Rights Commission on the various aspects of fluoride poisoning in the hope that it will act to influence and evoke changes in related state and central government decisions.

Working against the interests of the multinational lobby of the country, she has been successful in creating policy changes that require manufacturers to incorporate in writing the exact amount of fluoride in each tube of toothpaste. Her success as an activist-researcher has given her international recognition and respect. In Britain, she was instrumental in advising the British government not to fluoridate their water supply; as a result, the British Government's effort to fluoridate more cities is on hold and has led to debates in various forums.




THE PERSON

Born in Malaysia to Indian parents, Dr. Susheela spent her school years in a Catholic hostel in Kerala. The discipline she developed in her early years helped her later in life as both a researcher and as individual working for change. Always a bright student, she chose her research subject–fluorosis–by accident, at a time when scientists had little knowledge of it. She went on to become a pioneering researcher at the premier research institute in the country. Rather than restricting herself to research, she chose to work closely with the public to create awareness of the disease. She traveled throughout India, evaluating the inadequate government programs used to cure water, one of the most common sources of elevated levels of fluoride. One particular study that confirmed both her findings and the failure of the government to monitor water fluoride levels inspired her to commit herself to activism in this field. Dr. Susheela has continually shown dedication to her work and creative use of her knowledge to raise awareness through messages of prevention through simple interventions.




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