To contact your representatives please email them at…

Ms Sandi Humphrey—Sollas
sandisolas@gmail.com
Mrs Chrstina Dick—Lochmaddy
christinadick@hotmail.com
Mrs Isa Mackillop—Locheport
isamackillop@aol.com
Mr Archie Campbell—Bayhead
akcampbell@cne-siar.gov.uk
Mrs Theona Morrison—Grimsay
tmorrison@nce-siar.gov.uk
Mr John Maclean—Berneray
mvshipping@hebrides.net

I am pleased to introduce to you the two new arrivals in North Uist medical practice.

Dr Woods has come over from Glasgow where she has been working for the last few years.  She brings a wealth of experience to North Uist and has a special interest in respiratory medicine.

Jan Barker has been in post for just over 3 months now as our new practice nurse.  She has already fitted in very well with the team.  I am sure many of you have got to know her over the past weeks.

I will try and persuade both of them to post a little bit about themselves in due course.  Watch this space.

1) What level of aluminium is acceptable in our water? This is an interesting question. The WHO have set international accepted levels in a document which can be accessed here. These levels have been selected as being the lowest that could be reasonably expected in public water supplies given the question marks over the risk that oral aluminium poses to human health. The level is in fact 0.1mg/litre of water, but 0.2mg/litre is stated as being acceptable in areas with small populations. It seems to be unfortunate but true that the 0.2mg/litre level that is used for Uist is far from ideal – it is instead a pragmatic response to the fact that it is very difficult to keep aluminium levels low in small water treatment works such as ours. As far as I am concerned this makes breaches of the 0.2mg/litre level even more important than would be the case if breaches occurred elsewhere in the UK where the 0.1mg/l limit is generally adhered to.

2) How high have the aluminium levels been? I have seen the figures for this but unfortunately have not been given permission to publish them. I strongly feel that this kind of information should be freely available in the public domain and would have preferred it if the early figures were highlighted at a much earlier stage than they were. I can tell you that in general the levels have consistently been higher than the 0.2mg/L standard since the 19th September – often several times higher. For a few brief periods the levels went between 9-10 times the accepted level for small water treatment plants – which equates to 18-20 times the level that the WHO indicates that we should generally aspire to.

3) What does all this mean? Good question – I wish I knew the answer. As I stated in my previous post – I am reasonably reassured after looking at various papers and editorials on the Camelford disaster that it is very unlikely that we in Uist will see problems in the future from this short term breach of aluminium levels – but I still have underlying concerns.

The WHO document I linked above summarises the findings of 6 different studies – 3 of which pointed towards a link between levels of aluminium above 0.1mg/l in water (note that in Uist 0.2mg/l is accepted) and 3 did not. It summarises these results by saying…

‘On the whole, the positive relationship between aluminium in drinking-water and AD, which was demonstrated in several epidemiological studies, cannot be totally dismissed. However, strong reservations about inferring a causal relationship are warranted in view of the failure of these studies to account for demonstrated confounding factors and for total aluminium intake from all sources. Taken together, the relative risks for AD from exposure to aluminium in drinking-water above 100 µg/litre, as determined in these studies, are low (less than 2.0). But, because the risk estimates are imprecise for a variety of methodological reasons, a population attributable risk cannot be calculated with precision. Such imprecise predictions may, however, be useful in making decisions about the need to control exposures to aluminium in the general population.’

So – not clear cut, but some cause for concern.

Unfortunately for us there has been a much more thorough and as far as I can tell methodologically sound report in recent years which many of the resources on the net reassuring us about aluminium have not taken account of (presumably because it is relatively recent).

This study looked at almost two thousand French people over 15 years, and for the first time was able to factor in total daily water consumption at different aluminium rates. In a nutshell, their conclusion was that aluminium levels over 0.1mg/l were statistically linked with an increased risk of dementia (a relative risk of 2.26 – or just over twice the risk of matched controls with low levels of aluminium in the water supply).

This does not sound great – though like with any research we need to be careful before drawing conclusions.

Putting all this together what kind of questions do we need to be asking Scottish water / public health over the coming weeks?

1) Since we are already forced to adhere to a lower standard of aluminium levels in our water than on the mainland – why were we not informed as soon as the breach of levels became known? (As far as I am aware this would have been within a few days of the 19th September).

2) Why is there not full public disclosure of the levels of aluminium in the water supply even now – several weeks after the event?

3) Given the slow public response to these aluminium levels… how often have aluminium levels breached the 0.2mg/l limit in the past – and were the public ever informed of these breaches?

4) Have there been breaches of the 0.2mg/l limit at the other Uist treatment plant in the past?

5) For the longer term – given the continuing question marks hanging over aluminium levels in our water supply. Is it time to start having public debate about alternatives to using aluminium in our rural water treatment plants? If this is impossible – then at the very least I think we should insist on knowing when the levels go above the 0.2mg/l limit – even transiently.

I found out about the high aluminium levels in our water supply at the same time as everyone else (Wednesday night). Most doctors will know from seeing dialysis patients during their training that aluminium toxicity is a serious problem to be avoided in that section of the population. But my knowledge beyond that was pretty much zero.

As such I, and by extension we, need to rely on Scottish water and public health to help guide us through the crisis. Hopefully they are accessing expertise at the highest level relating to the issue. I have to say however that I am disappointed at the lack of hard factual evidence concerning the scale of the problem / the effects that it might have on health that have so far been given to the community.

In this information vacuum I am sure that a lot of you will be doing the same as me – googling aluminium to see what the score is. Unfortunately the net is full of the kind of sites that make the medical profession in general despair. A quick search reveals a multitude of poorly researched and hysterical resources about all sorts of environmental toxicities… and it can be hard to separate fact from fiction if you are not used to analysing evidence/ reviewing medical material. I suppose this post is an attempt to a) show that I am trying to keep abreast of the issue, and b) help guide you in a limited way to some resources that may be better than others.

The first thing to say is that as far as I have been told, there is very little chance of the recent water changes causing any acute problems with our health. You need to take in a lot of aluminium to feel acutely unwell, and compared to (for example) the Camelford disaster in 1988 where aluminium levels where hundreds of times higher than recommended, our problems are much less serious. In the severe exposure at Camelford initial symptoms included nausea and vomiting, skin rashes and mouth ulcers – but there haven’t been any of these acute symptoms locally as far as I am aware.

What about long term effects? Again – I think the evidence is in general reassuring (with caveats which I will come to). Although there is some controversy over the issue (litigation has continued for many years in Cornwall) repeated reviews over time have suggested that there have been no clear cut long term effects on health from that incident. Particular concern has been raised over the years about possible issues with cognitive function including dementia like syndromes. On this point I would direct people to the statement regarding the issue on the Alzheimer’s society website -

‘There is no conclusive medical or scientific evidence of a link between aluminium and Alzheimer’s disease. There have been three independent scientific enquiries into the Camelford incident, none of which have found a causal link with dementia.
Whilst this is a sad and tragic incident, it should not lead to wider panic. Aluminium is one of the most abundant minerals in the world, and worldwide research has not found any evidence that exposure to everyday levels of aluminium is a risk factor for Alzheimer’s disease.
The Alzheimer’s Society offers help and support to families affected by dementia throughout the country and we would be happy to offer advice to any families living in the Camelford area.
We still do not know what causes Alzheimer’s disease, and until this time the Alzheimer’s Society supports all research into potential causes and cures.’

So – in summary. This acute exposure to excess aluminium should have minimal if any short term health effects.

The long term health effects from aluminium exposure of a short duration also seem to be limited if we can rely on the extensive research that has been carried out over the years into Camelford, but in the process of my research I have come across some concerning information about aluminium exposure over the longer term which I will outline in another post later today.

As most of you will now know – Scottish water will be holding drop in sessions -Monday 10 October and Tuesday 11 October at Paible Primary School, Ashdail Cottages, from 4pm to 7pm to answer questions that you have, and I believe representatives from public health will be in attendance also.

In the meantime if you have any significant physical symptoms of any nature – the advice as always is to phone the practice and seek advice.

The North Uist Patient Participation group (PPG) has now had a series of initial meetings to set out its role and allocate responsibilities for different members.

The idea of the group is primarily to act as a sounding board for the community – a way for the practice and its patients to communicate on a variety of topics.

There is a different representative for each of the main North Uist areas. For simplicities sake we have divided the island by its telephone directory codes.

Your representative for each area is….

Ms Sandi Humphrey—Sollas
sandisolas@gmail.com
Mrs Chrstina Dick—Lochmaddy
christinadick@hotmail.com
Mrs Isa Mackillop—Locheport
isamackillop@aol.com
Mr Archie Campbell—Bayhead
akcampbell@cne-siar.gov.uk
Mrs Theona Morrison—Grimsay
tmorrison@nce-siar.gov.uk
Mr John Maclean—Berneray
mvshipping@hebrides.net

You can contact your local representative to bring up issues relating to the practice. This could be a request for more information on a particular topic / an idea that you would like to implement to help the health of the community / or a suggestion for changes to the way that the practice works.

Please note that the group is not an appropriate forum for complaints – these should be addressed directly to our practice manager Helen Maclean.

We plan to publish the minutes of each meeting on the website for anyone to see – the first of which can be downloaded here.

To get more info on how the PPG could be used – go to this page in our practice info section.

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Hi everyone,

Yes today is voting day for the Taigh Sgire. Lines are open from 9am till 12midnight, you will see our project on the north tonight news at 6pm tonight. Remember it only costs 11p for each vote and you can vote ten times from the same land line, so please please spend that £1.10 on us. You can also vote 10 times from the same mobile, but I don’t know what those calls will cost.

The number to phone is – 08716268888

Thank you all very, very much.

I’ll let you know tomorrow how we get on.

Cheers,
Joan,
Dunskellar

I am copying an email below from Joan in Sollas about the lottery funding for the community hall. I hope everyone in Uist can pull together to help the Sollas community get through this – it would make a huge difference.

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Hi everyone,

Taigh Sgire Sholais have been shortlisted by the lottery to compete on STV North on Wednesday 29th June for funding to FINISH the repairs to Dunskellar School. We are up against one other project that night, and if we win we will get £60,000 !!!

What we need is for you to pass this email on to all your friends, family members, work colleagues etc so that we can get as many votes as possible, put it on your facebook, twitter etc. The winner is decided by a public phone vote, the phone number will not be made available to us until 9am on the day we will be on telly and lines are then open till midnight. The number will be in the Daily Mirror and on the link below. Calls cost 11p from a land line and any number can make up to 10 calls, so please vote for us 10 times, this will be the best spent £1.10 ever for the Taigh Sgire. Calls can also be made from mobile phones but I don’t know how much they will cost.

Please follow this link where you will get all the details – www.peoplesmillions.org.uk

Many thanks for your support, I will send you all an email nearer the time to remind you all, meantime follow the link and click sign in and leave us a message and click support to register your support to our project.

Please, please vote for us, and get everyone you know to vote for us also.

Thanks everyone,
Joan,
Dunskellar