On a rural island off the coast of Nicaragua, the landscape seems picturesque at first, with children bicycling along dirt roads that encircle vast fields of sugarcane. Until you start to notice how few men there are on the Nicaraguan island, you might not guess that "La Isla de las Viudas" is one of the many areas in Central America whose population has been devastated over the past two decades by a mysterious kidney disease. This regional epidemic lies at the intersection of a social injustice and a public health crisis, where “Chronic Kidney Disease of Unknown origin” (CKDu) has become more deadly than HIV/AIDS, diabetes, and leukemia combined.
As the name indicates, experts don't really knows what causes the disease, but CKDu has been sweeping through sugarcane fields in Latin American countries such as El Salvador, Nicaragua, and Costa Rica, cutting a large swath in populations of poor manual laborers. The chronic disease attacks the kidneys of its victims, resulting in renal failure and death. Over the past decade this mysterious affliction has taken the lives of more than 20,000 sugarcane workers in the region, leaving thousands of widows struggling to support their families.
In the U.S. kidney failure is usually found among older patients with equal gender distribution. It is often the result of diabetes or hypertension, manageable conditions that can be treated and whose origins are well understood by doctors. The type of kidney failure found in such patients affects the glomerulus – the small units within the kidney that work to filter blood.
In contrast, CKDu is primarily found in males between the ages of 20-40. Generally speaking, the population is not afflicted by diabetes or hypertension, and their disease affects the internal tubules of the kidney, rather than the glomeruli – a condition only found in 3.7% of kidney failures in the U.S. These unique factors of CKDu among impoverished sugarcane laborers have lead doctors to hypothesize about specific working conditions that may be causing the regional epidemic of kidney failure.
Photo by Mette Nielson
Most research indicates that toxin exposure, chronic dehydration, and heat stress may be central factors in the disease’s onset. Workers toil for hours in extremely hot conditions with little access to fresh water, experiencing dehydration often on a daily basis. A recently published report revealed that these laborers routinely work in conditions that exceed the recommended heat standards of the U.S. Occupational Safety and Health Administration. And sugarcane laborers in the six countries affected by CKDu are not paid hourly or daily wages; their income is based upon how much they harvest. This incentivizes many laborers to work past the limits of their physical health in an area where temperatures have been steadily rising since the 1980s. South American sugar corporations have been tight-lipped on the issue. They have been highly resistant to allowing health researchers to study their businesses in fear that CKDu will be classified as an occupational illness. The sugar companies deny that their production methods are in any way connected to the rise of the epidemic among its workers, but they often provide a food stipend to the widows and families of deceased sugar laborers that can be revoked if the family speaks up to spread awareness about or protest the epidemic.
Two of the largest sugar companies in Nicaragua now regularly test the blood of their workers to measure creatinine levels, an indicator of kidney failure. This seems like a positive step for sugar companies to take in the interest of their workers – except workers who have high creatinine levels are then dismissed from their jobs. The sugar companies posit that this is necessary to prevent the workers’ health from further diminishing in the sugarcane fields, but it also cuts workers off from receiving care at company hospitals. It also eliminates their eligibility for company pensions, pushing them further into poverty and disease.
In an industry dominated by a multi-billion dollar demand for sugar-derived biofuels, the plight of sugarcane field workers are frequently omitted from any official reports, stifling public awareness of the epidemic. People in high income countries sweeten their morning coffees with South American sugar, largely unaware that the average lifespan of the workers who harvest that sugar has fallen to a mere 49 years. Meanwhile on the Island of Widows, where 1 in 3 men are in the final stages of renal failure, families continue to decorate their tables and countertops with framed photos of their deceased husbands and fathers.
By João Henrique Rosa (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html)
Sources: https://www.huffingtonpost.com/entry/epidemic-climate-change_56210714e4b069b4e1fbb8c0 ; https://www.publicintegrity.org/2011/12/12/7578/thousands-sugar-cane-workers-die-wealthy-nations-stall-solutions ; https://www.icij.org/project/island-widows/project-methodology-island-widows