Chronic Kidney Disease in Central American Workers - Social Impacts (Part 3 of 4)

Photo Credit: Ed Kashi

Part 1- Introduction

History of the Epidemic in Central America

Statistics

Chronic Kidney Disease – basics

Part 2 – Research and Literature Review

                        Introduction to the Research

                        Etiology

                        Morphology and Pathology

                        Possible Solutions

                        Areas for Additional Research

Part 3 – Social Impacts

                        Narrative

                        Financial Impacts

Part 4 - Interventions

Narrative

Barú Ordoñez was 13 years old when he began working on the sugar cane plantations of Ingenio San Antonio, the predominant sugar cane producer in his town of Chichigalpa, Nicaragua. After only two seasons of work as a cañero, he had abnormal levels of creatinine, calcium, and potassium. Upon finding this out, he began to imagine his future unfolding the same way his father’s did; also a cañero, his father died from failed kidneys when Barú was young. Barú never wanted to work as a cañero, but it was his only choice. After becoming ill, he could not go on to study and find better work; at 20 years old, he says, “my dreams have already passed me by.” In Ordoñez’s village, La Isla, almost three quarters of the men have Chronic Kidney Disease; it is so prevalent, and death is so common, that the village has become known as “The Isle of Widows”.

In the same town, Maudiel Martinez says through protruding cheekbones and a pale face, while hunched over like a much older man - he is 19 - “The way this sickness is - you see me now, but in a month I could be gone. It can take you down all of a sudden”. Those dying are young – in their 20’s and 30’s – and are being taken at the prime of their lives. Martinez’ father, grandfather, and three brothers were all affected by CKDu. The disease has devastated communities where men work in the sugar cane fields, leaving grieving loved ones behind as more young men continue to die far too young.

Man receiving dialysis at home. After years of working on sugar cane plantations, he developed CKDu.
http://www.cnn.com/2016/05/02/health/mystery-kidney-disease-global-spread/

Communities

The people of affected communities can only guess at the possible cause for the deadly epidemic. As the BBC reported, “most of the men who are ill show no signs of high blood pressure or diabetes - the most common causes of CKD elsewhere in the world” (“Mystery Kidney Disease in Central America”). Some communities believe that the men are becoming severely dehydrated from long days of work in the hot sun, making them more susceptible to toxins, noting that “it has been seen that a person who works in the sugar cane fields loses approximately 2.4 kg [5.3 lbs] of weight in one working day” Many of the sugar cane workers have pointed to agrochemicals as a potential culprit, though the association between the widely used Roundup chemical and the disease has yet to be proven. As discussed in part 2 of this series, there may be a variety of causes of CKDu, making it difficult to impossible for researchers to find a single cause. This provides few concrete solutions, and little comfort, for the victims and their families. The intervention methods of providing shade and encouraging workers to try to stay hydrated are a start, but it is not clear yet how much of an impact these interventions will be – or how closely they will be followed by the workers.

Financial Impacts

In addition to the emotional toll of the disease on families losing their fathers, brothers, sons, and husbands, the financial toll is also great -  as the disease progresses, the cost of treatment to stay alive far exceeds their income;
dialysis costs tens of thousands of dollars annually, while the laborers might only make a couple thousand dollars a year, if they are fortunate. In Chichigalpa, Ingenio San Antonio (the sugar can plantation where Barú Ordoñez worked) decided to begin testing employees for kidney failure; if they were affected, they were laid off. This has also been true for employees of the Pellas Group, another major sugar can plantation. “The sick workers who have been dismissed say what they receive from the companies and from social security isn't enough to live on — and when they lose their jobs, they lose the right to be treated at company clinics,” making treatment unlikely.

Continue to Part 4 - Interventions

This series was researched and written by (in alphabetical order by last name): Jessica Chepp, Aleena McDaniel, Cara McShane, Christine Spees, and Kimberly Vargas
All are Master of Public Health candidates at the University of Illinois - Chicago