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Kidney Disease Epidemic In Nicaragua’s ‘Land of Rum and Sugar’

June 5, 2014

In Chichigalpa, Nicaragua’s “tierra del ron y del azúcar” (land of rum and sugar), hundreds of men who developed a “mystery” illness while working in local sugarcane fields are seeking compensation from their former employer, a powerful conglomerate called Grupo Pellas.

So far the cañeros (cane cutters), all of them with a debilitating medical condition known was chronic kidney disease (CKD), have failed to secure either money or medical attention. Their quest did, however, put them in the cross-hairs earlier this month of a police assault that left one person dead and another, a 14-year-old boy, half-blind and fighting for his life.

The incident occurred on the evening of Jan. 18 near the entrance to the Ingenio San Antonio (ISA), Nicaragua’s largest sugar mill and plantation. Grupo Pellas owns both the ISA complex, which accounts for nearly half of the country’s total sugar production, and a nearby distillery, where much of that sugar is used to make Flor de Caña, a popular brand of rum. Both are located in the coastal municipality of Chichigalpa, some 140 kilometers west of Managua, the Nicaraguan capital.

Earlier that day, approximately 300 of the ex-sugar industry workers staged a protest at the gates of the sprawling ISA. Local police responded with force, using anti-riot personnel to clear the area. Reports on what happened next vary. In a press release, the Policía Nacional (PN) said its officers were attacked by “troublemakers” wielding stones and homemade mortars. “Members of the patrol responded by firing shots with their regulation weapons,” the PN claimed. Witnesses said the shots were unprovoked. Either way, the result was the same: a man named Juan de Dios Cortés, 47, took a bullet in the stomach and later died. A second person, José Ignancio Valladares, 14, lost an eye but survived the incident, barely.

“We were violently repressed by Policía Nacional anti-riot forces,” one of the CKD-afflicted protestors, Paulo Nájera, told the Associated Press. “What we asked for is that they pay us what’s fair given the damage they’ve caused to our health. They responded instead with violence and death. Today we bury Juan de Dios, who would have died from his condition. The police made it an even earlier death because they came and shot to kill.”

“Tired of being deceived”

The PN “lamented the results of these acts” and, following a quick internal investigation, announced it would place six officers on leave pending disciplinary proceedings. It denied suggestions that the shooting had been ordered on high, saying instead that the officers in question fired their weapons “on their own initiative.”

The violence in Chichigalpa drew a response as well from the central government, which announced Jan. 20 that it had assigned a top official to mediate the impasse. The chosen representative, Deputy Interior Minister Carlos Najar, will present possible solutions to the ex-ISA workers’ demands in the coming days, according to a government statement.

Opposition lawmakers are also promising to help the disgruntled laborers. “They have suffered serious health problems, besides having low salaries,” said Dep. Raúl Herrera of the center-right Partido Liberal Independiente (PLI). “We’ll support them in any way they need.”

Whether this sudden gush of goodwill results in any concrete steps to resolve the protestors’ plight remains to be seen. Ignored until now by both Grupo Pellas and the Nicaraguan government, the cañeros have good reason to be a bit skeptical. Already this year the group saw one potential deal fall through. On Jan. 11 the protestors agreed to stop mobilizing after local politicians, including Chichigalpa Mayor Víctor Sevilla of the governing Frente Sandinista de Liberación Nacional (FSLN), promised to mediate on their behalf and push for a settlement of US$26,000 per person for 479 former workers. The deadline for that deal, Jan. 18, came and went without word from either Sevilla or Grupo Pellas. In a recent interview with the news site Confidencial, an unnamed company official claimed talks never even took place. “We are tired of being deceived,” Nájera told reporters last week. “This time we want real solutions because there is indignation.”

No consensus on the cause

Grupo Pellas denies it is in any way responsible for the many CKD cases that crop up among its sugar industry workforce. Research regarding possible causes of the “mysterious” disease – as many in the press have taken to calling it – has been inconclusive, the company points out. Strictly speaking, that assertion is correct. Theories abound. Yet so far, scientists have been unable to narrow the field to a single predominant factor.

Some blame the workers themselves, saying their kidney problems stem from alcohol and pharmaceutical drug abuse. Others suspect farm chemicals, namely pesticides and herbicides. Another possible culprit is heat stress and fluid depletion, which would explain why CKD, a problem throughout Central America’s steamy lowland areas, is also known to affect port workers and miners. Cane cutters and other manual laborers, in other words, may literally be working and sweating themselves to death.

A team of US researchers involved in a first-hand study on CKD incidence among ISA workers found the heat stress hypothesis “compelling” and worthy of “further investigation.” In a 2012 article published in the Clinical Journal of the American Society of Nephrology, the team – led by Dr. Daniel Brooks of Boston University – noted that CKD has a particularly high incidence rate among people who perform strenuous physical activity in “extreme environmental conditions,” meaning hot and humid regions.

“Sugarcane cutting is an exceptionally physically demanding task,” the article explains. “On the night before harvesting, the cane field is burned, defoliating the field without damaging the cane stalk. The next morning, typically beginning before 6 a.m., cane cutters use machetes to harvest the cane as close to the base of the stalk as possible, with the average cutter harvesting between 5 and 7 tons of cane each day. The conditions can be oppressive, with a combination of very high temperatures, humidity, and solar radiation.”

Awaiting “God’s will”

For all the confusion about CKD’s causes, observers do seem to finally be reaching a consensus about the gravity of the situation. A group called the International Consortium of Investigative Journalists – basing its research on World Health Organization data from 2005-2009 – estimates that more than 2,800 Central American men die annually because of the disease. The majority of those deaths occur in El Salvador and Nicaragua.

Last April, health ministers from throughout the isthmus signed a document declaring CKD a top public health priority. The San Salvador declaration, as the agreement has been dubbed, notes that CKD “fundamentally affects socially vulnerable groups of agricultural communities along the Pacific Coast of Central America, predominates among young men, and has been associated with conditions including toxic environmental and occupational risk factors, dehydration, and habits that are damaging to renal health.”

Eights months later, those same health ministers joined their counterparts from throughout the Americas at an assembly of the Pan American Health Organization (PAHO) in Washington DC, where CKD once again took center stage. The PAHO identified the disease as a “serious public health problem that requires rapid, comprehensive, and coordinated action among sectors, agencies, and ministries.”

For CKD-afflicted laborers in Chichigalpa and elsewhere in Central America’s tropical lowlands, time is certainly of the essence. In countries like the US, where CKD is most commonly associated with high blood pressure and diabetes, the disease is considered manageable. But for most of CKD’s Central American victims, impoverished laborers who are unable to access the right facilities and treatments, diagnosis often amounts to a death sentence.

Esteban Félix, an Associated Press photographer who has spent considerable time in Chichigalpa, says victims of the disease are so desperate they sometimes ask him to photograph their bodies after they’ve died. “Their hope is that it’ll help somehow in getting the word out, and in denouncing what’s happening,” he said in an interview published recently in various nongovernmental organization (NGO) and left-wing news sites.

“From my point of view there’s no mystery here,” said Félix, whose work in Chichigalpa earned him a prestigious Colombian journalism award late last year. “The people are dying because of poisons, because of the type and excess of working hours, and because of the high temperatures to which they’re exposed.”

Two weeks ago, at the same moment Juan de Dios Cortés and his fellow protestors were being set upon by police, another ex-ISA laborer lay dying in his bed. Carlos José Martínez Rivas, 50, began working in the sugarcane fields when he was 15. He was diagnosed with CKD 12 years ago. ISA, following company policy, let him go – with a monthly pension of approximately US$109, Martínez’s wife told a Confidencial reporter.

“The doctors said there was nothing that could be done, that we’d just have to await God’s will,” she said. Martínez died on Jan. 20, the same day community members buried Cortés in a coffin donated by the local police.

(This article originally appeared Jan. 30, 2014 in LADB)

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