The past few years has seen an escalation of kidney disease and failure in farm workers in both Central and South America, Sri Lanka and other agricultural areas in the world.
A series of studies, funded and carried out by separate entities, has failed to ascertain the single cause of the dreaded disease. But is the failure to find the cause just due to concomitant causes or by a concerted effort to hide the true reason for the increasing number of sickened farm workers?
Initial studies focused on the most plausible cause: pollution from weed and insect killers, often used indiscriminately in the farm fields. Other recent studies however, have shifted the focus on the working conditions of the farm workers.
Farm labor in the poor countries of Central America and the more developed South America is notoriously grueling. In fact, many laborers in disparate latitudes seem to be afflicted by similar problems, leading many to believe that it is the excessive work, long hours, and dehydration that causes the farm workers to develop kidney disease.
Some however are not convinced.
In Central America alone, thousands of farm workers develop the deadly degenerative syndrome yearly that leads to kidney failure and later, death. Almost all of the people afflicted are believed to be men. Some are dying when barely in their third decade of life. In Nicaragua alone, a location called La Isla, has been renamed the Island of the Widows.
Although governments in Central America are beginning to investigate the problem, the result is usually some directive to the farming sector to change the harsh working conditions.
Dr. Orantes, In El Salvador's Bajo Lempa region believes the culprit is not just heat and dehydration. The reason why, he says, is due to exposure to toxic chemicals in the fields, pesticides and herbicides which are heavily used in the fields. Many of the chemicals routinely used in these fields have long been banned in the United States, although good part of the produce that is cultivated in Central America is exported to the United States.
The amounts used and the complete lack of concern for the farm workers' safety means that they work without masks or protective gear that could minimize exposure.
Another concomitant cause however, could be painkillers, Orantes says. Both painkiller and high alcohol consumption, when taken together, can cause kidney disease.
But such assertions have been often supplanted by large studies - well funded ones at that - that shift the responsibility to climate and labor practices on the ground. Some studies also try to dispel the notion that the chemicals are to blame by pointing out that other sectors are affected by the problem. Miners, for example, are also dying of kidney disease.
One research, conducted by Boston University, points to the extreme heat and harsh working schedules for the kidney problems the workers experience. But other scientists have argued that while dehydration and heat can affect kidney function, they do not lead to kidney disease.
The Univ. of Boston researchers noted that those people who worked in the harshest conditions have the most signs of kidney disease. Cane workers who had the longest hours, in the low lands where the heat is more intense, had the most kidney damage.
To make things worse, dialysis, which is the only way the more severe patients can survive, is costly and inaccessible to many of the workers. To boot, when some of the workers start exhibiting signs of the kidney disease, they are let go, and by doing so, the agribusinesses block them out from receiving care from the company clinics that treat the cane plantation workers.
But the epidemic is not a new thing: workers say that it has been going on for at least 20 years. Some researchers believe it begun in the 1970s. Many laborers cite the fact that both their fathers and grandfathers died of the disease. And it is different from chronic kidney disease as it is usually known. This particular CKD involves damage of the tubules of the kidneys, instead of the filtering system.
A passing of the buck has developed among different industries that compose the agricultural sector. The cane industry asserts that their labor practices have nothing to do with the deaths, and obliquely point their finger at other factors, such as the climate or even the chemicals in the field. Researchers are also divided, but there is a sense that if there are concomitant causes, that no one is really drawing the necessary conclusions or connecting all the dots.
Many of the fields now cultivated with sugar cane, however, used to be fields of cotton owned by the US, where DDt and other powerful chemicals were used abundantly after world war II. The health minister in El Salvador has said he believes that this might be the cause of the disease. In addition, many of the afflicted workers say that they had - and still have- to spray chemicals, besides cutting the cane, without protection.
However, the University of Boston researchers have published data that shows that people working in the cane field under the harshest conditions, have a higher rate of kidney failure than the ones who were directly exposed to the chemicals. Another study, published in the American Journal of Kidney Disease, shows that workers in cane plantations in higher elevations have less incidence of kidney disease than their low land counterparts.
But again, is it really only the heat to blame, and the long hours?
An investigator for the Guardian, who traveled to the Bajo Lempa region of El Salvador, one of the worst areas for kidney related disease in laborers, found that workers were dousing the cane fields with a syrupy chemical concoction which clung to their bodies and was freely inhaled. The investigator learns that the syrupy mixture is composed of a potent chemical cocktail of Amine, Terbutryn, Pendimethalin, 2,4D and Atrazine.
The Guardian investigator continued his research, not convinced that the University of Boston researchers could completely exclude exposure to chemical as a cause of the kidney disease epidemic. One of the things he found is that some women are dying of the kidney disease too, and that many of them spray their own chemicals in their own land for their own produce. None of them use protective gear or read the instruction on handling the chemicals. Some of the villagers tell the tale of the aftermath of the spraying season each year: animals die, people vomit and get headaches, the chemicals permeate the air and penetrate even inside shuttered houses.
In addition, this area is in the lowlands affected by yearly floods. Water from the fields floods into the villages and into people's water sources and wells. After the floods, the water becomes syrupy and salty.
The investigator then spoke with El Salvador's Health minister, Carlos Orantes, who is a nephrologist. He too is investigating the kidney disease epidemic. His numbers are in net contrast with other research, including the University of Boston one. In fact, he found that 25.7 of men and 11.8 of the women in the Bajo Lempa region are afflicted by the CKD.
Doctor Orantes has his own findings to relate to the Guardian investigator: "banned pesticides, lack of protective gear, and lethal mixtures of chemicals in the field."
Although Orantes also concedes that dehydration can play a role, he too knows that dehydration does not cause the kind of kidney damage seen in the farm workers. To have that, he contends, one must be exposed to nephrotoxic agents. He also says that if dehydration was the sole culprit, the problem could be easily solved. But the mystery of the kidney epidemic is much, much more difficult to unravel.
When queried, the University of Boston chief researcher, Dr. Brooks does admit that a precursor factor could be at the onset the causative factor, still unknown, and that heat later on precipitates the full blown disease. That small concession opens a very large door.
The investigator then sent a sample of the concoction of chemicals he saw sprayed in El Salvador to the leading authority in agrochemicals. His response is that Atrazine causes kidney damage at certain levels of exposure and so does 2,4D. Terbutryn was also found to cause kidney damage in lab rats.
Another researcher at the University of Colorado thinks he has found another possible cause of the kidney disease. In the words of R.J. Johnson, of the Univ. of Colorado, the body that is under constant dehydration stress produces excess fructose which then in lab rats was shown to cause kidney disease. The researcher also believes that many workers might be rehydrating with sugary drinks, exacerbating the problem. This theory however, is not yet fully tested, and cannot be taken as the definitive answer.
In Sri Lanka, the President just last month banned the use of Roundup, which he said has been linked to the increasing numbers of kidney disease cases.
In the words of the President Mahinda Rajapaksa, "An investigation carried out by medical specialists and scientists have [sic] revealed that kidney disease was mainly caused by glycophate." El Salvador is now quietly following in Sri Lanka's footsteps. Almost 53 agrichemicals were banned last September, together with Roundup, in an effort to stem the growing epidemic of kidney disease. It is important to remember that most of the 53 chemicals have already been banned in most of the world.
Of very great interest might be the result of a investigation by the Sri Lanka authorities that shows that the data collected from CKD patients show that their urine contains both cadmium and pesticides.
Another, brand new research result was published in Andra Pradesh in India, showed that incidence of kidney disease was centered around contaminated wells. These wells were found to have silica residue in the water. Silica is contained in many pesticides and it is shown to be a contributing factor to CKD. This research, although preliminary, was done in conjuction with Harvard University and the Andra Pradesh Health Authority.
In the meantime, workers will continue spraying the fields unprotected, work in abject conditions in the cane fields and dying. Whatever the cause, something must be done, and quickly, before a 4th generation of farm workers succumbs to the dreaded disease.
Sources: Kickstarter/BBC/PBS.org/The Guardian UK/ Daily MIrror/Sunday Times: 4.15.14