Tag Archives: CKD

La Isla de las Viudas

I was browsing for sugar at the supermarket in León when I realized I was about to be complicit in the deaths of thousands.  Let me explain: I’ve been teaching English to the children of sugar cane workers in a rural community an hour from León.  All of the children in my class have lost fathers, brothers, uncles, cousins, or grandfathers as a result of their work in the cane fields.

Students from my English class in La Isla, Israel in front

To get to their community I take a bus to the town of Chichigalpa, through flat farm- and ranchland, past bright green cane fields.  In Chichigalpa I grab a taxi to the river which separates the communities of Guanacastal Sur from town during the rainy season.  (The sugar company removes the gravel “bridge” each year, replacing it when the dry season returns).  I cross the broad river on foot and walk a half mile to the school, cinderblock homes with small plots of land on one side, impenetrable cane on the other.

The nickname for one of the communities where my students live is “the island of the widows” because so many men have died.  Twenty-five percent of the men are sick with Insuficencia Renal Crónica, Chronic Kidney Disease (CKD).  Nearly all of them worked for the sugar company, mostly cutting and burning cane, also applying chemicals, driving tractors, and in the mill.  Men as young as 16 and as old as 70 get sick from CKD, characterized by the decreased ability of the kidneys to regulate fluids and to excrete waste.  Later stages of the disease include complications from heart disease and other illnesses, eventually progressing to death.  While in the US people with CKD have access to dialysis and kidney transplants, providing a better quality of life, in rural Nicaragua there is no treatment other than dietary recommendations.

The exact causes of the disease in Nicaragua are still unknown—no full-scale study has ever been undertaken.  In developed countries CKD is caused by diabetes and hypertension, and is normally seen in people over the age of 50, where in developing countries it is also seen in high rates in young males without chronic illnesses.  In particular, agricultural workers in Central America have a far higher incidence of CKD than the general population.  According to figures from the Nicaraguan government, the rate of mortality from CKD in Chichigalpa is 13 times higher than the rate for Nicaragua overall.

One week I visited the family of one of my students to learn more about the widows.  Israel is lanky with a sweet smile, and enthusiastically answers my questions in class.  We walked fifteen minutes from the school towards the river, until we arrived at a brick home surrounded by a well-swept yard.  Israel’s mom, Doña Ursula, was widowed 6 years ago.  Israel and his sister Delenia are the youngest of ten children, the only ones still in primary school.  When Ursula’s husband died her sons went to work in the fields—now the four oldest are all sick with CKD.  She told me she struggles to support her family and would like to start a small business selling tortillas.

Ursula, like many workers and community members, points to harmful working conditions as the cause of CKD: workers have no access to potable water while working in the fields, are given infrequent breaks, and are exposed to a variety of chemicals.  They also cite contamination of water and soil in their communities as a result of decades of use of pesticides and herbicides.

The sugar companies, in the case of Chichigalpa the Nicaraguan Sugar Estates, which also produces Flor de Caña rum, deny that working conditions or exposure to agricultural chemicals cause CKD.  They claim that CKD is a “public health problem” with multiple causes, including smoking, alcohol abuse, and a potential genetic link.  They in turn blame the Nicaraguan government as having failed to address the epidemic of CKD.  According to one source, 60 people die from CKD each month in Nicaragua.

Regardless of the cause, the company has refused to take any responsibility for the health of its workers.  In fact, cane workers receive only short-term contracts (6 months or less) and are given thorough medical exams before their contracts are renewed.  An above-normal level of creatine, a marker of the beginning stages of CKD, disqualifies you from working for the company—ever.  In a region where the only large employer is the sugar company, this may be as much of a death sentence as the actual illness.  Further, families of sick or deceased former cane workers are often denied disability pensions.

I’ve been able to volunteer with and learn about this community through the La Isla Foundation, an organization dedicated to address the health crisis there.  They run a Spanish school in León as well as several projects in the community, including a health clinic and educational programs.  The organization has formed partnerships with local universities and hospitals as well as the government to study the disease, and continues to advocate for the community.

The English classes I teach are part of an effort to teach skills that will provide greater opportunities for the young people of La Isla.  In the case of Israel, bright and enthusiastic, one day of English per week seems a meager offering in the face of such daunting history.  Yet I have to have hope for him and for his classmates.

In the end I did buy the sugar, ubiquitous in its bright white packets, its logo a palm-lined road stretching to the mountains on the horizon, not a worker in sight.

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