The Mesoamerican Kidney Conundrum: How Did Your Sugar Make it to the Table? by Jessica Kenny

CHICHIGALPA, NICARAGUA - Across the sugar cane plantations of Central America, a conundrum of development is consuming laborers, agribusiness, international finance, NGOs, and the public sector. The instigator: Mesoamerican Nephropathy of unknown origin (MeN). I first heard about it during our visit to a rice and sugar cane plantation in the region of Bagatzi, Guanacaste. The sun was scorching and we were sweating just from listening to Nico talk about how the intense work of slashing sugar cane dehydrated workers to the point of inducing kidney failure. Dehydration is one hypothesis for the increasing incidence of MeN among 18-25 year old males – a condition that terminates their working life and sentences them to an expensive regime of peritoneal- or hemo-dialysis, if they want to live for another 4 to 8 years. The prospects of a kidney transplant are nearly nonexistent, available to only 10-20% of Costa Ricans, and to just 200 Nicaraguans in the country’s history. Another hypothesis for the rise of MeN was that sugar cane workers might drink up to 18 liters of water a day filled with hard minerals and levels of pesticides that, according to the EPA, would be safe were they to drink the usual volume of just two liters required to maintain hydration under normal conditions.

We had the pleasure of meeting the board members of Asociación Chichigalpa por la Vida (ASOCHIVIDA), including Dr. Juan José Amador who partners with Boston University in the investigations for the cause of MeN, which began in 2009 and are projected to generate more “conclusive evidence” in the next few years. The men of ASOCHIVIDA are desperately awaiting these results. Without evidence linking their past occupation to their current medical condition, lawmakers will not budge to declare MeN a work-related health problem, which would qualify families for social security indemnities. Surprisingly, the Nicaraguan sugar company appears to be cooperating with the investigations and has made improvements to working conditions – improving housing, delivering rehydration salts, and offering micro finance, though skeptics are calling these palliative measures to avoid dealing with the pesticide issue. The improvements won by ASOCHIVIDA are the result of a long process of non-violent resistance including protests and litigation, as well as crucial partnerships with the private sector: NGOs, universities, the World Bank and even the German Bank. The Nicaraguan socialist government has given scant support to this cause, as it is not a communicable disease, like Chikungunya, that presents a visible public health threat, despite its severe economic and psychological harm.

Sadly, even the tools that are available encounter resistance due, in [small] part, to cultural misunderstandings and, in [large] part, to poverty. Currently, health workers are having trouble convincing patients of MeN to use peritoneal dialysis because they have come to believe it is a quicker sentence to death, since many of those who have tried the procedure have gotten peritoneal infections because they did not have a sufficiently sterile environment in which to do it at home. Moreover, misuse of some medicinal plants and alternative therapies (which the government is promoting without careful orientation) has dangerously increased levels of creatinine (an indicator of kidney injury) in patients who have taken exaggerated herbal doses while attempting to lower inflammatory pain, in order to continue working because their families may starve otherwise. On this note, some patients are even selling the medication they get for free because food is their utmost priority.

Clearly, there is no easy fix. However, as consumers of sugar, biodiesel, and perhaps Ron Flor de Caña, it is our responsibility to reflect on the human security struggles that underpin our consumption, and to do our part to raise resources and voices that need to be heard.