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What is killing the young men of Cañas

first_imgJosé Manuel Calvo stands outside his home in Verdero de Cañas with his family behind him. Calvo was diagnosed with renal deficiency months ago and is beginning to search for a possible organ donor.Lindsay Fendt A crop-dusting plane flies over a field of sugarcane outside of Cañas. A popular local theory is that pesticides are causing kidney disease in the area, but there is little scientific evidence to support it.Lindsay Fendt Chronic Kidney Disease (CKD) plagues more than 400 people in the Cañas area, an agricultural town 166 kilometers northwest of Costa Rica’s capital, San José. Most of the afflicted are men between the ages of 20-55, and almost all of them worked the sugarcane plantations or some other job as field hands. In Cañas, the disease has a rate 18-20 times higher than anywhere else in the country. Two months ago, 15 people died from kidney failure in the same week, including two people in their early 20s. There is no cure.The agricultural workers affected by the disease have largely remained quiet about the problem, and many have continued working to support their families.Their reticence has been a contributing factor in a growing problem that now threatens agricultural communities across Central America and also in Sri Lanka and India, leading doctors and scientists to label CKD an epidemic. The causes of the disease have remained elusive, but the number of patients continues to grow along with the list of patients requiring kidney transplants. In Guanacaste, the northwestern province that includes Cañas, hospitals are struggling to treat the incoming floods of patients, and the transplant list in Cañas alone is 40 people long. These patients are all in the final stages of the disease and without a new kidney, they will die.The making of an epidemic Since its discovery, kidney disease has widely been considered a disease for the old, the overweight and the out of shape. Only in the late 20th century did the disease creep up in parts of the rural third world, where it silently afflicted agricultural workers for nearly three decades, until the problem became too grave to ignore.Data suggest that Central American farm workers have suffered from CKD since the 1970s, but it wasn’t until the early 2000s that clinicians began to notice an influx of young, otherwise healthy men to hospitals in Central America. By then, the disease had already taken hold, and the dead and dying numbered in the thousands. Related posts:Study links sugarcane fieldwork with kidney disease epidemic in Central America Costa Rica banana workers affected by Nemagon still waiting on compensation Honduras, Myanmar, Haiti top disaster risk list, says climate group Chikungunya and dengue viruses overtake Guanacaste From an oversized chair in his air-conditioned office, Ingenio Taboga’s Human Resources Director Carlos Barboza flatly denied that work in the sugarcane fields causes kidney problems.“Some of these guys just don’t take care of themselves,” he said. “There are external factors that we can’t control.”Roy Wong, an investigator for the Costa Rican Social Security System, known as the Caja, says patients’ habits at home can become a factor, but on their own do not seem significant. Alarmed by the high rates of the disease in Guanacaste, Wong and a team from the Caja have been researching possible causes of the disease since last September. “Because the disease does not affect many women, we are looking for a behavioral factor that has to do with being a young man,” Wong said. “That may be drinking unadulterated, contraband liquor, or it may be working in agriculture.”For Wong and a host of other researchers, frequent use of non-steroidal anti-inflammatory drugs like ibuprofen is another potential contributor.Though Barboza has heard that heat is a possible problem, he says the area’s exorbitant CKD numbers are the result of high arsenic levels in the town’s water. He isn’t the only one who thinks so.Since 2009, scientists have warned the public about arsenic in wells throughout the Cañas area. Tested wells have shown arsenic levels as high as 136 micrograms – the WHO’s recognized level for safe drinking water is 10 micrograms.Despite pressure from the community and an order from Costa Rica’s Constitutional Chamber of the Supreme Court to President Laura Chinchilla to solve the problem, the country’s Water and Sewer Institute (AyA) has denied responsibility and promised rate hikes if it must decontaminate the water. With CKD-related deaths mounting, though, community groups are increasingly concerned about arsenic.“They say there are multiple factors,” said Mainor Picado Camareno of the People’s Voice Association of Bagaces, “but even if there are thousands of variables, here we have one. Arsenic is a dangerous poison. It’s a carcinogen. These people are dying and it is their fault.”Rebecca Laws, a doctoral student at the Boston University School of Public Health, is currently analyzing data from when she studied arsenic levels in Nicaraguan sugarcane workers. The study found that workers with the highest levels of arsenic in their urine also had the lowest levels of kidney function. There is also some evidence that many CKD hotspots in Central America have problems with arsenic contamination.Other factors, however, have been deemed more relevant than arsenic on the list of possible causes.“Arsenic is not generally recognized to cause kidney disease,” Laws said. “We think that if arsenic is the cause, it is probably not the sole cause, because then we would expect that men and women would be affected equally.”Also on the table as potential causes are pesticides, STDs, genetics, and lead and mercury poisoning, all of which could be combining with other factors to create a perfect storm for kidney failure. A nurse removes a tube from a patient’s catheter after dialysis in the Cañas hospital.Lindsay Fendt “This epidemic emerged in rural and sometimes remote areas at a time when there was less access to specialized medicine in such areas,” said Catharina Wesseling, a researcher with the Work and Health Program of Central America (SALTRA). “It is a slow disease, a chronic disease. It was simply not so evident in the beginning.”Today, an estimated 68 percent of men in southwestern Nicaragua have some form of renal deficiency. In El Salvador, kidney disease ranks as the country’s third leading cause of death, and preliminary studies in Guatemala and Costa Rica show similar upward trends in CKD.Similar outbreaks have cropped up in other parts of the world. In Sri Lanka, 8,000 people suffer from the same kidney disease wreaking havoc in Central America, according to the World Health Organization (WHO).Although they are suffering thousands of miles apart, those with the disease in Central American and Sri Lanka share a strikingly similar profile. The disease in these countries primarily affects young men and agricultural workers, and seems to be exacerbated by hard work.Researchers also found that in both locations, the specific kind of kidney damage people suffered suggested that dehydration, and in some cases toxic poisoning, might be the culprit.What’s causing the disease?It’s a typical Friday at the Cañas Hospital’s dialysis ward. Three nurses run around carrying bags of fluid and emptying metal bowls as they slowly fill with toxins that the patients’ failing kidneys can no longer filter.Dago González is among them. It’s 4 p.m. now, and like the others, he’s been in the ward since 7 in the morning, a routine he’s been through four to six times a week since January.Dago was diagnosed with renal deficiency last July, but the first time he could really feel that something was wrong was at the beginning of the last zafra, or sugarcane harvesting season, when he was out in the fields with a fertilizing machine. There was a pain in his legs and his feet felt swollen. He remembers the hot sun overhead, then waking up on the ground, then again in Liberia Hospital hooked up to a dialysis machine.Dago’s story is not unusual. He and the other three men in the ward that day, along with almost all of those suffering from CKD in Central America spent most of their lives working on sugarcane plantations. Iysabel López shows off his box of medicine outside his house. López is on some of the same pills as his brother Juan was before he died at the age of 49.Lindsay Fendt Manuel Camacho flips through his medical files outside of a bunkhouse used by sugarcane workers. Camacho continues to work in the sugarcane fields, despite his severe case of renal deficiency.Lindsay Fendtlast_img

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