Esteban Felix / AP

Silent kidney epidemic ravages Central America sugar belt

Researchers puzzle over cause, with pesticides and labor conditions chief suspects

Nicaraguan widow Isabel Zapata Manzanares looks out over the sugarcane fields beside her home in Chichigalpa. Zapata lost her husband and four sons to kidney disease.
Tim Gaynor / Al Jazeera America

CHICHIGALPA, Nicaragua — Isabel Zapata Manzanares lost her husband to kidney disease shortly after he retired from the sugarcane fields in 1993. Then, one by one, four of her sons sickened and died.

Eusebio Ernesto, a fieldworker, perished a decade ago. Victor Emmanuel died four years later, followed by Jose Graviel two years after that. Then last year Francisco took sick with disease.

"They told him it was too late for dialysis,” she recalled, sitting on a plastic chair outside her tin-roofed shack near this city in Nicaragua's coastal lowlands. “He swelled up ... he had pains in his body... and he died here at home."

The five men in Zapata's family are among tens of thousands cut down by a new form of chronic kidney disease striking like a scythe across the sweltering plains of Central America's sugar belt from Mexico to Costa Rica.

Chronic kidney disease rates began to climb in poor farming communities in the Pacific coast strip at least a decade ago, although it was not immediately clear to doctors that they were witnessing a lethal new form of the disease.

Dubbed chronic kidney disease of unknown causes, it has since killed at least 20,000 people, and probably many more, across the region just two hours' flight from the United States. The cause has baffled researchers, although there is no shortage of suspects.

The fertile strip is drenched in toxic agrochemicals. The cane cutters themselves risk heat stress toiling long hours in sauna-like conditions, while the fields they work are perfect for propagating deadly rat-borne pathogens.

As researchers puzzle over a cause, the illness is hammering communities hardest in the volcano-studded plains of Nicaragua and neighboring El Salvador, where deaths from chronic kidney disease are now four times the global rate. In El Salvador, it is currently the leading cause of hospital deaths for men, according to research published by MEDICC Review.

So many working men have died in the rural community of La Isla, or The Island, near where Zapata lives that it has become known as "The Island of Widows." And in Chichigalpa, the company town for Nicaragua's largest sugar producer, Ingenio San Antonio, almost a third of working-age men now have irreversible kidney damage.

"Most people who worked for Ingenio San Antonio have lost a family member to kidney failure, whether it be a father, a son or a cousin ... or they have someone at home who is sick," said former sugarcane worker Juan Salgado. Salgado himself is sick with the disease, as are two of his brothers. Three of his cousins are dead. 

Most people who worked for Ingenio San Antonio have lost a family member to kidney failure, whether it be a father, a son or a cousin.

Juan Salgado

Former sugarcane worker

Young, male farmers prone

Former sugarcane cutters protest outside Grupo Pellas, the conglomerate that owns Flor de Caña rum, in March 2013. The demonstrators accused Pellas of being responsible for an epidemic of fatal kidney disease due to chemical and insecticide contamination.
Esteban Felix / AP

The sickness breaks with known patterns of chronic kidney disease in industrialized nations, where it is usually linked to high blood pressure and diabetes associated with aging and obesity. In the United States, it is slightly more common among women than men, according to the U.S. Centers for Disease Control and Prevention.

But the epidemic rampaging across Central America is three times more prevalent among men, most of them farmworkers under 60 years of age who exhibit none of the other known causes.

"There was obviously something different going on," said Ramon Garcia, the Salvadoran nephrologist who first documented the disease as a young intern early in the millennium. "They were male farmers, younger than expected ... and something was silently killing their kidneys without any warning."

While the cause or causes of the lethal condition remain unknown, chief among suspects are the highly toxic agrochemicals sprayed and dusted on fields throughout Central America, which is the largest consumer of pesticides per capita in Latin America, according to MEDICC Review.

In El Salvador, farmworkers said they applied extremely toxic weed killers including Paraquat and deadly organophosphate pesticides to their land using backpack sprayers without any more protection than a long-sleeved shirt.

"We didn't use masks, gloves or eye protection ... it was in direct contact with the skin," said small farmer Jesus Reyes, who is among a quarter of men in the Bajo Lempa area of southeast El Salvador sickened by the disease.

Another theory posits kidney damage wrought by repeated dehydration in the sun-blasted sugarcane fields, where machete-wielding laborers paid by the ton work week round at harvest time in temperatures above 90 degrees F — a physical effort likened by one doctor to "running an ultra-marathon in a sauna." The cane cutters could also be aggravating damage by slaking their thirst with high-fructose sodas that can harm kidneys, researchers said.

Other specialists, meanwhile, said irreversible damage may be caused by leptospirosis or a hantavirus, killer pathogens spread by the urine and droppings of infected rats and mice that infest hundreds of square miles of cane fields, gorging on cuttings.

"Looking at the fields, there are tons of rodents there," said Kristy Murray, a "disease detective" at Baylor College of Medicine and the Texas Children’s Hospital, who recently visited Chichigalpa, a municipality of around 50,000 people. "When I went down there, I actually didn't think it was infectious. When I came back I was willing to put money on it that it was."

When you have this disease, it’s basically a death sentence. It’s irreversible.

Jimmy Mayorga

Diagnosed with kidney disease at age 21

Huge public health challenge

Nicaraguan sugarcane worker Jimmy Mayorga, 25, was diagnosed with kidney disease four years ago. He hasn't worked long enough to accrue enough social security credits to receive care, so he takes only vitamins.
Tim Gaynor / Al Jazeera America

The sheer number of people with end-stage kidney failure requiring either a costly lifesaving transplant or dialysis would present a huge challenge even to the public health system of a developed country.

But striking two of the poorest in the Western Hemisphere — El Salvador is ranked eighth out of 39, and Nicaragua second, after Haiti — the public health services are overwhelmed.

"It's devastating,” said Aurora Aragon, an occupational health specialist at the National Autonomous University of Nicaragua in León, a few miles from Chichigalpa. “The number of patients is too large, and they can do almost nothing [to respond to] this epidemic.”

A lucky few in both countries receive hemodialysis, although more common is an antiquated peritoneal form of the treatment, which involves inserting a rigid catheter into the abdomen to rinse out toxins. While some accept the treatment, doctors and patients told Al Jazeera that others are put off by the discomfort and frequent infections associated with it, and opt simply to die at home.

Detected early enough, the disease can be treated with medicines and lifestyle changes. But for those diagnosed at an earlier stage, prospects of survival depend too often on chance factors such as where they live and whether they made enough social security contributions before falling sick.

In El Salvador, agricultural worker Reyes' illness was diagnosed early, and he is fortunate to live opposite a new health center in the town of Ciudad Romero that helps him actively manage his illness.

"I think that if they hadn't detected the problem I would now have this disease in a very advanced state, or would even be dead, because I would not have taken care of myself," he said. As it is, he now receives medical care, follows a strict diet and has stopped using chemicals other than fertilizer on his small plot of land.  

But in Chichigalpa, 25-year-old Jimmy Mayorga is not so lucky. Diagnosed with kidney disease at age 21 in tests to screen out the sick from working at Ingenio San Antonio, he had too little time in his brief working life to accrue enough social security credits to receive care. Now unemployed, he takes only vitamins for treatment, in the forlorn hope that they will "strengthen the blood."

"When you have this disease, it's basically a death sentence. It's irreversible," said Mayorga, a young man with a serious, angry and somewhat haunted look. "It throws your life into turmoil, because you don't know when your hour will come."

Related News

Find Al Jazeera America on your TV

Get email updates from Al Jazeera America

Sign up for our weekly newsletter

Get email updates from Al Jazeera America

Sign up for our weekly newsletter