======================================================================
Rule #1: YOU MUST clip all extraneous text when replying to a message.
======================================================================
NY Times, May 9 2014
Deadly Illness in Nicaragua Baffles Experts
By HEATHER MURPHY
CHICHIGALPA, Nicaragua — During the harvest season, when exhausted
workers spend seven days a week cutting sugar cane, the signs of illness
were hard to spot at first.
It was in the off-season, out on the baseball field, that some residents
noticed a change. Base-stealers were lethargic. Pitchers were losing
their aim. In the evening, outfielders were burning up as if standing
under the scorching sun of the day.
“That’s Mosquito, now dead,” said Arnulfo Téllez Aguilera, 49, pointing
to a photograph of his smiling teammates before their muscles withered,
like his. “That’s my brother, Danilo, dead too.”
Across Central America, a painful disease that affects the kidneys has
killed at least 20,000 people over the past decade and has become the
leading cause of deaths in hospitals among men in El Salvador. But the
illness, often called Chronic Kidney Disease of unknown causes, or CKDu,
is so poorly understood that it still does not have a universally agreed
upon name.
Theories vary drastically, citing a combination of possible factors,
including heat stress, chronic dehydration, toxic chemicals,
painkillers, sugar consumption and even volcanic ash.
But there is a rare point of consensus, many researchers say:
Nicaragua’s sugar cane heartland — in particular Chichigalpa, the town
that is home to the country’s largest sugar mill — has been one of the
hardest hit places in the world. Cane-cutting fathers and sons in the
same family have died, and seemingly healthy young men are quickly
wasting away.
The Nicaraguan government, the country’s sugar mills, even the World
Bank, which has poured tens of millions of dollars into the sugar
industry here, all say that until the mystery of the disease is solved,
there is little they can do to prevent it. Now, after years of
inconclusive research, the Centers for Disease Control and Prevention is
stepping in to help with some of the most ambitious studies of the
illness yet.
But the sick former sugar cane workers here have little faith that more
studies will bring improvements anytime soon. The fact that the research
will be funded entirely by the sugar industry is only fueling the distrust.
“I don’t think anybody has clean hands,” said Kristen Genovese, a lawyer
who helped sick former workers file a complaint against the World Bank’s
lending arm in 2008 for lending $55 million to the sugar mill here,
called San Antonio, without looking into the disease or the possibility
that it might be connected to the industry.
“The government of Nicaragua has done nothing to help these people,”
said Ms. Genovese, who was with the Center for International
Environmental Law in Washington when she filed the complaint. And the
World Bank, she argued, “should have spotted this problem, and didn’t do
anything about it, and continued to invest in sugar in the region.”
Along the Island of the Widows, as one area next to the big sugar mill
is called, the disease is such a dominant part of life that health
updates sometimes replace “hello.”
Before each harvest, workers must take blood or urine tests that measure
kidney function to determine whether they will be allowed to return to
the fields. In preparation, some ingest concoctions of fresh tamarind
juice and linseed oil, avoid the sun and force themselves to rest.
Others simply pray.
“When you’re sick they tell you, ‘You’re done here,' ” said Mr.
Aguilera, who failed the test in 2001. “They washed us away, without any
kind of helping hand.”
The complete dependence on the industry, whatever the risks may be, is
stark. Glassy-eyed men are convinced that something in the water or the
fields made them sick. Yet they are desperate to return to work,
borrowing their wives’ and sisters’ identity numbers in a furtive
attempt to stay employed. In one neighborhood, even conservative studies
show that one in three men have the illness.
“The sugar mill said that all of this is part of nature. But this isn’t
nature,” said Gilma Urbina, 37, a mother of five who recently lost her
husband to the disease.
“The day that my husband died, he died at 6 in the morning,” Ms. Urbina
said. “Down the block, another one died at 2. The next day, three more
died.” She added, “I think we’re going to end up without any people here.”
Radically different perceptions of the cause have stirred debate over
who should cover the enormous costs of treating patients with the disease.
Mario Amador, general manager of Nicaragua’s National Committee of Sugar
Producers, one of the groups financing the C.D.C. studies, said the
sugar cane business in Nicaragua had quadrupled over the past 10 years
into a $500-million-a-year industry, supplying everything from Coca-Cola
to rum makers. But he said the annual kidney exams, which he called
necessary to avoid putting sick workers at additional risk, had created
the false impression that the mills were linked to the disease.
“I don’t think there’s any relationship between CKD and the sugar cane
industry,” Mr. Amador said.
Executives at the San Antonio mill in Chichigalpa say they also take the
annual test, but it is rare that they fail.
“We drink the water here, too,” said Álvaro Bermúdez Castillo, the
mill’s administrative director, who has been working at the mill since
the 1970s.
Lawmakers in El Salvador and Sri Lanka, where similar kidney problems
have emerged, have moved to ban certain herbicides. But few of the
researchers who are focusing on Nicaragua — the country with the highest
death rate from the disease, according to the Pan American Health
Organization — are willing to say the answer is that simple.
Agricultural chemicals alone, they say, do not explain why the disease
has been detected in some Nicaraguan miners at similar rates, why women
who grew up on the sugar mill’s grounds have generally been unscathed,
or why workers here are affected at much higher rates than people
exposed to the same chemicals elsewhere. Perhaps extreme heat,
dehydration, the intensity of the labor or other factors play a role,
the researchers say.
“The problem is, this is a silent killer,” said Aurora Aragón, a
Nicaraguan researcher.
Residents say they began noticing the sickness shortly after the
Nicaraguan government, which had nationalized the sugar industry,
returned the mills to private owners in 1992. As the operations at San
Antonio rapidly expanded, driven partly by American and European
appetites for sugar and a move into ethanol production, families say the
cane cutters — many of whom had been born in a hospital on the mill
grounds and went to a school there — grew sick in larger numbers.
The mill says it pays the government every year so that workers can
receive pensions and health insurance. Without a scientifically decisive
link to the disease, industry officials question why they should be
responsible for more.
Throughout the early 2000s, lawsuits seeking compensation from the mill
mostly went nowhere. Then in 2008, a workers’ group known as the
Association of Chichigalpinos for Life filed the complaint against the
World Bank’s lending arm, known as the International Finance
Corporation, which had lent the mill $55 million. The complaint alleged
that by failing to acknowledge the disease in documentation about the
project, it had violated its own lending standards.
When deciding whether to invest in the industry, no one had brought up
or looked into the disease, a spokesman for the finance corporation said.
“CKD is not a common disease in the sugar sector worldwide, so I.F.C.
did not look into this issue at appraisal,” said the spokesman, Aaron
Rosenberg, based in Washington. The institution has lent more than $100
million to Nicaraguan sugar mills over the past decade.
After the complaint, the mill agreed to provide food and other
assistance to widows and sick workers. It also agreed to open its door
to a team of outside researchers.
Yet “nature can be very reluctant to give up its secrets,” said Daniel
Brooks, a researcher from Boston University, which was selected to
investigate the disease by a committee that included mill executives and
sick workers.
Five years later, Dr. Brooks has as many questions about the disease as
answers. His report published in 2012 neither entirely ruled out nor
formally endorsed any theory.
Now, Dr. Brooks and his team from Boston University will be leading the
charge in three C.D.C. Foundation studies, which he believes could have
implications far beyond Nicaragua.
“We don’t know if this is the tip of the iceberg yet,” he said. “If this
is heat stress and the climate is changing in the direction of getting
hotter over time, are we seeing something that will happen much more in
the future and maybe extend its geographic range?”
“Similarly, if it’s agrochemicals, the agrochemicals they use are very
widespread across the whole world,” he added.
For now his team is more focused on two other areas: whether the disease
has a genetic component and its presence in children. Research into
work-related risk factors is also planned, but sugar industry funding so
far covers only preliminary work. The C.D.C. says that numerous measures
are in place to protect the research from undue influence. Some others
are suspicious.
“If your main concern is limiting liability, you are never going to get
to the bottom of what is causing this,” said Jason Glaser, president of
La Isla Foundation, an organization focused on the disease in Nicaragua.
On a recent afternoon, Mr. Aguilera was feeling well enough to take
careful steps toward the graves of his two brothers and father, all
victims of the disease. He was thrown off by all the new mounds of earth
that had appeared — at least 30 over the past few months.
“I will be buried over there,” he said calmly, pointing to a plot nearby.
He died three weeks later.
________________________________________________
Send list submissions to: [email protected]
Set your options at:
http://lists.csbs.utah.edu/options/marxism/archive%40mail-archive.com
