Hard Life Leads to Hard Death

When I began to work in Honduras, the economy I experienced was quite different from what exists today. San Pedro Sula was growing, but the many free trade zones that would lure sweatshops were in the future. In the Bay Islands, where today hotels stand side by side, we saw almost deserted beaches and pristine reefs.

What supported the economy then was agriculture, cattle ranching, banana and sugar plantations, all dependent on the laboring bodies of campesinos.

I spent my work days walking across the countryside, meeting these working people and seeing their daily lives. They worked hard. In the sugar plantations in particular, the work was hot, long, and intense. I could barely stand the heat myself, and I was not swinging a machete to cut the mature cane, a grass whose strands cut into your skin like a thousand tiny glass knives.

In those days before purified water was commercialized in Honduras, I carried a half-gallon water bottle with me, filled from the taps in La Lima where the banana company that owned all the housing provided drinkable water. If I emptied my water bottle, I would have had no alternative to combat the sun and the heat. I had learned on my first trip to Honduras what would happen if I did not stay hydrated: collapse from heat stroke took me out of the field for days.

So it always amazed me to see the relatively tiny water bottles that workers carried to the field. When I offered a drink to someone, they would politely refuse, and then possibly take a tiny sip from their own container. I thought it was something about growing up in that setting; that they were more adjusted to the heat, and needed less water.

Now, an AP story tells me otherwise. It describes a mysterious epidemic of kidney disease killing agricultural workers in Central America. Despite original suspicions that the cause might be a chemical used in the fields, tests for these, and for heavy metals, came up negative. Instead, "the roots of the epidemic"

appear to lie in the grueling nature of the work performed by its victims, including construction workers, miners and others who labor hour after hour without enough water in blazing temperatures, pushing their bodies through repeated bouts of extreme dehydration and heat stress for years on end. Many start as young as 10. The punishing routine appears to be a key part of some previously unknown trigger of chronic kidney disease, which is normally caused by diabetes and high-blood pressure, maladies absent in most of the patients in Central America.

My naive impression that the men I saw toiling all day, with less water than would get me through a couple of hours, were somehow avoiding the damage I feared for myself was wrong. They were not avoiding it: they were accruing that damage year in and year out. Some were probably already dying of it.

But not in such numbers as in the last decade, when in El Salvador and Nicaragua, the frequencies of deaths from kidney disease doubled. The article cites rising mortality in sugar-cane zones of northern Costa Rica, and possible indications of the same in Panama, although "at less dramatic rates".

Because the report didn't mention Honduras, I went off to see what I could find about the incidence of chronic kidney disease there. The International Consortium of Investigative Journalists, responsible for the original story about chronic kidney disease in Central America on which the AP report is based, describes its methods of investigation. The note on methodology posted by the Center for Public Integrity says "studies have indicated the disease is spreading in Honduras and Mexico as well" but then adds "no data were available for Honduras."

Saying its data come from the World Health Organization, a site called World Life Expectancy claims that in 2011 Honduras deaths from kidney disease made up 4.67% of the mortality there, making this the fifth most common cause of death and placing Honduras 8th in the world for deaths from this cause. El Salvador ranked first; Nicaragua trailed Honduras slightly at 10th. I was unable to find a specific source on the WHO website that would let me verify these numbers, but that's not my specialization, and as the Center for Public Integrity note on methodology indicates, deaths from chronic kidney disease are not coded transparently. What the relative ranking would indicate is, as the International Consortium of Investigative Journalists suggests, Honduras is experiencing a similar level of the disease as Nicaragua and El Salvador. Some support for the conclusion that chronic kidney disease is a more urgent health problem in contemporary Honduras than previously comes from news coverage of protests by 1000 patients dependent on dialysis in Honduras suggests the number of those needing this treatment is outstripping the resources the government has to provide.

In the case of El Salvador and Nicaragua, where they could find comparable data, the scientists the reporters talked to argue that increases in kidney disease are not simply due to better reporting. They point out that

in nations with more developed health systems, the disease that impairs the kidney's ability to cleanse the blood is diagnosed relatively early and treated with dialysis in medical clinics. In Central America, many of the victims treat themselves at home with a cheaper but less efficient form of dialysis, or go without any dialysis at all.

International demand for the products of sugar plantations may be putting increased pressure on the labor force:

In 2006 [one plantation in Nicaragua] received $36.5 million in loans from the International Finance Corp., the private-sector arm of the World Bank Group, to buy more land, expand its processing plant and produce more sugar for consumers and ethanol production.

As the AP article notes, some companies are taking steps intended to prevent the chronic disease; but the need of employment leads workers to desperate measures:

about eight years ago [the Nicaraguan factory] started providing electrolyte solution and protein cookies to workers who previously brought their own water to work. But the study also found that some workers were cutting sugar cane for as long as 9 1/2 hours a day with virtually no break and little shade in average temperatures of 30 C (87 F).... many worker protections in the region are badly enforced by the companies and government regulators... Many workers disqualified by tests showing high levels of creatinine go back to work in the fields for subcontractors with less stringent standards, he said. Some use false IDs, or give their IDs to their healthy sons, who then pass the tests and go work in the cane fields, damaging their kidneys.

"This is the only job in town," Glaser said. "It's all they're trained to do. It's all they know."

The article notes, grimly, that the conditions that probably produced this increase in kidney disease and death exist elsewhere:

they have seen echoes of the Central American phenomenon in reports from hot farming areas in Sri Lanka, Egypt and the Indian east coast.

These are deaths of people who matter. And if the diagnoses are correct, they are completely avoidable consequences of the choices made in global centers of capital; the desire for more sugar in foods and for ethanol to postpone the inevitable transition of the world economy from petroleum fuels to other sources. These working bodies are dying for us.