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Along the Pacific Coast of Central America, a mysterious form of kidney failure is killing men in the prime of their lives. It first showed up two decades ago, yet researchers still haven't been able to pinpoint its exact cause. The condition appears to be concentrated among agricultural workers, mainly sugarcane cutters. NPR's Jason Beaubien recently travelled to a sugar town in Nicaragua which has been hard hit by the disease.

JASON BEAUBIEN, BYLINE: Something is stalking the sugarcane cutters of Chichigalpa. The town is surrounded by the cane fields of El Ingenio San Antonio, one of the oldest and largest sugar estates in Central America. Manuel Antonio Tejarino used work in those fields. Now he is slumped in a faded cloth deck chair outside his sister's house on the outskirts of town.

Tejarino's kidneys are failing. He's grown gaunt. His arms droop by his side. In the tropical midday heat he alternates between wiping sweat off his brow and pulling a sweatshirt up over his bare chest.

MANUEL ANTONIO TEJARINO: (Through interpreter) I feel like I'm burning. My blood pressure goes down. I get dizzy. Someone has to help me walk. If I'm alone, I'll fall down.

BEAUBIEN: Tejarino spends his days here in this flimsy deck chair in his sister's yard. The 49-year-old says it's cooler here than at his shack across the ravine. In the past, Tejarino used to join the roughly 7,000 people who work the sugarcane harvest here each year. Now he's among the ranks of the more than 2,000 locals suffering from a strange form of early onset kidney failure.

TEJARINO: (Through interpreter) I worked nine years in the sugarcane harvest and that's what's made me sick.

BEAUBIEN: That's what all the former workers say, that it's something in the sugarcane. But despite this disease being around for at least 20 years, researchers simply can't explain what's causing it.

REINA TURCIOS-RUIZ: We don't know. That's the unfortunate part, we don't know, and we do desperately need to find some answers.

BEAUBIEN: Reina Turcios-Ruiz is an epidemiologist with the U.S. Centers for Disease Control and Prevention's office in Guatemala City. She says this form of kidney failure is being found throughout Central America, from southern Mexico to Panama, but only along the Pacific Coast. At first, health officials dismissed it as a fluke or attributed it to a misdiagnosis of diabetes or some other underlying health problem.

The disease tends to strike relatively young men, sometimes while they're still in their early 20s. As it progresses, agricultural laborers, who earn 10 or 15 dollars a day, end up in need of dialysis that can cost tens of thousands of dollars a year.

TURCIOS-RUIZ: If a person doesn't receive treatment in the advanced stages of kidney failure, a person will die.

BEAUBIEN: And treatment options in El Salvador, Guatemala and Nicaragua are extremely limited. By one estimate, 20,000 people in the region have died from this form of kidney failure over the last two decades. Cutting sugarcane is a grueling physical activity. One of the prominent theories about the disease is that dehydration somehow makes the men more susceptible to environmental toxins. Under the intense tropical sun, men wielding machetes hack their way through towering rows of sugarcane.

Adding to the hellish nature of the work, the fields were burned the night before. The burning gets rid of dead leaves and makes the cane easier to process. Sweat and soot cling to the men's clothes and skin. More than a decade ago, the sugar company here recognized that something was amiss. The company started testing the kidney function of workers before each harvest. Anyone showing signs of kidney failure, even early stage kidney disease, wasn't given work.

Manuel Antonio Tejarino and other sick former workers say there's clearly a link between the disease and the cane fields.

TEJARINO: (Through interpreter) It was the chemicals, the chemicals in the plantation. We drank the water from the river and it was really dirty.

BEAUBIEN: Agricultural chemicals are high on the potential suspects lists among researchers. In response to a similar epidemic of kidney failure among farm workers in Sri Lanka, the Sri Lankan government banned the use of glyphosate. Glyphosate is the generic version of the popular herbicide marketed by Monsanto as Roundup.

Scientists, however, have yet to figure out whether the herbicide causes the disease and sugar growers in Nicaragua continue to use Roundup. Tejarino says if it's not Roundup, it's some other agricultural chemical and he accuses the company of abandoning its own workers.

TEJARINO: (Through interpreter) They got rid of me. They treat us like garbage.

BEAUBIEN: Company officials, of course, deny that they treat their workers like garbage. The refinery has its own state-of-the-art hospital. The company offers free education to its workers' children. They feed employees during their shifts and they say they haven't abandoned the former laborers.

The company provides monthly food packets and basic medical supplies to a group of roughly 2,000 ill workers and their widows in Chichigalpa. Alvaro Bermudez, the head of El Ingenio San Antonio, says the company is as eager as everyone else to find the cause of the disease. It's a problem for the refinery.

ALVARO BERMUDEZ: (Through interpreter) It's a problem in the sense that any problem that affects our community affects us. But not in the sense that we caused the disease.

BEAUBIEN: Besides dehydration and agricultural chemicals, researchers say the cause could be many things - over-the-counter pain pills, local moonshine, rat urine, hantavirus and possibly even genetics. Turcios with the CDC says the scientific research into this problem, unfortunately, is still in its infancy.

TURCIOS-RUIZ: There have been a number of studies, some better than others, but that have started to describe the problem. So I look at this like the three blind men touching different parts of the elephant and saying, you know, this feels like a worm, this feels like a tree, this feels like a twig, depending on where they are. We need a study to take a look at the whole elephant.

BEAUBIEN: But in the meantime, frustration over the disease has led to violent protests against the sugar company in Chichigalpa. Earlier this year, police killed one protester and seriously wounded another just outside the plantation gates. On a recent weekday morning, Manuel Antonio Tejarino's wife, Laura, is also frustrated, but frustrated in a quiet, matriarchal way.

LAURA: (Through interpreter) He's been throwing up all morning. It's very hard to see him this way.

BEAUBIEN: Laura sits next to her husband. She slowly runs her fingers through his black hair. People all around them are dying, she says. It's been going on for years, and in her opinion everyone's ignoring it.

LAURA: (Through interpreter) An uncle of mine too, and before him, my brother, and a man over there on the corner, he also died of it.

BEAUBIEN: This disease doesn't spare anyone, she says. The next step for researchers is to reconstruct the daily lives of these men and try to track what they've been exposed to. They warn that with so many possible causes, it could take years to untangle what exactly is making these men's kidneys fail. Jason Beaubien, NPR News.

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