For several years now, a mysterious kidney disease epidemic has been underway in several parts of the global South. The victims are young, male outdoor workers - far from the usual demographic of older patients with sedentary lifestyles and a history of diabetes or high blood pressure. In Central America, thousands of young men who work in the sugar cane plantations have died of failing kidneys; in Sri Lanka and parts of rural India, it is rice farmers who are similarly afflicted. Although the "mystery disease" has garnered medical attention - at first as an anomaly, but increasingly as an inexplicable mass killer - for over 20 years now, the causes remain unknown. In fact, the disease goes by the moniker "chronic kidney disease of unknown etiology" (CKDu) to distinguish it from the ordinary form, CKD.
Numerous medical studies have considered heat stress (prolonged exposure to the sun, often in conjunction with insufficient access to drinking water) and exposure to chemicals in pesticides and fertilizers to be possible causes. However, the results are far from conclusive. What is conclusively evident, however, is that there are an inexcusable number of lives being cut short with no concrete effort at prevention. Most evidence points to one (or a combination) of the two above-mentioned factors. Accordingly, it would be relatively simple for interested parties to devise a preventive strategy on this basis. However, the response has been woefully inadequate.
Although definitive knowledge of causal factors is lacking, a name that is repeated in medical papers is that of the pesticide glyphosate. Marketed most notably by the Monsanto Corporation under the brand name Roundup, this chemical has been noted in academic literature, as well as in the media, as likely to be an aggravating factor.
A paper co-authored by Channa Jayasumana, an academic who has published several papers on the issue, says, "Results being produced through the current study that is ongoing in the California State University, Long Beach are highly supportive of this hypothesis." On being confronted with his findings, Monsanto has, predictably, categorically rejected the veracity of these findings. Subsequently, the Sri Lankan government banned a number of agrochemicals, including Roundup; however, their enforcement has been placed on hold due to severe political opposition.
Meanwhile, Central American activist groups such as Fairfood International have hauled up the Bacardi Corporation for sourcing sugar from plantations whose workers are afflicted with CKDu. The inhumane working conditions, specifically the long hours and heat stress, have been the focus of these campaigns. Bacardi has responded by recognizing the risks posed by CKDu (or CKDnt, as it is commonly referred to in the Central American context), but by denying the claim that its supply chain extends back to afflicted regions.
The problem caused by CKDu is further exacerbated by the poverty of the people affected and by the expensive nature of the treatment. The treatment is often unaffordable, and the workers often cannot opt out of the profession, leaving them trapped with the disease. In an interview with Sasha Chavkin from The Center for Public Integrity, a Nicaraguan laborer who lost his father to CKDu and was himself diagnosed with the condition at age 17, having worked in the fields since the age of 14, explained his helplessness, saying, "We work there because the company is the only option we have." As a result of their poverty, farmers in Sri Lanka are also hesitant to discontinue their use of pesticides, as it would result in a decrease in yield.
In Andhra Pradesh in India, the issue is compounded by the fact that the closest hospital with dialysis facilities is 200 kilometers away, and in the words of a village leader, the villagers "cannot go to that place because of lack of money, so they are staying here and dying here." Afraid of whatever unknown reason that is causing all the deaths, and feeling helpless to do anything about it, people are abandoning their villages in search of a safer place to live.
Meanwhile, as many as 40,000 Sri Lankan rice farmers and up to 37 percent of the population in villages in Uddanam District, Andhra Pradesh, are slowly and painfully dying, according to The Center for Public Integrity. CKDu is already one of the leading causes of death in Central American countries such as El Salvador and Nicaragua, overtaking the number of deaths caused by HIV and diabetes combined. It is only a matter of time before it reaches similar proportions in South Asia, through a combination of ignorance and inaction.