CHICHIGALPA – One of thousands of sugarcane workers whose kidneys have stopped working in what has become a health epidemic in this agricultural region of Chinandega, Necdaly Peña lies on a rusty bed frame with no mattress, a sheet barely hiding his frail body and twiggy limbs.
“You give your life to the sugar mill,” he said, referring to San Antonio, a sugar mill owned by sugar export giant Nicaragua Sugar Estates Limited, a holding of the powerful Grupo Pellas.
After working 14 years in the cane fields, Peña was let go in 2000 when the company’s annual blood exam showed he had signs of chronic renal disease. The company, one of Central America’s leading sugar producers with 11,000 hectares of sugarcane fields, hires workers for six-month terms and contract renewal is contingent upon test results for creatinine – a waste product in the urine that indicates kidney disease.
The company doesn’t renew contracts for workers whose levels exceed 1.4 milligrams per deciliter (mg/dl), according to a complaint cane workers filed with the World Bank, which recently gave the company a $55 million loan to invest in alternative energy. Normal creatinine levels are between 0.6 and 1.2 mg/dl.
Peña’s father worked for San Antonio Mill his whole life and died of the same disease that Peña suffers from today. Like many of the sick workers who developed the occupational illness while working for the San Antonio Mill, Peña, whose creatinine level is 3.8, no longer receives compensation from the company, and survives from the modest widow’s pension the company pays his mother.
“Tell the company to help me. I need to buy things but I can’t move,” he said, avoiding eye contact and glowing with sweat because the electricity that powers his fan had been cut.
Over the past eight years, his kidneys have been slowly giving up on him. The five-stage disease begins with an increase in creatinine and a few other symptoms. Treatment can slow the deterioration of kidney malfunction, but over time, the kidneys – the body’s filters of toxins – begin to lose function, leading to myriad other diseases that range from malaise to anemia. In the fifth and final stage of the disease, patients must be hooked up to a dialysis machine or receive a kidney transplant to stay alive.
“Life is hard,” Peña said, “I need help to survive.”
Chronic renal syndrome has become a defining fact of life in Chichigalpa and the surrounding communities, where the 118-year-old San Antonio Sugar Mill is the main employer.
Widows of sugarcane workers dominate entire communities. Yet young boys continue to head out into the cane fields each season, despite the grim odds against them – as many as 3,500 cane workers have died of kidney disease here in the past decade, according to local cane worker unions.
“A cycle of death is happening,” said Jason Glaser, a New York resident who is filming a documentary on cane worker deaths and is helping to support their families through a non-governmental organization in León.
Chronic kidney disease is the seventh leading cause of death in Nicaragua. A 2005 Pan American Health Organization report on the growing kidney-disease “epidemic” in Nicaragua estimated there were as many as 1,000 sugarcane workers with the disease in Chinandega, concentrated in neighborhoods of sugarcane worker families. Between 1990 and 2003, mortality rates among those with the disease increased by 2.5 percent, mainly among male farmers between 35 and 49 in León, Chinandega, Granada and Rivas, with the highest death rates in Chinandega.
The report estimates that 100,000 farmers exposed to occupational and environmental hazards have the disease.
Even younger cane workers stoically accept bad results from the sugar mill’s seasonal blood exams as an announced visit from the grim reaper.
“I’m waiting for death” said 25-year-old Nelson Martínez, whose creatinine level is at 6.0, well above the 1.4 mg/dl limit.
A mix of heavy farming chemical use, extreme poverty and extreme weather conditions are the main culprits of the disease, with some studies suggesting the presence of heavy metals in rural drinking wells.
Contamination associated with aerial fumigation and irrigation runoff from manually-sprayed crops are widely suspected, according to Kristen Genovese, staff attorney of the U.S.-based Center for International Environmental Law (CIEL).
Chinandega is also one of the driest parts of the country, and dehydration can also be a cause of chronic renal syndrome.
Over the past three decades, Chinandega has become increasingly dry due to climate change, according to climatologist Jose Milan, with rainfall decreasing by 10 percent across the region. And it’s doesn’t seem to be getting any better (see separate story, N3).
The way things are going, rain will continue to decrease, and temperatures here could increase by up to 5 degrees Celsius by 2090, according to climate experts.
“Temperatures in Chinandega could reach 45 degrees, like the desert of Arizona,” Milan predicts.
Yet the health epidemic may not be limited exclusively to cane workers, as was once thought. Epidemiologists at the National Autonomous University in León have found high prevalence of the disease in a Chinandega mining community as well.
But in a country where there is no government-certified water testing lab, the cause of the epidemic has largely remained a mystery.
Cane workers allege the company’s environmental impact studies have been kept a secret from the larger public.
“You see a lot of ex-sugarcane workers who are sick. You start to ask the question: what is in the sugar cane?” said Genovese, one of several U.S. activists who have converged on Nicaragua in recent years to help cane workers seek solutions to the epidemic.
Part of what makes the sugarcane worker struggle in Nicaragua a unique endeavor is the convergence of an array of U.S. activists who have gotten behind their cause over the past few years, from Yale University forestry students to sister city project volunteers to film producers.
In March of this year, Genovese’s CIEL and a Yale forestry student Olivia Kaplan helped a group of Chichigalpa cane workers file a complaint with the Ombudsman’s office of the International Financial Corporation (IFC), the financial arm of the World Bank that in 2006 approved a $55 million loan to increase Nicaragua Sugar Estates Limited (NSEL) sugarcane production and fund construction of an ethanol plant.
The workers filed a complaint after a lack of results in dealing with local authorities.
“All the institutions act like they’re deaf,” said ex-cane worker Juan Salgado.
In the IFC complaint, cane workers allege the sugar company is not in compliance with Nicaraguan law, and that the IFC has failed to meet its own environmental and social standards in its relationship with the company.
The 29-page complaint alleges that Nicaraguan Sugar Estates workers and community members who live next to its sugar fields are experiencing an epidemic of chronic kidney failure. The complaint alleges the company has interfered in the creation of independent cane-worker unions; pesticides have impacted indigenous lands; residents living near sugar cane fields suffer from respiratory illnesses related to burning practices at the harvest; company irrigation practices have depleted ground water; pesticides and runoff waters have contaminated local drinking water supplies; and former employees and community members who complain against the company have been harassed, persecuted and even jailed.
Over the course of a month, The Nica Times tried unsuccessfully to coordinate a visit to the Sugar Mill’s clinic with company spokesman Ariel Granera.
“Some people presented a complaint that the World Bank is contemplating within the framework that exists between the IFC and companies with which it works. Any time there’s a complaint – well-founded or not by people that represent the community or not – they follow up on it and come meet with us,” Granera told The Nica Times.
Amar Inamdar, of the IFC ombudsman’s office said that the World Bank entity is “currently assessing these issues with the cooperation of all parties.”
The complaint says that as the company has grown, it “involuntarily” resettled workers living on its property to the community of La Candelaria, allegedly because the worker’s drinking water source on the property had been contaminated.
In the complaint, workers demand that Nicaraguan Sugar Estate Limited pay adequate pensions to ex-employees who suffer from occupational illnesses.
Despite the long list of health and social concerns at the mill, the sugar company failed to make public its social and environmental assessment that the IFC required for its ethanol plant production to begin, according to the complaint.
Genovese said the company has responded positively to the complaint and is cooperating with IFC compliance officers.
“It’s a pretty good case. I just can’t say with any certainty what’s going to come of it. It’s not a perfect process. We don’t have a lot of power to force them to do anything really. There’s a huge power imbalance here and the (ombudsman’s) office is meant to somewhat balance that. I really hope we can get some remedies for the victims and the families affected by the operations in the mill,” she said.
The Sandinista government is also promising to help cane workers at the country’s largest mills, including San Antonio.
Nicaragua’s Ombudsman’s office announced last month it will sit down with cane worker leaders to negotiate pay that they are owed from when the government of President Violeta Chamorro (1990-1996) agreed to pay cane workers 25 percent of their assets after privatizing cane fields and mills that the Sandinista government had nationalized in the 1980s.
“Those sugar mills were state-owned in the ’80s. When Violeta won, we were stripped of that,” said Marco Sandino, head of the San Antonio Sugar Mill cane worker union.
It’s not yet clear where the Sandinista government will find the money to compensate the workers.
Life in the Cane Fields
In the community of La Isla, which borders sugarcane fields and a stream that is potentially contaminated, Ursula Aguilar, 42, sits rocking in her chair in a dirt yard shared with a pig.
“Once they turn up sick, they’re treated like a piece of scrap,” she says of cane workers such as her late husband.
Aguilar is one of some 80 widows of cane workers in this tiny community. Her husband died of chronic renal disease after cutting cane for 17 years.
“Doctors gave him two months to live, but he lasted eight,” she recalls with pride. As a mother of eight, the San Antonio mill paid her a widow’s pension of about $80 a month after her husband died. Because two of her kids dropped out of school to cut cane, the pension was cut in half. She now makes tortillas, raises pigs and washes clothes to get by.
“We’re just surviving, sort of,” says Aguilar, as seemingly endless rows of sugarcane tremble in the breeze across the stream behind her.
She fears all her kids will end up working in the cane fields because “that’s all there is.”
Two of her sons who worked in sugarcane now suffer from the disease that took her husband and her grandmother.
She is aware solutions exist for chronic renal disease victims, but they’re beyond her income level.
“Dialysis costs $200 a day. We can’t afford it, so instead we’re waiting for the will of God. Out here we’re dying due to a lack of money,” she says.