Wednesday, December 21, 2011

The kidney disease epidemic in El Salvador

There is a health crisis in El Salvador and other Central American countries which has been greatly under-reported.  Chronic kidney disease is killing thousands in the region, and the causes are not known.

At a regional health conference in February 2011, El Salvador's Health Minister Dr. María Isabel Rodríguez spoke of an epidemic of chronic kidney disease afflicting the country, where kidney disease is now the leading cause of hospital deaths for men aged 20 to 60 and the third leading cause of death for women. One in four men living in coastal areas has the disease.

Recent news reports from the International Consortium of Investigative Journalists, a project of the Center for Public Integrity, together with PRI have now highlighted this epidemic. From the report by the Center for Public Integrity titled Thousands of sugar cane workers die as wealthy nations stall on solutions:

Each year from 2005 to 2009, kidney failure killed more than 2,800 men in Central America, according to the International Consortium of Investigative Journalists‘ analysis of the latest World Health Organization data. In El Salvador and Nicaragua alone over the last two decades, the number of men dying from kidney disease has risen fivefold. Now more men are dying from the ailment than from HIV/AIDS, diabetes and leukemia combined.

“In the 21st Century, nobody should die of kidney disease,” said Ramon Trabanino, a physician from El Salvador who has studied the epidemic for a decade.

The surge of kidney disease is overwhelming hospitals, depleting health budgets, and leaving a trail of widows and children in rural communities.
The causes of this epidemic in El Salvador and other Central America countries are not yet understood:
Victims are mostly men who conduct manual labor — mostly harvesting sugarcane. In El Salvador and Nicaragua over the last two decades, the number of men dying from kidney disease has risen fivefold.

The disease’s cause remains a mystery. A key contributing factor and potential culprit: dehydration and heat stress from strenuous labor. Researchers also suspect that exposure to an unknown toxin may trigger onset of the disease.
It is a disease of major epidemic proportions in the Bajo Lempa region of El Salvador.   From PRI's The World:
At a health clinic in El Salvador, in the farming region of Bajo Lempa, Dr. Carlos Orantes recently found that a quarter of the men in his area suffered from chronic kidney disease.

What’s more, he says, most of the men who are ill show no signs of high blood pressure or diabetes – the most common causes of CKD elsewhere in the world. “Most of the men we studied have CKD from unknown causes,” he says.

What the men in the area have in common is they all work in farming. So Dr. Orantes thinks a major cause of their kidney damage is the toxic chemicals – pesticides and herbicides – that are routinely used here in agriculture. “These chemicals are banned in the United States, Europe and Canada, and they’re used here, without any protection, and in large amounts that are very concerning,” he says.

But he’s not ready to rule out other possible causes. For instance, the overuse of painkillers can damage the kidneys, and so can drinking too much alcohol. Both are major problems here, he says.
Because of the prevalence of the disease among sugar cane workers, the reports note that many are looking for connections in the conditions and environment under which such work is conducted. But the reports also note that workers in other areas of El Salvador's economy also suffer from the disease. Sugar cane growing is a major industry in El Salvador and elsewhere in Central America, and there are powerful economic interests in the way that cane is currently grown and harvested.

This video discusses the epidemic of chronic kidney disease among sugar cane workers in a community in Nicaragua:




The size of this epidemic requires that the international community support the countries in Central America with resources for greater investigation of the sources of kidney disease, as well as resources for maintenance and treatment of patients who often live in some of the regions most impoverished areas.

EcoViva reports that the Spanish government is funding construction of a multi-million dollar clinic for dialysis patients in El Salvador.


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