As it turns out, the CKDu epidemic also made the cover of Science magazine this week (article link here, sadly paywalled), thanks to some new studies that were recently announced. Here's hoping more scientific attention will pave the way for workable and just solutions.
Everything Will Live Where the River Goes
Written by Timothy DonaghyApril 15, 2014
The Book of Ezekiel offers up a beautiful vision of humans living in harmony with the natural world:
“He said to me “Mortal, have you seen this?” [...]
9Wherever the river goes, every living creature that swarms will live, and there will be very many fish, once these waters reach there. It will become fresh; and everything will live where the river goes. 10People will stand fishing beside the sea from En-gedi to En-eglaim; it will be a place for the spreading of nets; its fish will be of a great many kinds, like the fish of the Great Sea. [...] 12On the banks, on both sides of the river, there will grow all kinds of trees for food. Their leaves will not wither nor their fruit fail, but they will bear fresh fruit every month, because the water for them flows from the sanctuary. Their fruit will be for food, and their leaves for healing.” (Ez 47:7-12, NRSV)
In this passage we find ourselves immersed in Ezekiel’s promised land, with trees on all sides and our toes in the river. Our baptism into nature brings us both abundant food and good health. There are fruit and fish and even the leaves of the trees have the power to heal. We know instinctively that there is an intimate connection between our health and the health of the natural world. After all, without healthy food, clean water and clean air the human body cannot survive. Even when our modern world locks us away in office buildings and parking lots, our connection with the creation can only be muted but not severed.
Over the past year, Laura Jean and I developed and taught a university class making the connections between environmental science and theology. Her background is as a pastor and theologian, mine as a scientist and environmentalist. We also strove to base the class on the concepts of popular education, which takes as a starting point the experiences, expertise and values of the students. The first assignment was to reflect and write about an environmental problem that affects their local community. Our students came from a variety of backgrounds – women and men, rural and urban, young and old – and they told us vivid stories of neighborhood trash heaps, erosion and floods, contaminated lakes, the loss of fresh water springs due to deforestation, and more.
One group of five students traveled every week for our class, two hours or more each way, from the cities of León and Chinandega in the western region of Nicaragua. One had to leave his house at four in the morning to catch the first of three buses that would bring him to class in Managua. These students had grown increasingly concerned with the news from their region about a mysterious and tragic epidemic of kidney disease that was killing young sugar cane workers. For their final project for the class, the group got to work doing interviews and pastoral counseling with the sick workers, their families and community advocates. It was a moment that every teacher lives for, when the ideas up on the blackboard resonate with the lives of your students and then catch fire.
In developed countries, Chronic Kidney Disease (CKD) is an ailment that affects mainly older people suffering from diabetes or high blood-pressure. Often it can be controlled with diet and medication. In Nicaragua CKD is an aggressive illness that affects young, otherwise healthy men. It is painful and progresses rapidly, leading to kidney failure and death in a matter of years. In some regions nearly 50% of all male deaths are from kidney failure. One village has watched so many of its young men die that it is now known as the ‘Island of the Widows.’ The epidemic has been growing throughout Central America, from the south of Mexico down to Panama.
The disease poses a scientific mystery. The epidemiological evidence points to extreme dehydration and hot working conditions as key factors damaging the kidneys. Such hot working conditions are indeed typical in the sugar cane fields of Central America. However, workers have been cutting sugar cane in these fields for centuries, but it is only in the past few decades that kidney disease has appeared. Other sugar cane producing regions such as those in Cuba and Brazil have not seen similar epidemics, although similar cases have been reported as far away as Sri Lanka and India. This has led some researchers (including the Ministry of Health in El Salvador) to speculate that another factor – possibly contamination of drinking water by heavy metals or pesticides – is playing a role in triggering or worsening the disease.
In Nicaragua, the sugar cane plantations are owned by the country’s richest family, the Pellas, and the cane is processed to make sugar and Flor de Caña rum. The sugar plant admits no responsibility, although they have taken some steps to insure that workers have access to hydrating fluids and they have put some money toward scientific studies of the disease. Nonetheless, there are a large number of current and former workers suffering from the disease many of whom lack access to dialysis and medical care. This has led to ongoing contentious protests against the sugar plant. Earlier this year, police fired on protesters camped outside the plant gates, killing one protesting worker, Juan de Dios Cortés, and injuring several others.
One of the concepts we highlighted in our class was the idea of environmental justice. In the United States, the environmental justice movement grew out of the civil rights movement, drawing attention to the fact that people of color have borne an unfairly heavy burden of environmental contamination. Toxic waste sites are located disproportionately in communities of color, whose residents then must pay the economic and health costs of their contaminated environment. The United Church of Christ (UCC) has a long history with the environmental justice movement. In 1987, the UCC Commission for Racial Justice published an influential report titled Toxic Wastes and Race in the United States that brought the struggle to a wider audience and started a conversation that has led to some reforms.
The banner of environmental justice has spread far beyond the U.S. and has been taken up across the globe by indigenous groups fighting off transnational corporations, by landless campesinos and urban squatters, by people everywhere demanding an equitable solution to climate change. Our students made the case that the epidemic of CKD among sugar cane workers was also an example of environmental injustice. Whether the primary cause of kidney disease turns out to be harsh working conditions or environmental toxins or some combination of causes, it is clear that the overall environment of these workers is literally killing them. And when our brothers and sisters are too poor turn down a job they know might kill them, and who are too poor to afford health care once they get sick, we are witnessing an extreme lack of justice.
The beautiful vision found at the end of Ezekiel is in direct contrast to the earlier chapters of the book. Before we were exiles, alienated from nature, lost in the valley of the dry bones. We suffered, we became sick, we lacked for healthy food and clean water. Even the air we breathed was dusty and unhealthful. But now we have been restored, renewed, revitalized, reenergized. With the blessings of God, the land blossoms and so do we.
Further Reading
- The website Global Voices has highlighted the work of photo-journalists Ed Kashi and Esteban Félix who have documented those suffering from CKD in Nicaragua. A video based on Félix’s photography is below. [VIDEO]
- Over the past 3 years Sasha Chavkin of the Center for Public Integrity has published a series of articles on the disease. The epidemic has also been covered by the Guardian, Scientific American and the Associated Press.
- The website Confidencial reported (spanish) on the recent tensions between workers, the sugar plant and the government. Following the recent violence a group of Nicaraguan and international organizations signed a declaration calling on the government to address the situation.
- In 2007, the UCC Justice & Witness Ministries published an updated report Toxic Wastes and Race at Twenty, which is a good introduction to both the history and current situation of environmental justice in the U.S.