[Marxism] Life goes on in Sandinista Nicaragua

Louis Proyect lnp3 at panix.com
Fri May 9 08:06:46 MDT 2014

NY Times, May 9 2014
Deadly Illness in Nicaragua Baffles Experts

CHICHIGALPA, Nicaragua — During the harvest season, when exhausted 
workers spend seven days a week cutting sugar cane, the signs of illness 
were hard to spot at first.

It was in the off-season, out on the baseball field, that some residents 
noticed a change. Base-stealers were lethargic. Pitchers were losing 
their aim. In the evening, outfielders were burning up as if standing 
under the scorching sun of the day.

“That’s Mosquito, now dead,” said Arnulfo Téllez Aguilera, 49, pointing 
to a photograph of his smiling teammates before their muscles withered, 
like his. “That’s my brother, Danilo, dead too.”

Across Central America, a painful disease that affects the kidneys has 
killed at least 20,000 people over the past decade and has become the 
leading cause of deaths in hospitals among men in El Salvador. But the 
illness, often called Chronic Kidney Disease of unknown causes, or CKDu, 
is so poorly understood that it still does not have a universally agreed 
upon name.

Theories vary drastically, citing a combination of possible factors, 
including heat stress, chronic dehydration, toxic chemicals, 
painkillers, sugar consumption and even volcanic ash.

But there is a rare point of consensus, many researchers say: 
Nicaragua’s sugar cane heartland — in particular Chichigalpa, the town 
that is home to the country’s largest sugar mill — has been one of the 
hardest hit places in the world. Cane-cutting fathers and sons in the 
same family have died, and seemingly healthy young men are quickly 
wasting away.

The Nicaraguan government, the country’s sugar mills, even the World 
Bank, which has poured tens of millions of dollars into the sugar 
industry here, all say that until the mystery of the disease is solved, 
there is little they can do to prevent it. Now, after years of 
inconclusive research, the Centers for Disease Control and Prevention is 
stepping in to help with some of the most ambitious studies of the 
illness yet.

But the sick former sugar cane workers here have little faith that more 
studies will bring improvements anytime soon. The fact that the research 
will be funded entirely by the sugar industry is only fueling the distrust.

“I don’t think anybody has clean hands,” said Kristen Genovese, a lawyer 
who helped sick former workers file a complaint against the World Bank’s 
lending arm in 2008 for lending $55 million to the sugar mill here, 
called San Antonio, without looking into the disease or the possibility 
that it might be connected to the industry.

“The government of Nicaragua has done nothing to help these people,” 
said Ms. Genovese, who was with the Center for International 
Environmental Law in Washington when she filed the complaint. And the 
World Bank, she argued, “should have spotted this problem, and didn’t do 
anything about it, and continued to invest in sugar in the region.”

Along the Island of the Widows, as one area next to the big sugar mill 
is called, the disease is such a dominant part of life that health 
updates sometimes replace “hello.”

Before each harvest, workers must take blood or urine tests that measure 
kidney function to determine whether they will be allowed to return to 
the fields. In preparation, some ingest concoctions of fresh tamarind 
juice and linseed oil, avoid the sun and force themselves to rest. 
Others simply pray.

“When you’re sick they tell you, ‘You’re done here,' ” said Mr. 
Aguilera, who failed the test in 2001. “They washed us away, without any 
kind of helping hand.”

The complete dependence on the industry, whatever the risks may be, is 
stark. Glassy-eyed men are convinced that something in the water or the 
fields made them sick. Yet they are desperate to return to work, 
borrowing their wives’ and sisters’ identity numbers in a furtive 
attempt to stay employed. In one neighborhood, even conservative studies 
show that one in three men have the illness.

“The sugar mill said that all of this is part of nature. But this isn’t 
nature,” said Gilma Urbina, 37, a mother of five who recently lost her 
husband to the disease.

“The day that my husband died, he died at 6 in the morning,” Ms. Urbina 
said. “Down the block, another one died at 2. The next day, three more 
died.” She added, “I think we’re going to end up without any people here.”

Radically different perceptions of the cause have stirred debate over 
who should cover the enormous costs of treating patients with the disease.

Mario Amador, general manager of Nicaragua’s National Committee of Sugar 
Producers, one of the groups financing the C.D.C. studies, said the 
sugar cane business in Nicaragua had quadrupled over the past 10 years 
into a $500-million-a-year industry, supplying everything from Coca-Cola 
to rum makers. But he said the annual kidney exams, which he called 
necessary to avoid putting sick workers at additional risk, had created 
the false impression that the mills were linked to the disease.

“I don’t think there’s any relationship between CKD and the sugar cane 
industry,” Mr. Amador said.

Executives at the San Antonio mill in Chichigalpa say they also take the 
annual test, but it is rare that they fail.

“We drink the water here, too,” said Álvaro Bermúdez Castillo, the 
mill’s administrative director, who has been working at the mill since 
the 1970s.

Lawmakers in El Salvador and Sri Lanka, where similar kidney problems 
have emerged, have moved to ban certain herbicides. But few of the 
researchers who are focusing on Nicaragua — the country with the highest 
death rate from the disease, according to the Pan American Health 
Organization — are willing to say the answer is that simple.

Agricultural chemicals alone, they say, do not explain why the disease 
has been detected in some Nicaraguan miners at similar rates, why women 
who grew up on the sugar mill’s grounds have generally been unscathed, 
or why workers here are affected at much higher rates than people 
exposed to the same chemicals elsewhere. Perhaps extreme heat, 
dehydration, the intensity of the labor or other factors play a role, 
the researchers say.

“The problem is, this is a silent killer,” said Aurora Aragón, a 
Nicaraguan researcher.

Residents say they began noticing the sickness shortly after the 
Nicaraguan government, which had nationalized the sugar industry, 
returned the mills to private owners in 1992. As the operations at San 
Antonio rapidly expanded, driven partly by American and European 
appetites for sugar and a move into ethanol production, families say the 
cane cutters — many of whom had been born in a hospital on the mill 
grounds and went to a school there — grew sick in larger numbers.

The mill says it pays the government every year so that workers can 
receive pensions and health insurance. Without a scientifically decisive 
link to the disease, industry officials question why they should be 
responsible for more.

Throughout the early 2000s, lawsuits seeking compensation from the mill 
mostly went nowhere. Then in 2008, a workers’ group known as the 
Association of Chichigalpinos for Life filed the complaint against the 
World Bank’s lending arm, known as the International Finance 
Corporation, which had lent the mill $55 million. The complaint alleged 
that by failing to acknowledge the disease in documentation about the 
project, it had violated its own lending standards.

When deciding whether to invest in the industry, no one had brought up 
or looked into the disease, a spokesman for the finance corporation said.

“CKD is not a common disease in the sugar sector worldwide, so I.F.C. 
did not look into this issue at appraisal,” said the spokesman, Aaron 
Rosenberg, based in Washington. The institution has lent more than $100 
million to Nicaraguan sugar mills over the past decade.

After the complaint, the mill agreed to provide food and other 
assistance to widows and sick workers. It also agreed to open its door 
to a team of outside researchers.

Yet “nature can be very reluctant to give up its secrets,” said Daniel 
Brooks, a researcher from Boston University, which was selected to 
investigate the disease by a committee that included mill executives and 
sick workers.

Five years later, Dr. Brooks has as many questions about the disease as 
answers. His report published in 2012 neither entirely ruled out nor 
formally endorsed any theory.

Now, Dr. Brooks and his team from Boston University will be leading the 
charge in three C.D.C. Foundation studies, which he believes could have 
implications far beyond Nicaragua.

“We don’t know if this is the tip of the iceberg yet,” he said. “If this 
is heat stress and the climate is changing in the direction of getting 
hotter over time, are we seeing something that will happen much more in 
the future and maybe extend its geographic range?”

“Similarly, if it’s agrochemicals, the agrochemicals they use are very 
widespread across the whole world,” he added.

For now his team is more focused on two other areas: whether the disease 
has a genetic component and its presence in children. Research into 
work-related risk factors is also planned, but sugar industry funding so 
far covers only preliminary work. The C.D.C. says that numerous measures 
are in place to protect the research from undue influence. Some others 
are suspicious.

“If your main concern is limiting liability, you are never going to get 
to the bottom of what is causing this,” said Jason Glaser, president of 
La Isla Foundation, an organization focused on the disease in Nicaragua.

On a recent afternoon, Mr. Aguilera was feeling well enough to take 
careful steps toward the graves of his two brothers and father, all 
victims of the disease. He was thrown off by all the new mounds of earth 
that had appeared — at least 30 over the past few months.

“I will be buried over there,” he said calmly, pointing to a plot nearby.

He died three weeks later.

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