Mystery in the Fields

 Ramarao Laxminaraina, a 25-year-old rice farmer, receives dialysis treatment. Anna Barry-Jester

In India, verdant terrain conceals clues to a fatal kidney disease

By Sasha Chavkin

UDDANAM, India — A tangle of green blankets the land amid thick tropical heat. Shady groves of cashew trees strew the ground with juicy, perfume-scented fruits. Men can be seen climbing coconut palms to tap into the trunks for wine. The region’s name, Uddanam, comes from a word in Sanskrit that means “Beautiful Garden” or “Paradise.”

Uddanam’s rich terrain seems an unlikely place for the mysterious strain of illness tormenting the area. For more than a decade, a rash of chronic kidney disease has been striking down the villagers of this remote agricultural belt in the state of Andhra Pradesh, India. In some villages, the disease has impacted from 24 to 37 percent of the population, two to three times higher than elsewhere in the district, according to unpublished results from a study by Harvard Medical School.

As the death toll mounts, the seemingly idyllic region has become stigmatized. In contrast to Nicaragua’s “Island of the Widows,” which is named for the alarming rate of chronic kidney deaths among the community’s husbands, residents of Uddanam say they now have trouble getting married at all.

“Other people, they don’t want to come for marriage,” said Dr. Priya Prathibha, the state medical officer in the hard-hit village of Varaka. “They are not giving any bride or bridegroom to this area, this Uddanam area.”

Mystery in the Fields

Mihintale Dhammarakkita Thero, a monk in Sri Lanka, donated his kidney to a high school principal with kidney disease. Mystery in the Fields is a three-part series that explores in text, photos and video how a rare form of kidney disease is killing laborers and crippling communities in three different regions, from Central America to Sri Lanka to India. As the death tolls mount, researchers remain puzzled, unable to definitively uncover the disease’s causes. Anna Barry-Jester

In Sri Lanka, breakthroughs, setbacks and a spiritual touch

By Sasha Chavkin and Anna Barry-Jester

KEBITHIGOLLEWA, Sri Lanka — For two decades, chronic kidney disease has been a mystery and death sentence in Sri Lanka, striking 15 percent of the residents of its north central region.

This summer, after years of secretive official research, a glimmer of scientific hope emerged. The government and World Health Organization announced in June that they identified a key cause of the disease in Sri Lanka: chronic exposure to arsenic and cadmium, likely consumed in food.

Yet in a disease that has confounded experts across continents, even potential breakthroughs come with asterisks. The new report left huge questions unanswered — including where in the country the toxins were found, how they entered the food and what foods were contaminated. The key unsolved question: the extent fertilizers and pesticides contributed to the outbreak.

In Sri Lanka’s lush northern farmlands, the mystery and the death sentences continue. Lacking firm answers from the scientific community, some victims’ best hope for survival comes through the spiritual community — and offers of kidney transplants from Buddhist monks and those they inspire to make extraordinary sacrifices for strangers.

At 21, Sampath Kumarasinghe is among the victims awaiting that miracle.

The soft-spoken farmer was diagnosed last September with kidney damage so severe it had reached its terminal phase: end stage renal disease. Healthy his entire life, he suddenly became feverish and too sick to work in the rice paddies. His mother mortgaged their land to pay for his medical care, and they began the search for a kidney donor. One day, like a vision, a man appeared in his hospital offering to donate his kidney.

“I am only thinking of ways to save my son’s life,” said Sampath’s mother, Punchirilalage Dingiri Manike. “That is what I think of day and night.”

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Sasha Chavkin talks to NBC about mystery kidney disease

Visit NBCNews.com for breaking news, world news, and news about the economy

NBCnews.com interviewed journalist Sasha Chavkin about a mysterious kidney disease that's killing rural workers in Nicarauga. Chavkin traveled to Central America, India and Sri Lanka to write about the condition, those suffering from it and the doctors working to identify and treat it. Read Sasha Chavkin's stories in two Center for Public Integrity projects, The Island of the Widows and Mystery in the Fields.

Mystery in the Fields

Mihintale Dhammarakkita Thero, a monk in Sri Lanka, donated his kidney to a high school principal with kidney disease. Mystery in the Fields is a three-part series that explores in text, photos and video how a rare form of kidney disease is killing laborers and crippling communities in three different regions, from Central America to Sri Lanka to India. As the death tolls mount, researchers remain puzzled, unable to definitively uncover the disease’s causes. Anna Barry-Jester

In Sri Lanka, new steps target mysterious kidney disease

By Sasha Chavkin

The Sri Lankan government is vowing to impose tighter controls on pesticides and fertilizers amid growing concern the chemicals are helping fuel a mysterious epidemic of chronic kidney disease devastating its north central region.

In September, in Mystery in the Fields, the Center for Public Integrity explored how a rare form of chronic kidney disease is killing agricultural workers in Sri Lanka, India and Central America. Scientists in each region are struggling to identify the cause of these parallel epidemics, which have led to tens of thousands of deaths worldwide and are suspected to be linked to a toxic exposure.

In a November 2012 speech laying out a national budget proposal, Sri Lankan President Mahinda Rajapaksa pledged to take action to crack down on contaminated agrochemicals.

“There is a theory that pesticides and chemical fertilizer contribute to increase non-communicable diseases,” Rajapaksa said, referring in oblique terms to the politically controversial kidney epidemic. “Therefore, regulations will be formulated to require suppliers and distributors of all agrochemicals to comply with quality standards.”

A committee of government ministers is meeting with scientific experts and interest groups and will submit a report to the cabinet with recommendations for the regulations, said Sri Lanka’s Registrar of Pesticides, Dr. Anura Wijesekera. 

Wijesekara, whose office oversees imports and permitting of agrochemicals, said Sri Lanka had already taken a significant step earlier this year: establishing limits of detection for nine toxins including cadmium and arsenic. Pesticides and fertilizers containing more than the permitted amounts of these chemicals are prohibited from distribution.

Mystery in the Fields

Slideshow: Mystery in India

 

Along the coast of northern Andhra Pradesh, a mysterious epidemic of chronic kidney disease has affected the region for the last two decades.

Anna Barry-Jester

 

The northern coast of Andhra Pradesh is suffering from a mysterious form of chronic kidney disease. The region’s name, Uddanam, comes from a word in Sanskrit that means “Beautiful Garden” or “Paradise.”

Anna Barry-Jester

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Siva Bendalam feeds a cow in his village in Varaka, Andhra Pradesh. “So many people are leaving,” said Siva, who helps support his family since the death of his father and uncle in 2007. “If the disease continues, no one will be here.”

Anna Barry-Jester

 

According to unpublished results from a Harvard University study, chronic kidney disease affects 24 to 37 percent of the population in some villages in Uddanam, 2 to 3 times higher than other parts of the district.

Anna Barry-Jester

 

Women collect water from a bore well in Varaka, Andhra Pradesh, India. Water is widely suspected as the cause for the epidemic, due to the strange geographic patterns and the particular form of CKD, which is likely caused by a toxic exposure.

Anna Barry-Jester

 

A long line of patients wait to see a doctor at King George Hospital in Vizag, India, during a twice weekly nephrology clinic at the hospital. Vizag is the closest hospital with a nephrologist for people with a mysterious form of chronic kidney disease in the Uddanam region of Andhra Pradesh.

Anna Barry-Jester

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A crowd of patients and family members wait to be seen at the nephrology clinic at the public King George Hospital in Vizag.

Anna Barry-Jester

 

Dr. Sasidhar Goriparthi, a nephrology fellow at King George Hospital in Vizag, India, talks to patients waiting in line for care in the hospital's nephrology ward. Patients travel from all over the state to be seen in Vizag as there are very few, if any, nephrologists available in rural areas.

Anna Barry-Jester

 

The Aarogyasri card of Savara Jayamma Balakrishna, 38. Aarogyasri is an insurance plan in the state of Andhra Pradesh that pays the insurance premiums for citizens below the poverty line.

Anna Barry-Jester

A man and woman receive dialysis at the  Rajiv Gandhi Institute of Medical Sciences in the Srikakulam District of Andhra Pradesh. As part of a public-private partnership with the state, the newly opened dialysis ward is run by a private company. The state has had difficulty finding a nephrologist willing to live in the area to manage the ward.

Anna Barry-Jester

 

Ramarao Laxminaraina, a 25-year-old rice farmer, receives dialysis treatment.

Anna Barry-Jester

 

Prameela Bendalam lost her husband to chronic kidney disease in 2007. "I borrowed money thinking that he would survive, but he died, and now the loans have to be paid back as well," she said.

Anna Barry-Jester

Residents of Uddanam celebrate a festival for the goddess Asiripolamma, said to protect three of the villages in the area. Unlike similar epidemics in Sri Lanka and Central America, this mysterious form of chronic kidney disease in India affects men and women equally, according to separate research by Harvard and Stony Brook Universities.

 

Anna Barry-Jester

Mystery in the Fields

Stories from our partner

Our story on Chronic Kidney disease in Sri Lanka was reported in conjunction with PRI’s The World. Listen to Rhitu Chatterjee's story.

Mystery in the Fields

Slideshow: Mystery in Sri Lanka

By Anna Barry-Jester

Men walk through rice paddies after morning's work near Anuradhapura, Sri Lanka. In Sri Lanka, people with CKDu are predominantly male agricultural workers living in an area known as the "rice bowl."

Anna Barry-Jester

Sampath Kumarasinghe's aunt sweeps dirt outside their home near Kebithigollewa, Sri Lanka.

Anna Barry-Jester

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A farmer tills his rice paddy in Padaviya, Sri Lanka.

Anna Barry-Jester

21-year-old Sampath Kumarasinghe relaxes with family outside his home near Kebitigollewa, Sri Lanka. Sampath has the most advanced form of CKDu, end-stage renal disease. He is slated to have a kidney transplant in the next few weeks, one of the first transplants to take place at Anuradhapura General Hospital.

Anna Barry-Jester

Nurses talk in the dialysis ward of Anuradhapura General Hospital.

Anna Barry-Jester

Sampath Kumarasinghe discusses the next steps towards getting a kidney transplant with nephrologist Rajeewa Dissanayake at Anuradhapura General Hospital, Sri Lanka. The 21-year-old rice farmer has end-stage renal disease.

Anna Barry-Jester

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Sampath Kumarasinghe talks to Ajantha, a potential kidney donor, while undergoing dialysis treatment at Anuradhapura General Hospital, Sri Lanka.

Anna Barry-Jester

Mihintale Dhammarakkita Thero, a Buddhist monk, and high school principal G Gunasena sit outside the educator's home near Kebithigollewa, Sri Lanka. The monk donated a kidney to the principal, who suffers from CKDu.

Anna Barry-Jester

Mihintale Dhammarakkita Thero, a monk in Sri Lanka, donated his kidney to a high school principal with kidney disease. Mystery in the Fields is a three-part series that explores in text, photos and video how a rare form of kidney disease is killing laborers and crippling communities in three different regions, from Central America to Sri Lanka to India. As the death tolls mount, researchers remain puzzled, unable to definitively uncover the disease’s causes.

Anna Barry-Jester

Mihintale Dhammarakkita Thero (center), a monk in one of the regions of Sri Lanka most affected by CKD, donated his kidney to a high school principal with the disease.

Anna Barry-Jester

Buddhists visit the Temple of the Tooth in Kandy, Sri Lanka on Vesak, the anniversary of the day the Buddha attained enlightenment, one of the most auspicious days for Buddhists.

Anna Barry-Jester

Doctors replace a catheter inserted into the neck of Sampath Kumarasinghe. The tube facilitates his twice-weekly dialysis

Anna Barry-Jester

A rice farmer and his daughter outside their paddy fields in Anuradhapura, Sri Lanka.

Anna Barry-Jester

Sampath Kumarasinghe's grandmother cooks by candlelight in their home near Kebitigollewa, Sri Lanka.

Anna Barry-Jester

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Writers and editors

Sasha Chavkin

International Consortium of Investigative Journalists

Ronnie Greene

Senior Reporter The Center for Public Integrity

Greene joined the Center in 2011 after serving as The Miami Herald’s investigations and government editor.... More about Ronnie Greene