LA ISLA, Nicaragua — Maudiel Martinez is 19 years old and has a shy smile, a tangle of curly black hair and a lean, muscular build shaped by years of work in the sugarcane fields. For most of his adolescence, he was healthy and strong and spent his days chopping tall stalks of cane with his machete.
Now Martinez is suffering from a deadly disease that is devastating his community along with scores of others in Central America, where it has decimated the ranks of sugarcane workers. The same illness killed his father and his grandfather and affects all three of his older brothers.
“This disease eats our kidneys from inside us,” Martinez said. “We don’t want to die, and we feel grief because we already know that we’re hopeless.”
Martinez’ illness stands at the heart of a lethal mystery — and legacy of neglect by industry and governments, including the United States, which have resisted pleas for aggressive action to spotlight the malady and find a remedy. Wealthier nations are more focused on spurring biofuels production in the region’s sugarcane industry and keeping up the heavy flow of sugar to U.S. consumers and food manufacturers than the plight of those who harvest it.
Little noticed by the rest of the world, chronic kidney disease (CKD) is cutting a swath through one of the world’s poorest populations, along a stretch of Central America’s Pacific Coast that spans six countries and nearly 700 miles. Its victims are manual laborers, mostly sugarcane workers.
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. In El Salvador, CKD is the second leading cause of death for men. In the province of Guanacaste, Costa Rica, the regional hospital had to start a home dialysis program because it was overwhelmed with so many CKD victims that it began running out of beds to treat patients with other ailments.
So many men have died in some parts of rural Nicaragua that Maudiel Martinez’s community, called The Island, now is known as the Island of the Widows — La Isla de las Viudas.
At first glance, the lush community bounded by vast sugarcane fields looks like many places in Latin America: children ride bicycles over dirt roads and play alongside dogs, pigs and chickens. But now there are few men in the front yards. Indoors, framed photographs of dead husbands, fathers and brothers adorn tables and countertops. No older men converge in small groups, trading gossip and news, as one often sees in communities farther inland from the Pacific coast.
Here, women struggle to make at least a little money doing odd jobs. Some are now in the sugar-cane fields they believe claimed their husbands.
“My children have suffered a lot,” said Paula Chevez Ruiz, a widow from La Isla whose husband Virgilio died in 2009, leaving her to support four children on her own. When she can find customers, she sells fruit and enchiladas. “It is sad to want to give to your children, but not to have anything. Sometimes not even enough to buy a bag of salt.”