Thousands of Sugarcane Workers Die While Authorities Stall

In most of the world, chronic kidney disease - CKD - is a manageable illness that primarily affects the elderly. But in Central America the condition is instead devastating whole communities, according to a new investigation by the International Consortium of Investigative Journalists.

Between 2005 and 2009, about 2,800 people have died each year - mostly men and most manual laborers in harsh sugarcane fields of El Salvador, Nicaragua and Costa Rica - according to an ICIJ analysis of global health data behind the Island of the Widows investigation.

As the death toll rises, those in a position to fight the disease - the region's sugar industry, wealthier nations such as the U.S., and international development agencies - have largely resisted pleas to take action.

What triggers CKD remains a mystery - researchers suspect exposure to toxins. There is strong evidence, however, that a key factor in the disease's development is dehydration and heat stress. Workers toil until they suffer severe dehydration or collapse, damaging their kidneys.

"In the 21^st Century, nobody should die of kidney disease," says Ramon Trabanino, a doctor in El Salvador who has studied CKD for a decade.

Among the key findings in Island of the Widows:

* Internal studies by one of Central America's largest sugar plantations show that the company has long had evidence of an epidemic tied to working conditions, yet some of its employees continue to be exposed to severe heat stress and dehydration.

* Those with the resources to help solve the mystery - wealthier nations such as the U.S. and Canada, as well as international development agencies - beat back recent efforts by Central American nations to boost the disease's profile among global public health officials and the United Nations.

* The World Bank issued two loans totaling more than $100 million to Nicaragua's sugar industry during the height of the epidemic without formal consideration of kidney disease. After workers protested, it agreed to provide $1 million to sponsor Boston University's ongoing study.

Island of the Widows will also air on Public Radio International's news show, The World, and in English and Spanish on the BBC World Service. The television partner is the Spanish-language Univision network. Print partners for this project include El Nuevo Herald of Miami, Hoy of Chicago, La Opinion of Los Angles and Al Dia of Dallas. In Latin America, publishing partners include the online newspapers El Faro in El Salvador and Semana in Nicaragua, and the daily newspaper La Nacion in Costa Rica.