The Mysterious Disease Affecting Sugarcane Communities in Nicaragua

The British called it white gold: Sugar. Sugar is so important that entire populations are centered around it! Take for example Sugarland, Texas (near my lovely hometown of Houston), which arose as a company town around Imperial Sugar’s business in 1906.



Chichigalpa, Nicaragua is another one of those communities. One of the barrios, or neighborhoods, is named after the first and principal sugar mill in Chichigalpa: Ingenio San Antonio.


Sugarcane productivity is high in Chichigalpa, Chinandega, Nicaragua; It is also home to Ingenio San Antonio, a prominent sugar mill in the area. Gloria Giron/ La Prensa Nicaragua.


The tenants that previously lived in the mill’s acquired land were moved to another barrio, La Candelaria, which the mill bought to relocate the tenants in 1999. Victor Sevilla, former mayor of Chichigalpa, said, “Let’s put it this way: Chichigalpa originally had 174 acres. The amount of land that the mill bought for the tenants was, at first, 104 acres. But they got to buy 174. So Chichigalpa practically doubled when they founded La Candelaria.”

La Isla is another agricultural community in Chichigalpa that  lives in this sugarcane company town reality. In recent years, however, a mysterious string of deaths among its young, male sugarcane workers earned it the name La Isla de las Viudas, or The Island of the Widows.


Pedro Amador, a resident of La Isla, demonstrates with his hands how only a sidewalk separates his home from the sugarcane fields in Chichigalpa. Gloria Giron/ La Prensa Nicaragua.


Pedro’s wife collects water from a well in front of their house. This is their only access to water, and they have no control over the water’s quality. Gloria Giron/ La Prensa Nicaragua.


Along the Pacific coast of Central America, young, working class men in their 20s and 30s (typically but not limited to sugarcane workers) are dying of a mysterious, end-stage disease of the kidneys. The disease was first reported in the 1990s, and from 2005-2015, nearly 24,000 men died in this region, mainly El Salvador, Nicaragua, and Guatemala. Since then a few details of the disease have been discovered.

Firstly, the etiology, or cause, of the disease is unknown. Secondly, the disease is clinically silent, or not showing any symptoms, until the late stages of kidney failure. Thirdly, laborers often lack illnesses that would explain kidney failure such as hypertension or diabetes. Due to these reasons, the disease has been named Chronic Kidney Disease of unknown etiology (CKDu), among other names (insuficiencia renal cronica, as it is called in Nicaragua).

CKDu has a high prevalence of cases in the agricultural communities of Central America and South Asia, as well as a lesser amount of cases in Africa and the Middle East. Proposed causes of the disease include pesticides and agrochemicals, contaminated water, inflammation, and infections. The geographic distribution of cases of the disease, however, has led some researchers to attribute heat and dehydration as a primary cause of the disease. Nonetheless, the bottom line is that there is not enough concrete evidence to pinpoint a cause yet.


Workers harvesting sugarcane in Chichigalpa, Nicaragua. Jason Beaubien/NPR


In 2015, sugarcane workers in Chichigalpa started to demand healthcare assistance and answers after more and more workers started dying of CKDu. In response, Grupo Pellas, proprietor of Ingenio San Antonio and producer of Flor de Caña rum, offered to aid families that have lost family members to CKDu in the form of food vouchers and money. They did not respond to the principal demands of their workers, however.


The Sandinista government stayed silent on this matter, and to this day no extensive government action has been taken against CKDu. Critics say that Sandinista President, Daniel Ortega, need(ed) the sugar barons’ support to stay in power, and in February 2015, The Guardian reported this: “The exploitation of Nicaragua’s landless rural poor by a handful of wealthy families working with US agribusinesses was one cause of the 1979 uprising against the dictator Anastasio Somoza. The country is now ruled by a former Sandinista revolutionary, President Daniel Ortega, and he faces accusations of abandoning the country’s campesinos in pursuit of a political pact with big business.” The World Bank also came under fire for financing sugar businesses for the ends of producing more bioethanol fuel from sugarcane and meeting export quotas. In the face of the CKDu epidemic, they also reportedly funded Dr. Brooks research group.


Ingenio San Antonio in Chichigalpa, Nicaragua. In 2017, it received the first Bonsucro award for sustainability of any mill in the country. Image courtesy of Bonsucro.


Mario Amador, director of the National Committee for Sugar Producers in Nicaragua (CNPA), suspected bad intentions against sugar mills amid the 2015 demands by the campesino working class. “They are entirely wrong,” says Amador, “Anyone can go and see the conditions in which the cañeros work in any sugar mill in Nicaragua. We have been recognized among Central America for having the best working conditions. There are mobile clinics, hydration stations…” In addition to hydration stations, some workers in San Antonio mill are being encouraged to drink hydrating fluids created on company grounds. A factory technician described the drinks as, “Gatorade but with more sugar for extra energy.”



Two workers in the sugarcane fields. The worker on the right is holding bags of the hydrating fluid produced on factory grounds. Meridith Kohut/ NYT.There is no doubt that more work needs to be put in to save the lives of the young workers dying from CKDu. Additionally, more work needs to be put into giving Chichigalpans, and everyone in Nicaragua, access to clean drinking water. If excess heat and stress are causing sugarcane cutters to overwork their kidneys, then hydration is of utmost importance. Perceptions around drinking water may present a barrier in saving the lives of these individuals. A study conducted in 2013 showed that workers with CKDu may be reluctant to hydrate because of perceptions around the presence of contaminants like heavy metals and pesticides in drinking water. In fact, Chichigalpans in general express worry over the presence of contaminants and chemicals in their environment. In March 2014, NPR interviewed Manuel Antonio Tejarino, who had to stop working as a sugarcane cutter after he got CKDu. When asked about the cause of his kidney failure he said, “It’s the chemicals, the chemicals.” Two months later, he lost the battle against CKDu.


Manuel Antonio Tejarino, a sugarcane cutter from Chichigalpa who lost his battle against CKDu in May 2014


The mystery and suffering surrounding CKDu has inspired researchers like Neal Pearce from the London School of Hygiene and Tropical Medicine to advocate for awareness around the disease and its affected communities. In Pearce’s 2019 article in Kidney International Reports, he highlights the lack of research around the disease and the lack of access to healthcare by those people affected by the disease. In light of scant data and healthcare inaccessibility, Pearce and other co-collaborators around the world established an international initiative to remedy these problems surrounding CKDu: the disadvantaged populations estimated glomerular filtration rate epidemiology study (DEGREE). DEGREE came out in 2017 and aims to create a standardized test for diagnosing CKDu. A press release from the DEGREE website shows that the initiative received funding from the U.K. Medical Research Council Foundation.

Dr. Daniel Brooks from Boston University’s School of Public Health is leader of the Research Group for the Study of Chronic Kidney Disease in Central America; Many of the group’s studies are conducted in Nicaragua. Dr. Brooks says that, “Heat stress is a contributing factor, probably in combination with one or more occupation or non-occupational factors.” In response to the various studies put forth by Dr. Brooks and his team, El Pais Internacional reported in 2015 that, “… the pieces of evidence from Boston University back up what rights sugarcane workers, sick with CKDu, have demanded from sugar barons and political authorities.”

Grassroots NGOs have also taken charge in defending the most vulnerable communities from CKDu. For example, when sugarcane workers from the capital city Managua were protesting for their rights, the Nicaraguan Association for those Affected by Chronic Kidney Disease (ANAIRC) set up a permanent camp for them in Managua so that they could turn their presence in the issue into a permanent one. As a result of the protestor’s visibility, Eat United, another organization, found out about the community and has operated a rescued food-sharing service in the community since 2014.


The permanent camp of ex-sugarcane workers in Managua. Eat United has collaborated with this community in providing them with food since 2014. Courtesy Eat United.


Last, but certainly not least, La Isla Network (LIN) is another organization that aims to generate independent evidence to find out the cause of CKDu. They plan to use the evidence to find a cure and fight for sugarcane workers’ rights. The Worker Health and Efficiency Project, or WE, is an example of one of their initiatives; It promotes adequate hydration, rest, and shade for workers. You can find out more about WE here.

Dr. Brooks, in response to the challenges brought by CKDu, said, “Nature can be very reluctant to give up its secrets.” Yet, in the face of this challenge, we should unite behind the principle that anyone and everyone deserves treatment, no matter the circumstances.


Clinic in Chichigalpa. Gradual changes in the Nicaraguan health system have strengthened the treatment network for those with CKDu. Glenda Giron/ La Prensa Nicaragua.


For an in-depth look into CKDu, you can download an extensive report by the Pan American Health Organization and the World Health Organization here.

Alfredo Eladio Moreno | Pomona College
Alfredo is a second year student at Pomona College studying Latin American Studies. Although he has a profound background in medicine and chemistry, Alfredo hopes to nurture his knowledge of Latin America and the Caribbean, and possibly mix both disciplines. He seeks to combine his passion for history and advocacy by drawing on his natural talents of storytelling and helping people realize their full potential. As a Latin American Correspondent, Alfredo is not only excited to write compelling narratives and forge long-lasting friendships, but also inspired to create actionable change through non-profit work.