Introduction

A truck full of sugarcane workers leaves the Nicaraguan plantation Ingenio San Antonio at the end of a day’s work. (Kate Sheehy and Sasha Chavkin)

A mysterious kidney disease that is afflicting Central American agricultural workers has been raising growing alarms among governments, and in April the region’s health ministers jointly declared that the ailment was among their top public health priorities.

Yet only weeks after the health ministers issued their declaration, the World Bank approved a new loan to expand a sugar plantation in Nicaragua, renewing its support for an industry whose workers have been devastated by the disease. The $15 million loan to the Montelimar plantation in Nicaragua is estimated to create 1,300 new rural jobs, according to World Bank documents.

Over the last two years, the International Consortium of Investigative Journalists has examined how a rare type of chronic kidney disease (CKD) is killing thousands of agricultural workers along Central America’s Pacific Coast, as well as in Sri Lanka and India. Scientists have yet to definitively uncover the cause of the parallel epidemics, which have caused tens of thousands of deaths worldwide and are suspected to be linked to dehydration and toxic exposure.

ICIJ’s initial report, Island of the Widows, focused on a leading Nicaraguan sugar plantation that received substantial loans in 2006 from the World Bank’s private sector lending arm, the International Finance Corporation. Sick former workers from the plantation filed a complaint to the IFC’s ombudsman alleging that the loan violated the Bank’s guidelines by failing to consider the epidemic. The complaint resulted in a recently concluded study of the epidemic’s causes by a team from Boston University, which found that there was still not enough evidence to get to the bottom of the mystery.

Now, for the first time since the controversy emerged, the World Bank has approved a new loan to another Central American sugar plantation within the affected region. In its environmental and social review of the loan, the IFC stated that there was no proof that the disease is linked to sugarcane work.

“Disease epidemiology and an alleged connection between sugar industries in general have previously been investigated through studies requested by the IFC Compliance Advisor Ombudsman,” stated the IFC’s review documents, referring to the Boston University study. “No direct relationship between the sugar sector and the disease has been established.”

It’s an interpretation that Daniel Brooks, the lead scientist for the Boston University team, said is technically accurate. But it’s quite different from how Brooks characterized his findings, which included a study of workers over the course of one six-month harvest season that found that laborers in more physically strenuous jobs were suffering significant levels of kidney damage.

“What I wouldn’t say there is that there’s no direct link and what I wouldn’t say is that the evidence is most consistent with no link,” Brooks said. “It’s pretty much the consensus of researchers in the region that heat stress and these occupational exposures are most likely to be playing a role.”

The declaration adopted by Central America’s Council of Health Ministers in April sounded a similar note. The agreement stated that the disease “predominates among young men, and has been associated with conditions including toxic environmental and occupational risk factors, dehydration, and habits that are damaging to renal health.”

The World Bank’s review process for this year’s loan, which was approved in May and signed in June, also had significant differences from its review of the initial 2006 loan. While its 2006 review did not address CKD at all, the review of the current loan to Montelimar describes the company’s preventive measures for protecting its workers from CKD. After the document states that there is no direct link between the sugar industry and the illness, it notes the hydration and worker education policies for CKD that Montelimar has put in place.

IFC spokeswoman Adriana Gomez said that as part of the Environment and Social Action Plan developed as a part of the loan, these preventive measures were formalized and incorporated into Montelimar’s management system.

“To this date, there is no definitive scientific answer to what the cause of CKD is, so all possible connections remain open to future research,” Gomez said. “Manual cane harvesters are performing physical work under hot weather conditions. Preventing dehydration is a key part of these workers occupational health and safety.”

The sugar industry is a major exporter in Nicaragua and elsewhere in Central America, and in some rural communities it is one of the only sources of employment. Earlier this month, Nicaragua’s National Commission of Sugar Producers confirmed that Nicaragua had entered an agreement to export 40,000 tons of sugar to the European Union.

As the mysterious kidney epidemic continues to afflict sugarcane workers and other agricultural laborers, the stakes will only continue to grow in determining whether it is related to their grueling labor in the fields.