The Island of Widows: Tracking A Mysterious Chronic Kidney Disease

Nicaragua, Sri Lanka, India, at the opposite side of the earth, shared one thing in common: the loss of young agricultural laborers due to an unknown chronic kidney disease, since the 1990s. Sasha Chavkin of the Center for Public Integrity found out the sad stories behind.

Sugarcane field in India (Credit: Sarangib/Pixabay)

Sasha Chavkin’s investigative story “Island of the Widows: Thousands of sugar cane workers die as wealthy nations stall on solutions” was named as one of the 100 Great Stories by the Columbia Journalism School Centennial. Backed by Kickstarter crowdfunding, Chavkin went on a global investigation in Central America and South Asia to discover how a mysterious chronic kidney disease, that scientists are scrambling to find a cure for, ate up the lives of young agricultural laborers in these regions.

When Chavkin was doing his master’s project about international human rights for his dual master’s degree in Journalism and International Affairs at Columbia University, he was interviewing a lawyer about one of her cases. At the end of a conversation, the lawyer mentioned that she would not be available the following week because she would be in Nicaragua for a case regarding tens of thousands of sugar cane workers who were dying because of an unknown disease. It caught his attention immediately, and he knew there would be a story.

Chavkin spent one week in Nicaragua in 2010 and another six weeks in Central America in 2011. He talked to local communities, non-profit organizations and patients who were suffering from the disease. The more local people he talked to, the more he realized how severe the epidemic was. “Tens of thousands of poor agricultural workers have died because of it,” he said. “But there was nothing they could do.”

He researched medical information to understand the difference between this Unknown Chronic Kidney Disease (CKDu) and Common Chronic Kidney Disease (CKD) that usually occurs among older people with diabetes or overweight individuals.

One possible explanation Chavkin obtained came from his interview with an internal doctor at the sugarcane plantation, Ingenio San Antonio. During the meeting, the plantation CEO stepped in the room and said to Chavkin: “You graduated from Columbia University. It’s a legitimate university.” He then turned to the doctor, asking him to share his research work about the disease.

Chavkin sensed the CEO’s willingness to talk, so he expressed how deeply he understood the issue even from a medical perspective and seized the chance to interview him. In the end, the doctor showed Chavkin all his research throughout the years which pointed out that the cause might be dehydration and heat stress.

“It was a strange meeting,” Chavkin said. “But the irony is, in retrospect, dehydration and heat stress should be entirely preventable.”

Starting from there, Chavkin turned to more private organizations as well as doctors from different institutions and government officials.

More stories behind it emerged.

Chavkin soon realized while doctors from different institutions had been working on the issue, there wasn’t much academic collaboration among them, making medical research progress slow. Doctors also shared that similar cases happened in South Asian countries like Sri Lanka and India. Meanwhile, private companies like Ingenio San Antonio hired agencies to recruit local laborers as outside contractors who were not entitled to medical care compensation or pensions. “It was all just about the sugarcane business,” Chavkin said.

The sugar-exporting industry in Central America led to questions about the involvement of different countries in the trade — a leading one being the United States. Through open resources and Wikileaks, Chavkin discovered that the United Nation’s promotion of biofuel had boosted the cane industry. He also discovered that U.S. delegates refused to include the disease on the list of the continent’s most serious chronic illnesses in order not to obstruct the supply.

The result? Plantations received more money to expand, sending more contractors to sugarcane fields while their working conditions remained as strenuous as before.

The understanding of a bigger picture shaped Chavkin’s story angle to focus on not just the patients who suffered from the disease, but also how the society has been reacting to the issue. “The purpose of our story aimed to raise the awareness and to draw a global attention so that there could be a better global collaboration and governmental resolution,” Chavkin said.

On the other hand, he also encountered difficulties as the Nicaraguan government declined an interview request. He heard people claim that the government had a deal with the Pellas Group, the biggest conglomerate in Nicaragua that largely controlled the sugarcane industry. However, with no access to Nicaraguan officials, he was not able to prove such a claim.

With all the information Chavkin had found out, his story needed a main character. “A human story is crucial,” he said. “These poor and suffering agricultural workers deserve the same attention as those successful company CEOs.”

When he was in Nicaragua, Chavkin was introduced to Maudiel Martinez, who would be his main profile in the story, through a local non-profit organization, La Isla Foundation. Martinez was diagonalized with CKDu when he was 19 years old. After his diagnosis, he kept on working in the sugarcane field to support his family but could only be hired as a contractor with no medical care coverage.

“It was awfully shocking,” Chavkin said. “He was an amazingly hardworking and kind kid. Too kind to be real. If he were born in New York City, he could get into Harvard.” Chavkin also observed and tracked the vehicle that picked up contract workers like Martinez and marked the time they took off and returned. He found out they worked for around 12 hours a day under extremely strenuous weather.

Martinez was a typical case in Nicaragua: a hardworking young man who got the disease while still working in the sugarcane field to support his family until he was too sick to work. After that, he, like many others, had no choice but to wait for the kidney disease to end his life.

Following the publishing of “Island of the Widows,” Chavkin went to Sri Lanka and India in 2012 for a series of follow-up stories since his initial research in Nicaragua indicated a possibility that the epidemics in all three regions were connected.

The stories were also published by different partners to maximize the impact including the British Broadcasting Corporation and the Nicaraguan local press.

Chavkin said the most depressing thing about his reporting experience was to find out “how incredibly hard it is to get government attention and industry recognition and have them do something about it.”

He finally added, “They just took these tens of thousands of young people as expendables.”