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A. LE FLOCH
LA ISLA, Nicaragua – Ursula Tobal knows the names of almost all the 20 widows who live on this tiny islet between two narrow streams, and almost all the orphaned children who play in the dusty fields.
The 40-year-old Tobal became a widow herself in late 2005 when her husband, Luis Abraham Martínez, a cane cutter at the nearby San Antonio sugar mill, died of the same disease that has earned this islet the nickname of Island of the Widows.
‘’My life has been very hard,'’ said Tobal, who was left with 10 children and a social security payment of $74 a month. ‘There have been times when I’ve had to put my children to bed telling them, `If you sleep, you won’t feel hungry.’ ‘’
The widows are just part of the human tragedy being wreaked in the Chichigalpa region of northwestern Nicaragua by chronic renal insufficiency (CRI), an illness whose cause remains a mystery.
Nearly 2,000 current and former employees of two nearby sugar mills in the surrounding Chichigalpa region now suffer from CRI, according to Nicaraguan government figures. A workers group puts the death toll at more than 560 employees of one of the mills alone over about 30 years.
There is broad agreement that the region has an unusually high number of reported CRI cases. But both the government and the mills acknowledge that no study has ever pointed to the reasons behind the high incidence of CRI in the region. Maybe it’s in the genes, one mill doctor says, or in the heavy metals spewed by the nearby San Cristóbal volcano.
But to many people in this area, the cause is in the chemicals used in sugar-cane fields at the San Antonio and Monte Rosa mills, which produce most of Nicaragua’s sugar exported to the United States. The mills flatly deny that they are responsible, and workers who have sued the mills have presented no scientific evidence.
Whatever the cause or causes of the CRI, Chichigalpa, a town of about 62,000 people some 75 miles northwest of Managua, and neighboring villages like La Isla, had the air of a doomed region during a visit last month by El Nuevo Herald.
La Isla, a hamlet of about 80 mud and sometimes brick houses, has 20 widows, said resident and widow Marta Yesca. The district that encompasses La Isla, Guanacastal Sur, has 63 widows and about 300 houses.
MOBILITY LOST
Former mill and sugar-cane-field workers, dismissed when their kidneys showed signs of failing, now walk the streets aimlessly or sit on stools outside their homes. They cannot work, because they become exhausted within minutes.
‘’His agony was awful,'’ Tobal said of her husband. “He couldn’t walk. That sickness takes away people’s strength, affects their eyesight, bursts their innards, mouths and skin, and they vomit blood.'’
All the victims can do is take calcium tablets to compensate for the loss of that element as a result of the kidney malfunction, and slow their deterioration.
But in the end, they can no longer stand, and they just lie in bed. Their bodies are swollen, their breathing labored. They sip Gatorade to keep hydrated. And they wait for death.
The figure of 2,000 people afflicted with CRI comes from Dr. Edwin Reyes, a kidney specialist with the Nicaraguan Ministry of Health and an authority on CRI who has been watching the Chichigalpa situation for the last 10 years. When he began to count CRI cases in Chichigalpa in 2004, he said, there were 800.
The national government now runs a special CRI unit at the Julio Durán Zamora Health Center, a government clinic in the town of Chichigalpa.
But Reyes conceded that neither the government nor the mills have carried out any studies on the causes of CRI. Asked why, he simply said, “I don’t understand why not.'’
The number of victims is so high that three years ago, local residents pressured Nicaragua’s national legislature to pass a law defining CRI as an ‘’occupational disease'’ – allowing its victims to collect government disability payments.
Many of the affected people worked for San Antonio, a 117-year-old mill that produces 80 percent of Nicaragua’s sugar exports to the United States. It is owned by the Pellas family, the country’s richest. The family also owns BAC Credomatic Network, a financial network that includes the BAC Florida Bank in Coral Gables.
Alvaro Bermúdez, managing director of the San Antonio mill, said the company has done everything possible to investigate the causes of CRI. It offered to cooperate with the Nicaraguan government over the past decade to investigate the causes, but ‘’nothing came out of it,'’ he said.
AN ISSUE OF FAULT
San Antonio also contacted foreign universities to help with the scientific research, Bermúdez said. But the universities require Nicaraguan government support for such studies, and authorities in Managua have not cooperated because of what Bermúdez called official bureaucracy.
‘’There is a real problem, there is a real epidemic, there is a disease that is very sad and very difficult, and there is a company that wants to help,'’ Bermúdez said. “But it turns out that . . . now people say the company may be at fault. Then we won’t solve this, because the company is not at fault.'’
San Antonio nevertheless should have some responsibilities, said Juan Salgado, who worked for the mill for 31 years, now suffers from CRI, and heads the Chichigalpa Pro-life Association, a group of former mill employees who have sued for indemnification. He said San Antonio began required testing of its workers in the late 1990s and dismisses any who show signs of kidney malfunction.
‘’We worked for them our whole lives, and they threw us out on the street when they discovered we were sick – the way the Romans did with their slaves after they were no longer useful,'’ Salgado said.
But the problem is not just unemployment. It’s the possibility of death.
At least 563 people who worked at San Antonio have died of kidney disease since 1978, according to María Eugenia Cantillano of the Global Nica Foundation, a group created to defend workers’ rights throughout Nicaragua. Her records included dozens of death certificates listing the cause of death as “chronic renal insufficiency.'’
Dr. Alejandro Marín, director of a hospital run by San Antonio for workers and relatives, told El Nuevo Herald that 200 current employees have been found to have abnormally high levels of creatinine in their blood – a substance that signals kidney malfunction. He acknowledged that the company dismisses workers who come down with CRI, saying they are no longer strong enough to work. The company does not pay them for disability, he said, but they qualify for government aid.
About 1,100 workers filed three lawsuits over the last two years against the two mills, alleging negligent use of chemicals in the cane fields. Those lawsuits have not reached the stage where evidence has to be submitted.
In another lawsuit filed earlier by about 1,100 workers, the San Antonio mill agreed to an out-of-court settlement in which the company denied any responsibility for CRI but agreed to make ‘’humanitarian payments'’ totaling more than $2 million to victims.
Adrián Mesa, the lawyer who represented the plaintiffs in the earlier cases, said the lawsuits reached a point where the plaintiffs could not prove that the chemicals were the cause of the disease, and the mills could not prove the opposite.
‘’We said, let’s not talk about who is guilty. Let’s look at this as a humanitarian issue, because what our clients need is money to cope with their disease,'’ Mesa said.
Sacarías Chávez, one of the plaintiffs’ lawyers in the more recent lawsuits, alleged in court papers that CRI is caused ‘’by being in contact – directly or indirectly and without any protection – with chemical agents'’ used in the cane fields. But the lawsuit cites no scientific evidence for that link.
A list of eight chemicals identified by a San Antonio legal advisor and workers was sent by El Nuevo Herald to Chen-sheng Lu, a professor at the Environmental and Occupational Health Department of the Public Health School at Emory University in Atlanta.
‘’None of the herbicides that are being used by the sugar-cane farmers would raise any red flag for health effects that the farmers are experiencing,'’ Lu wrote in an e-mailed reply. He speculated, however, that perhaps CRI might be the result of the “interaction of different herbicides.'’
Bermúdez, the San Antonio director, noted that while it’s easy to assume a link between CRI and the mill because most of the workers affected worked for the mill, in fact most of the region’s residents work or worked for the mills – one of the few sources of jobs in this region.
‘’Everyone who gets sick has in some way been linked to the San Antonio mill, not because we are the causers of the illness but because we’re in the area where the problem exists,'’ Bermúdez said.
Felix Celaya Rivas, a physician who works at San Antonio’s hospital, argued that while both men and women work at the mill and the cane fields, few women have been stricken with CRI.
Celaya also said CRI has been reported in other parts of Nicaragua not related to sugar-cane fields.
Reyes, the government’s kidney specialist, said high incidences of CRI have also been found in three other sugar mills around Nicaragua, as well as some nonsugar agricultural areas. He added that smaller outbreaks of CRI have been reported among sugar-industry workers in neighboring El Salvador.
Celaya, in an interview with El Nuevo Herald, raised several other possibilities for the cause of CRI.
The indigenous people of Central America – most Central Americans are descended from a mix of indigenous people and Europeans – might have a genetic vulnerability to kidney disease, Reyes said.
The metals that spew from the volcanoes, homemade alcohol or malnutrition also could cause CRI, he added.
While the cause of CRI remains a mystery, its impact on the people around Chichigalpa has been harsh.
In the town of Chichigalpa, Hermógenes Martínez – father of eight, evangelical pastor and San Antonio employee for decades – died last month of CRI.
He had been one of the CRI victims who received humanitarian aid from San Antonio – about $850, the equivalent of 16 months of the minimum monthly salary as set by the government at the time of the payment. Cane cutters make an average of about $1.80 a day.
Martínez’s widow, Cándida Reyes, said two of their children now have CRI: Henry, 34, and Liliana, 35. Her younger brother, who also worked for the mill, died of CRI, and another brother is in a wheelchair with CRI. Four other half-siblings also have the disease, she added.
The situation is pretty much the same at the Monte Rosa mill, where about 300 former workers who claim they were fired after company-required blood tests showed that their kidneys were failing have been protesting near the mill’s main gate for months to demand indemnification.
The mill was bought in 2000 by Pantaleón, a powerful Guatemalan business group.
When Verónica Medrano, one of the women who hope to get compensation, became a widow four years ago, she was left with a shack and 11 children. Her husband, Juan Senón Bartodano, a cane cutter at Monte Rosa, was felled by kidney disease and received no indemnification, she said.
In La Isla, Ursula Tobal’s son Nelson Moisés Martínez said that he began to cut cane at 14, and started to feel sick at 20. Now 24, he says his last checkup showed a creatinine level nearly eight times higher than normal.
He would like to work to help his widowed mother, he says, but he can’t. He cracked a morbid joke about the guanacaste trees that cover the Chichigalpa cemetery.
‘’If I work, I die more quickly,'’ he said, laughing a bit. “I’ll go faster to the guanacastes .'’