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. In Nicaragua, they don’t come bigger than the Pellas Group, the conglomerate which owns ISA. Pellas companies also make the prizewinning dark rum Flor de Caña, and produce ethanol, a lucrative sugar cane byproduct used to make biofuels. The group’s CEO, Carlos Pellas – nicknamed the sugar king – is close to President Ortega, and was recently declared the country’s first billionaire.
Sugar accounts from about 5% of Nicaragua’s GDP. Exports of sugar and its byproducts were £160m in 2013 – with more than a third sold to the US. At least 20,000 people are estimated to have died of chronic kidney disease (CKD) in Central America in the past two decades – most of them sugar cane workers. CKD was first documented in Costa Rica in the 1970s, and has since been detected throughout Central America. In Nicaragua, the second-poorest country in the Americas after Haiti, CKD is officially recognised as an illness that can be caused by work. There is a growing scientific view that CKD is linked to harsh work conditions, particularly long hours exposed to sun without sufficient shade, rest and water. Dr Catharina Wesseling, an epidemiologist based at the Karolinska Institute in Sweden said that while other factors - such as pesticides, heavy metals and genetics – could also play a part, there was “absolutely no doubt” that CKD was an occupational disease. “It predominantly affects male workers exposed to excessive heat and dehydration – conditions which are most severe in the sugar cane industry,” she said.
Walter, 32, will soon become another statistic; his wife another CKD widow. For his first nine harvests, or zafras, Walter was contracted to work for Ingenio San Antonio (ISA), Nicaragua’s oldest and biggest sugar mill. Each year, before the harvest, a company doctor would test his blood, urine and blood pressure before declaring him fit for the backbreaking work of cutting cane with a machete in oppressive heat. But in 2012, his blood test showed the first signs of kidney dysfunction. His annual contract was not renewed and he was left without a medical follow-up, compensation or benefits. “I was healthy when I started working for the company and sick when they got rid of me,” saidWalter, “Every family here has lost someone, the work is making us sick, but there are no alternatives. We are all dying from it, it’s a total epidemic.”
To qualify for limited state disability benefits and specialist healthcare, patients must prove they became sick while working. Walter and other cane cutters have not qualified for benefits. They say ISA does not give sick workers a copy of their medical records. Dr Ben Caplan, a kidney specialist at University College London and part of a British team investigating CKD in Chichigalpa, told the Guardian: “The morally right thing to do is follow up patients with abnormal kidney function, if the company has the resources. There is no justification for not giving patients their test results, that is unethical.”
An ISA spokesman said: “The company cannot compensate for something that it has not caused.” ISA does not accept there is a connection between CKD and working conditions on its plantations. “To date, scientific studies have not been able to determine the causes of CKD or establish a causal link between sugar cane work and the disease,” said a spokesman. ISA and other Nicaraguan sugar cane companies are supporting research into possible non-occupational causes – recently donating £430,000 for research into genetic and childhood links to CKD. The company quotes a review of scientific literature on CKD carried out in 2010 by Boston University to claim there is “no evidence whatsoever that current labour practices or chemicals used by ISA now or in the past are generally accepted causes of CKD”.
The World Bank has also cited the BU research to defend its multimillion pound loans to the Nicaraguan sugar cane industry, including ISA. But Dr Daniel Brooks, who lead the BU study – which was funded by ISA – said these interpretations did not reflect their findings: “It would be incorrect to interpret the report as stating that working in sugarcane does not cause CKD.”
ISA says its field hands work on average six hours a day and rest for 20 minutes every hour under shade to minimise the risk of heat stress. Supervisors ensure everyone drinks 1.6 litres of water every hour, and in cases of heat stress or injury, a mobile health clinic is always on site. But former and current ISA workers interviewed by the Guardian describe very different conditions. They say that during the harvest, cane cutters work for eight to 14 hours daily in temperatures often reaching 38C. They usually work a six or seven day week, cutting on average 7 tonnes of sugar cane every day. To put this in context, the US Occupational Safety and Health Administration advises that 15 minutes of heavy work in such conditions should be followed by 45 minutes of rest to avoid the body dangerously overheating. But ISA workers say they rarely rest as they are paid a piece rate of about 23 cordobas (55p) for a tonne of cane, and claim that supervisors pressure them to meet quotas. La Isla undercover researchers said they found no evidence of shade, regular breaks, adequate water, mobile health clinics or protective clothing. Cutters told the Guardian that the company brings out the mobile clinics and shade tents only for government inspectors, the press and researchers.
Outside the sugar plantations, there are very few jobs in Chichigalpa, so like many CKD sufferers Walter used a fake ID and went back to work cutting cane – this time in a “ghost team” for an ISA subcontractor. “Almost all 50 cutters in my team have the disease and are using false IDs. Of course the company knows, they see us working in the fields … the ghost teams are an open secret,” said Walter. La Isla Foundation, a local human rights and public health group, said its researchers had found hundreds of sick workers employed by subcontractors on the current harvest, which started in November and will run until May.
Julio Rivas, 53, who worked 22 harvests for ISA, has end-stage kidney disease and has dialysis three times a week. “When we get sick, the company washes its hands of us. People in other countries should know that,” he said.
Critics say Daniel Ortega has ignored the plight of rural folk because he needs the sugar barons’ support to stay in power. Opposition MP Victor Tinoco, a former Sandinista politician expelled by Ortega in 2006, said: “We have a dramatic situation with people dying at a very fast rate from a disease clearly linked to harsh working conditions, yet they’ve been virtually abandoned by a president more interested in maintaining his business alliances.” In October, opposition MPs from the parliamentary labour committee tabled a motion to invoke a state of emergency in Chichigalpa so that CKD patients could get medicine, access to doctors and specialist services such as dialysis. The motion remains unheard by a parliament, which Ortega’s party controls.
In December, Chichigalpa’s sick cane cutters and widows marched 80 miles to the capital, Managua, to demand action. One was Juan Rivas, 74, a former Sandinista fighter. He was diagnosed with CKD in 2001 after 30 years working in ISA’s fields. Three of his sons, all in their 20s, and one son-in-law also have the disease explained “Whole families are being wiped out by this illness, we want to be compensated fairly, and make sure every sick worker has access to medical treatment, this is our right. We are disappointed with Commandante Ortega’s government, they have no concern for our health … us ordinary working people have been sold out,” said Juan Rivas. No one from the government met the marchers.