News of the CKDnt epidemic – and PREP

Key words: CKDnt; La Isla Network; San Antonio Sugar Mill; work practices.

Despite early friction between the La Isla Foundation and the San Antonio Sugar Mill in Chichigalpa, Nicaragua, in 2019 an initiative called Adelante was funded by two German organisations. The initiative helped the foundation and the mill to cooperate in research to validate and adapt new work practices which would help sugar cane workers avoid or reduce the risk of contracting CKDnt (chronic kidney disease of non-traditional sources) as a result of their work in searing temperatures, with little shade and insufficient water.

The Adelante Initiative is a workplace intervention focused on providing adequate measures such as water, rest, shade, and improved ergonomics to prevent CKDnt among sugarcane workers. The La Isla Network (LIN), which sprang out of the La Isla Foundation, is concentrating its efforts in the sugarcane sector due to the high prevalence of the disease. The results from the initiative will be adapted to other geographies and industries.

The San Antonio Sugar Mill and LIN continue to invest their own resources into the project and additional support is provided by other project partners who are critical to the success of Adelante. The Nicaragua Sugar Producers Association ensure the project grows both within Nicaragua and the region. Bonsucro ensures the findings are disseminated internationally and the findings are being incorporated into an improved Bonsucro Standard.

Most recently the LIN has become a recipient of a Belmont Forum grant for the project ‘Prevention Resilience Efficiency and Protection’ (PREP) for workers in industrial agriculture in a changing climate. The Belmont Forum is a partnership of funding organisations, international science councils, and regional consortia committed to the advancement of science.

PREP will use the results of the Adelante Initiative to investigate:

  1. the immediate and long-term impact the intervention has on workforce health (kidney health and heat-related injuries) and productivity;
  2. the economic and social impacts on those affected by the disease and whether LIN’s intervention aids resilience, which includes mitigating migration pressures;
  3. the economic burden on health systems treating CKDnt;
  4. an analysis of public health policies to understand what specific policies, or absence of them, have contributed to CKDnt, while investigating what policies are required to effectively address the disease.

The PREP Project aims to strengthen protections for worker’s health by building on the Adelante Initiative.

The lay summary of LIN’s most recent publication is available at:[UNIQID]

For more information on PREP, please visit:[UNIQID]

Other LIN, CKDnt and PREP videos:[UNIQID][UNIQID

LIN website:

Sugar cane production and the CKDnT epidemic

In May 2016, ENCA members Esma Helvacioglu and Martin Mowforth, spent a day as guests of the organisation PASE (Profesionales para la Auditoria Social y Empresarial / Professionals for Social and Business Auditing), a non-profit organisation formed in 2003 that is dedicated to the promotion of labour and human rights in the agricultural and textile industries of Nicaragua. Their work has alerted many people to the epidemic of chronic kidney disease suffered particularly by workers in the sugar cane fields. The following report uses much of PASE’s education and awareness-raising material along with various impressions gained by Esma and Martin during their visit.

As we sip our tea, coffee, lemonade, juices and numerous other sugary drinks, it is quite possible that most of us have no idea that there is a global epidemic of chronic kidney disease of non-traditional causes (CKDnT) amongst sugar cane workers around the world. In particular this is affecting cane workers in the Indian sub-continent and in Central America, especially El Salvador and Nicaragua. Sugar, one of Nicaragua’s most lucrative crops, feeds our insatiable sweet tooth. It is harvested by workers who labour under intense heat for poverty-level wages. They are also dying in epidemic numbers.

Researchers have linked poor labour conditions to the epidemic of Chronic Kidney Disease of non-traditional causes (CKDnT) sweeping across Central America. One of the populations most acutely affected by the epidemic is sugar cane cutters in western Nicaragua, although the same disease is noted in plantation workers in the Indian sub-continent and in El Salvador.

The lack of treatment options and resulting medical complications mean that a CKDnT diagnosis in Nicaragua is likely to lead to a slow and painful death. In the past ten years, 46% of male deaths in Chichigalpa, the most affected town, were caused by CKDnT. The epidemic devastates not only the lives of the sugar cane workers, but also the well-being of their families and entire communities.


Social security can mean life or death for a family

When cane cutters become sick, they are fired from their jobs and illegally denied social security benefits and compensation for their occupational illness, leaving their families with no income and forcing their children out of school and into labour. Nicaragua has few dialysis machines available for treatment and, despite its laws regarding labour conditions of work, there is precious little enforcement of these laws. Obtaining social security benefits in the poverty stricken rural sugar cane communities of Nicaragua can literally mean the difference between survival and death.

In response to this situation, a non-profit organisation has opened up an office in the city of Chinandega, located between the two biggest sugar producers in Nicaragua. Professionals for Social and Business Auditing (Profesionales para la Auditoria Social y Empresarial), or PASE, was formed in 2003 and is dedicated to the promotion of labour and human rights in the agricultural and textile industries of Nicaragua. PASE provides free legal aid to workers regarding their and their families’ rights to social security and other labour rights.

In the last twelve months, PASE has published a manual on social security rights for agricultural workers in understandable language and conducted training workshops of community and union leaders across western Nicaragua. It also holds training workshops on alternative skills for employment for current and former cane cutters.

For the future PASE aims to:

  • become a permanent resource for agricultural workers;
  • expand its services beyond social security assistance;
  • provide more workshops to workers and their leaders;
  • publish and distribute more copies of their manual with a view to reaching the most rural and vulnerable communities;
  • directly aid widows and orphans of deceased cane workers affected by CKDnT;
  • publish a policy paper providing concrete recommendations to government and industry on how to address the effects of CKDnT;
  • engage with the international community to identify practical solutions to this epidemic;
  • produce a short video clip explaining CKDnT and workers’ rights in an easily accessible way that workers will understand.

During their visit to PASE, Esma and Martin visited the Monte Rosa sugar cane processing plant where they spoke with union leaders and workers about the conditions of work, CKDnT and the effects of aerial spraying of pesticides. They briefly visited a newly built school located right next to the sugar cane fields which are sprayed by air. They also visited two clinics where they spoke with a doctor about the kidney disease epidemic and with other medical workers. At La Isla Community Centre they recorded an interview with all the workers at the Centre who run workshops in alternative means of income generation and give assistance in informing cane workers about their social security rights.


  • PASE (March 2016) ‘Project Proposal: PASE Legal Services Office’
  • PASE (October 2015) ‘Seguridad Social: Manual para Trabajadores Agrícolas y sus Familiares’
  • Comité Nacional de Productores de Azúcar (undated) ‘Azúcar de Nicaragua: Endulzando el Mundo’

Donations to the work of PASE can be made through the following link:–2