In developed countries, the disease is commonly caused by diabetes and high blood pressure. However, other factors seem to be driving the kidney disease that researchers are seeing in farmers in Nicaragua and rural India. Because of this, researchers refer to the condition in these areas as chronic kidney disease of non-traditional causes, or CKDnT. Although there is still uncertainty about what causes CKDnT, heat stress and recurrent dehydration are likely factors.
Functioning kidneys keep the body healthy by filtering waste out of the blood. Kidney disease can be fatal in advanced stages, and people with advanced CKDnT must receive dialysis every week to stay alive. But this treatment involves special machines that artificially filter a person’s blood, and for people in the Indian states of Andhra Pradesh and Tamil Nadu, these treatments are often too expensive or can only be found at facilities that are too far away.
Photographer and filmmaker Ed Kashi has been documenting CKDnT in Central America and India to encourage doctors, researchers, and scientists to help combat this epidemic. We spoke with him about the disease and its impact.
A wife cares for her husband, who has CKDnT, at their home in the village of Kota, outside of Nellore. [Photograph By Ed Kashi, Vii]
How does the problem in India compare with the problem in Nicaragua?
It’s actually quite different. In Central America, it’s mainly sugarcane workers, and they’re paid based on how much they cut. So there’s an onus on them to work extremely hard in extremely hot climates. In India, you might have a plot of land, whether you own it or you lease it, and if you don’t feel good that day, there’s no foreman over you saying you have to go into the fields to work. In Central America, thousands of people are working sick, which then accelerates the disease.
As far as we can see, in India the numbers are not as great, proportionately, as in Central America. Some of it might be because … it’s just underdiagnosed and underreported. In India, what we heard over and over again is that often people don’t have the money or access to healthcare.
The teenage daughter of a CKDnT patient stands outside her family’s home. [Photograph By Ed Kashi, Vii]
What has the Indian government’s reaction been to this?
The Indian government has certainly been building dialysis clinics, and I can’t judge whether they’re doing a good or bad job, but the Indian government is absolutely attempting to deal with this. I would say that there’s no question that in a number of rural areas, folks felt very frustrated that there aren’t enough dialysis clinics, and they’re too far away.
Laborers work on the Marakannam salt pan fields near Pondicherry, India. [Photograph By Ed Kashi, Vii]
Tell us about the impact of this disease.
The financial burden of this disease is quite profound. We saw so many families where their whole lives are now basically dominated by this disease.
Medical staff members treat CKDnT patients in Visakhapatnam.[Photograph By Ed Kashi, Vii]
In one case, there was a family whose 40-something-year-old breadwinner was unable to work, and the daughter couldn’t go to school and she tried to kill herself, and the son couldn’t go to school, and everybody—not just in the family but even in the community—had to take care of this man, make sure he got to dialysis three times a week.
In one village we went to, there were 120-some-odd widows—the husbands had all died of CKDnT. They all work much harder, and some of them were starting to get sick.
A man sits in a dry rice paddy in Balliputtuga. [Photograph By Ed Kashi, Vii]
What changes might help prevent this disease in rural areas?
The simplest would be rest, water, and shade, particularly for rural workers who are working incredibly long hours in incredibly hot conditions. They must hydrate and rehydrate on a consistent basis. You need to have rest breaks, because when you’re working so hard and sweating and getting dehydrated, you’ll break down your kidneys. And there needs to be shade.
So these are things that are not incredibly costly solutions, they’re relatively easy to implement. It’s about taking care of our workers. This is to me a human rights issue.