A mysterious epidemic is devastating the Pacific coast of Central America, killing more than 24,000 people in El Salvador and Nicaragua since 2000 and striking thousands of others with chronic kidney disease at rates unseen virtually anywhere else.Last year it reached the point where El Salvador's health minister, Dr Maria Isabel Rodriguez, appealed for international help, saying the epidemic was undermining health systems.
- Patients, local doctors and activists say they believe the culprit lurks among the agricultural chemicals workers have used for years with virtually none of the protections required in more developed countries. But a growing body of evidence supports a more complicated and counter-intuitive hypothesis.
- The roots of the epidemic, scientists say, appear to lie in the gruelling nature of the work performed by its victims, who labour hour after hour without enough water in blazing temperatures, pushing their bodies through repeated bouts of extreme dehydration and heat stress for years on end. Many start as young as ten.
The punishing routine appears to be a key part of some previously unknown trigger of chronic kidney disease. Because hard work and intense heat alone are hardly a phenomenon unique to Central America, some researchers will not rule out manmade factors. But no strong evidence has turned up.Dr Richard J. Johnson, a kidney specialist at the University of Colorado, Denver, is working with other researchers investigating the cause of the disease. They too suspect chronic dehydration.
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