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Entry Title: "CKDnT in India"
Ed Kashi
Category and Expertise: Science-Medicine, Science, Professional

Entry Description: Chronic kidney disease (CKD) is a scourge of the rich world generally caused by diabetes, high blood pressure or obesity. However, an alternative form of CKD is finding it’s way into the developing world. Chronic Kidney Disease of nontraditional causes (CKDnT) is a deadly epidemic attacking agricultural workers. Though experts acknowledge the enormous financial, societal, and ecological implications of CKDnT, doctors, scientists, researchers, and activists involved with efforts to defeat the disease are still debating its multi-factorial causes. Because CKDnT’s greatest impact globally has been on agricultural workers, suspicions of chemical toxins, dehydration, contaminated water, and extreme working conditions have all been postulated as some of the contributing factors to the rising death toll. Pervasive in tropical or subtropical countries around the world, CKDnT is of concern as both a universal public health crisis and a social injustice.

Since 2013, I've made 4 trips to visually document the CKDnT epidemic among sugarcane workers in both Nicaragua and El Salvador. Continuing my investigative journalism in January 2016, I traveled to India’s eastern coast, near the northern border of the Andhra Pradesh state, where a 100-mile stretch of communities has suffered for over 20 years from what is known as ‘Uddanam nephropathy.’ Although India’s incidence of CKDnT appears to be lower than the Central American countries, which span close to 700 miles of the Pacific coast, the affected areas in India are extremely concentrated. In the hardest hit village we visited, Akkupalli, unpublished results from a Harvard Medical School study found that 37% of the population had CKDnT. In villages like Gonaputtuga in the fertile Uddanam area of Srikakulam district, CKDnT sufferers mirror their counterparts in Central America: young farmers with little or no formal education, doing strenuous manual labor, drinking potentially contaminated groundwater, and lacking easy access to medical care. Here, many of those who are ill spend their lives climbing coconut trees to harvest the fruit.

Almost 80% of CKDnT patients suffer total kidney failure and die within 2 years after initial diagnosis. Since a death represents not just the loss of a loved one, but also often the loss of a family’s main breadwinner, the consequences go beyond personal tragedy. Regrettably, the high medical costs, lack of specialized doctors and nurses, and a shortage of treatment facilities make death nearly inevitable for most of the poverty-stricken victims. Sympathy and support owed its sufferers often yield to indifference as political and economic interests shroud this vital, environment-related health issue. With environmental sustainability and human welfare lying at the heart of current social movements, understanding and eliminating this mysterious killer is of worldwide concern.