Chronic kidney disease: a whodunit
The answer seems to be: no one really knows yet. The World Health Organization and the Sri Lankan Ministry of Health produced a study that suggests the cause of CKDu may be due to chronic, low-level exposure of workers to cadmium and arsenic that can be found in pesticides and fertilizers. But the Sri Lankan government appears reluctant to widely publicize the report in order to inform both farm workers and food consumers, who also may be at risk. This reluctance has raised suspicions among observers: is the Sri Lankan government unwilling or unable to regulate agro-business, particularly the corporations that sell pesticides and fertilizers in the country. Is it because the government itself partly to blame for the rising incidence of CKDu, due to it subsidizing the costs of the fertilizers and pesticides that farmers then tend to overuse in their fields? Public Radio International (PRI's The World) has a report on the issue from a number of different angles. It goes without saying that because the epidemic is serious and because there is no clarity about the etiology of disease, speculation and conspiracy theories abound.
Whatever the causes and the responsibility, the current consequences for farmers and their communities is clear, and clearly bad. Those with CKDu find themselves unable to work and having to seek treatments (like dialysis) they can barely -- or not -- afford. Research, surveillance, policy-making and political will have to come together, and quickly, to prevent laborers in a crucial industry in developing countries from becoming seriously ill and dying.