Jump to content

Nephrology in Low Resource Countries


Recommended Posts

Hello -- I am a PA student who is working on a project related to global health, and interventions for chronic kidney disease in low resource countries (especially, but not exclusively, in Central America).  I am particularly interested in the challenges of setting up dialysis.  Has anyone had first hand experience with this?  Would you be willing to let me interview you about your work?  I'd love to have a PA on my list of informants.

 

Thanks!

Link to comment
Share on other sites

I'm not a PA yet and I can't help you (sorry)

But I have done a lot of reading about the issue and I am so glad to know that there is an increased interest in studying this problem.  It's very sad and a bit of a mystery (but if you want my two cents, I'd bet that it's some sort of nephrotoxin that the men are exposed to in the fields, combined with dehydration and lack of access to fresh, safe water on-site.  The "it's their genetics" argument is appalling to me. These men experience some of the most brutal working conditions on earth).

Anywhoo...I do know that they have succesfully used peritoneal dialysis in some places in Nicaragua, and that men are able to do this in their own homes.  But I'm sure you already knew that, and also you probably know much more than I do about how peritoneal dialysis actually works...

Link to comment
Share on other sites

Thanks for chiming in.  I am beginning to make contact with an organization in Nicaragua that seeks to facilitate research and drive policy.  It's a fascinating topic.  There was a great article in the Guardian a few months ago.

 

http://www.theguardian.com/world/2015/feb/16/-sp-nicaragua-kidney-disease-killing-sugar-cane-workers

 

I just wish I had more access to someone who has attempted to facilitate dialysis in such places.

Link to comment
Share on other sites

Thanks for the article.  I'm disturbed by the following statement: “To date, scientific studies have not been able to determine the causes of CKD or establish a causal link between sugar cane work and the disease,” said a spokesman [at ISA].

 

Sure...there's no causal link between CKD and sugar cane work...only rock solid correlative evidence!  There's also no causal link between rising CO2 and global warming, yet most of us agree that the evidence is strong and so we try to limit our carbon footprints as a precautionary measure.

 

The attitude of the sugar cane industry is so appalling.  Also, the team at Boston University who has done a lot of the recent research into causes of CKDu actually recieved the majority of their funding from the World Bank ombudsman...which is a total conflict of interest because the World Bank has supplied Nicaragua with loans that haven't yet been paid off.  The World Bank's perogative is to support the sugarcane industry and ensure its profitability!

 

Ug...ranting makes no difference but at least it's nice to commiserate.

 

Good luck with your project!  Once I start PA school in August I will check in to see if there's someone who could help you and/or whom you could interview.

Link to comment
Share on other sites

  • 3 weeks later...

Just an update -- I am down in Nicaragua now, in the sugar producing area.  I literally walked through a cane field this morning, and past the ISA.  Getting great material from health care workers in the area.

 

More and more evidence is supporting the hypothesis that dehydration is causing the kidney damage.  But yes, the politics of it are maddening.  The politics of it all are also a great Capstone project.  :)

 

 

Check this out, if you have access to Pubmed articles:

 

García-trabanino R, Jarquín E, Wesseling C, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador - A cross-shift study of workers at risk of Mesoamerican nephropathy. Environ Res. 2015.

Link to comment
Share on other sites

  • Moderator

hypertensive renal disease drives most of the renal failure in the developing world.

In Haiti  in 2010 there were 14 dialysis machines in a country of 10 million people and 1 surgeon doing kidney transplants. I believe the first one was done right before the earthquake.. if you get ESRD there you have a fairly grim prognosis. the key is jumping on htn renal disease early with ace inhibitors and fairly low bp thresholds for tx, like 130/80 or so. moderate salt restriction is also very important in these settings.

Link to comment
Share on other sites

EMEDPA -- The chronic renal disease in Central America, Mesoamerican nephropathy, is an entirely different beast.  It looks a lot like  interstitial nephritis, and it's causes are not completely understood.  It is not associated with your typical risk factors, such as hypertension, diabetes or obesity.  It tends to affect young, otherwise healthy sugarcane workers, and kills many people before age 35.  But, like you mentioned, treatment isn't always accessible in Central America due to low resources.  

Link to comment
Share on other sites

  • 2 weeks later...

My question is - if it's really just dehydrated that is causing CKDu then why aren't all the other millions of farm workers in hot climates also getting this disease?  It's great to hear your insight on the topic...since you are actually in Nicaragua and are observing your surroundings.  I'm curious to know what the workers themselves are saying.

 

Have you checked out the articles written by Jeniffer Crowe (2009, 2013)?  Based on these interviews, it seems like the farm workers are given water to drink but they do not trust that it is clean.  They also have very little access to shade, rest, and electrolytes during their workday.  So even if the "root" cause of this is dehydration, it still leads me to belive that the "root root cause" is an issue or worker's rights and occupational safety...treating workers as assets rather than as disposable units.

Link to comment
Share on other sites

Eparks -- I've incorporated some of J. Crowe's articles into my literature review.  She has done quite a bit the early manifestations of CKDu, especially in Costa Rica.  I really believe that CKDu is a human rights issue.  I've been told the work conditions in the cane fields are abysmal, but I haven't witnessed them personally because this is not harvest season.  Apparently, the fields are burned the night before, and often, the ashes are still hot as the workers work.  This is on top of the factors you mention.  Also, the sugar companies are very reluctant to assume responsibility, or even grant access to the fields in Nicaragua.  It's a very politically intense issue.

 

However, a friend in El Salvador pointed out to me that Western Nicaragua is dominated by the sugar industry.  In coastal El Salvador, the economy is a bit more diverse, and they are noticing that workers in many manual labor positions are experiencing CKDu.  Stoneworkers, construction crews, road workers.

 

Fortunately, my project is more focused on structural barriers to research and treatment, and I don't have to figure out what causes it.

Link to comment
Share on other sites

  • 1 month later...

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More