La Isla Foundation is a public health and human rights organization focused on addressing the epidemic of Chronic Kidney Disease of nontraditional causes (CKDu). CKDu affects agricultural workers throughout Mesoamerica and is possibly related to epidemics occurring in other parts of the world where climatic and working conditions are similar. Studies show disease onset is linked with chronic dehydration and heat stress among other co-factors. Temperatures can rise above 40°C (104°F) in areas where CKDu is most prevalent. The Panamerican Health Organization (PAHO) recognizes CKDu as a public health crisis with occupational ties. Sugarcane workers in Central America are the most commonly affected by the disease, especially in Western Nicaragua. In the Nicaraguan city of Chichigalpa, where the nation’s largest sugar producer is located, CKDu caused 46% of all male deaths in the last decade.
This situation in Chichigalpa is a stark example of the costs of CKDu and the structures that have allowed it to reach epidemic proportions. The most dependable source of employment for Chichigalpinos is Ingenio San Antonio (ISA), the largest sugar mill and processing facility in Nicaragua. ISA is owned by Nicaragua Sugar Estates Limited (NSEL), which is majority owned by Nicaragua’s Pellas Group, with Britain’s Tate & Lyle also a minority owner.
Workers commonly start in ISA fields as minors, before the legal age of 18. The prevalence of CKDu is so high at ISA that the company now mandates health checks at the beginning and middle of each six-month harvest season. ISA tests the workers’ blood for creatinine, a biomarker indicative of kidney function. ISA does not acknowledge that the disease is related to work, yet the company does mandate that workers’ are checked for healthy kidney function. If creatinine levels are above 1.4 mg/dl, workers are fired or not hired depending on their current employment status with the company. Those who lose work in this way do not receive company medical benefits or pensions. Due to pressures of poverty and despite their CKDu diagnosis, many sick workers go on from being fired to seek work with ISA anew through independent sub-contractors. The subcontractors accept borrowed or fake identification cards from the sick workers or turn a blind eye to their health status. ISA does not take responsibility for subcontracted sick or underaged employees working in the fields. Despite this stance, the bulk of ISA’s workforce is made up of subcontracted workers. The Nicaraguan sugar industry generates 35,000 direct and 140,000 indirect (i.e., subcontracted) jobs, according to Nicaraguan newspaper El Nuevo Diario.
From April 22 to May 3, 2014, photojournalists Ed Kashi and Jessey Dearing independently investigated CKDu in Chichigalpa. They received live translation and logistical assistance services from La Isla Foundation Director of Community Development Katie Stark. Kashi and Dearing interviewed affected families, current and former workers, community members, an ISA occupational health doctor, and Dr. Juan Jose Amador of the Boston University (BU) Research Group. The BU Research Group is one of many teams around the world currently investigating CKDu. Its projects are largely funded, either directly or indirectly, by NSEL and other major sugar producers. During this time, the photojournalists entered and filmed three ISA sugarcane fields during working hours.
The field visits revealed to the investigators a sharp contrast between what ISA representatives and BU researchers portray as the present working conditions on the ISA plantation and the actual conditions facing the majority of workers. Investigators discovered ‘camouflage’ teams comprised mainly of workers whom ISA had fired after they were diagnosed with CKDu. The workers now dealt exclusively with sub-contractors, cut off from social security, company benefits, and pensions. These groups also contained underage workers laboring on behalf of older family members too sick with CKDu to continue working.
Field One (Supervised by NSEL)
Through Ariel Granera, a public relations officer of NSEL, ISA granted Kashi and Dearing a tour of its grounds, which included an interview with an NSEL occupational health doctor, a visit to what was presented as a typical sugarcane field during harvest, and a stop at the ISA health clinic.
The interview with the company doctor was outside of a mobile clinic, adjacent to a mist-producing tent set up on the edge of a sugarcane field within ISA’s gates. Here we saw men cutting burnt cane. After the interview, we were given an opportunity to go into the fields for several minutes to film work under the supervision of our handlers from NSEL and a public relations representative from NSEL/Pellas Group headquarters in Managua, who stayed with us throughout the day’s tours and all interviews. The workers seemed uncomfortable with our presence. We were not able to have conversations with them.
Here there were shade tents scattered throughout the fields, a misting tent, and a mobile health clinic. We were told water would be served to workers, although we did not observe any water being distributed over the course of two hours. We also did not observe workers making use of the shade or misting tents during our time in the field.
Field Two (Unsupervised by NSEL)
A local informant tipped Kashi and Dearing as to the location of a ‘camouflage’ team. A camouflage team is a team of sick and/or underage workers who obtain work in ISA fields through subcontractors, without direct company oversight or documentation. Workers younger than 18 are not legally able to work, and sick workers are banned from working in the fields via the aforementioned ISA policy on health checks. Given the lack of economic opportunities in Chichigalpa, both groups work under the radar in order to provide for their families by joining camouflage teams. However, the existence of these teams is no secret in the community or among the workforce.
The team that investigators visited in Field 2 was mostly made of sick men, a few young workers, with women working in supervising positions. Investigators were told that children as young as 14 years old work with this team, but those encountered were closer to 17. The legal age for this type of work in Nicaragua is 18.
Kashi and Dearing sought the captain of the work team, who permitted them to access the field, saying, “I didn’t see you.” The investigators spent an hour on site.
Due to the presence of supervisors, workers were reticent to interact with investigators. After shooting photos and videos Kashi and Dearing left without interviewing any workers.
There was no visible water provision at this field nor was there shade provided for the work force. There was no misting tent. No mobile health clinic was present. It was unclear whether these teams were provided lunch or rest time since the workers were too nervous to speak with the investigators.
Field Three (Unsupervised by NSEL)
Earlier in the week, Kashi and Dearing had found a cane field along the highway to Chichigalpa owned by a colono, or private farmer who rents land to NSEL. (All work on colono farms is performed by ISA workers. The owner receives a rent payment for the land use.) Later in the week, it was noted that the field had been burnt during the night, meaning teams would soon be arriving to cut the cane. At this time most teams were finished for the season. Those still working only had a few days left. Often NSEL field supervisors are absent during the last weeks of the harvest, and on this specific day the supervisors had not come to the fields. The caretaker on the farm allowed investigators to access the fields.
Since the field was not ISA property, the workers didn’t feel uncomfortable with the photojournalists filming the process of cutting burnt cane. They were able to film, converse, and hear some stories from those who took a moment to talk.
In this field there was no water or shade provided by NSEL. No mobile health clinic or misting tent were there. Without the presence of their supervisors, workers cut at a quick rate, but they felt the liberty to rest more often than in a supervised field. They took breaks in an exposed area, with no cover, in temperatures between 35-40°C (95-104°F). A local woman had arrived to sell sugary drinks for a profit, but no company-provided relief was present.
Working Conditions and Claims: Contrasting the tour and claims in Fields 1 to the unsupervised visits in 2 and 3
ISA is a company that could protect the wellbeing of the workforce but instead portrays an unrealistic example field as the norm for its working conditions. On several occasions NSEL has shown both researchers and the press this unique worksite that incorporates a mobile clinic, shade tents and even a misting tent for workers while explaining to the visitor that this is standard practice throughout the entire NSEL production system. While this would be a most welcome improvement to work practices, it appears to be a manipulation of the public instead of a normalized practice and a grave violation of corporate social responsibility standards. Aside from the unethical nature of lying about the reality the working conditions facing a workforce that is largely illiterate and impoverished is the very real impact on the health and wellbeing of this workforce, which lacks access to potable water, restrooms, and shade. Minors and sick laborers working in conditions detrimental to their already fragile health in combination with extreme heat stress appears to be the norm at other worksites. Dangers related to heat stress and dehydration are of special note given the latest research into the causes of CKDu which demonstrates that such conditions cause extensive acute damage to the kidneys that over time may be the main driver of CKDu.
Claim 1: Rest Breaks and Lunch
Claim: It was stated that each worker had time to rest every hour, for up to 20 minutes if desired, in company provided shade tents. Directly contracted workers (a minority of the workforce) are provided lunch. Both sub-contracted and contracted workers get one hour of break time for lunch.
Reality: In Field 2, there were no workers resting during the hour observed. Those who had already finished their work found naturally occurring shade to eat in while waiting for the bus to take them home to Chichigalpa. They didn’t get a lunch break or food provided by ISA. The waiting workers had arrived earlier in the morning and finished their work, but they still had to wait through the rest of the day for the other teams to finish before they received transportation home. Only then would they rest and eat.
In Field 3 there were no supervisors, so some workers did take time to rest and talk. Nevertheless, there were no tents, chairs, hydration, or other ISA resources available to them.
In NSEL-supervised Field 1, there were shade tents set up. Nevertheless, despite ISA’s stated policy granting workers 20 minutes of rest per hour, no resting was observed during a two-hour period. In interviews, workers told investigators that supervisors often prohibit breaks for resting, food, or even water. These informants even said that if workers do take breaks, their pay is affected. Most workers earn depending on how much they produce (rows of cane cut, packets bundled, etc.) and are pressured to complete as much as possible to meet quotas and maintain income.
Claim 2: Water Provisions
Claim: ISA’s occupational health doctor stated that the workers’ intake of water is carefully supervised and documented by women in the fields who ensure all workers consume at least one liter per hour. These women will also give refills if required.
Reality: Investigators never once heard of these water supervisors outside of interviews with NSEL. There were no water supervisors in Fields 2 and 3. Workers told investigators that water trucks do show up from time to time, but that they are inconsistent, coming in some days or weeks and not others. Workers also said that refills are generally a rarity, almost never occurring. Workers also complained about the quality of the water on those trucks, claiming it is “hot and smells of chemicals,” likely chlorine.
Men bring their own bottles of water with them to the fields, which will have to last them all day, even during shifts longer than 12 hours. The bottles typically hold around eight liters. Underage workers, because of their size, usually only carry small bottles and ask for water from adult workers. During the tour in Field 1, where NSEL representatives were present, women were seen in the fields documenting the progress of the harvest, but water refills or hydration oversight were not observed. Investigators did see NSEL hydration packets handed out to workers in Field 1, but in Field 3 there was a sole woman (employed under ISA according to workers) selling handmade juice packets to the men. No free hydration packets were given. In Field 2 there were neither free packets nor juice for sale.
Claim 3: Health Infrastructure
Claim: Inside the ISA gates, in Field 1, ISA representatives told investigators that the staffed mobile clinic, shade spots, and mist tents/rest stations were protocol for all fields. According to the representatives, the in-field shade spots could be used at the worker’s convenience, and if the worker needed a longer break, then he could return to the mobile clinic and its adjacent mist tent to rest until comfortable. The mist tent had a ceiling and four walls of cloth tarps that blocked out sun and provided mist from small pipes on the ceiling. The mobile clinic was small trailer. Investigators did not have the opportunity to see inside. ISA representatives claimed the clinic’s purpose was to treat incidents of heat stress and work accidents.
Reality: These services were seen in Field 1, but not observed in use. The mobile clinic and mist tent appeared to be sound facilities, although no workers utilized either during the time of the investigators’ visit. The tents available in the field were also not used by the workers and appeared to be of poor quality. No seats were available, just a thin cloth tarp on four posts placed in the sun. In no other field did investigators find these tents. When asking workers afterwards about claims of mobile clinics, mist tents and shade tents, all said they had never worked in a field with these measures in place to protect workers. Many had never even heard of such services.
Claim 4: Working Pace
Claim: ISA representatives claimed that the men in Field 1, who were working very slowly, cutting one stalk at a time, and making very little progress during the observed time, were working at a normal pace.
Reality: This contrasted greatly with what was seen in the last two fields, where people moved and worked quickly making great progress in little time and appearing to work until exhaustion. Workers are paid per amount of cane cut. They earn less than a dollar per ton, so they work extremely quickly to make as much money as possible during a shift. During the hour spent in Field 3, the men completely cleared an entire field, working quickly to move onto the next. During almost two hours spent interviewing people around Field 1, relatively no difference in the amount of cane cut was noted between arrival and departure.
Claim 5: Protective Gear
Claim: The NSEL doctor claimed that all workers were protected from the sun during their shifts. He also mentioned that protective equipment is given out to workers.
Reality: This claim was not true even in Field 1. Field 1’s workers did wear shirts, but not of a type that would provide protection from the sun. They also did not have appropriate hats, eyewear, or other protective equipment such as gloves or shin guards. In other fields men often worked without shirts. The only notable difference between fields was that in Field 1 men worked in company work boots, where as in the other fields people wore boots or sneakers brought from home.
Claim 6: Workers Affected
Claim: During the interview, the doctor repeatedly claimed that less than 1% of workers are affected by CKDu.
Reality: Multiple studies have shown that this disease is far more prevalent than 1% of the workforce. Through community visits, we can see how prevalent CKDu is. ISA provided some of the data from their calculations (not related to BU studies) that seemed to be flawed even by brief analysis. One problem is that each time someone is contracted, whether it be for a season or just a temporary job, he or she is counted as a new employee. An employee may be contracted up to ten times in just a couple of years before he or she falls sick, but only by the last contract will he or she be counted as sick. Another problem stems from the medical creatinine checks. With these checks, a person can be fired for having high creatinine levels before he or she is even diagnosed with the disease. Once that worker is diagnosed, he no longer is an employee and therefore not counted in these statistics. Finally, it is unclear from what pool of the workforce these calculations are made. Is it from the entire workforce, including office workers, administrators, security, etc., or just from the agricultural laborers?
Claim 7: Minors Working
Claim: ISA representatives told investigators that without a shadow of a doubt there were no minors in the fields. When asked how ISA would respond to claims from interviewees that a large amount of workers started working around 16 years of age and have worked with children even younger, ISA representatives claimed that the interviewees must be “confused,” that “there would never be minors working in the fields.” The representatives claimed that if children are ever seen in the fields, they must be from neighborhood communities that sometimes wander into the fields to talk to the workers.
Reality: There is no doubt that there are minors working in the fields. Although minors are not directly contracted, they work under subcontractors. The prevalence of underage workers is high and can not escape the notice of NSEL. La Isla Foundation studies both published and forthcoming attest to this state of affairs, and the data therein are being provided to the US Departments of Labor and State.
Historically, La Isla Foundation (LIF) has found it difficult to have a dialogue with Nicaragua Sugar Estates Limited’s Ingenio San Antonio (ISA). In light of LIF’s new Worker Health and Efficiency (WE) Program, however, we believe there is a model for a constructive way for both parties to collaborate on addressing the CKDu crisis. By improving working conditions and efficiency for sugarcane harvesters and tracking health changes over time, the WE Program takes an integrated approach to generating knowledge and understanding about the CKDu epidemic while protecting workers’ health.
If ISA finds it untenable to work with LIF on improving working conditions in such a transparent and verifiable manner, we hope the company will at least apply the claims it has publicly made regarding worker health and safety more consistently and verifiably throughout its harvesting and production process. Sugarcane producers must arrive at a point where investigative reports of this kind are unneeded. They must comply with their own social responsibility claims as publicized to the press, researchers, governments, buyers of their products, and, of course, their own workforces.