For Immediate Release

For more information contact:

Ilana Weiss, Senior Director of Public Health and Policy
La Isla Network

From La Isla Network, July 12, 2017

Results from Year 1 of the Worker Health and Efficiency Program have been published in the Scandinavian Journal of Work, Environment & Health. The results indicate that a water, rest, shade (WRS) and efficiency intervention can be successfully implemented in the context of sugarcane cutting. A promising reduction of the impact of heat stress on acute and over-harvest biomarkers of kidney function were recorded. Additional analysis of the WE Program is underway, including data from Years 2 and 3.

Important findings include:

  • Heat related symptoms, such as dizziness, vomiting and disorientation, decreased with the availability of WRS: Workers felt better at work and when they arrived at home afterwards.
  • Evidence of mitigating kidney decline over the season with intervention: Though the workers did not return to normal with the intervention in place, kidney function did stop declining.
  • Productivity increased by almost 40%. In an effort to convince workers and their employers that the intervention was worthwhile, we aimed not to lose any productivity with the introduction of the WE Program.

Significant questions and challenges remain. No research can answer all questions; indeed, good research frequently leads to further questions. In the case of the WE Program, the following issues require further consideration:

  • It is too early to conclude that the intervention prevents chronic kidney disease. More observations and rigorous evaluation over a longer time frame are needed before determining that such a program prevents CKDnT.
  • Challenges of piecework payments: Maintaining productivity with more rest is encouraging; however, productivity must be understood in the context of the piecework remuneration structure. We must carefully consider whether we are limiting the benefits of the intervention due to people feeling better, therefore working harder and increasing their daily workload.
  • Scale-up and sustainability: The WE Program has shown that an intervention program is feasible in sugarcane fields; however, we need more evidence to show this is generalizable beyond one mill in El Salvador. In our Year 2 scale-up, we found that even within the same mill, different cutting groups presented a range of challenges for implementation. More work is also needed to establish the sustainability and consistent implementation of the program without the direct involvement of research personnel.

Using these important findings, we hope to build momentum towards a multisite study including Central America, Sub-Saharan Africa and India so that remaining questions about the effectiveness of interventions, the drivers of disease and sustainability of the intervention can be answered in an occupational setting. The Adelante Initiative, an effort of Bonsucro, La Isla Network, and Nicaragua’s largest sugar mill, Ingenio San Antonio, is the first step forward. The Initiative will be dedicated to further understanding CKDnT, interventions and improving access to care for those affected.