When I first met Doña Ismara Granados, all I had been told was that she had a story to tell.

We sat outside Ismara’s casita in northern Chichigalpa, chickens and taxis passing us in turns.

She began by relating her husband’s death. The details are too gruesome to print here, but it should suffice to say that the man died in agony.

The 72-year-old matriarch’s hands were folded on her lap as she narrated the demise of her best friend in the world. I was reminded of how my own widowed mother talks about my father’s bout with Lou Gehrig’s disease. There was the loss, the horror, yes, but also the resolve, the commitment to look forward and carry on.

Ismara Granados holds a picture of her son José on his wedding day.

My mind went further. My dad died of a neurological disease the cause of which is unknown, but Ismara’s husband, like 20-25 thousand other Central Americans in the past eight years, suffered and died from CKDnT, a fatal incurable disease that is nonetheless both manmade and preventable.

Evidence points to chronic dehydration, strenuous labor, and exposure to toxic agrochemicals as the causes of the disease. CKDnT, now grown to an epidemic, is sustained by the unsafe, exploitative work practices of the sugarcane industry.

Ismara finished her narration by cursing this industry for robbing her of her husband. “Who will bury me?”

I was preparing to say my goodbye when her only child, José, arrived.


It turns out José himself is in the terminal stages of CKD. A lifelong advocate for workers’ rights, he was one of the first community organizers to fight CKD in Nicaragua alongside La Isla Foundation co-founder Juan Salgado.

José told me that five months ago he was on his deathbed, the spitting image of his father. But because he worked for more than 750 hours in his lifetime, he qualified for social security and received life-extending medical treatment. Most younger workers these days don’t survive long enough to get such coverage.

Now 52 years old, Jose is in many ways the lucky one. He spends half his week in transit to a Managua hospital where all the blood in his body is transferred through a dialysis filtering machine. The rest of his time is spent in delirium with a dead arm, dizziness, and nausea.

José Granados bears neck and arm scars from hemodialysis treatment.

José stopped speaking when the first of Ismara’s three brothers arrived. It turns out the man is sick.

Then a second, the eldest of Ismara’s brothers, arrived. It turns out he is sick too.

And so are his sons. All five of them.


Above, a cross-section of the Granados family. Below, the same photo minus those with CKD.

I looked at them, these men of all ages reduced to just waiting around to die. I felt my eyes wet.

It was the cruel symmetry of it all. The same disease that killed the grandfather is killing the father and will kill the son. The coffin and the cradle lost in vertigo.

The fact of the matter is that Chichigalpa is caught in a web of violence so slow and insidious it could snuff out three generations of men and the rest of the world might never hear a word.

Or you and I could grant these troubled voices an audience.

Behind José Granados, two of his grandchildren play with a bag of chips.

At the end of my last interview with José, I asked him if he was afraid to die. I wanted to get him to talk about his emotions, because this society often laughs about its sorrows or remains silent just to stay sane.

Jose was resolute. “Everyone’s going to die in one way or another. But this humanitarian fight is for my grandchildren, for the cause.”

The motivation of everyone I’ve met working for La Isla Foundation is the same. We want the people of Chichigalpa and all of Central America to get a chance at the most basic human decency, and that starts with the youth.

Look at Alejandro, 11 years old, the oldest of Ismara’s six great-grandchildren. He’s holding a piece of medical equipment that was inserted six inches into a neck artery of his grandfather Jose during his initial medical treatments for end-stage CKD.

In the New Year, Alejandro will finish his first year of school. When he grows up, he says he’d like to be a police officer.

That seems perfect to me. In a city where the rules on the book have been thrown out the window, and an entire community’s health has been jeopardized in the name of profit margins, someone is going to have to stand up as a guardian, a protector, a leader.

Alejandro and his generation can inherit a better world than that of their parents and grandparents and great-grandparents. But this can only happen if their community is given the resources it needs to pick itself up.

If you can make a donation today you will help fund a school in one of the neighborhoods of Chichigalpa most severely affected by CKD.

In this school, kids like Alejandro will learn how to speak English and read Spanish and do math.

It is only by graduating high school that these young people will establish themselves on new paths to financial stability, freeing themselves from the sugar town’s cycle of death.

And you will be part of the solution.

Barefoot soccer is the Granados boys’ favorite game.

Please consider supporting La Isla Foundation’s efforts to empower the poor children of Chichigalpa today.

On behalf of the Granados family, and from the bottom of my heart, thank you for being a witness to their story.


Bennett Kuhn
Media & Communications Specialist


Bennett Kuhn is a New Yorker. As such, he loves pizza and self-reliance, art and the pursuit of happiness, and plants that grow in the cracks of concrete.

*All interviewees’ names are fictionalized to protect their identities.