Recent research published in the Asian Journal of Medical Sciences has identified a troubling presence of kidney-related health problems among migrant workers returning from working in the Gulf states and Malaysia. The vast majority (92.1%) of cases identified by this research were of unknown etiology, meaning that they are not attributable to traditional factors like diabetes and hypertension. When considered alongside the work of La Isla Network, whose researchers have frequently identified heat stress and dehydration caused by working strenuous labor in extreme temperatures as a leading driver of kidney injury and chronic kidney disease (CKDnt), this study indicates that those risks may be affecting large amounts of migrant laborers in Nepal.
We sat down with Jason Glaser, LIN CEO, to discuss the findings and their implication for workers currently subjected to extreme heat in a warming world.
- When did you first become aware that migrant workers were returning home to Nepal with kidney-related health problems?
For me, it was a logical deduction. I had posited back in 2015 that CKDnt was the first global epidemic related to climate change. While at the time there was an obsession with only agricultural workers, even then I was quite concerned about others working extreme jobs in high temperatures. So, I was quite pleased when I read that someone had finally done an assessment of dialysis patients in Nepal who had returned from work abroad and there seems to indeed be a signal that they have what appears to be CKDnt, or heat stress nephropathy.
- Over the past decade, La Isla Network has led the charge in identifying that extreme heat and strenuous labor are key drivers of kidney injury and chronic kidney disease (CKDnt). Did these recent results out of Nepal surprise you?
No, as noted above, I had been wanting to do a clinic based study to start investigating this years ago, and was so pleased when I saw that someone had the resources and contacts to make it happen. This confirmed my hypothesis that A. this disease exists where there is a venn diagram of high environmental temperatures, heavy workload, and poor labor protections for workers, and B. it is far more prevalent than people think and that researchers and others should stop saying things like, “well it doesn’t exist in “X” location” before looking. I’ll be very clear, anywhere we have been told that CKDnt doesn’t exist, but has those elements of high heat, high workload and low protections, we find the disease. There has been no negative. I think this is hard for people as it shows how weak our surveillance systems are and that there is still an underclass that does not receive adequate consideration, be it India, Nepal, the USA or Mesoamerica. We can do better and LIN can help countries and employers do so.
- Qatar specifically has had plenty of attention ahead of World Cup 2022 on numerous labor violations, human rights issues, and kidney-related occupational injury, illness, and death. What role do you see states and multinationals like FIFA/construction and development companies playing in addressing these violations?
It pains me to say that no one acted sufficiently to save the lives already lost or now irrevocably shortened by kidney disease. What I think is incumbent on all of those orgs, and those of us in research and prevention efforts, is that we assure we work now to ensure that no one else faces such a preventable fate. It’s absurd when you think about it, that anyone should die or get sick from too much heat at work. Therefore we must assess current practices, design better interventions, assist and measure implementation and work until adequate protection is the norm. Long overdue, totally attainable, it’s time for those profiting off the labor of others to ensure those folks are protected, be it FIFA, the players in the cup, or the construction companies who weren’t providing adequate protection.
- What do you see as the way forward for responding to the increasingly global epidemic of heat-related kidney injury?
Per the points above, I think we need to improve surveillance at worksites and in the community, focus on risk mitigation based preventative efforts, and of course ensure implementation is effective and consistent. Improved policy in government regulation is important, but I also think insurers should think about including language that ensures that adequate heat stress protections are in place. Why should an insurer pay out a liability claim or similar claim if an employer wasn’t providing water, rest, shade and adequate cooling to people working in 40 C/104 F heat?
- While the majority of LIN’s research has focused on the agricultural industry in Central America, many of Nepal’s migrant workers affected by kidney injury have gotten it while working in construction in the Gulf States and Malaysia. Why is this significant?
The findings in Nepal are important for three main reasons
- They demonstrate that heat stress is a persistent exposure across industries that appears to eventually result in kidney disease.
- Heat stress is addressable and that means lives going forward are saveable and this is an excellent opportunity to adapt what we have learned via the Adelante Initiative to new settings and help employers, countries and workers create better protection and prevention systems.
- The work of the group from Nepal and the University of Bournemouth creates the basis for comparable clinical studies globally, which can be used to identify populations of those who are sick at home for community surveillance and early treatment, and finally identify where workers were exposed and in which jobs so we can begin targeting interventions and policy work to get them protected.
They are troubling findings, but they are the foundation we can work from to protect workers and eliminate this threat going forward.
- Closing thoughts: What are the practical steps you would like to see implemented in Nepal (and the countries Nepali workers travel to) to ensure workers are protected from the risks of kidney injury and chronic disease?
I think LIN’s job is to listen to our Nepalese colleagues, to offer them our experience and insights to date, and support them in navigating the systems at home and abroad to protect their countrymen and their families. My plan is to support the lead author, Nirmal, his team, and my other Nepalese colleagues with whatever helps them in pursuing their objectives, including working on finding them adequate funding for research, access to media coverage, and support in study design and analysis as they request it.
Jason Glaser is the founder and CEO of La Isla Network, an occupational health research organization and consultancy dedicated to ending heat related illnesses, including chronic kidney disease from non-traditional causes (CKDnT) among workers and their communities worldwide. A recognized global voice on CKDnT and occupational heat stress, Glaser has led research, advocacy, policy change, and guided employers in addressing some of their most challenging occupational health challenges. He is the author of numerous academic articles and policy reports, and has brought the world’s attention to the CKDnT crisis via media appearances in The Guardian, New York Times, Vice News, and Al Jazeera.
Through La Isla Network, Jason pulls together an international community of researchers, advocates, media professionals, and industry contacts, forging multi-stakeholder partnerships to protect workers in a warming world. He has markedly improved conditions for workers throughout Central America via programs like the Adelante Initiative, and is now working with partners with funding from the Belmont Forum on Climate Change and European Commission to scale up protections for workers at risk of heat stress globally.