Reform in Costa Rica signals new strategy against lethal epidemic

In an unprecedented measure to combat a deadly kidney disease that is devastating agricultural workers in Central America, the president of Costa Rica announced a national regulation to limit heat stress and dehydration among manual laborers.

The new rule, made public on July 25, represents the first time that a government has sought to curb the epidemic by focusing on heat stress and dehydration. The policy comes as growing body of studies point to chronic dehydration from hard labor in tropical conditions as a leading cause of the disease.

In short, the studies show, laborers who harvest sugarcane and other profitable agricultural exports may literally be working themselves to death.

“All the data we have produced continue to indicate that recurrent heat stress and dehydration is the primary driver,” said Catharina Wesseling, a Costa Rica-based epidemiologist for the Karolinska Institute who has studied the disease for a decade.

For more than three years, the International Consortium of Investigative Journalists has examined how a rare type of chronic kidney disease, CKD, is afflicting agricultural workers along Central America’s Pacific Coast, as well as in Sri Lanka and India. A 2012 study estimated that the ailment has killed more than 20,000 people in Central America alone.

Scientists have long suspected the disease is caused by a combination of factors, from heat stress and dehydration to exposure to toxins such as pesticides. Previous policy responses considered by governments mainly focused on pesticide exposure, including a ban in Sri Lanka on Monsanto’s top-selling weed killer glyphosate that was announced in 2014, placed on hold amid industry pushback and questions about the scientific evidence, and recently reinstated this year.

Costa Rica’s new regulation, which was issued by presidential decree, will require all enterprises that employ laborers in tropical conditions to provide water, rest and shade to those workers at increasing levels depending on how hot it is in work areas. The details of which protections are required at which temperatures will be set in negotiations between the government, unions and representatives of the sugar industry and other agricultural companies, said Dr. Roy Wong, a government epidemiologist in Costa Rica who led the official research into the disease.

The rule marks the culmination of a multi-year study into the causes of CKD and whether it should be classified an occupational disease, which was launched in 2012 shortly after the publication of ICIJ’s “Island of the Widows” investigation.

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This story is part of Hard Labor. Threats to America’s workers, and the fragile federal net that protects them. Click here to read more stories in this investigation.

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Copyright 2015 The Center for Public Integrity. This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.