Central America’s Silent Massacre: The Politics of Chronic Kidney Disease Amidst Scientific Uncertainty

As a doctoral student in the Joint UCSF/UC Berkeley Ph.D. in Medical Anthropology program, I seek to analyze how politically structured health inequities impact marginalized communities and the ways that social movements and state programs attempt to intervene upon these forces. In general, I intend to explore the intersection of health inequities, care (in its multiple formal and informal facets), and social activism. In previous work, I have researched and written about grassroots movements in El Salvador and Venezuela. In my current research, I seek to situate the emergence of the widespread chronic kidney disease (CKD) epidemic in Nicaragua and El Salvador within a broader examination of the ongoing structural and political violence experienced by Central America’s historically marginalized communities. Over the last two decades, this epidemic has claimed thousands of lives, primarily those of young males who work in sugarcane production along the Pacific coasts of these countries. Although it has received greater attention from epidemiologists in recent years, the etiology of the disease continues to elude researchers. My goal for my summer research was to explore how this particular outbreak is being interpreted, experienced, and confronted by advocates, researchers, governments, and affected communities. Following medical anthropologist Charles Briggs’ work on biomediatization, I sought to explore how these distinct groups and entities do not simply collect or disseminate health knowledge, but also actively produce particular disease narratives. In Nicaragua, I collaborated with La Isla Network (LIN), an international non-governmental organization that collaborates with multiple stakeholders to produce research on the CKD epidemic and advocate for occupational health changes in the sugarcane industry. Through LIN, I was able to meet with researchers as well as former and current sugarcane workers affected by CKD. In El Salvador, I collaborated with Asociación Mangle, a non-governmental organization that was created to support a grassroots social movement called La Coordinadora del Bajo Lempa y Bahia de Jiquilisco. Asociación Mangle engages in advocacy in respose to the CKD epidemic and supported the development of a public dialysis clinic for those affected. During my time in El Salvador, I met with epidemiologists, nephrologists, and spent time in the dialysis clinic. Most importantly, my fieldwork provided me with an intimate understanding of the distinct ways that communities in El Salvador and Nicaragua are reacting to CKD. While in El Salvador there appeared to be no cohesive grassroots response to the disease, the FMLN-controlled government established a dialysis clinic to serve the most impacted region of the country. The opposite appeared to be true in Nicaragua, where the government responded minimally to the disease, but where a number of grassroots organizations had formed among the affected. Moreover, the etiological theories that guided particular interventions also diverged and, at least in some cases, appeared to be influenced by the political objectives of the researchers. These findings have provided me with a far more nuanced understanding of how CKD is being interpreted and responded to. This has also provoked me to consider why divergences exist in responses and interpretations between reseaerchers and between countries, which I seek to continue exploring in future research.