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A SWEET AND SOUR EPIDEMIC

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    A cane cutter, covered in the soot and ashes of charred sugar cane, works in a field that was burned the night before, in Chichigalpa, Nicaragua on May 1, 2014.
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    A worker slices through the burnt stalks of sugar cane.
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    Cane cutters take a break from working in the field to sharpen their blades and recuperate from the intense heat.
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    Sugar cane workers return from a day of work in the fields.
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    A worker closes the hydration tent on the plantation of Ingenio San Antonio in Chichigalpa.
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    Workers for Ingenio San Antonio, the sugar company which controls the town, line up for their food stipends. The company supplies most of the workers who are sick with Chronic Kidney Disease of unknown origin (CKDu), and the families of those who are deceased with a food stipend.
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    A woman carries out her family's monthly food provisions.
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    Sugar cane workers and their families hold a meeting in a park in Chichigalpa. The rally is to discuss strategies for getting their companies to improve their labor, health and employment policies in light of the chronic kidney disease epidemic effecting their community.
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    Sugar cane workers collect their pay and relax after a long day in the fields.
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    Women affected by the CKDu epidemic, attend a meeting at the Cultural Center in Chichigalpa. Sugar cane workers and their families gather to discuss how best to address the CKDu epidemic that is sickening and killing so many of their people.
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    A woman, 31, looks at photographs of deceased loved ones in her home. She has lost a total of seven relatives, including her father, to CKDu, and now works in the sugar cane fields to support her two small children.
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    Four women, all cousins, take a break from working in the cane fields to care for their families. These women work in the sugar cane fields to because either their husbands or brothers have died or gotten sick from CKDu.
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    A former sugar cane worker, 57, receives help with dialysis at home from his daughter at their family compound in Chichigalpa. He suffers from end stage kidney disease after working in the sugar fields for decades. His son, 24, who worked in the sugar fields for 5 years, is now suffering from kidney disease as well.
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    A former sugar cane worker, 57, sits by his son and daughter outside his home in Chinandega. He now suffers from end stage kidney disease after decades of working in the sugar fields.
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    Siblings play together at their home in Chichigalpa. The children's father worked in the cane fields for ten years. After he was diagnosed with CKDu, the Ingenio San Antonio Company fired him and then rehired him as an electrician. When he got sicker, the company fired him again, with 3.5 months severance. He nows lives on subsistence farming with his wife and 3 children. His father, who worked in the fields for decades, died from CKDu.
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    Family and friends attend the the funeral of a sugar cane cutter who died of CKDu at 49 years old, leaving behind four children.
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    A former sugar cane worker, 57, spends the morning at his family compound. After working in the sugar fields for decades, he now suffers from end stage kidney disease.
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    The family of a CKDu-diagnosed former sugar cane worker, 32, spends an evening together at home.
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    Family members gather for the wake of a former cane worker, 29, who died of CKDu in Chichigalpa. The deceased had worked in the sugar cane fields for 5 years before contracting CKDu in 2004. The youngest of six, three of his brothers are also sick with this kidney disease.
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    A former cane worker, 29, who has just passed away after long battle with CKDu, is laid to rest.
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    Locals gather at a cemetery for the funerals of two men who have died of CKDu.
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    Family and friends gather for the funeral procession and burial of a former sugar cane worker, 36, who fell victim to the epidemic after working in the sugar cane fields for 12 years. He is part of a steady procession of deaths among the cane workers in Chichigalpa, Nicaragua.
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    The community turns out to attend the funeral procession and burial of a former cane worker, 36.
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    Family and friends grieve over the body of a former sugar cane worker, 36, who died of CKDu.
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    Family and friends mourn the loss of a former sugar cane worker, 36, who died of CKDu.
A Sweet and Sour Epidemic

In Nicaragua, the average life span of men who harvest sugarcane is 49 years. At the root of these early deaths is an epidemic known as Chronic Kidney Disease of unknown origin (CKDu). In the town of Chichigalpa, often called the “Island of Widows,” 1-in-3 men, mostly cane workers, are in end-stage renal failure from a disease that is both a public health crisis and a social injustice. In Central America alone, more than 10,000 sugarcane workers have become sick or have died from this illness in the past twenty years.

Research on the subject of CKDu has indicated that repeated dehydration, severe heat, and environmental toxins might play a huge part in the rising death toll among sugarcane workers. Pervasive from southern Mexico to Ecuador, Sri Lanka, India, and on into other tropical or subtropical countries, CKDnT is undoubtedly of global concern. After all, nearly everyone on earth consumes sugar in some form, and the United States alone imports a large portion of Nicaragua’s sugar exports.

The reportage features images of sick workers, widows and families left behind, along with funerals, home dialysis and other aspects of daily life. All identities are withheld for the protection of the subjects.

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