By 10am in the sugarcane fields outside the town of Tierra Blanca in El Salvador, the mercury is already pushing 31\u00b0C. The workers arrived at dawn: men and women, young and old, wearing thick jeans, long-sleeved shirts and face scarves to prevent being scorched by the sun\u2019s rays. They are moving quickly between rows of cane, bending, reaching, clipping and trimming in preparation for harvesting the crop in the weeks to come. In the scant shade, old Pepsi and Fanta bottles full of water swing from tree branches, untouched. Gulping only the thick air, the workers won\u2019t stop until noon, when their shift is over.<\/p>\n
Among them is 25-year-old Jes\u00fas Linares. His dream, he explains in English, was to be a language teacher, but like many Salvadoran children he went to work to help support his parents and siblings. Aged eight, he learned to hide in the towering canes whenever the police sought out underage workers; since then, he\u2019s tended sugarcane from dawn to noon and then pigs until dusk. In the evenings, he tries to listen to English audio programmes or read a language book, but for the last year he\u2019s been too tired to concentrate. So tired, in fact, that a few months ago he visited the Tierra Blanca clinic. Blood tests revealed that Linares was in the early stages of chronic kidney disease.<\/p>\n
It\u2019s a familiar story here in the Bajo Lempa region, where recent studies suggest that up to 25 per cent of its nearly 20,000 inhabitants have chronic kidney disease. Across El Salvador, kidney failure is the leading cause of hospital deaths in adults. But while chronic kidney disease is most commonly caused by hypertension and diabetes, two-thirds of patients in Bajo Lempa don\u2019t have either of those conditions, and the cause of their illness remains uncertain.<\/p>\n
Scientists have identified certain key themes. The majority of people with the unexplained disease are men, and it strikes predominantly in hot, humid regions where people are engaged in strenuous outdoor labour: farming, fishing or construction work. Dehydration, which seems an obvious factor, causes acute kidney disease that is easily reversed by drinking water, rather than this chronic form. This has left two burning questions: what causes this new form of kidney disease, and will it be likely to spread as the world gets warmer?<\/p>\n
Meanwhile, in El Salvador over the last two decades, more and more patients have arrived at clinics and hospitals, often taxing them to their limit. Many people, unable to get treatment, simply return to their homes to die.<\/p>\n
\u201cThis is really a silent massacre,\u201d says Ram\u00f3n Garc\u00eda-Trabanino, a Salvadoran kidney specialist.<\/strong><\/p>\n\n