In the recent past, the farming communities in Sri Lanka have been witnessing a troubling surge in cases of kidney disease, a health issue that was once rare in these rural areas but has now become a significant concern affecting a large portion of the population. The underlying reasons for this sudden increase in kidney disease cases remain unclear, leaving researchers, healthcare professionals, and community members puzzled. This article aims to explore the potential factors contributing to this worrying trend and the implications it has on the affected communities.
A Glimpse into Rural Life in Sri Lanka
In the serene village of Ambagaswewa, nestled in the Polonnaruwa district of Sri Lanka’s North Central province, 63-year-old TMH Gamini Sunil Thennakoon leads a relatively peaceful life. Despite nearing retirement, Thennakoon spends his days tending to his rice paddies and cherishing moments with his grandchildren and family. Agriculture is a cornerstone of Sri Lanka’s economy, accounting for 21.7% of its total exports.
Thennakoon, however, has been grappling with unexplained kidney issues for over seven years. While his symptoms, including abdominal and back pain, are not severe enough to warrant dialysis, he relies on medication to manage his discomfort. His monthly visits to a local government health facility, located over 30km away, disrupt his farming routine, necessitating the hiring of laborers to tend to his rice fields.
The Impact on Local Farmers
Thennakoon is not the only individual affected by kidney disease in his community. U Subasinha, a 60-year-old rice farmer residing nearby, shares a similar tale of hardship. With one of his children disabled since birth and his wife diagnosed with chronic kidney disease, Subasinha himself has been battling acute kidney failure for the past eight years. The burden of dialysis, which he undergoes four times a week, coupled with the financial strain of treatment expenses, weighs heavily on his family.
Unraveling the Mystery of Kidney Disease
Globally, chronic kidney disease (CKD) has emerged as a significant health concern, with 10% of the world’s population affected by the condition. In rural Sri Lanka, a distinct form of kidney disease known as chronic kidney disease of unknown etiology (CKDu) has garnered attention. Research indicates that up to 22.9% of individuals in hotspot regions like Polonnaruwa and Anuradhapura districts are grappling with acute kidney damage or failure, with no definitive cause identified.
Nishad Jayasundara, a researcher specializing in global environmental health, sheds light on the disproportionate impact of kidney diseases on rural farming communities in Sri Lanka. He emphasizes that over 20,000 individuals in the country are in the end-stage of kidney failure, with 6 to 10% of the population in affected areas diagnosed with CKDu. Studies suggest a correlation between CKDu and agricultural irrigation water sources in Sri Lanka, underscoring the complex interplay between environmental factors and public health.
Conclusion
The rising incidence of kidney disease in Sri Lanka’s rural communities underscores the urgency of addressing this public health crisis. As researchers strive to unravel the mysteries surrounding CKDu and its impact on farming populations, concerted efforts are needed to implement preventive measures and provide accessible healthcare services to those affected. By raising awareness and fostering collaboration between stakeholders, we can work towards mitigating the burden of kidney disease and safeguarding the well-being of vulnerable communities.
Recognizing the Absence of Early Symptoms
Chronic Kidney Disease (CKD) typically presents identifiable signs such as weight loss, swollen ankles, shortness of breath, and itchy skin in its early stages. In contrast, Chronic Kidney Disease of Unknown etiology (CKDu) is asymptomatic until the advanced stages, making early detection nearly impossible. By the time patients receive a diagnosis, the disease is often untreatable.
Even when symptoms do appear, they are usually vague and include back pain, body aches, and swelling in the legs and hands. These symptoms are often overlooked by farmers and fishermen accustomed to strenuous manual labor.
Dr. S B A M Mujahith, a nephrologist at Batticaloa Teaching Hospital in Sri Lanka, emphasizes the challenge of identifying CKDu early on. He highlights the geographical link to the eastern and north-central provinces of the country, where the disease is prevalent among agricultural workers.
Originally recognized as a concern in the 1990s, CKDu, also known as Chronic Interstitial Nephritis in Agricultural Communities (CINAC), primarily affects male agricultural workers exposed to toxic agrochemicals through various means. The economic crisis in Sri Lanka has exacerbated the situation, leading to limited access to essential resources for disease management and treatment.
The Role of Education in Addressing CKDu
Researcher Jayasundara, who hails from a farming village in southern Sri Lanka, is investigating the factors contributing to CKDu. He explores the impact of agrochemical concentrations during drought periods and the broader implications of the economic downturn on the country.
Chronic kidney disease, particularly in agricultural communities, serves as a significant indicator of environmental damage according to Jayasundara. The complex nature of CKDu makes it challenging to provide solutions to villagers, even as some individuals transition from groundwater to filtered water sources.
Filtered water remains inaccessible to many due to financial constraints, particularly in rural areas. The economic crisis has made it difficult for farming and fishing communities to invest in water filtration systems, despite the known benefits of clean water in preventing kidney diseases.
Addressing Environmental Exposures and Public Health
Research scientist Sameera Gunasekara from Theme Institute in Sri Lanka focuses on the impact of climate change and environmental exposures on public health, particularly kidney diseases. He emphasizes the need for further education in underserved regions to promote awareness of the importance of clean water.
In the affected farming provinces, Gunasekara works to educate the local population on reducing agrochemical use, avoiding prolonged sun exposure, and staying hydrated. Overcoming the challenges of convincing hardworking farming and fishing communities to prioritize their health remains a critical aspect of disease prevention.
The economic crisis further complicates efforts to address CKDu, as many families struggle to afford basic necessities like filtered water. Gunasekara emphasizes the importance of early screening and intervention to prevent the long-term consequences of kidney disease in vulnerable populations.
In the era of small farms and rice and fish processing industries, there was once a site of intense conflict during the country’s recent, long-standing civil war between the Sinhalese and Tamils. This area is particularly known for the prevalence of Chronic Kidney Disease of unknown etiology (CKDu).
The civil war, an ethnic conflict that spanned 26 years and ended in 2009, resulted in the deaths of over 100,000 civilians and 50,000 soldiers from both the Tamil and Sinhalese communities.
Christy PL Navil, a 58-year-old fisherman with 12 years of experience, spends his days fishing for calamari along the Pasikuda sea near Batticaloa. Despite the challenging conditions, including limited water supply on the boats, Navil continues his work tirelessly, sometimes going without water or food for hours due to the demands of fishing.
Due to the economic crisis, many fishermen are forced to reduce their food intake, often surviving on just one meal a day. This chronic dehydration poses a significant risk to their health, leading to various health issues, including CKDu.
Sivanandarajah, a marine researcher, highlights the factors contributing to CKDu, such as hereditary traits, water sources, pollution, and lifestyle choices. She also points out the lack of formal fishing collectives or societies, which hinders the understanding of the impact of ocean resource depletion on these communities.
The scarcity of food, especially during the low season and economic downturn, further exacerbates the challenges faced by fishermen. Additionally, the excessive use of tube wells, which extract hard water from deep underground, contributes to kidney-related health issues among the fishing communities.
Geological shifts linked to climate change, such as rising sea levels and increased seismic activity, pose additional threats to coastal communities, including fishermen. These environmental changes can further impact the livelihoods and health of those reliant on the sea for their sustenance.
In Pasikuda, fishermen like Nadaraja Pereatambi have been grappling with kidney issues, possibly due to poor water quality in the area. Pereatambi, who had to take out a significant loan to cover his medical expenses, emphasizes the financial burden faced by fishermen in accessing healthcare.
In Negombo, along Sri Lanka’s western coast, W Sirani Silva, a 48-year-old patient with acute kidney damage, reflects the struggles faced by individuals battling kidney-related illnesses. Despite the challenges, Silva remains determined to seek treatment and manage her condition with the support of her husband.km is a woman who undergoes dialysis sessions at a health facility twice a week and is currently awaiting a kidney transplant. Due to her illness, she is unable to take care of her home and three children, but she is grateful that they are healthy. The family has made the switch to drinking filtered water since her diagnosis, although they still use well water for cooking and other household needs.
Ample Usdesangar, km’s husband, accompanies her to every dialysis appointment, which results in him losing income from his job as a tuk-tuk driver (previously a fisherman) on those days. He expresses confusion about the origin of km’s illness, as she had no history of hypertension or diabetes, which are common causes of kidney disease. He speculates that it may be a hereditary issue within the family.
It is a challenging time for km and her family as they navigate through her illness and treatment. The financial strain, coupled with the emotional toll of the situation, adds to the difficulties they face on a daily basis. Despite the hardships, they remain hopeful for a positive outcome and continue to support each other through this trying time.