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Sri Lanka: Chronic Kidney Disease

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By A Correspondent *

 “For two decades, chronic kidney disease has been a mystery and death sentence in Sri Lanka  striking 15 percent of the residents of its north central region.” Sasha Chavkin and Anna Barry-Jester of The Center for Public Integrity report, headlined “ Mystery in the Fields , In Sri Lanka, breakthroughs, setbacks and a spiritual touch ” [1], from Kebithigollewa , Sri Lanka.

On the same issue Rhitu Chatterjee's report “ Sri Lanka kidney disease blamed on farm chemicals” was carried by BBC [2] on September 18, 2012 .

The reports said:

Thousands of people in Sri Lanka have been struck by a mysterious and deadly form of kidney disease. A new study points to a likely cause – pesticides and fertilizers.

Thousands of people in the country's North Central Province are suffering from chronic kidney disease. The Ministry of Health informed: 15% of the population there is affected. Most of them are rice farmers.

The disease first came to the attention at the public hospital in Anuradhapura , the provincial capital, about 20 years ago.

These patients didn't fit the typical profile. They didn't have diabetes or high blood pressure, the common causes of chronic kidney disease worldwide. To distinguish this illness from the more common form of chronic kidney disease, the government labeled it chronic kidney disease of unknown etiology (meaning, of unknown cause) – CKDu.

For CKDu, there's still no specific treatment, and no known way to prevent it.

Four years ago, the World Health Organization (WHO) and the government launched an investigation into its causes. People and the environment – blood, urine, tissue samples and the region's food, water, and air were tested.

The results, released this summer, suggested that the culprits were two toxic metals – chronic exposure to cadmium and arsenic – contaminating food and the air.

A similar mystery kidney disease is found in Costa Rica , Nicaragua , Guatemala , and El Salvador , and also India .

In Sri Lanka it mainly affects rice farmers while in Central America the victims mostly work on sugar cane plantations

Relatively high levels of the metals showed up in the blood and urine of people in the North Central Province , says Palitha Mahipala, an official with the Sri Lankan Ministry of Health.

Although the levels were generally within what is considered the safe range, Mahipala says that continuous exposure to those levels may have been damaging.

But if arsenic and cadmium are to blame, where are they coming from?

The new study blames farm chemicals, which are cheap in Sri Lanka . These are subsidized and often overused.

Cadmium is found in some fertilizers. Arsenic is an active ingredient in some pesticides.

Companies importing and selling pesticides and herbicides contest the government's conclusion. They point out that the government and WHO have not yet released their full study.

The WHO says it will publish the study in the coming months, but are still finalizing details.

Some doctors and scientists familiar with the study agree that more research needs to be done, but many assume that farm chemicals are at least partly to blame for CKDu.

In its press release about the study, the government writes that preventing "indiscriminate use of fertilizers and certain pesticides… can help protect the kidney".

Yet little has been done to spread that message to the people who should hear it.

Farmers […] in the North Central Province say they know nothing about the study.

Nor have consumers been told what foods are most likely to be contaminated. The government says it will release that information after it has conducted more detailed studies.

This failure to publicize the results of the WHO study frustrates doctors.

Dr Palitha Bandara, the top health official in the North Central Province , wants the government to improve tests on farm chemical imports.

Many fertilizers, he says, come from China . "We don't know what types of chemical ingredients - elements are there in the fertilizers."

As for pesticides, last year customs officials did test some imports and found four types that contained small amounts of arsenic, although arsenic-based pesticides are illegal in Sri Lanka .

Those pesticides were seized by the authorities, but later released. The head of the pesticide regulatory agency assured the public that the levels were too low to cause any harm.

Aniruddha Padaniya, president of the Government Medical Officers' Association, blames "vested interests" for preventing strict policing of agrochemicals. Tackling the illness should be a national priority, he argues.

There are many unanswered questions:

Are the levels of cadmium and arsenic found in people's bodies high enough to cause harm? If the metals are to blame, is the main culprit cadmium? Arsenic? Or are the metals acting in combination? Are the metals coming mostly from pesticides, or fertilisers? And if farm chemicals are the root cause of CKDu, why aren't farmers elsewhere in the country affected?

Government hospitals provide […] medical care, including dialysis, free of charge.

Other countries that have been struck by a similarly mysterious form of chronic kidney disease, most notably, in Central America , offer dialysis to only a small fraction of patients who need it. Kidney dialysis is an expensive procedure.

In Sri Lanka , the government is trying to help larger numbers of patients. It is expanding access to dialysis and to kidney transplants. These efforts are keeping many patients alive.

But doctors and public health officials remain frustrated. They say more should be done to prevent people from getting sick in the first place.

In the lush northern farmlands, the mystery and the death sentences continue. Lacking firm answers from the scientific community, some victims' best hope for survival comes through the spiritual community — and offers of kidney transplants from Buddhist monks and those they inspire to make extraordinary sacrifices for strangers.





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