A Mystery Kidney Epidemic Is Slowly Killing Sri Lankan Farmers

Sri Lankan worker in a rice field
Sri Lankan worker in a rice field
Ric Wasserman

ANURADHAPURA — More than 20,000 farmers in Sri Lanka, mostly rice farmers in the north, have lost their lives in recent years because of an unexplained surge in kidney disease. It has now reached epidemic proportions, and patients are descending on overwhelmed clinics, lining up for the few dialysis machines available.

Karnu Jemanta and his brother, who are working their rice field outside the village of Rambewa, are worried. "We're not sick yet, but we may be soon," Jemanta says. "People from the Health Ministry came and said it could be chemicals, or that we should drink more water when we're working. We're doing what they've told us to do."

In his small house near the Rambewa village, 74-year-old Puntibanda is stretched out on his bed, desperately ill and in the last stages of kidney failure. "Four of my farmer friends are in the same condition as me," he says. "We all drank water from the canals or directly from the fields when we had to. The doctor said I'm dying of kidney failure, but he couldn't say why."

At the kidney unit of the Anuradhapura provincial hospital, it's clear just how devastating the epidemic has become. More than 100 people are waiting for kidney examinations today. The estimated number of those affected is 400,000, according to the Sri Lankan Health Ministry.

"I would say it was first noticed some 15 to 20 years back," explains nephrologist Rajeewa Dissanayake. "They looked into it in detail and found that there were lots of patients with kidney disease here." He says a screening program has helped to identify those affected. "So far I think about 150,000 have been screened, and a number of them have been detected and have been treated." But, he says, "We don't know what the cause is, so it's difficult to prevent."

Channa Jajasumana, a medical faculty member at Rajarata University, says more research is needed. He's been studying Sri Lanka's rampant kidney disease for the last 10 years and says there are two important questions that need to be answered: "Why has this epidemic come after the mid-1990s? And what is the reason for this unique geographical distribution?"

On his computer screen, Jajasumana displays a map of Sri Lanka where the districts that are most affected are highlighted. He points to a clear area where there is no disease. "You will see that this disease is confined to certain regions of the dry zone in Sri Lanka — but not in the northern peninsula," he says. "There, the climate is quite hot compared to Anuradhapura, but there's no disease. What could be the reason?"

Are agrochemicals to blame?

He speculates that the explanation has to do with terrorism over the last 30 years, and the fact that the Sri Lankan government didn't allow agrochemicals to be sent to that area. "The people in the northern area have not used those chemical because terrorists used these fertilizers to produce explosives."

But so far this theory hasn’t been substantiated with hard, empirical evidence. What is certain is that 80% of those affected are poor rice farmers.

The World Health Organization released a 2013 study regarding the Sri Lankan kidney disease epidemic, and it points to several possible causes: low levels of cadmium and other heavy metals, the presence of pesticides, and dehydration and genetic factors among the farmers.

Curiously, there is a similar ongoing epidemic in Latin America. Research being conducted there by a Swedish team of researchers and led by kidney specialist C.G. Elinder points to chronic dehydration as a major factor.

In Latin America, it’s sugar cane workers who are being taken ill. "We've done specialized examinations on patients, and we've seen that their kidneys don't have the typical appearance of those affected by chemicals, which usually bear marks of inflammation," Elinder says. "What we see is kidneys that are affected by lack of oxygen. That can mean that they are suffering from chronic dehydration and loss of electrolytes."

In the hot climate, cutting sugar cane all day and not drinking enough fluids can cause chronic damage to the kidneys, Elinder says. But specialists don’t know if the underlying cause is the same in both Latin America and in Sri Lanka. In a few months, the Swedish and Sri Lankan research teams will meet in northern Sri Lanka to conduct more studies.

Despite thousands of deaths related to kidney disease on several continents, it's difficult to find sufficient funding for research, says Annika Werneson, a pathologist with the Swedish research team. She's frustrated that the disease hasn't been given the attention it deserves from more developed countries. "If this epidemic had happened in Europe, we'd certainly have found plenty of research money."

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The Food Truck, A Sign That The White And Wealthy Are Moving In

In San Diego, California, a researcher tracked how in the city's low-income neighborhoods that have traditionally lacked dining options, when interesting eateries arrive the gentrification of white, affluent and college-educated people has begun.

Balboa Park Spring Fling Food Truck festival

San Diego Food Trucks via Facebook
Pascale Joassart-Marcelli

SAN DIEGO — Everybody, it seems, welcomes the arrival of new restaurants, cafés, food trucks and farmers markets.

What could be the downside of fresh veggies, homemade empanadas and a pop-up restaurant specializing in banh mis?

But when they appear in unexpected places – think inner-city areas populated by immigrants – they're often the first salvo in a broader effort to rebrand and remake the community. As a result, these neighborhoods can quickly become unaffordable and unrecognizable to longtime residents.

An appetite for gentrification

I live in San Diego, where I teach courses on urban and food geographies and conduct research on the relationship between food and ethnicity in urban contexts.

In recent years, I started to notice a pattern playing out in the city's low-income neighborhoods that have traditionally lacked food options. More ethnic restaurants, street vendors, community gardens and farmers markets were cropping up. These, in turn, spurred growing numbers of white, affluent and college-educated people to venture into areas they had long avoided.

This observation inspired me to write a book, titled The $16 Taco, about how food – including what's seen as "ethnic," "authentic" or "alternative" – often serves as a spearhead for gentrification.

Take City Heights, a large multi-ethnic San Diego neighborhood where successive waves of refugees from places as far away as Vietnam and Somalia have resettled. In 2016, a dusty vacant lot on the busiest boulevard was converted into an outdoor international marketplace called Fair@44. There, food vendors gather in semi-permanent stalls to sell pupusas, lechon (roasted pig), single-sourced cold-brewed coffee, cupcakes and tamarind raspado (crushed ice) to neighborhood residents, along with tourists and visitors from other parts of the city.

Informal street vendors are casualties.

A public-private partnership called the City Heights Community Development Corporation, together with several nonprofits, launched the initiative to increase "access to healthy and culturally appropriate food" and serve as "a business incubator for local micro-entrepreneurs," including immigrants and refugees who live in the neighborhood.

On paper, this all sounds great.

But just a few blocks outside the gates, informal street vendors – who have long sold goods such as fruit, tamales and ice cream to residents who can't easily access supermarkets – now face heightened harassment. They've become causalities in a citywide crackdown on sidewalk vending spurred by complaints from business owners and residents in more affluent areas.

This isn't just happening in San Diego. The same tensions have been playing out in rapidly gentrifying areas like Los Angeles' Boyle Heights neighborhood, Chicago's Pilsen neighborhood, New York's Queens borough and East Austin, Texas.

In all of these places, because "ethnic," "authentic" and "exotic" foods are seen as cultural assets, they've become magnets for development.

Food vendor at outdoor international marketplace called Fair@44.

Fairat44 via Instagram

A call for food justice

Cities and neighborhoods have long sought to attract educated and affluent residents – people whom sociologist Richard Florida dubbed "the creative class." The thinking goes that these newcomers will spend their dollars and presumably contribute to economic growth and job creation.

Food, it seems, has become the perfect lure.

It's uncontroversial and has broad appeal. It taps into the American Dream and appeals to the multicultural values of many educated, wealthy foodies. Small food businesses, with their relatively low cost of entry, have been a cornerstone of ethnic entrepreneurship in American cities. And initiatives like farmers markets and street fairs don't require much in the way of public investment; instead, they rely on entrepreneurs and community-based organizations to do the heavy lifting.

In City Heights, the Community Development Corporation hosted its first annual City Heights Street Food Festival in 2019 to "get people together around table and food stalls to celebrate another year of community building." Other recent events have included African Restaurant Week, Dia de Los Muertos, New Year Lunar Festival, Soul Food Fest and Brazilian Carnival, all of which rely on food and drink to attract visitors and support local businesses.

Meanwhile, initiatives such as the New Roots Community Farm and the City Heights Farmers' Market have been launched by nonprofits with philanthropic support in the name of "food justice," with the goal of reducing racial disparities in access to healthy food and empowering residents – projects that are particularly appealing to highly educated people who value diversity and democracy.

Upending an existing foodscape

In media coverage of changing foodscapes in low-income neighborhoods like City Heights, you'll rarely find any complaints.

San Diego Magazine's neighborhood guide for City Heights, for example, emphasizes its "claim to authentic international eats, along with live music venues, craft beer, coffee, and outdoor fun." It recommends several ethnic restaurants and warns readers not to be fooled by appearances.

Longtime residents find themselves forced to compete against the "urban food machine"

But that doesn't mean objections don't exist.

Many longtime residents and small-business owners – mostly people of color and immigrants – have, for decades, lived, worked and struggled to feed their families in these neighborhoods. To do so, they've run convenience stores, opened ethnic restaurants, sold food in parks and alleys and created spaces to grow their own food.

All represent strategies to meet community needs in a place mostly ignored by mainstream retailers.

So what happens when new competitors come to town?

Food vendor at outdoor international marketplace called Fair@44.

Fairat44 via Instagram

Starting at a disadvantage

As I document in my book, these ethnic food businesses, because of a lack of financial and technical support, often struggle to compete with new enterprises that feature fresh façades, celebrity chefs, flashy marketing, bogus claims of authenticity and disproportionate media attention. Furthermore, following the arrival of more-affluent residents, existing ones find it increasingly difficult to stay.

My analysis of real estate ads for properties listed in City Heights and other gentrifying San Diego neighborhoods found that access to restaurants, cafés, farmers markets and outdoor dining is a common selling point. The listings I studied from 2019 often enticed potential buyers with lines like "shop at the local farmers' market," "join food truck festivals" and "participate in community food drives!"

San Diego Magazine's home buyer guide for the same year identified City Heights as an "up-and-coming neighborhood," attributing its appeal to its diverse population and eclectic "culinary landscape," including several restaurants and Fair@44.

When I see that City Heights' home prices rose 58% over the past three years, I'm not surprised.

Going up against the urban food machine

Longtime residents find themselves forced to compete against what I call the "urban food machine," a play on sociologist Harvey Molotch's "urban growth machine" – a term he coined more than 50 years ago to explain how cities were being shaped by a loose coalition of powerful elites who sought to profit off urban growth.

I argue that investors and developers use food as a tool for achieving the same ends.

When their work is done, what's left is a rather insipid and tasteless neighborhood, where foodscapes become more of a marketable mishmash of cultures than an ethnic enclave that's evolved organically to meet the needs of residents. The distinctions of time and place start to blur: An "ethnic food district" in San Diego looks no different than one in Chicago or Austin.

Meanwhile, the routines and rhythms of everyday life have changed so much that longtime residents no longer feel like they belong. Their stories and culture reduced to a selling point, they're forced to either recede to the shadows or leave altogether.

It's hard to see how that's a form of inclusion or empowerment.The Conversation


Pascale Joassart-Marcelli is a Professor of Geography and Director, Urban Studies and Food Studies Programs at San Diego State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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