What we immediately liked about Jason, besides the fact that he has quite successfully campaigned in favour of the carrying out of independent research into the causes of the disease, i.e. research that would not be funded only by the industry, was his relentless efforts to put in place concrete solutions without waiting for scientific conclusions.
It can take years to reach such conclusions, and they are always questionable and questioned (as was demonstrated in Europe with the issue of endocrine disruptors), whereas the use of common sense only takes a few moments…
For that reason, after completing several pilot projects in Salvador, he recommends very simple solutions based on a limpid trilogy: rest, hydration and shade. The only missing element is the fourth ingredient, maybe the most important one: political will.
This interview was amended several times due to changes in the case. It began in November 2016, but was updated in March 2018 for the last time. It is interesting to note that, between our first contact and today, whether this was a fortuitous event or not, Jason started to work in close collaboration with the directors of the Pellas Group (Flor de Caña) under a cooperation agreement (the Adelante initiative) providing for the sharing of data and the common use of practical, innovative solutions.
Rumporter: You have spent most of the past 7 years in Nicaragua struggling for the sake of sugar cane cutters in the country. What first led you there? How did you end up in Chichigalpa?
Jason Glaser: The first night I went to Chichigalpa was on the recommendation of my friend who was an x-sugarcane worker and advocate. He and I started La Isla Foundation together in Nicaragua about 9 months later.
At the time I was working on the documentary Banana Land.
That first night there was a protest by the once independent community group ASOCHIVIDA (years later the board of that group would be asked to either work with the company or leave and was stocked by the company and the organization is supported now by the company) and it was a very sad protest. They were at the company gates, over 5 km from the Panamerican. So, no one of influence was ever going to see this.
There were 8 men or so in hammocks strung up in front of the gate. They were dying of CKDu and dying there in public in protest. Other community members were arguing with a line of cops and there had clearly been a scuffle.
The cops took our producer for an hour of questioning and took her number.
The next morning we got a call from the Miami offices of Burson-Marsteller the massive US public relations firm and we were told there was nothing to see there in Chichigalpa and we should not worry about the situation.
In short order I did what I could to help with the complaint made by the still independent ASOCHIVIDA community group, to the World Bank. However, very quickly the board was reformed of ASOCHIVIDA and they started becoming yes-men for the company and the bank. The focus of the complaint became less about understanding, or preventing, CKDu and more about giving people hand outs (food, etc.). If a ASOCHIVIDA member spoke out against the company, their food stipends were cut.
So, something was clearly going very wrong in Chichigalpa. We also had a good relationship with community members and the local university so we worked to start putting the data out on the issue and serve as a counterbalance to the emerging Worldbank/IFC process named CAO (www.cao-ombudsman.org)
That process, the CAO, increasingly appeared as a hand washing mechanism and they used Boston University’s studies, which at that time were not peer reviewed but published straight to the CAO website, to justify giving further loans to the sugar industry (see article).
R : When was the first scientific study on the disease made? What made you claim that its conclusions were poor and/or orientated? What made them do another one?
JG : The first one published on the CAO website was in 2010 I believe. They did not publish an independently reviewed paper until 2013. Their first conclusions, despite the data, were very opaque and placed little, to no focus on the occupational link. They were completely non-committal.
The hygiene assessment also reported a total fiction of worker conditions for the vast majority of the field work force and it was carried out in a pathetic way. They toured the company from air-conditioned buses. They did not meet with independent community members or observe field conditions without chaperones.
They later got money from the industry that the industry laundered through the CDC Foundation which aside from this issue had engaged in other questionable acceptance of funds: http://www.bmj.com/content/350/bmj.h2362
I then called a meeting at CDC with leading researchers on the issue. Some of the leaders in their fields of occupational health and epidemiology. It was decided that BU could use the money but they would have to have an oversight committee made up of people from CDC-NIOSH and leading research institutions that approved research questions and studies before submitted for publication.
BU’s research has much improved since the CAO reports and they’ve added important information to the understanding of CKDu. Of interest to me, and what really makes the point that even good people and institutions can be coopted when the proper lines of peer review of conflicts of interest are not followed is that the study that concludes that the disease is indeed associated with occupation is based on the EXACT data that without peer review and oversight they concluded for the IFC was ‘not clear’.
R : In your deepest what is to you the main cause for the CKDu?
JG : I’m a fairly patient person. I do think we’ll understand the causal drivers of this disease by doing both intervention studies and both occupational and community-based cohort studies. From the data I’ve seen, and what we are working on I think that this disease is truly multi-causal. The populations affected have nearly every disadvantage and every exposure that has been offered up, from poor nutrition choices due to poverty, to toxin exposure at work and at home, to heat stress and dehydration at work etc.
But I believe that if you intervene on the dehydration and heat stress risk, that you’ll give the individual’s body a chance to manage the other affronts they are facing. There may well be something that is extant in the environment that is affecting people from day one, but the groups that are most affected, worldwide, appear to be those who work the fields. So, if we address the risks identified in those fields, and continue to understand what is in the environment, we’ll be able to intervene and stop it. I hope there isn’t much longer to go to understand the causal drivers, and our colleague’s current research in Nicaragua, Sweden and the UK should illuminate this more.
R : If the cause is mainly occupational how do you explain no other country, no other industry is put on the grill like Nicaragua’s sugar producers?
JG : Several other industries and countries are affected. While it’s not completely clear what is occurring in Sri Lanka and India is the same thing as what is occurring in the Americas. We are pursuing biopsy, and other studies to ascertain that. But the groups affected are heavy laborers in hot areas. We are getting reports now from Tanzania, Cameroon, Indonesia. They are reports in several crops and industries, from steel to sugarcane. To say that it is not in other crops or industries for places at this stage is not correct but it illustrates the need for standardized prevalence studies like the DEGREE initiative, (a global prevalence initiative we have started).
Sugar is the best studied and the biggest crop in Central America. We need to know what else is going on out there though with other heavy laborers. That’s why we push for the DEGREE study. I have attached two nice articles on the global scope of disease. Here is this nice article from Science: http://www.sciencemag.org/news/2016/03/mysterious-kidney-disease-goes-global
I also agree the EU quota/preferential price system situation is going to change the dynamics! You should go to Bonsucro week in London on December 1 and 2. I will be there. Labor, CKDu, the new rules for 2017 are all to be discussed. Many industry people.
R: How has the sugar producing company addressed the issue during all these years?
JG: That said, Flor De Caña has repeatedly had the best opportunity to do this right and address this issue for those affected locally and globally. Until recently they’ve consistently chosen the most narrow and short-term way to do it. So, in a way, they absolutely deserved the focus and ire whether or not they now treat their 400-500 remaining cutters reasonably well.
I never would have stayed in Nicaragua to pursue what was going on if a PR company from Miami hadn’t called to say “there is no problem, and nothing to see here” after the Nicaraguan national police clearly gave our information to a private company. Later I got informed by a leak about the strategy of this PR company to put and keep pressure on us: horrifying.
It’s also very important to note that an internal report from 2001 was given to us from the company and the sugar association in Nicaragua. It concludes that the drivers of the disease are likely:
1.High heat and high dehydration during the work day.
2.Potential exposure to certain types of pesticides
3.Consumption of anti-inflammatory medication due to the harsh working conditions
4.Potentially the consumption of certain antibiotics
The recommendations they made in 2001 were to :
1. Shorten the workday to 8 hours, suggesting it was much longer and we certainly documented as such.
2. Provide water and rest during the day, along with hydration beverages akin to Gatorade.
3. Encourage healthy lifestyle practices.
The issue I have is that while the company provided this to a very small number of their workforce via direct contracting, less than 400 from what we could tell, thousands were subcontracted by the company and often received nothing during their workday and child labor was still an issue.
Once the Vice article hit, I must say that the company really started to take concerns seriously and now directly contracts the workforce. However, this is 15 years after the in-house study and years of denying an occupational link publicly. A lot of wasted time and lives.
That said, we have to focus on working with them towards a more secure future for the workforce and those that are no longer able to work who are sick. The past is the past, the company appears focused on moving forward and doing so in a collaborative, and as far as I can tell, open way. This is an important shift and I will work with them as long as we keep everything transparent, and focused on the health outcomes of the workforce as it pertains to CKDu.
Another concern is that the industry in general has rapidly mechanized leaving thousands without work. If we do not address things in an integrated manner with development banks and health NGOs and the UN via PAHO, may people will die without aid as the hiring practices from the bad old days cut affected people out of social security. It’s a horrible situation.
R: When have things started to change with Grupo Pellas?
To the company’s credit when I told them they had not in fact included all the science and provided them with a full list they then put it all up on their site but only after getting caught only offering the weakest and least convincing research. Lesson learned they respond to pressure but left to their own devices will still try and control the information and focus on their image . I don’t think this is unique and standard corporate protocol.
Mechanization is a major issue, most of these workers when sick were fired after being tested by the company and then worked for subcontractors. This cut them out of the social security system. That means that the company knew their labor needs, but did not want to directly contract sick workers. The biggest problem aside from being in a tough situation re: Social Security is that the conditions for work under subcontractors were particularly difficult, often without water or shade or hydration solutions provided, and much longer workdays.
So really 2 things:
1. Workers who are sick with no access to care despite their showcasing their hospital the hospital cannot help ckdu patients as there is no dialysis).
2. Massive unemployment due to a rapid transition to mechanization. This requires an immediate and serious conversation with development agencies, banks and government.
R : What are you implementing with San Antonio now and how do you plan to monitor it? What are the main issues remaining?
JG : We are setting up the Adelante Initiative with them and Bonsucro. The idea is to:
1. Answer remaining questions re: occupational interventions and measure the outcomes to ensure we are limiting identified risks and that limits damage during the day and over a harvest. This is a multi-year effort by nature.
2. Once we have devised a scalable and systematic and measurable approach we will create interventions for other at-risk workers. The hope is a modular system that can be applied to different jobs in the sugar industry but also to other industries and via a system that is scalable and affordable to less resource rich companies. The Pellas Group has a lot of ability and know how so if we work together in good faith we will accomplish a lot.
3. We would like to address the needs of the community due to mechanization with the company and others.
R : Now that Nicaragua’s case is in the process of being taken care of what is the next step for you. You have mentioned the idea of chasing Ckdu in other countries, which ones are you looking at?
JG : Putting CKDu on the map and demonstrating the economic impact is the most important thing we can do while working on interventions and continuing to study etiology. We need those three things together.
We are looking at CKDu in Sri Lanka, India, Malawi, Cameroon, Tanzania, South Africa, Brazil, Ecuador, Uruguay, Argentina, USA, Spain, and other sites.
This disease increasingly appears to be the disease of the underclass, those that are not measured or monitored effectively by their health systems in their home countries or the countries they work in. Of note are reports of Nepalese workers returning home with what could be CKDu after working on world cup and other construction in Qatar.
R : Thinking of the rum industry again, what would you like the players in our industry to do to fight against the disease?
JG : What we have set up with the Adelante initiative is important, but we must receive more support, especially financial, from the brands and other producers in the region.
Personally, I think that powerful brands such as Bacardi or Zacapa or even others should join us, instead of letting Flor de Caña carry alone the burden of all the investments. It is likely that big brands buy their molasses from sugar refineries whose supply chain has been affected by the disease. And I think it’s ludicrous that they haven’t been required to comply with the same standards. Why has so little money been invested by associations and other sugarcane trade unions in Central America.
These projects directly benefit workers, but they prefer to spend up to millions of dollars on mediocre studies. The only concrete project aiming at really improving workers’ lot has been supported by only one driving force, Ingenio San Antonio. This doesn’t seem fair to me, bearing in mind that the Adelante initiative, because of our good collective knowledge of the disease, is certainly the one with the most chances to lead to an understanding of the causes of the disease, while protecting workers. A win win situation if ever there was one!