by Duminda Alahakoon (Activist)

A country shaped like a teardrop, located in the Indian Ocean, at the end of southern tip of Indian continent called Sri Lanka. Once upon a time, considered as the granary of the Eastern World. As for centuries, farmers there used to largely produce rice. Not only to feed the country but also the world. Today that famous crown has become a thorny one, falling on those farmer’s heads drawing them into an undefeatable suffering of an epidemic for nearly three decades.

CKDU otherwise known as Chronic Kidney Disease of Unknown remains as a silent epidemic in Sri Lanka due to its lack of symptoms at disease onset, complex multifactorial aetiology and social determinants. Chronic Kidney Disease of Unknown Aetiology (CKDu) is one of the leading public health problems commonly seen among farmers in the North Central and Uva provinces in Sri Lanka. The official health reports, estimate that 16% are impacted out of the total population of NCP. Since early 90s around 20,000 patients have died from this fatal epidemic. Mostly affected are farmers and their families with low socio-economic status.

Previously this was identified by the villagers with various kind of names relating to its outer symptoms. But recently, there has been a body of research done by local and international academics including WHO, local universities and health ministry of Sri Lanka. The general purpose is that residues of heavy metals such as cadmium, arsenic, lead and mercury (either naturally present in the soil or added through fertilisers) are now present in virtually all water, soil, and human samples. Along with chemical exposure, dehydration, contaminated water from shallow wells and tube wells, modern diet, and extreme working conditions have also been postulated as contributing factors to the disease, which is now showing up increasingly even in younger generations from age between 18-40. Experts in the fields have proven through their published papers that those heavy metals exceed its standard level in most of agro-chemicals and fertilisers farmers use today for their crops. Most of the areas in Sri Lanka affected by CKDu have hard ground water, typified by high concentrations of calcium, fluoride and/or magnesium when combined with hard ground water containing heavy metals, agro-chemicals become extremely toxic to the kidneys.

Since the onset of Green Revolution in 1960, Sri Lanka also faced to a contrast change among farmers from its ancient farming practices to the modern techniques and chemicals. In 1977, since the country opened its economy to the world, generally known as the Open Economic System, changed the whole life pattern of the people with the economic race. Since then even farmers in remote areas took this opportunity as their fortune and substituted new chemical productions without any standard for their crops, to increase the harvest within a short time. After two decades, the whole country has become a hospital not only with Ckdu but also with other chronic ailments like diabetic, hypertension and cholesterol etc. resulting from following a racing life.

In my recent few trips to the impacted areas in Anuradhapura district alone, I witnessed how people exist amid the low socio-economic conditions and are affected by Ckdu in families regardless of how big or small. Most of the victims, were male farmers aged between 18-60. Within a few years after the diagnose, they come to the final stage of the disease and ultimately embrace the untimely death unless they received a kidney transplant. Although transplants units have been established in hospitals, most patients cannot reach them easily due to some other reasons like failure to afford the cost for medicines after the transplant, 200000LKR bank deposit (this must be shown by the patient to the hospital before the operation for urgent treatments in case the transplant was fail).

On the other hand, western treatments still have not been able to give the complete cure for the Ckdu patient unless diagnosed them in the first and second stages. The disease has 5 stages. When a patient comes to stages 3,4,5 it means he or she is in a fatal situation and then only dialysis can extend their life. In the Anuradhapura hospital alone, around 3000 patients have been identified to be dialysed, but due to lack of facilities only for 250 patients get this chance. Therefore, people do not want to rely on western hospitals anymore and as an option they used to follow on alternative treatments like Ayurveda, homeopathy and traditional methods. But still nothing has proven to cure fully this fatal epidemic.

Some of the young male patients I met had been left alone with children by their wives as they are not able to support the family anymore. It had created many problems with the patients not only breaking them down physically but also mentally, socially and culturally. Most to suffer were the wives of the affected families. The young wives I met, stated that they face the scarcities of life being alone with ailed husband and children. Facing problems like how to support the family alone, caring of patient and educations of children. Some had been the victim of forceful sexual activities by the male relatives or neighbours, sometimes even by the hospital workers when they come to hospital along with their husband. This probably creates other social impacts on the affected families in no times.

Most of farmers I met were very much aware with the general sense of the disease like what are the causes, how it comes and what could be happened. Even that they still want to rely on agro-chemicals and use heavily on their crops to produce a big harvest. They do not care how water can be contaminated, how the soil can be destroyed, how other creatures can be killed by the impact of using agro-chemicals. Most areas provide easy access for clean drinking water thanks to the Reverse Osmosis Water filters that have been set up by the government, NGOs and other big companies. People can get water at a cheaper price from those filters. But sadly, they are unaware of how drainage water filtered out increases the salinity of their farming lands in no time. It’s weird some areas I visited, saw many water filters had been set up by the huge multi-national companies like Hayleys which is known to import agro chemicals to Sri Lanka.

However, government has seemingly taken some snail actions to prevent the disease. By facilitating rural hospitals with the new technology, by expanding screening programs into the villages though it is not enough yet compared to the number of patients recorded daily. Also by putting a ban on the import of some fatal chemicals and fertilisers linked to Ckdu, but then why are farmers able to purchase them on the black market, with an expensive price even today? what can be done to stop the situation and rescue the people from this silent killing?

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