Dying Under the Sun: Portraits of how Guanacaste farmers suffer Chronic Kidney Disease

People with Chronic Kidney Disease know that they will spend most of their lives tied to a bag of serum or a dialysis machine. In rare exceptions, someone donates them a kidney. They don’t have enough money for anything more with their pensions of ¢130,000 per month ($200 in the most expensive country in Central America). But the state of Costa Rica still doesn’t recognize that the chronic kidney problems that Guanacaste farmers face is a labor risk.

This is the story of more than 20 Guanacastecan farmers and their families. All of them, victims of their long hours of work under the sun.

I realized it when I was working and I would arrive home and in the afternoon I would get feverish. I kept working that way and after that I went to the insurance company and they told me that I had the disease. That was about 10 years ago. Now I take a treatment, pills and creatinine. I’m still working in the rice and sugar fields. I go at six in the morning until 10, but the boss pays me for eight hours and the insurance and everything. He’s a good boss. They give me the treatment. The told me that it surely comes from the water and the sun. They told me not to get too much sun. I have the last name of my dad’s wife. García is from my stepmother. My birth mom is sick in Nicaragua. She used to work in landscaping, along the channels, rice fields, he worked in the hills of Rancho Horizonte. We worked from 5am to 5pm there. I worked there several years, Mojica too in Taboga in Guanacaste. I had a friend here and he told me that he was going to come and that he had a job for me. I have three children. All three are studying. One of them is in kindergarten, another one is in grade school and the third is in high school. - Israel Lazo, kidney patient. Bagaces, Guanacaste. July, 2018.

When they told me about the disease, I laughed and the doctor got after me. I told him, I will take care of him. Then a doctor came and told me that it could be hereditary. My grandfather died because of it and I have an aunt who died because of kidney failure. My aunt lived in Cañas and my grandfather in Upala. But they didn’t say anything to me. They think it could have been the sugarcane because back then you would show up, put a pump and everything on your back and it would drip. It’s a product that has fertilizer and a very hot liquid. You feel like your back is burning. That was on our plot of land. Working here (milling rice instead of working on his mom’s land) is the same or harder than in the fields. Because here you have to show up, put the rice in and put your shoulder into it. When I used to work watering rice or spraying, there were weeks that I did 50,000 or 60,000. Not here. Here it’s per hector (of rice) milled. There are fortnights when I grab 14, 15, 30 (in thousands of colons). It varies. It depends on how much you mill. - Carlos Boliche, kidney patient. Bagaces, Guanacaste. July, 2018.

I was alone that day. I arrived and I started to work the water. Around 8am in the morning I felt a pain as though everything was cramping up on me. I said, what’s happening? And I thought, I’m going to rest here and maybe someone will come. I lied down beneath some cane plants and no one came. It was one o’clock and I was there. I thought to myself, ‘I feel stiff.’ I pulled myself up as best I could and got on the motorcycle and turned it on. I had my legs wide open because I couldn’t close them because of the cramps. I got home and this one (his wife) called an ambulance. - Dimas López Carrillo, kidney patient. Bagaces, Guanacaste. July, 2018.

Pedro Alvarado Quirós has to go to Hospital Mexico three times a week to change all his blood with a machine. Bagaces, Guanacaste. July, 2018.

They operated on us on September 21, 2011. Back then my dad was suffering a lot because I couldn’t donate because I had hypertension. I told her that if there was no problem that I could donate a kindey because she was suffering so much. That’s why I made the decision. My brother went directly into hemodialysis and he had to travel Tuesday, Thursday and Saturday because at the beginning he would lose a lot of liquid and other nutrients, so he would leave disoriented and we had to accompany him because he would get dizzy sometimes. I had a two-year-old son. My other brothers, the oldest, couldn’t because he was a different blood type and he was exposed to chemicals. The one who hadn’t been in contact with chemicals was me. We had other sisters but they were underage. - Marisela Boliche, kidney donor. Bagaces, Guanacaste. July, 2018.

All that’s left of Bernardo Quirós and Luis Segundo, mortal victims of CKD, are these pictures on the wall of Juana Quirós’s, Bernardo’s widow and Luis’s mother-in-law. Bagaces, Guanacaste. July, 2018.

I got the shivers and it felt like tachycardia. I lied down in the bed and my whole body was trembling. It’s a good thing the room was ready for dialysis because my dad also had kidney failure and we had been preparing the room little by little for dialysis for him. But now I have to use it. The doctor said that I have to use it because I’m the most urgent case. - Diego Quirós Martínez, kidney patient. Bagaces, Guanacaste. July, 2018.

Enrique Quirós undergoes peritoneal dialysis at home every six hours. Bagaces, Guanacaste. July, 2018.

I have a disease they call kidney failure. It got worse now that I lost the implant and now i’m back to square one, waiting to see if a kidney arrives, that is of God wants to give me a kidney in order to get through this. I noticed the disease when I started to get thin, vomit and feel weak. I got cramps all over my body. The treatment is a 1.5-liter bag of saline solution and i use it every six hours. You have to stick in your stomach in order to clean out all the poison because its poison that is in the stomach and in your body. As long as the kidney doesn’t work, food and water is poison. That’s why I swell up sometimes. The taste in your mouth is horrible, awful. It tastes like silver in your mouth. - Enrique Quirós Quirós, kidney patient. Bagaces, Guanacaste. July, 2018.

Carlos Boliche, kidney patient, shows his scars from dialysis while he works milling rice. Bagaces, Guanacaste. July, 2018.

Enrique Quirós Quirós is a CKD patient who lost his kidneys because of the disease. Bagaces, Guanacaste. July, 2018.