Timeline of Medical & Environmental Activities

YEARDESCRIPTION
1992Doctors from Ingenio San Antonio’s hospital report to authorities an unusual increase in cases of Mesoamerican Nephropathy disease.
1992During Doña Violeta Barrios’s Government, directors of Ingenio San Antonio, Dr. Alvaro Bermudez and Eng. Javier Arguello, visit authorities from the Ministry of Health and the Institute of Social Security to inform them about an abnormal increase of MeN patients in the area. During the administration of the Governments of Enrique Bolaños, Arnoldo Alemán and Daniel Ortega, authorities of Ingenio San Antonio also reported the problem.
1992Dr. Mauricio Jarquín, nephrologist, was hired to give medical care to MeN patients and study cases were developed to identify possible causes.
1998Dr. Indiana Pastora and Dr. Mauricio Jarquín carried out research on Haematuria and Proteinuria and its connection to risk factors in the school population from the western part of the country. A high prevalence of haematuria and proteinuria (protein and blood in urine) was found in preschool-age children.
1999Dr. Felix Zelaya, an internist with a master’s degree in public health, was hired to join San Antonio’s Hospital medical staff.
2000An environmental analysis was made at Ingenio San Antonio of drinking water, deposition of excreta and liquid and solid wastes, use of chemicals in the production process. The samples were processed in Polutech Laboratory, Canada. No harmful health levels were found.
2001Research of possible causes of mesoamerican nephropathy disease in the workforce at Ingenio San Antonio. Author: Dr. Felix Zelaya. It was found that people with MeN had high ethylic alcohol consumption (guaro lija). Workers who don’t get sick consume on average 10 liters of water per day and electrolytic solution. Those who get sick consume less than 3 liters per day. Patients consume more self-medicated nephrotoxic drugs (NSAIDs, aminoglycoside).
2001Study of prevalence of passive heavy metal intoxication and its pathological relation in MeN patients in Nicaragua’s west region. Authors: multidisciplinary team from MINSA and UNAN León. Small kidneys were found in all patients and also increased blood lead in all patients from the west region.
2003Ingenio San Antonio gave humanitarian aid in cash to 1,311 former temporary workers of the company.
2005An assessment of the impact of preventive measures was made to avoid heat stress in agricultural workers from Nicaragua. Author: Dr. Felix Zelaya. It is concluded that preventive measures to reduce heat stress and dehydration are effective.
2006Study of MeN ultrasonography findings and its connection with creatinine and kidney function in Ingenio San Antonio’s workers. Author: Dr. Indiana Pastor. Tutor: Dr. Mauricio Jarquin. There is a direct and proportional relation between the value of creatinine and kidney echogenicity. There is a positive connection between age and the onset of nephropathy and kidney hyper echogenicity.
2008Water samples analysis in wells and waters of Ingenio San Antonio, in ABC laboratory of Mexico D.F. Values that are recognized as harmful for health were not found.
2008ASOCHIVIDA filed a complaint before the Compliance Advisor/ Ombudsman (CAO) Office requesting his mediation for a dialogue with NSEL and a compliance audit.
2008Under the auspices of CAO, ASOCHIVIDA and NSEL signed a Framework Agreement to initiate a dialogue between both parties.
2009ASOCHIVIDA and NSEL selected Boston University School of Public Health School among a group of prestigious scientific organizations, to investigate possible causes of MeN. Contribution without precedent in Nicaragua and Central America.
2009Ingenio San Antonio provides unrestricted access to all their labor and health files to begin the investigation.
All the investigation reports by Boston University have been published on the CAO Ombudsman’ website.
Cohort Pilot Study Report: Evaluation of the Potential for an Epidemiologic Study of the Association between Work Practices and Exposure and Mesoamerican Nephropathy Disease at the Ingenio San Antonio (Chichigalpa, Nicaragua), January 30, 2012. “Based on the information obtained in the pilot study, we have concluded that a retrospective cohort study could feasibly be undertaken and that such a study could represent a valuable contribution to an understanding of the causes of MeN”. “The records at ISA and nearby health centers represent a 20 unique resource, and their analysis would make an important contribution to scientific knowledge and improve our understanding of the causes of MeN in Nicaragua”
Industrial Hygiene/Occupational Health Assessment: Evaluating Potential Hazards Associated with Chemicals and Work Practices at the Ingenio San Antonio (Chichigalpa, Nicaragua), Boston University, August 30, 2010. “Based on the investigation described in this report, we found no evidence to conclude that work practices and chemicals used by ISA are causing CRI in ISA workers. Establishing whether there is in fact an association will require the creation of new scientific knowledge”.
Phase I Environmental Monitoring: April 2010 Assessment of Water Samples. “Accordingly, at the time samples were collected at the six locations included in the first phase of the environmental sampling program, none of the chemicals analyzed were present at concentrations above US EPA drinking water criteria and therefore are not believed to be harmful to human health”.
Biomarkers of Early Kidney Damage in Nicaraguan Adolescents September-November 2011 (Independent Report prepared by: Oriana Ramírez-Rubio MD, MPH; Daniel Brooks ScD; Juan José Amador MD, MPH; James S. Kaufman MD; Daniel E. Weiner MD, MS; Chirag R Parikh MD, PhD; Usman Khan MD; Michael McClean ScD; Rebecca Laws MPH) – June 2012. “Overall, our results suggest some evidence of early-stage kidney damage in adolescents in Nicaragua that appears to extend to all regions studied, but with higher frequency in Chichigalpa. This finding is preliminary and requires further data collection and examination. If the finding is correct, it will be important to identify the causes and the relationship to the ongoing epidemic of MeN in adults”.
Biological Sampling Report: Investigating biomarkers of kidney injury and mesoamerican nephropathy disease among workers in Western Nicaragua, April 26, 2012. “Overall, our results show evidence of tubulointerstitial kidney injury among workers at ISA and in other industries, which also appears to be associated with decreased eGFR. These findings suggest that there is an occupational component to the MeN epidemic, but that the epidemic is not limited to sugarcane workers”. http://www.cao-ombudsman.org/cases/document-links/documents/Biological_Sampling_Report_April_2012.pdf
Mesoamerican Nephropathy In Nicaragua: A Qualitative Analysis Of Semi-Structured Interviews With Physicians And Pharmacists, Independent report prepared by Boston University Research Team (prepared by: Oriana Ramírez Rubio, MD, MPH, Madeleine Kangsen Scammell, DSc; Contributions by: Juan Jose Amador, MD, MS, Daniel Brooks, DSc, James Kaufman, MD, Daniel Weiner, MD, MS), December 2011. “In summary, these interviews have highlighted several potential contributors to MeN in Nicaragua and medical conditions that may be related to MeN. They have also helped us to identify beliefs and practices (about use of diuretics, bathing and drinking water) that could contribute to kidney damage” “Interviews also provided evidence suggesting that diuretics, antibiotics and NSAIDs are widely used and sold over the counter for very general symptoms”. http://www.cao-ombudsman.org/cases/document-links/documents/BU_Interviews_Report_FEB_2012_Eng.pdf
Currently, Boston University is developing a research project with three focus areas: a. Mesoamerican nephropathy genetic study in Nicaragua; b. Early kidney damage markers in Nicaragua’s teenagers; c. Occupational follow-up study in Central American workers
2014Baylor College of Medicine from Houston initaites a research project aimed at identifying the presence of pathogens in rodents collected in Ingenio San Antonio’s fields, to determine prevalence of antibodies that indicate infection in those workers and describe the disease process through the review of 1800 worker’s files. This work is ongoing.
2015MINSA performs pilot study in Leon with stem cells to determine if it is possible to stop or reverse the loss of kidney function.
2016In April 2016, the Board of Directors of Nicaragua Sugar Estates Limited announced the formation of a Board of Advisors as a key part of the company’s efforts and initiatives to combat Mesoamerican Nephropathy (MeN). The Board of Advisors is comprised of prestigious and highly qualified experts from the areas of epidemiology, toxicology, nephrology research, medical practice, education and occupational health and safety. The board advises the company in its efforts to find the cause of the disease, prevent new cases and help those afflicted.
2016In November 2016, Ingenio San Antonio, owned by Nicaragua Sugar Estates Limited, became the first sugar mill in Nicaragua to have its operations certified by BONSUCRO, an industry leading, global non-profit, multi-stakeholder organization that fosters sustainability of the sugarcane sector through its leading metric-based certification scheme and its support for continuous improvement for members.
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