Borderlands Road Trip: Chronic Kidney Disease of Unknown Origin in Texas?
Along the Texas-Mexico border, the scorching summer sun is merciless. In McAllen, Texas, the average high for the entire month of July so far has been 103 degrees Fahrenheit. Last week, Deliana Garcia, MA, Director of International Relations, Research, and Development, and her colleagues at the La Isla Network, blasted the A/C as they made their way through Texas for a five-city tour of health clinics, Ventanilla de Salud offices, and medical schools, to pick apart the puzzle of Chronic Kidney Disease of Unknown Origin (CKDu) in this sun-baked state.
“We chose Texas because, for most of the year, work is conducted at temperatures greater than 90 degrees,” Garcia explained. “The amount of growth with new construction is significant, and there is a corridor of movement from South Texas through Central Texas, as individuals move for work,” which helped define the cities covered: Austin, San Antonio, Del Rio, Brownsville, McAllen, and Rio Grande City.
CKDu is truly unknown, killing otherwise healthy young males who do not suffer from diabetes or hypertension, two of the common co-factors of CKD. Recent epidemics among sugarcane workers, particularly in the lowlands of Nicaragua and Central Mexico -- just two of several hot spots around the world studied by La Isla Network-- have lead some researchers to suggest that excessive and long-term exposure to heat may be a major factor in the development of CKDu. On the borderlands of Texas, workers like agricultural workers, construction workers, and landscapers -- those who work in high heat, with limited or no rest, shade, and water -- are at risk. Many of the immigrant workers of the area have migrated north from the areas of the epidemics. But little is known about CKDu in Texas.
The road trip was the inaugural effort of Migrant Clinicians Network and La Isla Network’s new partnership to take a closer look at CKDu in Texas. Joining Garcia from La Isla were Jason Glaser, co-founder and CEO, Ilana Weiss, Senior Director of Policy and Public Health, and Tom Laffay, documentary photographer and videographer.
“An initial goal is to create a network where we can do screenings of young workers to see if there’s been any reduction in kidney function,” Garcia noted, which will be followed with educational efforts and interventions to reduce factors that may cause CKDu and better track cases that do occur.
In speaking with clinicians, the group uncovered anecdotal accounts of patients suffering from CKDu. In Del Rio, the Mexican Consulate is currently assisting a patient with CKDu. But for some clinicians, it can be hard to tease out the few cases of CKDu among the hundreds and hundreds of cases of end-stage renal disease related to diabetes that the clinics are seeing, Garcia noted. So, to better understand the breadth of the problem historically, the group turned to local medical schools.
In Austin, a medical school contact will review data collected on indigent care including ER utilization since 1994. Garcia began to ask questions: “Would it be possible to go back through and see if we could find the ICP9/ICP10 codes for CKD where there wasn’t diabetes or hypertension? Is there some information that we could spend some time gathering now, before we start screening,” to better understand the starting point? it is unknown whether these cases represent an actual increase in the number of CKDu cases, or whether recent attention has just increased their visibility. Partnerships with local medical schools to sift through data may illuminate the CKDu picture.
The group visited several consulates and their Ventanilla de Salud (VDS) projects as well. VDS is a health services program housed within the 50 Mexican consulates in the United States and which provides information on health topics, counseling, and referrals to health services. “It was heartwarming to see how engaged the teams from the various consulates were in trying to understand what might be going on among young workers, and their immediate commitment to work with us,” Garcia said. The consulates will be key to the project to assure that co-nationals without health access aren’t left out of screening and educational interventions.
MCN and La Isla’s project will include other partners in Texas to complement data collecting by researchers in California’s San Fernando Valley and in areas of the South.
“La Isla Network has been on the cutting edge of understanding CKDu and I am thrilled to be working with them and other researchers, such as Bethany Boggess here in Austin, to protect vulnerable workers,” Garcia said.
Learn more about La Isla Network at: www.laislanetwork.org.
Check out the Ventanillas de Salud at: www.ventanillas.org.
See photographer/filmmaker Tom Laffay’s work on CKDu: www.tomlaffay.com