Diseases Left Behind

Equity in healthcare is a key part of the global health agenda, one that we have approached over and over this semester. Despite great strides in battling disease epidemics, reducing infant mortality and increasing life expectancy, the health needs of certain marginalized groups remain unaddressed. The Tropical zone, including Central America, bears the enormous burden of a class of diseases know as Neglected Tropical Diseases. These diseases are often vector-borne and associated with poverty, lack of clean water, sanitation and/or basic preventative care. So-called “developed” nations have the technology and resources to combat NTDS, but may be blind to the burden of NTDs on the productivity and wellbeing of afflicted nations.

During our time in the agricultural zone surrounding Palo Verde, I learned about Mesoamerican Nephropathy, a neglected Tropical health issue, for the very first time. Thousands of people in Mexico and Central America with no other cause of chronic kidney disease are suffering or dying due to kidney function complications, and doctors don’t know why. I was shocked that I had never heard of this critical health and social justice issue. Chronic Kidney Disease of Unknown Causes (CKDu) primarily affects young male agricultural workers in the lowland pacific side of Mesoamerica. No cause has been identified yet, although chronic dehydration, manual labor under the sun and heavy metal or toxin exposure have been suggested as possible risk factors.

Little funding or research attention has been devoted to solving the puzzle of CKDu, and the incidence and mortality rates keep rising. The Area de Salud that we visited in Guanacaste has organized an investigative committee to find answers and decrease the incidence of CKDu in the community. However, without the attention and resources of major research organizations and drug companies, progress in the fight against CKDu will likely be slow going. Meanwhile, each year more otherwise healthy Costa Ricans will end up hospitalized, hoping for a new kidney and undergoing daily dialysis as their body mysteriously fails them. Many of the afflicted agricultural workers in Costa Rica are migrant workers, who likely have no one to advocate for their unique needs and challenges.

Women, minorities, the disabled, indigenous groups, and those in poverty all face extra challenges when it comes to health care access and attention. Developed world chronic diseases, including cancers and COPD, are the main concern of more privileged populations and thus are the focus of cutting edge medical innovation and discovery. Less research resources are directed toward Neglected Tropical Diseases and conditions specific to marginalized groups. We need to start prioritizing the health of the voiceless, and turn our attention toward sadly overlooked epidemics.

Abigail Mahoney