Pantaleon sugarcane plantation, established in 1849 by Manuel Maria Herrera, sits on farmland in southwest Guatemala. Pantaleon commits to community development projects on a yearly basis. These projects focus on developing clean water systems, building and equipping health centers and nursing homes, and providing adult and childhood education programs for women and children. Pantaleon is also an industry leader in promoting occupational health and safety initiatives. Their commitment to cultivating a healthy and happy workforce led to a collaboration with occupational health and safety expert Lee Newman, MD, MA, FCCP, FACOEM, and the Center for Health, Work and Environment at the Colorado School of Public Health, University of Colorado Anschutz Medical Campus.
To address common workplace hazards in the sugarcane fields and mills, Pantaleon has systems in place to identify and control risks, and report incidences when they occur. They clocked almost 52,000 hours of specialized occupational health and safety training for their workforce in 2015. Each year they provide more than 55,000 primary care, ophthalmology and dental consultations in their on-site clinics. With this solid track record of activities in social responsibility and occupational safety, Pantaleon recognized that the best way to maintain and elevate this trajectory is through research and consultation. So, Dr. Claudia Asensio, Manager of Responsible Development at Pantaleon visited the Center for Global Health El Trifinio site in February 2016 to learn about a kidney screening event carried out for banana plantation workers employed by AgroAmerica. Shortly thereafter, Dr. Asensio connected with Dr. Newman, and Dr. Edwin Asturias, Associate Professor of Pediatrics, Section of Pediatric Infectious Disease, University of Colorado School of Medicine, and Director of Latin American Projects at the Center for Global Health, Colorado School of Public Health.
Dr. Newman provides some background on the collaboration, “She became aware of the successful work Dr. Asturias was doing at the El Trifinio site, and our partnership in worker health. She contacted me and asked if we could come down and advise them. The idea that they could address worker safety in a holistic way using the Total Worker Health® model was very attractive to her and Pantaleon.” Total Worker Health® is a framework developed by the National Institute for Occupational Safety and Health (NIOSH) which they define as “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.” Dr. Newman’s Center for Health, Work and Environment is one of six centers designated by CDC/NIOSH as a national Center of Excellence in Total Worker Health®. “My group is functioning very much like we do with other major companies like in the US,” Newman explains. “When we come in with a research and evaluation approach, it kicks their occupational safety program up to another level.”
Some initial meetings between Pantaleon leadership and Drs. Newman and Asturias resulted in the decision to prioritize concerns around an emerging epidemic of chronic kidney disease (CKD). This condition, whose etiology remains unknown, mostly affects men ages 20-40 working in agricultural industries in Central America. The condition does not seem to coincide with traditional risk factors for kidney disease like hypertension, diabetes, or obesity. Rather, the current hypothesis is that recurrent dehydration and heat stress may be damaging the kidneys, potentially leading to kidney failure. Because its causes are unknown, scientists are referring to the condition as CKDu. “Pantaleon has been doing a lot over the years to mitigate the risk of chronic kidney disease, but they felt they wanted more help. We agreed that this was where to start,” says Dr. Newman. Thus began a research collaboration to systematically evaluate occupational and non-occupational risk factors for CKDu and explore potential preventive approaches.
Dr. Newman hopes the results of their research will provide evidence for change in worker protections, but not just at Pantaleon, and not just for the sugarcane industry. “For us to make an impact, we want Pantaleon to disseminate our research findings widely to other companies and other industries, in the same way we are disseminating [this information] to the academic and occupational health communities around the world. We have a shared mission in this, and it is one of the biggest reasons for our collaboration. We want to not only address the safety issues facing their workers, but take that lesson around the world,” he explains. The goal of global dissemination is appropriate since the prevalence of chronic kidney disease of unknown origin is increasing in other regions besides Central America. CKDu has also been reported in Sri Lanka, India, and Egypt, but there is little data on the magnitude of the epidemic.1 While research from these regions emphasize different risk factors, there are also some similarities, such as high burden of disease in agricultural workers, and the absence of known risk factors like diabetes or hypertension. There is little scientific consensus on the most important risk factors. Dr. Newman explains, “Employers will be responsible for providing certain things, like rest periods and access to clean water. But it’s clear to me that we are going to have to look at personal risk factors as well: smoking, use of non-steroidal anti-inflammatory drugs, and other factors.” Understanding these risk factors and how to modify them will be critical to designing and implementing prevention efforts for at-risk workers. Preventive approaches are needed, since the cost of treating CKD with dialysis or transplant is unfeasible or simply unavailable in many low income countries. According to the National Kidney Foundation, over 2 million people receive treatment with dialysis or transplant (for all causes of CKD), but this number is a mere 10% of people who actually need life-saving treatment.
This work is also providing unique educational opportunities at the University of Colorado Anschutz Medical Campus. “We are helping Pantaleon set up their first hearing conservation program. An occupational medicine resident is working on setting up an audiology testing booth, evaluating decibel levels in the mills, and using an existing data set to analyze potential sources of work related injury. We are getting a better understanding of other health related issues that can be addressed including tobacco use, nutrition, stress and behavioral health, a bit on infectious disease risk. It is part of taking a more comprehensive look and making an informed decision about the most important things to address to achieve net improvement,” Newman explains. This collaboration is a win for both partners, and the thousands of Pantaleon employees who will benefit from advancements in occupational safety.
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