Sugar cane cutters load onto buses in the early morning to head into the fields for a hard day of work at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 24, 2020.
Father and son in the cane fields of Chichigalpa, Nicaragua on Jan. 6, 2013. Both men suffer from chronic kidney disease.
(left) Sugar cane cutters take a rest break in the shade as part of the Adelante Initiative, at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 24, 2020.
(right) Sugar cane cutters are outfitted with heart rate monitors on their chests, as part of the Adelante Initiative, at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 25, 2020.
A cane cutter, covered in soot and ashes of charred sugar cane, in a field that was burned the night before, in Chichigalpa, Nicaragua on May 1, 2014.
A sugar cane worker poses for a photograph on the Ingenio San Antonio plantation, in Chichigalpa, Nicaragua on May 2, 2014.
Laborers prepare the Marakannam salt pan fields for salt harvest near Pondicherry, India on Jan. 21, 2016.
Cousins pose for a portrait in the cane fields of Chichigalpa, Nicaragua on April 26, 2014. They support their families with this work after their husbands and brothers have either died or gotten sick from CKDnT.
A farmer sprays his rice fields with herbicide to prepare them for planting in the village of Kongahanagama, in the North Central Province of Sri Lanka on June 28, 2016. Pesticides are considered one of the primary causes of CKDnT, a disease that afflicts primarily agricultural workers in hot, poor countries.
(left, right) Students are tested for CKDnT at their rural secondary school in Rajanganaya, Sri Lanka on June 28, 2016. With the support of the government, a local CKDnT organization performs a mass blood screening of 342 students. This area in the North Central Province is the hot zone for CKDnT in the country.
Former sugarcane worker, 57, receives dialysis at home with help from a family member where they live in Chichigalpa, Nicaragua on Jan. 9, 2013. He suffers from end stage kidney disease after working in the fields for decades without access to water, rest or shade.
A coffin maker poses in his workshop in Chichigalpa, Nicaragua on Jan. 7, 2013.
A nurse who serves many sick sugarcane workers with CKDnT, poses for a portrait at home in Chichigalpa, Nicaragua on Jan. 10, 2015. She conceals her identity because the hospital she works for does not want anyone talking to the media.
Agricultural workers harvest black whole grain in the village of Uchapalli, India on Jan. 16, 2016.
Mary Pacherres Alvarez, 32, at home feeling ill from an infection, while her mother cools her down in Ignacio Escudero Montelima on Feb. 12, 2018.
K. Adman, 62, and his son, Anushka Adman, 31, both suffering from CKDnT, pose at home in the village of Theriyankulama, Sri Lanka on July 4, 2016.
Sugar cane worker with CKDnT poses in the cane fields in Chichigalpa, Nicaragua on Jan. 9, 2013.
A cane cutter, covered in soot and ashes of charred sugar cane, in a field that was burned the night before, in Chichigalpa, Nicaragua on May 1, 2014.
Laborers prepare the Marakannam salt pan fields for salt harvest near Pondicherry, India on Jan. 21, 2016.
K. Bandulawarna, 37, poses for a portrait at home in Nelumvila Billewa, Sri Lanka on July 2, 2016. He was a farmer from the age of 18-25, and then became a Civil Security Department guard during the civil war. Now he suffers from end stage CKDnT, must have dialysis every 3 days and is dependent on his pension to support his wife and two children.
Mary Pacherres Alvarez, 32, in her parent’s home in Ignacio Escudero Montelima on February 11, 2018. She has had CKDnT for 8 years and has been on dialysis for 8 years.
Walter Arsenio Rivera, 29, a sugarcane worker suffering from CKDnT, poses for a portrait in Chichigalpa, Nicaragua on Jan. 7, 2015.
Community meeting to raise money for their community-built and maintained water system, which provides clean water to 1500 people, in Chichigalpa, Nicaragua on Feb. 23, 2020.
(left) Don Raphael Diaz, 53, at home in Sullana, Peru on Feb. 15, 2018. He has spent 3 days a week on dialysis for the past 5 years.
(right) Ventkataiah, a CKDnT patient, rests at home in the village of Kota, outside of Nellore, India on Jan. 13, 2016.
Ventkataiah, a CKDnT patient, sits for a portrait with his wife and daughter at home in the village of Kota, outside of Nellore, India on Jan. 15, 2016.
Locals gather at a cemetery where a funeral for two men who have died of chronic kidney disease are buried in Chichigalpa, Nicaragua on Jan. 6, 2013.
Family and friends gather for the funeral procession and burial of a former sugar cane worker, 36, who died of CKDnT, in Chichigalpa, Nicaragua on Jan. 7, 2013. After working in the sugar cane fields for 12 years, he is part of a steady procession of deaths among young cane workers who replaced their fathers in the fields when they fell ill.
Family and friends gather for the funeral procession and burial of a former sugar cane worker, 36, who died of CKDnT, in Chichigalpa, Nicaragua on Jan. 7, 2013. After working in the sugar cane fields for 12 years, he is part of a steady procession of deaths among young cane workers who replaced their fathers in the fields when they fell ill.
V. Aushadahami, 74, rests at home with family in Billewa, Sri Lanka on July 4, 2016. He was a rice farmer and has suffered from CKDnT for decades. He is now incapacitated and requires constant care by his family.
A patient with CKDnT receives treatment in the dialysis unit of the Narayana Medical College in Nellore, India on Jan. 13, 2016.
Neraldo Jardiel Cantillano Carrero, 30, and his wife, Norma Elena Ortiz Melendez, 26, in a room built for at-home dialysis in Chinandega, Nicaragua, on Feb. 25, 2020.
A former sugarcane workers who has just passed away is laid to rest after a long battle with CKDnT in Chichigalpa, Nicaragua on April 30, 2014.
(left, right) A family enjoys time at the Puerto Corinto beach near Chichigalpa, Nicaragua on Jan. 9, 2013. Both father and son suffer from CKDnT.
Cesar, 12, tends to his ailing father, Don Julio Lopez, 35, a former sugarcane worker, as he suffers through the end stages of CKDnT, in Chichigalpa, Nicaragua on Jan. 5, 2015. He worked for 15 years in the cane fields before getting sick.
Former sugar cane worker, 31, poses for a portrait in Chichigalpa, Nicaragua on April 24, 2014. After 16 years cutting sugar cane, Valdivia is sick with kidney disease. He vows, “I’ll die working,” and now drives a tricycle taxi.
A family spends an evening at home in Chichigalpa, Nicaragua on April 29, 2014.
A mother poses with her husband and two sons, all former sugarcane workers who are sick with CKDnT, in Chichigalpa, Nicaragua on May 2, 2014.
Sugarcane workers begin their morning commute to the fields before dawn in Chichigalpa, Nicaragua, on Jan. 7, 2015.
A former sugar cane worker, 67, photographed in the sugar cane fields where he worked for 25 years, in Chichigalpa, Nicaragua on April 25, 2014. He is currently sick with CKDnT after years of toiling without protection from heat stress and dehydration, made worse by a changing climate.
Miurel Lopez, 15, cries by the body of her father, Julio Lopez, 35, who died of CKDnT earlier that day in Chichigalpa, Nicaragua on Jan. 8, 2015.
Sugar cane cutters load onto buses in the early morning to head into the fields for a hard day of work at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 24, 2020.
Sugar cane cutters load onto buses in the early morning to head into the fields for a hard day of work at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 24, 2020.
Father and son in the cane fields of Chichigalpa, Nicaragua on Jan. 6, 2013. Both men suffer from chronic kidney disease.
Sugar cane cutters take a rest break in the shade as part of the Adelante Initiative, at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 24, 2020.
Sugar cane cutters are outfitted with heart rate monitors on their chests, as part of the Adelante Initiative, at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 25, 2020.
A cane cutter, covered in soot and ashes of charred sugar cane, in a field that was burned the night before, in Chichigalpa, Nicaragua on May 1, 2014.
A sugar cane worker poses for a photograph on the Ingenio San Antonio plantation, in Chichigalpa, Nicaragua on May 2, 2014.
Laborers prepare the Marakannam salt pan fields for salt harvest near Pondicherry, India on Jan. 21, 2016.
Cousins pose for a portrait in the cane fields of Chichigalpa, Nicaragua on April 26, 2014. They support their families with this work after their husbands and brothers have either died or gotten sick from CKDnT.
A farmer sprays his rice fields with herbicide to prepare them for planting in the village of Kongahanagama, in the North Central Province of Sri Lanka on June 28, 2016. Pesticides are considered one of the primary causes of CKDnT, a disease that afflicts primarily agricultural workers in hot, poor countries.
Students are tested for CKDnT at their rural secondary school in Rajanganaya, Sri Lanka on June 28, 2016. With the support of the government, a local CKDnT organization performs a mass blood screening of 342 students. This area in the North Central Province is the hot zone for CKDnT in the country.
Students are tested for CKDnT at their rural secondary school in Rajanganaya, Sri Lanka on June 28, 2016. With the support of the government, a local CKDnT organization performs a mass blood screening of 342 students. This area in the North Central Province is the hot zone for CKDnT in the country.
Former sugarcane worker, 57, receives dialysis at home with help from a family member where they live in Chichigalpa, Nicaragua on Jan. 9, 2013. He suffers from end stage kidney disease after working in the fields for decades without access to water, rest or shade.
A coffin maker poses in his workshop in Chichigalpa, Nicaragua on Jan. 7, 2013.
A nurse who serves many sick sugarcane workers with CKDnT, poses for a portrait at home in Chichigalpa, Nicaragua on Jan. 10, 2015. She conceals her identity because the hospital she works for does not want anyone talking to the media.
Agricultural workers harvest black whole grain in the village of Uchapalli, India on Jan. 16, 2016.
Mary Pacherres Alvarez, 32, at home feeling ill from an infection, while her mother cools her down in Ignacio Escudero Montelima on Feb. 12, 2018.
K. Adman, 62, and his son, Anushka Adman, 31, both suffering from CKDnT, pose at home in the village of Theriyankulama, Sri Lanka on July 4, 2016.
Sugar cane worker with CKDnT poses in the cane fields in Chichigalpa, Nicaragua on Jan. 9, 2013.
A cane cutter, covered in soot and ashes of charred sugar cane, in a field that was burned the night before, in Chichigalpa, Nicaragua on May 1, 2014.
Laborers prepare the Marakannam salt pan fields for salt harvest near Pondicherry, India on Jan. 21, 2016.
K. Bandulawarna, 37, poses for a portrait at home in Nelumvila Billewa, Sri Lanka on July 2, 2016. He was a farmer from the age of 18-25, and then became a Civil Security Department guard during the civil war. Now he suffers from end stage CKDnT, must have dialysis every 3 days and is dependent on his pension to support his wife and two children.
Mary Pacherres Alvarez, 32, in her parent’s home in Ignacio Escudero Montelima on February 11, 2018. She has had CKDnT for 8 years and has been on dialysis for 8 years.
Walter Arsenio Rivera, 29, a sugarcane worker suffering from CKDnT, poses for a portrait in Chichigalpa, Nicaragua on Jan. 7, 2015.
Community meeting to raise money for their community-built and maintained water system, which provides clean water to 1500 people, in Chichigalpa, Nicaragua on Feb. 23, 2020.
Don Raphael Diaz, 53, at home in Sullana, Peru on Feb. 15, 2018. He has spent 3 days a week on dialysis for the past 5 years.
Ventkataiah, a CKDnT patient, rests at home in the village of Kota, outside of Nellore, India on Jan. 13, 2016.
Ventkataiah, a CKDnT patient, sits for a portrait with his wife and daughter at home in the village of Kota, outside of Nellore, India on Jan. 15, 2016.
Locals gather at a cemetery where a funeral for two men who have died of chronic kidney disease are buried in Chichigalpa, Nicaragua on Jan. 6, 2013.
Family and friends gather for the funeral procession and burial of a former sugar cane worker, 36, who died of CKDnT, in Chichigalpa, Nicaragua on Jan. 7, 2013. After working in the sugar cane fields for 12 years, he is part of a steady procession of deaths among young cane workers who replaced their fathers in the fields when they fell ill.
Family and friends gather for the funeral procession and burial of a former sugar cane worker, 36, who died of CKDnT, in Chichigalpa, Nicaragua on Jan. 7, 2013. After working in the sugar cane fields for 12 years, he is part of a steady procession of deaths among young cane workers who replaced their fathers in the fields when they fell ill.
V. Aushadahami, 74, rests at home with family in Billewa, Sri Lanka on July 4, 2016. He was a rice farmer and has suffered from CKDnT for decades. He is now incapacitated and requires constant care by his family.
A patient with CKDnT receives treatment in the dialysis unit of the Narayana Medical College in Nellore, India on Jan. 13, 2016.
Neraldo Jardiel Cantillano Carrero, 30, and his wife, Norma Elena Ortiz Melendez, 26, in a room built for at-home dialysis in Chinandega, Nicaragua, on Feb. 25, 2020.
A former sugarcane workers who has just passed away is laid to rest after a long battle with CKDnT in Chichigalpa, Nicaragua on April 30, 2014.
A family enjoys time at the Puerto Corinto beach near Chichigalpa, Nicaragua on Jan. 9, 2013. Both father and son suffer from CKDnT.
A family enjoys time at the Puerto Corinto beach near Chichigalpa, Nicaragua on Jan. 9, 2013. Both father and son suffer from CKDnT.
Cesar, 12, tends to his ailing father, Don Julio Lopez, 35, a former sugarcane worker, as he suffers through the end stages of CKDnT, in Chichigalpa, Nicaragua on Jan. 5, 2015. He worked for 15 years in the cane fields before getting sick.
Former sugar cane worker, 31, poses for a portrait in Chichigalpa, Nicaragua on April 24, 2014. After 16 years cutting sugar cane, Valdivia is sick with kidney disease. He vows, “I’ll die working,” and now drives a tricycle taxi.
A family spends an evening at home in Chichigalpa, Nicaragua on April 29, 2014.
A mother poses with her husband and two sons, all former sugarcane workers who are sick with CKDnT, in Chichigalpa, Nicaragua on May 2, 2014.
Sugarcane workers begin their morning commute to the fields before dawn in Chichigalpa, Nicaragua, on Jan. 7, 2015.
A former sugar cane worker, 67, photographed in the sugar cane fields where he worked for 25 years, in Chichigalpa, Nicaragua on April 25, 2014. He is currently sick with CKDnT after years of toiling without protection from heat stress and dehydration, made worse by a changing climate.
Miurel Lopez, 15, cries by the body of her father, Julio Lopez, 35, who died of CKDnT earlier that day in Chichigalpa, Nicaragua on Jan. 8, 2015.
Sugar cane cutters load onto buses in the early morning to head into the fields for a hard day of work at the Ingenio San Antonio (San Antonio Sugar Mill), in Chichigalpa, Nicaragua on Feb. 24, 2020.
