By Apoorva Mandavilli

Something odd has been happening to young men in the sultry farming and fishing communities of Sri Lanka.

Since the 1990s, men in their 30s and 40s have been turning up at hospitals with late-stage kidney failure, needing dialysis or even transplants. In some communities, as many as 1 in 5 young men is affected.

Their condition has no clear cause; in fact, it is called ‘chronic kidney disease of unknown origin’. But experts say the illness is most likely the result of exposure to extreme heat, exacerbated in recent years by climate change, and the resulting dehydration, as well as an overuse of toxic pesticides that have seeped into the groundwater.

The trend is most striking in young men, but some women, too, seem to have the disease. And children as young as 10 already show early signs of kidney trouble.

These communities may be the most vulnerable and the first to show signs of damage, but their plight is a reminder of the dangers posed by rising temperatures across the planet.

“Sri Lanka has made the perfect case for how climate change is affecting people in real-time,” said Nishad Jayasundara, an expert in global environmental health at Duke University.

Young men in agricultural communities in Nicaragua and El Salvador also experience the illness, and a similar pattern may be emerging in East Africa. But basic health care in Sri Lanka is free and ubiquitous, so there is a better lens on the problem here than in some other low-income nations.

Kidney disease is usually a consequence of obesity, high blood pressure and diabetes. It typically strikes people in their 50s or 60s, progresses slowly and can be managed with some monitoring.

What fishermen and farmers in Sri Lanka are experiencing is far more insidious. They sometimes transition from showing early signs of damage to requiring dialysis or a transplant in just one to four years, Jayasundara said.

Women and children are less vulnerable, but about 5% to 10% of children — perhaps those helping out on the family farm — show early signs of kidney damage, Jayasundara said. His team is following more than 3,000 children aged 10 to 17 in farming communities.

Thenuka Nethsara Bandara, 12, is unluckier than most. He lives in Kadawala Wewa village with his parents, and about a year ago, he suddenly felt a sharp pain in his abdomen. Now diagnosed with acute kidney damage, he is waiting for a transplant.

In his village and in many others, the sun is ablaze by midmorning and remains mercilessly hot until the evening, leading to cases of dehydration and heat stress. Climate change compounds the risks. It may fuel hotter days, and more of them, but few can afford to stop their work to hydrate or seek shade.

Pests and weeds are more hardy, requiring farmers to use more and more pesticides. The runoff from the fields leaches into nearby wells from which families draw water. Frequent floods also speed the absorption of chemicals into groundwater.

But the problem is not just chemicals. In Kalpitiya, a tranquil fishing town on the country’s west coast, the water is ‘hard’, containing up to 700 milligrams of magnesium and calcium carbonate deposits per litre, compared with less than 40 in bottled water.

“Boiling water removes this to a certain extent, but not all,” said Mangala De Silva, a researcher at the University of Ruhuna in Matara.

Many people in Kalpitiya are now dimly aware that contaminated water may explain kidney problems in their community, but only about 1 in 5 have access to filtered water.

Even those who drink filtered water may continue to cook with well water. In any case, some filters are not up to the task of purifying water with astronomical levels of contaminants.

Sri Lankans often have too many urgent concerns to fret about a distant health problem, said Thanusanth Santhalingam, a fisheries biologist at the country’s National Aquatic Resources Research and Development Agency.

“They would rather buy food than clean drinking water, not realizing the impact of their decision,” Santhalingam said. “They may figure it out only years later, and even then, not link health issues to drinking water.”

At Pasikuda Beach, north of Batticaloa, the government provides water in large tanks that are replenished every two days. Still, the men set out to fish for calamari at 5:00 a.m., with just five litres to last until they return mid-afternoon.

“Sometimes fishing is busy — we aren’t drinking water or eating,” said Christy Navil, 58. “We want to catch the fish.”

Many turn to alcohol, rather than water, to avoid sea sickness, which intensifies their dehydration.

Pesticide contamination is a menace particularly in agricultural areas such as Medirigiriya, in the central part of the country, and Matara, in the south. High levels of glyphosate, a widely used broad-spectrum herbicide, are thought to damage the liver and kidneys.

Rising awareness of the problem has prompted the Sri Lankan government to provide filters and to set up more clinics in the affected areas.

Ajith Pushpakumara, a rice farmer in Ambagaswewa village, in central Sri Lanka, found out that he had kidney problems about 15 years ago, at a government-sponsored clinic held at a local temple.

He was advised to drink clean water and take care of his health, but he ultimately lacked the means to do so. Medications are supposed to be free, but Pushpakumara missed out on many because of shortages. As the family’s sole breadwinner, he could not stop working in the fields.

About five years ago, his family began drinking filtered water but continued to use well water for most other purposes, including cooking. Two years ago, when he suddenly began feeling weak and nauseated, doctors told him his kidneys were failing.

Now 40, Pushpakumara is at the hospital every four days for dialysis. His only hope for recovery is a transplant. His wife, Sulochanie Sandalatha, 39, shows early signs of kidney failure, so she cannot be a donor.

“People keep writing about it,” he said, bitterness in his voice. “But why isn’t anything happening?”

-New York Times