Just south of Coatepeque, Guatemala, female sugar cane workers labor in the fields for long hours in rural fields under constant, unwavering heat. During brief breaks, some of these women meet with students and researchers from the Centers for Health, Work & Environment of the Colorado School of Public Health and from Colorado State University for a study examining occupational and environmental risk factors. Participants undergo health assessments, including blood and urine tests, weight, and air exposure monitoring. The primary concern driving the research? Chronic Kidney Disease of Unknown Origin, also known as CKDu.
The Guatemalan Kidney Health Study began because there is very little pre-existing research on the CKDu epidemic in women in Central America. The study expanded into a broader evaluation of environmental and occupational risk factors affecting women in physically demanding agricultural jobs.
Field Team Lead Madison Goering, MSW, MPH, explained that the project evolved into a larger evaluation in response to workforce changes in the region. “More women are entering the workforce in Guatemala,” said Goering. Thus, the team pivoted to larger participant groups and a more comparative group study design.
Early findings revealed that the issue extends beyond individual health outcomes; it was not just a public health challenge but an environmental one. Long work hours with limited breaks increase the risk of heat exposure. Furthermore, field testing for particulate matter indicates an associated risk of hazardous air quality and raises concerns about local air quality.
When asked whether these health outcomes should be viewed as environmental or public health issues, researcher Shelby Kardel, MPH, emphasized the role of working conditions: “The environmental factors are only an issue because of the occupational health issue.” Kardel said. “The particulate matter is a risk because of where they’re working.”
Community engagement proved critical to the study’s success. Recruitment began through partnerships with employers, including Pantaleon, a sugarcane production company, and Banasa, a banana plantation. While the research team aimed to enroll 90 participants in January, more than 100 women workers ultimately joined the study.
“The women seemed excited (that we were back),” Kardel noted. A local nurse visited each packaging plant the week before to remind the women that we would be returning to conduct another round of health assessments. “Other fieldworkers were asking if they could step on the scale to weigh themselves...I was there collecting blood and urine samples, and they would ask if their health was okay.”
If some health results are outside a normal range, workers in the research study can receive free check-ups at the Trifinio clinic, care that may not be readily available. For some workers, commuting to work requires one to two hours of bus travel each way, making routine medical visits unrealistic given time and financial constraints.
As the field team begins to wrap up their initial research in the coming year, the focus is shifting toward application wraps up their initial research in the coming year, the focus shifts. Goering hopes the findings will inform Banasa and Pantaleon's representatives and lead to improved protections for workers.
“Our goal is to improve worker safety,” she said. By sharing organized and evidence-based findings with employers, the team aims to support meaningful changes that address both health risks and workplace conditions.
When Goering and Kardel spoke about the project, they had just returned from their fourth fieldwork round in the region. Kardel was set to travel back with additional team members to explore further research opportunities in silica and particulate matter testing.
The study is overseen by the Centers for Health, Work & Environment of Colorado School of Public Health and Colorado State University, in partnership with Trifinio Center for Human Development. It is led by Edwin Asturias, MD, Director of Latin American Projects. Together, these collaborators reflect the coordination and scale required to conduct occupational health research in agricultural communities.