"We were born to die of this. Look around you, all there is, is sugarcane.”


Between 2011 and 2016, I lived and worked in the agro-industrial lowlands of Nicaragua among communities affected by the Chronic Kidney Disease Epidemic of unknown cause (CKDu). The city of Chichigalpa, in the Western department of Chinandega, is the center of this epidemic, and the center of the sugarcane industry in the country. Sugar, rum and ethanol are all produced here for national and international markets. The barrios surrounding this lucrative industry are often made up of wooden and tin shacks, dirt floors, plastic sheets for walls and roofs and suffer water shortages regularly. A cycle of poverty, sickness and death is the norm for the families that cut the cane in the fields to generate these products. An externalized population in a global market, ‘necessary but dispensable’, is the message given to them.

As a visual journalist and activist I am moved by the fortitude and strength of the families being destroyed by this preventable disaster. I have been privilege to bear witness to some of their most vulnerable moments and trusted with sharing them. Early on I asked a 20 year old boy in a pickup on his way to a health screening,” Does it anger you that so many men in your community were sick and had died?”. He replied, “No. We were born to die of this. Look around you, all there is, is sugarcane.” While local, official records cannot confirm exactly, it’s accepted that over 10,000 men have died of CKDu in Chichigalpa since 2000.

Systemic violence in barrios Erick Ramirez, Marvin Salazar, San Antonio, Manhattan and comarcas La Isla, La Cuitanca, El Triunfo, Paises Bajos, places gutted of their men.  Workers denied their rights to social security and quality healthcare. Families denied dignified living conditions and the freedom to express themselves to journalists in their own country. Patients who lose food stipends and medical supplies, or are beaten and jailed by police when they take to the streets in protest. These images are meant to reflect the quiet collateral of this epidemic; a sensation of the living knowing they are condemned to die. Their stories and countless more are the direct result of a savage system that has facilitated the deaths of tens of thousands of men and women in Central America and continues to do so.

All photographs copyright Tom Laffay. Any use requires explicit authorization. Thank you.