The kidney ward in Nepal

The signs are all there. Warmer winters. Wilder storms. Species wiped out.

The natural world is changing in profound and mostly terrible ways, and our way of life (where our = developed and rapidly developing nations) - a way of life based on unceasing/unthinking consumption - is a major contributor to the changes.

One of the ways in which global warming is showing up is with the "link between exposure to extreme heat and chronic kidney disease."

Exactly how heat scars and cripples the microscopic tubes in the organs is still debated, researchers say, but the correlation is clear. (Source: Washington Post)

Not surprising, it's the world's most impoverished people who have things the worst. 

That link has been observed among workers toiling in rice fields in Sri Lanka and steamy factories in Malaysia, from Central America to the Persian Gulf. As the world grows hotter and climate change ushers in more frequent and extreme heat waves, public health experts fear kidney disease cases will soar among laborers who have no choice but to work outdoors.

More than 50 years ago, my father died after a many-year bout with kidney disease. Although he spent plenty of time working on his precious yard, my father's kidney disease wasn't caused by working outdoors in the blazing sun. He worked indoors.

Was his kidney disease genetic? Did his Uncle Jim - who died very young - have kidney disease? On the other side of his family, was it kidney disease that killed his cousin Francis X, who died in his forties?

Or was it triggered by rheumatic fever, acquired while my father was in the Navy?

Who knows?

But I do know that it kidney disease isn't a lot of fun. Over the seven years he lived after his diagnosis, my father had plenty of life left in him. But the disease was progressive, and he was in and out of hospitals throughout my high school and college years. 

Yes, dialysis and kidney transplants both existed back then (we're talking the 1960's; my father died in January 1971), but the treatments weren't as advanced as they are now. By the time my father was declared a candidate for dialysis, my understanding is that he would have been hooked to some sort of cumbersome machine 24/7. He and my mother decided that wasn't an option. So...

So, kidney disease is rotten.

And it's especially rotten when it mows down young men, forced by poverty to work in dreadful conditions.

This was brought home as I sat in the comfort of my nicely climate-controlled home when I read a recent article in the Washington Post about kidney disease in Nepal. 

Nepal is a very poor country, and because of its poverty, many of its young men work abroad, where they can make better money working dirty and dangerous jobs than they could with the meager wages they could earn if they stayed home. Work abroad is the lifeline for many direly impoverished families.

Suraj That Magar, now 28, was from one of them. Half the

families in his village have sent someone to work in nations in the Persian Gulf. Suraj, whose father died when he was six and who was raised by his older sister, left Nepal for Kuwait, where he found work installing windows in skyscrapers. His family didn't want to see him go, but there was no choice. His sister's husband made too little to support an extended family of eight. 

“No family wants their sons to go work in scorching heat,” [Suraj] said. “But we were in financial crisis, so everyone gave me their blessing.”

His sister took out an unimaginably large loan - $1,000 - to pay the recruitment agency. She told Suraj that if the work became too hard to handle, he should come home. 

Six months later, Suraj found himself on construction sites where he installed massive, one-ton window frames on skyscrapers rising from the Kuwait desert. Because elevators were not operational, he recounted, he had to walk several stories to access water. But with work schedules so pressing, most workers gathered around the water tank only during their one-hour break. On many days, the water would be gone before the break ended. Often, Suraj didn’t drink anything all day.

Through his hard work, Suraj was able to send his sister $150 a month, doubling the family's income. He began building a more solid house for the family, hoping to replace living in a mud-and-bamboo hut with the relative luxury of a concrete house. A propane stove would replace cooking in an open fire on the floor. 

Suraj avoided every hazard, except the one that quietly ravaged his kidneys.

One day in January, Suraj collapsed with dizziness and pain shot through his torso and swollen legs. When he checked himself into Kuwait’s Farwaniya Hospital, his Indian doctor took one look, Suraj recalled, and immediately sent him to the intensive care unit.

Suraj had severe anemia and developed a blood clot in his stomach. Before long, he lost consciousness and would need eight pints of blood replaced, according to his Kuwaiti medical records. The diagnosis: end-stage renal disease.

Suraj wasn't alone. A disproportionate number of those in the kidney ward were young men who'd worked abroad, laboring outdoors under harsh conditions.  

The Nepalese government provides some assistance to those needing medical help, but families still struggle, further impoverishing themselves in the hunt for a new kidney. (The Nepalese medical system sounds plenty familiar...)

Meanwhile, back in Nepal, Suraj and his sister are doing what they can to keep him alive. They're planning on selling the half-built house. Any plans Suraj had to get married and start a family of his own are on (likely permanent) hold. They're hoping they can somehow scrounge a kidney, scrounge a kidney transplant. That Suraj will once again be able to work.

“These epidemics of chronic kidney disease that have surfaced … [are] just the beginning,” said Richard Johnson, a professor of medicine at the University of Colorado who is studying pockets of kidney disease globally. “As it gets hotter, we expect to see these diseases emerge elsewhere.”

Oh.