Saturday, May 13, 2017

In Fukushima, a land where few return

The evacuation orders for most of the village of Iitate have been lifted. But where are the people?


Go to Original
BY  AND 



Some day when I have done what I set out to do, I’ll return home one of these days, where the mountains are green, my old country home, where the waters are clear, my old country home.
— “Furusato,” Tatsuyuki Takano
A cherry tree is blooming in the spring sunshine outside the home of Masaaki Sakai but there is nobody to see it. The house is empty and boarded up. Weeds poke through the ground. All around are telltale signs of wild boar, which descend from the mountains to root and forage in the fields. Soon, the 60-year-old farmhouse Sakai shared with his mother and grandmother will be demolished.
“I don’t feel especially sad,” Sakai says. “We have rebuilt our lives elsewhere. I can come back and look around — just not live here.”
A few hundred meters away the road is blocked and a beeping dosimeter begins nagging at the bucolic peace. The reading here is a shade over 1 microsievert per hour — a fraction of what it was when Sakai’s family fled in 2011.

The radiation goes up and down, depending on the weather, Sakai says. In gullies and cracks in the road, and up in the trees, it soars. With almost everyone gone, the monkeys who live in the forests have grown bolder, stopping to stare at the odd car that appears instead of fleeing, as they used to.
A cluster of 20 small hamlets spread over 230 square kilometers, Iitate was undone by a quirk of the weather in the days that followed the nuclear accident in March 2011. Wind carried radioactive particles from the Fukushima No. 1 nuclear power plant, which is located about 45 kilometers away, that fell in rain and snow on the night of March 15, 2011. After more than a month of indecision, during which the villagers lived with some of the highest radiation recorded in the disaster (the reading outside the village office on the evening of March 15 was a startling 44.7 microsieverts per hour), the government ordered them to leave.
Now, the government says it is safe to go back. With great fanfare, all but the still heavily contaminated south of Iitate, Nagadoro, was reopened on March 31.
The reopening fulfills a pledge made by Mayor Norio Kanno: Iitate was the first local authority in Fukushima Prefecture to set a date for ending evacuation in 2012, when the mayor promised to reboot the village in five years. The village has a new sports ground, convenience store and udon restaurant. A clinic sees patients twice a week. All that’s missing is people.
Waiting to meet Kanno in the government offices of Iitate, the eye falls on a book displayed in the reception: “The Most Beautiful Villages in Japan.” Listed at No. 12 is the beloved rolling patchwork of forests, hills and fields the mayor has governed for more than two decades — population 6,300, famous for its neat terraces of rice and vegetables, its industrious organic farmers, its wild mushrooms and the black wagyu cow that has taken the name of the area.
The description in the book is mocked by reality outside. The fields are mostly bald, shorn of vegetation in a Promethean attempt to decontaminate it of the radiation that fell six years ago. There is not a cow or a farmer in sight. Tractors sit idle in the fields. The local schools are empty. As for the population, the only part of the village that looks busy is the home for the elderly across the road from Kanno’s office.

“The village will never return to how it used to be before the disaster,” Kanno says, “but it may develop in a different way.”
Recovery has started, Kanno says, wondering whether returnees will be able to start building a village they like.
“Who knows? Maybe one day that may help bring back evacuees or newcomers,” Kanno says. “Life doesn’t improve if you remain pessimistic.”
Even for those who have permanently left, he adds, “it doesn’t mean that their furusato can just disappear.”
The pull of the furusato (hometown) is exceptionally strong in Japan, says Tom Gill, a British anthropologist who has written extensively about Iitate.
Yearning for it “is expressed in countless sentimental ballads,” Gill says. “One particular song, simply titled ‘Furusato,’ has been sung by children attending state schools in Japan since 1914.”
The appeal has persisted despite — or perhaps because of — the fact that the rural/urban imbalance in Japan is more skewed than in any other developed nation, Gill says; just 10 percent of the nation’s population live in the country.
This may partly explain the extraordinary efforts to bring east Fukushima back to life. By one study, more than ¥2.34 trillion has been spent decontaminating an area roughly half the size of Rhode Island.
There has been no official talk of abandoning it. Indeed, any suggestion otherwise could be controversial: When industry minister Yoshio Hachiro called the abandoned communities “towns of death” in September 2011, the subsequent outrage forced him to quit a week later.
Instead, the area was divided into three zones with awkward euphemisms to suggest just the opposite: Communities with annual radiation measuring 20 millisieverts or less (the typical worldwide limit for workers in nuclear plants) are “being prepared for lifting of evacuation order,” districts of 20-50 millisieverts per year are “no-residence zones” and the most heavily contaminated areas of 50 millisieverts or more per year, such as Nagadoro, are “difficult-to-return.”
In September 2015, Naraha, which is located 15 kilometers south of the Fukushima No. 1 nuclear plant, became the first town in the prefecture to completely lift the evacuation order imposed after the triple meltdown. Naraha has a publicly built shopping street, a new factory making lithium batteries, a kindergarten and a secondary school.
A team of decontamination workers has been sent to every house — in some cases several times. Of the pre-disaster 7,400 residents, about 1,500 mainly elderly people have returned, the local government says, although that figure is likely inflated.
In Iitate, the cost of decontamination works out at about ¥200 million per household. That, and the passage of time, has dramatically reduced radiation in many areas to below 20 millisieverts a year. However, Kanno says, the cleanup extends to only 20 meters around each house, and three-quarters of the village is forested mountains. In windy weather, radioactive elements are blown back onto the fields and homes.
“All that money, and for what?” asks Nobuyoshi Itoh, a farmer and critic of the mayor. “Would you bring children here and let them roam in the fields and forests?”

Itoh opted to stay in one of the more heavily toxic parts of the village after everyone fled, with little apparent ill effect, although he says his immune system has weakened.
One of the reasons why Iitate was such a pleasant place to live before the nuclear crisis, he recalls, was its unofficial barter system. “Most people here never bought vegetables; they grew them,” he says. “I would bring someone potatoes and they would give me eggs. That’s gone now.”
At most, he says, a few hundred people are back — but they’re invariably older or retired.
“They alone will not sustain the village,” Itoh says. “Who will drive them around or look after them when they are sick?”
As the depth of the disaster facing Iitate became clear, local people began to squabble among themselves. Some were barely scraping a living and wanted to leave, although saying so out loud — abandoning the furusato — was often difficult. Many joined lawsuits against the government.
Even before disaster struck, the village had lost a third of its population since 1970 as its young folk relocated to the cities, mirroring the hollowing-out of rural areas across the country. Some wanted to shift the entire village elsewhere, but Kanno wouldn’t hear of it.

Compensation could be a considerable incentive. In addition to ¥100,000 a month to cover the “mental anguish” of being torn from their old lives, there was extra money for people with houses or farms. A five-year lump sum was worth ¥6 million per person — twice that for Nagadoro. One researcher estimates a rough figure of ¥50 million for the average household, sufficient to leave behind the uncertainties and worries of Iitate and buy a house a few dozen miles away, close enough to return for work or to the village’s cool, tranquil summers.
Many have already done so. Though nobody knows the true figure, the local talk is that perhaps half of the villagers have permanently left. Surveys suggest fewer than 30 percent want to return, and even less in the case of Nagadoro.
Yoshitomo Shigihara, head of the Nagadoro hamlet, says many families made their decision some time ago. His grandchildren, he says, should not have to live in such a place.
“It’s our job to protect them,” Shigihara says. He lives in the city of Fukushima but returns roughly every 10 days to inspect his house and weed the land.
Even with so much money spent, Shigihara doubts whether it will bring many of his friends or relatives back. At 70 years of age, he is not sure that he even wants to return, he says.
“I sometimes get upset thinking about it, but I can’t talk with anyone in Fukushima, even my family, because we often end up quarreling,” he says. “People try to feel out whether the others are receiving benefits, what they are getting or how much they received in compensation. It’s very stressful to talk to anyone in Iitate. I’m starting to hate myself because I end up treating others badly out of frustration.”
Kanno has won six elections since 1996 and has overseen every step of Iitate’s painful rehabilitation, navigating between the anger and despair of his constituents and the official response to the disaster from the government and Tokyo Electric Power Company Holdings (Tepco), operator of the crippled nuclear plant.

He wants more money to complete decontamination work (the government claims it is finished), repair roads and infrastructure. Returnees need financial support, he says. However, it is time, he believes, to end the monthly compensation, which, in his view, induces dependency.
“If people keep saying that life is hard, they will not be able to recover,” he says. “What we need is support for livelihoods.”
A new system gives seed money to people who voluntarily come back to start businesses or farms.
“We don’t want to give the impression that we are influencing people’s decisions or forcing them to return,” the mayor says, using the phrase “kokoro ni fumikomu,” which literally means “to step into hearts.”
Yet, next year, thousands of Iitate evacuees will face a choice: Go back or lose the money that has helped sustain them elsewhere for six years. Evacuation from areas exposed to less than 20 millisieverts per year will be regarded as “voluntary” under the official compensation scheme.
This dilemma was expressed with unusual starkness last month by Masahiro Imamura, the now sacked minister in charge of reconstructing Tohoku. Pressed by a freelance reporter, Imamura tetchily said it was up to the evacuees themselves — their “own responsibility, their own choice” — whether or not to return.
The comment touched a nerve. The government is forcing people to go back, some argued, employing a form of economic blackmail, or worse, kimin seisaku — abandoning them to their fate.
Itoh is angry at the resettlement. For him, politics drives the haste to put the disaster behind.
“It’s inhuman to make people go back to this,” he says. Like the physical damage of radiation, he says, the psychological damage is also invisible: “A lot of people are suffering in silence.”
Itoh believes the government wants to show that the problems of nuclear power can be overcome so it can switch the nation’s idling nuclear reactors back on. Just four are in operation while the fate of 42 others remains in political and legal limbo. Public opinion remains opposed to their restart.
Many people began with high hopes in Iitate but have gradually grown distrustful of the village government, says Kenichi Hasegawa, a farmer who wrote a book titled “Genpatsu ni Furusato o Ubawarete” (“Fukushima’s Stolen Lives”) in 2012. Right from the start, he says, the mayor desperately tried to hide the shocking radiation outside his office.
“Villagers have started losing interest,” Hasegawa says.
Meetings called by the mayor are poorly attended.
“But they hold meetings anyway,” Hasegawa says, “just to say they did.”
Kanno rejects talk of defeatism. A tourist shop is expected to open in August that will attract people to the area, he says. Some villagers are paving entrances to their houses, using money from the reconstruction budget. As for radiation, everyone “has their own idea” about its effects. The lifting of the evacuation is only the start.
Itoh says he once trusted public officials but those days are long gone. By trying to save the village, he says, the mayor may in fact be killing it.

Climate Change Is Turning Dehydration Into a Deadly Epidemic

Go to Original
By  Jane Palmer



By 10 am in the sugarcane fields outside the town of Tierra Blanca in El Salvador, the mercury is already pushing 31°C. The workers arrived at dawn: men and women, young and old, wearing thick jeans, long-sleeved shirts and face scarves to prevent being scorched by the sun's rays. They are moving quickly between rows of cane, bending, reaching, clipping and trimming in preparation for harvesting the crop in the weeks to come. In the scant shade, old Pepsi and Fanta bottles full of water swing from tree branches, untouched. Gulping only the thick air, the workers won't stop until noon, when their shift is over. 
Among them is 25-year-old Jesús Linares. His dream, he explains in English, was to be a language teacher, but like many Salvadoran children he went to work to help support his parents and siblings. Aged eight, he learned to hide in the towering canes whenever the police sought out underage workers; since then, he's tended sugarcane from dawn to noon and then pigs until dusk. In the evenings, he tries to listen to English audio programs or read a language book, but for the last year he's been too tired to concentrate. So tired, in fact, that a few months ago he visited the Tierra Blanca clinic. Blood tests revealed that Linares was in the early stages of chronic kidney disease.
It's a familiar story here in the Bajo Lempa region, where recent studies suggest that up to 25 percent of its nearly 20,000 inhabitants have chronic kidney disease. Across El Salvador, kidney failure is the leading cause of hospital deaths in adults. But while chronic kidney disease is most commonly caused by hypertension and diabetes, two-thirds of patients in Bajo Lempa don't have either of those conditions, and the cause of their illness remains uncertain.
Scientists have identified certain key themes. The majority of people with the unexplained disease are men, and it strikes predominantly in hot, humid regions where people are engaged in strenuous outdoor labour: farming, fishing or construction work. Dehydration, which seems an obvious factor, causes acute kidney disease that is easily reversed by drinking water, rather than this chronic form. This has left two burning questions: what causes this new form of kidney disease, and will it be likely to spread as the world gets warmer?
Meanwhile, in El Salvador over the last two decades, more and more patients have arrived at clinics and hospitals, often taxing them to their limit. Many people, unable to get treatment, simply return to their homes to die.
"This is really a silent massacre," says Ramón García-Trabanino, a Salvadoran kidney specialist.

You don't feel any kind of pain, but you feel like you are slowly decaying.

The patients at the Hospital Nacional Rosales in San Salvador all have the same story: until three months ago they were perfectly fine. Most of them had never seen a doctor in their life before, and had ignored any early signs of ill health this time as well. The turning point came only when they were too sick to work.
Working hard lies at the heart of Salvadoran culture. During the 1980–92 civil war, the armed forces carried out a scorched-earth strategy, targeting the civilian population in the countryside to remove any possible support base for the rebels. Tens of thousands died and a quarter of the populace fled. When peace finally came, the rural communities were able to return to their land, which was parcelled out to cooperatives, industry and independent farmers. For the survivors, the only way forward was to work, and work hard, to overcome other challenges that peace could not resolve.
At 8,124 square miles, El Salvador is one of the world's smallest countries, yet within its boundaries lie endless stretches of coastline, mountain ranges and an abundance of agricultural lowlands, which owe their fertility to rich volcanic soil. There are 23 volcanoes in El Salvador, standing over the cities and central plateaus like guardians. In 2013, people in the San Miguel province fled their homes when the Chaparrastique volcano began spewing hot ash and smoke into the air.
Volcanoes aren't the only natural hazard. The country sits right where the western part of the Caribbean Plate overrides the Cocos Plate, making it one of the most seismologically active regions on earth. In 2001, two earthquakes south-west of San Miguel killed at least 1,000 people and destroyed or damaged nearly 300,000 homes.
Such challenges only add to the determination to work hard, and in keeping with this cultural work ethic, many agricultural laborers don't admit to getting ill, even to themselves. But kidney disease is a sneaky opponent. It can totally destroy one kidney while the individual remains blissfully unaware. Only in the final stages of the disease do the workers get a hint that all is not well, and by the time they arrive at the emergency ward, they are dying.
García-Trabanino started a fellowship at the Rosales hospital as a young doctor in 1998, and what he encountered resembled a scene from a battlefield. He had expected to be treating heart disease, neurological patients, eye problems -- the full gamut of medical conditions. Instead all he encountered were men dying -- sometimes slowly, but usually quickly -- from kidney failure. They came in such numbers that they overwhelmed the beds and spilled into the corridors.
"Sometimes, even with [our] obsolete dialysis techniques, we managed to get some of them to survive a night. A day. A week," he says. Most died within a month, however, and no one seemed interested in finding out why, or even how many cases there were. So García-Trabanino and a colleague started counting them, one by one, at the door of the emergency ward until, after a few months, their count reached more than 200. The Ministry of Health in El Salvador didn't follow up on their findings, but it did grant the doctors a medal, which garnered media attention.
"The next month people from the social organizations of the coastlands came," García-Trabanino recalls. The visitors told him stories of years of living with unexplained deaths among their otherwise healthy young people. Every other week they had to burn the dead.
"You've just discovered what we have been living for years," they said. "Tell me, doctor, what is the cure?" He had no answer.
Today, the hospital has 1,000 cases of chronic kidney disease, with more than 30 new patients arriving each month. "But we only have resources for half of them," saysRicardo Leiva, head of the nephrology unit. By the time the new victims arrive they typically need dialysis, but the waiting list is long. Sometimes the nephrologists can administer peritoneal dialysis instead, using a hard plastic tube inserted into the belly by surgery. "It is an old technique that is not being used anywhere else in the world," says Leiva. "But we need it."
Back in Tierra Blanca, Juan Pablo Paniagua, a lean 60-year-old with a permanent toothy grin, talks about how the disease caught him totally by surprise. Working in the cornfields since he was a boy, then as a fisherman, he felt fine until seven years ago. "Then your body starts feeling something strange. You don't know what it is," he says. "You don't feel any kind of pain, but you feel like you are slowly decaying."
Paniagua received dialysis three times a week for two and a half years. After that, he was unable to pay for the regimen, which typically runs to about $120 for a single blood-cleansing session. So the doctors showed him how to take care of a catheter in his abdomen and instructed him in how to do peritoneal dialysis at home. "I've had moments of nearly dying but," he says, "once I started dialysis, I realized that I was actually improving." 

We realised the problem was all across Central America and southern Mexico.

Early in 2016, 32-year-old José Luis Morales, a healthy-looking man with a footballer's physique, began to feel cramps in his legs and became so weak he couldn't pick up a glass of water. Morales works as a truck driver in Chalatenango, a humid lowland area in northern El Salvador and another hotspot for chronic kidney disease. Unable to work, he went to San Salvador to see García-Trabanino.
"He had the classic picture of this disease," García-Trabanino says. "He is not diabetic, he is not hypertensive. He is young without any past medical history." Blood tests revealed low potassium and high uric acid levels, which García-Trabanino treated with medication. Currently in stage two of the disease, Morales will need to take medication for the rest of his life. "We can't revive or bring back to life the lost kidney tissue, but we can take care of what is left," says García-Trabanino.
Chronic kidney disease destroys kidney tissue until it can no longer filter waste from the blood. Without dialysis, this can lead to high blood pressure, weakness, dizziness and a host of other symptoms. But while diabetic kidney disease damages the glomeruli, the tiny units that clean the blood, the new form destroys the renal tubules, where urine is made and transported, and the interstitium, which surrounds the other structures in the kidneys and helps maintain the right balance of fluid. This is the same pattern of damage caused by some toxins, and because the new disease hit the agricultural communities so heavily, García-Trabanino suspected that exposure to herbicides and insecticides might be to blame. 
To investigate, he teamed up with the Emergency Social Fund for Health in Tierra Blanca, as well as with Emmanuel Jarquín, an occupational health and safety consultant. Together, they investigated the incidence of chronic kidney disease in agricultural laborers in the lowlands, and compared them with similar workers in a region 500 meters above sea level. In the latter group, however, they found almost no cases of the mysterious disease. "They were working the same crops and using the same chemicals, but they were not getting sick," García-Trabanino says. "We were clueless."
The physicians began to wonder if they were just seeing a local problem, as most of the patients in Rosales hospital had come from the Bajo Lempa region. So Jesús Domínguez, a Spanish volunteer physician in Tierra Blanca, went on a mission. Renting a car and equipment, he drove from Mexico to Nicaragua, stopping by fields and taking urine samples from outdoor laborers toiling under the sun. His study indicated that many of the workers were already in the first stages of chronic kidney disease.
Far from being local, says García-Trabanino, "we realized the problem was bigger than we thought, and it was all across Central America and southern Mexico."

We lose one or two people from this region every week. It's poverty, not the disease, that kills them.

Richard J Johnson, a kidney specialist at the University of Colorado, helped organize the World Congress of Nephrology in Canada in 2011. There, he learned about the strange new form of chronic kidney disease spreading through Central America. Researchers from various countries were beginning to get together and discuss the evidence. Like others, Johnson began to think about possible causes.
His own research was focused on the sugar fructose -- identifying its role in obesity, high blood pressure and heart disease. When a person eats fructose, the liver bears most of the brunt, but some of the sugar eventually ends up in the kidney. With each meal, fructose enters the kidney tubules, where it is metabolized into uric acid and causes oxidative stress, both of which can damage the kidney.
At first, Johnson thought people in the sugarcane fields could be eating so much of the plant itself that they were generating high levels of uric acid and oxidative stress in their kidneys. But, he calculated, even sucking on sugarcane all day wouldn't produce enough fructose to cause disease. Then he discovered that, under certain conditions, the body processes regular carbohydrates to make its own fructose. And one of the triggers of this deadly alchemy is simple dehydration.
Until that point, nephrologists had thought that dehydration could only cause acute kidney injury, but Johnson's findings put a new spin on the role of insufficient water intake. Could dehydration day in, day out be causing continuous fructose overproduction that, in turn, could be leading to long-term kidney damage?
Johnson took his theory to the lab, where his team put mice in chambers and exposed them to hours of heat at a stretch. One group of mice was allowed to drink unlimited water throughout the experience, while a second group had water only in the evenings. Within five weeks the mice with a restricted water intake developed chronic kidney disease. During the day, loss of salt and water caused the mice to produce high levels of fructose, and crystals of uric acid would sometimes form as water levels dropped in their urine. When the scientists disabled the gene that metabolizes fructose and repeated the experiment, neither group developed chronic kidney disease.
Johnson took these results to a meeting of the Program on Health and Work in Central America, or SALTRA, in Costa Rica in 2012, where they caught the attention of García-Trabanino: "I was astonished. His animal models were absolutely in line with our findings."
The two collaborated to investigate the biochemical effects of dehydration on workers in the fields of El Salvador. Levels of uric acid started high in the morning and increased throughout the day. "Some patients just had sheets of uric acid crystals in their urine," Johnson says.
From these studies, Johnson believes that heat stress and dehydration drive the production of fructose and vasopressin, which also damages the kidney. However, he believes that another mechanism may also play a part in the epidemic: rehydration with sugary drinks. Frequently, not trusting the quality of local drinking water, workers drink sodas and soft drinks, and experimental evidence suggests that doing so can lead to even more kidney damage. 
"At this stage, that heat stress and dehydration might be causing this problem is still a hypothesis," Johnson admits. "Although it is a strong one."

hey went out because they were expecting it to be a relatively normal day and they got hit.

Each month, in the blistering afternoon heat, men sporting cowboy hats or baseball caps and women wearing short frilly aprons over their dresses gather at the Centro Cultural Monseñor Romero in Tierra Blanca. Seated in a shady area next to a garden overgrown with tropical plants, the 40-odd throng hold bottles of water provided for the occasion.
On a makeshift table, a volunteer nurse straps the inflatable cuff of a blood pressure monitor on thick arms, skinny arms, arms hardened by years of labor, wrinkled arms softened by old age. Amid the ministrations, raising his voice to drown out the chaos and laughter of children learning traditional dances nearby, Julio Miranda, the imposing leader of the Emergency Social Fund for Health, takes centre stage: "If you want to tell your experience, it will bring benefit to the community," he says.
One by one, men and women stand to tell their stories. As they talk, heads nod in assent, some ask questions. But in true El Salvadoran style, despite the gravity of the accounts, good-humored jibes prevail alongside the murmurs of empathy. 
For Santos Coreas, an emaciated 57-year-old man who has worked in the fields since his teenage years, the money he receives from his sons working in the USA is the difference between life and death. It pays for his weekly haemodialysis, although that still falls short of the recommended three-times-a-week regime. His wife quickly interjects: "We can't afford more; we do what we can."
In El Salvador, social security benefits cover health costs for only a quarter of the population. Private, military and teachers' schemes cover a further 5 per cent, and the Ministry of Health provides public healthcare to the remaining 70 percent, according to García-Trabanino. From 2004 to 2013, in this area, 271 patients reached end-stage renal disease, the point at which the only options are dialysis or death. Only a third of them received any type of dialysis, a quarter of these relying on El Salvador's largest source of income: relatives sending money home from abroad.
Of the 235 patients who relied on the public health system, many didn't have access to dialysis or were afraid of outdated techniques that are associated with a high death toll. Transport costs to and from the city for treatment often proved beyond their means, too. Only 12 of these people were alive one year after diagnosis.
"You need dialysis or transplantation or you die, and we lose one or two people from this region every week," García-Trabanino says. "It's poverty, not the disease, that kills them."
But dialysis isn't the only line of defense if you can act early enough. For Rogelio Sánchez, a bout of gastroenteritis more than 10 years ago indirectly saved his life. Blood tests revealed his kidneys were in the early stages of chronic disease and, since then, medication has stopped the disease from progressing.
Sánchez has come to the meeting today with one of his four sons, Henry, a doe-eyed and healthy-looking boy who appears much younger than his 23 years. Five years ago, Henry started to feel sick and blood tests revealed that he also had the new form of chronic kidney disease. García-Trabanino, who is a volunteer physician at the meetings, prescribed a drug to boost his potassium levels, along with potassium and calcium supplements, and advised Henry to seriously reduce his football playing, avoid sun exposure and drink lots of water. Like his father, Henry now has the disease under control. 
In 2006, the Emergency Social Fund for Health started taking blood samples from all the locals. In 6,000 samplings since, they have found 1,500 people in various stages of the disease. Only 100 have died, and these were workers already in the final stage. For the others, early diagnosis and medication can keep end-stage disease at bay for decades. This requires funding, however. Unsupported by the government, the organization relies on donations. But in recent years, the number of people who need such treatment has continued to rise.

We predict the kidney is going to be one of the prime targets as heat increases.

For Johnson, a clue as to why the epidemic is escalating came from a disturbing occurrence during his research with García-Trabanino. One day, when the field researchers were measuring uric acid levels, only seven workers showed up for work. "But they all had uric acid crystals in their urine. All of them," Johnson says. "It was bad news for these seven."
Alarmed, he contacted the lead investigator of the study, who felt that the team should ignore the finding as so few workers had turned up that morning. "But I said that maybe this is the most interesting group, because 100 percent of the workers got it that day."
He looked up the weather and found out that it had, in fact, been the hottest day of the year at the study location. "Suddenly a really, really big heatwave came in and the workers weren't ready," he says. "They went out because they were expecting it to be a relatively normal day and they got hit."
Instead of his usual fare of nephrology and diabetes papers, Johnson began to pore over global maps of climate and solar radiation. The rise in average temperatures over the last few years in Central America had been incremental, but the number of extreme events had gone up disproportionately. "And, by gosh, the areas that have the highest solar radiation and heatwaves are overlapping the places right where the epidemics are."
He contacted climate experts at the nearby National Oceanic and Atmospheric Administration in Boulder, Colorado. They verified and finessed his original discovery, and the team published an assessment report in May 2016, which suggested a connection between climate change and the epidemic. Johnson says it "may well be one of the first epidemics because of global warming."
Climate change brings dire predictions of extreme weather and sea-level rise in the future, but it is affecting the world's most vulnerable populations right now, he says. And although heat exposure can affect the body in many ways, our kidneys are in the first line of attack, as their role is to keep electrolytes within the normal range and blood volume stable. "We predict the kidney is going to be one of the prime targets as heat increases." 
Researchers currently classify the new form of chronic kidney disease as 'climate-sensitive', which means that climate is one ingredient contributing to the epidemic. As temperatures continue to rise, many such climate-sensitive diseases will become climate-driven, and monitoring and bringing attention to them will become even more crucial.

It starts as a little problem and it will grow and grow and grow.

"Climate change is not like a new thing, it has been here for a long time," says Emmanuel Jarquín, who has seen the impacts of rising temperatures on farmers in El Salvador. Already the country has had hotter summers and longer, drier winters. Coffee plantations, usually between 600 and 1,000 meters above sea level, where ideal cool conditions exist for the crop, have shrunk upwards towards the top of the hillsides. The heat has also increased the number of pests and droughts, and some farmers have begun to swap coffee for cocoa trees. 
And while climate change isn't the root cause of the new chronic kidney disease, it is making it a lot worse, he says. "It will hit the poor people harder. It starts as a little problem and it will grow and grow and grow."
For the people of El Salvador, then, this is yet another life-threatening obstacle to overcome. Living under constant threat from earthquakes and volcanoes, but also gang violence, political unrest and poverty, they have developed a strong defense mechanism: a forceful loyalty to family, community and fellow countrymen. "Even taking into account the conditions we live in, we still believe in good things and we are fighters," says Jarquín. "We always try to do good things, against all odds."
For García-Trabanino, the towering volcanoes have come to symbolize what it means to be El Salvadoran: "I used to think we were stupid people when I was younger, to build under the volcanoes," he says. "But then I realized they were everywhere." But living underneath the volcanoes gives people both an appreciation of life -- because they can die any day -- and a sense of strength.
"We have survived the civil war, earthquakes and volcanoes, but El Salvadorans fight, and they will fight again."

Chelsea Manning prepares for freedom: 'I want to breathe the warm spring air'

On Wednesday, after seven years, Chelsea Manning will walk out of military prison a free woman. Edward Snowden leads the tributes, and tells the Guardian how Manning ‘left behind the safety of silence to speak a truth that saved lives’

Go to Original
By 



On Wednesday, some time after dawn, the security gates at the US disciplinary barracks at Fort Leavenworth, Kansas, will be thrown open and a slight 5ft 2in woman will walk out into the open air and freedom.
For Chelsea Manning, release from military incarceration will mark a colossal turning point. Having been arrested seven years ago when she was an unknown, lowly and outwardly male soldier, she will emerge into an entirely new life as a civilian, a celebrity, and an openly transgender woman.
The day will be momentous in ways that go far beyond its huge personal ramifications for its subject. Manning’s discharge, a parting gift of President Obama as one of his final acts in office, will bring to an end one of the more shameful chapters in US military history.
It began with the humiliating breach that saw vast quantities of state secrets downloaded by a relatively junior army private from supposedly secure intelligence databases on to a Lady Gaga CD. It passed through the harsh treatment of the perpetrator in the military brig in Quantico, Virginia, denouncedby the UN as a form of torture. And it was capped by the imposition of the longest prison sentence ever recorded in the US for an official leak: 35 years in military prison.
Now Manning, her punishment foreshortened, has the chance to put all that behind her. “I’m looking forward to breathing the warm spring air again,” she said from her prison cell as she prepared for release.
“I want that indescribable feeling of connection with people and nature again, without razor wire or a visitation booth. I want to be able to hug my family and friends again. And swimming – I want to go swimming!”
Manning’s release will be greeted with rejoicing by public figures who have spoken out in her support over the years, from Daniel Ellsberg of the Pentagon Papers to Michael Stipe of REM and the designer Vivienne Westwood, among many others. But no one carries as much weight as an empathizer of Manning’s spell in the whistleblowing wilderness than Edward Snowden, the NSA contractor who followed her into the abyss and who has paid a similarly heavy price in the form not of imprisonment but of exile.
Snowden, speaking from asylum in Russia, told the Guardian that in his opinion the timing of the soldier’s release was apt, given the ominous noises coming out of the White House in the week of the firing of the FBI director James Comey. “With a president who offers democracy nothing but contempt and a Congress that represents party over public, whistleblowers have never been more important,” he said.
Snowden lamented what he called the “draconian sentences” handed down to Manning and others like her, that “weaken democracy’s safeguard of last resort, the free press, by cutting off its most reliable source of critical truths”. He praised her as a “citizen who, knowing the costs, left behind the safety of silence to speak a truth that saved lives”.
Despite the hardship Manning has endured over the past seven years, Snowden said he draws solace from the worldwide campaign for her freedom that will culminate with her release this week. In a comment that might be said to contain more than a grain of wistfulness, given his own state of limbo, he said: “I’m grateful that Chelsea will finally have a chance to enjoy the freedoms she gave so much to defend. Courage to her – and volume to her voice.”
Manning has indicated that she intends to live in Maryland after her release, a move that will bring her story full circle. It was here in early 2010, at a branch of the Barnes & Noble in suburban Maryland, barely 20 miles away from the Pentagon, that she used the bookstore’s open public wifi network to upload to WikiLeaks what she later described at her trial as some of the “more significant documents of our time”.
Manning was on leave from duty in Iraq at the time and staying with her aunt in Potomac. She had brought with her from the US forward operating base Hammer outside Baghdad a camera memory stick carrying hundreds of thousands of secret documents that she had downloaded from intelligence databases initially onto that infamous Lady Gaga CD.

As Manning had been poring through those classified databases in her work as an army intelligence analyst, she had grown increasingly disturbed by what she was reading, material that she believed pierced through the fog of war and revealed“the true nature of -21st-century asymmetric warfare”. Other documents she transmitted to WikiLeaks exposed civilian casualties from US attacks as well as evidence of corruption, censorship and other nefarious behavior on the part of Iraqi government forces and other US allies.
David Coombs, the lawyer who represented Manning at trial, spent three intense years preparing her defense and got to know her very well. He said that he came to appreciate the motives that drove her to commit a massive leak of classified information.
“I can understand how Chelsea Manning was the person who did this,” Coombs said. “She is caring, intelligent, she sees that we don’t always do the right thing and that we could be better – and that if people are informed, maybe they would make better decisions.”
He added: “This was not someone trying to harm America or the war effort, but a person who was hoping that this would spark a debate.”
By the time Manning had completed the dump of data to WikiLeaks, she had effectively put into the public domain a vast mountain of previously secret digital information. The trove included war logs from Afghanistan and Iraq, more than 250,000 US embassy cables from around the world, and official files on 765 Guantánamo detainees.
The single element that probably had most impact was footage of an aerial attack by a US Apache helicopter in Baghdad in which two Reuters staffers and other civilians were killed. WikiLeaks published the video in April 2010 under the title ‘Collateral Murder’, causing an international outcry.
When a collective of international news organizations led by the Guardian began publishing stories on the back of Manning’s leaks, the global reaction was immediate, and highly divided. There were those, like the current deputy National Security Advisor to President Trump, KT McFarland, who called for the source of the leaks to be executed.
Then there were those like Hillary Clinton who were fork-tongued in their response. The then US secretary of state, embarrassed by the unveiling of hundreds of thousands of intimate diplomatic cables, insisted publicly that the leak “puts people’s lives in danger, threatens our national security and undermines our efforts to work with other countries”. Privately, though, she spent hours on the phone with foreign diplomats reassuring them that no one was in peril.
Seven years later, Manning’s leaks continue to evoke sharply differing opinions from informed observers. Micah Zenko, an expert on US national security policy at the Council on Foreign Relations, is skeptical of their long-term significance. They provided fascinating detail and color, he said, “but I do not think they had a lasting, strategic impact, except on officials and diplomats themselves who now assume everything can leak.”

“WikiLeaks undermined key US allies in the Middle East by opening a window on how the US really sees and reported on its closest middle east allies and how they see each other, in turn undermining them further in the eyes of their people,” Hearst said. “The disclosures confirmed the existence of US war crimes in Arab eyes, such as the Apache helicopter tape, and provided Arab youth with a unifying message that acted as an accelerator for the Arab spring uprising.”David Hearst, chief editor of the London-based news and opinion site Middle East Eye, is convinced that Manning’s leaks have had a far more substantial legacy. He points to embassy cables whose revelations helped to spark the Arab Spring by exposing for instance the nepotism of the Tunisian leader Zine al-Abidine Ben Ali and the suppression of popular movements in Bahrain.
A third attitude prevalent among conservatives and parts of the military is that the leak, irrespective of its content, was an act of treachery that Obama was wrong to have rewarded with this week’s release. “It was a breach of the fundamental trust between fighting men and women on which the military depends,” said David French, a former major in the US army who now writes for the National Review. “Obama doesn’t understand that – to grant early release breaks the faith.”
Amid such diversity of views, one thing is certain: the US government responded to Manning’s act with the severity of a category five hurricane. Coombs recalls the feeling of having virtually the entire US national security apparatus bear down on them, with the army, Pentagon, Department of State and the intelligence services all piling in to prosecute the soldier. “They were pushing every legal extreme in order to obtain an outcome that would give them the greatest chance at a lengthy sentence.”
Coombs and his client fought back as best they could. In the most memorable moment of the trial at Fort Meade in Maryland, the lawyer taped out on the floor of the court the precise measurements of the isolation cell in Quantico in which Manning had been penned for months, and placed inside the outline her actual prison mattress to illustrate the draconian conditions of her confinement. “We couldn’t bring the courtroom to Quantico, so laying it out inside the court was the next best thing,” Coombs said.
Coombs and Manning succeeded in rebuffing the most serious charge, aiding the enemy, which was an important victory. But they couldn’t prevent the final outcome of the trial landing like a body blow. “The sentence was deflating,” Coombs said.
Jesselyn Radack, a human rights lawyer who defends whistleblowers, said the 35-year sentence was wholly out of kilter with previous cases. “The sentence was radically harsher than the treatment of any of the other whistleblowers that have been prosecuted in recent times,” she said.
The prison term left Manning facing decades in captivity, a grim prospect starkly compounded by the fact that she would be in a male-only institution even though since childhood she had privately identified as a woman. The day after the sentencing, Coombs went on NBC’s Today show and announced that Manning was a transgender woman and was determined to transition, and within hours of that statement the US military gave its considered reply: no way.
“Chelsea’s captors took a blatantly anti-constitutional anti-trans position,” said Chase Strangio, the ACLU lawyer who has represented Manning in her battles over gender transition while inside military lock-up. “Even in 2013 it was pretty clear that they couldn’t just announce they were going to withhold all care.”
Not for the first time, the US government underestimated the doggedness of Chelsea Manning and her supporters. Over the past four years, with the help of the ACLU, she has managed to push the military into the 21st century.
She won the right to hormone treatment, a first for a military prisoner. Last year she broke further ground when she was told that she could have gender reassignment surgery while in Fort Leavenworth.
But she also had to endure the daily struggle of being in an all-male environment in which she was obliged to undergo a forced haircut every two weeks to keep her within male military grooming standards. At times the denial of treatment sapped at her confidence and threatened even her survival.
“There was a hopelessness. She was never going to get the treatment she needs,” Strangio said. “Chelsea was punished not once but twice with solitary confinement for trying to take her own life for reasons directly related to the denial of her care.”
If gender transition has been Manning’s overwhelming priority in her years of captivity, transition in more ways than one will likely remain a dominant theme when she walks out of those Fort Leavenworth gates. Her battle to live as a woman will continue, coupled with the arguably even greater transition of the return to civilian life.
“Chelsea has been through years of institutional life of one sort or another, with a lot of trauma. Nothing is going to be easy,” Strangio said.
Manning’s aunt Debbie, with whom she was staying in Maryland when she uploaded the files to WikiLeaks, said that now was Chelsea’s chance to put her difficult childhood and troubles with the military behind her and finally achieve her dream of going to college. “She’s extraordinarily gifted intellectually and will make a real contribution to society.”
Debbie, who has rarely spoken in public, also had a stern word for military chiefs. She told the Guardian: “I hope that these past few years have caused the army to think seriously about its treatment of Chelsea before and after she was deployed and make sure that other emotionally challenged soldiers are given proper treatment and are not sent into global hot spots when they are in serious need of psychological counselling.”
On the up side, the minute Manning steps out into the blazing sunlight of freedom she will find herself surrounded by a family of like-minded people who will understand her journey and her challenges. As Strangio put it: “She’s going to get the benefits of a beautiful and vibrant community, people who she can hug and touch and talk to, there’s going to be a huge amount of support.”
“Touch is so important,” Chelsea Manning agreed, after seven long years having been deprived of it. Not to forget swimming. There will be plenty of time for swimming.