San Salvador, El Salvador - Cutting sugarcane manually is one of the most physically difficult jobs somebody can do. In the coastal regions of El Salvador, where temperatures regularly reach over 35C, workers chop burned cane with machetes and are paid by weight, making $2.26 a tonne and earning around $10 to $15 on a good day.
Further complicating their lives is an epidemic of chronic kidney disease of unknown origin, or CKDu, which has killed between 20,000 to 30,000 people alone in the Central American nations of Nicaragua and El Salvador since the start of the millennium. It is one of the leading causes of death among men in El Salvador, a country ravaged by gang violence.
Now, an international team of doctors, researchers, scientists and activists are collaborating with Salvadoran sugarcane mill El Angel in Apopa, on the outskirts of the capital, to study and prevent the disease among its sugarcane-cutting workforce.
The Worker Health and Efficiency Programme (WE Programme) brings water, rest and shade to the fields, where before there had been little, if any. They've been working with three of 43 cutting groups, moving from field to field with the workers.
Workers who cut sugarcane for El Angel, and their families from the community of Los Almendros, are caught in the everyday reality of this disease, which seems to be as much a result of extreme poverty and economic conditions as it is related to heat stress, dehydration and extreme physical conditions. Families are locked into cycles of poverty and sickness. This occupational health programme, which strives to be a model for other companies and governments to adopt, aims to restore the health and dignity of the workers who produce the sugar that the world consumes.
WATCH: El Salvador's sugarcane workers and their silent killer