Abstract
Background: Chronic kidney disease of non-traditional origin (CKDnt) is an ongoing epidemic that has taken the lives of tens of thousands of people in Mesoamerica, also affecting other tropical geographies. Occupational heat stress, which will increase worldwide as climate change persists, has been identified as a primary trigger of kidney injury and reduced renal function. At Nicaragua's largest sugarcane mill, the water, rest, and shade (WRS) intervention has proven to reduce the risk of heat stress and kidney injury effectively as assessed by the research and policy NGO La Isla Network (LIN) and their academic partners, who have worked with the sugar mill to improve the design of their intervention system. However, discrepancies between intervention design and implementation have been found. This study explores the perceptions of the WRS intervention in the company from the perspective of positions responsible for the workers' environment and heat stress prevention implementation.Methods: A qualitative design was used in the study. Twenty-one key informants of low and middle management, field assistants, and two members from LIN took part in the study. Semi-structured interviews were used to collect the data. Interviews' transcriptions were analyzed using interpretative phenomenological analysis (IPA).Results: Four main themes were developed in the analysis of the data: “A worthwhile struggle,” “Culture of care”, “Traditional production culture Vs. Culture of care,” and “The importance of the formalization of care.” Each theme contained sub-themes, all of which were further discussed in the light of organizational psychology.Conclusion and Implications: Discretionary differences resulting in low and middle management prioritizing production over health protection appeared to relate to a fair part of the implementation challenges and indicate that more efforts are needed to align operations' production and health goals. Education enhancement might be necessary, while further focus on health metrics for performance assessment might offer an opportunity to level perceived incentives and value of health and production.
Highlights
Rising temperatures due to climate change are making occupational health and safety risks more severe for a large share of the world’s working population (1, 2)
According to all foremen, their struggle was most difficult at the beginning of the implementation of heat stress preventive measures
Four main themes were developed in the analysis: “A worthwhile fight,” “Culture of care,” “Traditional production culture vs. Culture of care,” and “The importance of the formalization of care.”
Summary
Rising temperatures due to climate change are making occupational health and safety risks more severe for a large share of the world’s working population (1, 2). The CKDnt epidemic has impacted agricultural laborers dramatically, sugarcane workers in particular, with a death toll that runs into the tens of thousands of people (6, 7). These workers are mostly young men who are affected together with entire communities, as they are usually households’ sole source of income in socioeconomically disadvantaged rural settings (6, 8). Chronic kidney disease of non-traditional origin (CKDnt) is an ongoing epidemic that has taken the lives of tens of thousands of people in Mesoamerica, affecting other tropical geographies. This study explores the perceptions of the WRS intervention in the company from the perspective of positions responsible for the workers’ environment and heat stress prevention implementation
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