The CDKU – Kidney disease epidemic
Posted on June 16th, 2013

By Garvin Karunaratne,Ph.D Agricultural Econmics & Non Formal Education(Michigan State University)

Things seem to be moving from bad to worse, though research has been done, the WHO has made a study and given recommendations and many personages have offered ideas. The situation is gathering momentum every day and I am perturbed to hear the statemnt by the Minister of Health to the effect  that the disease, though it was confined to the North Central Province is now spreading to other districts. It has spread to the Badulla District. It has even been found that youths from the North Central Province, who have not yet been diagnosed as suffering from CDKU have smaller kidneys.(Daily Mirror: 12/4/13). The situation looks serious in the extreme.

 It is my opinion that in addition to all other factors that have been identified the excessive use of fertilizer is a major cause.

 The problem with the use of fertilizer is that there are three varieties, phosphate, potash and sulphate. Each fertilizer has to be used at different stages of the paddy plant and can have negative results if misused.  Further the effect of some varieties like ammonium sulphate and urea is easily visible which make farmers use this variety only and ignore the rest. Thus for best results a vibrant extension service is essential.

 Let me draw on my experience as an administrative officer. I handled fertilizer distribution to the entire island in 1962 in the Agrarian Services Department and was instrumental in sending out the first island wide circular which detailed the amount of fertilizer to be used, which fertilizer and at what stage. At that time farmers used very little fertilizer and the green revolution was pursued apace with the introduction of new varieties of paddy that had a high response to inorganic fertilizer.

 Later in 1962 to 1964, I was implementing the Paddy Lands Act in the Anuradhapura District, establishing cultivation committees and planning the use of fertilizer and  high yielding varieties. The farmers were very enthusiastic and there was great progress.

 The use of fertilizer proceeded apace and Sri Lanka almost reached self sufficiency whilst implementing the rice ration scheme, issuing rice at reduced rates by 1970.

 During these years of expansion- I was working in Sri Lanka till 1973 and even for another decade later there was no major problem about the negative use of fertilizer.

 At that time there were two major Departments that attended to agricultural extension. The long standing department was the Department of Agriculture, which was well staffed with qualified officers. At the District level there were District Agricultural Extension Officers(DAEO) who were authorities in the use of fertilizer. Under them in each District there were Agricultural Instructors at the Divisional level. They had studied agriculture for two years. I have met them again and again on my visits and I was always impressed with their knowledge. Each Agricultural Instructor had a number of Krushikarma Vyapti Sevakas(KVSs)- Field Assistants who were posted at the village level. These officers had an years’ training in paddy cultivation.

 With the establishment of the Agrarian Services Department in 1958, to implement the Paddy Lands Act a boost was given to paddy cultivation by the establishment of cultivation committees. Each District was headed by an Assistant Commissioner and under him there were District Officers  who had around half a dozen Field Assistants.  The Field Assistants were trained in agriculture. This staff guided the work of the cultivation committees and we got down to planning the use of fertilizer at the village level. The KVSs of the Agricultural Departments  also worked with the cultivation committees. Peoples participation was foremost in the working of the cultivation committees and this combined strength of the Department of Agriculture and Agrarian Services did create wonders in increasing paddy production.

 However this efficient extension service went through four major changes from the Seventies.

 Firstly the Agrarian Services Department  which was following the socialist concept of people’s participation was given less and less prominence and ultimately the cultivation committees were disbanded with the abolition of the paddy lands act. Though the Agrarian Services yet has petty offices at the divisional level, these offices have hardly any tasks and their work today is a fraction of the work we did in the Sixties and early Seventies.

 The Department of Agriculture which was the technical department with specialist officers had a major shake up when President Premadasa decided to absorb all KVSs as Grama Sevakas. Out went the qualified officers who were working at the village level guiding the farmers. For a few years there was no agriculture staff at the village level under the Agricultural Instructors, till President Kumaranatunge created the Samurdhi Niyamakas.  O Level qualified youths were appointed and they knew no agriculture. Till today these Niyamakas continue. Some of them have of their own accord mastered something in agriculture due to their enthusiasm but unfortunately to date they have never been trained.

 Another change was devolving Agriculture and Agrarian Services to the Provincial Councils by the 13 th Amendment to our Constitution. Thenceforth the efficiency depended on the whims and fancies of the Provincial Minister of Agriculture.

 A fourth force was the IMF and the World Bank which came up with their Training & Visit System of Agricultural Extension which did away with the use of people’s institutions- cooperatives and in Sri Lanka, cultivation committees and instead drafted a direct role for the Departments of Agriculture. This did away with popular participation. There is room to think that this move of the World Bank was aimed at crippling the development in agriculture that was taking place apace in the Developing Countries. One will be convinced of this sabotage only when one learns about the ill effects of the Structural Adjustment Programme which  the IMF introduced to our countries in the next few years, which I have detailed in my book: “How the IMF Ruined Sri Lanka”: (Godages)

 In 1995 I came back to Sri Lanka and working on my small family farm, I had the occasion to go again and again to the extension offices at Udupila and Kadawata. I have narrated my experience in my book: “How the IMF Ruined Sri Lanka.”

“The officers there did not know the exact amount  of fertilizer I should use and relate it to the high yielding varieties of paddy. At my insistence they raked their files and provided me with details. The circular advised the use of ammonium sulphate and urea at the basal stage and no mention was made of its use as the top dressing.. I brought this to the notice of the Secretary to the Ministry  and “¦..months later I got a reply to the effect that the advice given to me was out of date by half a dozen years.   About a year later I dropped into one of these Centers  and to my amazement I found that even then the top dressing had not been incorporated into the advice.” There is not a single farmer who does not know that ammonium sulphate/urea has to be used as the top dressing.

 What this illustrates is a total break down in agricultural extension. This  is  corroborated by Agricultural Officer Cecil Dharmasena in his very insightful article in The Island of  22/4/13, he states,

“The lack of an organized and coordinated extension and advisor system today as we had in the past(prior to the Provincial Council Administration System), where the Department of Agriculture through its comprehensive  island wide extension division provided an efficient service appears to be the biggest drawback in agriculture at present.”

 He refers to both the decision of President Premadasa to make all KVSs Grama Niladharis leaving a gap at the village level as well as the decision based on the 13 th Amendment to our Constitution to devolve the subject of agriculture to the Provincial Council as the cause. He even states that today “all types of agencies of the Provincial Council and private sector offer confusing services.”

 These details about the lacuna in the extension services is further  corroborated by another Agricultural Officer,  Ranjith Mulleriyawa in The Island of 4/6/13, where he states that after the “ƒ”¹…”promotion’ of the KVSs- the Field Assistants  at the village level to become Grama Niladhari, the Agricultural Instructors had to supervise and offer extension services to as much as 13,000 farmers at Yodakandiya and 3,500 farmers at  Ranoruwa. Covering even 500 farmers is a major task for a single officer and covering thousands mean that the service will be severely crippled. Even today the Agricultural Instructors cannot offer a proper service as their assistants are the Niyamakas who in their ignorance of agriculture are actually the laughing stock of  the farmers. Having met a few farmers here and there on my annual visits I can definitely corroborate with both Ranjith Mulleriyawa as well as Cecil Dharmasena for the total breakdown of agricultural extension. The heading of Ranjith Mulleriyawa’s article  itself  “Truth is Stranger than Fiction: Messing up Agriculture” speaks volumes.

 In fact I was convinced for long about the fact that the extension system had broken down with fertilizer being misused but I wanted definite corroboration and this paper emerged after reading their insightful comments. I am most thankful to them.

 Many in authority will not admit this. They cannot be expected to cut their own throats. It is not their fault. The 13 th Amendment was thrust upon us and similarly the other changes took place and the officialdom have to do their best. However may I humbly suggest that a key officer accompanied by an Agricultural Officer should go unannounced, in an unmarked car, in normal attire, posing as if they are normal farmers, without pomp and pagentry to a few divisional centers and inquire about what varieties of high yielding seed should be used and the quantity of fertilizer that should be used at each stage of plant life to assess the current state of the extension service. The answers they get will amply prove that the entire extension system has broken down.

 The fact that the extension service is broken up is also clearly evident because the planting of paddy is now not adhering to the rainfall pattern, though the bulk of  paddy cultivation is rainfed. In the earlier system under the Vel Vidanes of the days when the Government Agents handled minor irrigation and later when the cultivation committees handled paddy cultivation there was a definite system where the farmers met at Kanna meetings at the beginning of each season and decided when to cultivate, what seed to use and when to harvest etc. Even fines were decided which was strictly enforced by courts of law.  After the cultivation committees were disbanded these Kanna meetings are not held systematically, with the result that late cultivation is common and the harvest gets damaged by the oncoming rains.

 It would augur well for our Ministry of Agriculture to please consider establishing a people’s institution  like the cultivation committee to handle paddy cultivation and the use of fertilizer could be attend to by this organization. This is a prime requirement today.

 With the breakdown of the extension service the farmers are left to their own devices. I have spoken to a few farmers on my  visit last year and they were using ammonium sulphate and urea at the basal stage, Every one research paper I have read of fertilizer use tells me that ammonium sulphate or urea if used at the basal stage just leaches into the soil in the absence of a standing crop to absorb it. To my thinking this misuse of fertilizer is one of the main causes for the CDUK disease. I have no doubts about it.

 Today The Government offers a massive subsidy. A 50 lb, bag of fertilizer is given at Rs. 350.00, at 10% of the actual cost. The Government spends as much as  Rs. 34,850 million a year. A major saving can be made in this subsidy if immediate action is taken .

 Further the Niyamakas have to be trained and may I suggest that this be taken up immediately- at least a months’ crash course in paddy plantation.

 I can remember that for over the last decade or more, spraying to keep away dengu and mosquitoes, for household gardens and drains was undertaken by the Urban Councils. Scores of sprayer workers on cycles could be seen daily at work. But many do not know that they sprayed water unless a good gratification was offered. That neglect led to the Dengu epidemic of today. I myself wrote about this. Already around 10,000 people have died in the NCP alone due to CDKU.(The Island:27/8/2012) I fear that the neglect in agricultural extension which is key to neglect in the use of fertilizer if not corrected will lead to the  kidney disease spreading in Sri Lanka which may kill perhaps millions.

 Let that predicament not happen to my motherland. We do have the ability to avoid it.

 Garvin Karunaratne, Ph.D

Author of “How the IMF Ruined Sri Lanka & Alternate Programs of Success”, Godages.

Former SLAS-Senior Assistant Commissioner of Agrarian Services. & Govt Agent, Matara District
16/6/2013

14 Responses to “The CDKU – Kidney disease epidemic”

  1. Fran Diaz Says:

    Further to Dr Karunaratne’s article, for which we thank him, further damage is done to the environment with excess fertilisers.

    “Damage to the Environment
    When too much fertilizer is applied to the soil, the excess leaches into groundwater and runs off into rivers and lakes, and ultimately into oceans, where it can cause trouble for marine life. First, nitrates from the fertilizer help algae grow more than usual. Then, when these algae die, they fall to the bottom of the ocean and are decomposed by bacteria. To do so, the bacteria use oxygen dissolved in the water. When the number of dead algae is larger than normal, the bacteria can use up all of the oxygen present in water and, as a result, fish and other marine life cannot breathe, and they die. Nitrates from fertilizers can also be converted into nitrous oxide (N2O), which is released into the air. This gas contributes to global climate change and reduces the amount of ozone (O3) present in the stratosphere. Ozone is a chemical that absorbs much of the harmful ultraviolet radiation that comes from the sun. The stratosphere is a layer of the atmosphere located at altitudes between 6 miles and 30 miles above the Earth’s surface “.

    The measures to use fertilisers properly must be done immediately, as recommended by Dr Karunaratne.

  2. Ben Silva Says:

    Thanks Gavin for responding to this major crisis. Yet many are sleeping. The number of people affected are over 450000, same magnitude as Tsunami. For over 20 years people in the NCP area have been getting seriously ill and dying of serious Kidney disease. This tragedy has produced death, suffering and orphans.
    Without costing even a single rupee, I made recommendations over 5 years ago ref http://www.island.lk/2008/09/17/features4.html: , which are similar to WHO recommendations. Even as long as 5 years ago, chemicals harmful to kidneys were found in water and the environment. If the rest of Sri Lankans ignore the problem, the problem will eventually get to them, as the country will continue to import pesticides and toxins that will poison the environment. Greedy people make money and commission whilst poor farmers loose their lives. The people need to act on the 13A and the CKDu issue. If not the Sinhalse would be just history and memories in Lanka, and we will lose our only homeland. The fault is with Sinhalese themselves and no one else.

  3. Fran Diaz Says:

    Not only ocean fish die, but fish and other life forms in any water accumulations such as ponds, lakes, etc. suffer the same fate with fertilizer accumulations.

  4. kavdayako Says:

    I am afraid Dr. Karunaratna has expressed the “kne-jerk” reaction of most people. However, we ned a scientific approach. When CKDU came to the fore, most medical people and scientists thought that it must be the fertilizsers that dump the toxins like As, Cd, leadto the water table, and then this goes into the food, plants, drinkingwater etc., and people get CKDU. There were many studies, and a more recent, very comprehnsive one that took three years, and conducted with WHO funding and healp. This involved over 50 of our best medical, chemical, and soil scientists, analatical chenmists. There report is called the who-final report, and it can be found at the Lankaweb site.
    Go to its page 15, and it says that 234 samples of water (i.e., quite a LOT of samples) were tested for As, Cd, Pb, and other toxins, organic and inorganic. Finally, all were found to be within the WHO allowed amounds of a few parts per BILLION. So, you can’t keep saying that the fertilizers have done it. True, our farmers use far too much of it. But thanks to the torrentials we have, much of it gets wahsed away.

    Karu talks of Badulla. but no statistics. How many extra cases? Why not any increase in the Udarata where they use almost twice the amount of fertilizer per hectar used in the Baduula and rajarata areas?

    The rpobelm can be solved if we look at other factors too. The answer lies, I think, in our food and water habits of the people. The new generation drinks coke and pepsi — highly laced in sugar — mnaking the kidneys work twice as hard. They don’t drink enough water (people ned about 8-10 glasses per day), and also take in a lot of polluants from diesel gases, conj3sted living etc. People should begin to follow the Buddhist path of simple diets, no alcohol, etc to save themselves

  5. Fran Diaz Says:

    Fertilisers etc. used Upcountry may get used up by plants/washed downwards away from the hills quite fast. When these waters meet flat land as in NPC, it is slow motion from there onwards. Also, it may be that the fertilisers etc. are done under supervision as the tea crop has always been important, and the tea shrub is already grown and has a long life, unlike various stages of a paddy plant which is completely removed on harvesting and needs a different way of application as Dr K suggests.

    I am no expert on this matter, but something is definitely wrong here, and the reasons for that must be found soon and acted on to remove them. That the WHO found no significant amounts of heavy metal does not mean much at this point in time. Our own scientists found large amounts of As & Cd in tests done in Mahaweli waters downstream in 2009.

    Drinking soft drinks in large amounts ? Do farmers have money to do that ? Certainly, drinking lots of clean water will help.
    But why the increase in kidney disease ?

  6. Cerberus Says:

    Here is what I found in Wilkepedia on the Urea breakdown.
    “For plants to absorb nitrogen from urea it must first be broken down:

    Urease is a naturally occurring enzyme that catalyzes the hydrolysis of urea to unstable carbamic acid. Rapid decomposition of carbamic acid occurs without enzyme catalysis to form ammonia and carbon dioxide.The ammonia will likely escape to the atmosphere unless it reacts with water to form ammonium (NH4+) according to the following reaction:

    This is important because ammonium is a plant available source of nitrogen while ammonia is not. Additionally, the formation of the hydroxide ion may cause soils around the applied urea particle to have a pH around 9.0 which increases ammonia volatilization. This area is also highly toxic due to elevated ammonia concentration for several hours so it is recommended that urea based fertilizers not be applied or banded with planted seed at a rate that exceeds 10–20 kg/ha, depending on the crop species. It is important that there is adequate moisture because up to thirty percent of the available nitrogen can be lost through atmospheric volatilization within seventy-two hours of application.”

    Therefore I do not think it is the Urea that is the culprit. It is more likely that it is use of weedicides which have been shown to contain Arsenic and Cadmium which is likely to be the culprit. There was an article some time back where someone had found that they were adding Arsenic and Cadmium to imported weedicides in Sri Lanka.

    In any case this is a serious matter which should be investigated with high priority by the GOSL.

  7. Sunil Vijayapala Says:

    one interesting thing about ben’s comment is that he has completely ignored the silk route, nalanda episodes, as every thing points out to this according to him. why did he miss out this time to relate ckdu to wise Indians dumping Buddhism? isn’t there a connection ben?
    thanks gk for you practical insight to this problem. most here are theoretical pundits who go by statistics while you have done a yeoman service to educate the farmers on the perils of western encroachment of minds of sri lankans. our leader fails to appreciate people like you. he is surrounded by advisors 100 of them on a payroll amounting to 10 billion rupees – an utter waste of money – he lacks his own wisdom and conscience to run a country. champika when he handled the environment ministry clearly showed how the upcountry tea estate crap in the form of wash away had affected the coral reefs around the island. we need a wise leader now. this current leader is playing the game of politics, which is the only thing he knows well and a master of it. why cant the expats realize this I wonder.

  8. hela patriot Says:

    It is the censorship by sites like Lanka web that prevents the publication of the truth that has caused this kind of evil in Sri Lanka. As long as people are prevented from having a open discussion on the damage that has been done, this kind of harm to the country will continue.

  9. Ben Silva Says:

    Sunil is now blaming the man who saved the country. Heavy metals in the human body can bring about mental retardation and mental health problems. Toxicity of heavy metals is well known and immediate action has to be taken so that humans are not poisoned by heavy metals. (See my article in the Island). Looks like Sunil had a good dose of heavy metals. Unfortunately, unless the CKDu problem is solved, we will have many like Sunil, that will believe in any Indian myth. People like3 to blame the Government, but do nothing to help.

  10. aloy Says:

    Quoted Cerberus below is indeed a serious matter which need investigation with high priority.
    ” There was an article some time back where someone had found that they were adding Arsenic and Cadmium to imported weedicides in Sri Lanka.

    In any case this is a serious matter which should be investigated with high priority by the GOSL.”
    There is a paper published in the latest edition of “The Ceylon Medical Journal” on this topic, delivered to my house for my son-in-law just yesterday. Since he is working overseas I decided to open the cover and read it. It was written by four persons, namely:J.M.K.B.Jayasekara, D.M.Dissanayake, S.B. Adhikari and P.Bandara. The title is “Geographical distribution of chronic kidney disease of unknown origin in North Central Region of Sri Lanka”
    I will take the trouble of typing out the abstract here as I find the finding of the foursome to be very important:
    “Abstract:
    Objectives: In early nineties investigators noticed an alarming high incidence of an apparently new form of chronic kidney disease of unknown aetiology (CKD-U) in some parts of Sri Lanka.The aim of the study was to investigate the geographical distribution of using GIS and GPS mapping.
    Methods: community based information was collected from 11630 patients for GIS mapping using ARC 9.2 software. Based on GIS mapping two locations were selected for GPS mapping to locate 863 CKD-U patients with reference to reservoirs, irrigation canals and the topology of the areas.
    Results: GIS mapping indicated five high prevalent areas of CKD-U. Communities who consumed water from natural springs showed a low prevalence of the disease. GPS mapping showed that most of the affected villages were located below the reservoirs and canals with stagnant irrigated water.
    Conclusion: Epidemiological data on geographical distribution infers that while older foci of CKD-U are persisting there is an emergence of new foci with time. The location of the affected villages below the levels of reservoir/canals may indicate the possibility of draining of irrigated water to the shallow wells of the households, which is the source of the drinking water.”
    I think the government can make use of these findings and start supplying clean drinking water using bowsers to the areas below the levels of reservoirs and canals as a matter of urgency. Perhaps this also suggest that the problem is due to use of agro inputs from unreliable sources. From where are we getting these inputs?. though I have asked this question on numerous occasions no answer seems to be forth coming.
    I have seen on TV, HE the president and Minister in Charge of water supplies distributing bowsers, yesterday for supplying water to the affected areas. This is a commendable step.

  11. Sunil Vijayapala Says:

    sir ben – mad cow should now bestow you with this title. I was just reminding you of you dementia. silk road and nalanda. root cause of everything according to your pathetic grey matter which has degenerated to an extent where you blame us being Buddhists and believe in indian myth. in one way you admire them for dumping Buddhism and in other respects you attack them. I may have ckd-u but you have many diseases incurable. you have a severe problem in comprehending and understanding what exactly a person writes about. big ben strikes again!

  12. Lorenzo Says:

    If CD comments under his name or similar instead of “kavdayako” it would carry more weight.

  13. Lorenzo Says:

    Ben,

    IF MR is a real leader he should not hesitate to SCRAP 13 amendment.

    His brother (who saved the country) and his secretary have both said 13 amendment should go.

  14. Sunil Vijayapala Says:

    if not for gota and sarath mr would not have won the war. it’s a fact for those who get inside info.

    outside this topic – I just got the confirmation yesterday by an asst. director at customs that govt. has scrapped duty and vat on photovoltaic solar panels. I don’t care whether my letter did it or not, the winners are the poor masses who are struggling with electricity bills. I am now educating the people in our capital city, Anuradhapura, both young and old on the merits of solar energy.
    well what I cant believe is what the hell these f… advisors are doing? sometimes you cannot blame mahinda he is ignorant of these issues but surely his dumb 100 odd advisors can give this man a direction! I think these f…… are all
    ‘yes president’ people who venerate and fear this man and addressing him he all the time maybe peeing in their pants and panties.

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