The Kidney Cane
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jeansegataThe Kidney Cane
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jeansegataAlex M.
Nading
The Kidney
and the Cane
Planetary Health and
Plantation Labor in Nicaragua
The Kidney
and the Cane
Critical Global Health: Evidence, Efficacy, Ethnography
A series edited by Vincanne Adams and João Biehl
The Kidney
and the Cane
Planetary Health and
Plantation L
abor in Nicaragua
Alex M. Nading
Duke University Press Durham and London 2025
© 2025 Duke University Press
This book is licensed under a Creative Commons Attribution-
NonCommercial-NoDerivatives 4.0 (CC BY-NC-ND 4.0) License,
available at https://creativecommons.org/licenses/by-nc-nd/4.0.
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Library of Congress Cataloging-in-Publication Data
Names: Nading, Alexander M., III, 1979– author.
Title: The kidney and the cane : planetary health and plantation labor in
Nicaragua / Alex M. Nading.
Other titles: Critical global health.
Description: Durham : Duke University Press, 2025. | Series: Critical
global health | Includes bibliographical references and index.
Identifiers: lccn 2024041594 (print)
lccn 2024041595 (ebook)
isbn 9781478031871 (paperback)
isbn 9781478028666 (hardcover)
isbn 9781478060864 (ebook)
isbn 9781478094302 (ebook other)
Subjects: lcsh: Sugarcane industry—Environmental aspects—
Nicaragua. | Sugar workers—Health and hygiene—Nicaragua. |
Kidneys—Diseases—Risk factors—Nicaragua. | Chronic diseases—
Risk factors—Nicaragua. | Sugarcane—Climatic factors—Nicaragua.
Classification: lcc hd9114.n52 n35 2025 (print)
lcc hd9114. n52 (ebook)
ddc 331.25/6097285—dc23/eng/20250217
lc record available at https://lccn.loc.gov/2024041594
lc ebook record available at https://lccn.loc.gov/2024041595
Cover art: Sugar mill workers, Chichigalpa, Nicaragua. 2012. AP Photo/
Esteban Felix.
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laboration of the Association of American Universities, the Association
of University Presses, and the Association of Research Libraries. TOME
aims to expand the reach of long-form humanities and social science
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Funding from Cornell University made it possible to open this publication
to the world.
Contents
Note on Words, Names, and Places
vii
Prologue. Lives Worth Supporting
ix
introduction
1
1
grievance, ground, and grace
21
2
atmospheric fixes
45
3
renal environments
65
4
toxic mediation
85
5
working conditions
107
6
plantation patienthood
129
conclusion
151
edgments Notes Bibliography Index
Acknowl
159 163 189 217
Note on Words, Names, and Places
This book, like all ethnographic works, is about real people and places, and
events that happened not too long ago. One common convention in such
works is to give pseudonyms to the p eople, and sometimes the places, de-
scribed. Some of the reasons for this are ethical. Almost no one ever asks to
be the subject of an anthropological study; the issues at play remain politi
cally fraught; and revealing precise identities and locations could put innocent
people at unnecessary risk. Other reasons are intellectual. In anthropological
scholarship, as opposed to journalism or historiography, what m atters are the
things that can be generalized from specific contexts, which means that often,
the specifics can be less important than the big takeaways.
With the exception of public officeholders or scientists who are regularly
quoted or publicly profiled in the press, I have chosen to provide pseudonyms
or otherwise obscure the identities of the individuals whose stories constitute
this book. And although the names I give to villages and communities in the
book are drawn from those of actual places in Nicaragua and within the environs
of the Montelimar plantation, I have altered them to protect the identities of the
people I describe. The majority of the direct quotations drawn from interviews
or conversations were either recorded with participants’ informed oral consent
or reproduced from written notes I took at the time, also with the oral consent of
those present. When I attended public events, I recorded when permission was
granted by the organizers but otherwise took handwritten notes. Since nearly
all these events, conversations, and interviews were originally in Spanish, and
since I was the only person with access to the notes and recordings, any errors
in translation or transcription are mine.
The names of Nicaraguan sugarcane plantations, and of the community
organizations that raised questions about environmental and labor conditions
on them, are real. One reason for this is that when it comes to the social move-
ments I describe in the book, many of the facts, names, and even points of
dispute were already part of publicly accessible records, news accounts, or
peer-reviewed scientific articles before I began my research. Another is that
the corporations themselves have, since the start of my research, embraced an
industry-wide move toward transparency in addressing the uncertain health
effects of sugarcane production. In the case of the Montelimar Corporation,
whose workers and former workers are the main subjects of this book, man
agers were informed of my presence on company land and in meetings of
community organizations about the conditions t here. I am grateful for the cor-
poration’s willingness to be so accommodating, and even though I know that
some readers may not agree with every conclusion I make, I have tried to rep-
resent both the company and the people in the surrounding community fairly
and accurately in these pages. Again, any factual errors are my own.
From the beginning of this project, I felt I had no choice but to position
myself alongside rural Nicaraguans living in the sugarcane zone as an engaged
observer, rather than as a detached or neutral one. The stories I tell in this
book, then, come with a definite point of view. Even though this is primarily a
book about the community that surrounds a sugarcane operation and not any
particular sugar corporation’s managerial or organizational structure, I believe
there are lessons in what follows not just for anthropologists or health scholars
but also for those, including the corporations named herein, who are inter-
ested in ensuring the welfare of those who continue to make a living in and
through the sugarcane industry.
viii Note on Words, Names, and Places
Prologue
lives worth supporting
In 2015, two statements were published about environmental health crises.
One was written by a group of twenty-two experts from global power centers
including London, New York, New Delhi, and Beijing. The other was written
by the representatives of a fledgling grassroots community movement in rural
Nicaragua. One uses the crisp technical languages of economics, public health,
and ecology. The other oscillates between the stilted prose of international law
and the morally charged poetry of social suffering. One contains page after
page, footnote after footnote, and graph after graph, illustrating the planetary-
scale dangers posed by climate change. The other contains modest testimony
to environmental and bodily harm in one particular place. Both statements
contain lots of bullet points. One list of bullet points outlines a comprehensive
strategy for sustaining life on a planet soon to be home to nine billion people.
Another list outlines a set of politely worded suggestions about how t hose in
corporate and p olitical power might begin to consider the lives of a few hun-
dred people.
The first of these statements was a blockbuster, at least in global public health
terms. Published in November 2015, “Safeguarding Human Health in the An-
thropocene Epoch,” the report of the Rockefeller Foundation–Lancet Com-
mission on Planetary Health, has been cited more than two thousand times.
The Rockefeller-Lancet report is the result of a painstaking meta-analysis of
environmental and epidemiological research. Among other things, it blames
unchecked agricultural intensification for the loss of human and animal habi-
tats, the erosion of soils, toxic chemical exposure, and (even though agricultural
intensification was meant to produce more food) a rise in food insecurity
worldwide.1 Action must be taken, the report’s coauthors suggest, to reimagine
global health as planetary health, an approach premised on “the understand-
ing that human health and h uman civilization depend on flourishing natural
systems and the wise stewardship of t hose systems.” Though it is written in the
sober and apolitical language of sustainability and economics, the Rockefeller-
Lancet report acknowledges that poverty and inequality remain serious im-
pediments to both h uman and environmental flourishing. It advocates policies
that create a “safe and just operating space for humanity.”2
The other statement is decidedly more obscure. Its title, “Complaint of cfi
Project 32253,” d oesn’t help. It was published in August 2015, just three months
prior to the release of the Rockefeller-Lancet report, on the website of a little-
known office of the World Bank called the Compliance Advisor Ombuds-
man (cao). The complaint was filed in the name of a group of around seven
hundred rural Nicaraguan people who identified as “workers, former works
[sic], residents and members of the communities belonging to the Montelimar
Sugar Mill.” Project 32253 was the title of a loan given to the Montelimar Cor-
poration by the International Finance Corporation (ifc), the private lending
arm of the World Bank Group.3
The Montelimar complaint is not a sprawling document. It runs to just
seven pages, but it specifies how the unchecked push for agriculturally fueled
economic growth damages lives and landscapes, causing a loss of water and
forest resources, deterioration of soils, and chronic exposure to toxic chemical
pesticides. For the Nicaraguan p eople who filed the complaint, the most dis-
tressing consequence of sugarcane production was the onset of an epidemic of
chronic kidney disease. While chronic kidney disease is normally associated
with diabetes or hypertension, by 2015, thousands of workers and residents liv-
ing around the Montelimar sugar mill had become sick or died of what became
known as chronic kidney disease of nontraditional causes (CKDnt). They were
neither diabetic nor hypertensive. They suspected that the CKDnt epidemic
was a result of their proximity to the industrial sugarcane industry. Based on
this suspicion, residents formed a community association “to respond to the
crisis of health and environment, and to develop v iable m easures to restrict it.”
“All of us,” the complaint states, “have the right to a dignified life in a healthy
environment.”4
To me, that last turn of phrase is more satisfying than the Rockefeller-Lancet
report’s call for “a safe and just operating space for humanity,” but whichever
you prefer, I hope you can see the overlap in sentiments. Divergent as they are in
length, audience, and style, the Rockefeller-Lancet report and the Montelimar
x Prologue
complaint each ask their audiences to consider which lives are worthy of eco-
nomic, political, l egal, and technical support.
On Nicaragua’s Pacific coast, one particular form of life has been supremely
well supported over the past twenty-five years: industrial sugarcane. Nicaragua
is a small country, and while its sugar production accounts for just a fraction
of global supply, the country’s sugar businesses began expanding at an unpre
cedented rate around the turn of the twenty-first century. According to an
estimate by the Nicaraguan Investment Promotion Agency, by 2013–14, sug-
arcane exports were growing faster than those of any other agricultural prod-
uct. Those in political power during the first two d ecades of the twenty-first
century, whether they hailed from the left or the right of the p olitical spec-
trum, had come to view supporting the life of sugarcane as a means of support-
ing human life. And, significantly, climate crisis was on their minds. For the
Nicaraguan government and its supporters at the ifc and the World Bank,
more investment in sugarcane might not only perpetuate the country’s gains in
food export but also develop its capacity to produce biofuels, including ethanol
and energy generated from sugarcane pulp, or bagasse. This alternative energy
strategy has been a key policy tenet of Nicaragua’s current government, which,
since the 2007 accession of Daniel Ortega and the left-leaning Sandinista Na-
tional Liberation Front to power, has touted its commitment to reducing fossil
fuel consumption.5
Since 2005, the country’s two largest sugarcane firms, Nicaragua Sugar
Estates Limited, a privately held Nicaraguan company, and Monte Rosa, a
subsidiary of Central America’s largest sugar producer, the Guatemalan corpo-
ration Pantaleon, have received over US$100 million in loans from the ifc to
develop cogeneration facilities that burn bagasse to power sugar mills and the
national electrical grid, and to expand ethanol production. The ifc’s $15 mil-
lion loan to Montelimar, the country’s smallest sugarcane firm, would help the
company launch a third biofuel plant. The Montelimar project also promised
to increase the company’s annual sugar production from thirty-three kilotons
to sixty-seven kilotons, to increase its landholdings by some 25 percent, and to
divert more water toward irrigation.6
Though the spike in investment in industrial sugarcane in places like Nicara-
gua is somewhat recent, it is best understood as part of a longer history. Efforts to
make improvements in commercial agriculture that would simultaneously im-
prove human well-being are the calling card of what Raj Patel calls “The Long
Green Revolution.”7 During the Green Revolution’s first phase in the 1960s,
its proponents—including the R ockefeller Foundation—justified the consol-
idation of smallholdings for commercial crop production with an appeal to
Prologue xi
global health. They argued that increased agro-export capacity was the only
way to provide abundant food and thus stave off famine.8 The World Bank’s
more recent turn to investment in energy indicates a continued belief in the
linkage between agro-industrial growth and human health. One argument in
favor of biofuel, in fact, is that a reduction of dependence on fossil fuels could
lower fuel prices and thus reduce overall food costs.9
What transpired after the ifc made its loans to Nicaraguan sugarcane plan-
tations highlights the weakness of such arguments. For a start, the expansion of
sugarcane has intensified an already steady deterioration of Nicaraguan forests.
Starting in the 1950s, the World Bank, the US government, and a variety of
agricultural corporations, including US-based pesticide firms, supported the
conversion of Nicaragua’s Pacific region into a cotton-producing belt. The re-
sult was the destruction of thousands of hectares of old-growth forest.10 Even
after the cotton boom faded, the damage continued. According to the envi-
ronmental watchdog World Rainforests, between 1990 and 2010, Nicaragua
lost 31 percent of its remaining forest cover, as sugarcane operations started to
expand, alongside peanut farming and cattle ranching.11 There is now nearly no
forest left on the country’s Pacific coast. Loss of forests means increased car-
bon in the atmosphere and increased annual temperatures. Instead of creating
more salubrious environments, investments by private capital, states, and su-
pranational organizations in cotton and sugarcane monoculture in Nicaragua
and elsewhere have created even more extreme environments, marked by de-
creased biodiversity, increased presence of toxic agrochemicals in air and water,
and more intense heat. Th ese points are all highlighted in the 2015 report of
the Rockefeller-Lancet Commission on Planetary Health, and they are echoed
in climate modeling studies that place Central Americ a among the regions at
highest risk for catastrophic heat waves.12
Though the stories to come all take place in the context of the Long Green
Revolution, this book is not an indictment of the ifc’s policy regarding Nic-
araguan sugarcane. The ifc’s repeated investment in Nicaragua’s sugarcane
zone did not, by itself, cause deforestation, the overuse of agrochemicals, or
steadily increasing mean annual temperatures. Nor did the ifc’s investment
cause the CKDnt epidemic that was the primary concern of the group that
filed the 2015 complaint to the cao. What the conversion of the sugarcane
zone into an investment hot spot did do was make an ecological and medical
disaster more visible.13 The recent wave of investor interest in Nicaraguan sugar
underscores how the global drive for agro-export-driven growth has reached
what one group of CKDnt researchers calls “a physiological limit . . . at which
xii Prologue
acclimatization and behavioral modifications can no longer overcome the bi-
ologic stressors of unsafe working conditions and environmental exposures.”14
What happens socially and politically when bodies and places reach t hese
kinds of limits? This is the central question for the anthropology of planetary
health, and late industrial disaster more broadly. As this abbreviated history of
Nicaragua’s sugarcane boom shows, supporting the life of sugarcane requires
extreme measures, and it requires sacrificing the viability of some species and
some ecological systems for the viability of o thers. Supporting compromised
bodies (like, say, supporting the bodies of p eople with kidney failure through
dialysis) and supporting artificial monocultures (like, say, maintaining hun-
dreds of thousands of hectares of sugarcane) is a m atter of working along the
edges of life and death.15
For all its bullet-pointed policy recommendations, the Rockefeller-Lancet
report is not particularly inspirational reading. My favorite part is panel 14, on
page 2014, an inset box titled “Why the grassroots matter.” It tells the story of
how the movement for hiv treatment access led by African, Asian, and Latin
American hiv patients and allies took on pharmaceutical corporations and
governments to demand lifesaving drugs. In doing so, panel 14 tells us, these
grassroots activists turned the tide of the aids pandemic. This is a story I tell
my medical anthropology undergraduates every year. It is a story that finds a
group of disenfranchised and marginalized p eople, many of them very sick, ask-
ing those with more power and influence if their lives were worth supporting.
As much as I was heartened as a medical anthropologist that panel 14 made
it into the Rockefeller-Lancet report, it remains troubling that a scholarly
paper with 432 references and twenty-two named authors contains no example
of a grassroots effort to actually address what the report’s executive summary
calls “the degradation of nature’s life support systems.”16 Instead, panel 14 says,
“Better evidence is needed for the importance of planetary health than exists
at present.” There are plenty of possible ways to provide such evidence, but
none of them, including the one in this book, has the satisfying narrative arc of
the hiv treatment access story.17 Attempting to foreground such stories in the
context of an emerging epidemic remains risky, since so much of contemporary
science, including climate change science, agricultural sustainability science,
and global health science, depends not on the telling of relatable, h uman sto-
ries but on the collection of replicable, hard data.18
While the term planetary health is never used in the Montelimar complaint,
that obscure document opens a window onto what planetary health might look
like in practice, and why it is important. This book approaches the question
Prologue xiii
of planetary health—for planetary health is still a question, rather than a
paradigm—from the vantage point of a particular group of people in a spe-
cific place, over a relatively short time. Like many stories told by anthropolo-
gists, it works from the edges. It recounts lives lived and lost not just on the
margins of the global health industry represented by the Rockefeller Founda-
tion and top-flight journals like the Lancet, but on the margins of the global
sugarcane industry.
To take a cue from the wording of the Rockefeller-Lancet report, the stories
in this book are about “life support systems.” In colloquial medical English,
the term life support indexes a technological achievement (think of respirators
and breathing tubes). Used more broadly, the term reminds us that to be alive
is to be in relation to things and beings that cooperate with us, like technol-
ogies and drugs and foods and caregivers, and even to t hings that do not do
such a good job cooperating, such as sugarcane and the tools large companies
use to cultivate it, from w ater to harvesting equipment to toxic pesticides. But
the thing about life support is that it is always temporary. In every individ-
ual case, life support will eventually fail. At some point, agrochemicals stop
helping produce crops and start damaging soil and w ater to such a degree that
industries are no longer viable (just google “Nicaraguan cotton” and find out).
At some point, hemodialysis stops keeping end-stage kidney disease patients
alive. Life support is what happens when the possibility of a full resolution is
no longer available. An appropriate term to describe a variety of projects aimed
at addressing the crisis of the Anthropocene, life support is the project of en-
suring collective endurance amid the certainty of individual loss.19
This book is about how people grapple with life support systems, from legal
frameworks like the cao, to irrigation works, to pesticide application regimes,
to state-sponsored social security programs, to occupational health m easures,
to dialysis treatment itself. It explores how these systems are stabilized and de-
stabilized by one another. It suggests that a close look at what happens along
the unstable edges where life support systems meet might provide insights into
the possibilities and limitations of planetary health.
xiv Prologue
Introduction
Saúl Bermudez was around thirty-five years old and just about to start his third
year of law school when he was diagnosed with type 2 diabetes. He took his
law courses at night and on Saturdays so he could keep his paying job, driving
a taxi in his hometown of León, Nicaragua. One day, about a year after his
diagnosis, Saúl helped organize a wake for his uncle, who had died from com-
plications related to diabetes. Wakes in Nicaragua are big events, and in the
León neighborhood where Saúl grew up, it sometimes seemed like everyone
was related to everyone e lse in some way. There were so many people coming
to pay their respects that the family had rented a plastic tent and pitched it
over the sidewalk and curb, with plastic chairs set up underneath. As Saúl sat
in the shade wiping the July afternoon sweat from his face, he was accosted by
a mildly drunk distant cousin.
“Your aunt tells me y ou’re working in the sugar mill,” the cousin said, with
a slap of Saúl’s back.
Saúl was startled. Even though León was surrounded by thousands of hect-
ares of sugarcane fields, Saúl hadn’t ever worked in them. But the phrase “work-
ing in the sugar mill” (trabajando en el ingenio) had another, more metaphorical
meaning. It meant “diabetic.” In Nicaragua, as in other parts of the Americas,
diabetes is often euphemized as “sugar” (azúcar). “Working in the sugar mill” is
gallows humor. Keeping track of your blood sugar in a place where glucometers
are prohibitively expensive, and trying to eat well in a place where the cheapest
available food is high in sugar, high in carbs, and high in fat, is a lot of work.
So is cutting sugarcane, Saúl thought to himself. Though he had never actually
worked in a sugarcane plantation, he knew what they were like. In fact, his recent
interest in studying the law was directly connected to his work as a taxi driver,
which had been how he had come to know more than most p eople about the
sugarcane industry. Around 2005, Saúl was hired as a driver for a team of in-
ternational lawyers who came to Nicaragua to assist a group of people that
had been diagnosed with a previously unknown condition: chronic kidney
disease of nontraditional causes (CKDnt).1 While “traditional” chronic kid-
ney disease is associated with diabetes, CKDnt is not. As its name indicates,
there is no scientific consensus about what triggers it. In Nicaragua, CKDnt
has sickened or killed thousands of p eople. Unlike “traditional” chronic kid-
ney disease, CKDnt tends to strike p eople at a relatively young age. Many of
the Nicaraguans with CKDnt are in their thirties and forties, and diagnosis as
young as twenty-five is not unheard of.
Aside from their age, most of t hose who became sick with kidney disease
had another thing in common. They once worked as field laborers on sug-
arcane plantations. Most believed that the sugarcane company that had em-
ployed them bore responsibility for their illness. They w ere convinced that
exposure to something in the plantation landscape—probably poisoned w ater
or polluted air—was causing their kidneys to fail. This conviction led them
to contact the lawyers, who hired Saúl. By the time Saúl got involved, CKDnt
was already reaching epidemic levels. But people wanted to know why, after
years of service, sick workers were being sent home to die. The lawyers and the
ex-workers w ere in the midst of a tense debate with the o wners of the sugar
company over how (and whether) the company should help affected work-
ers in the later stages of disease get access to dialysis, and how (and whether)
research should be done on how occupational conditions in the fields might
have contributed to the epidemic. First, though, they had to work out how
(and whether) the company should acknowledge the epidemic’s very existence.
Formal negotiations between that company, Nicaragua Sugar Estates L imited
(nsel), and the workers’ organization went on for nearly six years, and the
2 Introduction
movement that began there gave rise in 2015 to a second movement, which
called itself the Asociación Montelimar Bendición de Dios (ambed). ambed
was composed of former workers at the Montelimar sugar plantation, located
about one hundred kilometers to the south of the nsel plantation. By the
time of ambed’s founding, Saúl had decided to enter law school. As ambed
was forming, he again acted as driver and fixer for the international lawyers on
the case, but he also took on an advisory role. He organized meetings and an
executive board, and he helped communicate ambed’s concerns to the Mon-
telimar Corporation. As at nsel, the work with ambed was stressful and
sometimes dangerous. In the early days of the movements at both plantations,
Saúl, his international counterparts, and the former sugarcane workers who
had organized themselves w ere alternately physically threatened and tempted
with bribes and gifts in exchange for their silence. The Nicaraguan police e ither
jailed those who spoke out about the epidemic or threatened to do so. Money
for running meetings and filing legal papers was in chronically short supply,
and the sugar industry, one of Nicaragua’s oldest and most powerful, mounted
a sustained legal and public relations counteroffensive to deflect blame and
sow uncertainty.
Saúl’s diabetes diagnosis came during ambed’s early days. If the cause of
CKDnt remained a mystery, the cause of his diabetes seemed anything but.
Saúl’s family, like many in Nicaragua, was full of diabetics, and he was not
eating well. He had spent hundreds of hours in a car driving across the Mon-
telimar plantation and back and forth from León. When he was diagnosed,
Saúl’s older brother, a doctor, told him that to protect his kidneys, he needed
to change his diet, keep his stress level low, and try to get some exercise. Know-
ing how quickly diabetes could progress, Saúl’s b rother counseled him either to
take a leave of absence from the work at Montelimar or to quit law school. His
brother figured that Saúl would choose to stay in law school. After all, a qual-
ified lawyer could make good money d oing lots of uncontroversial, low-stress,
safe tasks: notarizing documents, handling divorces, settling property claims.
Instead, Saúl chose to continue at Montelimar, where I joined him and began
following his work with ambed in 2017.
The Work of Planetary Health
Within the corridors of global policy and science, a call to reimagine global
health as “planetary health” was sounded in the m iddle of the 2010s. Planetary
health has its roots in the ecological and land health movements of the mid-
twentieth century, but at its core is the alarming idea that the contemporary
Introduction 3
medical and public health sciences are simply not equipped to address the
health consequences of climate change, from increasing heat to air pollution to
water scarcity to land degradation.2 One reason is that the health sciences have
historically been put in the service of furthering the very economic projects
that caused climate change in the first place: aggressive resource extraction, fos-
sil fuel–driven development, and the expansion of pesticide-driven industrial
monocrop agriculture, including that of sugarcane. For too long, planetary
health advocates claim, care for the environment and care for human health
have been treated as separate domains. The challenge is to think of care for
what they call “Earth’s life support systems” not just as environmental work
but as work for human health.3
But planetary health is work in another sense. Many of the health problems
now associated with climate change, including respiratory disease, reproduc-
tive abnormalities, metabolic diseases, and CKDnt, can also be understood as
consequences of inequitable labor relations. It is safe to say that those whose
working lives are the least valued, in terms of pay and on-the-job treatment, are
most at risk of climate change–induced illnesses. There is a growing recognition
that climate change is a major contributor to health inequities worldwide. To
date, however, relatively little attention has been given to the role that might
be played in addressing those inequities by the people most directly affected by
global warming, the saturation of ecosystems with toxic substances, the loss of
forest cover, the extinction of species, and the depletion of water resources—
that is to say, the role played by the p eople for whom planetary health is at
root a question of working conditions. One problem is that even those inter-
ventions designed to protect workers from climate-related diseases ignore the
simple fact that workers are also people—people for whom the question of
health in the workplace is inseparable from the question of health at home.4
This book, then, treats the category of “plantation l abor” broadly, giving analy
sis of the work of making and maintaining h ouses, gardens, and communities
an equal footing with analysis of the work of growing sugarcane.
To do so, I draw on ethnographic research conducted between 2017 and
2020 with ambed and o thers living in the environs of the Montelimar sugar
plantation. I adopt a critical approach to planetary health. By “critical,” I do not
mean “dismissive.” Rather, following an approach taken to health and disease
in the context of sugarcane plantation production by other anthropologists,
I explore how actions taken in small, seemingly out-of-the-way places, such
as the villages that dot the Nicaraguan sugarcane zone, reverberate across the
globally dispersed spaces of capitalism and global health. The literary scholar
Elizabeth DeLoughrey defines climate change as a “world-changing rupture
4 Introduction
in a social and ecological system.”5 For people in the sugarcane zone, the mass
onset of a novel kidney disease was just such a rupture. My interest is in what
planetary health might look like if their understanding of that rupture w ere
treated as just as valuable as the knowledge produced by ecologists, epidemiol-
ogists, and medical doctors.6 Doing so, I offer a glimpse of what the goings-on
in individual bodies might tell us about planetary-scale change.7
Put another way, this book takes planetary health’s central conceit—that
Earth’s life support systems are h uman systems—to its logical conclusion. It
considers what happens when we think of human bodies not as existing in a
planetary environment but, through work, as constitutive elements of that en-
vironment.8 The book’s six chapters explore how people living in the sugar-
cane zone worked across six systems designed to support life—both human life
and that of the sugarcane crop. Th ese included legal systems like the ones that
brought Saúl into the story of CKDnt; occupational health systems; agricul-
tural systems of irrigation and pesticide application that may have contributed
to environmental and bodily harm; state and corporate social security systems;
and systems of biomedical care. Making sense of CKDnt, and of the limits and
possibilities of planetary health, entails understanding how such life support
systems “are animated and interrelate.”9
Planetary health is relatively new. Plantation labor is not. But the relation-
ship between the two is far from incidental. The formation of sugar plantations
in the C
aribbean, and later in Central America, began with a violent clearing
of forests, which led to extensive soil erosion and the choking of essential wa-
terways. Across the Americas, this landscape transformation depended on the
forcible conscription of human labor through enslavement and, later, through
the seasonal coercion of poor and disenfranchised rural peasant populations
with promises of food, money, or medicine.10 Over more than four centuries,
deforestation, water contamination, and mass displacement at the hands of
the plantation complex became key contributors to what we now call “climate
change.” Thanks to sugarcane cultivation, landscapes like that of Nicaragua’s
Pacific coast were permanently, irrevocably altered well before any of the prin-
cipal figures in this book drew their first breath. The change in the landscape
continues. Some of the elements have been subtracted or added. Enslaved
people no longer predominate in the sugarcane industry, but that is still a rela-
tively new development. In addition to radical deforestation and rerouting of
waterways, agrochemicals are now central to sugarcane cultivation.
This centuries-long effort to support the life of one crop, sugarcane, has
caused what the geographer Julie Guthman, drawing on the language of
medical philosophy, calls “iatrogenic harm” to the plantation complex and the
Introduction 5
p eople who work in it.11 In other words, the continued effort by plantation
companies to find new ways of sustaining the life of this valuable crop causes
damage to h uman lives, and to the lives of other animals and plants. This is not
to suggest that plantation agriculture is a zero-sum proposition, or some sort
of trade-off between one form of life and another. Plantations that produce
sugar, as well as tea, coffee, or soy, are not stable enough systems for that.12 As
Alex Blanchette has argued in his writing on industrial pig farms, industrial
agriculture is best seen as an unruly, uncertain experiment in the admixture of
human and nonhuman life with machinery, pesticides, fertilizers, pharmaceu
ticals, air, and water.13 Industrial agriculture is not a singular thing but an “as-
semblage,” an unstable arrangement of capital, labor, land, and technology.14 It
is this instability that c auses iatrogenic harm. As monocrop production comes
to economically and socially envelop the surrounding spaces of social repro-
duction like rural villages and towns, and as it comes to rely on more intensive
and more dangerous mechanical, chemical, and h uman inputs, efforts to keep
the agricultural system running begin to threaten the system itself. The nature
of the threat ranges from antibiotic resistance to the deepening of racial, eth-
nic, and gendered disparities in economic and political power to novel human
diseases like CKDnt.
As its name indicates, the cause of CKDnt is still debated. Th ere is a swirl
of theories about the connection of the disease to the accreted bodily burden
of decades of agrochemical application, to the sheer bodily exhaustion of sug-
arcane labor, to genetic predisposition, and even to the overuse of over-the-
counter anti-inflammatory drugs by sugarcane workers. Today, the most widely
circulated theory has to do with rising temperatures. As a leading CKDnt re-
searcher told the Guardian newspaper on the eve of the 2021 cop26 confer-
ence in Glasgow, Scotland, the kidneys are “the immediate interface between
[humans] and the climate crisis—because when it starts getting hot, we lose a
lot of water and salt through sweat.”15 People with CKDnt are now being por-
trayed as bellwethers for a global climate crisis.16
The continued uncertainty around which of the possible “nontraditional”
causes is to blame for CKDnt is instructive for a critical understanding of
planetary health. Many of the factors associated with CKDnt—including
chemical toxicity, diminished water tables, food insecurity, and rising annual
temperature—have become associated with climate change. It would be mis-
leading, however, to claim that new diseases like CKDnt are caused by climate
change. The flaw in the claim that climate change causes h uman disease is that
it externalizes the planetary climate from the bodily one. This flies in the face of
decades of historical and social research on allergies, immunity, environmental
6 Introduction
epigenetics, the h uman microbiome, and chemical exposure.17 This research
shows that bodies become healthy or diseased not because chemicals, heat, mi-
crobes, or allergens invade previously sealed bodily systems but because h uman
biologies are, as the anthropologist Margaret Lock puts it, always already
“situated” within fundamentally unstable ecologies.18 What is happening to
the kidneys of sugarcane workers is not a result of climate change. It is climate
change.19
This may sound hyperbolic, but it has some grounding in the history of kid-
ney science. For some time, the kidney has been viewed by doctors as what
the twentieth-century American physician and philosopher Homer William
Smith, in a rather strange book called From Fish to P hilosopher, called the “mas-
ter chemists” of the body’s “internal environment.”20 The kidneys absorb and
break down toxins that enter the body through ingestion, respiration, and exer-
tion, which means they are the organs that are most actively involved in adapt-
ing bodies to their surroundings. Smith believed that humanity itself was the
result of a biological and evolutionary struggle to adapt to a violently changing
planet. Human bodies are, he suggested, “a product of Earth’s troubled his-
tory.”21 Were it not for the evolution of the kidney, with its unique capacity to
filter external toxins and wastes from the body’s internal environment, Smith
argued, livers, lungs, and brains would not have evolved as they did. By doing
this, our kidneys “constitute the major foundation of our physiological free-
dom,” as well as freedom of thought and w ill. The kidneys, he wrote, “make the
stuff of philosophy itself.”22
I agree with Smith, up to a point. Where I quibble with him is on his insis-
tence that bodies and environments are insides and outsides to one another.
In recent years, thanks to the rise of planetary health, kidneys and their func-
tion have stirred a g reat deal of philosophizing about humanity’s place in the
world, but that body-environment binary tends to get reproduced in bold pro-
nouncements such as Time magazine’s 2023 declaration that kidney disease is
“the black lung of climate change.”23 In this book, I call attention to less stark
and less declarative speculations about what kidneys and their struggle to func-
tion might mean. To do so, I turn to the concerns that first emerged among ex-
workers in the Nicaraguan sugarcane zone back at the start of the twenty-first
century.24
It is thanks in large part to the willingness of those ex-workers and their allies
to ask questions about what was harming them that CKDnt is now recognized
as a global epidemic, affecting rural p eople, primarily industrial farmworkers,
in Central Americ a, Mexico, Sri Lanka, India, Egypt, and even, evidence sug-
gests, the United States.25 In what follows, I recount some of the controversial
Introduction 7
and dangerous work they did in the early days of the epidemic, but my main
emphasis is on the everyday task of forging collective existence in irrevoca-
bly damaged bodies, in an irrevocably damaged place. While the question of
exactly what causes CKDnt has not yet been answered, my goal is neither to
develop a forensic argument about why so many thousands of sugarcane work-
ers have died nor to indict any particular sugarcane company or government
agency for malfeasance. Instead, I am setting out to examine how p eople take
meaningful action amid what I see as the central conundrum of planetary
health: while the generalized damage to the Earth is undeniable, uncertainty
abounds about how to think and take action in the face of that damage. Rather
than search for root causes, I ask what becomes of environmental health in a
world beset by what the geographer Kathryn Yusoff calls “excessive causality.”26
In this book, t here is no “big reveal.” No magic gene. No toxic chemical turned
smoking gun. This is a story about planetary health, not as an encompassing
condition but as an ongoing, messy, and paradoxically very local p rocess.
Helicopter in the Hot Sun
The Nicaraguan sugarcane zone is haunted by helicopters. It seems odd, but
most of the time we d idn’t really hear them overhead. Maybe this was b ecause
Saúl’s Hyundai Accent sedan made such a racket as it slogged through the
sometimes muddy, sometimes rocky plantation roads. The road that took us
out to the village of El Zapote was actually one of the better ones. When I first
visited El Zapote, an old man who lived there assured us with g reat confidence
that that road might as well be an autopista, a highway, compared with the
other routes in and out of the village.
I’m not sure I’d go so far as to compare it to a highway, but this road, which
wound for several miles at sea level through acres of cane that formed a green-to-
golden wall on either side, was certainly easier on Hyundais than some others in
the zone. Lowland dirt roads like this one eventually connected to the yet-to-
be-completed asphalt autopista that would take you to a string of always-under-
construction beach resorts that awaited Nicaragua’s always-about-to-happen
tourist boom. The few motorcycle taxis and trucks that passed for public trans-
portation in and out of El Zapote tended to take the shorter, steeper, and de-
cidedly more treacherous road: the one that led straight up the ridge from sea
level to the only paved highway in the area, which ran from the outskirts of
Managua to the town of San Rafael del Sur. Men like the one who promised
us a smooth highway-like ride at sea level knew that bumpy ascent well. It was
the route they took, three times a week, to meet the bus that would take them
8 Introduction
to one of the few hemodialysis clinics in Managua, about two hours away. The
dialysis patients were all former sugarcane plantation workers, and they all had
CKDnt. During the four days each week when they w ere not traveling to or
from dialysis, some of them theorized together about the cause of their disease.
The helicopter figured prominently in those theories.
But like I said, it sometimes took extra work to even notice the h elicopter.
Spotting the l ittle black aircraft overhead was a bit like spotting a guardabarranco
(Eumomota superciliosa), the stunning multicolored bird that is Nicaragua’s
official national ambassador to the tropical skies. One minute we would be
putting along, avoiding the deep ruts made by the giant cane-collecting trucks
and just trying to keep our heads still, and the next minute, a blue and red and
orange flutter in the cane would snag one of our eyes and draw it back to the
section of green wall we had just passed. Birds visited now and again as if to
remind us that our monotone surroundings w ere actually alive, metabolizing
the all-too-abundant sunlight, the adequate if not abundant nutrients in the
Pacific coastal soil, and the precious water from the rivers and creeks that fell
down from the tropical uplands, only to be sucked into the stalks of cane be-
fore they reached the sea.
The helicopter, on the other hand, reminded the men recovering from the
dialysis journey that death—their own and that of the cane—was not far off.
From the helicopter’s belly, clouds of odorless chemicals, aimed with vary-
ing degrees of precision, would cascade in the direction of the monoculture
below. If my research on the global sugarcane industry provides any guide
(agricultural companies in Nicaragua are not required to disclose their pre-
cise cultivation methods), that chemical was probably the massively successful
commercial herbicide glyphosate. Whatever it was, it worked. It turned the
green cane to brown, bringing the oversize grass one step closer to becoming
that most unavoidable, irresistible, and terrible of global commodities: refined
sugar. Modern sugar production, like the production of most any modern agri-
cultural product, really begins with mass slaughter.27
When you ask people with CKDnt, as I did over and over again between
2017 and 2020, what might be causing it, they still frequently gesture with their
hands, or more often with that unique jerk of the chin that Nicaraguans some-
times provide in lieu of words, to the air. By the time I started doing research
in the sugarcane zone, the h elicopter and the chemical, which cane plantation
managers and workers call a “ripener” (in Spanish, madurante), were relative
newcomers to the local agricultural complex. Many of the former workers who
depended on hemodialysis to stay alive could remember when the only way to
“mature” the cane—to get rid of the unwanted leaves of grass and condense the
Introduction 9
sugars in the hardy stalks those leaves protected—was to wait for it to ripen on
its own time, and then set it on fire. Mass cane burning had not disappeared
by the time I started visiting the sugarcane zone, but many could reckon the or-
igins of the CKDnt epidemic back to when the helicopters and chemical ripen-
ers first came on the scene, sometime around the late 1990s.
Their logic went like this: the chemicals the helicopters unleashed, whatever
they were, did tend to drift past the borders of the cane fields, through the slots
in the narrow curtain of trees that guarded workers’ villages, into their gardens,
and onto their heads. While ideas about the deadly effects of agrochemicals
and the wave of human death in the sugarcane zone have made their way into
some epidemiological theories, more than a d ecade and a half of research on
the disease has not found a clear and unambiguous connection between toxic
exposure and CKDnt on sugarcane plantations.28 This is not to say there is no
connection, or that the people who look skyward when trying to explain the
thousands of deaths in their communities are deluded. When the helicopter
misses its target and chemicals fall onto plantation villages, residents feel
some reasonable sense of entitlement to speak out about the acute damage that
chemicals do to crops, and about the less certain long-term toll they take on
humans, animals, waters, and soils. In that sense, the haunting helicopter gives
these residents an opening to begin questioning not just the specific harm done
by the chemical but the more general fate of life in the sugarcane zone.29
Those residents know that what is uncertain in Nicaragua’s sugarcane zone
is not simply the cause of CKDnt. While it is easy to think of disease as the
central source of uncertainty in the region, what is actually uncertain—indeed,
deeply fragile—is the region’s dominant environmental form, the sugarcane
plantation itself. Journalists, food justice advocates, and even many CKDnt
scientists frequently depict the sugar industry as an enormous behemoth, ruth-
lessly exploiting people and land for short-term profits. The truth is less stark.
Sugarcane plantations are ecologically fragile in ways that are certainly different
from, if not entirely unrelated to, the fragility of the bodies of those who work
them.30 It is the fragility of a plantation, rather than its strength and coher-
ence, that makes it so destructive, but that same fragility also provides room
for p eople to develop what Katherine McKittrick calls “creative space to chal-
lenge” the plantation system.31
Plantations are not the same everywhere, but one important way of sep-
arating a plantation from other kinds of industrial monocultures is that a
plantation depends for its existence on the reproduction not just of crops
but of racialized and gendered difference. Since its inception, the Nicaraguan
sugar business has explicitly operated on a racial and class hierarchy in which
10 Introduction
white landowners or well-connected ladinos exploited the labor of Indigenous
people and campesinos whom they considered fundamentally inferior.32 An
equally important feature of plantations is that those who own and manage
them consistently find ways to disavow their culpability in racial and gendered
violence through paternalistic gestures to care for laborers. Such gestures—
from patronage systems in which access to work comes with access to limited
food, medicine, or housing, to contemporary corporate social responsibility
schemes—keep workers and other plantation residents minimally alive. Planta-
tions may promise care, but what they offer both crops and the p eople who do the
work of planting and harvesting them is a rudimentary and time-limited form of
life support, one that is premised on the continued productivity of both.33
Such a minimalist approach to life support was essential to the global suc-
cess of sugarcane. Since cane is not native to the Americas, colonial plantation
owners and field laborers experimented to find t hose varieties that would grow
best in vast monocultures.34 The harvest required a violent intensity of labor,
and it rewarded economies of scale. The seeding, burning, and cutting p rocess
lent itself to the expansion of a chattel slavery model premised on the fungibil-
ity and interchangeability of bodies.35 Sugarcane’s potential for ecological and
bodily violence was rooted in its potential for scalable expansion: more and more
of the same crop system, adjusted for climate and geography. The suffering of
field laborers multiplied in parallel, reverberating across time in stories and im-
ages about the inhumanity of both past colonialism and contemporary capi-
talism. An eighteenth-or nineteenth-century painting of cane production in
Louisiana, or Haiti, or Cuba, or Brazil tends to look remarkably similar to a
twenty-first-century photograph: Black and brown (mostly male) bodies, ma-
chetes in hand, skin glistening in the hot sun, swinging, killing, dying.36 One
era’s imagery haunts another’s.
Nicaraguan sugar complexes, though relatively new by world-historical
standards, are haunted by the legacy of the system of chattel slavery that de-
veloped elsewhere in Latin America and the Caribbean. Working in Puerto
Rico in the middle of the last century, the anthropologists Eric Wolf and Sidney
Mintz illustrated how, as sugar production industrialized, companies dis-
carded the “old style” obligation to provide land and housing to workers, an
obligation that began when the sugar barons’ ancestors w ere slaveholders.
“New style” plantations attempted to banish the ghosts of the premodern slave
plantation by severing economic operations from other aspects of rural life.
For example, they replaced direct provision of land and food with indirect
economic and political investments. Such investments were often couched as
promoting modernity and development.37 In places like Nicaragua, where
Introduction 11
sugarcane operations did not begin in earnest until after the formal end of the
transatlantic slave trade, the “new style” form at first seems dominant. T oday,
large operations like Montelimar have achieved economies of scale by con-
trolling massive tracts of land and hiring workers on a seasonal basis, limiting
their obligations to provide the care that previous generations of plantation
owners might have offered.38
Yet even in Nicaragua, vestiges of the “old style” remain. One sign of the
overlap between the old and the new appears in language. People around Mon-
telimar rarely used terms like plantación or hacienda. In this book, plantation
is by and large an analytical term that I adopt. Instead, Montelimar’s residents
interchangeably portrayed the sugar complex as an externality, el ingenio (lit-
erally, “the mill”), and as a murkier space of interdependency, la zona (the sug-
arcane zone). Well before the h elicopters started appearing overhead, p eople
who worked in the sugarcane zone understood their pasts and f utures as inex-
tricably entangled with the surrounding monoculture. Many of their villages
were constructed on land ceded to their ancestors by large landowners (pa-
trones). Access to land would have been given in exchange for l abor power, but
just as important, a patrón could, potentially at least, be a source of support in
times of need. As in other parts of Latin America, a loose “moral economy”
driven by senses of obligation and debt operated in parallel to an agricultural
economy shaped by labor-management relations.39
This moral economy is another haunting presence on contemporary plan-
tations. As Jeffrey Gould recounts in his historical study of the Ingenio San
Antonio, a sugar plantation to the north of Montelimar, a myth once circu-
lated among the workers, which said that “the company had signed a pact with
the devil in order to further accumulate wealth. . . . The devil pact specifically
allowed the company to convert dead laborers and their families into cattle.”40
The company would then sell these cattle to a hacienda. “The death of [a la-
borer] did not mean the end of his service to the company,” Gould writes.
“Rather . . . the worker continued to produce wealth for the company . . .
either as oxen or as food for the work force.”41 Dead workers haunted the liv-
ing ones. This is an old tale, a variation of stories about the devil and capi-
talism that recur across Latin America.42 Those I met at Montelimar talked
frequently about bodily sacrifice, and some could even remember when the
patrón who controlled Montelimar’s land was none other than Nicaragua’s
dictator, Anastasio Somoza, whose vacation home sat just down the ridge from
the sugar mill, until his ouster by the popular Sandinista revolution in 1979.
Former workers framed their relationship to sugarcane as one that was defined
by a donation not just of time and energy but of bodily substances, particularly
12 Introduction
sweat and blood, to the commodity crop.43 In the moral economy, such sacri-
fices were supposed to be rewarded by patrones with a modicum of care and
concern, but as we w ill see in this book, that sense of mutual obligation was as
much a haunting collective memory as a reality.
Haunting matters to this narrative in one final way. Plantations are not just
systems for producing crops and keeping workers minimally alive and healthy.
They are also, fundamentally, systems for sustaining the transfer of wealth and
power through channels of white, elite privilege. This is true in Nicaragua, as
it was in the American South, where my own ancestors were slaveholders. My
great-great-great grandfather Benjamin Rush Jones was the b rother of Eliza
Theresa Jones Sims, the wife of J. Marion Sims. Sims was a Montgomery, Al-
abama, doctor whose research on vaginal fistula involved exploitative experi-
mentation on the bodies of at least sixteen enslaved Black w omen, including
painful repeated surgeries and involuntary administration of opium.44 Sims’s
niece, my great-great grandmother Susie Theresa Jones Waller, lived at a planta-
tion located near Mt. Meigs, where Sims had his first clinic. I am thus a descen-
dant of the very same slaveholders who enabled Sims’s work in Montgomery
during that period, and I am related to Sims by marriage.45 In a fairly direct
way, I am an economic and social beneficiary of the medical exploitation Sims
enacted through the Alabama plantation economy. My grandfather, Susie The-
resa Jones Waller’s grandson, helped pay for my education with wealth accrued
from a plantation. For me, this connection is an example of how antiblackness
haunts the field of medicine but also the field of medical anthropology.46 There
is no redemptive way for me to write about the plantation ethnographically,
because I too am haunted by it.
Six Life Support Systems
ambed was one of several advocacy organizations that sprang up in Nicara-
gua’s sugarcane zone after CKDnt became a recognized problem there. It was
neither the largest nor the most well-known. Its most enthusiastic participants
over the years included a part-time taxi driver with two-thirds of a law degree,
a couple of American lawyers, three former sugarcane cutters, and a former
sugarcane company clerical secretary. As an anthropologist, I was an adjunct of
sorts to ambed’s activities between 2017 and 2020.
For ambed, the terms and tactics of environmental advocacy that might have
been borrowed from other environmental or health activist groups w ere never
sufficient for maintaining momentum. Over the past two d ecades, anxieties
about CKDnt and its possible relationship to sugarcane plantation production
Introduction 13
have drastically rearranged social and political relationships among former
workers, their families, international aid workers, university scientists, doctors,
and sugarcane companies in Pacific coastal Nicaragua. These individuals and
institutional players do not constitute a collection of “stakeholders.” Instead,
they meet one another in an ongoing process of trying to give name and form
to a bundled set of economic, medical, environmental, and p olitical prob
lems.47 During the time we worked together, ambed struggled to maintain
a steady base of members who fit the conventional definition of “active.” The
dozens of general assembly meetings I observed were often sparsely attended.
Many of ambed’s international supporters (including me) drifted in and out
of the picture due to funding constraints, family obligations, changes in em-
ployment, and communication breakdowns. Saúl Bermudez himself would
eventually leave ambed under a cloud of suspicion about his loyalties, but this
book is not a story about the messy intrigue of a struggling social movement.
Even if it included almost no public protests, boycotts, or voting drives, the
group’s work was political, if politics means, as Tania Murray Li puts it, “the
expression, in word or deed, of a critical situation.”48 Yet ambed’s story reflects
a version of politics that is at odds with the one that tends to dominate both
liberal political theory and many studies of environmental health. This domi-
nant version of politics imagines what the Chilean scholar Manuel Tironi has
described as “well-organized, outspoken and articulated individuals . . . mobi-
lizing cognitive (and economic) resources in the face of an externality.”49 Pol-
luting industries make easily objectifiable externalities, yet even when groups of
people are deeply affected by industrial actions, ethnographic work reveals again
and again that those groups frequently choose not to externalize industry in an
agonistic or directly confrontational way, but to work with and against it in a
more creative, heterogeneous, and open-ended way. One reason they do this is
that histories of labor—in factories, in plantations, in mines—put them in a
double bind. These histories give them a sense of connection to the very pollut-
ers that harm them.50 The p eople whose stories make up this book worked to
trouble the sharp distinction between field and village, worker and caregiver.
They refused to operate within the fixed categorical slots of medicine, environ-
ment, or labor. The effect of this refusal was to keep the questions surrounding
CKDnt open to scrutiny and, by extension, to establish what many saw as the
central fact of life in the sugarcane zone: that people who resided there, even
if they did not work directly in the cane, were entangled with the industry—
biologically, economically, and ethically. Thus, ambed is less a subject of this
book than an example of how contemporary environmental advocacy traps its
14 Introduction
participants in multiple double binds: both calling on them to join together
with corporate, state, and supranational organizations to repair the world, and
to acknowledge that that very process of joining is a reductive one that can
drive people apart. As Kim Fortun puts it, advocacy is not the antidote to di-
saster; it is part of disaster itself.51
Each of the six chapters of this book explores how people grappled with
a system designed to support plantation life—both the human life of labor-
ers and residents in the zone and the life of the sugarcane monoculture itself.
These are all “open” systems, and they all traverse scales from the bodily to the
regional to the global. Each has imperfections and gaps, which means, as For-
tun has argued, that no person’s role in them is ever fixed. Furthermore, each
system has pressure points where they are subject to change.52 As each chap-
ter shows, it was at such pressure points that problems like CKDnt, toxicity,
the economic and social rights of workers, and planetary health itself became
workable and thinkable, but also where the scope of the slow-moving disaster
of plantation capitalism became apparent.
In chapter 1, the system in question is a quasi-legal transnational corporate
grievance mechanism underwritten by the World Bank’s Compliance Advisor
Ombudsman (cao). When the lawyers who hired Saúl first came to Nicara-
gua, they were preparing to file a petition to the cao on behalf of sugarcane
workers at nsel affected by CKDnt. Later, ambed filed its own cao griev-
ance, in hopes of convincing the Montelimar Corporation to address commu-
nity concerns about environmental health. It is easy to be cynical about the
capacity of an unwieldy supranational body like the cao to effectively deliver
social and environmental justice, but chapter 1 describes how ambed cau-
tiously embraced the cao’s logic of grievance-making. The cao grievance
mechanism encourages mediation over litigation. It invites companies to meet
community members in a dialogue about specific, tangible demands, and to
seek trade-offs between the needs of both parties, as if they were equals. The
chapter shows how ambed creatively blended the equalizing, universalizing
logic of the legal grievance with place-based knowledge, or “knowledge of the
ground.” Along the way, it elaborates on the group’s ethical orientation. As the
group’s name (“Blessing from God Association”) implies, ambed took a non-
secular approach to collective organizing and accountability, one that offers a
counterpoint to the dominant liberal, technocratic approach to climate justice
emblemized by the cao.
One of the most visible outcomes of the cao mediation process was
the onset of occupational studies of CKDnt in Nicaragua and elsewhere.
Introduction 15
Chapter 2 thus turns from legal systems to systems of occupational health. The
leader of one of the first groups of international scientists to study the CKDnt
epidemic told me that when his team initially came to the Nicaraguan cane
fields in 2008, sick workers approached them demanding that they test the soil,
the water, and then their blood for the presence of the poison chemicals they
were sure would be t here. Such tests are notoriously difficult u nder the best of
circumstances, and no link between toxic substances and CKDnt was found.
Instead, the scientists started to notice another possible trigger. Perhaps, they
hypothesized, CKDnt was the result of something as essential to the produc-
tion of sugar as water, chemicals, and soil: heat. What has become known as
the “heat stress nephropathy” hypothesis now appears in nearly e very reputable
scholarly paper on CKDnt. More than any other causal theory, the heat stress
hypothesis has helped make CKDnt emblematic of the need for a new science
of planetary health. A desire to test that hypothesis has drawn international
occupational health researchers to the sugarcane zone. While the coming of such
research offers some hope to workers, chapter 2 shows how the recent scientific
and corporate focus on mitigating heat elides the fact that rising heat is en-
abled by national policies and transnational industry norms that permit the
expanded use of agrochemicals. The systematic push to find ways of continuing
to profitably produce sugarcane u nder conditions of extreme heat was paral-
leled by the efforts of nonworkers, particularly w omen, to make knowledge
claims about the slower and more accretive changes in climate wrought by
chemically driven cane production.
I delve more deeply into how those changes w ere embodied in chapter 3,
where the life support system in question is the vast irrigation network that fed
Montelimar’s expanding cane fields. For ambed, waterways were a means of
both dividing and connecting plantation and nonplantation space, work and
home, and human and nonhuman life. The embankments of irrigation canals,
dams, and pipes, as well as beaches and riverbeds, turned out to be effective
places not just for producing evidence of the impact of sugar production on
bodies but also for flipping the terms on which CKDnt could be understood—
from a disease of agricultural production to a disease of social reproduction.
Questions about the distribution of w ater, as well as its quality, highlighted
how the work of supporting the life of sugarcane became problematically at
odds with that of supporting the lives of o thers who called the sugarcane zone
home. Ethnographically, I show how ambed and the communities it repre-
sented linked the kidney’s primary biological function, cleansing the body of
wastes, to the social acts of cleaning that took place along t hese embankments,
conjuring a “renal environment” out of the plantation landscape.
16 Introduction
Chapter 4 turns to the system of pesticide application and regulation.
Chemical toxicity was perhaps the most pressing concern for residents of the
sugarcane zone, but because toxic damage here, as in other places where chemi-
cal exposure occurs, was sometimes slow and sometimes acute, sometimes pain-
fully obvious and other times merely possible, residents had to develop creative
ways to keep attention on the problem. Rather than see toxicity as simply a
question of material interactions between bodies and chemicals, the chapter
illustrates how people in the sugarcane zone worked to make toxicity legible
through a variety of media, including the oral sharing of stories and the ex-
change of videos and photographs on platforms like Facebook and WhatsApp.
By rethinking toxic worlds as mediated worlds, people in the sugarcane zone
found a method for questioning the premises of both pesticide regulation and
toxicology. If toxicity is made in the circulation of narratives, and not just in the
circulation of molecules, then the media of telecommunication, digital pho-
tography, and storytelling become essential tools in environmental politics.
Even those life support systems that appeared to be designed explicitly to
provide aid to people affected by CKDnt often served in practice to support
sugarcane production—to rescue the industry from itself. Chapter 5 discusses
former Montelimar workers’ engagements with Nicaragua’s national social
security system. Those affected by CKDnt had to work through the corpora-
tion to wrest benefits from the social security agency. Social security systems
may seem less “open” than legal or regulatory or irrigation systems, but his-
torical evidence about the place of sugar production in the development of
the Nicaraguan welfare state shows how conditions like CKDnt challenge the
structural integrity of social safety nets. Social security systems are premised
on the idea that to receive insurance from the state, one must be identifiable as
a productive worker. Since social security provides aid to injured workers, such
systems also depend on an ability to clearly define what counts as a workplace
injury. What the CKDnt epidemic has exposed is that the categories of both
the worker and the working environment turn out to be fluid and contestable.
The chapter uncovers the messy negotiations that go into establishing which
bodily and ecological conditions count as “working conditions.”
Moving from social safety nets to systems of care for the sick, chapter 6
examines what was perhaps the most significant outcome of ambed’s medi-
ated settlement with the Montelimar Corporation: access to hemodialysis for
dozens of former workers with late-stage kidney disease. The chapter charts
the journeys of hemodialysis patients back and forth from the sugarcane zone
to the hemodialysis wards of Nicaragua’s capital, Managua. To be honest, it
may be unfair to call the kidney disease treatment approach in Nicaragua
Introduction 17
a “system.” Not all those who are offered the opportunity to receive dial-
ysis treatment accept it, and not everyone who does accept it sees it as an
unambiguous good. Moreover, those who qualify for this benefit constitute a
decided minority of all those affected by the epidemic. Through stories about
the ambivalence of patients toward treatment, I argue that corporate social re-
sponsibility, a key element of most designs for planetary health, has the effect
of reinforcing a view of labor that is as old as the plantation itself, namely, that
working bodies are fungible and interchangeable.
Against Problem Closure
An impulse to identify discrete and measurable determinants of disease con-
tinues to animate many of us who are concerned about planetary health. This
book is intended as a check on that impulse. Along with other critical an-
thropologists, I agree that it is appropriate to push back against the distribu-
tive hope that is lodged in many policy and institutional approaches to health
(planetary or otherwise), namely, that with enough of the right kind of exper-
tise, we might restore nature and normalcy.53 Across this book, many of the
actors are the same: Saúl, ambed’s leaders, the people who tended to small
houses and gardens in villages dotted across Montelimar’s vast sugar-growing
complex. The actors are the same, but the problem, how to work at the inter-
section of the multiple systems that have been designed to support plantation
life, is reconfigured. This makes closure a challenge. One of the lessons this re-
configuration provides for a critical approach to planetary health is that t here
is no way of returning to a “before,” when life support systems worked better,
when the drive to expand human health could be reconciled with the drive to
expand economic growth.
Each chapter finds people eschewing an approach to social action that is
based on the presumption that a return to a prediseased condition is possible,
or even desirable. Instead, they approach CKDnt in a noninnocent register, one
that over time has come to suppress the search for root causes and cures. The
search for root c auses, as the disability studies scholar Eli Clare writes, “requires
damage, locating the harm entirely within h uman body-minds, operating as if
each person w ere their own ecosystem.” The notion of restorative cure, Clare
continues, relies “on a belief that what existed before is superior to what ex-
ists currently.” These beliefs about cause and cure, in turn, are rooted in dom-
inant definitions of what counts as “normal and natural.”54 While the people
whose work and lives I discuss in this book certainly see failing kidneys as a
18 Introduction
form of damage, they refuse to locate that damage solely within their bodies.
Furthermore—and this is not surprising if you think about it—they refuse
to believe that what existed before the CKDnt epidemic began, a destructive
plantation system that thrived on the exploitation of poor and marginalized
rural people, is either superior to what exists t oday, or is normal, or is natural.
While CKDnt has been devastating, it has also created an opening for multiple
ways of imagining health.55
There is a temptation, perhaps especially among critically minded medi-
cal anthropologists, to approach stories about contested or neglected diseases
with a particular kind of cause in mind: cause as end point or goal. Think so-
cial justice or human rights. We anthropologists tell ourselves that through in-
depth, long-term, place-based research, we can arrive at a previously hidden
empirical vantage point that will unlock the mystery. This makes sense. Schol-
ars committed to the marginal, the disempowered, the unfree, or the afflicted
have a stake in the clinical project of alleviating suffering. But such scholars
(and I include myself h ere) might do well to hold in abeyance that temptation
to unlock, to solve, to provide problem closure.
What if instead we worked toward a way of knowing that, in the words of
John Jackson, refused to “simply treat mystery as its mortal enemy, as nothing
more than a land to be conquered”?56 That is a good summary of what many
of the Nicaraguan CKDnt patients and their allies have tried to do. Today,
they still point anxiously to the helicopter, but they don’t all agree that the
helicopter is some sort of smoking gun. They acknowledge the heat, and they
even buy into the narratives that link CKDnt to global warming. But—and I
admit this has been frustrating—people in Nicaragua’s sugarcane zone experi-
encing the CKDnt epidemic have never galvanized around a single cause. In-
stead, they find themselves on edge.
For that reason, the chapters that follow take place not in the sugarcane fields
themselves but in the rivers, villages, and roadways that run along their edges. It
is along these edges, I suggest, that we might come to a more convincing under-
standing of how the unraveling of planetary ecology manifests in local biology.
The villages in which sugarcane zone residents live and die are physically lo-
cated on the ecological and economic edges of monocrop production systems.
Residents’ day-to-day lives entail work (only some of it remunerated and recognized
as such) in the forest edges and irrigation embankments that separate homes
from cane. As the sugarcane zone heats up, and as the chemical regimes of crop
management become more intense, they find themselves enveloped in the anxi
eties of corporations and states navigating uncertain profit margins and varying
Introduction 19
degrees of financial solvency. All the while, they find themselves on the edge of
inclusion in economic and political o rders, as they struggle to extend the reach
of private and public systems of medical care.57 As a global reconfiguration of
the norms and practices of medical and environmental science, planetary health
still remains something of an aspiration. But as a grassroots project, it has al-
ready begun, in an unlikely place: on the edge of the sugarcane zone.
20 Introduction
Notes
prologue. lives worth supporting
Portions of this prologue were published in Nading, “The Plantation as Hotspot.”
1. Whitmee et al., “Safeguarding H uman Health,” 1997. “Anthropocene” is the name
that scientists have given to the geological epoch brought on by irreversible, human-
induced change to the Earth’s geological and atmospheric systems. See Crutzen, “Effects
of Industrial and Agricultural Practices”; Steffen et al., “Anthropocene.” The Rockefeller-
Lancet report is implicitly critical of the twentieth-century development ethos that saw
the improvement of human health as naturally compatible with the steady growth of
economies, m easured through gross domestic product (gdp) indicators. See Murphy,
Economization of Life; Farman and Rottenburg, “Measures of Future Health”; and Liv-
ingston, Self-Devouring Growth.
2. Whitmee et al., “Safeguarding H uman Health,” 2008. The rise of planetary health
follows on from the roughly twenty-year period in which states, universities, and supra-
national o rganizations organized around the notion of “global health.” In some ways,
planetary health represents a pivot to a more explicitly environmental posture, and in
its emphasis on measuring and mitigating the effects of climate change, it is also distinct
from the One Health and Eco Health movements, which have tended to focus on the
pathways of zoonotic disease transmission and, to a lesser extent, overlaps between the
health of key ecosystems like forests and farms and the health of h umans. See Dunk
and Anderson, “Assembling Planetary Health”; Brown and Nading, “Human Animal
Health”; Brown, Cueto, and Fee, “World Health O rganization”; Packard, History of
Global Health; Craddock and Hinchliffe, “One World, One Health?”; Chabrol and
Gaudillère, Introduction à la santé globale.
3. cao, “Complaint of cfi Project 32253.” The International Finance Corporation
goes by the E nglish abbreviation ifc. In Spanish, its name, Corporación Financiera
Internacional, shortens to cfi.
4. cao, “Complaint of cfi Project 32253,” 1.
5. Nading, “Ethnography in a Grievance”; Johnson, “Nicaragua’s Latest Revolution.”
6. International Finance Corporation, “Disclosure—Ingenio Montelimar.”
7. Patel, “Long Green Revolution.” Hetherington, in Government of Beans, builds on
this idea to suggest that the Long Green Revolution ushered in an age of “agribiopolitics,”
in which the regulation of human life, through the idiom of health, became entangled
with the regulation of the lives of commodity crops.
8. Laveaga, “Beyond Borlaug’s Shadow.”
9. Zubrin, “In Defense of Biofuels.”
10. Faber, “Sea of Poison”; Faber, “Imperialism, Revolution, and the Ecological Crisis.”
11. Butler, “Nicaragua Forest Information”; Mayer, “Conceptualizing Settler Colonial-
ism in Nicaragua.”
12. Thompson et al., “Most At-Risk Regions.”
13. As the medical anthropologists Hannah Brown and Ann Kelly have argued,
“Disease risk is not . . . ‘located,’ in the sense of being a feature of a particular kind
of place. . . . R ather, it is locational . . . arising from particular configurations of
social, biotic, and material conditions” (Brown and Kelly, “Material Proximities and
Hotspots,” 287).
14. Sorensen and Garcia-Trabanino, “New Era of Climate Medicine,” 694.
15. Solomon, “Life Support”; Kaufman, Ordinary Medicine; Biehl and Adams, Arc of
Interference.
16. Whitmee et al., “Safeguarding H uman Health,” 1973. For an alternative reading of
this point, see Hinchliffe, Manderson, and Moore, “Planetary Health Publics.”
17. As critical global health scholars (and maybe my students!) w ill recognize, panel 14
vastly oversimplifies the aids story. Despite widespread availability of hiv drugs, it is
not clear that the movement for treatment access has fundamentally addressed political
or racial i nequality, partly b ecause the provision of therapy is so narrowly implemented,
and partly because other basic aspects of public health still receive too l ittle attention (see
Kalofonos, All I Eat Is Medicine; Yi Dionne, Doomed Interventions; Biehl, W ill to Live).
18. Adams, Metrics.
19. Carse, “Ecobiopolitics of Environmental Mitigation.”
introduction
1. The disease that forms the backdrop to this book has been known by several names
over the past twenty years, including Mesoamerican nephropathy (MeN) and, more
commonly, chronic kidney disease of unknown causes (CKDu). Using the term chronic
kidney disease of nontraditional causes, I join other researchers and advocates who hold
that emphasizing the “unknown” in discussions of the epidemic risks deferring investiga-
tion and critique of the likely sources of harm to workers and communities, namely, the
drastic ecological transformations that have come along with the making of monocrop
landscapes in Nicaragua and elsewhere.
2. Anderson and Dunk, “Planetary Health Histories,” 769.
3. Whitmee et al., “Safeguarding Human Health.”
4. Horton, They Leave Their Kidneys in the Fields; Holmes, Fresh Fruit, Broken Bodies;
Besky, “Exhaustion and Endurance.”
5. DeLoughrey, Allegories of the Anthropocene, 7.
6. Hecht, Residual Governance.
164 Notes to prologue
7. Agard-Jones, “Bodies in the System”; Trouillot, “Making Sense”; Scheper-Hughes,
Death without Weeping.
8. Besky and Blanchette, How Nature Works; Farmer, aids and Accusation; Farman
and Rottenburg, “Measures of Future Health”; Livingston, Self-Devouring Growth.
White reminds us that “labor rather than ‘conquering’ nature involves h uman beings
with the world so thoroughly that they can never be disentangled” (Organic Machine, 7).
9. Fortun, “Poststructuralism, Technoscience,” 314.
10. Moore, Anthropocene or Capitalocene?; Mintz, Sweetness and Power; Mintz, Worker
in the Cane; Moran-Thomas, Traveling with Sugar.
11. Guthman, Wilted, 10.
12. Besky, Darjeeling Distinction; Hetherington, “Beans before the Law.”
13. Blanchette, Porkopolis.
14. Guthman, Wilted; Hetherington, Government of Beans.
15. Grover, “Too Hot to Handle.”
16. Whitington, “Fingerprint, Bellwether, Model Event.”
17. Mitman, Breathing Space; Lorimer, Probiotic Planet; Lamoreaux, Infertile Environ-
ments; Murphy, Sick Building Syndrome; Kenner, Breathtaking.
18. Lock, “Recovering the Body.”
19. H
ere, I am paraphrasing an observation made by the anthropologist and writer
Amitav Ghosh, who has argued that mass migration out of vulnerable areas such as the
Sundarbans of the Bengal Delta should not be viewed as consequences of climate change
but as a manifestation of climate change itself (Ghosh, “Embattled Earth”).
20. Smith, From Fish to P hilosopher, 3.
21. Smith, From Fish to P hilosopher, 10.
22. Smith, From Fish to P hilosopher, 3.
23. Baker, “Chronic Kidney Disease.”
24. Like other medical anthropologists who have studied chronic kidney disease
(e.g., Hamdy, Our Bodies Belong to God; Crowley-Matoka, Domesticating Organ Trans-
plant; Kierans, Chronic Failures), I aim to use ethnographic storytelling to highlight a
“conviction on the part of people who face some of the worst health conditions on the
planet,” namely, as Charles Briggs and Clara Mantini-Briggs write, “that their ideas could
play a crucial role in making a healthier and more just world” (Briggs and Mantini-Briggs,
Tell Me Why My Children Died, 1). Briggs and Mantini-Briggs wrote t hese words in
the context of another medical mystery—a rabies epidemic that devastated an Indige-
nous Warao community in Venezuela. As in the stories I will tell in this book about the
Nicaraguan sugarcane workers and others affected by CKDnt, the search by the Warao
for answers was at the same time a quest to be seen and heard not merely as “victims” but
as active producers of knowledge. Elizabeth Povinelli, following William James, puts it
another way: “The poor ‘who live and feel’ the regions of existence sucked dry of value
‘know truth’ as an actuality. They are always, even if immanently, opposing the dominant
(if ultimately sterile) ideas of bourgeois p hilosophers and statesmen” (Povinelli, Between
Gaia and Ground, 5).
25. Horton, They Leave Their Kidneys in the Fields; de Silva, “Drinking W ater”; Senan-
ayake, “Towards a Feminist P olitical Ecology”; Kierans, Chronic Failures.
Notes to introduction 165
26. Yusoff, “Indeterminate Subjects,” 92.
27. Hetherington, “Concentration of Killing.”
28. Gunatilake, Seneff, and Orlando, “Glyphosate’s Synergistic Toxicity”; Seneff and
Orlando, “Is Glyphosate a Key Factor?”
29. Haunting in this (metaphoric) sense is the feeling of being repeatedly visited by a
troubling presence, of both a troubling past and an uncertain f uture. Such a presence may
provide openings for imagining and enacting justice. See Good, Chiovenda, and Rahimi,
“Anthropology of Being Haunted”; Derrida, Specters of Marx.
30. Guthman, Wilted.
31. McKittrick, “Plantation Futures,” 10; Li and Semedi, Plantation Life.
32. Walker and Wade, Nicaragua; Quesada, “Brief History of Violence”; Gobat, Con-
fronting the American Dream. This formulation emerges from Black feminist frameworks,
as well as from the work of anthropologists of the plantation who attend to the specific
ways in which racial and gendered violence manifests itself across different monocultured
spaces (Besky, Darjeeling Distinction; Jegathesan, “Black Feminist Plots”; Wynter, “Novel
and History”; Davis et al., “Anthropocene, Capitalocene”).
33. Trouillot, “North Atlantic Universals.”
34. Tsing, “On Nonscalability”; Mintz, Sweetness and Power.
35. Tsing, “On Nonscalability,” 512; Spillers, “Mama’s Baby, Papa’s Maybe”; Marshall,
“Political Life of Fungibility.”
36. Medical anthropology and critical food studies have gained a notable amount of
traction in global health—at least at the level of college curricula—in part b ecause of the
allure of the “suffering stranger” (Butt, “Suffering Stranger”; Biruk, “Ebola and Emer-
gency Anthropology”). Elsewhere, Anna Tsing writes of the need in global capitalist sup-
ply chains for suitable, transposable “figures.” Figures like the injured male farmworker
are as essential for food justice and l abor advocacy as they are for fair trade certifiers and
corporate social responsibility c onsultants (see, e.g., Holmes, Fresh Fruit, Broken Bodies).
These h uman figures form a fractal dyad with recognizable commodity crops like cane,
packaging a story about runaway capit alist growth, its consequences, and its solutions. As
Tsing puts it, “Businessmen, policy makers, voters, trade u nions, and activists . . . use con-
crete figurations to imagine which projects might succeed” (Tsing, “Supply Chains,” 152).
37. Wolf, “Specific Aspects of Plantation Systems”; Mintz, Worker in the Cane.
38. Gould, To Lead as Equals.
39. As Elizabeth Ferry defines it, a “ ‘moral economy’ entails a parallel, often unwritten
set of moral prescriptions over economic activities and their proceeds that contrast with
official often elite or managerial prescriptions” (Ferry, “Geologies of Power,” 424; see
also Scott, Moral Economy of the Peasant; Thompson, “Moral Economy of the E nglish
Crowd”; Rueda Estrada, “Campesinado Migrante”).
40. Gould, To Lead as Equals, 29.
41. Gould, To Lead as Equals, 30.
42. Nash, “Devil in Bolivia’s Nationalized Tin Mines”; Taussig, Devil and Commodity
Fetishism.
43. This narrative arc tracks with the ones in perhaps the two most famous anthro-
pological accounts of sugarcane in Latin America, Sidney Mintz’s Worker in the Cane
166 Notes to introduction
and Nancy Scheper-Hughes’s Death without Weeping. In t hose books, the authors re-
count how by the 1960s, mechanization and industrialization in Puerto Rico and Brazil
led to a loss of jobs and an onset of a sense of abandonment, not to mention a renewed
contemplation among workers about the role of God in their lives. Nicaraguan work-
ers’ descriptions of exertion followed by abandonment reflected what Maya Mayblin,
writing about Northeast Brazil’s sugarcane zone, calls “the drama of work . . . as a form
of sacrifice, a veritable spillage of bodily s ervice to others” (Mayblin, “The Way Blood
Flows,” s47).
44. Cooper Owens, Medical Bondage.
45. I was able to piece together this genealogical relationship with a few clicks of a
mouse, while thirteen of the sixteen women who suffered under Sims remain unnamed.
No one needs to fight to build public statues of my ancestors, as many are d oing now to
celebrate those women’s memory, because my ancestors’ names and faces are preserved on
the internet. I can think of few better examples of the banality of white supremacy.
46. I wish to express my gratitude to the historian Rachel Dudley for (albeit unwit-
tingly) provoking me to do some genealogical digging. I imagine that many of us in
academia who descend from white plantation slaveholders know intuitively that we are
still reaping the benefits of that institution, but at the risk of distraction, I feel compelled
to state what I know in concrete terms.
47. Fortun, in Advocacy after Bhopal, calls this kind of meeting-in-process an “enuncia-
tory community.”
48. Li, Will to Improve, 12.
49. Tironi, “Hypo-interventions,” 443.
50. Graeter, “Infrastructural Incorporations”; Auyero and Swistun, Flammable; Lora-
Wainwright, Resigned Activism. Other plantation scholars have pointed to the ethical,
economic, and political compromises that are emblematic of plantation life. “Weapons
of the weak” tend to be wielded alongside a host of creative strategies for ensuring social
reproduction, accessing resources, and otherwise sustaining everyday existence. For
contemporary workers, tactics can entail sabotage not just of industrial farm machin-
ery or plants, as in classic renderings of weapons of the weak, but of fellow plantation
workers and satellite residents (Scott, Weapons of the Weak; Li and Semedi, Plantation
Life; Scheper-Hughes, Death without Weeping). The work of enduring and reproducing
life, then, becomes integrated into the work of reproducing the plantation itself (Besky,
“Exhaustion and Endurance”; Jegathesan, Tea and Solidarity).
51. Fortun, Advocacy after Bhopal, 16.
52. Actors’ roles in open systems are “continually being reconstituted through the
interaction of many scales, variables, and forces” (Fortun, “Poststructuralism, Technosci-
ence,” 296). Ethnography in the mode of “open system analysis conjures and temporalizes
its ‘object,’ both synchronically and diachronically, recognizing diverse forces of change
and diverse ways change happens” (Fortun, “Figuring Out Ethnography,” 169–70).
53. Hecht, Residual Governance, 8; Livingston, Self-Devouring Growth; Marya and
Patel, Inflamed.
54. Clare, Brilliant Imperfection, 15 (emphasis in original). See also Shotwell, Against
Purity; Wool, “in-Durable Sociality.”
Notes to introduction 167
55. In their critique of the concept of planetary health, Farman and Rottenburg make
clear that unlike global health, planetary health cannot be one single t hing—though the
name implies a deep interconnection and a singular planet (Farman and Rottenburg,
“Measures of Future Health,” 3).
56. Jackson, Thin Description, 94.
57. “Identity,” as Wendy Brown notes, is created on edges, where borders and opposi-
tions are established (Brown, Edgework, 60).
chapter 1. grievance, ground, and grace
Portions of this chapter were published in Nading, “Ethnography in a Grievance.”
1. cao, “Agreement,” 2.
2. Neely and Ponshunmugam, “Qualitative Approach to Examining Health Care.”
3. Guevara, Guerrilla Warfare, 56.
4. Gobat, Confronting the American Dream; Quesada, “Brief History of Violence”;
Walker and Wade, Nicaragua; Grossman, “The Nation Is Our Mother.”
5. As Allewaert writes, “The entanglements that proliferated in the plantation zone
disabled taxonomies distinguishing the h uman from the animal from the vegetable from
the atmospheric, revealing an assemblage of interpenetrating forces . . . an ecology. This
ecological orientation departs from an eighteenth-century political and aesthetic tradi-
tion distinguishing persons, in particular, white colonial subjects from the objects and
terrains they surveyed” (Allewaert, “Swamp Sublime,” 341). Her observation is resonant
with Sylvia Wynter’s much earlier argument that the life lived by Afro-Caribbeans, en-
slaved and f ree, on the “plot” was a p olitical and conceptual foil to the stories told about
them from the linear perspective of the plantation (Wynter, “Novel and History”; see
also chapter 4).
6. Allewaert, “Swamp Sublime,” 343.
7. Spillers, “Mama’s Baby, Papa’s Maybe”; King, “Labor of (Re)reading Plantation
Landscapes”; Povinelli, Economies of Abandonment, 108.
8. I did not explicitly set out to do an engaged anthropological project, but collab-
oration, which included the sharing not only of data but also of the costs of food and
fuel, became the defining feature of my research with ambed. While the Montelimar
Corporation was always aware of my presence, and I never felt threatened, t here is
certainly a degree of risk in this methodological choice. As Scott Knowles has pointed
out, whether they are acute or slow, disasters tend to summon calls for documentary investi-
gation, usually by various kinds of elite scientific experts. Precisely what such investigations
will yield is always uncertain. They might be politically co-opted by corporations or states,
they might “pave the way for legal proceedings,” or they might simply “channel the anger of
interest groups” (Knowles, “Learning from Disaster?,” 78). The ethnographic challenge is
in part to resist the urge to turn complex associations like ambed into ciphers for fixed
categories of political or social action. ambed’s willingness to independently navigate
the zona was part of a set of pragmatic and ethical commitments to place. This work was
also a form of what Wendy Brown, drawing on Michel Foucault, calls “local criticism,”
which “articulates potency and humility vis-à-vis both the complex powers producing the
present and the difficult task of apprehending this present” (Brown, Edgework, viii).
168 Notes to introduction
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