Across rural El Salvador, men and children are being struck by chronic kidney disease of non...
As I stepped off the plane that had brought me to El Salvador, a wave of heat immediately wrapped around me. It knocked the air from my lungs.
It was January, yet the heat was already oppressive. For people in the region, however, it was only a brief reprieve before April and May, when spending a few hours under the sun can bring on migraines, exhaustion or dehydration.
When I arrived in the communities of Usulután and the Bajo Lempa, I followed a path many journalists had taken before me. Mesoamerican nephropathy has been reported on for years, and I came armed with months of preparation, academic papers and a carefully constructed beat memo. I thought I knew what story I was looking for.
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The doctors leading the CURE study helped shape my first questions. They described how the disease extended beyond agricultural workers exposed to agrochemicals. Cases had also appeared among military personnel, construction workers and others whose jobs demanded long hours in extreme heat.
As the days passed, I began to notice that heat was the common thread running through nearly every conversation. I saw it in the sugarcane cutters working under an unforgiving sun.
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Global Health Under Construction
I saw it in people selling cashew seeds along the roadside and in police officers spending entire shifts outdoors in heavy uniforms. Heat was not simply part of the landscape. It shaped daily life, work and, increasingly, health.
What I had initially imagined as a reporting project about agrochemicals slowly became a story guided by heat.
That shift reminded me of a lesson every reporter eventually learns: stories change once you arrive where they unfold. Sitting down with people affected by Mesoamerican nephropathy forced me to question many of the assumptions I had formed from afar.
My reporting evolved in the field. And while it is not always easy to accept, journalism often means surrendering the version of the story you carried with you on the plane. You have to be willing to abandon theories, rethink hypotheses and sometimes even leave behind sources you once considered central.
Then I met Evelyn.
As she described her brother's illness, a new question emerged. His diagnosis had not remained in El Salvador. It had traveled north with him. The disease, like so many of the people affected by it, had crossed borders.
That realization reshaped my reporting once again. I began asking different questions. What happens when people living with Mesoamerican nephropathy migrate? How do they access treatment abroad? How does a disease so closely linked to labor and heat follow workers as they search for new opportunities? And what does migration mean for communities where illness and economic necessity are already deeply intertwined?
What I had imagined as a story about adolescents affected by the disease ultimately revealed itself to be a story about migration and the burdens people carry with them. At its core, it became a story about how heat shapes decisions, bodies and futures long after people leave home.
