The Triple Burden: Tramadol, NSAIDS, and Energy Drinks Among Agricultural Workers in La Gomera, Guatemala: An Anthropological Study

INTRODUCTION: Agriculture is a major economic activity in Guatemala. Workers in sugarcane, banana, and African palm plantations face high risk of chronic kidney disease of non-traditional causes (CKDnT). During 2021- 2023, Médecins Sans Frontières (MSF) implemented a project in Guatemala to provide comprehensive care for CKDnT. The frequent use of potentially nephrotoxic substances, such as medications and energy drinks, was documented. This qualitative study, conducted during 2023, aimed to understand this practice and its relation to agricultural work. METHODS: = 4). Interviews were audio-recorded and transcribed. Deductive and inductive thematic analysis was performed using NVivo. RESULTS: Three core themes emerged: (1) substances, motivations, practices of use, and availability, with tramadol, energy drinks, and non-steroidal anti-inflammatory drugs commonly consumed in various ways (drunk, swallowed, inhaled, or spread on cigarettes to be smoked) to sustain labor; (2) work dynamics and its relation to the use of substances; and (3) perception of health risks related to the use of substances. DISCUSSION: Piecework payment systems incentivize high production, framing substance use as a necessity to increase energy and manage pain and fatigue. Use of medications and other substances was described as socially accepted and normalized. Addressing CKDnT requires structural interventions and culturally adapted health promotion strategies. CONCLUSION: Agricultural work dynamics in Guatemala contribute to the use of medications and substances that influence agricultural workers health. Structural causes, including factors such as poverty, instability, and social dynamics, further hinder substance discontinuation. Further interdisciplinary research is needed to deepen the understanding of this practice and its relationship with the high prevalence of CKDnT.