Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Alicia Quella PHD, PA-C


The increased demand of sugarcane in Costa Rica and the lack of occupational opportunities in Nicaragua has resulted in an increase in migrant sugarcane workers. Because many individuals cannot afford proper documentation for immigration, a significant number cross the border undocumented looking for financial stability. The vast availability of sugarcane work in Costa Rica provides Nicaraguan migrants with an opportunity for work, however, they are often paid less than minimum wage due to their undocumented immigration status. Migrant workers are subject to harsh working conditions including extreme physical exertion, dehydration, and heat exposure. The combination of this trifecta seen in the Nicaraguan migrant population employed in sugarcane harvestation is thought to be correlated with the significant increase in incidence and prevalence of renal pathology, namely, MeN. Although those at highest risk for acquiring MeN are undocumented Nicaraguan migrant sugarcane workers, this population does not have access to the public health insurance or healthcare provided by Costa Rica. This has inhibited implementation of preventative measures, delayed diagnosis and treatment, and allowed for disease progression to ESKD and death.


SC 11.PAS.2021.Schmitz.K