In the 16th century, Spanish conquistadors named the Rio Grande de Matagalpa in Nicaragua the 'River of disaster.' Two weeks ago it lived up to its name, swelling from barely a trickle to a raging deep chocolate- coloured torrent, sweeping houses, trees and roads before it.
Now, remote communities in Nicaragua and neighbouring Honduras face the combined threats of starvation and disease until engineers can re-establish vital road links and repair damaged water and sewage treatment systems.
Before Hurricane Mitch struck, the Nicaraguan town of Matagalpa was a quiet enclave nestling on the banks of the river and surrounded by mountains. Now its people are struggling to come to terms with the aftermath of a storm which, in just three days, left much of Central America in tatters.
There are many tragic tales to tell. Two days after the rain had stopped, a group of 12 teenagers were bathing in a stream feeding into the river when an upstream surge suddenly swept them away. Further to the north of the country, on the banks of the Rio Coco two whole towns have apparently been wiped off the map.
But according to water and sanitation policy adviser Harold Lockwood, worse could be on the way. Lockwood has been working for the state water department in Matagalpa for the last two and a half years and had just finished a study of 10 communities before the hurricane struck.
In the last four years, he says, cholera had been eradicated from all but one of the settlements. But days after the disaster six people were already showing symptoms of the deadly illness, and dozens more had diarrhoea, skin rashes, conjunctivitis, malaria and dengue fever.
All the settlements Lockwood inspected were close to the main pan-American highway. Hundreds more are isolated rural communities which he fears have still not been reached by relief workers and will have spent the last fortnight without food, water or medical supplies.
'As time goes on we are going to hear a lot of horrible stories,' he says.
Lockwood estimates that at least 150 of the area's 630 rural water schemes, which supply 200,000 people with drinking water, have been destroyed. A further 150 have been badly damaged and around 200 will need to be cleaned up and disinfected.
In one part of the region, urgent plans to repair and expand the water supply and sewerage system have been set back by a year. The change of topography following the floods has rendered hundreds of hours of design and survey work useless.
Matagalpa itself has severe water problems at the best of times. Following the main part of the storm, those who did not have their homes swept away collected water from their roofs.
'It was a double edged sword. We were hoping for rain but we knew that if it did the river would rise again,' says Lockwood.
The process of re-establishing water supply systems is now the number one priority. In Nicaragua, the state water department is working with local and international non-governmental organisations such as CARE and Oxfam. But for remote communities all over Central America, water supplies can only be repaired if relief workers can reach them.
An international appeal for Bailey bridges for Honduras has so far fallen on deaf ears. The US Corps of Engineers has damage assessment teams in both Nicaragua and Honduras, but no firm plans to send equipment and troops. Meanwhile, the UK's armed forces rescue operation ended at midnight on Sunday.
Time is running out for isolated communities, despite all the good work of disaster relief organisations. They are tenacious and resourceful enough to help themselves once equipment arrives, but without emergency repairs to roads and bridges they face more deaths and misery.