Rural areas which only had basic water and sanitation before Mitch are now ticking time-bombs for disease. In southern Honduras one RedR engineer is trying to make a difference.
Sheltering under a blue sky dotted with cirrus and cumulus clouds, the village of Los Llanitos, 30 minutes drive from Choluteca in southern Honduras, seems an idyllic spot.
But on closer inspection it becomes clear that a wall of water has remodelled the whole landscape. Barren expanses of cracking mud have erased neat homes and gardens. Many of the houses that have survived are buried almost up to their eaves.
Few people died in the flooding in Los Llanitos, but for its 2,000 residents the problems are only just beginning. Wells relied on for drinking water have been left with a couple of metres of sludge at the bottom; latrines have been completely buried; and everywhere pools of green, stagnant water provide perfect breeding grounds for mosquitoes.
RedR - Engineers for Disaster Relief - volunteer Matthew Ridout has taken three months out from working as a highway designer for Northern Ireland consultant Kirk McClure Morton to become Oxfam's 'pumps and pipes' man in southern Honduras. He says that Los Llanitos is just one of scores of villages devastated by Hurricane Mitch.
Health problems have so far been limited mainly to skin rashes, stomach upsets and conjunctivitis. But there have already been a few cases of dengue fever, leptospirosis, malaria, cholera and measles.
'With people defecating everywhere because the toilets are blocked up and no clean water it is only a matter of time before things get worse,' says Ridout.
When he first got to the village 10 days ago he carried out a survey of all 54 public and private wells. In all of them the sludge deposited by the floods had left the water turbid and 'stacked with bacteria'. The people were weak from clinging to the roof tops, and had not eaten for three or four days.
Ridout's first response, in tandem with an Oxfam health team's efforts to distribute emergency food and medical supplies, was to get the handful of public wells cleaned up quickly.
'The idea is to settle the solids, then get the sludge out and super- chlorinate them,' he says.
It sounds a reasonably straightforward task, but it has turned out to be harder than anticipated. The first suction pumps, with which Ridout attempted to remove the sludge, burned out in half an hour. Since then he has had a frustrating wait of almost a week for a more heavy duty submersible pump which can cope with solids.
'In a week at home I could have designed a roundabout but over here I am still fiddling about trying to get basic things done. It is a big culture shock,' he says.
The new pump, which will be tested today for the first time, should be more effective. The big problem is getting it down the well safely as it is too heavy for one person to lower on their own. Using three locally recruited men, Ridout rigs up a frame using six 2m long logs and nylon rope. Three are lashed together on each side of the wellhead to produce tripods, and a cross beam is then lashed over the top.
Using a block and tackle the pump is lowered down the 6m deep well and the power pack started up. After a couple of seconds of suspense the discharge pipe kicks and thick brown water splutters out.
'Fantastic,' says Ridout. 'I should be able to set the guys off and move on to another village now.'
The problem with the latrines is perhaps less easy to solve. They are fairly low-tech facilities - a 2m deep lined pit covered with a concrete slab with a pipe to sit on and a shed over the top. But most of them are buried beneath the mud and there is little option but to completely rebuild.
As a temporary measure Oxfam plans to construct simple trench latrines in five villages, but Ridout wants to do more.
'We can dig these guys latrines which will last three months, but what they really need are long term solutions,' he says.
Talking to the villagers, they seem willing to do the work themselves. Indeed now that their crops have been ruined they have little else to do. But materials for the latrines cost 1,500 lempiras (70) - well over a month's wages - and with no insurance this is certainly more than most people can afford.
The villagers ask Ridout if he can get the materials for them. It is an emotional moment; to pay for latrines in the five villages where it is working would represent a significant part of Oxfam's 300,000 budget which also has to cover medicines and food. 'I will see what I can do for you,' Ridout tells them.