Rural areas which had only 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 huge 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 remain 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 of them; 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 which have been 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 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 very turbid and 'stacked with bacteria'.
Ridout's first response, in tandem with an Oxfam health team's efforts to distribute emergency food and medical supplies, was to try and 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.
This task 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. He 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 should be more effective. The big problem is lowering it down the well safely as it is too heavy for one person alone. Ridout rigs up a frame using six 2m long logs and nylon rope. Three are lashed together on each side of the well head 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 the discharge pipe kicks and thick brown water splutters out.
The problem with the latrines is 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 are buried beneath the mud and there is little option but to rebuild.
As a temporary measure Oxfam has planned 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.
The villagers seem willing to do the work themselves. But materials for the latrines cost 1,500 lempiras ($115) - well over a month's wages and more than most people can afford.
And for Oxfam to pay for latrines in the five villages where it is working would represent a significant part of its $500,000 budget which also has to cover medicines and food.