A mysterious epidemic is sweeping Central America - it's the second biggest cause of death among men in El Salvador, and in Nicaragua it's a bigger killer of men than HIV and diabetes combined. It's unexplained but the latest theory is that the victims are literally working themselves to death.
In the western lowlands of Nicaragua, in a region of vast sugar cane fields, sits the tiny community of La Isla.
The small houses are a patchwork of concrete and wood. Pieces of cloth serve as doors.
Maudiel Martinez emerges from his house to greet me. He's pale, and his cheekbones protrude from his face. He hunches over like an old man - but he is only 19 years old.
"The way this sickness is - you see me now, but in a month I could be gone. It can take you down all of a sudden," he says.
Maudiel's kidneys are failing. They do not perform the essential function of filtering waste from his body - he's being poisoned from the inside.
When he got ill two years ago, he was already familiar with this disease and how it might end. "I thought about my father and grandfather," he says. Both died of the same condition. Three of his brothers have it too.
All of them worked in the sugar cane fields.
Kidney disease has killed so many men here that locals now call their community not simply La Isla - which means "The Island" - but La Isla de las Viudas - "The Island of the Widows." (You can see a slideshow from Nicaragua at PRI's The World).
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