A sugar cane cutter poses for a picture during a break of the San Antonio sugar plantation where 'Flor de Cana' rum is produced, Chichigalpa, Nicaragua. A mysterious epidemic is devastating the Pacific coast of Central America, killing more than 24,000 people in El Salvador and Nicaragua since 2000 and striking thousands of others with chronic kidney disease at rates unseen virtually anywhere else. Many of the victims were manual laborers or worked in the sugarcane fields that cover much of the coastal lowlands.