Dr Elmer Mejia is exhausted. He's been working through the day and night for 70 consecutive days, fighting an epidemic that's threatening the existence of one of Central America's most isolated and neglected indigenous groups.
But the Miskito people of Honduras's legendary Mosquito Coast aren't being endangered by any infectious outbreak. They are being killed and left paralysed in their thousands because of the demand for affordable luxury in the US and Europe. They make their living diving for lobster to sell on the international market, but have to plunge to perilous depths to reach it. It's not disease that's claiming the lives of so many Miskito men - it's the bends.
His small clinic in La Ceiba is home to one of only three working decompression chambers on the north coast of Honduras. A specialist in hyperbaric medicine, Dr Mejia treats up to ten Miskito divers a day here. Many arrive paralysed, incontinent and terrified, but they are the lucky ones - the bends has not killed them yet.
"No one other than the Miskitos dive for lobster, all their young people are diving. The future of this ethnic group is being threatened," he says. "There's no difference between what is happening here and blood diamonds in Africa. They don't want to go diving, but they don't have any choice - they need to feed their families."
On the remote, unforgiving Mosquito Coast, lobster is a necessity, not a luxury. Cut off from the rest of Honduras and accessible only by sea and air, there's no other way to make a living here, apart from drug trafficking. I joined the Miskito divers on a voyage into the Caribbean, filming the incredible challenges they face for Channel 4's Unreported World.
For 12 days, over 100 men must share a 60ft ship, sleeping in a fetid dormitory, packed together like battery chickens. Every diver I speak to says they have experienced the bends to some degree. Everyone has a story of someone who didn't make it. "There was a friend diving deep, and when he came up something burst inside him. It was either his lungs or a vein," Warwin Solis tells me. "He was bleeding through his nose, ears and mouth."
Ever since multinational seafood suppliers started exporting Caribbean spiny lobster on an industrial scale, lobsters disappeared from the shallows. The divers now plunge as deep as 150ft, 12-15 times in day, scrambling on the sea bed for their catch with basic and often faulty equipment. With no air or depth gauge, they have no way of knowing how far they are diving, and can only tell if their tank is running low when it becomes difficult to breathe.
Any equipment failure at these depths can be fatal - if they surface too quickly or stay too deep for too long, nitrogen bubbles will form in their bodies that can kill or paralyse them. At least 4,200 Miskito men are known to be living with permanent disabilities from diving, and 352 are registered as having been killed by the bends since 2003, but this is far from the total number of fatalities: may will have died at sea never to make it onto the official books, and hundreds more will have died slowly from their injuries at home.
The chaos of the lobster ships gives way to industrial precision and efficiency in the docks at La Ceiba, because this is where the serious money begins to change hands. I watch a small boat unloading $72,000 worth of lobster from a 12-day fishing trip - an average haul. The manager at the processing plant tells me their customers don't ask how the lobster has been caught. "They haven't had that as a requirement," he says. "What they're more concerned about is the quality and handling of the product."
American and European consumers might demand that our food is safe and high quality, that our seafood is sustainable and our tuna is dolphin friendly, but we don't seem to care about lobster that's caught in a way that kills and maims humans.
A boycott of Caribbean lobster would make the situation far worse for the Miskitos - they rely on the industry for their survival - but if we ask questions about where our lobsters come from, then the big exporters will be under pressure to ensure there's proper equipment, training and medical support for the divers. Unless there's better regulation, the future of the Miskito people will be threatened by our desire for cheap luxury food.
Jenny Kleeman's film for Unreported World, 'Honduras: Diving into Danger,', will be broadcast at 7.30 on Friday 2 December on Channel 4. It will also be available to view online worldwide on channel4.com
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