The first confirmed case of Covid-19 appeared in Cuernavaca, the capital of Morelos, on March 16, roughly three weeks after the first potential cases were identified in the country, brought to the city by an Italian visitor who reported himself almost immediately upon arrival. But by then, the fear that has accompanied the virus around the globe had already established itself. It has yet to dissipate.

In the first weeks after the pandemic reached in the state, demand for tests skyrocketed, said Dr. Daniel Madrid, Morelos’ Director of Coordination and Supervision, the technical branch of the state Secretary of Health, though at the time the prohibitive cost of tests meant administering them statewide would have cost more than five times the secretary’s annual budget. In some state hospitals, said Dr. Madrid, as many as 40% of frontline workers took leave because of pre-existing conditions that made them especially vulnerable to infection. Meanwhile, demand for protective gear outpaced availability. In one state hospital, Dr. Madrid said, a supply of 2,000 PPE kits was used up in a single day.

As the single largest private supplier of donated protective equipment in Mexico, Direct Relief is not only working to protect frontline workers but also to fight panic, a grave danger for treating the virus and stemming its spread. On June 30 alone, Direct Relief delivered more than 10,000 masks, as well as gloves, surgical gowns, face shields and other protective gear, sponsored by the Coca-Cola Foundation, to three hospitals in Morelos, the first step in an ongoing effort to ensure that hospitals throughout Mexico’s under-served provinces remain equipped to combat the current crisis. It’s part of the latest wave of shipments that will distribute up to 1 million masks to more than 150 hospitals across Mexico in response to Covid-19.

Morelos, due in no small part to its proximity to Mexico’s capital city, is particularly vulnerable. According to Dr. Madrid, fully 75% of the state population over the age of 20 is overweight, some 35% have been diagnosed with hypertension, and 15% with diabetes. Only one of the state’s 10 hospitals has a CT scan, which can make diagnosis challenging. Beyond that, the city’s proximity to the capital, the primary focal point for contagion nationwide, leaves the entire state vulnerable to infection. “A significant number of the houses in Cuernavaca are weekend homes of people from the city,” said Dr. Madrid. “So instead of decreasing mobility, the beginning of the quarantine ended up increasing mobility because people from Mexico City came here to ‘self-isolate,’ but really, they came here to go to parties.”

Federal guidelines did not allow for the closing of highways or state borders, though some residents urged the Morelos state government to do just that. Instead, state health institutions had spent the previous months bulking up their capacity to the best of their ability, surveying available hospital beds in state hospitals, and setting up centers to treat Covid-19 patients at state-run hospitals. In the indigenous community of Axochiapan in the state’s southwestern corner, a large group of residents attempted to block the hospital’s opening, even going so far as threatening to burn it down before it could accept any infected patients, said Dr. Madrid. Not long after, that hospital received its first Covid-19 patient, the leader of those protests. He died within a week.

Now, several months into Mexico’s crisis, exhaustion is as critical a problem as fear for healthcare workers and residents alike.

The Mexican Institute of Social Security, or IMSS, a hospital in Cuernavaca, has seen some 1,300 Covid-19 patients since mid-March when the city’s outbreak started, and currently has around 70 patients under supervision on the three floors currently devoted to Coronavirus infections. Relatively few staff members took leave from the hospital – no more than 10%, said hospital director Dr. Delia Gamboa Guerrero.

“Doctors from all of our teams have been helping to deal with Covid-19 patients because if they didn’t, we wouldn’t have the personnel to handle it,” she said. “So the problem now is that people are tired, they’re exhausted.”

Though the IMSS hospital has never surpassed 85% occupancy, said Dr. Gamboa, “the beds aren’t everything: there are medication and tools that sometimes run out, even when you have space.” Among those tools are certified protective gear, increasingly challenging to get as both larger cities, like the neighboring capital, and larger countries, like the United States, consume the necessary equipment in enormous quantities.

Indeed, according to Dr. Madrid, the fact that Mexico’s hospitals have at no point been saturated is largely due to gaps in the country’s medical system. “A patient that, under other circumstances, might survive for a month in another hospital, here, no – their case will complicate more quickly.” High mortality rates, in other words, keep hospital beds empty.

The state’s first IMSS hospital, surrounded by sugarcane fields on the outskirts of Zacatepec, has been especially hard hit, with mortality rates of 50% among Covid-19 patients and some two dozen hospital workers infected (one among them has died, a young assistant nurse who passed away less than a month ago.) At the height of the pandemic in May, said Dr. Marco Antonio Bermudes Espinosa, the hospital’s clinical director, the Covid-19 team would see nine deaths daily. “There was a death and then maybe 20 minutes later another death and 20 minutes after that another,” said Dr. Bermudes. “Some days there were lines of people outside,” said Fabiola Cabrera Santana, the hospital’s head of nurses.

While hospitals in Cuernavaca face the same difficulties as urban hospitals everywhere – namely dense populations and high mobility – in the region surrounding Zacatepec, communication has been the primary struggle. Residents in the neighboring community of Xoxocotla, continued to run their weekly outdoor market and local businesses even as large numbers of people fell ill. Many residents died in their homes or took the bodies of loved ones to an unlicensed crematorium. Others waited too long to seek medical help, said Nurse Cabrera, “and they would die at the entryway; they wouldn’t even make it inside.”

For now, said Dr. Bermudes, the situation appears to be under control. Deaths are intermittent and usually of much older patients, and there are no major holidays on the horizon to spark another outbreak. Still, for doctors here at the IMSS hospital in Zacatepec, the ongoing crisis has become an endurance game, a daily struggle to remain on your feet, to continue treating new cases as panic in the general population fades to anger and frustration as they wait to resume their lives. “We’ve learned a lot,” said Nurse Cabrera in the afternoon that her team received its PPE delivery from Direct Relief. “You learn to channel your fear and your pain and you learn–” she shrugged “–well, you learn to survive.”

– Michael Snyder is a freelance journalist based in Mexico City. His work has appeared in the New York Times, the Los Angeles Times, The Believer, and The Nation, among others.

– Felipe Luna is an independent photographer, reporter, and editor based in Mexico. His work has been published in Bloomberg, El País, the Los Angeles Times, the New York Times, among other media outlets.

The post Protective Gear Continues Reaching Hospitals in Mexico as Covid-19 Cases Rise appeared first on Direct Relief.

In a high-ceiling playroom on the ground floor, a group of ten children gather with their caretakers and nurses, passing a ball around a circle in an animated game of hot potato. Each time the ball stops, the children answer different questions about their homes all across Mexico. They talk about the foods they miss while they’re in the capital for their treatment, about their heroes and dreams. One child speaks eagerly about her trips between her home in Cancún and Casa de la Amistad, about missing the beach but appreciating the capital’s rich culture and about her hero, Wonder Woman. She also shares her dreams of returning to Mexico City to study psychology when she’s older and healthy so that she can help other children the way her doctors at Casa de la Amistad have helped her.

Over the course of the last 28 years, Casa de la Amistad has served more than 9,000 children and expanded its network of trained professionals – some 1,700 have been trained professionals since 2016 – to 27 of Mexico’s 31 states. Within Mexico City, a metropolis of 22 million people spread out over a low valley and up onto the flanks of the surrounding hills, children and young people at Casa de la Amistad travel to top specialists at eight hospitals around the city, navigating the cities notoriously snarled traffic in vehicles provided by the Baxter International Foundation’s (the philanthropic arm of Baxter International), Driving Your Health community health program.

In an effort to make a meaningful difference in the lives of those who depend on its products, Baxter partners with organizations to increase access to healthcare for the underserved. Through Direct Relief and Baxter’s support, the overall Driving Your Health program has directly benefited over 81,000 patients. Another 706,000 people have been indirect beneficiaries of the program by participating in patient counseling from trained healthcare workers or receiving healthcare literature.

At Casa de la Amistad specifically, over 11,000 patients and their caregivers were transported roundtrip via the Baxter bus from their lodging facilities to local treatment hospitals in Mexico City.

Medical education from trained health workers, focusing on early detection, and cancer prevention and detection literature reached more than 150,000 people in Mexico. Baxter also formed collaborative partnerships with the Mexican Diabetes Association and Association Gilberto to provide other medical outreach health programs for the communities around Mexico City.

Beatriz Martínez Navarrate was diagnosed with bone cancer at a young age. Her father worked in construction and her little brother had special needs, which meant that her family had little to no extra money for her treatment. At first, doctors said that Beatriz would likely lose her knee, but once her treatments began, they revised their prognosis. Her doctors would be able to save the knee, but she would need an interior prosthesis in order for it to function properly. While her prognosis was better, this prosthetic was an expensive piece of technology and procedure. That’s when she heard about Casa de la Amistad. Beatriz and her family turned to the organization for help, and she is now 18 months into her treatment.

For older patients like Martínez whose futures are closer at hand, the access to treatment hospitals made possible at the Casa de la Amistad has allowed them to focus on their own needs and desires, rather than on the heavy financial burden that might otherwise have fallen on their families. “I’ve always loved traditional dance, so that’s what I want to do after my surgery,” said Martínez.

Not only is Casa de la Amistad a residential center, but it’s also a space that allows kids and their families to continue dreaming despite the stress of their illness and treatment. Patients who are receiving treatment at the center can continue their studies and preserve some elements of normalcy in their lives that have been upended by cancer. Patients also benefit from the support of other young people living through a similar experience.

Felipe Alamilla Figueroa was diagnosed with lymphatic cancer at the age of 20. One of seven siblings, he’s had the support of the entire family over his two years of treatment, but says that Casa de la Amistad was able to help relieve the burden that can come along with a cancer diagnosis. “Over time, the cost of treatment is really crushing,” said Alamilla. “But once I came here to the Casa de la Amistad and thanks to the resources here, my family was able to manage things more easily.”

Michel Hernandez Flores came to the Casa de la Amistad from the port city of Coatzacoalcos at the age of 15 after he was diagnosed with bone cancer. Two years later, she was entering her undergraduate program. She plans to study medicine, a new dream that was born here at Casa de la Amistad. “Before I wanted to be an architect,” Hernandez says, “but now I want to be a pediatric oncologist.”

The post In Mexico City, a Joyful Respite for Children with Cancer appeared first on Direct Relief.

English

En una sala de juegos de techo alto en la planta baja, un grupo de diez niños se reúne con sus cuidadores y enfermera/os, pasando una pelota alrededor de un círculo en un juego animado de papa caliente. Cada vez que la pelota se detiene, los niños responden diferentes preguntas sobre sus hogares en todo México. Hablan sobre los alimentos que extrañan mientras están en la capital para realizar su tratamiento, sobre sus héroes y sueños. Una niña habla con entusiasmo sobre sus viajes entre su casa en Cancún y Casa de la Amistad, sobre extrañar la playa, pero apreciar la cultura rica de la capital y sobre su héroe, la Mujer Maravilla. También comparte sus sueños de regresar a la Ciudad de México para estudiar psicología cuando sea mayor y saludable, de modo que pueda ayudar a otros niños en la forma en que sus médicos en Casa de la Amistad la han ayudado.

En el transcurso de los últimos 28 años, Casa de la Amistad atendió a más de 9000 niños y amplió su red de profesionales capacitados (unos 1700 han sido profesionales capacitados desde 2016) a 27 de los 31 estados de México. Dentro de la Ciudad de México, una metrópolis de 22 millones de personas repartidas en un valle bajo y en los flancos de las colinas circundantes, los niños y jóvenes de Casa de la Amistad viajan a los mejores especialistas de ocho hospitales de la ciudad. Los traslados se dan en medio del complicado tránsito de las ciudades, en vehículos proporcionados por la Fundación Baxter International (el brazo filantrópico de Baxter International), el programa de salud comunitaria Driving Your Health.

En un esfuerzo por marcar una diferencia significativa en las vidas de quienes dependen de sus productos, Baxter se asocia con organizaciones para aumentar el acceso a la atención médica para los desatendidos. A través de Direct Relief y el apoyo de Baxter, el programa global Driving Your Health ha beneficiado directamente a más de 81,000 pacientes. Otras 706,000 personas han sido beneficiarias indirectas del programa al participar en el asesoramiento a pacientes por parte de trabajadores de la salud capacitados o al recibir literatura sobre la salud.

Específicamente, en la Casa de la Amistad, más de 11,000 pacientes y sus cuidadores fueron transportados ida y vuelta a través del autobús Baxter desde sus instalaciones de alojamiento a hospitales de tratamiento locales en la Ciudad de México.

La educación médica de profesionales de la salud capacitados, centrada en la detección temprana y la literatura sobre prevención y detección del cáncer llegó a más de 150,000 personas en México. Baxter también formó asociaciones de colaboración con la Asociación Mexicana de Diabetes y la Asociación Gilberto para proporcionar otros programas de salud de alcance médico para las comunidades alrededor de la Ciudad de México.

Para pacientes mayores como Martínez, cuyo futuro está más cerca, el acceso a los hospitales de tratamiento se hace posible en Casa de la Amistad y les ha permitido centrarse en sus propias necesidades y deseos, en lugar de en la pesada carga financiera que, de otro modo, podría haber recaído sobre sus familias. “Siempre me ha encantado el baile tradicional, así que eso es lo que quiero hacer después de mi cirugía”, dijo Martínez.

Casa de la Amistad no solo es un centro residencial, sino que también es un espacio que permite que los niños y sus familias sigan soñando, a pesar del estrés de su enfermedad y tratamiento. Los pacientes que reciben tratamiento en el centro pueden continuar sus estudios y preservar algunos elementos de normalidad en sus vidas, que han sido alteradas por el cáncer. Los pacientes también se benefician del apoyo de otros jóvenes que viven una experiencia similar.

A Felipe Alamilla Figueroa se le diagnosticó cáncer linfático a la edad de 20 años. Tiene siete hermanos y ha recibido el apoyo de toda la familia durante sus dos años de tratamiento, pero dice que Casa de la Amistad pudo ayudar a aliviar la carga que puede conllevar un diagnóstico de cáncer. “Con el tiempo, el costo del tratamiento es realmente abrumador”, afirmó Alamilla. “Pero, una vez que vine aquí, a Casa de la Amistad, y gracias a los recursos con los que cuentan, mi familia pudo manejar las cosas más fácilmente”.

Michel Hernández Flores llegó a Casa de la Amistad desde la ciudad portuaria de Coatzacoalcos a la edad de 15 años, después de que le diagnosticaron cáncer de huesos. Dos años más tarde, estaba ingresando a su programa de pregrado. Planea estudiar medicina, un nuevo sueño que nació aquí en Casa de la Amistad. “Antes quería ser arquitecta”, dice Hernández, “pero ahora quiero ser oncóloga pediátrica”.

The post En la Ciudad de México, un Alegre Descanso para Niños con Cáncer appeared first on Direct Relief.

HOPE opened in Alief in 2002 as the Asian American Health Center, operating once-per-week out of the Chinese Community Center, a United Way affiliate in Houston’s Chinatown. In the summer of 2005, Hurricane Katrina swept through the Gulf, transforming the region’s cultural and physical topography. The clinic was forever changed, too.

Of the 15,000 people of Vietnamese origin who were resettled in Houston after leaving New Orleans, some 3,000 found their way to HOPE Clinic, which, by then, had a staff of 20 people working four days per week.

“At the time, we were one of the only clinics that could accommodate the Vietnamese population coming in,” said Cathy Phan, the clinic’s business development coordinator. Today, HOPE employs 150 people at three locations who speak a combined 29 languages. Many of those staff members, including Yen Ly, who coordinates outreach within the Vietnamese community, come from the same communities they serve.

Though relatively few of the clinic’s patients suffered damage in Hurricane Harvey, said Dr. Andrea Caracostis, the clinic’s CEO, “they had the heart to go out and help,” exposing themselves to flu and tetanus. “Thanks to Direct Relief, they had access to the shots they needed.”

Other communities were not so lucky. Just 17 miles to the west, the Christ Clinic in Katy, Texas, serves a community that, according to Executive Director Lara Hamilton, is generally viewed as one of Houston’s more affluent suburbs. “Hurricane Harvey came and it hit Katy pretty hard,” Hamilton said on a recent afternoon the day after a winter storm that had brought Houston, still understandably weather-sensitive, to a complete stand-still. Several of the surrounding communities, she said, had been inundated by water released from the Addicks Reservoir in the heart of the area.

“What we found is there were a lot of people living at the top of their means and they had no safety net,” Hamilton said, adding that, before the storm, the Katy school system had 900 homeless students on their rolls. That number has since climbed to 3,000.

Like the HOPE Clinic following Hurricane Katrina, the Christ Clinic has seen a substantial increase in patients coming through its doors in the wake of Hurricane Harvey. Prior to the storm, the clinic saw an average of 750 patient visits per month. In September, there were 2,300 patient visits. A month later, that number had gone up to 2,800 visits for 2,300 unique patients. “We really have no idea what our patient volume will be this year,” Hamilton said. “We have no idea.”

Following the hurricane, Christ Clinic set up in several local shelters to distribute tetanus and flu shots donated by Direct Relief. “People who didn’t know who we were — and the first time they encountered us was through our services after the hurricane —they will always be supporters,” said Hamilton. “People always remember what you do to help in a crisis.”

The disaster has raised awareness not just of the clinic, but of the fragility of security faced by even the most affluent people. “Before there were a lot of wealthy people who didn’t recognize the need for a charity clinic here who now recognize that ‘oh, this could happen to me.’ People are now acutely aware that poverty can be out of your control,” Hamilton said. Having worked as a nurse practitioner in both private practice and in a cash-only practice for the “super wealthy,” Hamilton described her patients at Christ Clinic as “the most resilient people you’ve ever met. For many of them, if it’s not one disaster, it’s another.”

Though they come from different communities and, in many cases, very different backgrounds, the same could be said of many people who seek help at HOPE. Though overall patient visits have remained consistent for HOPE after the storm, Dr. Caracostis, like Hamilton, said that it’s impossible to tell just yet what may come in the future. “Going through Katrina, we recognize that the real need is long-term,” she said, which is why the clinic is currently in the process of beefing up its behavioral health services.

“When your world is so shaken up, you’re not thinking about having your vaccines up to date, so to have someone to do that for you, that makes a huge difference,” said Yen Ly on that January morning from behind her desk, where she uses social media to track medical needs in the Vietnamese community in real time. As HOPE continues to expand in the coming years, the clinic will build a new campus in the heart of Alief that will include offices, healthcare facilities, and also a health food café that will employ people from the community while raising awareness about healthy cooking techniques derived from the virtually infinite variety of cuisines available in the surrounding area. “We want to be more of a community center,” Phan said. “We don’t want people coming in just because they’re sick.”

Walking through the waiting room at HOPE’s clinic headquarters that morning, Dr. Caracostis gestured across a room filled with people from every corner of the globe, chatting happily with each other whenever language wasn’t an insurmountable barrier, and sometimes even when it was.

“Health,” she said, “is the great equalizer.”

Crisis is another.

The post In Houston’s Most Diverse Neighborhoods, Clinics See More Patients Than Ever After Harvey appeared first on Direct Relief.

Water had first started pouring into the first floor of her house at 8 p.m. the night before. The power had gone out sometime before that, while Casmire was preparing dinner, tuna casserole. “I don’t have a taste for that dish at all anymore,” she said in a phone interview on a recent January afternoon as a winter storm swept icy rain and sleet into the Houston area. As the water rose, it drove Casmire and her family into the stuffy upper floors of the house. “We could hear the linoleum floors buckling and popping loose. It was like the sound of people breaking and entering,” she remembered that afternoon, five months after the storm hit. “At one point the water rose so high that we decided we had to get to the roof.” They waited there for five hours until a helicopter came to rescue them. “Now,” she said, punctuating the story with a characteristically uproarious laugh, “every time my son sees a helicopter overhead he waves and says ‘Hi.’”

Casmire and her husband had purchased their house in June 2016, and moved in January 2017, after six months spent renovating. They’d spent barely eight months in their home when it was destroyed. FEMA declined financial assistance several times, so the Casmires had little choice but to empty their savings accounts to rebuild, a process that took four months. “Our Christmas present to ourselves was moving back in,” she said. “This time we hope to get more than a year in our home.”

In Harvey’s wake, Casmire’s saving grace was the job that she had started barely two weeks before the storm swept in, as the nurse practitioner at the Triangle Area Network Health Clinic, known as TAN, a Federally Qualified Health Center that has operated out of Beaumont, in one form or another, for 30 years. The team at TAN, Casmire said, was invaluable not just for her emotional recovery — “it’s really felt like everyone here has known me for years” – but also in contributing financially to the reconstruction of her home, using funds drawn from a $25,000 grant donated by Direct Relief.

Casmire was one of 13 of TAN’s 25 staff members to have suffered major property losses in the hurricane.

Compliance Officer Misty Kibodeaux’s apartment didn’t start flooding until the early hours of the morning, but it took no time to reach waist height. She and her husband called a friend who lived on higher ground and had a boat to come get them from their place. She left with nothing more than flip-flops, three pairs of shorts, and two t-shirts. For the next 45 days, the Kibodeauxs lived in a hotel. Later, a friend offered her an empty property out near Lake Charles, a two-and-a-half-hour commute from Beaumont. “There was nothing left on the housing market after the storm,” Kibodeaux said. “Now I’m waking up at 4:30 or 5 a.m. to get to work.”

Dena Hughes, TAN’s CEO, was one of the lucky ones. She and her home came out of the storm unscathed. A natural and vibrant leader, she soon found herself taking on a great deal of responsibility in local recovery efforts, using social media to disseminate information and the TAN offices, just off the I-10, as an informal center of operations.  Hughes said Direct Relief reached out to staff after the storm made landfall and “listened and responded to what we said and what we needed as a healthcare facility.”

Over the next two weeks, Hughes and members of her staff labored day and night to serve both the local community and the nearby town of Orange, a rural settlement closer to the Louisiana border, where they have a second clinic. The response was extraordinary. “I know that now we have people coming here who started coming right after the hurricane and they’re still using us as their primary care facility,” she said.

Kibodeaux and Casmire both have long journeys ahead to return to normal, but both are deeply grateful for the support they’ve found in their workplace, an openness and generosity that they and everyone at TAN hope to pass along to the community they serve. “I have one lady who comes in here just because there are people to talk to,” Casmire said. “People know that they don’t need an appointment to just come in and be warm.”

To date, Direct Relief has supported more than 52 health centers and free clinics in communities impacted by Hurricane Harvey. Nearly $14 million worth of specifically requested medical aid has been shipped to these clinics in the months since the storm made landfall, and Direct Relief will continue to support these communities in their recovery.

The post As Harvey Floodwaters Rose, Health Workers Needed a Rescue of Their Own appeared first on Direct Relief.

That afternoon, the elementary school was crowded with children and their mothers waiting in line to be seen by one of eight dentists from Mexico City who’d come for the week with the Asociación Gilberto, one of Direct Relief’s newest partners in Mexico. Most of those children would be seeing a dentist for the first time in their young lives. “At a private doctor, they’ll charge you 500 pesos for an extraction,” said Rita Revollar, whose two primary school-aged children had both come to the center for care. “My girl was scared because this was her first time, and her teeth seem fine, but you never know.”

“Of the 120 kids that come in each day, I’d say maybe 10 have healthy teeth,” said Dr. Fernando Cabrera Enriquez, who oversees the other eight dentists providing care. “One girl came in today with eight cavities and we’ve found four- and five-year-olds with really serious pathologies in their gums. I’d say Mexico State is really badly affected by these problems.”

Zacozonapan is just one of 72 communities in Mexico State that the local branch of Asociación Gilberto has reached in the last year, using funds from Baxter International Foundation (philanthropic arm of Baxter International Inc.) and channeled through Direct Relief. Though Zacozonapan is relatively prosperous, with most families earning their livings either as employees of the government or at the nearby mines, Maricela Sanchez Paz, who came that day with her two young daughters, said “the economy makes it hard to access a dentist. Work here is okay, but dental care isn’t included in public health service.”

That’s exactly why Laura Franco, the president of the Asociación Gilberto’s Mexico State branch, chose to focus on dental care when she started this program in January 2015. “The government offers certain services, so I thought, what they can’t offer – and that’s what we can do. So why dental care?” she asked. “Because it’s a luxury – and a necessity.”

For many families in Zacozonapan, logistics present an even more substantial problem than finances. The closest major city, the state capital of Toluca, is a two-hour drive on a good day, and the dental care that does come through Zacozonapan, Dr. Cabrera said, is woefully inadequate. That’s where Baxter Foundation and Direct Relief came in.

The dental program is part of a three-year comprehensive initiative funded by Baxter International Foundation called Driving Your Health. The program’s primary goal is to avert preventable medical conditions by expanding access to health care, providing health education, and increasing the early detection of potentially serious health conditions. The program was officially launched on September 22, 2016 in Mexico City.

As part of the Driving Your Health program, Direct Relief has channeled the Baxter International Foundation funds to four different organizations, all focused on bringing healthcare to communities in need. The Mexican Diabetes Association directed its portion of the funding toward establishing mobile glucose test sites that travel throughout Mexico City, raising awareness about diabetes – the single largest killer in Mexico – and, in many cases, providing people with a first warning of a developing or fully-blown glucose problem. Casa de la Amistad, or Friendship House, a center for pediatric cancer that has, to date, helped 9,000 children with limited resources, has used its funding to purchase a bus to transport patients from its center in Mexico City’s southern extreme to hospitals scattered around the city. The Order of Malta brings medical care to 150 underserved communities in and around the capital’s metropolitan area.

For all these organizations, the dissemination of care through mobile medical units is also a means of disseminating information, arguably an even more important mission for improving health in underserved communities. “Most people have at least three cavities in Mexico because they don’t know how to care for their teeth, so our Dentists talk with mothers about how to brush correctly,” said Franco. “In Mexico our culture is to give love through food – if you give more you love more – so we’re also trying to teach families to prepare healthier food.”

Families in Zacozonapan are, evidently, eager to learn. The school director who helped organize the event that week has, Franco said, already asked to schedule a date for next year. Franco, for her part, heaped praise on the community for doing so much to welcome them and make the process go smoothly by distributing information in schools and dividing visit days by age to avoid confusion, over-crowding, and disappointed families leaving without help. Numbered tickets were given out each morning to 120 families, some of whom traveled from smaller villages as much as two hours away. All of them waited patiently for their turn.

“Some people have already left,” Revollar said that afternoon as she waited with her daughter, both smiling nervously as they advanced slowly in line, “but you have to be patient for your health.”

– Michael Snyder is a journalist based in Mexico City.

The post In Mexico City and Beyond, Connecting Patients to Care appeared first on Direct Relief.

Families that have spent the last month living under tarps – scant protection from the blazing sun and torrential rain – greeted Mexfam volunteers with eager smiles and stories of the 8.2-magnitude quake that brought down half the homes in this fishing village of 4,000 people. Providing temporary shelter is not, historically, one of Mexfam’s primary directives, but, as Beatriz Ramos Reyes, Director of Mexfam’s program in the Istmo de Tehuantepec region of Oaxaca, said, “in times like these, what’s happening out there is our priority.”

Since the earthquake, Mexfam’s Istmo branch has used its connections to international aid organizations like Direct Relief to acquire tents, foodstuffs and, in a few cases, hard-to-find medications. The clinic has deployed its small fleet of vans to distribute those goods to affected municipalities throughout the region. “When we don’t have goods to distribute,” Reyes said, “we help other groups to distribute theirs.”

An organization with over 50 years of experience promoting sexual health across Mexico, Mexfam first opened its Istmo branch in 1995 with a focus on sex-education programs. Representatives from the organization, like Dr. José Javier Jimenez Cruz, traveled to towns and villages throughout the region to give talks and raise awareness in schools. “In the 1990s, we had to ask permission from the school director, then get permission from the parents, so it was a whole bureaucratic process, though fortunately no one ever denied us permission,” Jimenez said.

Three years later, Mexfam opened its clinic in Ixtaltepec, a town of some 15,000 people six miles north of Juchitan, one of the region’s most important towns. “In the state of Oaxaca, the Istmo is a flashpoint for teen pregnancy,” said Reyes, “and within the Istmo, Juchitan.”

Since opening its doors 20 years ago, the Mexfam clinic in Ixtaltepec has grown into a general community medical center, continuing its work in sex education, STD testing, and pre- and post-natal care, but also providing general medical services to the community at large.

In Jan. 2017, Mexfam launched a program called Transformandome (literally ‘transforming myself’) that supports transgender and queer populations across eight municipalities in the Istmo region, an area with a rich culture of non-binary gender awareness.

Though the devastation wrought by the September quakes spared Mexfam’s physical spaces – the treatment facility attached to the clinic suffered minor damages, but nothing to threaten the integrity of the structure – some of its most valuable equipment was critically damaged, including its X-ray machine, microscopes and portable ultrasound. Programs like Transformandome, in the meantime, have been temporarily suspended as participants, including those in Xadani, direct their energies toward the more immediate needs of their neighbors.

According to Dr. Jimenez, who has worked with Mexfam’s branch in the Istmo from the beginning, the biggest medical challenges for the region have only just begun. “We’re all in a moment of incredible stress,” he said, which results in many people deferring care both for chronic and acute conditions. “Since the earthquake, no one has come for a colonoscopy, for instance, even though we have above average levels of colorectal cancer in the region.”

Meanwhile, even as Mexfam steps in to perform procedures like appendectomies and C-sections, helping to compensate for the space that was lost when Juchitan’s general hospital collapsed, the organization’s primary directive of tackling sexual and reproductive health remains as urgent as ever. “People told us, ‘No one’s giving out condoms!’” Reyes said. “I hadn’t thought of it, but it’s true, in such close quarters we’re going to see a lot of pregnancies.”

Disaster creates new complications, but old ones don’t simply disappear. As the adrenaline of emergency response mellows into the slower rhythms of reconstruction, Mexfam, in partnership with Direct Relief, will find new ways to balance its day-to-day work with the imperatives of disaster relief in an oft-ignored region struggling to return to normalcy.

In towns like Xadani, that struggle has only just begun. That afternoon an old woman called Lucia Ramirez looked on as Mexfam volunteers erected a tent over the blank patch of concrete that used to be her home. “Diu xi cu’ndaya latu,” she said in Zapoteco, the mother tongue for the indigenous peoples in much of the region. “You don’t speak Zapoteco, do you?” she asked, as the volunteers shook her hand and leaned in to kiss her wrinkled cheek. She translated: “I’m asking for more life. That’s what matters most.”

– Michael Snyder is a journalist based in Mexico City.

The post With Gaps in Health Care Left by Earthquake, Mexfam Steps Up in Oaxaca appeared first on Direct Relief.

The hospital’s primary storage facility collapsed as well, taking a month’s worth of medications with it. In the end, some 71 people died in Oaxaca, the majority of them in Juchitan. Had the quake hit during the day, when the Municipal Palace would have been full of government employees, the market full of vendors, and the schools full of children, many times that many would have perished.

By the following day, the hospital had relocated into the auditorium of a local school. “We had everything there. We were using the bleachers to store medications,” said Eugenio José Juarez Coronado, an employee of the Directorate of Health for the state of Oaxaca. “That’s where the hospital was working – except it wasn’t working. The auditorium was on loan and, though it wasn’t hurt itself, the building next to it was.”

Over the next two weeks, a temporary hospital, built using facilities provided by the federal government and the state government of Hidalgo in central Mexico, had set up on an empty baseball field near the city’s northern edge.

By Sept. 20, three days before a 6.1-magnitude quake struck the same region, bringing down a new batch of damaged buildings, the temporary hospital was up and running. But the issue of stocking medications both for the hospital and for the 118 health centers scattered around the region remained critical.

Working in conjunction with the state government, Direct Relief’s Mexico team helped find a new storage facility – a large warehouse not far from the temporary hospital – where the Directorate of Health could store medications coming in from individual donors, pharmaceutical companies, and non-governmental organizations. Three weeks after the first quake struck, roughly half the floor space in the cavernous, hangar-like space was full of donations.

The medications gathered at the Juchitan storage facility will not only service the temporary hospital in town, but also regional hospitals in five towns, health centers, and itinerant medical teams traveling between smaller municipalities, where daily tremors continue to cause panic more than a month after the first quake struck. Plans are already underway to rebuild Juchitan’s general hospital with capacity increased by 30 beds, but that process could take months. Until then, channeling medical services to patients scattered widely around the region poses a logistical challenge in a poor corner of Mexico.

One of the most immediate issues is effectively managing the medical aid coming in. “When I came here the first time, there was just this one stack of boxes,” said Dr. Emilio Esperón, a doctor with the State Medical Service, of the new warehouse space. “Now, five days later, there’s three times as much.”

Working directly with pharmaceutical companies and the State Medical Service, Direct Relief helps see that medical workers on the ground are getting the medications they need. For now, said Dr. Castillejos, that’s principally IV antibiotics and analgesics. In the coming months, as different medical issues arise, those needs will almost certainly change.

“Initially, as with any disaster, the issues to come up were trauma, like fractures. What came next were more minor problems, like skin irritations and lacerations,” said Dr. Esperón. In the coastal town of San Mateo del Mar, which suffered flooding from torrential rains beginning shortly after the first quake, many people are experiencing severe swelling and skin irritation on their feet from constant exposure to stagnant water, which has also increased the risk for stomach infections, cholera, and dengue.

“The next stage will be the more serious epidemiological issues throughout the region – issues like hypertension and untreated diabetes. All that stuff is going to flare up,” Dr. Esperón said, “because people are finally thinking about themselves after weeks of only thinking about what’s going on around them.”

– Michael Snyder is a journalist based in Mexico City.

The post Amid Oaxaca Earthquake Destruction, Creating a Hub for Medicine appeared first on Direct Relief.

As they lowered the body into the earth, the ground began to shake furiously. The chapel crumbled, sending stone and concrete flying. “Right there, by the church, that’s where we were hit hardest,” Soberanes remembers. “When the cupola fell, it crushed his body completely. Even I’m still here hurting here” – she ran her fingers over her left shoulder – “from where some concrete hit me as I ran.”

Soberanes’ house withstood the worst of the tremors, but the embroidery workshop where she had earned her living for the past 15 years collapsed, leaving her without a source of income for the foreseeable future. “I talk as though I’m really affected, but at least I have a place to sleep,” she said on the afternoon of Saturday, Sept. 23, as she gathered personal care items for her family from a group of Direct Relief volunteers. “I don’t know how much more we can take, though. I’m here now just to get out of the house, just to go somewhere.”

That afternoon, and for the three previous days, Hueyapan and its surrounding villages, straddling the border that separates the states of Puebla and Morelos, were jammed with traffic. Cars and trucks carrying donations and volunteers threaded the narrow streets, winding past walls marked with the word PELIGRO, or DANGER; signs taped into their windshields announced their provenance – State of Mexico, Hidalgo, Puebla, Guanajuato – a map of solidarity radiating across the republic.

Direct Relief’s aid effort on Saturday, made in partnership with the CIDE (Centro de Investigación y Docencia Económicas, or Center for Research and Teaching in Economics), included ten vehicles and more than 30 volunteers who distributed nearly 450 individual hygiene kits to 13 towns and villages in heavily affected areas. Saturday’s efforts represent the first wave of aid that Direct Relief will continue channeling into the region in the coming weeks.

Hueyapan, where at least two dozen houses have been condemned, was relatively lucky. Down the hill in San Antonio Alponocan, just over the state line from Morelos into Puebla, some 90 percent of homes were damaged or destroyed.

As the sun descended Saturday evening, families along the sloping main street, crowded with dust-covered volunteers carrying pick-axes and shovels, gathered relief packages with profuse gratitude. Signs taped to condemned walls and held by grateful families on the roads into and out of town read, “Thank you for your support! May God bless you!”

Having gathered a set of Direct Relief aid packages for his family, Vicente Lima Rivera walked back through the intact façade of his six-year-old home. Inside, he stood in an open patio that was once his living room. A makeshift roof of corrugated metal that he and his brother built on Wednesday afternoon covered his furniture, protecting it from the impending rain.

“This is where the kitchen used to be. The volunteers have already cleaned it,” he said. “My mother was in here cooking when it happened. If my brother hadn’t been nearby to help her out, she would have died.” He gestured vaguely toward a flat square of concrete elevated above the ground. “We’ve felt earthquakes before, but nothing like this.”

According to Lima, a significant portion of the aid that his village has received thus far has come from private citizens, businesses, and organizations like Direct Relief. One little boy said that he’d met volunteers from as far away as Baja California, 1,500 miles to the northeast. One woman had come from the state of Guerrero with a truck full of hot food to distribute among residents and volunteers. Four years ago, she says, floods obliterated her home. Help had come from all sides. “As soon as I heard what had happened, I knew I needed to do something,” she said.

Lima says it will cost some 350,000 pesos (nearly $20,000) to rebuild the home he lost. The reconstruction process could take years. Endelia Balderas Perez, whose house in Hueyapan collapsed in the quake, says, “it’s not like we build our houses here in a month. We have to buy materials bit by bit and put them aside, so it can take a year to build just a simple casita.” Lima and his neighbors have been deeply moved by the amount of support they’ve seen thus far, but worry what will happen as the initial enthusiasm from private citizens wanes.

Late Saturday night, as the truckloads of volunteers in hard hats pulled out of town singing patriotic songs, Gelacio Sanchez Rojas sat under the broken lintel of his shop on one of Alponocan’s devastated side streets. A trio of engineers from Mexico City, Puebla, and Monterrey (far away in Mexico’s north) had inspected his store and told him it could be repaired.

“This is what God sends us,” he said with jarring equanimity. “Now maybe we can make our town better than it was before.”

– Michael Snyder is a journalist based in Mexico City.

The post Morelos After the Quake: Hope and Generosity Amid Devastation appeared first on Direct Relief.

Situated at the edge of the well-to-do Roma neighborhood, one of the hardest hit in the devastating 7.1 earthquake that struck central Mexico on Tuesday, Pushkin Park has, for the last three days, been the site of a collection center, one of many set up around Mexico’s capital providing hot food, water and medication to the thousands of people displaced by the earthquake.

Gabi Allard, president of the association, said that staffers spent the better part of Saturday afternoon moving around the city, particularly the south, collecting insulin to administer to diabetics who had either lost their homes in the widespread devastation, or who could not reenter them due to structural damage.

The association itself has been temporarily displaced from its headquarters nearby. In Parque Pushkin, Allard pulled out her phone to show pictures of cracks in the office walls. “There was no way we could stay there and continue to serve people,” she said. Using a van also donated by Direct Relief, the association has been able to move its essential equipment out of the offices and into the public sphere.

“For now the most important thing is to provide for the community. This is still a state of emergency.”

According to Allard, Mexico is home to as many 14 million diabetics, roughly 2 million of them residents of Mexico City. “If you have this kind of stress, then people don’t control their diabetes, and that’s when they really start to feel ill,” she said.

As the afternoon wore on, families of volunteers, drawn by an association staffer announcing the team’s services over a megaphone, came by to test their blood sugar. Others who had not been able to return to their homes in three days came to have their teeth cleaned and to collect free toothbrushes and floss, essential habits to reestablish some sense of normalcy in uncertain times.

By Friday afternoon, life in some parts of Mexico City had already started returning to normal. In the historic center, which avoided the worst of the earthquake’s effects, shopkeepers had come back to work and street vendors hawked ears of corn off the grill. Even in Roma, where several buildings collapsed and many others suffered permanent damage, cafés and restaurants had opened for business.

But destruction was never more than a few blocks away. Some businesses continued to offer their bathrooms, wifi and power outlets along with free meals, coffee and ice cream to displaced people and the volunteers who continued to flock to the sites of major building collapses, waiting patiently in hard hats and orange vests to take their turns clearing the rubble.

Emilia Dionisio had come in to the city center from her home in the lower income districts to the north. Built on solid bedrock in the surrounding hills, Mexico City’s poorer neighborhoods suffered far less damage than better-off areas built on the unstable terrain of the city center.

“I don’t have any money to give, but I wanted to help in any way I could,” Dionisio said.

Once at the park, she decided to come take advantage of the association’s services, an important part of the organization’s efforts to spread awareness about a disease that, particularly in urban Mexico, has reached epidemic proportions.

Having now received substantial insulin donations, Allard plans to use the Direct Relief-donated facilities on Parque Pushkin to organize treatment and dispense it to those in need while also disseminating information to the many city residents who still know little more than myths about diabetes. Allard plans to have staff on site throughout the coming week from 9 a.m. until 7 p.m. – later if need be.

A woman who goes by the name Quetzaltlahuitli – Nahuatl for “beautiful light” – came through the tent with her daughter shortly after Dionisio had left. Residents of Iztapalapa, another outlying district built on bedrock, they had spent the previous three days volunteering.

“Way more buildings fell in 1985,” she said, referring to an even stronger earthquake that, 32 years before this one to the day, left nearly 10,000 people in Mexico City dead. “But the spirit of volunteerism and solidarity, that hasn’t changed.”

As she sat to have her glucose levels tested, one of the seven Association staffers on site asked how she was feeling. “How are you? Did you come in running? Did you come stressed?”

Quetzaltlahuitli smiled gently. “We’re calm, we’re calm. We’ve been walking over trying to find ways to help,” she said, “but we’re alright.”

– Michael Snyder is a journalist based in Mexico City.

The post After Chaos of the Earthquake, Clinics Give Stability to Patients with Diabetes appeared first on Direct Relief.