Ingenio Mexicano. It means Mexican ingenuity, or the art of doing a lot with a little.
Like inventing a way to turn a liter of donated breastmilk into seventeen liters, made available to mothers unable to nurse and babies orphaned at birth. Or creating a CPAP using only scotch tape, a tube, and a Coke bottle. This is a place of miracles—the most necessary, ingenious kind.
The nine-hour drive from Oaxaca’s capital city to the western coast winds us through lush forests with both pines and palms, long flatlands with placid lakes, and lightning-shaped mountain roads. “Oaxaca has everything,” they say, and it seems so.
Today the long drive on narrow switch backs is soothing and scenic, though a month ago as the mountains swayed with the quaking earth, we would have been among many others attempting to remain wheels-to-ground while dodging falling boulders.
In a six-month span, Oaxaca endured three 7.1 magnitude earthquakes. The first two were the strongest and most devastating in thirty years. The third hit in February 2018, just a couple weeks before our visit.
Attribution: Wikimedia Commons
Our host, Antonio Tovar, Director of Seguro Popular, tells me that after the first earthquake, he and his staff traveled to Juchitan to wade through the rubble and help triage needs. One little boy they found was buried up to his waist, wrapped in the arms of his father, who had died.
“The destruction was unimaginable. Many houses and the hospital dissolved to heaps of stone,” he remembers.
Crossing a small, newly rebuilt bridge, we arrive in Pinotepa Nacional, the epicenter of the most recent quake. The hospital is full, with beds in the hallways and a line out the door. Though only half-habitable and seriously lacking equipment, this hospital is known throughout the region as ‘The Place of Solutions.’ They receive the hardest, highest-risk cases from within a six-hour radius and yet have the lowest-mortality rate in the state of Oaxaca.
The oxygen helmet I held not more than hour ago is right now saving the life of baby David, who was born with his intestines and stomach outside his body. Down the hall, I hear a baby’s first cry followed by the splash of a first bath…the water warmed by a lightbulb.
Through the curtain on my left is the milk bank—the first of its kind in Mexico. The majority of patients visiting Pinotepa Nacional are pregnant mothers, many of whom are too malnourished to breastfeed so the bank multiplies donated milk to provide important sustenance to as many as possible. During the earthquake, the milk bank lost power, which caused a tremendous amount of spoilage and many babies suffered as a result.
This, the sort of simple suffering that a generator could solve. And this, the mission of Project CURE.
"I was coming out of the Emergency Room when everything started to shake. I thought at that moment the entire hospital would fall. I saw the walls move, from the screens of the ceiling lamps began to fall, and everyone was screaming," remembers Dorali Rocio Villa Aguilar, who works at the front desk.
"When I arrived, I found the whole hospital in motion and the patients outside," says Soledad Cruz Aguilar, a nurse. "The hospital was badly damaged with several cracks on the walls, starting from the Emergency Room, Obstetrics Surgery, and there was a very damaged operating room. The area of Neonatology was completely evacuated. Everything in Pediatrics was moved to Emergencies, adults, and my colleagues were working there with this climate, with four incubators in an office. It was truly terrible."
The hospital's Head Nurse, María del Carmen Méndez Ávila, had just ended a shift when it hit: "I don't remember the exact time, but it was about 5:00/5:30 PM. It really was chaos. My coworkers were scared because they thought in the first place of their family, their children, their parents, and the patients. It was a total mess; many people had nervous breakdowns, especially health staff."
She adds, "The priorities in a hospital at a critical moment are materials and medication. When you are going to provide immediate attention, you get frustrated because there is no catheter, there is no syringe, there is no medication, and you waste time."
The time to save a life is a matter of seconds, it isn't about minutes or hours. When we're missing something in the hospital, we have to ask the relative to go buy it and it's precious lost time.
María del Carmen Méndez Ávila, Head Nurse
Erika De Acequiros was pregnant when domestic abuse sent her to the hospital—the baby wasn't moving. Erika was admitted on March 8th and on March 9th she underwent a C-section, the doctors delivering a tiny, precious life into the world. "He was very tiny when he was born. The doctors told me it had been 36-weeks and they placed him in the incubator," Erika tells me.
Her baby son spent an entire month in the incubator, the nurses doing their best to nourish mom during that time so she could nurse. Like most of the patients here, Erika would have to choose between food and medicine. The nurses provide and borrow everything they can, balancing scarcity with incredible generosity.
As the walls crack and electricity fails, the nurses won't leave the incubators.
Erika continues, "When they were going to measure the baby's pressure, they didn’t have that device. They were asking to borrow it from another nurse," Erika remembers. "At some other point, they asked me for a medication, an ABC vitamin for the baby, because they didn’t have it. Later, they asked me for a medication—the one in the flask—it cost $30. They told me to buy five doses, and I didn’t have enough, so I only bought three. They told me, 'You have to buy it because we don’t have it here.'"
Nurse Flor De Liz López Clavel admits: "We as nurses are the ones who manage most of the shortages. There are many things we have to find or borrow, like IV equipment, urine collector bags, catheters, basic and essential material in a hospital. The most needed materials are solutions, IV equipment, catheters, even clothes, sheets, gowns."
Dr. Fatima Juárez, the hospital's Deputy Director, agrees: "Here every glove is valuable, every gauze is valuable. Here we take care of that material a lot because there are times when we are left without. And to ask, even the cost of gloves from a patient, sometimes it is to leave her without eating. There are even times when we have to give them food."
"Nurses are the strength here. When there is not enough staff, we have to work as stretcher-bearers, as janitors," says Nurse Flor, "We even have cooperated to buy medicines. Here, in Pinotepa, we are characterized by our culture, our sensitivity towards people, and we especially support our neighbors, which is the main thing."
All the nursing staff that work here, sometimes we say, improvises, but the truth is that we have in our hands the art of doing things with what little we have. Our career is really an art.
Soledad Cruz Aguilar, Nurse, Pinotepa Nacional Hospital
Surplus Meets Need
Every day in America, large shipments of donated medical products arrive to each of Project CURE’s six warehouses, where volunteers help sort, stack, and inventory. These items will eventually be shuffled into 40-foot containers, custom packed to meet the needs of hospitals and health centers that request them in disaster relief areas, conflict zones, and under-resourced contexts.
Before that happens, however, Project CURE will conduct a needs assessment to meet the hospital staff face-to-face, tour their facility, and listen to their needs.
This is a critical piece—the difference between dumping and resourcing—and it’s why Delana Lansgraf is with us in Pinotepa.
“I make sure to emphasize that it's a matching process,” she explains, “so that I'm here to hear the needs and the wants of the doctors, but I tell them nothing is guaranteed. Then I show them the list, the items in red are especially difficult to get, so I want to emphasize that.”
We spend the entire day—eight straight hours—going room to room, speaking with staff in every department and evaluating everything from typewriters to incubators. The fact that an earthquake-damaged, half-functioning hospital is the “least sad” she’s seen says something about where these containers are typically sent. She’s patient and optimistic, taking photos of the disrepairs or product labels and asking each department head, “Is there anything else that you need? How many? The container es muy grande…”
Hospital Director, Dr. Heriberto Canero, and Deputy Director, Dr. Fatima Juárez, guide us room by room, need by need through the hospital.
We learn the NICU has six incubators, three of which work. Sterile supplies are stored in gym lockers and insulin in the mini fridge. Old bed sheets hang over windows to block the sun and billow with the breeze as fluffing from the old-as-me hospital bed falls to the floor. The nurse stuffs it back in, and we move on.
The nurses and doctors are all in neat white, walking briskly past as the fan above me bounces and clacks a rhythm.
Last year, Project CURE conducted 200 assessments in 36 different countries.
For a place that deals with near constant crisis, there is a serenity still—the staff are warm and calm, moving with a graceful urgency. With half the hospital in disrepair, the hallway has become the ward, hospital beds lining the walls. I watch as a bed is turned over from a newborn to a grown man—every item, surface, seat is multi-purpose.
The nurses in the NICU pay out of pocket for the special needles they need, because the standard ones are too big for the babies and break easily. Similarly, the doctors recently pitched in to buy a projector so they could improve trainings and continue as a teaching hospital for practitioners from nearby clinics. No doubt, the staff are the heart of the hospital.
Each 40-foot CURE container delivers $400,000 worth of medical supplies and equipment on average, improving care for the most vulnerable populations in the world.
Project CURE was born a little more than 30 years ago, when a man named James Jackson was traveling in Brazil and came face to face with the needs of the sick and dying at a small clinic near Rio de Janeiro. When he saw patients turned away due to lack of basic medical supplies, he returned to his home in Evergreen, CO and rallied his network to stock and ship the first CURE container.
Now, three to four of these containers are shipped every single week. Project CURE has grown into a massive logistics operation involving more than 25,000 volunteers, collection centers across the country, and distribution warehouses in Phoenix, Chicago, Nashville, Philadelphia, Houston, and Denver.
In 2017, Project CURE delivered 181 containers carrying $61 million in medical supplies to 50 countries.
Learning that smaller is sometimes better, Project CURE has created a few different kits, that people like you and me can deliver personally. For example, their Stryker Kits include the essential drills, bits, blades and batteries for orthopedic surgery, and their Neuro and Spine kits are like extension packs, if you will...the packing list a bit too technical for me to translate.
For this visit to Pinotepa, I carried with me two CURE Kits, which are suitcase-sized, pre-packed duffel bags containing a broad assortment of the basics, like gauze, gloves, bandages, and hygiene items. These simple supplies are critical and desperately lacking.
Kits for Kids is another small CURE invention, one of my favorites. Each kit is a little drawstring backpack filled with personal hygiene and basic medicine cabinet items that enable parents to provide basic care at home, instead of having to travel long distances by bicycle, bus, or on foot.
When requested, clinic teams may accompany the cargo containers and carry-on kits. These teams consist of physicians, OB/GYNs, pediatricians, surgeons, nurse practitioners, and/or nurses who provide care and training on how to best utilize the resources. This past year Project CURE completed 26 clinics in 12 countries, serving nearly 10,500 people.
The strategic operations facilitating the constant collection of medical supplies is called ProCURE—a vast network of industry professionals, supply manufacturers, care providers, and university professors coordinating to ensure we send our best to those that need it most.
Project CURE's extensive network involves professionals and practitioners at every level to ensure a consistent flow of supplies to the places that need them most.
"In addition to hospitals, medical manufacturers, and distributors have made a huge difference in the quality of product Project CURE provides. From hospital beds and gurneys to anesthesia machines and infant incubators, manufacturers can channel trade-in or refurbished equipment," Project CURE reports.
"ProCURE is our linchpin program, through which we receive medical supplies and equipment from U.S. hospitals, medical manufacturers, wholesale distributors, and individual donors. Because of our large international distribution network, almost every type of medical item can be accepted."
Dr. Adam Murphy of the Feinberg School of Medicine at Northwestern University coordinates with Project CURE to donate materials and equipment.
The supplies and equipment delivered to severely resource-limited communities help save lives, make diagnosis and treatment possible, protect health workers and ensure better outcomes for surgery and emergency care.
More Cure Needed
In addition to the containers sent to Mexico following the devastating earthquakes, Project CURE has been intensely focused on resourcing clinics caring for refugees in the Middle East and also in West Africa, where the Ebola virus ravaged many communities.
So far, three containers and multiple CURE Kits have been sent to hospitals serving Syrian refugees in camps throughout the region—totaling more than $1.3 million in supplies and equipment.
In addition, Project CURE remains committed to the rebuilding of healthcare infrastructure in countries affected by the Ebola virus. In 2018, the 28th and 29th disaster relief containers filled with supplies to rebuild hospitals in Liberia arrived in-country. Items included E.R. supplies such as gauze, syringes, surgical gowns and masks, as well as critical lab supplies, beds, and mattresses.
This surgery center is the first of its kind in Liberia.
Next time you travel to the developing world, maybe request a CURE Kit to bring to a hospital or clinic. Or next time you need a meaningful volunteer activity for your family, classroom, or scout troop outing, see how many Kits for Kids you can pack.
For those into hosting happy hours or running marathons for fun, consider raising money to sponsor the shipment of a container. It's a life-saving world of good packed carefully and delivered to those hurting and sick in hard to reach places. This need is only increasing, and so must the supplies.