On the night of Sept. 7, the earth shook beneath the Istmo de Tehuantepec, a region in the southern Mexican state of Oaxaca, for nearly two minutes. In Juchitan de Zaragoza, a provincial city of 100,000 people, catastrophic damage was registered in over half the Municipal Palace, nearly all of the main market, practically every religious structure in town, at least 30 percent of residential structures (by modest estimates), and 90 percent of the city’s largest hospital, where patients were evacuated onto the dark street.

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.