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Health Care Hero: A Landfill Fire Was Poisoning Her Patients. She Cared for Them at Home.

For years, nurse Alejandra Hernandez Ezquivel has cared for patients in a rural community in eastern Mexico. A new primary care center, founded by Fundación Escala, is testament to her importance and dedication to her community.



Alejandra Hernandez Ezquivel provides medical care for patients in the Escalerilla community, as the nearest clinic is more than an hour away. (Courtesy photo)

Her husband saw the smoke first.

Alejandra Hernandez Ezquivel was in her house in the 500-person community of Santa María Chimalhuacán, in eastern Mexico, when her husband came running indoors. The landfill nearby — the one that had appeared one day out of nowhere years earlier, with no opportunity for the community to object — was on fire.


“It was like a monster, so immense,” she said through a translator, recalling the fire that began raging on May 29, 2022. The blaze was out of control by the time firemen arrived at the rural community, located in the municipality of Chimalhuacán, about an hour away from Mexico City. Even the portable water tanks they’d brought with them couldn’t fully quench it.

Burned areas inside of the landfill area as seen in April 2024. Direct Relief is supporting medical care in the community adjacent to the landfill. (Jonathan Mangotich/Direct Relief)

Ezquivel ran from house to house, telling neighbors to close the windows and turn off their gas tanks. But the smoke was so toxic that many had to evacuate to a government-run shelter.

In the weeks that followed, Ezquivel and other community members patrolled the streets at night, working to keep opportunistic looters at bay. Once a thief ran into her house, trying to convince her she needed to evacuate immediately. She wasn’t fooled.

And she cared for patients all the while, supplementing the government-provided services by seeing people affected by the fire’s toxic fumes. Her patients with diabetes and hypertension were experiencing complications. People had gastrointestinal, respiratory, and ocular health problems related to the ongoing flames. Ezquivel herself experienced eye irritation and respiratory distress.

The flames are still burning in the landfill two years later, too deep down in a mountain of refuse to be reached or effectively extinguished, Ezquivel said. But the nurse’s dedication to her community has been recognized with a full-time primary care center, funded by the NGO Fundación Escala and staffed by a dedicated doctor, therapists…and Ezquivel herself.

Embedded from the Start

When Ezquivel and her husband first came to what is now Santa María Chimalhuacán in 2008, there were only cornfields.

Tired of renting, they had decided to build a home, and sold their truck to buy a plot of land in this uninhabited area of the Chimalhuacán municipality. Houses sprang up around them. Today, about 500 people live in the formally recognized community. Most commute to Mexico City, where they work in construction. A few make a living locally, working in agriculture or waste sorting.

Formal recognition from the government came slowly. The community gained access to electricity only five years ago, and running water two years later. Even today, there is no municipal sewage. Most people have septic tanks instead.

Alejandra Hernandez Ezquivel provides medical care for patients in the La Escalerilla community, as the nearest clinic is more than an hour away. (Photo courtesy of Fundación Escala)

From the beginning, neighbors knew that Ezquivel was a nurse. The nearest clinic was more than an hour away, and she often found herself giving vaccinations and treating injuries in her home, both for community members and for neighbors from the community next door, La Escalerilla. Mexican NGOs, including Fundación Escala and Medical Impact, worked with her to implement local health campaigns and provide medical care.

But about a decade ago, workers began digging a massive hole next to Santa María Chimalhuacán, and quickly filled it with trash. Ezquivel and her neighbors couldn’t even figure out who was responsible — the two local municipalities blamed one another.

Then it caught fire.

A Primary Care Center from Scratch

Fundación Escala, working alongside Ezquivel to meet medical needs in the weeks after the flames, saw how indispensable the nurse was to her community — and that their need for health services was growing.

The NGO responded by pulling together the funds to develop a local primary care center in nearby La Escalerilla, procured medicine and equipment, and recruited Dr. Carlos Sanchez, with whom Ezquivel works closely. A local church provided the physical space.

Children play soccer in the community of La Escalerilla. (Photo courtesy of Fundación Escala)

Today, the center is called Consultorio Médico Escala. It does “a little bit of everything,” Ezquivel said. Prenatal care, chronic disease treatment, pain relief, vaccinations, therapy for mental health issues, and more are all provided. For low-income patients and those with physical disabilities, house calls are an option.

“Whatever patients need, that’s what we provide,” Ezquivel explained.

She has hopes and plans for the center. In particular, she’s hoping to be able to expand into specialty care like gynecology, so her patients will have the services they need close by.

The work isn’t always easy, but Ezquivel loves seeing patients leave with a smile after they’ve seen her or Dr. Sanchez. They’re “the reason I keep going.”

Much of Ezquivel’s dedication — from patrolling the streets of Santa María Chimalhuacán to offering wound care in her home — seems beyond the call of duty. But for her, it’s all in a day’s work.

“From the moment I decided to become a nurse, I knew my passion was to help people,” she said.

Through Fundación Escala, Direct Relief has provided more than $44,000 in medications and supplies to Consultorio Médico Escala.

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