After Deadly Floods, A Medical Brigade Finds Injury, Untreated Disease in Devastated Mexican Communities

The brigade arrived in Álamo, Veracruz on Friday, October 17, just days after heavy rainfall pummeled this area of Mexico.

There, the team - six doctors, four nurses, and a psychologist, among others - found people with nowhere to live after their houses had been flooded up to the second story. Patients with diabetes, hypertension, asthma, and HIV who'd lost their medication. Open wounds on the hands and feet of people working to clean up communities damaged by some of the heaviest rainfall Mexico has seen in years.

"The situation is not good," said Gabriel Sánchez, the team leader and a coordinator of medical operations at Medical Impact, an organization that deploys brigades of healthcare providers to communities in Mexico and around the world. "Many families were left homeless, their belongings were lost."

At least 76 people were killed last week when unexpected, heavy rainstorms caused flash flooding and landslides in the Mexican states of Hidalgo, Querétaro, Puebla, San Luis Potosí, and Veracruz. Hurricane Priscilla, which passed over much of this area earlier in October, brought heavy rainfall, but much less damage.

That's part of the problem, said Dr. Giorgio Franyuti, Medical Impact's executive director. "Usually…we are very adaptive toward activating protocols against hurricanes," he said of Mexico's extensive public and nonprofit emergency response systems. "We had this with Hurricane John, Otis, and Erick [in June of] this year."

But rains that aren't part of tropical storm systems are rarely so destructive, Dr. Franyuti said.

"The devastation is massive," he said. "It will take a very long time for health systems to achieve a reconstruction of their infrastructure." He said the heavily damaged cover more ground than the whole of Central America.

Medical Impact deploys brigades all over the world - Dr. Franyuti has provided medical care in Guatemala, Gaza, and Colombia, among other places - both in emergencies and to temporarily boost healthcare in overwhelmed or under-resourced settings. When Dr. Franyuti spoke to Direct Relief on Wednesday, he turned his phone camera on to show brigade members packing pharmaceutical supplies and field medic packs the organization had donated.

Direct Relief funded Medical Impact's flooding response brigades with a $25,000 grant. The organization also supplied essential medicines and medical supplies, as well as 10 field medic packs earlier this year, in advance of hurricane season, to enable swift in-the-field deployments like this one. (The organization also provided medical support to Mexico's Secretariat of National Defense, or SEDENA, and the Guerrero Ministry of Health's Urgent Care Unit, which mobilized responders to the area.)

The grant "enables us to jump-start the response so we can start right away," Dr. Franyuti said. Staff members were packing portable mattresses and potable water along with the medicines and supplies. "We do not know where we're going to stay, but we have to deploy anyway. It is so time-sensitive, and so critical. We usually resolve [logistical issues like shelter] on the spot."

Dr. Franyuti was already distressed by the high death toll caused by the flooding and landslides. But he warned it was only the beginning.

"Let me tell you about the bigger monster: the secondary disaster," he said. "These people do not have drainage. They do not have refrigeration. They do not have drinkable water."

The loss of medications, and of refrigeration to store medicines like insulin, was severely dangerous. Parasites and water-borne diseases would be a growing risk in coming days. Then, he said, mosquito larvae would hatch in standing water in the next couple of weeks, likely causing an increase in dengue cases. All of this threatens health facilities in affected areas, which "do not have the necessary productivity or capacity" to treat thousands of patients in acute need at once.

Of the 1,079 patients Sánchez's team treated over the next three days, he estimated that 90% needed replacements for chronic disease and other lifesaving medications that had been lost in the floods. All needed preventative deworming treatments.

For those three days, the brigade split into two, Sánchez explained. One team remained at a stationary clinic, and the other went door to door to treat patients who were injured, older adults, or unable to leave their homes.

One of them, he recalled, was a patient in her 70s. A neighbor alerted the mobile team that the woman was alone at home because her two adult children had gone in search of supplies. When asked if she needed medical attention, she showed providers a wound on her foot - she could not travel over the debris-filled streets - and asked for diabetes medicines to replace the ones the floodwaters had swept away.'

When the team treated her, "she cried in gratitude and wanted to give us food," Sánchez recalled in Spanish.

That kind of reaction is common, Dr. Franyuti said, and it's often what motivates volunteer providers to undertake this work, despite the dangers and the months of deployment.

The work "is sad, but it is also very hopeful," he said. "You get hugged every day. People come and give you sunflower seeds, they give you mangoes. It's a cultural experience so rich and so life-changing."

Dr. Franyuti estimated that this disaster would require at least six months of repeated deployment. Teams are rotated every week to give responders time to rest - "You do not want to have people exposed to a disaster for a long time…it does cause post-traumatic stress," he said - and the brigades continually collect and analyze data about community-level healthcare needs to enable tailored, efficient responses.

A brigade may respond to a volcano eruption, only to find that nearby health needs are relatively few, but people dozens of miles away are experiencing severe respiratory impacts as particles are carried on the wind. A flooding event may raise concerns about contaminated water and interrupted supply chains…but a severe outbreak of dengue may end up presenting the biggest risk. Pregnant women or children may be more affected than the team expected.

That's why data analysis is so key to Medical Impact's brigade deployments: "There's a gold mine behind the data," Dr. Franyuti said. "You do not achieve anything with only one intervention; you have to continually study" the situation.

Touching base with Direct Relief while back in Mexico City late Tuesday afternoon, Sánchez had already handed an early data set over to his colleagues. While they were analyzing it, the brigade was off to Huauchinango, in Puebla, another state badly affected by flooding.

The data doesn't just serve Medical Impact's response. Dr. Franyuti said one of the organization's highest priorities is ensuring that local health systems are ready to take over after a medical brigade leaves the field: "Handing the steering wheel back to the public sector" is always the goal, no matter where in the world a team is working. Providing accurate, on-the-ground data about healthcare needs, and how they've changed over time, ensures that a public health system can step back in as efficiently as possible.

"Every disaster is unique," Dr. Franyuti explained.