JUCHITAN, OAXACA – Driving into Juchitán de Zaragoza, one of the first things in view is a Volkswagen service station that has collapsed on itself. Shattered glass litters the parking lot, the behemoth structure an unsettling welcome to the area most affected by the historic 8.1 magnitude earthquake that hit off the coast of Mexico late Sept. 7. The death toll from the quake has climbed to 90, and 71 of those deaths occurred here in Juchitán and the surrounding areas.

Eduardo Mendoza, Direct Relief’s general manager of Mexico programs, arrived in the area on Saturday—a 50-pound suitcase full of medication, gauze, surgical gloves and other needed supplies in tow. But this suitcase is just a small token—Mendoza’s goal is to address medical needs on a grand scale. Working in cooperation with the state and federal governments, Mendoza and the Direct Relief team will be partnering with companies to bring large-scale shipments of medication and medical supplies to all of the hospitals in the region that are addressing the immediate and long-term needs of quake victims.

But doing that is easier said than done.

Arriving on Saturday night, Juchitán through Mendoza’s car window was dark and rainy. It is immediately evident that the town has experienced something catastrophic—piles of rubble begin to appear where houses or hotels once stood, menacing cracks scar the side of a new-looking supermarket, a bus stop lies in pieces at the corner. Mendoza knows what he needs to accomplish for the people of Juchitán, but where do you start when you land in a place flipped upside-down by a natural disaster?

The first stop is the hospital, which isn’t actually a hospital at all, but an indoor gymnasium. To even get to the door, you need to drive through a truck lot and past a small herd of sheep. The only clue that there might be a medical facility somewhere nearby is that ambulances are constantly passing in and out of the truck lot. Doctors relay to Mendoza that they are in need of surgical supplies, sterile dressing gowns, catheters, sutures, and medication for people with chronic illnesses like diabetes or high blood pressure.

There is an operating room at this facility, but they don’t have the supplies needed to perform surgery safely. Patients lie on gurneys as doctors flutter around the gym, moving from patient to government official to first responder and then back to their patient again. Florinda Castro Guzman lies in a daze on her hospital bed, her watchful mother-in-law beside her. “She has gallbladder stones,” says a passing doctor. “We don’t have any surgical supplies, so we just have to wait [to operate]. Lucky for her, she is stable and can wait. Not everyone is so lucky.”

A few beds down, there is a commotion as doctors, nurses and EMTs surround the bed of Rosalino Valdivieso Flores. His nephew, who stands vigilantly at his tio’s bedside, says that Flores’ pelvis was shattered in the earthquake and that his wife and daughter lost their lives. Flores is sedated but still grimacing in pain as the EMTs work to get him ready to be transported to a different hospital. On his arm is a simple tattoo, a name in a heart. His wife’s name, Irma.

With evidence from doctors that a serious need for medication and medical supplies exists here, Mendoza begins tracking down Mexican government officials who can help facilitate in organizing lists of needs from local medical centers as well as facilitate permits for large-scale medical shipments from the U.S.

As Mendoza texts and calls contacts, he also goes to meet a member of the community who is working to help those who aren’t yet receiving any sort of official aid. Cony Rueda, a quasi-political figure in Oaxaca, has a small-scale relief operation running out of her home. Neighbors, friends and members of the community sweat in her courtyard as they bag rations of food, basic care supplies and water and load them into the back of pickup trucks until the truck beds are brimming.

They head to Seccíon 7, an area of the city that has received little attention or assistance since the quake. The trucks pull up and immediately people are lining up, asking for water, diapers, feminine hygiene products, food, anything. People beg for someone to come see their homes, come see the destruction. When the rations are gone, people still linger around, nowhere to go. Most are sleeping outside for fear of an aftershock bringing down what little they have left.

Mendoza speeds back to the hospital/gymnasium when he gets the lead for a good contact in the government that can help expedite the process of getting aid here. After a day of meeting people who so desperately need it, the stakes feel higher than ever. As he walks in, a roundtable with Oaxaca’s secretary of health serendipitously begins. Direct Relief takes a seat at the table full of government officials, ready to make the offer of aid on a large scale. When Mendoza speaks, ears perk up and heads turn. “This is it,” says Mendoza later, recounting the moment. “This is what I was waiting for.”

Things move quicker now that officials know Direct Relief is here. A list, the officials promise, is coming from all of the hospitals in the area of what their needs are. Companies are expressing interest in helping, and FedEx has pledged to offer free transport for aid provided.

“Now we wait,” says Mendoza. Wait to get the list in hand, wait to get the products here in Mexico. “We are the only non-profit connecting with the local and federal government to coordinate a response, so that’s something.”

— Meghan Dhaliwal is a journalist based in Mexico City.