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Of Pandemics and Heterotopias

Paulina Sierra | Mexico City, Mexico

A framed children's drawing rests over one of the hospital walls.

“Heterotopias always presuppose a system of opening and closing that both isolates them and makes them penetrable. In general, the heterotopic site is not freely accessible like a public place. Either the entry is compulsory, as in the case of entering a barracks or a prison, or else the individual has to submit to rites and purifications. To get in one must have a certain permission and make certain gestures.”
Michel Foucalt, Des Espace Autres

I wanted to focus on all the people of the National Institute of Medical Sciences & Nutrition Salvador Zubirán. Environmental service workers washing windows, mopping floors, the strong, repetitive hands of those laundering and pressing bed sheets, emergency medical service employees carrying patients in or out of stretchers or unto wheelchairs, anaesthetists aiding intubation, cooks feeding administrative personnel, lab specialists performing tests, voluntarily assigned physicians willing to learn the new reality from residents, transporters carrying oxygen tanks, nurses buzzing everywhere, technicians and maintenance staff fixing ventilators, security forces in or outside the institute, paramedics moving patients to other facilities or pathology crew dissecting and filling paperwork at the morgue.

Since its inception in 1946, the National Institute of Medical Sciences and Nutrition Salvador Zubirán has positioned itself in the excellence of assistance, teaching, and research within the public national institutes of the Health Department in Mexico City.

Each year, hundreds of medical students fight for a spot in this hospital. My brother undertook his residency there from 1997 till 2000. In an unspoken recognition among his peers, this minor detail brought him to what is regarded the crème de la crème of medical attention in my country; when you speak of “Nutrición” is usually in a high appraisal.

After thousands of hours of operations and specializations abroad, he came back to Mexico in 2006 and became an affiliated surgeon and adjunct professor there. One day, I went to pick something up and inadvertently saw his name on a cubicle where he smiled broadly, as I peeked in. I was elated with joy, taking a picture of a door signaling a great achievement, one he considered perfectly normal, and in the great scheme of things, he had been modestly moving up the harsh bureaucratic ladder to a respected rarity, which is an ethical doctor and a great human being.

It is hard to see our siblings in their true essence, they are your brothers but soon become professional beings, husbands, fathers, dear friends, co-workers, and fully grown men. Yet, his becoming never eluded me or was an unexpected revelation, I was sitting by his bed when his fluorescent yellow marker stained his sheets after it rolled down from an open medical book. For reasons I cannot seem to place, I also witnessed the first time he inspected a cadaver at his former medical school, sealing my first memory of death with a poignant smell of vinegar along withered ochre tones of preserved flesh. In different ways, we have managed to coincide but at the same time, we have remained radically apart, artists and doctors definitely have different visions in life. Don’t they? I wonder now.

So when I asked him if I could go to the hospital to document the Covid-19 pandemic at Nutrición he was surprised: “Do you really want to go? After a few calls, he found out there was already a protocol within the hospital where I was signed up to. For a brief moment, I wondered if he admired or misunderstood my reasons, that is, despite everything I have read, heard or seen about the virus, I felt a sense of exhilaration, a voluntary golden pass was granted towards a silent, unnerving and inaccesible reality I was about to walk into. Nevertheless, this was no Willy Wonka’s factory ride.

My mother ushered me to the experience. My therapist tried to dissuade me from it. Was I driving myself to an unconscious extinction? What is the purpose of photographic documentation in a singular event such as a pandemic? Anxiety kept me awake the previous nights before leaving towards the hospital. Did I fail to mention that I am kind of hypochondriac? Yet, every single time I have embarked into something unknown, after I close the door behind me, I’m possessed by the sheer power that emanates from my body, my instinct, and, the determination to see it through.

I braced myself to encounter scenes from Italy or more recent ones from the US, but the stark tranquility of the hospital was completely unexpected. I kept looking for signs of alarm, carried on, opening doors, coming into more restricted areas but mostly, silence prevailed as patients were moved in or out, up or down the halls of the institution. Like any metaphor, “up” meant health improvement, “down”, sadly to the morgue. “In” implied being admitted and “out” could mean a range of different outcomes, either good or bad.

After a few days of taking pictures, I started to understand the main reason for this documentation. It came insightfully, as I sat down with the residents, making jokes on how the pandemic was really a global hazing drill for resident students; one of them laughed behind the mask and replied: “Cutting our hair would have been way easier!” It was right then, it became clear to me, his face was my brother’s, in his eyes, the same unquenchable thirst for technique and instinct. Overall, I was deeply moved by the compassion and demand this job requires out of someone at any age.

I also realized, I wanted to focus on the people, all the people that made this hospital seem like this was absolutely normal. Environmental service workers washing windows, mopping floors, the strong, repetitive hands of those laundering and pressing bed sheets, emergency medical service employees carrying patients in or out of stretchers or unto wheelchairs, anaesthetists aiding intubation, cooks feeding administrative personnel, lab specialists performing tests, voluntarily assigned physicians willing to learn the new reality from residents, transporters carrying oxygen tanks, nurses buzzing everywhere, technicians and maintenance staff fixing ventilators, security forces in or outside the institute, paramedics moving patients to other facilities or pathology crew dissecting and filling paperwork at the morgue.

What most people are unable to grasp is that these Foucauldian heterotopias have made a gigantic effort in changing their usual logistics and internal processes. Triage for example, admitting and testing patients within a facility changed entire protocols in a few weeks, once a patient is first screened, to determine the urgency of their condition. If admitted, the physician takes them either to intensive care or to a room for initial testing, after they clear this area, they leave a door hanger with the “Dirty” word printed in it. As soon as the cleaning staff notices them, they take over the room and disinfect it in its entirety, leaving a “Clean” hanger on the door. Over and over again.

Intensive care, which usually assists 30% of the patients in a hospital, was quickly reconfigured to receive 80% of them, that is, thus far. This phenomenal task meant hiring more personnel and assigning new chores to people that were unfamiliar to them. Every single person had to be reorganized, to access some doors, to restrict others, spraying things as they left, layering multiple coats of protection as they went in.

Nonetheless, there was something very poetic about nursing staff, physicians or paramedics helping dress each other up prior their entry to intensive care, crossing the back of their gowns with surgical tape, keeping the headbands in place after the safety goggles were fixed. They need each other to slip two or three sets of rubber gloves on, protective masks over N95 masks, pasting small strips of micropore protecting facial bruised skin from the friction of this new parafernalia. Finally, orderly lines of layered, courageous blue onions disappear behind a door where they become part of a feverish carnival of life and death.

Closing down the area of a dining hall does not necessarily mean shutting it down. It entailed rearranging preparation and delivery of food in recycled packaging, bringing carts in, bags handed over to one person who then, carries a number of credentials and is responsible for delivering it to the people at their work area. A few restaurant chains have pitched in with in-kind, raw, goodness or sizzling Mexican or Chinese prepared food.

Perhaps, the most difficult issue is dealing with the patient’s family protocols. Once they are admitted, they cannot see them anymore. Mexicans, used to cohesiveness, feel immediately banned from a right they lose immediately. No balloons, no flowers or greeting cards, no hugs or mariachis, just a cell phone number scribbled on a post-it note from the gloved hand of a doctor. Maybe that is just half of the quietude that circumscribes the medical facility, the lack of relatives crying on the halls, or praying on the small, universal chapel. They, either stand outside helplessly, or give up and end going back home, waiting for a call that delivers news of death or recovery. In both cases, they might eventually receive a bundle with their relative’s cell phone inside one of their shoes through the gated walls by a nurse or paramedic. A cold reminder of a virus that has created a great divide of infected and not infected, a rift that has provided more fuel to those who discriminate and abuse in this country, from rejecting rides to tired personnel going back home, to nurses and doctors avoided, verbally abused, sprayed with bleach, or physically attacked on their way to work, fracturing their precious hands.

Unlike many other countries who regard these people as heroes, in Mexico they receive very small demonstrations of gratitude. A heart shaped cookie here and there, a bag full of tortas (Mexican sandwiches) with little handwritten notes or drawings that have been filling the glassy walls of the kitchen area, but that’s it.

As more days went by, I found out that within the story of these changing structures and moving individuals lied a deeper one. What is a “calling” in such an uncertain environment? Well, I can inform in the most casual of ways, many of the nurses, physicians and personnel working at the hospital do not believe in God, that is, as a result of their experiences in the field. When asked about their previous thoughts to what lies ahead as they dress up in their medical gowns, they look confused, I assume is like asking a driver about the deep philosophical implications of the automatic responses of a machine and body coordination… There is none, just a procession of events in a focused lapse of time under great amounts of stress and anxiety. Doing the job. However, is it really as simple as it sounds?

What I realize now, is that there are no heroes in these stories, in the sense of needing superpowers to complete an impossible mission, or physicians believing they are saving humanity every time they put their mask on, as their white capes rustle in the wind (one they do not use by the way, to keep the virus from spreading). The cleaning staff is not erasing the disease from the planet with bleach, police forces in the rims of the CDC’s, banning the virus to exit the premises. These people have specialized in their own field of excellence for a number of years. They are prepared for it, or better put, even within an unprecedented environment, better prepared than any of us.

My humble brother (who by the way asked me to remove the paragraphs 2, 3 and 4) wrote to me in an email: “What is interesting, and you may have noticed, is that mystique, our way of treating patients and working with people from different socio-economical backgrounds represented by all the people you photographed; we never question ourselves or wonder why we are there because the only thing that has changed is the type of patient, and we are there for them… It is the main reason of our existence and how we do things. Keeping due proportions, we are just like a firefighter: everyone will run from the fire, meanwhile the fireman will jump into a building of raging flames. Same thing with us. An entire hospital will keel over, instead of running away, because we know we can help patients with complex diseases or infections, and Covid-19 is just one of them.”

What is absolutely true, is the fact that human species have been able to survive due to their communication skills. To contain other viruses and publish the proceedings, to make advancements and technological improvements based on scientific research and observation. To decode how, minuscule things break our organisms or prevent, as much as it can be done, large catastrophic events that can easily question the monarchy of the Anthropocene. This single skill, formal or informal storytelling is the real cure of an event of this magnitude, disinformation and ignorance, the real virus.

In that sense, my time at this hospital showed me the plowing attitude not all the medical facilities in Mexico City or the country will be able to demonstrate. This place has a multitude of initiatives, from a special Covid-19 ventilator, called VSZ-20 (Ventilador Salvador Zubirán 2020) completely manufactured in Mexico to 3D printed face masks, an alliance from in-house personnel and the Instituto Tecnológico de Monterrey in Mexico City (TEC Monterrey). Some centers might lack funds, but that can be eventually solved or assisted, what is atypical, is the will to understand this is not triage’s or intensive therapy’s duty to fathom, it takes a village, of real-time innovation to take everyone out of this one.

Therefore, after years of psychological, philosophical and sociological findings have been able to define fear as some unpleasant emotions that can arise from a threat, believe me when I say that when these professionals exit the doors of any large hospital like “Nutrición” or a small clinic anywhere in a minuscule municipality of Mexico, are not emotionally equipped for anyone out there to see them as a symbol of disease. They cannot understand how communities are willing to burn down hospitals because these are perceived as sources of infection rather than healing.

These medical teams are thinking about efficiency in their new knowledge, of lab tests and quantifying the information to find a palliative cure but also, solving practical issues of their own existence, about their rent almost due, concerns around their kids living temporarily away from them, heating food and gobbling it up on empty dinner tables, falling exhausted on half-made beds. But they also check their cell phones on short lunch breaks, social media posts and news outlets have also modified the way they enter their new acquired reality and sail the uneasy tides of an exterior one. Packing an extra set of clothes to wear back home, becoming anonymous, immune to comments or hearsay on the public transit system. I wonder if someone offers them a seat these days, sometimes, gratefulness requires simple actions and that is the only kind of virality that must be passed on.

Can I say I admire my brother more than I did before? My answer would be negative. I undoubtedly know him better than I did. I do not think we are so different from each other anymore. For the first time in my life, I read his bio. We are both inventors of sorts and the only place I can dare to trace this back is my mother’s radiant empathy and my father’s quixotic da Vinciness, if such a thing exists. This process has been exhausting and I needed to withhold many emotions. Ultimately, figuring this part out, has led to an outlet of jubilation that has been pouring out, unceasingly. The shared bond of our DNA, entwined and replicated through our common interests in other’s wellbeing, bodies, and machineries expressed in our own ingenious ways.


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