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Simply Smiles provides bright futures for children, families, and communities. The organization partners with populations in need to create physical and emotional environments where suffering is alleviated and from which local leaders can emerge.

Field Notes From Mexico: More Than Just "Deworming"

Simply Smiles blog

Follow our blog and read insights from Simply Smiles staff, volunteers and other individuals whose lives are affected by our work!

Field Notes From Mexico: More Than Just "Deworming"

Alex Gross

This latest edition of Field Notes comes from Simply Smiles President & Founder, Bryan Nurnberger. Bryan is currently visiting Simply Smiles program locations in Oaxaca, Mexico where he helped to staff a medical clinic.

In Oaxaca, Mexico, 2,504 people just received treatment for parasitic infection from Simply Smiles. At the same time, we distributed over 12 tons of food staples, began construction on 14 more latrines and announced the opportunity for children to be educated from kindergarten through the college level at our our new “Casa Hogar Simply Smiles Children’s Home”.

Efforts to treat populations for parasitic infection, or “deworming” programs as they are often called, are one of the most impactful and most common actions taken by governments and NGOs in impoverished areas. While deworming efforts are extremely common around the world, they are almost always done in a manner that is not in keeping with the principles upon which Simply Smiles bases our work. For example, in the village where our Director of Oaxacan Operations, Gabriela Chavez Hernandez, grew up, strangers would show up every six months, pass out pills to treat for parasites and leave. This “treatment only” approach is the global norm because it’s easy to execute and the relatively low cost of the medicine makes indefinite treatment possible - but it is clearly not a solution to the problem.

Treatment only perpetuates a system of dependency and is a disrespectful way to support individuals in need.


If the reader feels conflicted or unsure about the definitive nature of this statement consider this scenario:  If your own child continuously suffered with an ailment that left him malnourished, in pain, and at risk of death from blocked intestines would you rather A) provide temporary relief twice a year forever or B) address the root cause of the ailment and cure your child permanently? Treatment only approaches dictate that answer A is what parents want for their children. Simply Smiles, and every parent with a choice, chooses answer B - a permanent and respectful cure. 

Simply Smiles President & Founder, Bryan Nurnberger with one of the children he encountered on his first trip to the Oaxacan villages. At the time, Rigoberto was suffering from severe parasitic infection. Pictured here at Thursday's clinic (5/26/16) Rigoberto is healthy and attending one of the schools Simply Smiles built in the region.

Simply Smiles President & Founder, Bryan Nurnberger with one of the children he encountered on his first trip to the Oaxacan villages. At the time, Rigoberto was suffering from severe parasitic infection. Pictured here at Thursday's clinic (5/26/16) Rigoberto is healthy and attending one of the schools Simply Smiles built in the region.

Since 2009, Simply Smiles has been working in an extremely remote mountainous area of Oaxaca, Mexico. Here we encountered poverty that was nothing less than stunning. The globalization of the coffee market over the past decades left the population of Zapotec Indians, who have lived here for centuries, in a state of near starvation. During our first visit to the region, the ubiquitous distended and hardened bellies made it immediately clear that there was also an extremely high rate of parasitic infection. While our initial response to this humanitarian emergency was swift, Simply Smiles waited until 2013 to address what we soon learned was specifically parasitic round worm infection. Why? So that we could do it right. Because truly eradicating parasitic infection necessitates complete trust from, and partnership with, the population in need. And that takes time and effort to build. So for four years we built trust by focusing on other needs in the region including distributing over 2.5 million meals and building two schools. It was not until 2013 that we were in a position to begin our eradication efforts. 

(To provide a little more insight into why we waited four years to begin the eradication program, when an infected individual is treated for parasites the medicine kills the worms and they are passed out of the body through what is often quite extreme vomiting and diarrhea. Imagine if someone you didn’t fully trust gave you a pill that had this effect on you. Treating for parasites before we had earned the complete trust of the population would have surely prevented us from being welcome in the region and therefore prevented us from providing the support the population needs.)


I have just arrived at our administrative office in Mexico after helping our team to host a medical clinic that treated 2,504 individuals for round worm infection. Treatment was the focus of this week’s work, but it is just one part of the Simply Smiles holistic plan to eradicate parasitic infection in southern Oaxaca, Mexico:

Partnership & Trust: When there is a line of 2,500+ people, you need a lot of help to manage a clinic of this size. My wife, Kristen, and I were the only Americans staffing the event. Our partnership with the local population means that we can help the people to help themselves. Villagers managed the flow of people through the clinic, translated Zapotec to Spanish at the registration table, helped to prepare and dispense the medicine, and distributed the 12 tons of food staples that are given at every clinic we host. 

Treatment: Twice a year Simply Smiles hosts a medical clinic where the population is treated for parasitic infection with the highest quality name-brand medication. 

Education: Because Simply Smiles built two schools in the region we are able to fold educational programs about how to prevent parasitic infection in the curricula. We’ve distributed thousands of informational pamphlets and hung innumerable signs. A doctor and/or nurse sees every single individual as they come through the clinics to explain what the treatment is for and why it is important. 

Prevention: One contracts round worm from contact with feces, either through lack of hand washing or as a result of open defecation. Each person receives a large bag of soap when they pass through the clinic along with instruction on how to effectively wash your hands. In an area without plumbing, construction of basic pit latrines is an economical and extremely effective way to provide sanitary facilities. To receive a latrine from Simply Smiles, a family signs out shovels and picks and then digs a 3 meter deep hole. Once completed, Simply Smiles sends our local construction workers to build a brick latrine on top of the hole. These latrines have an estimated lifespan of over 40 years. This week, we began construction of 14 additional latrines. 

Scientifically Proven Results: Simply Smiles has partnered with American and Mexican universities and pharmaceutical companies to formulate and execute our unique holistic program to eradicate parasitic infection. At the end of each calendar year, medical professionals including an infectious disease specialist, travel to Oaxaca and test stool samples from 10% of the region’s children. In 2013 the results showed a 48% infection rate. By 2015, that infection rate had dropped to 20%. Our next scientific testing will take place in November of 2016. We are hopeful that we will see an infection rate of less than 10%.

Simply Smiles, of course, will continue our efforts until eradication has been achieved and sustained. The children, families and communities in our care deserve nothing less.


For more information and photos, please visit our More Than Just Deworming webpage.