In Puerto Rico You can`t get sick now

Is­land’s health care still stag­ger­ing in af­ter­math of Maria.

Dayton Daily News - - NATION - Frances Robles ©2017 The New York Times

CAGUAS, PUERTO RICO — Harry Figueroa, a teacher who went a week with­out the oxy­gen that helped him breathe, died here last week at 58. His body went un­re­frig­er­ated for so long that the funeral di­rec­tor could not em­balm his badly de­com­posed corpse.

Miguel Bas­tardo Beroa’s kid­neys are fail­ing. His physi­cians at the in­ten­sive care unit at Doc­tors Hospi­tal in Carolina are treat­ing him for a bac­te­rial dis­ease that he prob­a­bly caught in flood- wa­ters con­tam­i­nated with an­i­mal urine.

José L. Cruz wakes up in the mid­dle of the night three times a week to se­cure a spot in line for dial­y­sis. His treat­ment hours have been cut back to save fuel for the gen­er­a­tors that power the cen­ter.

“Be­cause of the elec­tric­ity sit­u­a­tion, a lot of peo­ple died, and are still dy­ing,” said Figueroa’s daugh­ter, Lisan­dra, 30. “You can’t get sick now.”

Nearly three weeks af­ter Hur­ri­cane Maria tore through Puerto Rico, many sick peo­ple across the is­land are still in mor­tal peril. The gov­ern­ment’s an­nounce- ments each morn­ing about the re­cov­ery ef­fort are of­ten up­beat, but be­yond them are hid­den emer­gen­cies. Se­ri­ously ill dial­y­sis pa­tients across Puerto Rico have seen their treat­ment hours re­duced by 25 per- cent be­cause the cen­ters still lack a steady sup­ply of diesel to run their gen­er­a­tors. Less than half Puerto Rico’s med­i­cal work­force has re­ported to work in the weeks since the storm, fed­eral health of­fi­cials said.

Hos­pi­tals are run­ning low on medicine and high on pa­tients, as they take in the in­firm from med­i­cal cen­ters where gen­er­a­tors failed. A hospi­tal in Hu­macao had to evac­u­ate 29 pa­tients last Wed­nes­day — in­clud- ing seven in the in­ten­sive care unit and a few on the op­er­at­ing ta­ble — to a U.S. mil­i­tary med­i­cal ship off the coast of Puerto Rico when a gen­er­a­tor broke down.

There are ur­gent at­tempts to help. The fed­eral gov­ern- ment has sent 10 Dis­as­ter Med­i­cal As­sis­tance Teams of civil­ian doc­tors, nurses, paramedics and others to the is­land. Four mo­bile hos­pi­tals have been set up in hospi­tal park­ing lots, and the USNS Com­fort, a med­i­cal ship, is on the scene. A 44-bed hos- pital will soon open in badly wrecked Hu­macao, in the south­east.

But even as the A rmy Corps of Engi­neers is in­stall- ing dozens of gen­er­a­tors at med­i­cal fa­cil­i­ties, and util­ity crews work to restore power to 36 hos­pi­tals, doc­tors, phar­ma­cists and pa­tients say that an in­tense med­i­cal cri­sis per­sists and that com- mu­ni­ca­tions and elec­tri­cal dif­fi­cul­ties have ob­scured the true num­ber of fa­tal­i­ties di­rectly re­lated to the hur­ri­cane. The of­fi­cial count rose Tues­day to 43.

Match­ing re­sources with needs re­mains a prob­lem. The Puerto Rico De­part- ment of Health has sent just 82 pa­tients to the Com­fort over the past six days, even though the ship is staffed to serve 250. The ship’s 800 med­i­cal per­son­nel were treat­ing just seven pa­tients Mon­day.

The mayor of Canó­vanas, in the north­east part of the is­land, re­ported over the week­end that sev­eral peo­ple in her city had died of lep- tospiro­sis, the bac­te­rial dis­ease Bas­tardo is be­lieved to have caught from the flood­wa­ters. The Puerto Rico Depart­ment of Health said Sun­day night that sev­eral cases were be­ing eval­u­ated, but that lab tests had not yet come back to con­firm the di­ag­no­sis. At the same time, the agency urged peo- ple to drink only bot­tled wa­ter and to wear pro­tec­tive shoes near bod­ies of wa­ter that could be con­tam­i­nated with an­i­mal urine.

Car­men C. Deseda, the Puerto Rico state epi­demi- ol­o­gist, said that six peo­ple were be­ing treated for lep­tospiro­sis, even though test re­sults to con­firm the di­ag­no­sis would not be com­plete for an ad­di­tional week or two. Puerto Rico usu­ally sees a few dozen cases a year and per­haps one death, but of­fi­cials are ex­pect­ing an in­crease be­cause of the flood­ing.

Forty per­cent of the is­land still lacks run­ning wa­ter, be­cause of the black­out, which still af­fects 85 per­cent of the is­land. As a re­sult, many peo­ple are bathing in streams and re­ceiv­ing non- potable wa­ter from huge tanks.

Yarelis Rosa, 37, said her hus­band, Bas­tardo, was in­fected be­cause he had cut his hand a few days be­fore the storm and the cut had not fully healed when he spent hours in the flood- wa­ters try­ing to es­cape his home in Canovanas. A few days later, Bas­tardo’s head, feet and knees hurt and his tem­per­a­ture soared to 106 de­grees. She took him to the hospi­tal more than a dozen times, she said.

“IV, in­jec­tion, go home. IV, in­jec­tion, go home. IV, in­jec­tion, go home,” Rosa said, de­scrib­ing the re­volv- ing door of med­i­cal treat­ment.

He was in­tu­bated Fri­day, she said, the same day that the pa­tient next to him died of the same ill­ness.

“Ner­vous? It looked like a ...(Con­tin­ued on next page)

war zone, where you have to evac­u­ate to save your life,” she said, de­scrib­ing the scram­bling doc­tors. “The politi­cians say that ev­ery­thing is fine be­cause they have nice places to live. Why didn’t they bring Don­ald Trump here?”

In Caguas, a city of 142,000 south of San Juan, the mu­nic­i­pal 911 man­ager, José Ora­mas, said that city am­bu­lances had re­sponded to at least four calls since the storm where a pa­tient who had lost power for oxy­gen tanks or ven­ti­la­tors had died. At Hima Hospi­tal in Caguas, doc­tors de­ployed by the fed­eral gov­ern­ment are treat­ing pa­tients un­der an air-con­di­tioned tent in the park­ing lot. But a health pro­fes­sional from another team, who was not au­tho­rized to speak pub­licly, said many of the teams were not see­ing pa­tients and felt pow­er­less to help with the main need, which is a sta­ble power sup­ply.

“It’s very crit­i­cal,” said Maria Ja­cobo, the ad­min- is­tra­tor of Hima Hospi­tal. “The whole is­land is crit­i­cal, es­pe­cially for oxy­gen.”

The sit­u­a­tion is par­ticu- larly se­ri­ous for Puerto Rico’s 6,000 dial­y­sis pa­tients.

On its hur­ri­cane up­date web­site, the Puerto Ri­can gov­ern­ment says that all 46 dial­y­sis cen­ters on the is­land have re­ceived as­sis­tance, and the Depart­ment of De­fense counts 43 cen­ters as op­er­a­tional. The web­site does not men­tion that the diesel fuel short­age is still so se­vere that many pa­tients whose blood is nor­mally cleaned for 12 hours a week are now be­ing treated for only nine.

“At one point, the gov­ern­ment said the dial­y­sis sit­u­a­tion was con­trolled and the fa­cil­i­ties were get­ting diesel,” said Lisan­dro Mon­talvo, the med­i­cal di­rec­tor of Fre­se­nius Med­i­cal Care North Amer­ica, a chain of dial­y­sis cen­ters here. “But they maybe sup­plied diesel to three or four fa­cil­i­ties, and we have 26 fa­cil­i­ties. We talk to FEMA ev­ery day. It’s al­ways an emer­gency. We have to say: ‘These three are low, please.’ Some­times they fill it, and some­times they don’t.”

Ri­cardo Ros­selló, the gov­er­nor of Puerto Rico, said Mon­day that the au­thor­i­ties were do­ing their best to stave off a pub­lic health dis­as­ter. About 70 per­cent of the is­land’s phar­ma­cies had re­opened, he said, and a spe­cial hot­line had been es­tab­lished for peo­ple to re­ceive in­sulin. He added that dial­y­sis cen­ters were “in the loop” for fuel and gen­er­a­tor re­pairs and main­te­nance, and sev­eral pa­tients had been evac­u­ated to the main­land United States.

Lt. Gen. Jef­frey Buchanan, who leads the mil­i­tary ef­fort on the is­land, said that sev­eral hos­pi­tals had sus­tained struc­tural dam­age in the storm, and that even those that are of­fi­cially listed as open face se­ri­ous lim­i­ta­tions.

“De­fine ‘open.’” Buchanan said. “The fact that they are pro­vid­ing treat­ment is one thing. Are they tak­ing new pa­tients? I won’t feel com­fort­able un­til the hos­pi­tals are back on the grid and they have suf­fi­cient medicines across the board.”

DEN­NIS M. RIVERA PICHARDO PHOTOS / NEW YORK TIMES

Dr. Stephanie Flood ex­am­ines Irma Ro­driguez’s legs, which were cov­ered in fes­ter­ing mos­quito bites, in Caguas, Puerto Rico.

Flood­ing in Canovanas, Puerto Rico, af­ter Hur­ri­cane Maria. Nearly three weeks af­ter the storm, sick peo­ple across the is­land are still in mor­tal peril.

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