In Puerto Rico You can`t get sick now
Island’s health care still staggering in aftermath of Maria.
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.”
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.