Surgeons work on a patient, in near-total darkness, at Dr. Isaac Gonzalez Martínez Oncological Hospital in San Juan, Puerto Rico. Photo: Carlos Giusti / AP

By Vann R. Newkirk II
29 October 2017

(The Atlantic) – It’s been over a month since the last of Maria’s Category 4 hurricane-strength winds swept over Puerto Rico, but there is still damage yet to come.

The darkness is persistent. Power and clean water are still tenuous and reliant on generators and outside aid. Contamination threatens basic necessities for dozens of municipalities, and the death toll—already likely a serious undercount—is only rising as diseases and the attrition from devastated infrastructure take their toll. Even with the aid of the federal government and the military, a health-care system facing multiple threats might not be able to protect some of the island’s most vulnerable citizens.

Many of those people are facing hard choices in Puerto Rico’s hospitals, which are at the front lines of disaster-relief efforts. While most hospitals have recovered from the storm’s early blows—which knocked most of them out of commission and left a few others dependant on generators—they have had to make do with shortages of power, water, and supplies; personnel crunches; and intensifying health-care needs from accidents and emergent diseases. Last week, a photograph posted by former Governor Alejandro García Padilla on Twitter showed doctors performing surgery by flashlight. From what physicians on the island tell me, such scenarios are common, as is physicians working double and triple shifts—circumstances made even more remarkable by the fact that the doctors themselves are victims of the storm.

Carolina Pichardo, a pediatrician working shifts at both the neonatal intensive-care unit at the University Pediatric Hospital in San Juan and at the pediatric emergency room at the HIMA San Pablo Hospital in nearby Caguas, is one of those doctors. Pichardo lives in a complex in San Juan where power is still tenuous, and she’s had to balance a survival routine with the extraordinary demands of her job.

During the night, when the generators run, she and her husband take cold showers; cook their canned food rations on a charcoal grill for dinner; and try to, by turns, avoid the heat and mosquitoes—keeping their door open to let in the breeze as they put their four-year-old daughter to bed, and closing it to hold off the insects. In the mornings, Pichardo sometimes braves standstill traffic in the capital’s newly congested transportation grid; sometimes it takes up to two hours just to get to Caguas, which is only 20 miles away.

At both hospitals, Pichardo has faced new challenges. At first, doctors and nurses dealt with a total collapse of power, which Pichardo said was the “scariest change” immediately after the storm. Hospitals couldn’t communicate with other hospitals; specialists often couldn’t be reached if they were needed; and patients were transferred to trauma centers or other facilities without any knowledge of whether those institutions could handle more patients.

While lines of communication have at least partially been restored, Pichardo said that problems still abound. “At this point, everything has become challenging,” she told me by email. “Many primary-care physicians are unable to provide services at their practice locations, so more and more people are using the emergency rooms for everyday medical problems. This places a larger burden on the emergency rooms and increases wait time among patients. Children have fallen behind on their immunization schedules, because either their pediatricians are not currently practicing or they have lost their refrigerated vaccines due to power outage.”

The collapse of primary-care structures on the island was a common theme of my conversations with medical professionals there. Primary care was already a bottleneck point for the Puerto Rican health-care system before this season’s hurricanes—with a mass exodus of doctors to the mainland and an increasing concentration of children, pregnant women, and elderly people back on the island. But now, with many doctor’s offices and smaller facilities closed, people with chronic health needs often have to go without care or seek it in emergency rooms, which can mean sitting in triage for hours. The shortage exacerbates the burden of both chronic and acute conditions as patients compete for space and resources. [more]

Puerto Rico's Dire Health-Care Crisis

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