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SAN JUAN, Puerto Rico — Two weeks after Hurricane Maria toppled Puerto Rico's …
Hurricane Maria left a path of destruction in Puerto Rico, leaving
most of its citizens without access to electricity and clean drinking
water. The island's residents talk about their daily struggle to survive
and make end's meet.
USA TODAY
SAN
JUAN, Puerto Rico — Two weeks after Hurricane Maria toppled Puerto
Rico's communications towers, wrecked its electrical grid and knocked
out power to water systems, medical officials said the island's health
system is "on life support."
"We have
hospitals that are working, but eventually we are going to have to
transfer patients," said Carlos Méndez, an associate administrator at
the Auxilio Mutuo Hospital, one of the island’s top medical facilities,
in the Hato Rey district of San Juan.
Among the multiple impacts that have left the island’s medical system deeply damaged:
-Patients
are dying because of complications related to the primitive conditions
and difficult transportation issues so many island residents now endure.
-A lack of transportation in small towns makes it difficult to transfer patients to larger hospitals.
-An
administrator in a small-town hospital has to drive her car to an
ambulance company a mile away to ask for a patient to be transferred to a
larger hospital.
-Severe
lack of communications on the island has resulted in less triage and
coordination between hospitals, and more patients arriving at large
medical centers than usual, which has stretched capacity.
-Doctors
are afraid to discharge patients after surgery to places with
unsanitary conditions and where care and transportation may not exist,
adding strain to an already strained system.
On
Wednesday, health officials in Puerto Rico toured the 1,000-bed U.S.
Naval Hospital Ship Comfort as it docked in San Juan, the capital. It is
the largest floating medical facility in the U.S. military and the ship
will be used to help deal with the medical crisis facing this island of
3.4 million residents.
Puerto
Rico has 69 hospitals. The total number of hospitals operating at least
partially is 64. Of those, 17 are connected to the grid. The rest are
operating with generators, according to the office of Gov. Ricardo
Rosselló. The island’s cellular system is still crippled, with 14% of
antennas and 26% of cellular towers operating, according to the web site
status.pr.
Méndez, whose hospital has Puerto
Rico's only fully functioning ward for cardio-thoracic surgery — for
treatments inside the chest — said the U.S.S. Comfort’s arrival comes
as the island's health system "right now is on life support."
Getting water, needing an ambulance
Across
the island in the hill town of Adjuntas, near Puerto Rico’s southern
coast, doctors and nurses at the Adjuntas medical center celebrated
Sunday the first shipment of water since Hurricane Maria blasted the
town.
But the celebrations were cut short
when Gladys Galarza, a nurse, brought a patient's electrocardiogram
(EKG) chart to emergency room physician, Jorge Gagos.
The chart showed an abnormal rhythm.
The
patient, an elderly woman with a history of heart trouble who was
complaining of chest pains, needed a better-equipped hospital — and an
ambulance to get there.
"We have a sick person and
no ambulance," Gagos said. "Normally we have a phone to call. The
nearest ambulance is one mile away."
Lacking a
radio or a satellite phone, Gagos asked a hospital administrator to get
in her car and deliver the message to the ambulance company, a private
contractor. That led to an argument over payment. Eventually, after more
than an hour, the ambulance showed up and took the woman to San Lucan
Hospital in Ponce.
Broken communications leave doctors in the dark
As
he prepared to tour the Comfort, Carlos Gomez Marcial, emergency
medical director at Centro Medico de Puerto Rico, the island’s top-level
trauma center, listed the top challenges facing patients and hospitals:
Water, food, communications.
"We can’t communicate
with anybody," Gomez Marcial said. "Less than 10% of communications
towers are standing. For command and control, it’s very hard to get
things done without communications."
As a result,
administrators cannot plan for receiving new patients. And without
communications, the process that usually results in triaging patients
based on how sick they are, and available beds in trauma hospitals,
doesn’t work.
Centro Medico de Puerto Rico operated
on generator power for three days after the storm, and contended with
water shortages. It was finally connected to the grid on Saturday and is
now nearing capacity.
After touring the floating
hospital, Gomez Marcial said he would confer with other hospital
officials on which patients to transfer.
"When they
arrive by helicopter there’s no way to turn them away," added Juan
Angel Nazario Fernandez, Centro Medico de Puerto Rico's senior medical
officer.
Outside, in a series of tents set up in
the hospital's parking lot, a low-level treatment center run by the U.S.
Department of Homeland Security’s Disaster Medical Assistance Team
(DMAT) is attempting to relieve some of that pressure.
“Our
mission here is to decompress the emergency room,” said Lesa Ansell of
Dallas, Tex., DMAT’s chief nursing officer here, and part of one of 18
teams across the island.
“We triage patients, treat some here, and send trauma and surgery patients inside."
Bad conditions, sicker patients
Orlando
López de Victoria, the only cardio-thoracic surgeon still on the
island, said more patients have arrived sicker than usual because of the
difficult conditions.
Some have died.
On
Monday, he operated on a patient whose transfer to Auxilio Mutuo in
Hato Rey was delayed because there was no gasoline. By the time she
arrived, her heart was so weak she didn't survive the operation.
On
Tuesday, Gov. Ricardo Rosselló raised the death toll from Hurricane
Maria from 16 to 34, citing several similar cases as part of the reason
for the increase.
"Yesterday, one of my patients
came with a very infected wound because he has no water to take a
shower," López de Victoria said.
Other cardiac surgeons left the island before the hurricane.
"I decided to stay because I love my country, my family and my patients," he said.
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