Puerto Rico’s health system in critical condition

World
Europe

Puerto Rico's medical services are in critical condition in the wake of Hurricane Maria. The strongest storm to hit the island in decades has left hospitals flooded, strewn with rubble and dependent on diesel generators to keep the neediest patients alive.

The precarious shape of the island’s medical facilities is adding to the misery and devastation of this U.S. territory, whose 3.4 million residents are American citizens.

For some, the only option is to evacuate to the United States for treatment.

Nurses and patients are seen at the Medical Center, in San Juan, Puerto Rico September 23, 2017. /Reuters Photo

Among them is Cheira Ruiz and her baby girl Gabriellyz, who was born two weeks ago with a serious heart defect.

The newborn was admitted to the Centro Cardiovascular de Puerto Rico in the capital shortly before Maria slammed into the island last Wednesday, but it was impossible for doctors to operate in such precarious conditions.

Gabriellyz was among the first infants cleared to take a medical flight out of Puerto Rico since the storm.

In the days since the storm, the island's residents have awakened to an altered reality.

Food is in short supply. The island's electrical grid is down and may remain so for months. Motorists and pedestrians queue for blocks trying to secure scarce fuel to power vehicles and generators.

Hurricane Maria pummels Puerto Rico with powerful winds on September 20, 2017. /Photo from The Washington Post

Cellular service, Internet, and email have virtually disappeared, hurling a modern society into a bygone era; radio has become a primary source of information.

For hospitals across this region, the challenges are mounting. After the power went out, backup generators at some hospitals failed quickly. Other hospitals are running critically low on diesel.

Fuel is so precious that deliveries are made by armed guards to prevent looting, according to Dr. Ivan Gonzalez Cancel, a cardiovascular surgeon, and director of the heart transplant program at Centro Cardiovascular.

“Another hospital wants to transfer two critical patients here because they don’t have electricity,” Gonzalez Cancel said.

Medical staffers are also running low on gasoline for their daily commutes to work. Puerto Ricans are queuing as long as seven hours at the island's few functioning filling stations.

Doctor's orders: "Leave"

Fuel is just the beginning. The cardiovascular center was “in shambles,” Gonzalez Cancel said.

Without air conditioning, the walls of the operating room were dripping with condensation and floors were slippery, he said. Most patients had been discharged or evacuated to other facilities, but some patients remained because their families could not be reached by phone.

Reuters Photo

On the sidewalk outside the cardiac center on Saturday, Jorge Rivera and his wife Dorca approached Gonzalez Cancel to ask about the woman’s father, a patient still inside waiting for triple-bypass surgery.

The couple are residents of Savannah, Georgia who was in Puerto Rico to care for their loved one. With the hospital scaling down operations and the island's infrastructure on its knees, Gonzalez Cancel estimated he would not perform another open heart surgery for a month or more.

His advice to the couple: leave. “I am talking to you, not as a physician, I am talking to you as a human being,” he said.

“Get him on a plane. You can be in Miami in two and a half hours.” But leaving is not simple. With the island's main airport still crippled, Gonzalez Cancel said he needed to secure a special waiver from authorities to obtain the medical evacuation flight for baby Gabriellyz.

"People are going to start dying"

Officials here expect the situation at Puerto Rico's hospitals could worsen before it improves.

At Centro Medico, the island's largest public hospital, the disaster medical assistance team of the U.S. Department of Health and Human Services is setting up makeshift hospital units.

Residents seek shelter inside Roberto Clemente Coliseum in San Juan, Puerto Rico, early on September 20, as Hurricane Maria struck the island. /AFP Photo

“I think this might be a calm before we see an influx as other hospitals lose generators,” said Commander Michael Garner, a regional coordinator for the effort.

The devastation caused by Maria is similar to that wrought by hurricanes Katrina, Harvey and Irma. But Puerto Rico’s remoteness, lack of communications and fragile infrastructure exacerbate the logistical challenges of recovery “on a very grand scale,” Garner said.

At least 10 people have died so far in Puerto Rico, where the humanitarian crisis is growing.

CNN Photo

The Federal Emergency Management Agency has been posting images on Twitter of U.S. responders on the ground in Puerto Rico, including the U.S. Coast Guard and FEMA search-and-rescue teams.

But patience is starting to fray with the speed of the aid response.

"We need a massive military response," surgeon Gonzalez Cancel said. Waiting for news about his father-in-law, Rivera, the Georgia resident and a 49-year-old Iraq War veteran, said the U.S. military could only do so much.

"You need God pretty much to fix every light bulb," he said.

Dr. Juan Carlos Sotomonte, the medical director of the Centro Medico's cardiovascular unit, said intervention – divine or otherwise – is needed fast.

"If this is not taken care of, people are going to start dying," he said.

13557km

Source(s): Reuters