Three months ago, Hurricane Maria devastated Puerto Rico. The health toll has been substantial, with reports of increased water-borne infections and storm-related deaths. For a time, hospitals lacked a working power grid and many outpatient facilities were shuttered.
Now, the health care system is slowly improving. Hospitals have reopened and patients are returning to doctors’ offices and clinics.
To get a sense of the current health status, U.S. News caught up with a family doctor and an island resident who previously described their struggles in the immediate Maria aftermath. In addition, physicians treating veterans and a medical volunteer talked about progress made and ongoing challenges.
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Dr. Asa Oxner has traveled to the island twice since Hurricane Maria with Doctors for Puerto Rico. Next time, she’ll be telecommuting.
On her mid-November trip, conditions were much better than what the group found during their humanitarian visit in early October, says Oxner, who is an assistant professor of general internal medicine at the University of South Florida.
All hospitals and most clinics were open. “All of the pharmacies were open and they were actually very well-stocked with medicines,” Oxner says. However, shortages of asthma medicines and devices persisted, along with some types of insulin to manage diabetes.
As of Dec. 14, about 64 percent of the island’s residents had power, according to the latest figures posted on a Puerto Rican government site. Problems with refrigeration and lack of clean water pose a threat. “Even in places that have water — but don’t have a water pump to actually get it to flow — they’re recycling standing water, which leads to a lot of health problems as well,” Oxner says.
Increased rates of leptospirosis, an infection spread by rats and other animals sharing the same water supply with humans, is one result. “They luckily have not had cases of cholera or other bacterial water-borne illnesses,” Oxner adds, thanks to residents’ diligence in boiling water and thoroughly cooking food.
Standing water on the ground presents the threat of mosquito-borne illnesses. So far, Oxner says, there have been no cases of malaria or West Nile disease, but Zika infection is a continuing problem. “There was Zika even before the hurricane and they haven’t updated the statistics about the number of cases since then,” she says.
With medical facilities reopened on Oxner’s second visit, she partnered with VarMed Clinic in San Juan, where she was inspired by the efforts she saw. Staff members shared clothing among themselves, washing and recycling garments so people could work their shifts. “They were putting everything out there for the patients and doing an awesome job,” she says.
Doctors for Puerto Rico continues to send in between 1,000 and 2,000 pounds of medications and other supplies weekly through a partnership with a medical-supply company. They’re now planning to use telehealth to connect patients to specialists in the University of South Florida system.
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Leaving the Island
After Maria, traveling out of Puerto Rico was a feat in itself. Heida Stearns Rivera, 81, and her son Paul Stearns encountered one difficulty after another as they tried obtain transportation out of her island municipality of Vieques to the San Juan hub, then find a flight from Puerto Rico to the mainland.
Airline pet embargos on commercial flights added another wrinkle. That meant they couldn’t take along Irma Maria , the dog they’d adopted off the street. “Leaving her behind would be a death sentence,” Stearns Rivera says. Eventually, she says, “Feeling stranded and hopeless, we had to charter a plane for $1,000 to get us and our pet to San Juan so we could catch our flight back to the mainland U.S.”
There, the three settled in Paul Stearns’ suburban Maryland home. For Stearns Rivera, keeping up with her routine medication regimen is a problem. Prescriptions she took with her from her doctor in Vieques have now run out. She and staff at the nearby Maryland pharmacy have tried to contact the doctor to no avail. Another family member who is returning from Puerto Rico will attempt to get a prescription renewal.
Life isn’t how it used to be. “Even though I am living with my son, I feel strange,” she says. “I have everything I need but it is still not my home. I miss the weather and sitting on the porch enjoying it.”
Once the situation with electricity, water and transportation improves, she intends to move back to Vieques. “When I can finally return, the first thing is I will go to church and thank God for letting me come back,” she vows. “After that, I will take care of fixing my home from the hurricane damage.”
No ‘Normal’
“Our clinic was gutted and destroyed.” That sight greeted Dr. Julia Bonilla, director of the Arecibo Community Based Outpatient Clinic, part of the Veterans Affairs Caribbean Healthcare System, after Hurricane Maria hit. Since then, she and her resilient staff continue serving U.S. military veterans in Puerto Rico.
For five weeks, the staff saw patients in a mobile unit assembled in the clinic’s parking area. Nurses, doctors, social workers, nutritionists and psychiatrists brought in water and sandwiches to share with each other and with patients who came by for care. “It was under abnormal conditions, but we did what we had to do,” Bonilla says. With outdoor temperatures climbing above 100 degrees, staff members had to acclimate.
On Oct. 25, the Arecibo clinic facility was upgraded as staff moved into a Western Shelter system. “It’s a huge tent with an air conditioner,” Bonilla explains. “It’s much better than what we had the first five weeks.” They’re now seeing 80 to 100 patients daily, with full services available. However, with transportation issues for staff members and sluggish internet capabilities at work, they’re not yet up to full speed.
“There’s no such thing as ‘normal’ in Puerto Rico now,” Bonilla says. Nevertheless, she adds, “We’re doing our work. I’m very proud of my staff.”
In several ways, being part of the huge network of VA hospitals on the mainland has buffered Puerto Rican facilities from shortages of critical supplies, says Mary Kay Rutan, a VA spokeswoman, as have incoming resources from the federal, state and local governments, and community partnerships.
Emergency preparedness meant bringing patients relying on mechanical ventilators or oxygen concentrators to area hospitals in advance of the hurricane, says Dr. Carmen Lozada-Aleman, the assistant chief of staff for geriatric and extended care with the VA Caribbean Healthcare System.
Older patients in the VA system ready to be discharged from hospitals but still needing home-health care faced different issues: “They were unable to go back to their home, because they had no home,” Lozada-Aleman says. With failing communication networks, it was hard to reach out to other family members. Such patients, as well as those receiving hospice care who needed special attention, were housed in the San Juan VA Community Living Center.
Still, progress is being made, Lozada-Aleman points out. Last week, for example, the VA’s Ponce Outpatient Clinic reopened its doors to patients.
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Being located in a major metropolitan area is a plus in terms of post-hurricane health care recovery, says Dr. Helen Rosa, a geriatrician and family practitioner at Plaza Las Americas in San Juan. She’s thrilled to have working electricity back, at least in her office. She’s heard of specialists in less-central practices, still lacking power, who’ve had to see patients in their cars.
Life hasn’t returned to normal for Rosa’s patients, either. Many continue to lack either electricity, water or both at home. Many feel worn down. “It’s curious,” she says. “The patients between 30 and 50, or 60, are really the most stressed and tired. Older patients are stressed out, too, but I guess they say, ‘You know, when I was younger, we went through things very similar to this.'”
Among her elderly patients, Rosa says, more than half have left for the mainland U.S. to stay with relatives in Texas or Florida: “That has been an escape route,” she says.
It’s been hard for patients with Alzheimer’s disease or other cognitive problems, Rosa says. Many are more confused, especially with the disorientating loss of electricity. “Then we have patients who are losing weight, and that’s not something I would want elderly patients to do,” she says. However, it’s good to see patients return, Rosa says, catching up with missed appointments and getting back on track with their medical care.
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Health Recovery in Puerto Rico: A Work in Progress originally appeared on usnews.com
