Hurricane Maria Aftermath

10/5/2017 (Permalink)

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 in Hato Rey, one of the island’s top medical facilities. 

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.

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 Wednesday 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.

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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