'There's a long way to go': Mount Sinai volunteer reflects on health, infrastructure issues facing Puerto Rico in Maria's aftermath
A team of 10 medical volunteers from Mount Sinai Health System in New York City completed a two-week mission in Fajardo, Puerto Rico, to help the Disaster Medical Assistance Team (DMAT) provide clinical care to over 1,600 patients.
The team arrived Oct. 12 and found that more than a month after Hurricane Maria hit the island, many patients were still seeking treatment for the exacerbation of chronic conditions and illness due to poor living conditions.
“It was a result of lack of access to primary care providers; people would be running out of their chronic medications,” said Dr. Emma Kaplan-Lewis, an assistant professor of infectious diseases at the Icahn School of Medicine at Mount Sinai, and one of the members of the medical volunteer team. “Almost all primary care doctors’ offices are closed.”
In this Oct. 19, 2017 photo, homes in the Cantera area are covered with FEMA tarps, where buildings from the Hato Rey area stand in the background in San Juan, Puerto Rico. More than 40 percent of the island lives below the poverty line, and tens of thousands are now out of work. (AP Photo/Carlos Giusti)
Other complications were due to the lack of access to healthy foods. Most people are eating canned foods or MREs (meals ready to eat), both of which consist of foods extremely high in salt.
“For an average person, that’s not a big deal but for somebody with cardiac conditions that becomes a problem,” Kaplan-Lewis said.
Many other patients came in with injuries related to clearing debris. Kaplan-Lewis listed machete injuries, chainsaw injuries and back strains as common issues.
A lack of access to clean water and crowded living conditions led to many patients visiting the clinic with infectious diseases. Contact with floodwaters led to issues such as outer-ear infections, cellulitis and other skin infections.
“We saw a bit of everything, but that’s the highlight of the high-volume stuff,” Kaplan-Lewis said.
An exterior view of the volunteer housing tent. (Mount Sinai Health System)
The team worked 12-hour shifts for two weeks, treating almost 200 patients a day.
“At the end, I felt very bittersweet about coming back [to New York],” Kaplan-Lewis said. “There’s still a lot more that needs to be done."
Mount Sinai has sent a second team of 10 medical volunteers. The second team arrived on Oct 24., just as the first team was preparing to leave the island. The two Mount Sinai teams are a part of a larger group of 70 medical professionals from New York state.
Though the 12-hour shifts are not extraordinarily different from their normal nine- to 11-hour shifts in New York in terms of length, the team experienced differences in other facets of the trip. Kaplan-Lewis cited that she had to adjust to the setup, available medications and increased volume of patients.
Another adjustment was the shaky power that would shut off for at least a few minutes every day. When the generator-based power would turn back on, everything would have to be rebooted.
The setting, tents set up by the Disaster Medical Assistance Team, was another major adjustment for the medical volunteers and also, as it turns out, for the community as well.
“Initially, there was some fear of the tents because the National Guard was there and the community people weren’t sure what was going on,” Kaplan-Lewis said.
A team of community students who volunteered to translate or register patients helped to diminish some of this apprehension.
“That engendered a ton of trust in the community,” Kaplan-Lewis said. “We’d even see people come back not as patients but bringing their loved ones in.”
The team experienced firsthand the struggles that many Puerto Rico residents are dealing with on a day-to-day basis.
“Being able to take more than a five-minute shower, having warm water, eating fresh fruit and vegetables… stuff like that that did not happen for two weeks,” Kaplan-Lewis said. “You just realize how big a deal it is.”
Kaplan-Lewis and the rest of the team were thankful that they were able to provide help without any complications with their work schedules. However, they realize that there is much more recovery work to be done on the island.
“There’s a long way to go, but I am hoping that with the increased media and public attention its receiving that more and more people will help and Puerto Rico will get the attention it deserves,” Kaplan-Lewis said.
Some issues on the island are more pressing to focus on than others, according to Kaplan-Lewis.
“Access to power that’s stable and clean water are really the most important things, and some infrastructural issues like the electrical grid need to be worked on,” Kaplan-Lewis said. “Otherwise, everything else is going to be in response, reactive and not proactive.”
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