Problems With Health Care Contributed To Hurricane Maria Death Toll In Puerto Rico

An estimated 3,000 people died in Puerto Rico due to Hurricane Maria. Most of those deaths occurred weeks or months after the hurricane made landfall — often because of problems with health care.

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It's been nearly 18 months since Hurricane Maria devastated Puerto Rico. The blackout after the storm caused a lot of the island's health system to collapse. For months, the Puerto Rican government insisted that fewer than a hundred people died from the disaster. Now the official estimate is nearly 3,000. Tom Dreisbach from the NPR podcast Embedded has the story of how one family navigated through the chaos.

TOM DREISBACH, BYLINE: Zaida Maldonado has lived most of her life in the mountains in the middle of Puerto Rico along with her husband, Luis, and her two kids and their dogs.

(SOUNDBITE OF DOG BARKING)

ZAIDA MALDONADO: (Speaking Spanish).

DREISBACH: One of her kids, Javier, was born in 1999, and he was diagnosed with a rare genetic disorder called Smith-Lemli-Opitz syndrome.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: When he was a toddler, a doctor only gave Javier a couple years to live. But Zaida told me through an interpreter that the doctor was wrong.

Z. MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: So she feels it's a sign from God that he wants to stay on this earth with her.

DREISBACH: Still, Javier could not talk or walk. The only way he was able to breathe was with a ventilator which pumped air into his lungs through a tube in his throat, and that ventilator ran on electricity. Then comes September 2017.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED NEWS ANCHOR: (Speaking Spanish).

DREISBACH: Two days before hurricane Maria is set to make landfall, Zaida says she gets a call from Puerto Rico's Health Department. The health official says that they should go to the local emergency room before the storm. They say if the power goes out, the ER has backup supplies plus its own generator. So Zaida, her husband and her two kids go to the ER, and the hurricane makes landfall.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: (Speaking Spanish).

DREISBACH: By midday, the entire island has lost power.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: (Speaking Spanish).

DREISBACH: All communication goes down - no landlines, no cellphones. Inside the ER, Zaida and her family are actually feeling OK. The generator kicks on, and there's electricity to power Javier's ventilator. But over the next few days, things start to change.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: Zaida says food, water and medical supplies are starting to run low, and even though the roads are flooded, Luis, Zaida's husband, takes the risk of driving home to get more supplies. Then a few hours later, a nurse comes to Zaida and says there's a problem. The ER has to shut down the generator. If they just leave it on, it will overheat and blow out. They can't take care of Javier anymore. And the family has to leave within about two hours.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: Zaida says, we have to wait for my husband, but the nurse says there's no time. Zaida has a car there, but she's terrified of driving through the flooded roads. So the staff at the ER managed to call an ambulance to transfer them to a hospital the next town over.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: But then the ambulance won't take them.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: The paramedic says that transferring patients from hospital to hospital is not an emergency.

Z. MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: She doesn't know how in such a moment you could be so inhumane.

DREISBACH: In the end, despite the danger, Zaida decides to drive herself and her two kids to the second hospital. They load up into Zaida's car where there's a special plug that connects Javier's ventilator to the engine. The hospital in the town of Aibonito is much larger, so Zaida expects it will be more prepared. After all, this is where they were told to go.

Describe just what it looks like at the hospital in Aibonito.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: "Total chaos."

Z. MALDONADO: (Speaking Spanish).

DREISBACH: Zaida says there were people screaming, people asking desperately for dialysis or insulin for their diabetes or the chemotherapy drugs to treat their cancer. But this hospital does have the one thing Zaida desperately needs right now - electricity. And at this point, that actually makes it an outlier. Almost a week after the hurricane made landfall, FEMA said only 11 out of 69 hospitals either had electricity or fuel for generators. That means the vast majority had no power for basics like X-rays, IVs, sterilized operating rooms or ventilators.

Meanwhile, Luis, Zaida's husband, is searching for his family, and he finds them at the hospital. But the relief of finding each other doesn't last long. Javier has a weak immune system, and the hospital is a breeding ground for the sort of bacteria that could kill him. So after about five days in this hospital, Zaida and Luis decide the safest thing...

Z. MALDONADO: (Speaking Spanish).

DREISBACH: ...Is to just go home.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: They do not have electricity there, but they do have a generator. So now the goal of every day is to find enough diesel to keep it running. They scrape by on donations. They get some money from FEMA, but Luis says it's not enough. And from September 2017 until the next February, they do not have power. One night, Luis is checking on the ventilator, and Javier starts having convulsions. Then he stops breathing. Luis starts CPR. Several minutes go by.

Did you think he could pass away in that moment?

LUIS MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: Yeah.

L. MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: We're conscious of in any moment that could happen.

DREISBACH: Finally Javier's lungs and heart start working again. He's alive. But Luis is just fed up.

(SOUNDBITE OF ARCHIVED RECORDING)

L. MALDONADO: (Speaking Spanish).

DREISBACH: So he goes to a radio station to try to talk about Javier's story. They actually put him on.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED RADIO HOST: (Speaking Spanish).

L. MALDONADO: (Speaking Spanish).

DREISBACH: The host says, so you've been without running water or electricity for more than 130 days. And Luis says, yeah. Then the host asks how Javier is doing.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED RADIO HOST: (Speaking Spanish).

L. MALDONADO: (Speaking Spanish).

DREISBACH: Luis says, "Javier is stable. Thank God he's stable." But they need help, and his visit to the radio station actually works. It takes about a month, but a volunteer crew from a power company in Illinois helps fix the grid in their neighborhood.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #3: (Speaking Spanish).

DREISBACH: There's this video of the moment when Zaida and Luis finally flip the circuit breaker on at the house.

(CHEERING, APPLAUSE)

DREISBACH: As the lights come on, Zaida covers her face with her hands and starts to cry. They have power, and Javier is alive. But of course they know how close they came. Thousands of people did not survive the storm and its aftermath.

OMAYA SOSA PASCUAL: Most people that died did not die those first 72 hours. They died weeks and months after.

DREISBACH: Omaya Sosa Pascual runs Puerto Rico's Center for Investigative Journalism, and she says of course a massive hurricane is always going to be bad. But she says many deaths were a result of the failures by both the Puerto Rican and federal governments, from the lack of disaster planning to the inaccurate death toll that minimized the scale of the disaster to the disorganized effort to restore power.

PASCUAL: That's not part of the nature. That's part of the human incompetence.

DREISBACH: President Trump has rejected any criticism and says the federal government's response was a quote, "10 out of 10." Puerto Rico's governor, Ricardo Rossello, did not respond to our requests for comment. But in the past, he has said he takes responsibility for his government's failures. But the key to preventing another disaster like Hurricane Maria is a working, resilient power grid. And Puerto Rico still does not have that. When I was talking to Zaida Maldonado, all of a sudden she had to interrupt the interview.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: The power actually went out. She had a check on Javier and make sure the generator was working. She says this still happens a lot.

Hurricane Maria is not over for you yet.

Z. MALDONADO: (Speaking Spanish).

DREISBACH: She says they're reliving it again. Tom Dreisbach, NPR News.

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