112 Degrees With No Water: Puerto Rican Hospitals Battle Life And Death Daily

Enlarge this image toggle caption Carol Guzy for NPR Carol Guzy for NPR

Every day across Puerto Rico, with its shattered power grid, hospitals are waging a life-and-death battle to keep their patients from getting sicker in the tropical heat. Now two weeks after the storm, about three-quarters of Puerto Rico's hospitals remain on emergency power. This creates dangerous conditions for critically ill patients.

At the Pavia Arecibo Hospital, about an hour west of San Juan, administrator Jose Luis Rodriguez wipes sweat from his worried brow. "We don't have any air conditioning," he says. "We can handle maybe a week, but it's already been two weeks almost."

The government calls them "indirect deaths" – those who died after the violent storm: heart attack victims, people on kidney dialysis machines that failed, people who fell off roofs inspecting storm damage, and people killed in auto accidents on highways made more treacherous from Maria's destruction.

"So far after the storm we have had 49 dead bodies," says Rodriguez. Earlier this week, the governor of Puerto Rico raised the official fatality figure for Hurricane Maria from 16 people to 34. But with unofficial reports like the one from Arecibo, that number is expected to rise.

Enlarge this image toggle caption Carol Guzy for NPR Carol Guzy for NPR

Enlarge this image toggle caption Carol Guzy for NPR Carol Guzy for NPR

The fourth floor of the Arecibo hospital has now been taken over by stocky mid-westerners in khaki pants, black boots and T-shirts emblazoned with DMAT, for Disaster Medical Assistance Team. It's a kind of National Guard for reservist medical workers that falls under the Department of Health and Human Services.

Chief medical officer of this DMAT currently deployed to Arecibo is Dr. Melissa Stein. She's normally an urgent care physician at Mercy Hospital in St Louis. "In telling team members coming here we tell them it's going to be an extremely austere environment," she says.

No power, no air conditioning, no local water, no local food, no Internet and very limited communication. Hurricane Maria falls somewhere between Hurricane Harvey in Houston — where teams stayed in a hotel — and the 2010 Haiti earthquake, where they created a field hospital in Port-au-Prince and slept outside.

Each deployment has its challenges. In the Arecibo hospital, it was the sweltering sixth-floor cardiac unit.

toggle caption Carol Guzy for NPR

The temperatures up there were as high as 108 degrees and even higher. "This was a huge stress on the patients who were quite sick. So we have ended up moving them to these tents where the hospital staff is caring for them," says Dr. Jim Fehr, who is on the DMAT team.

Lying in the cooling tent is a 77-year-old retired factory worker named Georgina Gonzales. Had she not been brought here she might have ended up as an indirect victim of the storm.

"Very hot, very hot! I was suffocating," she says. "When they transferred me here on Sunday, they rescued me from the dragon's mouth."

Back on the fourth floor, a distraught woman appears with a shocking story: the hospital an hour away in the city of Aguadilla, she says, has shut down, kicked out the patients, and it smells like decomposing bodies.

Team commander George Thorp springs into action. "We'll get a strike team there right away," he says. Within an hour, the strike team is racing down the highway, past utility poles snapped like pencils and the fallen arches of a McDonald's.

The team roars up to the Good Samaritan Hospital of Aguadilla. Two heavily armed federal agents enter first, then comes the DMAT expecting the worst.

They walk down a corridor past bewildered nurses and are ushered into a quiet, orderly office. There is nervous laughter.

Enlarge this image toggle caption Carol Guzy for NPR Carol Guzy for NPR

"I'm chief medical officer for a national disaster medical assistance team," Dr. Stein tells the hospital director. "We had been told that you needed significant help. I can tell when we pulled up the story was somewhat exaggerated."

The Aguadilla hospital administrator, Marilyn Morales, listens politely.

"Our emergency room is in bad condition in terms of the temperature," Morales says. "If you can install something next to the ER that would be excellent, with physicians, medications and supplies."

As it turns out, both the Arecibo and Aguadilla hospitals are in the same boat —there's no air-conditioning, the emergency generators need maintenance, and the patients and staff are hot.

After a tour, Stein promises to request some federal help, and the team files back out onto the sidewalk.

Enlarge this image toggle caption Carol Guzy for NPR Carol Guzy for NPR

"All right, saddle back up, get your packs," she says, adding with a smile, "This is not the hospital of the walking dead which is what had been described."

The experience is a good example of what happens after a traumatic weather event, when there's no communication — rumors fly, and people worry about their hospitals.