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As Covid-19 Sweeps Puerto Rico, The Island’s Hospitals Are Braced to Fight Back

Puerto Rico's long history of hardships – and an infusion of support – have helped prepare health providers for the challenges the coronavirus presents.

Dr. Pablo Rodríguez Ortiz receives a video laryngoscope from a Direct Relief staffer. (Ana Umpierre/Direct Relief)
Dr. Pablo Rodríguez Ortiz receives a video laryngoscope from a Direct Relief staffer. (Ana Umpierre/Direct Relief)

After Hurricane Maria, Puerto Rico’s Regional Hospital of Bayamón, severely damaged, struggled to rebuild.

Critical damages to their infrastructure, caused by leaks and broken glass, had made their fourth floor a total loss. To this day, FEMA continues to assess parts of the hospital, which is generally known as HURRA.

When rebuilding began, HURRA’s leaders were focused on being prepared for future storms, not a pandemic. But when Covid-19 hit, the hospital – one of three belonging to Puerto Rico’s Department of Health – was braced for the blow.

While Direct Relief continues to protect frontline workers during the global pandemic by providing PPE and other vital supplies, the organization remains focused on bolstering Puerto Rico’s health care system, strengthening it for the long haul.

As well as improving infrastructure, the organization has provided essential medical equipment, including video laryngoscopes, portable x-ray machines, ventilators, and other equipment to the HURRA hospital, as well as Puerto Rico’s Trauma Center and Pediatric University Hospital.

Critical cases

The HURRA hospital, as a public facility, already cared for patients regardless of whether they could pay, had insurance, or were documented.

When Covid-19 appeared, the hospital as designated a support facility – one that would receive patients in case other hospitals became saturated. But nearby diagnosis and treatment centers, which don’t have the facilities to hospitalize patients, quickly began sending patients their way.

Over the last seven months, HURRA’s isolation rooms have remained mostly full. In May, during a spike in cases, they even had to divert patients to other hospitals.

To treat the incoming flow of patients, the hospital acquired new medical equipment for what had been, before the pandemic, largely unused isolation rooms, outfitting them with ventilators and other equipment. For patients with renal disease, they added dialysis stations to rooms.

Even seven months into the pandemic, treatment guides change continuously, said Giselle Van Derdys, HURRA’s executive director. However, Covid-19 has given them an opportunity to acquire equipment they didn’t have, allowing them to better care for patients.

Treating the disease has taken its toll, said Van Derdys. “The fear and uncertainty that this pandemic generates is reflected in the employees,” she said. PPE was particularly hard to come by in the early days of Covid-19.

“Trauma and Covid”

The Puerto Rico Trauma Center, part of Centro Médico in San Juan, is used to treating critical cases. On any given day, they see the victims of accidents, shootings, and stabbings.

They’ve been lucky thus far. The center withstood the onslaught of Hurricane Maria, and the earthquakes that have rocked southwestern Puerto Rico are mercifully far away– although Dr. Pablo Rodríguez Ortiz, the director of the Trauma Center and a surgeon, worries that that Centro Médico may not be able to withstand a bigger earthquake.

But Covid-19 is another matter.

“During the first months [of the pandemic], I felt proud to say that we didn’t have any cases,” said Rodríguez Ortiz.

Dr. Rodríguez Ortiz saw the trauma center as a way to judge the larger Covid-19 situation on the island. “By receiving people from all over [the island], we could have an idea of what was happening,” he said.

But while emergency rooms were seeing patients with exacerbated symptoms of the disease, such as difficulty breathing, the Trauma Center primarily dealt with physical injuries, not with severe Covid-19 cases. They quickly realized that, to keep their employees safe, they would have to test every patient that arrived.

“Every patient is Covid positive until proven otherwise,” Dr. Rodríguez Ortiz said. “Patients arrive with trauma and Covid. That means that the number of infections has increased” as asymptomatic patients show up with physical injuries.

A history of help

In the three years since Hurricane Maria devastated Puerto Rico, Direct Relief has provided more than $100 million in aid and funding to the island, working closely with the pharmaceutical company AbbVie.

The organization’s support has varied widely. Health centers serving Puerto Rico’s most vulnerable have been supplied with solar installations that will allow them to keep their doors open during future storms and mobile units to help them reach the island’s remote communities, even if roads are damaged. Hurricane Prep Packs have been staged, and emergency backpacks distributed, throughout the island.

Vaccine fridges and freezers have vastly expanded the island’s cold storage capacity. Wells have been built in remote communities, providing a reliable source of clean water even during successive storms.

Direct Relief has also funded a range of programs on the island that treat mental health issues and substance use disorder – both of which increased in the wake of Hurricane Maria.

Most recently, the organization has provided PPE, emergency and operating room equipment, and ventilators and X-ray machines for patients being treated for Covid-19.

“A vital instrument”

“Direct Relief…has helped us a lot…We have been able to provide our employees and some patients with PPE,” said Van Derdys. Also, the hemodynamic monitors and blood gas analyzers have allowed a quicker screening of a patient’s condition and provide a more accurate treatment.

Dr. Rodríguez Ortiz called the video laryngoscopes “amazing,” explaining that the Trauma Center didn’t have access to them before Direct Relief’s donation. Now the device is “part of our strategy of intubating patients because of Covid, or in my case, because of trauma,” he said. “It has been a vital instrument” for high-risk intubations.

Both Van Derdys and Dr. Rodríguez Ortiz expect Covid-19 cases to rise over the next few months.

But both said that the PPE and equipment provided by Direct Relief would help them weather this new storm – and make them more resilient and able to help patients in the future.

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