JAYUYA, Puerto Rico -- After Hurricane Maria's landslides and flooding further isolated this mountain town, a volunteer doctor rushed to treat diabetic Brunilda Sovilaro, found on the floor of her home, covered in insects, unable to walk, disoriented and refusing to leave.
"You are sick. You are very hot," Dr. Jorge Lopez of Orlando told the 50-year-old woman. "Your sugar needs to be controlled. You have chest pain. It could be a problem with your heart. You need to go to the hospital."
Eventually, the Puerto Rico native who returned to the island from Florida to volunteer persuaded Sovilaro to board an ambulance to the nearby hospital.
"That lady was going to die if left there like that," said Lopez, who also volunteered after Hurricane Katrina in Gulfport, Miss., where he said the landscape was much less of a challenge.
Two weeks after Maria struck Puerto Rico, hospitals are still struggling, and many like the one in Jayuya are without electricity and communications, reliant on generators and running short of vital medications. As of Friday, 8,349 displaced people were still in 132 shelters.
Officials are worried about public health risks from the frayed medical safety net on the island of 3.5 million, and are trying to address hospitals' problems before they get worse.
Several Democrats in Congress spoke out this past week in Washington, calling on the Federal Emergency Management Agency to supply transportation to bring the ill, elderly and frail to the mainland.
"The reality of Puerto Rico doesn't allow for these vulnerable people, sick people, to stay in Puerto Rico and get the treatment that they need," said Rep. Nydia M. Velazquez, D-N.Y., calling the situation a "humanitarian crisis."
Rep. Luis V. Gutierrez, D-Ill. said that when President Donald Trump visited Puerto Rico Tuesday, he never made it to the mountains.
"The rain sent the mountains down upon the people through the rivers and washed away towns. There are no bridges, there are no roads. We should simply ask: 'Bring us your most infirm and sick,'" he said.
Puerto Rico Gov. Ricardo Rossello said shoring up hospitals in mountain towns like Jayuya is a priority because they "present potential future challenges, public health emergencies."
Rossello noted that the death toll of the hurricane had risen to 34, including 15 deaths indirectly caused after the storm. Local officials have said people died after the storm because of a lack of oxygen tanks, electricity to fuel life support and other problems.
Rossello said officials were also concerned about disease outbreaks, and have already seen some that were "localized," including several cases of conjunctivitis at a shelter in the southern city of Ponce. Rossello said federal medical disaster management teams had been mobilized in Ponce "so we can control it," and that the Centers for Disease Control and Prevention sent staff to check for the spread of mosquito-borne illnesses.
Rossello said his goal in shoring up hospitals ahead of outbreaks was "for us to be able to anticipate rather than just react."
He said Friday that 25 of 68 hospitals had power, and more were expected to be connected soon. The government supplied fuel to 11 hospitals and more was delivered Friday, he said.
In the past two weeks, volunteer doctors and other officials have visited incommunicado communities in Anasco, Ciales, Comerio, Juana Diaz, Las Marias, Maricao, San Lorenzo and Yauco, officials said Friday. Some sites were so hard to reach, helicopter had to land on the second floor of a house, according to the governor's chief of staff, William Villafane, who visited the sites. "We provided them with necessary medicines. We're saving lives," he said.
Eight medical disaster management assistance teams from the mainland were helping hospitals in San Juan, Arecibo, Caguas, Fajardo, Humacao and Ponce, he said.
The 250-bed military hospital ship Comfort arrived in Puerto Rico this week and was still in San Juan Friday. It can treat up to 1,000 patients and was expected to move to Ceiba, Ponce and Aguadilla.
But that wouldn't help those stranded in Jayuya.
Driving back to the Jayuya hospital on an all-terrain vehicle Wednesday, Dr. Lopez surveyed the town. He worried how the small hospital would cope with possible outbreaks in coming weeks, especially tropical mosquito-borne illnesses.
"It's not if, but when. With water all over the place you get dengue, chikungunya, Zika," he said.
Lopez and four other doctors from Florida Hospital in Orlando with Puerto Rican roots flew to the island Sept. 29 Friday to help hospitals to the south in Ponce and to the northwest in Aguadilla.
"We saw in two days five people die," said resident William Kotler, who was volunteering with the team.
He said they were still trying to get a generator to the hospital in Aguadilla to run the air conditioners.
"It's 90 degrees inside. People are becoming dehydrated," he said.
On Wednesday, the doctors took two U.S. Army helicopters to Jayuya, landing at the center of the town track, where stray horses roamed after the storm, to assess the hospital's needs and deliver medications in scarce supply, such as insulin, ibuprofen and acetaminophen.
"Many of these towns are so blocked, you need a helicopter to get to them," said Dr. Katia Lugo before consulting with staff at the 15-bed public Mario Canales Torresola Hospital.
They had another emergency: a patient with a severe head wound. Hilberto Torres Hernandez, 62, a retired mechanic, had been helping a neighbor repair her car after the storm, just as he had helped the mayor, when it fell and struck him.
Doctors couldn't reach the capital's Centro Medico to ensure they could receive Torres because the phones in Jayuya have been down since the storm. In some cases, staff has been transferring trauma patients to larger cities without knowing if they can accept them. So far, none have been turned away.
The volunteer doctors were able to borrow a satellite phone, call the hospital in San Juan and ensure that the man could be treated there.
"If they had not come, it might have been different. They might not have stabilized him," said relative Jessica Torres, 41. "The mountains need more medical services."
Other volunteers who arrived in Jayuya this week agreed.
"There's been a good system of health care here, but it's basically collapsed. People have run out of prescriptions, doctors' offices and hospitals have closed," said Natasha Tobias, a registered nurse from Portland, Ore., who was volunteering at the hospital through the Kansas City-based nonprofit Heart to Heart.
While the Jayuya hospital and others her group assisted in the mountain town of Barranquitas and south of San Juan in Caguas were still open, they were also seeing steady demand for care weeks after the storm.
"As the roads open, people are coming down and we're seeing more trauma," from more remote mountain areas, she said. "... We're all pretty worried this will turn into a bigger crisis as time goes on."
Across town, diabetic mother of two Esha Garcia was running out of insulin.
Garcia, 33, said the medication was covered by Medicare, but the local pharmacy computers were not working since the storm and they wouldn't refill her prescription. She uses four vials of insulin per month that cost $400 each and a $600 insulin pen each night. She had one vial and one pen left Wednesday.
"If I don't get the medication I need, I'll have to go to the hospital," she said.
On Friday, the U.S. Department of Health and Human Services activated its emergency drug assistance program in Puerto Rico that covers the cost of prescriptions, medical supplies, equipment and vaccines after a disaster. It wasn't clear how soon that could help people in the island's interior.
Jayuya's hospital, with its staff of five doctors and nine nurses, saw 78 more patients the week after the storm, 310 total, according to emergency room administrator Joanna Morales. So far, only one patient has died since the hurricane, a man struck by a landslide. But their treatment had been limited, she said. They were running low on diesel for their generator. Without an additional generator, they couldn't operate respirators or portable chest X-rays. And they needed to resupply basic medications and equipment, including oxygen tanks and insulin.
"Every day we see patients who come in without oxygen and we have to admit them," said Dr. Lourdes Rodriguez, who traveled north from Ponce to volunteer at the hospital after the storm.
The Puerto Rico National Guard had promised to come set up a temporary hospital outside with a team of 10 doctors, but had yet to arrive, she said.
The volunteer doctors had to leave after about an hour, bound for several other mountain towns, including Lares, Morovis and Orocovis. U.S. Army Rangers would return the following day with a generator and other requested supplies, they said.
"The focus today was the most isolated areas," said former U.S. Surgeon General Antonia Novello, who was traveling with the group.
Novello was working on a vaccination campaign set to begin Friday across the island to protect against mosquito-borne diseases. She also hoped to distribute donated treatment kits for the same illnesses.
After about an hour, the team returned to the helicopters, unloaded several boxes of much-needed medicine for the hospital, distributed food and water to a waiting crowd of families and prepared to take off.
"We don't waste time," Novello said. "We can't."
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