How my small hospital in rural Puerto Rico survived Hurricane Maria

When Hurricane Maria slammed into Puerto Rico, I wasn’t sure how well my hospital, Castañer General Hospital, would survive the howling, 150-mph winds that lasted for 15 hours or the 25 inches of rain that inundated the region.

When the winds eased and it was safe to go outside, what I saw was utter destruction: shattered houses, tangles of fallen trees and electrical lines, rivers pouring over their banks, landslides, blocked roads, and more. The region, characterized by the greenery of its mountains, was now mostly brown. There was absolutely no communication with other parts of Puerto Rico or the outside world. We were in the dark.

My 75-year-old hospital is in the small town of Castañer, in the district of Lares, whose 30,000 residents live nestled in the mountains of west-central Puerto Rico. The hospital also serves the small towns of Adjuntas, Yauco, Maricao, and Las Marías.

The hospital wasn’t too badly damaged. Nearly 2 feet of water flooded the first floor, which the staff kept bailing out from the clinics, emergency room, and administration building. The only other major damage was to the hospital’s wastewater treatment plant.

Thanks, in part, to advance planning, Castañer General Hospital had electricity throughout the storm and afterward — just days before Maria hit, a new electric generator had been installed under the emergency room. The hospital also had a steady supply of drinking water from its certified well. With electricity and water, we were able to care for the patients who were in the hospital when Maria struck, as well as immediately provide care to patients as they began to arrive afterward with injuries sustained from the hurricane and from working to clear homes and open roads.

People with asthma and chronic obstructive pulmonary disease began to trickle into the hospital so they could connect the machines that help them breathe more easily to electrical outlets in our clinic waiting area. We provided oxygen tanks for oxygen-dependent patients. We made the facility available for other patients who needed electricity.

One patient, a 55-year-old woman who suffered kidney failure, would have died in the days after the storm had she not been able to reach the health center and its generator. But we were able to provide her with lifesaving dialysis every day.

Medications, especially insulin, asthma inhalers, and blood pressure drugs, began to run out because there was no way to place orders or to get them delivered — we remained totally isolated from the rest of the shattered country. As a stopgap measure, we rationed medications, giving local patients 10 days’ worth of medications while those who came from a distance got a month’s supply.

One patient in critical condition needed to be transferred to a tertiary health center in Ponce, about 35 miles away, for specialized care that Castañer General Hospital isn’t equipped to provide. Blocked and eroded roads and the inability to communicate with the hospital made this a terrifying challenge.

Our hospital’s maintenance director, Agustin Ponce, drove his four-wheel-drive Jeep ahead of the ambulance, evaluating the way. Community members who accompanied him used rods to lift downed wires blocking the road, making it possible for the ambulance to pass. What was typically a little more than a 45-minute journey took over two hours.

Even with that serious obstacle conquered, we didn’t know for sure if the tertiary hospital in Ponce would be open for business. We also weren’t sure if it would accept the patient without prior notice, as is required by law. We got lucky on both counts. Thanks to a team effort, the patient arrived in stable condition, was admitted, and is recovering.

For another patient who needed to be transferred to Ponce, we used the police radio network to “call ahead.” We asked our local police station to transmit the information to their colleagues in the next town. The message was then passed from town to town until it arrived at the police station in Ponce. From there, a police officer personally took our request for a patient transfer to the tertiary hospital. Through this type of antiquated but effective referral system, we discovered that two of the four hospitals in Ponce were not working at capacity and could not accept the patient. One of two hospitals still operating agreed to accept the patient, who we transferred as soon as possible.

Our staff members were busy outside the hospital as well as inside of it. They joined community members to start clearing roads and damaged homes and businesses, using machetes, gasoline-powered chain saws, and other tools contributed by the community.

A major problem we needed to solve was getting diesel fuel to keep the generators running at the hospital and one of its outlying clinics in Adjuntas. We weren’t alone — long lines of desperate people waited at gas stations for diesel. The only supermarket in Lares closed for lack of this fuel, so the community had no place to buy groceries. We were forced to shut down our hospital’s kitchen for 10 days, which meant closing inpatient care.

Everyone got involved in the search for diesel — the chief operating officer, chief financial officer, maintenance chief, pharmacy chief, and I all reached out to everyone we knew. We finally connected with a diesel transporter who had a 500-gallon truck that could reach Castañer. This got us diesel for the hospital as well as for the supermarket and the bakeries of Castañer so they could stay open, which was a huge relief for the community.

Volunteers from the hospital traveled to outlying town such as Indiera of Maricao and Rio Pietro to treat patients who had been cut off from health care by roads damaged by landslides and blocked by debris. Our team often worked in buildings lit with lanterns. The team also brought water, supplies, and formula for infants.

Many of the people in our community are agriculture workers. Maria ravaged the farms in the area, putting most of these people out of work. Yet they are helping where they can, providing our clinicians with coffee, bananas, plantains, oranges, and other foods, and working to clear the mess that Maria left behind.

They are also trying to recover from the hurricane, but it isn’t easy. They have limited or no electricity or drinking water, no telephone, internet, television, radio, mail service, gasoline, newspapers, or garbage collection. People can’t buy food or anything else unless they have cash because without electricity the machines that process credit or debit card transactions aren’t working.

It is easy to develop post-traumatic stress, anxiety, or depression when seeing lost crops and devastated homes, and living with no money, no food, and little help. That’s why my colleagues and I are now focusing on mental health issues. Our mental health team began that work five days after the hurricane, visiting shelters, treating patients, and giving workshops to hospital employees.

During our struggle to stay open and recover from the hurricane, we had absolutely no help from state, municipal, and federal sources, including the Federal Emergency Management Agency. On the ninth day after Maria hit, a helicopter from FURA, an agency that is part of the Puerto Rico Police, landed on the hospital heliport with five boxes of medication and about six boxes of food — enough to feed maybe 40 people — to be handed out to the community.

Also on the helicopter were the governor’s secretary and the director of the Puerto Rico Office of Management and Budget. We informed them of the hospital’s precarious situation, and gave them a list of what we needed. They did not return with any resources.

Help for the hospital and the local communities finally began arriving in the second week after the hurricane. The first assistance was from the nonprofit San Benito Health Foundation, based in California. It sent a small team to assist with post-disaster health needs. The team helped us order medications from the mainland U.S. It also delivered a solar charger and satellite phone that were donated to us by the Migrant Clinicians Network, which has been a close collaborator with Castañer General Hospital on a number of projects to improve our community’s health.

Finally, by mid-October — a month after Hurricane Maria hit Puerto Rico — FEMA, the U.S. National Guard, and the U.S. Army arrived.

I don’t know what the future will bring for Castañer General Hospital and the communities it serves. I am proud of how my colleagues and the local citizens have pulled together and largely pulled ourselves up by our bootstraps. And I am dismayed at the paltry response from municipal, state, or FEMA authorities.

Nine weeks after the hurricane, our town is still without electricity, water, internet, or phone service. The hospital continues operating every day around the clock, and we are slowly recovering almost entirely on our own. If help comes, we will welcome it, but we know we cannot wait for it.

The community is proud of its hospital — and for that we keep working.

Jose Rodriguez, M.D., is the chief medical officer of Castañer General Hospital, a health center in rural west-central Puerto Rico.