Maria has disrupted those plans. “During the week after the hurricane, I had one of my patients who had HIV, she had a planned C-section delivery,” Zorrilla said, referring to the recommended delivery practice for preventing mother-to-child transmission. That patient was not able to make it to the hospital for the procedure after Maria, because roads from the interior of the island had been washed out. Instead, the woman was forced to deliver at home, and while the virus has not been detected in the infant, the delivery was essentially a gamble.
Some of Zorrilla’s other patients, who hail from all over Puerto Rico, have also been forced to alter their birth plans, delivering children in hazardous conditions and in facilities that might not be familiar with HIV management. And even for mothers without HIV, labor and delivery are increasingly fraught scenarios without consistent power and water available on the island.
Other patients with chronic diseases are facing crises as well. The risks to elderly people from any disaster are well known, and according to experts, any disaster region can expect up to 10 percent of all nursing-home patients to die in the aftermath. Puerto Rico so far has been no different. Many elderly patients, as well as nursing-home residents of all ages, initially faced critical shortages of electricity for medical devices. Some had to be airlifted to hospitals for continuous care.
A Los Angeles Times story published earlier this month illustrated some of the challenges facing nursing homes after Maria—especially those in places that aren’t particularly close to San Juan or to major federal-relief assets. While the official death toll on the island remains a subject of contention, that report noted that older Puerto Ricans are now dying much faster than normal:
About 100 people died in the three days after the storm in the Lajas region, twice the typical rate, according to a local funeral director. Eight elderly people have died in Lajas since the storm, at least one directly related to a shortage of medical supplies.
One common post-disaster failure is the scarcity of dialysis for people with diabetes, end-stage renal disease, and other kidney disorders. Dialysis requires regular visits from patients, fully staffed facilities, electricity, and a constant source of clean water, all of which have been lacking after Maria.
Mike Spigler, the vice president of the American Kidney Fund, a nonprofit organization that helps support dialysis patients and centers across the country, said that Puerto Rico has presented a one-of-a-kind challenge. “In all three [recent] instances of hurricanes, I will say that dialysis companies have done a good job at dealing with these problems,” Spigler told me. “But especially in Puerto Rico, you see stories of staff working triple and quadruple shifts at a time just to keep the clinics open. So you see people making really heroic efforts.” Even so, many centers have lost track of patients, and many patients have seen their conditions worsen.