Mission of care: Local nurse deploys to Puerto Rico

Patricia Mason, R.N.

From Nov. 5-16, 2017, was the second time this year that my DMAT, or disaster medical assistance team, had been in Puerto Rico. The first trip, a response to Hurricane Harvey, included staging in Florida. None of us could have known that just weeks later Hurricane Maria would ravish the island of 3.4 million people leaving them without power for months.

A DMAT is a group of professional and paraprofessional medical personnel organized to provide rapid-response medical care or casualty decontamination during a terrorist attack, natural disaster, or other incident in the United States. DMATs are part of the National Disaster Medical System and operate under the Department of Health and Human Services. DMATs were founded under the U.S. Public Health Service, operating under FEMA.

MA-2 consists of a commander, medical doctors, pharmacists, nurses, paramedics, emergency medical technicians, clerical staff and logistics. Our team of more than 100 members is on call several times a year, sometimes being deployed on non-call months as the need arises. As a member of the team you are required to attend trainings, complete online education, attend meetings and be able to deploy for at least two weeks when activated. Generally teams of 50 are deployed, although some situations require a smaller Strike Team consisting of 25 members. MA-2 has responded to numerous national emergencies such as Hurricane Katrina, the Anthrax Postal Mission and the 9/11 Attack on the World Trade Center.

Our mission in that first week of November was to work out of the largest hospital in San Juan, Centro Medico. By November, the hospital had power, running on a generator for most of the day with short periods on the main electrical grid. MA-2 had medical tents set up outside of Centro Medico’s emergency room. The emergency room was set up with 136 beds and gurneys lining the halls with waiting patients. Our tents were sent up to take 16 patients at a time. Our days were 12 to 14 hours long, seven days a week.

After the first week our team was split up and sent to four different areas of Puerto Rico; Manati, Bayamon, San Juan and Aquadilia. My mission on week two was to work in a hospital in Bayamon. The third floor of the hospital had been built specifically for the Ebola outbreak with negative pressure rooms available. We took 38 patients, many who were on ventilators, had end stage cancer, traumatic brain injuries and orthopedic issues. Other team members went to Manati where they set up medical tents in a local stadium.

Much of the island is still without electricity. Some days the power would come on for short periods only to go off again for hours at a time. Street intersections are dangerous as there are very few traffic lights working. Water is contaminated and the sewer infrastructure broken down. Many residents that live in the mountains of Puerto Rico have been without food, water and medication for months. Most days the weather was 85 degrees with relative humidity of 90 degrees making it extremely challenging to keep food from spoiling.

Patients in hospitals, tents or stadiums were being treated for a variety of conditions including orthopedic injuries (lots of fractures), dehydration, vents, cancer, tracheotomies, hypertension (sometimes due to lack of medications) and domestic violence trauma. The death toll on the island since the hurricane is at 1,050 although it is suspected that that the true number is much higher, with morgues being over capacity.

The people of Puerto Rico were very thankful we were there. Every resident that I encountered said “Thank you for what you are doing for us.” It was a message I heard repeatedly in both English and Spanish. After two weeks of non-working toilets, no (or cold) showers, and intermittent power on a good day, I have a greater appreciation for what I do have. Life is recovering for the island but it will take a long time and a lot of work. I hope our team made a difference in the lives of those we met. I think we did.

Patricia Mason, RN is the Family Planning Coordinator at Lamprey Health Care’s Nashua center. She has been a member of the MA-2, A DMAT out of UMASS Medical Center, Worcester since 2005.