James Fehr, MD describes work in hurricane-ravaged Puerto Rico

Nov 13, 2017

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Dr. Jim Fehr, front left, and a team of medical staff in a temporary tent at Pavia Hospital in hurricane-ravaged Puerto Rico. Photo courtesy Jim Fehr.

A week after Hurricane Maria hit Puerto Rico, the Hospital Pavia in the city of Arecibo had limited electricity and no hot water. A disaster medical team, including Dr. Jim Fehr of St. Louis, arrived to help the hospital’s staff work under blackout conditions.

At the hospital an hour west of San Juan, generators strained to provide some light to operating rooms and nursing stations. But when temperatures on upper floors topped 100 degrees, patients had to be transferred to tents in the parking lot.

“These were patients who had heart attacks and serious conditions,” Fehr said. “After we got them out, it went up to 120 degrees.”

Fehr, a pediatric anesthesiologist at St. Louis Children’s Hospital, worked in Puerto Rico from Sept. 26 to Oct. 12 with one of the U.S. Health and Human Services’ disaster medical assistance teams. The team of 36 doctors, nurses and paramedics from the Midwest was led by recently retired Clayton Fire Chief Mark Thorp.

After the hospital’s operations were stabilized, the team traveled to nursing homes, churches and schools around the island to provide urgent care services. By the time the team returned home, the hospital was running on full power.

“We all worked together, we all lifted boxes, we all took care of each other and the mission,” Fehr said. “Our job was always to be on the lookout to help the system help itself.”

But nearly two months after the storm, about 60 percent of the island still lacks electricity. Nearly half of the 1,100 schools remain closed. Thousands of families are living in shelters. Many who have returned to work are doing business outdoors when possible, and leaving before the sun goes down.

The Federal Emergency Management Agency has agreed to provide flights to relocate about 3,000 Puerto Ricans still sleeping in emergency shelters to temporary housing on the U.S. mainland. More than 140,000 people have fled the island since the storm.

The official death toll from the storm is 55, although the number of indirect and unrecorded deaths is thought to be much higher. While not noted on death certificates, the lack of power can be a factor in fatal accidents and natural deaths. Street lights and traffic lights are down. People can overheat in their homes without air conditioning. Others have fallen while trying to repair roofs.

Officials in the U.S. territory report the island had an average of 82 deaths a day in the two weeks before the hurricane hit Sept. 20. The average increased to 117 deaths a day through the rest of the month, but the rate then fell below normal in October.

Fehr joined the disaster medical team after Sept. 11, 2001. He spent a month in New Orleans after Hurricane Katrina and said the situation in Puerto Rico was very different. When a hurricane is expected to hit the mainland U.S., response teams can set up in a neighboring state and drive in as soon as the storm passes. It has been much more difficult to get supplies and workers to the island. Electricity and radar systems were knocked out at airports, so planes could land only in daylight. Rural areas were particularly difficult to reach with downed power lines blocking roads.

A curfew kept things quiet while Fehr and the team slept in an empty ward at the hospital, he said. But in daylight the landscape looked barren, because leaves and branches had been sucked off the trees. Many of the hospital’s staff members worked extra shifts without knowing how the hurricane had affected their homes and families.

Fehr said he was impressed by Puerto Ricans’ spirit in facing a recovery that will be measured in months and years.

“The people of Puerto Rico demonstrate amazing resiliency in the face of this tremendous natural disaster,” Fehr said. “They were stressed but pulling together. They say ‘Se levanta,’ or rise up.”

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