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I was following the news about Hurricane Maria like everyone else. A few days after it hit Puerto Rico (on Sept. 20), I read an article about how terrible things were and that there was an urgent need for doctors. I prayed and felt moved to respond.

I applied to a few relief organizations but didn’t hear anything. That’s OK, I thought. I wouldn’t mind spending Thanksgiving with friends and family. Then I got a call from Project Hope, which had a slot for a primary care doctor in their mobile medical units. I landed in San Juan on Nov. 19.

Two months after Maria, the healthcare needs were less about broken bones or infections and really more about primary care. I was happy about this — I’m a primary care doctor, so I assisted with things I see every day here in the clinic: asthma, diabetes, blood pressure, mental health.

But this was typical primary care in an atypical setting. We saw bread-and-butter cases without the benefits of a lab, X-rays or electronic records. We treated patients in a school, at a church, on a basketball court. Sometimes we went door to door. All told, we saw more than 500 patients in two weeks.

We typically woke up every morning, got into SUVs and drove several hours to small towns and isolated areas. Project Hope mostly operated in the southwest corner of the island. Some of these places hadn’t been hit that hard by Maria, but they still had large health needs. Getting to the doctor was a challenge for people even before an almost Category 5 hurricane.

Electricity is still inconsistent and unreliable. We had a generator running in our front yard that rumbled loudly and usually ran out of gas in the middle of the night. It seemed like an analogy for Puerto Rico straddling the first world and the developing world. We were in a nice house in an upscale neighborhood, but we still had to put on a headlamp to use the restroom at night.

Project Hope team

Healthcare efforts are transitioning away from disaster and recovery and toward long-term, sustained work. We have a mantra in medicine: First, do no harm. That applies to development work, too. We don’t want to replicate or undermine the existing system. But that system needed a lot of work even before the hurricane hit.

We worked with lots of talented local staff. But sadly, we saw a lot of experienced healthcare workers leaving for the mainland. Long-term, that brain drain is going to have a big impact on the island. Even our clinics at UW have gotten applications from people in Puerto Rico looking for jobs.

If there’s any silver lining for Puerto Rico, it’s that this might be an opportunity to reset – to rebuild its healthcare system and develop hydroelectric or solar electric grids. With every trial there is a chance for growth.

I got home around midnight and went back to work the next day. It’s the best cure for jet lag.

As told to Jake Siegel

Dr. Nelson Chiu: Family Medicine Physician, UW Neighborhood Kent/Des Moines Clinic

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