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Sick Puerto Ricans are facing long waits to see the doctor

From 2006 to 2016, the number of doctors in Puerto Rico dropped from 14,000 to 9,000, an exodus hastened by Hurricane Maria. With so many doctors leaving the island, many low-income families must travel long distances for medical appointments, and they can wait for months to see specialists. Special correspondent Sarah Varney of Kaiser Health News reports.

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  • Judy Woodruff:

    Hurricane season is under way in Puerto Rico, but daily life is still precarious for many after Hurricane Maria's widespread destruction last September.

    It's still a challenge to find a doctor on the island. Physicians were already leaving after a financial crisis began a decade ago, and last year's storm has fueled the exodus.

    As special correspondent Sarah Varney reports, the toll has been devastating.

    It's the second of two stories about health care on the island, produced in collaboration with our partner, Kaiser Health News.

  • Sarah Varney:

    Every three hours, Janisse Alicea prepares two bottles of Ensure for her daughters, Patricia and Natalia. The girls were born with a dire genetic disorder and microcephaly.

    They once attended school and birthday parties and smiled brightly.

  • Janisse Alicea (through translator):

    So, here is Natalia at school participating and in the Day of Triumph and Field Day.

  • Sarah Varney:

    But now, at 16 and 21, the disease has progressed and their bodies are fragile and misshapen. Ventilators help them breathe, and scoliosis makes it difficult to move them.

    Alicea and her daughters waited out Hurricane Maria here in Ponce, a city on the island's southern coast. But the chaotic aftermath put Patricia and Natalia in grave danger.

  • Janisse Alicea (through translator):

    We didn't have power, we didn't have water, we couldn't get enough Ensure. It was very hot. They were crying all the time, couldn't fall asleep. They had convulsions.

  • Sarah Varney:

    The family fled on a humanitarian flight and eventually ended up with relatives in South Carolina. Alicea and her two daughters returned home in March.

    Since then, she has struggled to find doctors who can treat them.

  • Janisse Alicea (through translator):

    We need pediatricians, we need neurologists, and we need geneticists. Before, we were able to get to some doctors, but now it has been impossible. We can't get them to come here. And their condition is degenerative, so they get worse and worse. So, I need to know what, as a mother, can I do for them?

  • Sarah Varney:

    Alicea says her daughters recently started getting bedsores. They're in pain, she says, and haven't seen a doctor since they returned to Puerto Rico.

    Physicians are in short supply here. Dr. Jose Cruz, a pediatrician, says the island's ongoing financial crisis and low payments from health insurers drove many physicians to seek work in the states. And Cruz says the hurricane badly damaged doctors' offices, requiring costly repairs.

  • Dr. Jose Cruz:

    So there's a lot of money that the pediatrician lost, and they just made the decision and left, left to United States.

  • Sarah Varney:

    From 2006 to 2016, the number of doctors here declined from 14,000 to 9,000. Families who lost their doctors are filling up waiting rooms, like here at a Varmed pediatric clinic in Bayamon, a suburb of San Juan.

    Physicians say running a medical practice is a losing business in Puerto Rico. At San Jorge Children's Hospital in San Juan, a pediatrician earning about $89,000 a year can double his salary just by moving to the States. The low salaries reflect the island's widespread poverty.

    Nearly two out of three children and half of all Puerto Ricans rely on Medicaid, and the territory receives far less money from Congress than poor states to pay doctors.

    With so many pediatricians and other doctors leaving the island, many low-income families here must travel long distances for medical appointments. And they can wait for months to see specialists.

    Sara Pallone braves the San Juan traffic with her son, Thiago, who was born with severe low muscle tone. A nurse travels with them. She drives an hour each way to Centro Medico, San Juan's public hospital, for her son's countless appointments.

    Today's visit to a neonatologist was originally scheduled for last September. But since the hurricane, it has taken eight-and-a-half months to reschedule. The family scrambled for safety during the storm. They were turned away from two hospitals and a storm shelter that didn't have a generator to power Thiago's oxygen machine that he needs nearly all the time.

  • Sara Pallone (through translator):

    We were five days without oxygen, and the baby started doing very poorly,so we had to get him right to the medical center. When we were there, the generator broke down, so we couldn't get the oxygen there either. And instead of trying to transfer him from hospital to hospital, they sent us home.

  • Sarah Varney:

    But surviving the hurricane was just the first hurdle.

  • Sara Pallone (through translator):

    And when the hurricane came, all of the appointments were canceled without warning. Many of the doctors didn't communicate with us to tell us they were canceled. We felt abandoned, like my son's life wasn't worth it.

  • Sarah Varney:

    That sense of abandonment is pervasive in the island's Central Mountains. Telephone and power lines are still being restored.

    Cables dangle from trees, roads remain badly damaged and power goes off and on. All of that has made it difficult to get medical care for even basic needs, like the flu or vaccinations.

    At Salud Integral en la Montana, a community clinic in Orocovis, the lack of electricity and refrigeration ruined the supply of vaccines. Some children, like ®MDNM¯Tanya Burgos, missed their vaccinations for months after the storm.

    But it's not only physical health challenges. Dr. Nelson Almodovar, a pediatrician at the clinic, says children, like 4-year-old Hiram Cruz Ortiz, are still showing signs of trauma from Hurricane Maria. He's anxious and refuses to sleep alone, and Dr. Almodovar wants him to see a psychologist.

    Those added demands for care combined with the shortage of doctors makes staffing this operation difficult.

    Gloria Amador runs seven clinics and four emergency rooms in this remote region. She says, while it's hard to get specialists to come here, she has many vacancies for primary care doctors as well.

  • Gloria Amador:

    We have 24 vacancies right now. So, it's very difficult for us to have such a huge system without having primary care doctors. So, right now, people's lives have been impacted because of the long time they have to wait.

  • Sarah Varney:

    Back in Ponce, Jeann Cruz and Edgardo Rivera say the scramble for doctors has added to the stress of being first-time parents. They would like their son, 6-week-old Jaxx, to see a pediatric gastroenterologist to treat his reflux, but there are only two in Ponce, and the wait is months-long.

    Still, they are undaunted by the island's challenges and by the new hurricane season under way.

  • Jeann Cruz:

    There's going to be many hurricanes. Come at us. Let them come, because we're going to stay here.

  • Sarah Varney:

    So they're heading across the island to San Juan to find a doctor there.

    For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in Ponce, Puerto Rico.

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