CABO ROJO, PUERTO RICO — Andrés Maldonado recalls the first time he crawled out of the sea and went blind.
The then-19-year-old diving fisherman thought his left leg was moving by itself.
“I poked myself with a knife and drew blood, but it didn’t hurt,” he says, as the coastal breeze drifts into his home, decorated with ocean colors and paintings of underwater creatures. “I was only able to see a black dot in the distance.”
Doctors diagnosed him with decompression sickness, or the bends, a condition that occurs when the body’s pressure reduces too quickly. Nitrogen that normally dissolves in the tissue and bloodstream instead builds and forms bubbles, similar to a person opening a carbonated soft drink — only much more deadly. The blood stops circulating, and tissue functions diminish.
Maldonado, now 60, recovered in days and returned to work. Then he got sick again, a pattern increasingly common among fishermen in Cabo Rojo, an ecologically diverse region of mangroves and white sand beaches on Puerto Rico’s southwest coast.
Warming water temperatures and violent hurricanes have decreased fish populations, forcing these self-employed workers to risk their health in deeper waters. Many fishermen exceed safe dive times and lack access to treatment for decompression sickness, turning an otherwise curable disease into a lethal one.
“Even though you understand, when it’s a job, you have to work hard,” says Maldonado, who wears thick glasses because the condition has permanently damaged his vision.
Coraly Cruz Mejías, GPJ Puerto Rico
An energetic man with an athletic build, Maldonado has worked the waters since he was 13. Back then, decades before Hurricane Maria swept through in 2017 and wrecked the seabed, grouper, lobster and snapper swam closer to the shore. Back then, he says, divers did not face the affliction so regularly.
He knows of around 10 incidents since January. One of about 40 local fishermen recently fell ill with decompression sickness that severely affected his brain.
The coronavirus has only further upset Maldonado’s livelihood as the restaurants that bought fish closed and customers stopped spending money. Puerto Rico is still recovering from Hurricane Maria, a bankruptcy and protests in July 2019 over alleged governmental mismanagement that led to the governor’s resignation. Maldonado has lost around 90% of his income.
The sea surface temperature surrounding Puerto Rico has risen by about 3 degrees Fahrenheit since 1910, according to the National Oceanic and Atmospheric Administration. Even so, limited data exist on the number of diving fishermen afflicted by decompression sickness in Puerto Rico.
But since 2017, up to 30 diving fishermen a year have undergone treatment for the first time at the Centro Médico hospital in San Juan, the capital and location of Puerto Rico’s only 24-hour emergency treatment chamber, says Pedro Luis Arroyo Ramírez, a specialist in underwater medicine. The per capita number is similar to that of fishing countries in the Caribbean, Japan or Mexico, he says.
Patients undergoing treatment enter a hyperbaric chamber, a pressurized, cylinder-shaped machine made of thick steel that resembles a spaceship and can accommodate up to 20 people. They place a hood on their heads and inhale through tubes that deliver high concentrations of oxygen to nourish depleted tissue.
Maldonado used the hyperbaric chamber after the first incident and then three more times. He now recognizes the symptoms of decompression sickness — massive headaches, loss of vision — and treats them himself with over-the-counter medicine and a day’s rest.
“It gives me such a big headache that nothing gets rid of it unless I dive again,” he says.
The do-it-yourself approach can prove even more dangerous. Symptoms may appear to improve, says Dr. Juan Nazario, director of the Departamento de Medicina Hiperbárica where the 24-hour chamber is located, but the illness continues to snake through the body and damage tissue.
The most effective way to prevent decompression sickness is to space out dives, he says. Decompression tables, used by professional divers in the United States Navy and elsewhere, recommend stop times to help the body eliminate the absorbed nitrogen.
Coraly Cruz Mejías, GPJ Puerto Rico
Fishermen like Maldonado start their day at 5 a.m. and dive as deep as 130 feet in search of conch and other ocean delicacies. Breaks become an obstacle for those who hope to find a fresh catch by noon.
“If I go by the table, the day is not long enough to fish,” says Julio Ramírez Cancel, a 70-year-old fisherman who was treated in the hyperbaric chamber two years ago.
But immediate treatment, which would help prevent tissue damage, isn’t always viable.
The shortest route from Cabo Rojo to the chamber in San Juan takes about 2.5 hours by car through high-altitude mountain ranges that only worsen the symptoms, Nazario says.
Injured fishermen can receive emergency air or ambulance service to the hyperbaric chamber. But Maldonado says that service isn’t efficient. A fisherman in his community had to wait 3.5 hours last year before an ambulance took him to the hospital.
The University of Puerto Rico is searching for ways to improve divers’ situations with federal funds from NOAA. University researchers have given six diving fishermen digital watches to gather information about diving patterns. They share the data with hyperbaric chamber doctors who can analyze diving trends and measure the risks.
The project, known as Sea Grant, also educates divers on the perils of decompression sickness and teaches consumers about eating more sustainable seafood from shallower waters.
Such cases aren’t unique to Puerto Rico. Poor diver health spans tropical fisheries around the world, says René Esteves, a marine adviser with Sea Grant. “It’s a risky activity, but they have to bring money home.”
Some Cabo Rojo fishermen find the threat too dangerous and have left Puerto Rico in search of other work. But not Maldonado. He knows he may die in these waters, the ones he has known since childhood.
“Those of us who have stayed,” he says, “don’t have a Plan B.”
Terry Aguayo, GPJ, translated this article from Spanish.
This story, originally published on August 2, 2020, has been updated.