SAN JUAN, PUERTO RICO — José Rodríguez Canales has been a nurse in Puerto Rico for 27 years, and he has never seen a scarcity of equipment like now.
At the hospital where he works in San Juan, Puerto Rico’s capital, face masks, lab coats and even hand sanitizer have been restricted since the government began preparing for the new coronavirus.
“In all my years of experience, I haven’t seen such a restriction of protective equipment,” he says. “At this point, we’re starting to see a shortage.”
Rodríguez Canales is one of many frontline workers in Puerto Rico preparing for the coronavirus within a health care system that already faced shortages of equipment, as well as staff. Over the past five years, Puerto Rico has endured a devastating hurricane as well as an ongoing debt crisis that forced budget cuts to the public health care system. Many medical practitioners have gone abroad in search of better opportunities.
All this spells trouble for Puerto Rico as it addresses the coronavirus. The region reports 2,173 confirmed cases of COVID-19, the disease caused by the coronavirus, and 108 deaths, as of May 9.
“An exodus” of doctors began in 2006, then increased after Hurricane Maria struck Puerto Rico in 2017, says Víctor Ramos, president of the College of Physicians-Surgeons of Puerto Rico. Many were lured away by hospitals in the United States, some of which recruited in Puerto Rico by offering higher salaries than can be found locally.
The number of doctors in Puerto Rico declined by almost 60% between 2015 and 2018, according to the Puerto Rico Medical Licensing and Studies Board.
Puerto Rico’s ongoing debt struggle also has made it difficult for local hospitals, particularly publicly funded facilities, to retain doctors.
The Puerto Rican government owes creditors over $70 billion. Financial experts have long attributed the debt to the mismanagement of funds. However, a number of sources, including a study by the Interamerican University of Puerto Rico and the Caribbean Institute for Human Rights, have argued the debt was caused by U.S. tax policies that stunted economic growth.
Puerto Rico in 2016 had to hand over control of its finances to the Financial Oversight and Management Board appointed by the U.S. president. Budget cuts followed, and public health facilities were not spared. Some were closed or privatized.
Facilities that remain open have less funding for the personal protective equipment health care workers need to care for their patients, says Gerson Guzmán López, president of the General Workers Union, which represents 6,000 public health care workers.
“Because of a lack of budget — the budget cuts that different administrations have been making year after year — they [the facilities] didn’t have the financial resources to have the equipment, buy the equipment, and keep them at a responsible supply level,” Guzmán López says. “Nobody was ready for a pandemic.”
The shortage of supplies includes ventilators, which are necessary to treat patients severely affected by COVID-19, says Fernando Ysern, an associate professor at the University of Puerto Rico’s School of Medicine. Puerto Rico does not have enough ventilators available if the outbreak were to “get out of hand,” he says.
The threat of the coronavirus has created an additional problem for private hospitals in Puerto Rico, says Jaime Plá, president of the Puerto Rico Hospital Association. Because of the outbreak, patients suffering from non-coronavirus conditions have avoided hospitals, and voluntary procedures have been canceled. Only about 38% of available private hospital beds are occupied, Plá says. This means less revenue for hospitals and a tougher time paying expenses, including salaries.
“We’re going to have to work with less personnel. We’ll be less prepared. It’s not that hospitals want that, but there’s no way [to employ people without money],” he says.
Officials at the Puerto Rico Department of Health did not respond to a request for comment for this article.
At a recent news conference, Governor Wanda Vázquez Garced addressed the issue, saying it was being discussed with the Financial Oversight and Management Board: “Nothing worries us more than being able to solve this and give options to hospitals so that they can be prepared to respond to the pandemic.”
In the meantime, Puerto Rico’s years of dealing with crises — both natural and man-made — have prepared the public to respond well to emergencies, including adhering to measures designed to prevent the spread of the coronavirus, says Ysern, the professor.
“We’ve been through hurricanes. We’ve been through earthquakes. We’ve been through recessions,” Ysern says. “We’ve been battered enough to be able to weather any storm. But every time funding is decreased, it makes it more difficult.”
Sarah DeVries, GPJ, translated this story from Spanish.