"Our strategy is to help those who have an immediate need for health services after Maria's strike," Robert Kadlec told El Nuevo Dia.

The US Department of Health and Human Services plans to bring two additional units of the Disaster Medical Assistance Team to the Island, according to Assistant Secretary for Preparedness and Response Robert Kadlec.

The plan would complete the creation of a network of patient care and support to the 69 hospital throughout Puerto Rico.

The network is supported by the US Department of Defense and the Federal Veterans Administration whose clinics will also assist patients who are not active or retired military.

The ultimate goal of Federal Health is to complement and, if necessary, provide health services to the population, following the damage caused by Hurricane Maria, explained Kadlec, who moved to the Island last Sunday along with  Surgeon General Jerome Adams.

"Our strategy is to help those who have an immediate need for health services after Maria's strike," Kalec told El Nuevo Dia.

However, due to the absence (so far) of a comprehensive strategy to ensure the independent operation of the Island's hospitals network, following a disaster and facing the damage to the structures of some of these facilities, the logistics established by the federal agency will remain in Puerto Rico "for months," admitted Kadlec.

"I had never seen such a scale and extent of devastation as here," added Kadlec. "Hurricanes Harvey and Irma were significant, but there is not a single person or place in Puerto Rico that has not been touched by Hurricane Maria."

A system in crisis

Still, nearly 15 days after the cyclone, ensuring fuel and supplies to hospitals and health facilities in Puerto Rico continues to be a priority on the list of Governor Ricardo Rosselló Nevares and the Federal Emergency Management Agency (FEMA, English acronym).

The situation of the health system of Puerto Rico after the passage of Maria is so critical that in the first days after the hurricane, at the request of FEMA, Federal Health moved 150 dialysis patients from Puerto Rico and US Virgin Islands to the state of Florida and other nearby states. In addition, the situation has required sending doctors and supplies to the central part of the Island by helicopter and even the arrival of the hospital ship USNS US Comfort.

The challenges of the Island's health system are such that until last week –according to El Nuevo Día- there were approximately one thousand bodies in hospital morgues without being claimed or sent to the Institute of Forensic Sciences for judicial process, these figures  were provided by the Association of Hospitals to this newspaper.

Having Kadlec on the Island, perhaps, confirms the complexity and gravity of the health situation in Puerto Rico. Kadlec, physician and career officer is the top advisor to the US Secretary of Health when it comes to public health emergencies, including bioterrorism. The expert is also responsible for designing strategies to protect civilian population from all kinds of disasters, from prevention and response stages to the recovery phase.

"What we are doing is consolidating our efforts in the areas of greatest need," added Kadlec, who participated in the response to hurricanes Harvey and Irma at the continental level.

According to the physician, handling health disaster response has required extensive logistics, since Federal Health, along with FEMA, had to deal with multiple issues. These issues include providing fuel to the main supplier of medical supplies so they can provide hospitals until they can install generators, supply them with water and food, ensure expedited shipment of materials needed for dialysis patients and to bring medicines to address shortages of certain drugs.

Strategy for the whole Island

The plan implemented by the teams commanded by Kadlec has its base of operations in the Medical Center of Puerto Rico and from where, Federal Health has gradually extended its support network to the whole Island.

Right now, Federal Health has established eight units of the Disaster Medical Assistance Team. In simple terms, these units could be described as an area of ??hospitalized, critical or emergency care patients. In addition, the network includes four support units provided by the US Department of Defense, and an air medical response unit that was created in Ceiba.

Federal Health has even built one of four medical stations in the Acropolis of Manati, with a capacity of up to 250 beds each that will start operating tomorrow, expanding the count of beds in the north of the Island.

In a way, the operation launched by Federal Health seems to fill the gap created by the fiscal crisis, as the problems of collection for medical plans, migration of professionals and the decrease in health funds resulted last year in almost a thousand layoffs and the gradual closure of a third of the inventory of available beds on the Island.

Support units, Kadlec explained, have been located in the immediate vicinity of existing hospitals and, after an analysis, it was concluded that they have certain capabilities to serve the region where they are located.

For example, Federal Health has established units of the Disaster Medical Assistance Team at Hima San Pablo Hospitals, located in Caguas and Fajardo.

In the case of Caguas facilities, Kadlec explained that electricity problems affected the air conditioning system, so some hospitalized patients were transferred to the unit established there, which alleviates the volume of patients being treated. Something similar was done at Ryder Hospital in Humacao, where Hurricane Maria ripped off the roof of the facility.

Meanwhile, the USNS Comfort boat will allow, if necessary, patients at the Pediatric Hospital, whose intensive neonatal unit suffered considerable damage, to be transferred to that facility for care or surgery.

According to Kadlec, as electricity service is restored and these facilities can resume operations at full capacity, Federal Health will mobilize backup units to other areas in need.

Now, groups of doctors and other health professionals from abroad provide services in these temporary facilities, but Federal Health expects that, as everything returns to normal, health professionals on the Island continue to provide services to the population.

Veterans will treat other patients

Kadlec added that in the disaster response, "Federal Health assets" have been integrated with those of Puerto Rico, that is, veterans hospital and clinics. These facilities will continue to serve this population, but services will also be provided to patients who have not been members of the Army.

According to Kadlec, the central and southern parts of the island are the areas in greatest need. In that sense, Veterans external clinics with units of the Medical Assistance in Disasters will serve in towns like Mayagüez and Vieques.

"At the moment, we have teams in Utuado, Comerío and Guayama," added Kadlec.

Once the health care situation stabilizes, Kadlec will focus his energies on the recovery stage.

"One of the critical things we learned from other hurricanes is that facilities have to be strengthened, structures will have to change, and generators will have to be different, but more important, institutions must have response plans. Planning is very important because Puerto Rico is in the region of hurricanes, other hurricanes are going to happen and systems have to be more resilient," he pointed out.

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