Puerto Rican Hospitals Battle Life and Death Daily | Hacker News Reader

Puerto Rican Hospitals Battle Life and Death Daily

npr.org

145 pointscurtis75 comments

Sadly, we can expect to see more of this into the future.

http://abcnews.go.com/International/wireStory/puerto-rico-fa....

> The territory's $73 billion debt crisis has left agencies like the state power company broke. It abandoned most basic maintenance in recent years, leaving the island subject to regular blackouts.

The Federal government can provide disaster relief (and should have done a better job here), but it's job isn't to rebuild local infrastructure (especially infrastructure that was already marginal due to decades of neglect). In that sense, Puerto Rico isn't different from Illinois, Detroit, Flint, or numerous other places where decades of mismanagement have hollowed out the resources of the local government. If a major disaster hit Detroit, I think you'd be surprised at how long it would take to recover.

It is different because it's not a state, can't declare bankruptcy, and has limited options for getting representation.

Detroit declared bankruptcy. Puerto Rico cannot.

States can't declare bankruptcy, cities can.

States can actually dismiss debt as sovereign entities. That doesn't protect them from the consequences.. for example no one loaning them money in the future. But they can do it.

States can't use federal bankruptcy courts to restructure their obligations and are Constitutionally prohibited from 'impairing the obligation of contracts'.

How can U.S States dismiss debt as sovereign entities? They can probably refuse to pay it but the debt holders would have a solid case to get judicial relief.

https://en.wikipedia.org/wiki/Sovereign_immunity_in_the_Unit...

That's a mechanism that might extend bankruptcy to the States at some point, but American States have always paid their debts to the financial market.

>American States have always paid their debts to the financial market.

I don't contest that, but what I am saying is, like National governments they can dismiss their debt. Although, of course they would have non existent credit after such an event. The States unlike some European governments are not used to functioning in the absence of borrowing.

True, but last year a law was passed (PROMESA) specifically to allow Puerto Rico to enter a court-supervised bankruptcy-like process, and it has done so. See also:

https://www.nytimes.com/2017/05/03/business/dealbook/puerto-...

Interesting. I'd read about their struggles over the last few years and how they were legally hemmed in, so it's good to see there's some way out of this mess.

It's still astonishing and borderline criminal that citizens in Washington D.C. and territories like Puerto Rico have nearly zero federal representation.

The American flag in World War II had only 48 stars, it's not even the same as the current flag, so if that can change, what's wrong with two more stars?

Point taken, but the article wasn't talking about "rebuilding local infrastructure", or long-term recovery. It was specifically talking about people dying, and in danger of dying, right now - for the lack of easily deployable (in the timespan since the hurricane - being as this is, you know, the richest country in the world) replacement "infrastructure" like air conditioners and gas-powered generators.

While their country's Executive Branch not only shows no signs of taking their plight seriously, but goes out of its way to make spiteful comments about it.

It's weird that when I read the article I form a picture of an immense response of very determined, brave, well funded, well trained, responsive professionals out there saving lives in a post-apocalyptic environment.

But your takeaway was that this "shows no signs of taking their plight seriously"? I honestly do not get it. Did we read the same article?

Did you read about Dr. Melissa Stein leading the DMAT team? About Commander Thorp responding to the false report of a disaster at a nearby hospital? About the conditions they are working in?

"In telling team members coming here we tell them it's going to be an extremely austere environment," she says.

No power, no air conditioning, no local water, no local food, no Internet and very limited communication. Hurricane Maria falls somewhere between Hurricane Harvey in Houston — where teams stayed in a hotel — and the 2010 Haiti earthquake, where they created a field hospital in Port-au-Prince and slept outside.

This is a island with 3.4 million people which won't have power restored for 4-6 months. From what I'm reading we have seen an overwhelming Federal response starts days before landfall.

No signs of taking their plight seriously....

We have very different ideas about what "immense response" means.

NYT reports FEMA is spending $200 million per day. Whitehouse has requested additional $29 Billion on top of the previous $15 Billion (which is still being being spent, now mainly on Maria recovery).

Then we have lower level efforts like the FCC approving $77 million in aid to restore communications.

And every one of the brave professionals deployed there will have stories like Dr. Stein's in the OP.

GDP of Peurto Rico is ~$100 billion, by comparison.

What the United States is doing for the people of Peurto Rico is exactly the extraordinary compassion I love to see from my country. I think people are blinded by politics on this one.

This isn't about Trump. America is responding to Americans in need, and I think we can actually be proud of the response. I'm not saying it has been perfect, but it certainly is immense.

https://www.theatlantic.com/science/archive/2017/10/what-hap...

This is a reasonably fair article although I want to make a couple key points.

The comparison point of the Haiti earthquake Makes No Sense! Deaths in Haiti we're maybe 230,000. Deaths in Peurto Rico are < 100.

Troops Deployed comparisons make no sense! Haiti is the poorest country in the Western hemisphere. It's GDP is $8 billion for 8 million people vs $100 Billion for 3.5 million people in PR. Peurto Ricans are 28x more productive per capita which has huge implications across the board for the level of response required. But it's not unfair to consider the average Peurto Rican is 28x more able to prepare, endure, and contribute to recovery efforts than the average Haitian.

Also Peuro Rico has 10,000 local US National Guard which are not being counted in Atlantics figures. That means actual US troops in PR are roughly equivalent to Haiti deployment actually.

Other reports I've read are that USMS Comfort did not initially deploy because PR locals wanted field hospitals not ship-based. Not because the Federal gov decided themselves not to send it.

And finally - to lead with "Almost two weeks after the storm abated, most of the island’s residents still lack access to electricity and clean water." First of all it will be months before most residents have power, mostly because the pre-existing state of their grid. I've read it needs to be rebuilt entirely. Second, clearly there is access to potable water as you can't live this long without it, and NYT reports as of yesterday Oct 4 a total of 34 deaths attributed to Maria including 15 "indirect" deaths which occurred after the storm passed.

Apologize for the spelling error - for some reason my phone is autocorrecting Puerto Rico to Peurto Rico. Embarrassing :-(

There is a robust federal response. It's also not enough to meet the challenge. Both things can be true.

Apparently the response in Haiti was faster and larger [1] And yet, people forget that the response in Haiti was screwed up too.

[1] https://www.washingtonpost.com/investigations/us-responded-t...

We are spending $200 million per day. NYT reports that 19 people died during the storm and 14 people have died since "indirectly" from the storm.

You claim what we are doing is "not enough to meet the challenge". By what metric? It was a "catastrophic event" which will take months to rebuild. It's been about two weeks, and a dozen people have died. It seems like the immediate challenge has been well and fully met. The long term challenge is already shaping up with Trump statements like "wipe out the debt".

By comparison deaths in Haiti were about 200,000. Please let that sink in when MSM tries to make the comparison.

One of the things we learned from Haiti is the deploy everything now mentality is counter-productive. You get a baseline then you assess, assess, assess and then figure out how to send the right resources that are actually needed on the ground.

Source for $200 million per day?

https://mobile.nytimes.com/2017/10/04/us/politics/trump-hurr...

FWIW, the full title of this article is: 112 Degrees With No Water: Puerto Rican Hospitals Battle Life And Death Daily

i think it's important to emphasize the temperature difference here because almost every hospital anywhere battles life and death daily

> No power, no air conditioning, no local water, no local food

46 celsius. Wouldn't be feasible to move at least some of those people to hospitals in the continent to be treated there? Seems a much easier and efficient way. Recovery could be much slower if patiens are keep in the current facilities.

I don't know what the extent is, but there have been medical evacuations.

I guess it isn't simple though, people may not want to leave the island if they think the hospitals will be back to full service soon and things like that. And also transporting sick people 1,000 miles isn't necessarily trivial.

Is an interesting thing that there are aircraft carriers but not hospital carrier ships... would make some things much easier

There are hospital ships, like the USNS Mercy and Comfort.

https://en.wikipedia.org/wiki/USNS_Mercy_(T-AH-19)

There is a hospital ship in San Juan:

https://www.defense.gov/News/Article/Article/1334349/usns-co...

It'd be interesting to see a real analysis of the difficulties. Among the first things that come to mind is efficient use of personnel. There is need for medical care there, so there is a decision between having medical people available locally and having them transporting patients.

My first thought as well - seems as though the USNS Comfort has been on site PR for a couple days now. I know the Navy only has two of those vessels - perhaps a third would be prudent and money well spent?

I had intended to use the full title, and only just now realized that I messed it up.

Big time, mind you.

In regards to people questioning why the US Navy and friends haven't swooped in yet, it is a question of logistics. Contrary to cinematic portrayal, an endeavour of this magnitude requires a ton of planning and legal acrobatics, not to mention hiring and deploying contractors. A worthy read on this subject is Shield and Sword, an account of the US Navy in Gulf War I.

It is truly shocking how slow the recovery is.

Something came to mind the other day, when someone was on Hacker News in Puerto Rico mentioning how they were leaving (for Atlanta I think)?

What if we just crowdfunded people getting out of PR and helping them get setup in the US? If the US government won't address the humanitarian crisis, yet its still a humanitarian crisis, could we still not address it collectively as private individuals?

When a government turns its back on its citizens, its citizens are left to help their fellow citizens.

EDIT: Based on the thread response, I suppose we'll just watch everyone suffer in Puerto Rico. Mission Accomplished /s

Scaling problem. If you wanted to get ten thousand people out and settled somewhere else, you'd be talking about close to ten thousand dollars apiece between transit and housing and job search and overhead--we're not crowdfunding a hundred million dollars.

BTW, Puerto Rico has about 3.5 million residents.

Crowdfunding as a patch is both mathematically unlikely in the short term and socially toxic in the long term--this is why we have governments, they can marshal the proper number of zeroes at the end of the number, it's their job. At least, when led by people who believe it is their mission to actually do their jobs.

Hopefully your last point gets remembered at upcoming elections.

Isn't it a fallacy to do nothing because you can't do everything for everyone?

Is crowdfunding some plane tickets really the most effective thing you can do? Is entirely abandoning Puerto Rico actually what Puerto Ricans want? Is crowdfunding abandonment the response you would want if your state faced a natural disaster?

> Is crowdfunding some plane tickets really the most effective thing you can do?

Yes. As a US citizen, it is far cheaper for me to help a Puerto Rican fly to the mainland and get a job, versus the enourmous money pit that is Puerto Rico's finances (which calls for, in their constitution, taxes be funneled to bondholders before infrastructure).

> Is entirely abandoning Puerto Rico actually what Puerto Ricans want?

This does not matter to me. I'm willing to help those that want to leave and can find opportunity elsewhere. The current US administration as shown they won't help. The Puerto Rican government has no ability to help themselves. Shall we just let people slowly suffer until death?

> Is crowdfunding abandonment the response you would want if your state faced a natural disaster?

When a ship is sinking, you don't demand people stop throwing life rafts and get back on the boat to repair the boat. If I were a natural disaster victim, I would happily accept any form of help provided if I was left with nothing.

I lived in PR for a few years. Almost everyone I met (thousands of people) had family in the mainland (and had been up there to visit them at least once). I was told that there were more Puerto Ricans on the mainland than in PR. I'm just imaging what would happen if everyone (or the majority) left PR to go live with their families in NY or Florida or wherever... for sure the debt would never get paid back since the tax base would be gone, the villages would quickly disappear as the fast growing plant life took things back over, the resorts would have to close unless they brought in a lot of Dominicans to fill the positions... it's crazy to think about, but I could totally see it happening.

instead, investors with money will buy up good locations and build bigger resorts and turn PR into something more like Aruba or the resort towns in Mexico. except closer. zero middle class and lots of cheap unskilled labor.

at least thats one possible outcome.

Don't forget those high-risk, high-return bonds Congress won't let them default on and all the effects of that. Things were already arguably headed that way.

Puerto Rico's population has been falling for the last 10 years or so, which is a strong factor in why they had so much trouble with debt. This is going to make it much worse. See https://www.cfr.org/blog/puerto-rico-maria for a lot more detail.

Because Is expected that those people will not work?. If they work they can contribute. People living in a different country pay taxes also. Dead people can't.

With most infrastructures distroyed, tourism industry in Puerto Rico will not employ much people for some time probably, so many Puerto Ricans will be unable to pay a lot of taxes in any case, not if they remain in the island.

Well, PR is not a different country. Puerto Ricans are Americans. When they live in PR they pay "state" taxes to PR. But if they are living in NY then they will pay NY state taxes, not PR "state" taxes.

People moving from Puerto Rico to the US aren't living in a different country. They’ll continue to pay taxes to the same country (in fact, more taxes to the country), but they won't pay local taxes in Puerto Rico, for the same reason a US citizen who used to live in San Francisco but now lives in Salt Lake City doesn't pay taxes in San Francisco or California.

Puerto Rico is a US colony (or, more politely, territory), not a foreign country.

Puerto Rico is not one of these extremely underdeveloped economies where the only work is in tourism. In fact the pharmaceutical industry is facing a bunch of shortages since PR is a major manufacturing hub for them.

Upvoted because I still find the second paragraph introducing crowfunding a valuable adition to the debate. I don't know how, and agree with the problems with asking people to do the job of the government, thus paying two times for the same thing, but maybe could still be useful at a minor scale or if headed towards a different goal

Im the one leaving to Atlanta [0]. Crowdfunding might work, but how would you scale it? In my case, I dont need money from a crowsource campaign. I just need a job once I arrive by the 15th. Others who are leaving do so, too. Keep an eye out for those. :)

I think everyone in the US should take notice of how things are being handled because this could be you in the future.

[0]Link to my resume in case you are hiring and interested:

https://drive.google.com/file/d/0B9bEeheRVaXZZm1YR3EyVkhVWUk...

FEMA is used to dropping massive quantities of supplies "at the doorstep" and relies on local infrastructure to distribute it.

Apparently there are 10,000 containers in port but no way to distribute the goods. No drivers, no gas for trucks, and no passable roads to drive on.

You can't rebuilt the islands electrical grid in a couple weeks, when first you have to rebuild the roads, which you can't build because there's no one there to build them because there's no food or water.

I'd say the devastation is truly shocking. It's not particularly shocking that the recovery is just getting started and that they are facing absolutely enourmous logistical problems compounded by the pre-existing state and very poor readiness for this level of event.

Where are you getting your assessment of the road damage?

I am unsure, but this site has been excellent for tracking progress of other indicators.

http://www.status.pr/

This is a very good source and runs off of mobile and desktop nicely to my surprise. Please anyone take a moment and donate even if its $5. It could be you or your family next time in need (hope not)

Just quoting CNN, NPR, etc.

The Puerto Rico Federal Affairs Administration tells NPR that the government is working with the truck driver's union to find a solution for driving with downed power lines and damaged roads, and the Department of Defense says it has sent teams to work on clearing blocked streets.

http://www.npr.org/sections/thetwo-way/2017/09/28/554297787/...

No drivers, no gas for trucks, and no passable roads to drive on.

Which is what the Army, Coast Guard, and Marines -- not to mention all those gold bars in Fort Knox -- are for.

If the current administration wanted to flex every available muscle to help the people of Puerto Rico, it would. But very clearly it doesn't.

I would encourage you take a few minutes to read about the extent of actual efforts undertaken, starting days before landfall, to manage this disaster.

DoD has in fact taken over responsibility for local management of disaster response. I couldn't find a MSM source but you can Google Translate this [1] - god help me I had to find the link on /r/the_donald.

[1] - https://www.elnuevodia.com/noticias/locales/nota/cambialalog...

Solar energy could be a good temporal solution for this kind of disasters:

https://www.reuters.com/article/us-usa-puertorico-solar/how-...

The military probably have a lot of experience deploying solar energy infrastructure in places with complex accessibility.

Afghanistan was a testbed for this technology because remote bases were often extremely expensive to maintain if running off of generator power. The cost of fuel was astronomical since it had to be ferried in by helicopter.

Your favorite vendor-of-the-future is on the case [1].

[1] https://www.ecowatch.com/tesla-batteries-puerto-rico-2490950...

I have a friend who sells containerized solar+wind+battery power systems, which is pretty handy in places where there's no grid. But still, given that PR does have a grid, repairing it plus sending in diesel for hospitals/cell cites is probably more cost-effective than sending in containerized solar now.

> Apparently there are 10,000 containers in port but no way to distribute the goods. No drivers, no gas for trucks, and no passable roads to drive on.

The US military relies on the ability to rapidly solve these kind of problems anywhere in the world (even across “big water” from the Continental US) including on-demand road clearing/building with either minimal pre-existing infrastructure or heaving damage to pre-existing infrastructure rendering it unusable.

US law provides broad authority for the use of military resources for disaster relief. It's a failure of the executive branch senior leadership if the need for such resources is not identified and acted on in a timely fashion.

It seems like there should be a carrier parked off the island providing relief. Those things are freaking cities, complete with state-of-the-art trauma centers and heavy logistics support. It's what the US does when there are massive tsunamis or similar in other parts of the world.

And don't tell me that the army's engineering corps can't spare a bunch of trucks, half-tracks, bulldozers, mobile bridges, etc. That and preparing for/preventing natural disasters is practically what the army's engineering corps exists for, domestically. The US army holds its place in the world because of its astonishing ability to provide extensive logistical support anywhere, anywhen. But we apparently can't manage basic distribution in our own home when the roads get swamped?

There is a carrier off the coast of PR: USS Kearsarge. The USS Oak Hill (not a carrier though) is also in PR. Both arrived shortly after Maria hit.

The USS Wasp was recently moved from Dominica to PR.

Note, this is still less help than FL received for Irma. FL got Kearsarge + Oak Hill + New York + Iwo Jima. (The last two ships have about 2000 people.. they were clearing roads, restoring electricity, and distributing supplies in FL.. they went home from FL the same day maria was upgraded to a cat 4 and was just off PRs coast.)

And note, USS Wasp was in PR for Irma, then moved to Dominica for Maria, now has moved back a couple of days ago. (USS Wasp has water purification systems.. they're literally distributing water)

Huh, cool. It's always nice to see them being used for relief efforts like this.

Good update from WaPo on ship deployments [1] including deploying USMS Comfort (which apparently PR officials initially declined).

[1] - https://www.washingtonpost.com/news/checkpoint/wp/2017/10/04...

> there's no one there to build them because there's no food or water.

Surely there are still 3.4 million Puerto Ricans on the island?

Are they all starving and without water?

Might you possibly be exaggerating?

I'm sorry, that was meant to read "no local food or water" which is what the OP says.

I can't imagine 3.4 million people stick around with no electricity for 4-6 months, and no local economy. I did not at all mean to claim 3.4 million people have left already.

I am guessing if the electrical grid is truly destroyed and will take 4-6 months to rebuild as reported, how could that not lead to a mass exodus?

A lot of people will leave (and a lot of people have been leaving because the economy's been in freefall and they've been imposing more and more extreme austerity measures to keep paying bonds), but the island will not by any stretch of the imagination be deserted.

Hyperbole, noun: Obvious and intentional exaggeration; an extravagant statement or figure of speech not intended to be taken literally, as “to wait an eternity.”

Is it? I don't have a good handle on the logistical issues involved. Does the media? Commenters on this site?

Which resources should the government haved used and didn't?

Don't all hospitals? It's a place to treat and care for sick people. Obviously some are going to die.

What's with the "force protection" with assault weapons? What exactly are they protecting from?

There's always a big looter/violence problem during disasters like this, and it's difficult for police/security to do their jobs at normal efficiency.

Useful to project authority.

Don't they all? Not criticizing the article, just the title.

"Great anger" -Trump, commenting on the divisiveness he sowed using his supporters & the subject of the NFL protests, while ignoring Puerto Rico.

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