Much of Puerto Rico has no running water – and the problem is not just cleanliness

Residents line up to collect water from a tanker parked next to the road in Naranjito, Puerto Rico, in the aftermath of Hurricane Maria
Residents line up to collect water from a tanker parked next to the road in Naranjito, Puerto Rico, in the aftermath of Hurricane Maria

In households across Puerto Rico, water has become a precious commodity. Stored in jars, bottles and tubs, it is the once-overlooked essential that now occupies full attention in daily life.

Water is used and reused. And its scarcity means that for many Puerto Ricans, their bodies, their homes and their clothes are not as clean as they would like.

“The majority of our colleagues are washing their clothes in a creek,” said Linaida Santiago Arroyo, a nurse at a kidney dialysis center.

Limited water particularly dismays Santiago because she has two young children, an infant only four months old and a 4-year-old boy, “and I don’t want them getting sick.”

“We don’t have enough water to clean things up. There’s mud. There’s garbage that they still haven’t picked up,” she said. “It can attract insects that then come closer to the house.”

Dr. Lilliam Borrego, medical director at Fresenius Kidney Care, talks about health care in the town of Naranjito, Puerto Rico, in the aftermath of Hurricane Maria. PEDRO PORTAL

Since Hurricane Maria lashed Puerto Rico two weeks ago, knocking out the water system for more than half the island’s 3.4 million people, every drop does double duty.

When I bathe the baby, I use the same water to flush the toilet.

Linaida Santiago Arroyo, nurse

“When I bathe the baby, I use the same water to flush the toilet,” Santiago said.

As the island thirsts for more water, medical experts say it is one of the factors that make them deeply concerned over a possible spike in infectious diseases in coming weeks. Nine out of 10 homes on the island still have no electricity, meaning fans and air conditioning units aren’t available to stave off pesky mosquitos carrying illness in the storm’s aftermath.

The Federal Emergency Management Agency says 64 of the island’s 68 hospitals are open, but Gov. Ricardo Rosselló said Thursday only 25 are hooked up to the power grid. Others have generators and rely on erratic diesel supplies and suffer occasional breakdowns.

“Their generators aren’t meant to last weeks and months on end. They need fuel. They need logistics support,” said Navy Capt. Kevin Buckley, commanding officer of medical facilities aboard the USNS Comfort, a massive naval hospital ship that arrived in San Juan earlier this week and sailed for Ponce on the island’s southern coast Thursday.

USNS Comfort arrives in Puerto Rico. The Mercy-class Military Sealift Command hospital ship is assisting in humanitarian relief efforts in the aftermath of Hurricane Maria. PEDRO PORTAL

Some 11,000 U.S. military personnel have come to Puerto Rico in the wake of Hurricane Maria, and convoys of military vehicles carrying pallets of bottled water and meals are visible in the interior. Mosquito control units deployed in six municipalities, officials said, and five temporary biomedical waste stations have been set up.

Gov. Rosselló said that while relief workers have taken food, water and other assistance across the island, a few hamlets may not have learned that assistance was near. With limited phone service and electricity, news of assistance does not always travel over across hillsides.

We keep hearing about people who haven’t received food and water.

Puerto Rican Gov. Ricardo Rosselló

“We keep hearing about people who haven’t received food and water,” Rosselló said, adding that the reports are not often substantiated. “This continues to be a big worry. It is always a priority to identify how to deliver more resources and water.”

For those who are in good health, water shortages amount to simply a nuisance.

“I was telling my wife yesterday, I would like to take a shower. For a week and a half, I’ve been bathing with a gallon of water,” said Victor Rivera Suarez, who works at the San Miguel drugstore in Naranjito that his family has operated for six decades.

But for those suffering illness, the stakes are higher.

For one thing, many drug stores operate with small generators and without internet connections. Cashiers cannot check the computer system for the health plans of patients who come demanding medicines. The patients must pay cash and seek reimbursement on their own.

Medical crew members aboard the hospital ship USNS Comfort arrive in Puerto Rico, which arrived in Puerto Rico to assist in humanitarian relief efforts. PEDRO PORTAL

A middle-school teacher deployed temporarily to Naranjito as part of a National Guard call-up, Luis Cuevas Serrano, told of a teen-ager in his hometown who cut his chin severely in an accident earlier this week. His mother took him to see an emergency-room doctor.

“By the time he was going to do surgery, the power went off. The doctor told the mother, I cannot do surgery. It needs to be in a sterile area and there is no light,” Cuevas said.

At kidney dialysis centers, supplies of both water and diesel fuel to run generators are critical — immediately sustain lives.

The medical director at the Fresenius Kidney Care branch here, Dr. Lillian Borrego, a nephrologist, said her center was shut down only one day after the storm. Some patients receive less dialysis care treatment than is ideal, she said, to stretch diesel and water supplies.

If you have residual renal function, you might get by a little longer.

Dr. Lillian Borrego, nephrologist

“If you have residual renal function, you might get by a little longer,” she said. “I’m at the mercy of the water supply.”

While the kidney dialysis center limps along, families of patients face their own challenges getting gasoline to bring loved ones for their three-times-a-week dialysis, she said.

Even so, the broader health challenges worry her.

A helicopter with Army National Guard arrived in Naranjito with supplies for the residents as part of the relief efforts in the aftermath of Hurricane Maria PEDRO PORTAL

“My concern right now would be public health, hygiene, getting the garbage picked up,” she said, adding that rumors about deaths in remote areas continue to circulate. “I’ve heard horror stories. And so far, the official [death] count is 34.”

Authorities hope the arrival of the USNS Comfort will help ease problems at hospitals around the island.

The hospital ship has one of the largest trauma facilities in the United States and is equipped with three operating rooms, 50 ICU beds along with another 200 other beds, and some 500 medical personnel. Two MH-60 helicopters sit on its landing-pad deck.

“We can essentially handle anything other than cardiopulmonary bypass like, you know, for heart surgeries,” said Naval Capt. Kevan Mann, a general surgeon aboard the vessel.

The ship will treat patients and also provide services to other hospitals such as refilling tanks for medical-grade oxygen and re-sterilizing hospital gear, Buckley said.

By early Thursday, the ship’s staff had treated 64 patients, and medical personnel expected to see many others with chronic conditions, such as diabetes, hypertension and lung problems.

“If they can’t get access to medical care, or their medicines or their doctors, they may have some issues two or three weeks out,” said Buckley, an emergency room physician. “Obviously, as loss of the fruits of civilization, such as clean water and running water, obviously you worry about, two weeks out, things like dysentery.”

Tim Johnson: 202-288-9536; @timjohnson4