Health care system “collapse”: Doctors, experts sound alarm over Puerto Rico’s medical system

After Hurricane Maria in 2017, Puerto Rico’s public health system was inundated with people in need.

Now, Hurricane Fiona is expected to contribute to the island’s health crisis. About half of the people living on the island depend on the public health system. And local officials say federal funding gaps have led to staff shortages and long waits for patients.

Experts say Hurricane Maria exposed an already deteriorating system.

“If you ask all the players in the healthcare system, patients, providers and administrators, they will all agree…Maria just showed you what’s happening, but the system collapsed long before that,” said Nelson Varas-Diaz, a researcher at Florida International University, which leads studies to assess the state of health care on the island.

Varas-Diaz cites debt as the reason for the collapse.

“The collapse is mainly caused by the debt and economic crisis in Puerto Rico and the historic privatization of the health system there. Our research shows that patients wait six to eight months to get an appointment with a specialist. If that isn’t a sign of collapse, I don’t know what is,” Varas-Diaz said.

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dr Edgar Domenech Fagundo, an ear, nose and throat specialist in Ponce, Puerto Rico, treated 30 patients a day when he began practicing in 1999. More than two decades later, that number has roughly doubled.

“The average I see is between 50 and 60 patients a day when I’m in the office,” Fagundo said.

His schedule is so full that he won’t be able to see any new patients until March 2023. He said the delay could have potentially life-threatening effects on people.

“The longer people wait, the longer their diagnosis is delayed. And that’s why you want to treat things like cancer and other diseases early so that patients have a better chance of recovery,” Fagundo said.

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dr Carlos Mellado, who became Puerto Rico’s health minister a year ago, said there are only 17 neurosurgeons in Puerto Rico for a population of 3.2 million people.

Nicole Damiani’s husband, Carlos Rivera, was hospitalized earlier this month after falling to the ground and suffering a seizure. He had to wait eight days before seeing a neurosurgeon. Carlos had bleeding and swelling in his brain.

“It’s really hard to find a neurosurgeon here in Puerto Rico. And it got to a point where I was really reluctant to give up on life,” he said.

One of the reasons Carlos has had such a hard time finding medical care is that many Puerto Rican doctors are relocating to Florida, where the pay is significantly better.

Registered nurse Gielliam Elias, who has been a nurse at Centro Médico de Puerto Rico for 19 years, rides her son’s bike to work because she can’t afford a car. She said her biweekly check is for about $891 and it’s not enough for her family to survive.

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Even those just getting into the field say they are concerned about the future of healthcare in Puerto Rico.

“We look at the conditions around us, the things doctors are telling us, our own professors, family members who may be in the medical field. We hear constantly about the problems the island is facing. And just within three years, we may have to make this fateful decision of where we either stay or go, and it’s not entirely under our control,” said Carlo Bosques, a second-year medical student.

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