Team One arrives home, sharing farewell hugs with the other volunteers from New York State with whom they served in Fajardo, Puerto Rico.

Conditions in Puerto Rico were austere after Hurricane Maria made landfall on Wednesday, September 20, pushing 155 mph winds across the island with the same force as a thunderous tornado 50 to 60 miles wide and leaving utter devastation to the infrastructure, power grid, and water supply.

In the days that followed—as hospitals, clinics, doctors’ offices, and pharmacies remained closed or opened with very limited capacity—the health care risks to residents escalated. Lack of routine care and medications exacerbated chronic health conditions, while those who incurred new injuries—for example, kerosene burns, scorpion bites, or cuts as they cleaned up debris with machetes and chainsaws—needed urgent treatment. Contaminated floodwaters, as well as the lack of access to clean water, had the added potential to unleash rampant viral and bacterial illnesses, such as conjunctivitis, norovirus, and gastrointestinal infections.

Sixteen hundred miles away in New York City, concerned faculty and staff throughout the Mount Sinai Health System—some with ties to Puerto Rico, but many without—were eager to help their fellow Americans. And, by early October, three physicians and seven nurses were selected to participate in the first of two medical relief missions to Fajardo, Puerto Rico. A second team of 10 volunteers would follow them in late October. The missions—staffed by individuals representing all hospitals across the Health System—were part of a massive effort involving the Governor’s Office, the New York State Department of Health, the U.S. Department of Health and Human Services, the Greater New York Hospital Association, the Healthcare Association of New York State, the New York State Nurses Association, and 1199 SEIU.

Team One medical volunteers in Fajardo, Puerto, Rico, front row, from left: Juan Baez, RN; Melanie Pratts, RN; Christine Mahoney, MS, RN; Stacey A. Conklin, MSN, MS, RN; and Kevin Munjal, MD; back row, from left: Colleen Fischer, RN; Karendip Kaur Braich, MD; Helen Rosario, RN; Emma Kaplan-Lewis, MD; and Erin Hogan, RN.

“The selfless devotion of our volunteers to care for patients under these conditions reflects the values of the Mount Sinai Health System and the health care profession,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “We, and the population of Puerto Rico, are all in their debt.”

Adds Kevin Chason, DO, Clinical Director of Emergency Management, Mount Sinai Health System, and Assistant Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai: “This was a tremendous team effort from the Health System, and we also truly appreciate the departments and the staff at home who generously reorganized schedules and covered shifts to support these volunteers and allow them to do this important work.”

Stacey A. Conklin, MSN, MS, RN, Vice President for Patient Care Services, New York Eye and Ear Infirmary of Mount Sinai, led Mount Sinai’s first team. Under large white tents—which were set up and supplied by the National Disaster Medical System in a lot adjacent to a functioning private hospital and staffed with other providers from Disaster Medical Assistance Teams—the volunteers helped manage a clinic and a triage area for walk-in patients.

“The need was great and the team was superb,” recalls Ms. Conklin. “We worked together seamlessly and tirelessly for long hours and without any days off, sometimes seeing close to 200 patients a day. Every team member was extremely grateful for the opportunity to serve the community of Fajardo.”

Team Two preparing to leave New York for Puerto Rico, front row, from left: Tamairi Vildoso, RN; Madeline Hernandez, RN; Gail Haynes, RN; and Stephanie Ortiz, MD; back row, from left: Samantha Rose, NP; Diego Giraldo, RN; Sarah Schaefer, MD; Trina Cosme, RN; Sam Kim, MD, and Annette King, NP.

Ultimately, Team One helped treat 1,636 patients during their time there, with few comforts themselves—eating prepackaged meals, sleeping in barracks-style cots, and using outdoor portable toilets and sinks. The camp, as it was called, was able to provide routine primary care, cardiac monitoring and oxygen for more urgent patient needs, and pediatric and women’s health services, and was equipped with an isolation area. While hundreds of cases involved common injuries and illnesses, minor trauma, and infections, the team also saw many potentially serious cases that occurred when patients were unable to manage chronic conditions.

When a diabetic man presented with abdominal pain, the team was alarmed. Because he had not been able to get insulin, his body was breaking down fat as fuel, and, with dangerously high blood-sugar levels and an increasing concentration of acid in his blood, he was spiraling toward a state of ketoacidosis, a fatal condition if not quickly and aggressively managed. The team was able to stabilize him after several hours.

A view of the volunteer housing tent

The second Mount Sinai team of three doctors, two nurse practitioners, and five nurses, led by Trina Cosme, BSN, RN, Assistant Nurse Manager, Labor and Delivery at Mount Sinai West, arrived in Fajardo on Tuesday, October 24, and after an intensive day of training they assumed the duties of Team One, treating nearly 2,000 patients.

Ms. Cosme recalls a visit by Eric D. Hargan, the Acting Secretary of the U.S. Department of Health and Human Services, and Robert Kadlec, MD, Assistant Secretary for Preparedness and Response, both showing support for every volunteer assisting in the effort, including a group of young Puerto Rican high school and college students—aspiring nurses and doctors—who helped the Mount Sinai staff. “We were embraced by the community,” says Ms. Cosme, who was also grateful for a local culinary institute that occasionally brought them home-cooked meals.

Mostly, Ms. Cosme wants to recognize her “awesome” team members. “We were from different hospitals and had never met before this trip, but we became a well-oiled team of volunteers on a lifesaving mission to help the people of Puerto Rico.”

Gerardo Miranda- Comas, MD, Assistant Professor of Rehabilitation Medicine

Like many other Puerto Ricans, I had not slept well after September 20 when Hurricane Maria hit Puerto Rico.

In the days that followed, I joined a group of health care professionals in New York City to discuss how we could help. With the support of the New York State government, nonprofit organizations and health care institutions including Mount Sinai, and other smaller groups, I was on a plane to Puerto Rico three weeks later with volunteers from Doctors for Maria Relief, a team of physicians, nurses, nurse practitioners, and logistics personnel on a mission trip to assess, treat, and educate communities and individuals to help them manage ongoing medical issues and prevent possible disease outbreaks.

In Toa Baja, we helped in a clinic that was based in a school building, triaging patients to the appropriate service—social work, psychology, nursing, pharmacy—and providing medical evaluation for primary care, pediatrics, and rehabilitation medicine. In Caguas, we set up small clinical areas in community centers. Lastly, we were escorted to Utuado by the National Guard, who helped clear the path for us to reach several inaccessible mountain communities.

Snapshot of the devastation in Utuado

The medical necessities varied. We helped educate the communities about their increased health risks and distributed food, water, and water filters. Because of the lack of access to usual care, patients with chronic conditions were on the verge of, or had already suffered, acute exacerbations, which we treated.

Mental health issues were, and still are, major concerns, especially post-traumatic stress syndrome and depression. There was an alert for cholera, leptospirosis, Zika virus, dengue fever, and hepatitis A, among other contagious illnesses.

The devastation on the island was hard to perceive and understand before I traveled there. My trip helped me comprehend the needs of my homeland, and sadly, the severity of the damage. It will take some time for Puerto Rico to recover, but I have returned confident that it will happen.’’

By Gerardo Miranda-Comas, MD, Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai.