A real-life post-apocalyptic dystopia in Puerto Rico

Regardless of who’s responsible for aid not reaching the people of Puerto Rico, it’s very instructive to look at what’s happening there and learn from it as we consider our own preparations for emergencies.  We may not have it as bad as they do . . . but we can’t guarantee that.  Health care, in particular, is critically important – and critically lacking.

Melted medications. Surgical procedures conducted in sweltering 95-degree heat. Malfunctioning X-ray machines.

This is the reality doctors in Puerto Rico are facing almost four weeks after Hurricane Maria devastated the island.

“We’re practicing disaster medicine in real life,” said Dr. William Kotler, a senior resident in emergency medicine with Florida Hospital in Orlando, who spent two weeks volunteering on the island earlier this month. “We improvise if we have to, with very little resources.”

. . .

The physicians have been visiting up to three towns a day, providing care and distributing supplies.

The teams have brought with them dozens of boxes of catheters, insulin, IV antibiotics, portable ultrasounds, X-ray machines and other critical medical supplies. Florida Hospital has been flying in additional supplies to the island every three days since the first medical team arrived.

“Just this [past] weekend, we flew in nearly 2,000 pounds of supplies,” said the hospital’s spokeswoman Samantha Kearns O’Lenick.
The physicians said they’re concerned Puerto Rico could be headed toward a full-blown health crisis.

. . .

Dr. Raul Hernandez, an internist based in San Juan, is bracing for an outbreak — possibly deaths — from waterborne diseases. He said Leptospirosis, a bacterial disease spread through the urine of an infected animals such as rodents, is becoming a growing concern.

Due to a lack of safe drinking water, people are drinking from whatever water sources they can find — rivers, creeks, he said. If that water contains urine from an infected rat, disease will spread, he said.

So far, at least two deaths have been attributed to Leptospirosis.

Hernandez is also worried about his geriatric patients. He has been unable to contact several of them and worries whether his diabetic patients have insulin that hasn’t spoiled in the heat and proper nutrition, given the food shortages. He’s also concerned his patients won’t be able to get prescriptions at pharmacies.

Dr. Miguel Acevedo led the second team of emergency physicians from Florida Hospital … “They say it could take six to nine months for power to be restored fully in Puerto Rico. No hospital can plan to survive on generators for that long,” he said … What doctors are dealing with in Puerto Rico is a “Mad Max kind of situation,” said Acevedo.

“The reality here is post-apocalyptic,” he said. “You can’t understand the seriousness of it unless you see it.”

There’s more at the link, and also in this article, which goes into far more than the health care situation.  It describes destroyed homes, flattened farms, lack of electricity, potable water, food, sanitation, etc.  (A similar situation appears to be affecting the Dominican Republic as well.)

I’ve heard many people say that things could never get that bad in the continental United States – that things are so much better organized here that we’d soon sort things out.  I’m not so sure.  If we had two or three major natural disasters occurring days or weeks apart – for example, “the big one” (earthquake) in California, a hurricane on the Gulf Coast, another on the Atlantic coast, and perhaps a volcanic eruption along the Ring of Fire where it crosses Washington state or Alaska (which might very easily be triggered by a major earthquake in California) – the demand for aid from all the affected areas would simply overwhelm our resources, which are not unlimited.

As far as health goes, remember that many of us (including yours truly) are dependent on daily doses of medication to maintain our health.  Many of us have suffered previous conditions that might recur under the stress of a disaster (e.g. heart problems, mobility issues, etc.).  If health care isn’t available for us, those conditions might just kill us – even if health care was not strictly rationed during the emergency, being provided to those considered to have the best chance of survival, while the rest of us, older and/or sicker than “average”, would be left to our own devices.  That’s not something to take lightly – because it’s happened before in this countryRemember what happened after Hurricane Katrina?

After reading those articles, I’m going to adjust my own emergency preparations to ensure that I have more supplies of health care essentials, at least 90 days’ supply of prescription medications, and more potable water than I think I need.  You never know . . .



  1. A disproportionately high number of those who died in the Wine Country fires wire older people with mobility issues – they couldn't evacuate in time. If the emergency situation isolates, perhaps injures, but don't kill immediately (floods, earthquakes, hurricanes, slower-moving fires) they can still survive, IF rescuers can reach them.

    In a "Black Swan" situation such as you describe, with transportation hampered and resources stretched thin, rescue efforts would be fragmented. And many who would have otherwise had a good chance – the elderly, the handicapped, and the very young – would probably not be reached in time.

  2. Sounds like third world behavior. The robbers have guns and the victims don't, because the police defend the robbers by caging victims who have and use guns. People are drinking water without boiling it, yet there is gas at the gas stations which could be used to boil.

    Human IQs don't vary that much between races (subspecies with regional color variations). Human races don't vary even as much as the size of deer between the North and South edges of the US. If the source of the problem is not genetic, then it's cultural. What could it be? Socialism. People don't produce, they beg.

    The lesson from Puerto Rico is: Socialism kills.

  3. P.R. is in dire straits because for decades, – not years, but swaths of years – they ignored electricity infrastructure, preferring to funnel state money to social programs and cronyism rather than update a power grid cobbled together and jury-rigged since McKinley was president.

    Now they're reaping the harvest of those decisions.

    Color me jaded: boo frickin' hoo.

    The last thing we should do is shelter them from feeling the consequences of their prior uninterrupted stupidity, because doing such is like covering hot stovetops with quilts, because the children are too stupid to learn not to touch them.

    Nature/Creation put a perfectly functional nervous system in place to make stupid hurt, and what's actually cruel is to prevent it from teaching the lessons people should learn.

    The people of Puerto Rico are going to learn there are some mistakes that hurt, and some of those you don't get to make twice in life, because they kill you. And as callous as it sounds, and heartbreaking as it is to hear of, the people you might otherwise pluck from the edge of the cliff moments from disaster are the exact ones who should be allowed to plunge off the cliff, or you'll just encourage the dumbest and most self-destructive of the lot to breed and multiply, which just means when you can't be there next time, even more will die. And you could have prevented it.

    We cut into people, even though it hurts, because a little pain will save their lives. We force them to get their lazy, in-pain bodies out of bed rapidly, post-surgery, because it helps them heal better and faster. In short we, just like nature, use pain to teach, and to heal.

    Stepping in now will only kill them with kindness.

    Let them suffer, let them stress, let them get sick, and yes, even let some of them die, if they're to ever learn that the time to fix their problems was yesterday, not manana, or you're just pre-selecting an even greater number to die when you finally can't carry them any more, and even more of them die next time. Does anyone want "I saved twenty, so that 1000 could die later." on their tombstone?

    Either the lesson will get painful enough to teach them, or the stupid will die off, and the smart will learn.

    There is no other way for some people to learn, and it would be a greater cruelty to deny them the lesson that will save more lives in the future than will ever be lost now. And the soft racism of condescendingly low expectations is part and parcel of the entire wrong approach to deal with disasters like this. Send them all the tools they need to fix the problem, but let them fix it themselves, and do it right, so they don't need the same thing next year, and the year after that. Build a power grid that doesn't go down forever from one hurricanes, or even two. Build storm drains that take into account the problem, and eliminate it the minute the clouds blow over. Instead of sending them food stamps, teach them to fish and raise food, so the entire island isn't a cargo cult dependent wholly on imported supplies 24/7/365. Teach them the hard way that they should have strategic stockpiles of medicine in storm-proof storage right there on the island, and not depend on immediate shipments because they never thought of that. And stop building things too flimsy to survive a Cat V hurricane, which they're going to get every decade or two.

    I'll send you all the hose and buckets you want once, but you're going to man the pumps and put the fire out your own d*mned self.

  4. I purchase all my prescriptions in 90 day quantities and reorder when they are down to 30 days. Took some effort with the insurance company, doctor, and pharmacy but they are aboard now.

    Should add none of the prescriptions remotely lend themselves to abuse.

  5. soft racism of condescendingly low expectations

    It's far nastier than that. Socialism is a deliberate Skinner box. During America's Westward expansion, Indians were put on reservations and the government gave them "everything they needed". This socialism was not for their benefit, it was to ethnically cleanse them by psychologically destroying individual adults and children. Removing the feedback loops that teach creating value as judged by other human beings in the marketplace prevent human personalities from growing into adults. Adult Indians had their livelihoods taken away, Indian children never developed a livelihood. Similarly, gun control stunts political maturity: http://www.catb.org/esr/guns/gun-ethics.html

  6. Lepto is scary. I had two rafting guide buddies die of it. The symptoms are a common cold and it moves freaking fast. Any small cut and it can get in.

  7. What about what's happening already—the wildfires in northern California alongside the unfinished cleanup in southeast Texas, Florida and Puerto Rico?

    You can't say those alone aren't taxing enough already.

  8. Mail order pharmacies supply meds in 90 day increments, and because of mail delays, usually allow ordering refills 3 weeks early. Judicious use of a calendar and that 3 week buffer means you can get 5 refills/year rather than 4, giving you about an 80-90 day "stash" of meds. In 2 years you have almost a 6 month stash. Do pay close attention to proper storage procedures, however.

    When I receive each (early) refill, it goes into a vacuum-sealed (Foodsaver is a great tool) bag in a fridge door pocket and marked "BUGOUT" and the previous BUGOUT stash is placed into "on deck" status for use (Pro tip: leave the meds in the vacuum-sealed bag for 24 hours to reach room temp so condensation doesn't form; I leave mine in the bag until I'm ready to use them).

    And, talk to your doctor – a 90-day supply of 20 mg tablets can be made into a 180-day supply by the MD specifying a 40 mg dose and you cutting them in half with a $4 pill cutter.

    In that same door pocket is a vacuum-sealed bag of "4 in 1s" – photocopies of important documents (deed, birth certificates, insurance docs, phone numbers, etc., copied in reduced in size so four 8.5X11 pages fit on one face of an 8.5X11 sheet. Double-side copy and you'll have 8 reduced pages on one sheet. Fold in half, vacuum seal and it makes s small package. Pro tip: Tape one set of important keys (house, car, whatever) to one side of a 4X6 card, quarters for pay phones to the other side, and include it in the vacuum-sealed bag, along with a thumb drive of PDFs of the docs, and you've got a pair of quickly accessible Grab 'N' Go stuff in one place (security consierations may dictate keeping that critical info in a safe rather than the fridge).

    Another Pro Tip: Get some bright orange postcard stock (60 lb paper) from the stationary store, print BUGOUT on it in large letters, cut to just fit inside the vacuum-sealed bag, one on each side, and not only will it be easily readable through the bag, it'll be permanent and make the bag very easy to identify (and harder to lose or misplace). A narrow strip or two of reflective tape on each side of the bag makes it easier to find in the dark.

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