When we met Dr. Bolivar Arboleda Osorio in the city of Caguas a few weeks back, he talked about his experience treating patients in the aftermath of the storm -- first came the trauma victims, then came the chronic and severe cases that were becoming emergencies as time dragged on and the lights stayed off. Electronic records were stuck in the cloud. Patients, not able to call for an appointment, just showed up.
Things are slightly better now. Arboleda Osorio said his house doesn’t have power, but the hospital he works in does. Slowly, small bits of progress are being made. But he’s thinking about the long-term, too -- and he’s concerned.
“A friend of mine, she’s a gynecologist,” he said. “She decided not to reopen her practice. She decided that this was it. She was not coming back.”
Much of Puerto Rico is still in emergency response mode, as water and electricity continue to be in short supply -- nearly two months after Hurricane Maria hit. But these immediate concerns could lead to longer-term problems. Arboleda Osorio is concerned that the storm will lead to another kind of shortage: a lack of doctors.
His office was fine after Maria. He didn’t lose his windows. But others, in the same building, had their windows blown out.
“Some lost everything, their offices,” Arboleda Osorio said. “So they’re moving into some of their friends’ offices to at least have some place to practice. Others that were looking into moving to the states decided that this is it. I’m gone.”
Now, he fears that Maria will make an existing problem worse. Doctors have been leaving the island for years. For a number of reasons, including low federal reimbursements for procedures, physicians have long made less money in Puerto Rico than they could on the mainland.
“Over this past year, we had lost physicians at a rate four times bigger than the rate of emigration. People are moving, going somewhere else. Not just because of the economy. It’s because they don’t feel safe,” he said. “They don’t feel that the government will be able to provide for everybody’s well-being.”
Making matters worse, the doctor said young surgeons are leaving, too. He said few will be around to take his place.
“We had only one program up to four or five years ago,” he said. “And that training program graduated five general surgeons a year. Most of those go to do a subspecialty and, when they do, they usually stay in the states.”
The numbers are bad. His hospital needs 250 doctors, but it only has 200. Island-wide, there are only 200 surgeons to serve 3.5 million people, he said. And he said most of those surgeons are around 60 years old.
So he, too, faces a choice. Arboleda Osorio and his wife -- who is also a doctor -- could very easily leave. But they won’t.
“Over the years, we’ve had a number of offers to move to the states,” he said. “Of course, we have two daughters in Connecticut. So it has been tempting. But we know that we owe our people what we are.”
And it’s that sense of debt and duty that seems to keep him and his wife on the island.
“I think God gave us that opportunity for a reason,” he said. “And that reason, to me, is to give back whatever we can to the people who are near us.”
He said they’ve been given too many opportunities to succeed in Puerto Rico -- too many to leave it behind.
This story is part of “The Island Next Door,” WNPR’s reporting project about Puerto Rico and Connecticut after Hurricane Maria.