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29 T M C » P U L S E | S E P T E M B E R 2 0 1 8 29 he said that he misses them, and hopes they will visit soon. Rodríguez also told Drs. Polo and Flores that he had lost almost all feeling in both feet, a sign that his diabetes was now causing permanent nerve damage. His left eye was swollen shut. But he will not give up his home in the Salinas hills. Like an atomic bomb On Sept. 21, 2017, the morning after the hurricane, Dr. Gloria Colón, a pediatric oncologist with the University of Puerto Rico Pediatric Hospital in San Juan, tried to drive to work. She described the scene as apocalyptic, "like an atomic bomb went off." Power lines lay haphazard on the ground, blocking the roads. Traffic lights dangled in the middle of the street and buildings and trees sat sloped and broken from surges of wind and rain. "We went to sleep in 2017 and woke up in the 1940s after Maria," Colón said. "We are not used to being without electricity, without facilities, without communications." Like so many others, Colón was unable to reach the hospital that morning. But in the days that followed, doctors, nurses, residents and medical students arrived in droves, prepared to treat patients and collect supplies. The hospital, which already served as the headquarters for trauma and specialty care on the island, quickly became the center of operation for relief efforts. Donations flooded in from charities and nonprof- its. The first-floor classroom became a makeshift warehouse, with medical students organizing and labeling inhalers and insulin and antibiotics for distribution. Teams ventured out to remote areas to check on the elderly and on patients who needed ventilation or whose medications required refrigeration. Everyone pitched in, even those who lost their own homes and belongings. Not once during the storm or its aftermath did the hospital shut down. But nearly a year after Maria, problems remain. A giant mobile power generator is parked out front. Inside, a NICU that split open during the storm is still undergoing repairs, and only two elevators are operational. Hospital-wide shortages of critical medicine and supplies are ongoing, Drs. Polo and Flores learned, and include staples such as ketamine, antibiotics, alcohol wipes, oxygen monitors, rabies vaccines and chemotherapy drugs. According to local physicians, though, it isn't simply a matter of the storm's aftermath, but rather one of government bureaucracy. Protocols requiring multiple layers of approval lead to delay after delay. "The hurricane aggravated our crisis," said Dr. Maria Echevarria, a pediatric neuro-oncologist with the hospital. "We now face, sadly, the same things we faced prior to Maria. We had the crisis, we resolved it, but the baseline—we have the same limitations, the same government." Even before the storm, physicians typically made double the salary in the contiguous U.S. for the same job in Puerto Rico. They are a large subset of the professionals who have left for the mainland, adding to an already challenging recovery effort. (continued) We went to sleep in 2017 and woke up in the 1940s after Maria. We are not used to being without electricity, without facilities, without communications. — GLORIA COLÓN, M.D. Pediatric oncologist with the University of Puerto Rico Pediatric Hospital in San Juan Become a Certi!ed Tobacco Treatment Specialist Nationally accredited program offered at MD Anderson Cancer Center October 1-5, 2018 Led by MD Anderson faculty who specialize in smoking cessation research and clinical practice, this program will familiarize participants with the latest findings related to tobacco use, dependence, and smoking cessation as applied to clinical practice. To become certified or get more information about this course or future program dates, visit www.mdanderson.org/tobaccotraining or email ctts@mdanderson.org. MD Anderson will offer continuing education hours from the Accreditation Council for Continuing Medical Education (ACCME), National Commission for Health Education Credentialing (NCHEC), American Association for Respiratory Care (AARC) and the University of Houston Graduate College of Social Work. CEs for LPCs are also available. For further information on MD Anderson's EndTobacco ® Program: http://www.mdanderson.org/EndTobacco Training is sponsored by the Moon Shots Program TM at MD Anderson.