After The Storm : Embedded For months, officials claimed fewer than 100 people died from Hurricane Maria in Puerto Rico. Then, all of a sudden, the official estimate rose to nearly 3,000 deaths. How did that happen? We have the story of one family that helps make sense of it.
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After The Storm

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After The Storm

After The Storm

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(SOUNDBITE OF MUSIC)

KELLY MCEVERS, HOST:

Hey, you guys. Kelly McEvers here. We know. It has been a few months since you've heard from EMBEDDED. But the good news is we're coming back. We've been working really hard on a couple of new seasons. And this spring, we'll be back with some good stuff. One season, we'll take you to one of the most complicated places in the world and follow families who are trying to get their people out.

In the other one, we're going to take a big, long look at one of the most powerful people in America. We are very excited about all this stuff. I promise you'll be hearing more about it soon. And in the meantime, we have another story we've been working on, so keep listening. And thanks so much for sticking with us. We cannot wait to share what we've been working on.

Hey. I'm Kelly McEvers. And this is EMBEDDED. And the way we do stories here sometimes starts with one of us getting kind of obsessed. Last year, Tom Dreisbach, one of our producers, got obsessed with a number he'd heard in the news.

(SOUNDBITE OF MONTAGE)

WOLF BLITZER: A shocking new study prompts Puerto Rico's governor to raise the death toll from Hurricane Maria...

UNIDENTIFIED REPORTER #1: Officials in Puerto Rico now say nearly 3,000 people...

UNIDENTIFIED REPORTER #2: ...Has found that maybe 3,000 people have died...

SHEPARD SMITH: Nearly 3,000 people actually died within six months of that storm.

TOM DREISBACH, BYLINE: And when the news about this number came out, it was shocking. Partly, that's because the Puerto Rican government had said for months that the death toll from Hurricane Maria was fewer than a hundred but also because the study showed that most of these people did not die in the storm. They died because of the massive loss of power after the storm and the failure to get the power turned back on.

MARTA SUAREZ: We were thrown back to last century, to the 1930s.

DREISBACH: Marta Suarez (ph) is a doctor in Puerto Rico. And she says during Maria, the island's health care system basically fell apart.

SUAREZ: If you need to have a surgery and there was no ORs because the ORs could not be kept sterile, then you die from an appendicitis.

DREISBACH: If your insulin couldn't be refrigerated and went bad in the heat, you died from diabetes. If there was no power for the dialysis machine you needed, you died of kidney failure. All of this happened after Hurricane Maria. And the hardest part, Dr. Suarez says, is that it didn't have to.

SUAREZ: That's why it's so frustrating for us as physicians to know that someone died. And we - in theory, we could have helped them.

(SOUNDBITE OF MUSIC)

DREISBACH: All of these people could have been helped but weren't. I mean, the estimate is that 3,000 people died. This is a huge event. And for whatever reason - whether the distance or the language barrier or the history of colonialism - it just felt like the magnitude of what had had happened in Puerto Rico was not getting through on the mainland. Like, where were the stories for all of these 3,000 people?

Dr. Suarez told me one story that showed all the ways the system fell apart. There's this family. The son was on a ventilator, and he needed electricity to live. And she told me how they went from one place to another, desperately trying to find power to keep their son alive.

MCEVERS: So we decided our whole show today would be the story of this one family...

(SOUNDBITE OF MUSIC)

MCEVERS: ...Because telling that story will help us understand what went wrong after Hurricane Maria and how people are trying to figure out how to do better when the next storm comes.

(SOUNDBITE OF MUSIC)

MCEVERS: OK. We are back. And here's Tom Dreisbach with the story.

DREISBACH: It actually took me a while to find this family. Marta Suarez, the doctor we mentioned earlier, remembered their story but not their name. And when I asked around doctors' groups in the health department, they weren't sure how to reach them. And then one day, my phone rang. The mother had found me.

ZAIDA MALDONADO: Hola.

DREISBACH: Her name is Zaida Maldonado (ph). And she's resourceful, assertive. She has to be. She spent much of her life taking care of her son, Javier. He was born in 1999 with a rare genetic disorder called Smith-Lemli-Opitz syndrome. When Zaida and I talked through an interpreter, she called Javier a miracle.

MALDONADO: (Speaking Spanish).

DREISBACH: When Javier was a toddler, one doctor said he only had two more years to live. But that doctor was wrong.

MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: So she feels it's a sign from God that he wants to stay on this Earth with her.

DREISBACH: Still, Javier wasn't able to live on his own.

MALDONADO: (Speaking Spanish).

DREISBACH: He couldn't talk or walk. The only way he was able to breathe was with a ventilator, which pumped air into his lungs through a tube in his throat. Thing is, in Puerto Rico, the electrical grid is pretty unreliable, so the family had to have a backup - a generator, which runs on diesel fuel. And that generator kept Javier alive when the power went out. Then in September 2017, the family hears that a big storm is coming.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #3: (Speaking Spanish).

(SOUNDBITE OF MUSIC)

DREISBACH: At this point, Javier is 18. He, Zaida, his father Luis (ph) and his younger sister Anjelica (ph) are living way up in the mountains in the middle of Puerto Rico. It's this town called Barranquitas. They listen to the news as the storm gets more and more intense.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #4: (Speaking Spanish).

DREISBACH: The governor tells people they should prepare to shelter...

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #5: (Speaking Spanish).

DREISBACH: ...For 72 to 90 hours. Two days before the hurricane is set to make landfall, Zaida says she gets a call from Puerto Rico's Health Department. Even though the family has a generator, the health official says that the best thing for everyone and especially Javier is to go to the local emergency room before the storm. That way if Javier needs medical care, they'll already be there. And if the power goes out, the ER has its own generator.

Zaida and her family trust what the Health Department tells them. So they board up the windows at their house, pack up their cars and head to the ER. They have a plan, supplies and a safe place to go. They've done everything right.

(SOUNDBITE OF WIND BLOWING)

DREISBACH: Then around 6 a.m. on September 20, Hurricane Maria makes landfall.

(SOUNDBITE OF MUSIC)

DREISBACH: The wind is as fast as 155 miles per hour. It starts to blow trees into the roads and roofs off of buildings.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #6: (Speaking Spanish).

DREISBACH: One part of the island gets almost 40 inches of rain in just two days. That's more rain than fell in any place during Hurricane Katrina.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #7: (Speaking Spanish).

DREISBACH: By midday, the entire island - 100% - has lost power.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #8: (Speaking Spanish).

DREISBACH: All communication goes down - no landlines, no cellphones.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER #9: (Speaking Spanish).

DREISBACH: This hurricane was much worse than people expected.

(SOUNDBITE OF MUSIC)

DREISBACH: Zaida Maldonado, her husband Luis and their kids are all holed up in the emergency room. The backup generator there has diesel, and it kicks on. And there's a power outlet where they can plug in Javier's ventilator. So at first, they're feeling OK. But over the next few days, things start to change.

MALDONADO: (Speaking Spanish).

DREISBACH: At the ER, Zaida says, food and water and medical supplies are starting to run low. The staff are having trouble finding more diesel to power the generator. People are panicking. Zaida says it doesn't seem like the people in charge have a plan for what to do.

MALDONADO: (Through interpreter) I don't know how else to describe it but just everything froze.

DREISBACH: Even though the roads are flooded, they decide that Luis, Zaida's husband, should risk trying to drive home to get the supplies they need - things like Javier's diapers and formula he eats. So Luis leaves in the morning. Zaida, Javier and her daughter stay put in the ER.

(SOUNDBITE OF MUSIC)

DREISBACH: And then a few hours later, a nurse comes to Zaida and says there's a problem.

MALDONADO: (Speaking Spanish).

DREISBACH: The ER has to shut down the generator. If they just leave it on, it'll overheat and blow out. You'll have to take your kids and leave now, the nurse tells Zaida. They can't take care of Javier anymore.

MALDONADO: (Speaking Spanish).

DREISBACH: Zaida says, no. I can't leave until my husband gets back. The nurse says, there's no time. So they don't have a choice.

(SOUNDBITE OF MUSIC)

MCEVERS: More after this break.

(SOUNDBITE OF MUSIC)

MCEVERS: All right. We are back. Remember. It's September 2017. And the thing that's happening to Zaida Maldonado and her family is happening in hospitals all over Puerto Rico. Almost a week after the hurricane made landfall, FEMA said only 11 of 69 hospitals either had electricity or fuel for generators. Still, the government didn't seem to realize just how bad things were.

(SOUNDBITE OF ARCHIVED RECORDING)

RAFAEL RODRIGUEZ-MERCADO: (Speaking Spanish).

MCEVERS: The secretary of health does a radio interview and gets defensive when he's asked about it.

(SOUNDBITE OF ARCHIVED RECORDING)

RODRIGUEZ-MERCADO: (Speaking Spanish).

MCEVERS: He said it was not true that people were dying because of a lack of medical care.

(SOUNDBITE OF ARCHIVED RECORDING)

RODRIGUEZ-MERCADO: (Speaking Spanish).

MCEVERS: Plus, he said, people die in hospitals all the time.

(SOUNDBITE OF MUSIC)

MCEVERS: In the town of Barranquitas, in the emergency room where Zaida Maldonado and her kids are staying, a nurse tells her that in two hours, they won't have power. Here's Tom again.

DREISBACH: So the staff at the ER scrambles to make a plan. They decide that an ambulance would come and transfer Javier and a second boy who's on a ventilator to another hospital. The other boy was 8 years old, and he had muscular dystrophy. But when the ambulance arrives, the plan falls apart.

MALDONADO: (Speaking Spanish).

DREISBACH: The paramedic says they need the ambulance to handle emergencies...

MALDONADO: (Speaking Spanish).

DREISBACH: ...And that transferring patients from hospital to hospital is not an emergency.

MALDONADO: (Speaking Spanish).

DREISBACH: Zaida thinks, this has to be a mistake.

What did you say?

MALDONADO: (Speaking Spanish). (Laughter).

UNIDENTIFIED INTERPRETER: She basically cursed him out.

DREISBACH: The paramedic.

MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: And she said that was irresponsible and that's not something that you do. And he said that he is just following orders. And that's the order that he received.

MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: She doesn't know how, in such a moment, you could be so inhumane.

(SOUNDBITE OF MUSIC)

DREISBACH: In the end, even though she's terrified to go without her husband, Zaida decides to drive herself and her two kids to the second hospital. They load up into Zaida's car. And there's a special plug that connects Javier's ventilator to the engine. A police officer drives ahead of them.

And the other boy on a ventilator, that 8-year-old with muscular dystrophy - he has to get his own ride, too. Another family lends the boy's family their car. This hospital is much bigger, so Zaida expects it will be more prepared. After all, this is where they were told to go.

Describe just what it looked like at the hospital in Aibonito.

MALDONADO: (Speaking Spanish).

DREISBACH: "Total chaos."

(SOUNDBITE OF MUSIC)

MALDONADO: (Speaking Spanish).

DREISBACH: Zaida says there's people screaming, people with open wounds, people who are asking desperately for dialysis or for their regular chemotherapy drugs they need just to treat their cancer. On top of that, the hospital's understaffed. More than a hundred hospital employees were dealing with the fact that their own homes were damaged or destroyed.

This was such a problem that around this time, one hospital network actually puts out a message on Facebook to its employees. It says, we hope you're OK and the damage to your homes was minor. We're waiting for you. It's unclear how many people could even access Facebook to read a message like that.

(SOUNDBITE OF MUSIC)

MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: She was angry because she said, you know, you're a hospital. How are you not prepared?

MALDONADO: (Speaking Spanish).

DREISBACH: But this hospital does have the one thing Zaida desperately needs right now - electricity.

(SOUNDBITE OF MUSIC)

DREISBACH: Meanwhile, Luis, Zaida's husband, has made it safely back to the family's home in Barranquitas. The roads were barely passable, but the house itself and their supplies are OK. He heads back to the first ER to tell his family the good news. But, of course, they're already gone. He eventually gets to the hospital where his family is, and they reunite. But the relief of being back together doesn't last long.

(SOUNDBITE OF MUSIC)

DREISBACH: For Javier, who has a weak immune system, a hospital is full of danger. It's a breeding ground for the sort of bacteria and viruses that could kill him. And after the hurricane, that danger escalated. Hospitals need working air conditioning to prevent the spread of germs, supplies to clean operating rooms and staff to actually do that cleaning. In a lot of places, they had none of those things.

Puerto Rico's Center for Investigative Journalism looked into the hospital deaths from septicemia, which is essentially blood poisoning from bacteria. They found that those deaths increased almost 50% after Hurricane Maria.

(SOUNDBITE OF MUSIC)

DREISBACH: After about five days in this hospital, Zaida and Luis start to rethink their whole plan. At first, they listened to the government, and they went to the ER in their town. When the power failed there, they were sent to this hospital in Aibonito, but then that wasn't safe either. Someone tells them there's a government-run shelter they could go to next. But they hear it's dirty and overcrowded, so that's when they decide to just...

MALDONADO: (Speaking Spanish).

DREISBACH: ...Go home.

MALDONADO: (Speaking Spanish).

(SOUNDBITE OF MUSIC)

DREISBACH: They do not have electricity there, but they do have a generator. So now the goal of every day is to find enough diesel to keep that generator running, and it's really hard. Before the hurricane, Luis worked as a chef. But now he can't find work, so they scrape by on donations from people on Facebook or their church. Luis shows a picture of Javier on his ventilator to this woman who owns a gas station, and she gives them free diesel and lets Luis go to the front of the long gas lines. Eventually, they get some money from FEMA, but Luis says it's not enough. The government keeps telling people to be patient, and power will be back soon. And this goes on for weeks.

(SOUNDBITE OF MUSIC)

DREISBACH: ...Through October...

UNIDENTIFIED REPORTER #10: It's been one month since Hurricane Maria hit Puerto Rico, and 80% of the island is still without power.

UNIDENTIFIED REPORTER #11: There are many people here still without food, still without electricity, still without drinking water. The real...

DREISBACH: ...Then November...

UNIDENTIFIED REPORTER #12: It's been nearly two months now since the hurricane hit.

UNIDENTIFIED REPORTER #13: About half the island remains without power.

UNIDENTIFIED REPORTER #14: Half the island doesn't have power yet.

DREISBACH: ...December...

UNIDENTIFIED REPORTER #15: Nearly three months after Hurricane Maria, one-third of Puerto Rico is still without power.

UNIDENTIFIED REPORTER #16: Living through what is now the longest blackout in American history.

DREISBACH: Christmas - there's still no electricity.

LUIS: (Speaking Spanish).

DREISBACH: And all this time, even after cell service starts coming back on the island, Zaida says they never get a phone call or visit from the Health Department to check in on Javier. She says they felt abandoned. And then it's February 2018, almost five full months after the hurricane. There's a problem with Javier's ventilator. It's really not made to run on a generator for so long, and the generator keeps causing the ventilator to short out. They actually have to get it replaced four times. And one night, around 3 in the morning, Luis is checking on the ventilator. Javier starts having convulsions, and then he stops breathing. Luis starts CPR. Minutes go by. Zaida is so freaked out that she faints.

Oh, my God. And so you were thinking - did you think he could pass away in that moment?

LUIS: (Through interpreter) Yeah. We're conscious of - in any moment, that could happen.

(SOUNDBITE OF MUSIC)

DREISBACH: Finally, Javier's lungs and heart start working again. He's alive. But Luis knows it could happen again at any time, and he's not sure Javier would survive.

UNIDENTIFIED INTERPRETER: And that's when he basically say, I can't anymore with this.

(SOUNDBITE OF ARCHIVED RECORDING)

LUIS: (Speaking Spanish).

DREISBACH: Luis goes to a radio station, and he asks to talk to the morning show host about Javier's story. And they put him on.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED RADIO HOST: (Speaking Spanish).

DREISBACH: The host says, "so you've been without running water or electricity for more than 130 days?" Luis says yeah. And then the host asks how Javier is doing.

(SOUNDBITE OF ARCHIVED RECORDING)

LUIS: (Speaking Spanish).

DREISBACH: He says Javier's stable. Thank God, he's stable. But they need electricity, and they don't think they can wait much longer. The interview does actually get attention from the government. Finally, almost a month after that interview, a crew from a power company in Illinois helps fix the grid in their neighborhood. There's this video of the moment when Zaida and Luis finally flip the circuit breaker on at the house.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON: Turn the breaker.

DREISBACH: People from the power company are watching. And as soon as the lights come on...

(APPLAUSE, CHEERING)

DREISBACH: Zaida covers her face with their hands and starts to cry.

(SOUNDBITE OF MUSIC)

DREISBACH: Zaida says that if Luis had not gone to the radio station that day and told their story, she's convinced that right now Javier would not be alive, like one of the thousands of people who died after Hurricane Maria. She tells me that the 8-year-old boy that they had traveled with from that first ER, the boy with muscular dystrophy who was also on a ventilator - that boy died, they believe from an infection he got at the hospital.

(SOUNDBITE OF MUSIC)

OMAYA SOSA PASCUAL: Hi, Tom.

DREISBACH: Hi. How are you?

SOSA PASCUAL: Fine, thank you.

DREISBACH: Thank you for making the time. I really...

To understand why so much went wrong in Javier's case, I called Omaya Sosa Pascual. She runs Puerto Rico's Center for Investigative Journalism. And ever since Hurricane Maria, she and her team have been trying to figure out why the Puerto Rican and federal governments were so unprepared for what happened. She says there are rules for hospitals to follow to prepare for disasters, and the Puerto Rican government is supposed to enforce those rules. But she says for the most part, it didn't.

SOSA PASCUAL: The government of Puerto Rico, through its Department of Health, was not inspecting hospitals as frequently as they should have. There were hospitals that had not been visited for eight years, for example, so that gives you a sense that they were already in a questionable condition before Hurricane Maria struck.

DREISBACH: What was the government's rationale for not doing these inspections? Did they give you one?

SOSA PASCUAL: They have no personnel because we are in the financial crisis, and they don't have enough manpower to do it.

DREISBACH: Do you buy that reasoning?

SOSA PASCUAL: No, I don't. I really don't because they have money for other things. We are in a financial crisis, that's true. But priorities should be shuffled around and should be rethought.

DREISBACH: Omaya has been trying to get official reports of government inspections of hospitals and medical facilities from before the hurricane. And so far, the government has refused to make that information public. Another problem was that the information the government did put out was bad information. For example, about two weeks after the hurricane made landfall, Puerto Rico's governor said 63 out of 69 hospitals on the island were, quote-unquote, "operational." But then Omaya and her team went to several of these operational hospitals, and they found the same thing that Zaida and her family did - total chaos.

(SOUNDBITE OF MUSIC)

SOSA PASCUAL: Many didn't have enough oxygen supplies. There were some hospitals that, at some point, were performing surgeries with flashlights, so that's one of the worst mistakes the government made, in my view. They misled people, and that was fatal.

DREISBACH: Of course, the other bad information the Puerto Rican government put out was about how many people died. For months, they said the number was just 16 and then 64. And critics think that's why it took FEMA and other federal agencies a lot longer to respond to Maria than to other hurricanes. And then there's the electricity. Some of the problem was just Puerto Rico's decrepit power grid and the challenge of getting electricity to remote areas. But people who have worked on rebuilding other power grids say a lot of the problem was just incompetence. There were accusations of corruption. There was even a federal raid on a warehouse that was accused of hoarding reconstruction equipment. And so, Omaya says, when you look at all of this, it's clear that a lot of people who died because of Hurricane Maria did not have to.

SOSA PASCUAL: A very strong hurricane is always going to be bad. It doesn't matter how well-prepared you are. But that's OK for one day, for two days, maybe for a couple of days or a week. Most people that died did not die those first 72 hours. They died weeks and months after. That's not part of nature. That's part of the human incompetence.

DREISBACH: President Trump has rejected any criticism. He said the federal government's response was a 10 out of 10. Puerto Rico's governor and its health department did not respond to our requests for comment. But in the past, the governor has said that he takes responsibility for his government's failures. Omaya Sosa Pascual says the Puerto Rican government has started to put together new disaster plans. And she says there are signs of progress in those plans. The government is also working with doctors on creating a database of families like Zaida's so they're not left on their own next time. But at this point, Omaya does not think Puerto Rico is prepared for another hurricane like Maria. And the power grid now is just as vulnerable as it was before the storm. I got a small sense of what it's like to live with that uncertainty when I was on the phone with Zaida Maldonado. It was raining in Puerto Rico. And all of a sudden, she had to hand the phone over to Luis.

MALDONADO: (Speaking Spanish).

DREISBACH: At first, I didn't realize what was going on. And then they tell me the power just went out. Zaida goes to check on Javier and make sure the generator is still set up.

Does this happen a lot?

MALDONADO: (Speaking Spanish).

DREISBACH: She says, "yeah"...

MALDONADO: (Speaking Spanish).

DREISBACH: ..."Because the system's still so weak."

Hurricane Maria is not over for you yet.

MALDONADO: (Speaking Spanish).

UNIDENTIFIED INTERPRETER: Yeah, they're reliving it again.

(SOUNDBITE OF MUSIC)

MCEVERS: This episode was reported and produced by Tom Dreisbach with help from Isabeth Mendoza (ph). It was edited by Lisa Pollak, Eric Mennel and me with help from Adrian Florido and Mark Memmott. Fact-checking was my Greta Pittenger. Our lawyer is Ashley Messenger. Big thanks to all the doctors we talked to - Shreni Zinzuwadia (ph), Antonio Dajer (ph), Yasmin Pedrogo (ph), Marta Suarez, Paul Bittinger (ph) and Mahshid Abir (ph). Also thanks to Kerrianne Rivera (ph), Millie Bonilla (ph), Omaya Sosa Pascual, Anna Campoi (ph), Erica Rodriguez (ph) and Ezequiel Rodriguez Andino (ph). Our theme music is by Colin Wambsgans. Other original music is by Ramtin Arablouei. And by the way, Ramtin is the co-host of a brand new NPR podcast called Throughline. Check that out. And while you're at it, if you listen to us on iTunes, make sure to leave us a review. You can holler at us on Twitter @NPREmbedded. You can also send tips or story ideas. Email us at embedded@npr.org. Like I said, we'll be back soon with more. Thanks for listening.

(SOUNDBITE OF MUSIC)

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