Fellowship Training During Natural Disasters: My Experience in Puerto Rico

January 17, 2017 | Carla P. Rodriguez, MD

As fellows, we are told that we will face many challenges, from long hours to the emotionally draining work, some of which might cause us doubt ourselves and the purpose of our effort. However, one challenge that is not expected is training during natural disasters. Last year, as the 2017 hurricane season was the busiest and scariest season in our history, Puerto Rico faced two hurricanes of the highest category of destruction within two weeks.

Before the hurricane arrived, the contingency plan at my academic hospital (one of three fellowship training programs on the island), created by the fellowship director and directors of different areas, was to have one fellow in-house before the beginning of the storm and re-evaluate accordingly if weather conditions allow it. Shortly after the hurricane hit, there was a complete shutdown of communication and power, as fellows in and out of the hospital were left unable to check in on family and friends for days. Inside the hospital, there were provisions of food and water for the medical staff.

The next challenge was organizing daily work duties and on-call schedules. After the storm ended, there was significant damage to infrastructure and communication, such as the paging system had stopped working and on-call nights were spent at the hospital using ground lines and satellites phones; gas, water and food became scarce; lines to get basic supplies were at least two hours long; several medications and IV fluids were limited; and there were problems with transportation and delivery on the island.

People looked desperate for help, and going outside was both a challenge and a risk. Based on the crisis, we worked every other day. Morning teaching conferences were placed on hold and everyone worked on the emergency contingency plan. The outpatient and non-emergent procedures were also cancelled.

One major challenge for my co-fellows and I, in our third-year of fellowship, was trying to travel during interview season. Commercial flights from the island were cancelled for weeks, and it was almost impossible for everyone to get to their subspecialty fellowships or job interviews.

After three months, patients began coming into the clinics, and most of the hospitals started to get electricity. I was able to complete my interviews and land the fellowship position I was aiming for. Life is starting to have a more normal flavor; but since September, my determination as a physician is definitively more defined.

This article was authored by Carla P. Rodriguez, MD, Fellow in Training (FIT) at the VA Caribbean Healthcare System in San Juan, Puerto Rico.