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Episode 96

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Translation – Headcount

[Daniel Alarcón, host]: Hello, Ambulantes, one little thing before we start. Many of you have told us that it’s time to produce more podcasts in Spanish, and we think you’re right. But, to do that, we need your help. So, please go to our website: radioambulante.org/encuesta; and answer a couple of questions. Tell us, for example, what kind of shows you would like us to produce, in addition to Radio Ambulante, of course: fiction podcasts, podcasts for kids, podcasts about food or football. Your answers will help us a lot. Go to radioambulante.org/encuesta. It will only take five minutes and it’s a big help. In advance, thank you!

Welcome to Radio Ambulante from NPR. I’m Daniel Alarcón. And I’m here with Luis Trelles. Hello, Luis.

[Luis Trelles]: Hello, hello, Daniel.

[Daniel]: Luis is our producer who lives in San Juan, Puerto Rico. And Luis, I have a question for you that should be simple: How many people died in Puerto Rico after Hurricane Maria?

[Luis]: Well, the hurricane passed through Puerto Rico on September 20th, 2017. And a week later, the government was saying that 13 or 14 people died. When President Trump visited the island in early October…

(SOUNDBITE FROM ARCHIVE)

[Donald Trump]: What is your… what is your death count as of this moment? Seventeen?

[Ricardo Rosselló]: Sixteen, certified.

[Donald Trump]: Sixteen people, certified.

[Luis]: And this is the president speaking with the governor of Puerto Rico, Ricardo Rosselló during that visit.

[Daniel]: Alright. Sixteen deaths is what Roselló told the president, and he added a word that seems interesting to me: certified. Certified by who?

[Luis]: Well, certified by Puerto Rico’s Secretary of Public Safety, an official named Héctor Pesquera, and he was the one who kept the government’s official list. And that same day, when the president left the island, the Puerto Rican government increased the count to 34 deaths. And two months later, the list increased again, this time to 64.

So we have 14, 34, 64. It’s like a list that is growing little by little. But the truth is, in the weeks and months after the storm, there were several local media outlets, like the Center for Investigative Journalism of Puerto Rico, that started reporting a much higher number.

(NEWS SOUNDBITE)

[Journalist]: Don Teodoro died the same day that Hurricane Maria tore through Puerto Rico. The case is one of the 47 that the Center for Investigative Journalism identified in its most recent journalistic report.

[Luis]: And there a discrepancy began that started growing and growing, because the official numbers and the ones reported in the media, those numbers never lined up, Daniel.

(NEWS SOUNDBITE)

[Journalist 1]: The funeral homes we consulted reported having seen 499 deaths, probably associated with the hurricane.

[Journalist 2]: Hurricane Maria which tore through Puerto Rico in September may have caused 1.052 deaths and not 62, as the official figures say.

[Daniel]: And what did the government do? Did they keep saying that… that there were just 64 deaths?

[Luis]: Well, yes. The government was locked into that number, 64, for almost a year. Eventually, the government of Puerto Rico did commission its own study to verify how many people had died, and that study was conducted by researchers from George Washington University. When in the end, the results of this study came out —in August of 2018—, it was devastating for Puerto Rico because that study indicated there were 2.975 excess deaths.

[Daniel]: OK, I have two questions here. First, 3.000 excess deaths, ok, so: how did they arrive at that number? That is my first question. And the second: I think you need to explain what exactly is meant by “excess death.”

[Luis]: OK, well… uh, the investigators from Georgetown University basically averaged all of the deaths in Puerto Rico in the previous seven months and took that average and compared it to the number of deaths there were in the five months after the hurricane. And that’s how they realized that almost 3.000 more people died than normal. And, well, Daniel, I’ve been speaking with epidemiologists, demographers, experts in this kind of thing, and they all tell me the same thing: a difference of 3.000 deaths in a place like Puerto Rico, that’s not normal. In other words, it’s something that… that happens in a place where there’s a war, for example.

[Daniel]: In other words, in demographic terms, Hurricane Maria is comparable to an armed conflict.

[Luis]: Exactly! But the problem is that there were a lot of people in Puerto Rico and in the United States that refused to accept this new number of deaths. And one of the first to reject this new count was President Trump.

(NEWS SOUNDBITE)

[Journalist 1]: A tweet that left many stunned.

[Journalist 2]: There is a new tweet from President Trump, and it’s very relevant to today.

[Journalist 3]: He says: “Three thousand people did not die in the two hurricanes that hit Puerto Rico.”

[Luis]: In a message on Twitter, the president denied that 3.000 people died.

(NEWS SOUNDBITE)

[Journalist 1]: So the controversy over the deaths continues.

[Luis]: And he added in another tweet.

(NEWS SOUNDBITE)

[Journalist 1]:If a person died for any reason, like old age, just add them on to the list. Bad politics. I love Puerto Rico.”

[Luis]: And, well, the president basically was denying the study’s conclusion and was alleging that the figures were being manipulated to make him look bad, personally.

And well, the truth is it’s hard to know which deaths can be connected to the hurricane and which can’t. I’ll give you an example, Daniel. I remember a few days after the storm I heard that someone was looking for cell signal in a neighborhood they weren’t familiar with. And you have to remember, in those days it was very hard to get cell signal because everything was devastated. It was at night, and this is another important factor because the electrical system was totally destroyed and had left everyone in the dark. He was on a bridge, and he didn’t realize that the bridge had collapsed, because it was so dark, and he fell. And he died.

And I’m sure that a case like that one never made it on an official list that the government kept. But I do wonder: if the winds hadn’t destroyed the electrical system, if the floods hadn’t destroyed that bridge, that man would still be alive, wouldn’t he?

[Daniel]: That’s the question exactly: what is defined as a death caused by a natural disaster. And perhaps more importantly: what good is it to know how lethal Maria was? To answer these questions, we’re going to examine the case of one family.

From Puerto Rico, Luis Trelles brings us this story.

[Luis]: Gladys Francheska Irizarry had only one thing on her mind the day before Hurricane Maria arrived: her grandmother Carmen González.

[Francheska Irizarry]: Well, my grandmother was a very special person. My grandmother lived in New York. And… when she found out I was born, well, she set out for here. And since then, well, I have to say, we’ve been inseparable.

[Luis]: It was like having a second mother. When she grew up, after Francheska got married and had kids, Carmen González continued living with her granddaughter. Francheska liked having her around.

[Francheska]: My grandmother is, like we say here, we were like a finger nail and dirt. Where I went, she went (laughs).

[Luis]: And that relationship grew even closer when her grandmother started showing signs of senile dementia. The doctors told Francheska that it could be Alzheimer’s.

[Francheska]: But like I always, well, I was with her, trying to play brisca or dominoes or “tell me a story.” Like her mind… was struggling there against what the… the condition is.

[Luis]: Everything changed two years ago when Francheska put her grandmother in an institution.

[Francheska]: Unfortunately, well I saw the need —I didn’t want to— but the need to… to look for a… a place where she could stay, where they were going to protect her, where they were going to take care of her and things like that.

[Luis]: And here I need to explain something that’s very important to this story. The elder care system in Puerto Rico is fragmented and difficult to navigate.

Older and senile adults —ones that can’t live alone anymore, like Francheska’s grandmother— a lot of them end up in what are called “prolonged care homes.” These are private homes that accept residents with chronic conditions. And this is an industry that’s heavily regulated by the government. Each care home must have more than 20 permits and requirements, from the fire department, from the Department of Health, from the Emergency Management Agency, even from the police, and it’s the Department of Family Affairs which supervises them.

And, of course, the level of quality in these places depends on the price. In Puerto Rico, the prolonged care homes that offer more personalized services —with more individualized care for each resident— can cost between three and four thousand dollars a month, or more.

[Francheska]: The more expensive, well, the better the care, or the more staff to… to treat them like… like kings and queens, ¿right?

[Luis]: But Francheska can’t pay that much. The majority of people in Puerto Rico can’t either.

[Francheska]: When I started looking, they were all 2,500, 3,000 dollars, and I’m like: “Oh my goodness. (Laughs) What is this!”

[Luis]: Though she didn’t want to get into the details, Francheska told me that she was going through a difficult time when she admitted her grandmother to the home. After spending several years in a toxic relationship, she had finally managed to get a divorce. It was right around that time she spent a few months at a shelter for people who had been abused. And even though the shelter allowed her to stay there for a time with her two children, they didn’t let her bring her grandmother.

That’s why she accepted a government program: a subsidy for seniors who can’t pay the full price of a care home.

[Francheska]: I had the chance to collect a benefit from the Department of Family Affairs, where they contribute the part that Social Security doesn’t. In other words, it was part from Social Security and part from the Department of Family Affairs.

[Luis]: Facing that decision —what to do with her grandmother— is more and more common Puerto Rico. The population of the island is getting older and older. Today, Puerto Rico is one of the jurisdictions with the highest number of seniors in the entire United States. Partially because young people leave. A massive migration has occurred in the past 10 years, in a decade of economic depression. And the result is that one in every four Puerto Ricans is 65 or older, and there is a great need to see what kind of care they can be given during that stage of their lives.

The home where Francheska put her grandmother is called “Tu Familia,” and it’s pretty representative of the industry.

[Mitosis Francisco]: It’s been here eight years.

[Luis]: ¡Eight years, wow!

In the summer of 2018, I went to visit it, to see the conditions the residents are in. Tu Familia is one of several prolonged care homes that I visited for this story. It’s a low-cost alternative, with a small staff that is tasked with making sure the residents take their medicine and eat three times a day. You can tell the home doesn’t cost very much, and the people who work there don’t make very much.

[Mitosis]: Los del segundo piso son nueve. ¡Catalino!, ¿cómo usted está? ¿Estás bien?

[Luis]: The institution is in a large three-floor home, in a very traditional working-class neighborhood in San Juan: with cement houses, some with dark, damp stains on the walls, and they all have bars on the windows; you need them to keep from getting robbed in a very violent city.

If it weren’t for the large sign that reads “Tu Familia” on the entry gate, I would’ve never known it was a prolonged care home.

[Mitosis]: Right now they are getting them up, because they already had a nap. And they’re going to start getting them out, you’ll see.

[Luis]: When I visited, there were 30 residents: elders, seniors, almost all of them with chronic health conditions. Some were incapacitated and were strapped to their wheelchairs, to keep them from falling on the ground or hurting themselves.

Miosotis Francisco is the home’s administrator and is also the ex-president of the Puerto Rican Federation of Care Institutions. When I interviewed her, Miosotis summarized the service that every resident receives from the institute this way:

[Miosotis]: It’s as if they were at your house but with more professional care. So, let’s see, we’re going to stay on top of their medication, what they need, their basic needs.

[Luis]: Basics. But not much more.

Francheska told me that since she left her grandmother at Tu Familia, she was shocked by how they limited visits. Especially in the beginning, when they asked her to spend two weeks without seeing her grandmother.

[Francheska]: So they could create that separation, honestly.

[Luis]: It’s a very common method in prolonged care houses so the transition to a new home might be, in theory, easier.

[Francheska]: Ah, which for me… well, today I get to thinking about it, and I say: “Wow. How horrible.” No mistake about it, how horrible.

[Luis]: But at least her grandmother seemed to be in good shape.

[Francheska]: She went in walking. She went in independent.

[Luis]: But quickly Francheska saw how she declined.

[Francheska]: And unfortunately, well after a year and a half, well she wasn’t the same. I almost didn’t recognize her. She was laying back in a wheelchair. She couldn’t eat on her own. They had to bathe her. They didn’t stand her up anymore.

[Luis]: When I spoke with Miosotis, she explained that they give the residents the best care they can, but you have to remember that the majority of residents come with chronic conditions and their health worsens with time.

Also, she told me that many relatives leave seniors in their home and then don’t come to visit them.

And when they finally come to see them, sometimes a year after their last visit, they’re upset because they look thinner, weaker, and even incapacitated. That’s why Miosotis has a policy of telling relatives…

[Miosotis]: We care for them, but you’re their family. You have to come visit them. You have a responsibility as their child, with your relatives, and you have to assume that responsibility.

[Luis]: But Francheska assured me that she wasn’t one of the ones who went months without seeing her grandmother.

[Francheska]: Yes, yes, yes. Every time I could, I went and visited her.

[Luis]: Even though she knew that there was no substitute for the care that she gave her when her grandmother could still live at her house.

When the news that Hurricane Maria was going to hit Puerto Rico hard, Francheska’s grandmother was already incapacitated. And Francheska was worried, it was already known that it would be the most powerful storm in the modern history of the island. That’s why she went to the care home the day before and spoke with the administrators and asked them…

[Francheska]: “Is everything OK? I mean, do you need anything? Not just for my grandmother, but for anyone else.” Because, well, you don’t know, right? If there were people who… whose relatives didn’t visit them or things like that. And I, well, I was moved by that. And I said: “Do you need anything?” “No, we’re set.”

[Luis]: Miosotis told me that the government requires all of the prolonged care homes to have an Operational Emergency Plan, an OEP.

[Miosotis]: What am I going to do if there’s a hurricane? What am I going to do if there’s a fire? What am I going to do if there’s a flood? That’s the OEP.

[Luis]: The government certifies the plan every year. And the Department of Family Affairs does inspections to corroborate that every home meets the requirements, requirements like having an emergency electrical generator, with fuel for ten days, the same for supplies of drinkable water and food.

[Miosotis]: Everything, all of that, that is the OEP. Which we all have.

[Luis]: But that night, when the most violent winds came, and more and more water was filtering into the Tu Familia home, Miosotis started to fear for her resident’s safety.

[Miosotis]: I was flooded with water… That was a powerful thing, what happened to us. And if I, who was so well prepared and my structure was so strong, imagine the people who weren’t.

[Luis]: Early that morning, she felt that perhaps the time to do an emergency evacuation had come.

[Miosotis]: And even though you’re prepared —I felt prepared— there was a moment in the early morning when I said: “I want to take my seniors out.” And I know I can’t, do you understand?

[Luis]: They held on. The house withstood the storm. And even though the power had gone out, the generator was working too. But that same morning, when the rain and the wind had already passed…

[Miosotis]: Yes, one of my seniors had a burst blood vessel, the day after the hurricane.

[Luis]: It was Carmen González, Francheska’s grandmother. Her condition was critical.

The home, Tu Familia, is very close to Centro Médico, the most important public hospital in Puerto Rico. Getting from one place to the other usually takes about ten minutes. But the morning after Maria, getting to Centro Médico was nearly impossible.

Electrical posts split in half, fallen trees, pieces of roofs, of signs even fences and walls that had been blown over by the hurricane were all piled up in the streets. You almost couldn’t set foot in the street, much less get an ambulance through.

[Miosotis]: The neighbors and my sister, well, stepped in and made a path for me. And I could get an ambulance and take her to the hospital.

[Luis]: That was at ten in the morning.

The morning after the hurricane, Francheska got up with a mission: going to see her grandmother to make sure that everything was alright.

[Francheska]: When they let us leave our homes, I went there right away to see how my grandmother was.

[Luis]: She had tried to call but couldn’t get a hold of anyone. The cell towers, the internet, almost all of the communication infrastructure was failing.

Francheska left in her car through the flooded streets. It took her several hours, and when she arrived…

[Francheska]: Then they tell me: “Didn’t they call you?” And I said: “Uh, no.”

[Luis]: Francheska had no idea what had happened to her grandmother.

[Francheska]: I got to the home to find out my grandmother was at the hospital. They had just taken her. Oh! I got hysterical.

[Luis]: Francheska arrived at Centro Médico as soon as she could, and this is what she found.

[Francheska]: The patients were practically naked, just covering their private parts. Because the air conditioning stopped working. The electrical generators stopped working. They were down. A place as important as Centro Médico. No, no. Very sad, very sad.

[Luis]: Centro Médico wasn’t the only hospital that was falling apart, of course. It was an emergency across the island. What was happening to Francheska’s grandmother was also happening to hundreds of people.

And many of them didn’t survive.

[Daniel]: After the break, we try to understand the magnitude of the crisis, in that chaotic week and a half after Maria struck.

We’ll be right back.

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[Daniel]: We’re back with Radio Ambulante. I’m Daniel Alarcón.

I’m here with our producer, Luis Trelles. At the beginning of this story, Luis mentioned that a study by George Washington University found that there were almost 3.000 excess deaths after the hurricane.

[Luis]: And the truth is that the topic of excess deaths is difficult to understand even for me, who experienced it, along with my family and all the people I know. I mean, I understand the details, how it feels going through it, but the scale of the disaster, how it affected the island, that’s lost.

[Daniel]: So, we got to thinking here at Radio Ambulante, how could we render those numbers in sound, to make it possible to understand such abstract numbers. 14 deaths, 64, 3,000. What does it really mean?

Each tick of the clock represents one hour.

(SOUNDBITE OF AUDIO RENDERING)

[Daniel]: And each of those beeps.

(SOUNDBITE OF AUDIO RENDERING)

[Luis]: Represents one death.

In a normal week and a half in Puerto Rico, an average of 75 people die a day. Something like this.

(SOUNDBITE OF AUDIO RENDERING)

[Luis]: And the average of the 11 critical days immediately after the hurricane shows that 120 people died each day.

(SOUNDBITE OF AUDIO RENDERING)

[Daniel]: Again. A normal period of 11 days.

(SOUNDBITE OF AUDIO RENDERING)

[Luis]: And the 11 days after Maria.

(SOUNDBITE OF AUDIO RENDERING)

[Daniel]: And, well, this is what the official government death count right after the hurricane sounded like.

(SOUNDBITE OF AUDIO RENDERING)

[Luis]: That’s because in the same period, the official number of deaths according to the government was 14, which would come out to one death a day. Of those 14, almost all of them were people who died during the hurricane: two police officers who died when they came across a storm surge, three sisters who died in a landslide, things like that.

[Daniel]: But the authorities weren’t counting all of the people who were dying in hospitals that were falling apart, like Centro Médico, where Carmen González was.

Luis Trelles continues the story.

[Luis]: It was the day after the hurricane, and Francheska Irizarry had arrived at Centro Médico to find her grandmother: she had suffered a burst blood vessel, and the doctor on duty gave her a terrible prognosis.

[Francheska]: In the emergency room, well, the doctor didn’t give her more than 36 hours.

[Luis]: Part of the problem was the kind of burst blood vessel she suffered.

[Francheska]: And unfortunately, she has… she had ischemia, in other words, a blood clot lodged itself in her brain when the blood vessel burst.

[Luis]: Since the generators at Centro Médico were failing, the doctors couldn’t use the machines they needed to do the tests.

[Francheska]: Of course, they don’t tell you like that. You… You find out in the hallways, do you understand? They manipulate it all like: “Well, mama, I mean, there’s nothing we can do. She’s.. she’s older.” I mean, they… they handle it all in terms of age.

[Luis]: In other words, older people —seniors— weren’t the priority. It was as if in the middle of the emergency, the doctors threw out the possibility that people like Francheska’s grandmother could survive.

An analysis we did here at Radio Ambulante of the data from the Demographic Registry reveals that 70 percent of the deaths were people over 65 and the majority died of causes related to chronic health conditions. Among the top five causes of death was illness related to the nervous system, including Alzheimer’s and senile dementia, like Carmen González.

Moreover, the report by George Washington University on the deaths indicated that the majority of them occurred in the municipalities with the highest rates of poverty in Puerto Rico.

Five months after the hurricane, people kept dying at a higher than normal rate. And the people who were most likely to die had three characteristics that Carmen González had as well: they were old, they were sick, they were poor.

After the burst blood vessel, Carmen González fell into a coma, and Francheska thought that she could die at any minute, that she wasn’t going to wake up. And so she started to say goodbye.

[Francheska]: And telling her to give us the privilege of opening her eyes so she could know we were there with her.

[Luis]: Francheska wanted her grandmother to know one thing.

[Francheska]: What I wanted was to be sure that: “Look. Do you see me? I’m here. Be calm. I’m going to be OK.”

[Luis]: But a few days later, Francheska’s grandmother did something that all the doctors said wasn’t going to happen.

[Francheska]: I can tell you she opened her eyes. The per… the person Centro Médico told me wasn’t going to last 36 hours, and they left her like that, laying on her side.

[Luis]: And even though she lost consciousness again, she stayed alive, one week and then another. But something was going wrong: it was her left leg.

[Francheska]: It started turning purple, purple. I would say to them: “But her leg, her leg.” And like… of course, they knew, but they hadn’t told me.

[Luis]: Her leg had gangrene, and it was getting worse. When she arrived at Centro Médico, Francheska’s grandmother had two blood clots, not one like they thought originally.

[Francheska]: Obviously, well, they identified the one in her head, but they hadn’t identified the one in her leg because they hadn’t put her in the machines. Guess why? Because the electrical generators stopped working.

[Luis]: And, of course, if they had detected the blood clot in time, it’s very likely they would have been able to prevent the gangrene or at least solve the problem before it was too late.

[Francheska]: It’s a shame because maybe we would have been able to catch it when her toe was purple and could have amputated the toe, but she’d live.

[Luis]: In early October, the doctors told Francheska that the gangrene was too far advanced and they preferred not to operate. Her grandmother was unconscious, she was too old, she was too fragile.

Francheska would have preferred that they at least try to save her.

[Francheska]: It’s an emergency room… we turn to them to prolong our lives somehow. Well, you’re supposed to have equal treatment, right? That… that everyone should be equal. A newborn is the same as someone who’s 100 years old.

[Luis]: Instead, the doctors told her there was nothing more they could do. Almost a month after entering the hospital, the doctors discharged Carmen González, with advanced gangrene in her leg and the understanding that there was only one thing left to do: alleviate the patient’s suffering in the little time she had left.

But instead of being alleviated, Carmen González’ situation got worse. Because there was no relief for people like her in Puerto Rico, at least not then.

When they discharged her grandmother, the first thing Francheska wanted to do was take her to her house.

[Francheska]: What I wanted for her was a calm, peaceful death surrounded by… by people who love her. But they didn’t allow that.

[Luis]: Her grandmother was in bad shape. Francheska had her doubts, and the doctors called Tu Familia, and at that home, they reminded her that her grandmother still had a contract with the institution and that she should bring her back because they would be able to take better care of her there. And Francheska went with what they said.

[Francheska]: I mean, the directions I received from the home was that I had… that I had to take her there.

[Luis]: In the month that Carmen González spent at the hospital, the care home was also in crisis, just like almost all of the institutions like it in Puerto Rico.

The trouble started the same day that Miosotis, Tu Familia’s administrator, took Francheska’s grandmother to the hospital.

[Miosotis]: The power. The power. The… The… what can I say? Oh, my goodness, because it’s so… it’s very sad. We went through a lot. You have no idea.

[Luis]: The electrical system in Puerto Rico was torn apart. No one knew when the electricity would be back up.

[Miosotis]: So, what happens? If you’re caring for these seniors, and you don’t get that power, it starts… then you start to have bigger problems.

[Luis]: Miosotis’ institution can accommodate 30 seniors, and many of them have conditions that require electricity for their treatment. Patients who need refrigerated medications or therapies that are done with machines that didn’t work anymore.

The Department of Family Affairs requires that there be emergency generators at the care homes, and Miosotis had her generator, but after keeping it running for several days, it started showing signs that it could break at any minute. And that’s not mentioning the unbearable heat on the island and how it affected the residents who didn’t have refrigeration or cold water to drink or fans or air conditioning.

[Miosotis]: My generator couldn’t be turned off. You see, the generators rest. Mine couldn’t be turned off because if you turned it off, it would break. It wouldn’t turn back on.

[Luis]: And in order to keep the generator on, Miosotis needed dozens of gallons of diesel a day.

[Miosotis]: So a generator that’s on 24/7… you have to be dumping diesel into it, dumping diesel, because if it turns off, it’s not turning back on.

[Luis]: In the first month after the hurricane, the big problem was fuel. Ricardo Rosselló, the governor of Puerto Rico, established a curfew that limited the time to look for diesel, natural gas, or gasoline. On top of that, there were massive shortages and delays in the distribution of diesel and gasoline all over the island.

(NEWS SOUNDBITE)

[Journalist 1]: From the air, you can see lines kilometers long to get gasoline, but on the ground, the situation is much worse.

[Man]: There are old people here, senior citizens.

[Journalist 2]: How long have you been here, ma’am?

[Woman]: Three hours.

[Journalist 2]: Already.

[Woman]: I’m 85 years old.

[Journalist 3]: The curfew will now be indefinite until the situation in Puerto Rico normalizes.

[Man]: There’s not much diesel here.

[Journalist 3]: And is diesel the most important thing for hospitals, for towns?

[Man]: It’s what’s being prioritized.

[Luis]: Miosotis spent several weeks on the brink of running out of diesel for her generator. She needed help, but the government agency that works directly with the prolonged care homes was down for the count.

[Glorimar Andújar Matos]: What happened to us? The next day we were without electricity, without communication, without anything.

[Luis]: This is Glorimar Andújar Matos, the secretary of the Department of Family Affairs. When I spoke with her in September 2018, she told me that her agency did have an emergency plan. That plan counted on their being able to organize a team from the agency itself to provide help to incapacitated seniors. In other words, the most vulnerable people.

[Glorimar Andújar Matos]: And our mechanism was, to communicate… it was going to be over the phone precisely as a first means. And we weren’t able to do that.

[Luis]: Cell towers, the internet, landlines stopped working for several days. Some areas were left without communication for months. The Department of Family Affairs hadn’t made plans to tackle a situation like this one.

There are more than 650 prolonged care houses across the island. Around 3.600 seniors live in these homes. While the secretary of the Department of Family Affairs struggled to communicate with her own employees, many seniors’ situations got worse. It was a part of the population that needed immediate help to face life or death situations.

But in the days after the hurricane, when there was a race against time to help institutions like Tu Familia, another problem arose that no one in the government had foreseen. Secretary Andújar Matos told me…

[Glorimar Andújar Matos]: The department didn’t even have a… a reliable… list of information about our homes, to know where they were exactly.

[Luis]: I mean, I have to repeat this because it sounds unbelievable. The Puerto Rican Department of Family Affairs didn’t have a list —a physical copy, on paper— with the addresses and contact information of the 650 care homes they supervise.

The official lists were on computers that had been damaged by the hurricane or that they couldn’t turn on because of the blackout that came after. And it seems that it didn’t occur to anyone as a basic preemptive measure to print that list before the hurricane. So, of course, that set back the rescue effort for more than three days. Miosotis told me that it took them weeks to get to her institution.

[Miosotis]: My needs were always the same: diesel. A preferred place in line, nothing more. So we could go anywhere and have them give it to us, so we didn’t have to wait in that long line, and the seniors wouldn’t have to go without it. That’s it.

[Luis]: Miosotis never got the special permission she was looking for. Without power, without any surefire way to get diesel and with the Department of Family Affairs out of commission, it was amid that uncertainty that Francheska’s grandmother returned to Tu Familia.

To make matters worse, Francheska discovered that her grandmother had an extremely contagious skin condition.

[Francheska]: So, it starts out as a rash and an irritation, and a rash and an irritation. And then you say: “Oh, I have a rash.” Yes, uh-huh, a rash. A rash that when you see it you want to pick off the skin because it itches so much.

[Luis]: Francheska was spending a lot of time with her grandmother.

[Francheska]: And my whole family caught that scabies.

[Luis]: After speaking to Francheska, I called Miosotis to ask her if there were cases of scabies in her institution after the hurricane. And she told me…

[Miosotis]: Carmen didn’t have that when she was in the home, or when she came from the hospital either.

[Luis]: She said no, Carmen González didn’t get a skin infection before or after going to the hospital. And so I insisted and asked her if there had been any case of this kind in the months after the hurricane.

But you’re telling me no, that in your home there were no cases of skin infection in the months after the hurricane.

[Miosotis]: It depends, also remember the time when this happened. Because that happens in all of the homes. It happens in hospitals. I already told you, that happens everywhere.

[Luis]: OK, but then you could have had cases after the hurricane.

[Miosotis]: Well, like in all the homes.

[Luis]: OK, OK.

Miosotis told me that outbreaks of skin conditions are common when it’s very hot, especially in summer. And yes, it’s possible that there was a case in her home, like in all of the institutions for seniors in Puerto Rico.

Francheska told me that her grandmother spent nearly a week and a half at the care home when she left the hospital. And in that time, the gangrene on her leg got worse.

[Francheska]: Horrible, she even caught worms. Even worms. I mean, why does it have to come to that. I mean, it’s so terrible.

[Luis]: Her grandmother was in a coma and was receiving hospice services to alleviate any suffering in her final days. But Francheska told me that despite this, her grandmother felt pain. She told me about a video she recorded on her phone, where she appears moving her grandmother’s leg to clean it.

[Francheska]: And her facial expressions were: “Ah, ah, wait. Don’t touch me, it hurts.” I mean…

[Luis]: A few days later, the staff at Tu Familia changed her room. Francheska explained that she already knew her grandmother could die at any moment. And that was what upset her the most.

[Francheska]: You know she’s on her deathbed because you’ve seen it a thousand times because you have a center for aging people. So, you can’t let her die there? Without moving her body? Which must hurt… even her soul must hurt at that point. Well, don’t you know they moved her?

[Luis]: Her grandmother died that same morning.

Carmen González Morales’ death certificate states that she died on October 26th, 2017. She was 90 years old. According to the certificate, the direct cause of death was a heart attack. Secondly, it comes out that she had a cerebrovascular “accident,” a burst blood vessel. And finally, the doctor who certified her death noted that the patient had gangrene.

Who decides what deaths are really caused by a natural disaster? Or the crisis that follows? What are the criteria?

When I asked Miosotis if she thought the deaths in her home —including Francheska’s grandmother’s— were in some way connected to conditions at her home and the crisis that came after the hurricane, she said no, not at all.

[Miosotis]: No, no, no. No, I can tell you no, that mine weren’t because of that. I understand that they were already sick, my seniors and their time came. I can’t tell you that they were caused by the hurricane.

[Luis]: This phrasetheir time camecan be heard all over. In many sectors. From bureaucrats, from doctors, from sons and daughters who saw their parents die after the hurricane. In a way, it’s the same argument that President Trump made when he dismissed the conclusions of the government study in a tweet. It’s comforting. Or perhaps the word is convenient. It’s a phrase that spares all Puerto Ricans especially political leaders on the island the responsibility for what happened.

We weren’t negligent.

Their time came.

[Daniel]: And so, a death like Carmen’s, Luis, can that be attributed to the hurricane?

[Luis]: The hurricane didn’t cause the burst blood vessel that brought her to a critical state because that burst blood vessel happened the same day as the hurricane. But what happened after that —in other words, the chaos that we all experienced on the island— and, of course, the lack of preparation to handle that chaos —in other words, the lack of efficient management of the disaster— all of that came together to cause terrible agony, like a kind of death in slow motion.

[Daniel]: But what else could the government have done?

[Luis]: For me, that’s the problem. Because there are a lot of people in the Puerto Rican government who think they did a great job. And that, well, that it was an unprecedented hurricane that left historic devastation on the island, and that, in those circumstances, government officials did the best they could. And frankly, that’s the argument that President Trump was making too.

But let me give you another clear example, Daniel. When I spoke with the coordinator of the emergency response, the Secretary of Public Safety of Puerto Rico, I asked him what he could have done if he had realized in time that people like Carmen González were dying. And he told me…

[Héctor Pesquera]: I don’t have… I’m not a fortune-teller, I don’t have any way to say.

[Luis]: That’s Héctor Pesquera —maybe you remember we talked about him at the beginning of the episode— and in that conversation I had with him, what he told me is that there was nothing they could have done because no one knew there would be so many deaths.

[Héctor Pesquera]: We didn’t have visibility. We didn’t have an established pattern. No one told us: “The people who are dying are coming from this sector, from this area.”

[Luis]: In other words, what he’s saying is that they didn’t have the information to know who was dying, where, and why. And that’s why they didn’t have that visibility. But the truth is they did have visibility: we heard it at the start of the story. Several Puerto Rican and US news outlets were reporting that the number of deaths was much greater than normal. And they were doing it almost from the onset of the crisis, Daniel. All the media that investigated these deaths tried to speak directly with Pesquera. But when I reminded him of that journalistic coverage, Pesquera told me…

[Héctor Pesquera]: The media was also saying that there were numbers of people that were in… that were in mass graves. And that was, well, the term they use there in the United States is, uh… fake news.

[Daniel]: Luis, as a Puerto Rican, when you hear a public official defend himself with the expression “fake news” instead of taking responsibility for… for… for not have made a good assessment of what was happening, when you hear that, what do you feel?

[Luis]: Well, I think it’s really problematic. Because there’s not a sincere desire to reflect and analyze, and realize the human errors they made. Yes, I mean, it’s undeniable that it was a historic storm and that yes it was an unprecedented disaster. And that’s exactly why we needed a response that rose to the occasion. And the truth is it didn’t.

[Daniel]: In August of 2018, the governor of Puerto Rico, Ricardo Rosselló accepted the figure of 2.975 excess deaths caused by Hurricane Maria. Rosselló also admitted that he had made errors in handling the emergency, though he didn’t take responsibility for the deaths. President Trump still insists on denying the number of deaths on the island.

Luis Trelles is a producer with Radio Ambulante. He lives in San Juan, Puerto Rico.

This reporting was done through the Diversity Fellowship, a subsidy from the Fund for Investigative Journalism and the Schuster Institute for Investigative Reporting of Brandeis University. We’d like to thank Sandy Bergo of FIJ and Florence Graces and Lisa Butten of the Schuster Institute for their support.

Hassel Fallas did the data analysis. Nathan Gress was the data assistant with the Schuster Institute. Lisabeth Bueno, Jennifer Almodóvar, and Santiago Montoya Palacios also collaborated on this story. Also, we want to give special thanks to Carla Minet and Laura Moscoso from the Center for Investigative Journalism of Puerto Rico.

This episode was edited by Camila Segura and me, with support from Luis Fernando Vargas and Victoria Estrada. The music, sound design, and audio rendering are by Andrés Azpiri and Rémy Lozano. Andrea López Cruzado did the fact-checking.

The rest of the Radio Ambulante team includes Lisette Arévalo, Gabriela Brenes, Jorge Caraballo, Miranda Mazariegos, Patrick Moseley, Ana Prieto, Laura Rojas Aponte, Barbara Sawhill, David Trujillo, Elsa Liliana Ulloa, Silvia Viñas, and Joseph Zárate. Carolina Guerrero is the CEO.

Radio Ambulante is produced and mixed on Hindenburg PRO. Learn more about Radio Ambulante and this story on our website: radioambulante.org.

Radio Ambulante tells the stories of Latin America. I’m Daniel Alarcón. Thanks for listening.

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