The devastating hurricanes that swept through the Caribbean last month called for a significant humanitarian response, and Direct Relief has been working to equip local healthcare providers with key medicines and medical supplies since they first made landfall.

In the weeks following the storms, Direct Relief has been on the ground in hardest-hit areas, including Puerto Rico, Dominica and throughout the Caribbean. The response has been a complex operation, spanning multiple countries and territories, many of which have transportation severely limited, with communication or power completely offline.

Here’s an overview of the response so far:

Puerto Rico

Direct Relief is working with several government agencies in Puerto Rico to coordinate logistics, including the Administracion de Servicios de Medicos de Puerto Rico, which runs eight hospitals and eight primary care clinics. This agency, known as ASEM, is using doctors and nurses to take incoming supplies and medicine and distribute them across the island.

Outside of the public health channels, Direct Relief is working with the Asociacion de Salud Primaria, which oversees 20 federally qualified health centers that operate 78 health care delivery sites.

Over the weekend, Direct Relief sent 24 pre-packed kits to equip both teams and hospitals. These kits included antibiotics, essential first aid items and medicines to manage chronic conditions, like heart disease and diabetes. These kits went to communities across the island that have had limited access to supplies and medicines, including Yabucoa in the southeastern part of the country, as well as to Toa Baja, on the northern coast.

Insulin has been identified as one of the most urgent medical needs across the island, and Direct Relief is working to distribute a significant amount of the medication this week.

Direct Relief also committed $300,000 in cash over the weekend to bolster community health centers on the island and will be supporting the health centers with ongoing deliveries of medicines based on needs. Satellite phones were also shipped to the Asociacion de Salud Primaria and are scheduled to arrive this week, enabling them to communicate what medical needs are most urgent in their communities.

Caribbean

Several Caribbean nations and territories were still reeling from Hurricane Irma’s impacts when Hurricane Maria struck them again, only a week later. A week after the storm made landfall, 44 people have been confirmed killed across nine Caribbean nations. UNOCHA reports that 99 percent of structures have been at least partially damaged in Anguilla, Barbuda, the British Virgin Islands, St. Martin and the U.S. Virgin Islands.

In the immediate aftermath of the storm, Direct Relief staff reached out and offered support to health professionals in St. Maarten, the British Virgin Islands, Anguilla, the U.S. Virgin Islands, Turks and Caicos, Antigua, Dominican Republic and Haiti.

Anguilla – Direct Relief coordinated with the Chief Medical Officer of Anguilla, and an Emergency Health Kit – which contains basic first aid supplies and medications – as well as three additional pallets of antibiotics, pain relievers, hygiene kits and tents, were sent from Miami, via FedEx charter plane, free of charge.

Antigua and Barbuda – Direct Relief has been coordinating with the Antigua Ministry of Health in the aftermath of the storm, and is in the process of shipping an Emergency Health Kit to the island to treat many of the residents of Barbuda who evacuated the island for shelter in Antigua.

British Virgin Islands – Direct Relief shipped a Hurricane Preparedness Pack, full of essential medications and supplies, a handful of pallets of specifically requested medicines and medical supplies, including antibiotics, IV solution, Oral Rehydration Salts, Direct Relief Hygiene Kits, and durable medical tents, to Peebles Hospital in Tortola. The shipment was flown to Tortola on Sept. 27 via the Royal British Air Force.

An additional $15,000 worth of medicines were purchased to support the 70 dialysis patients at Peebles Hospital, who were unable to receive their regular treatments due to power loss and damage to dialysis machines. Their treatment went from daily to twice a week in order to conserve water and the fewer machines.

The medications sent were needed in order to keep potassium levels down, extending the time without dialysis for patients. The medications were flown in on Saturday, Sept. 23 by private flight and delivered to the hospital, where they were used for the patients. There are 54 patients still on dialysis. Some were evacuated and some have passed away, reinforcing the urgency of the “second crisis,” which can occur after a disaster when people are unable to access life-saving medications or treatment.

Dominica – Dominica suffered an extensive hit from Hurricane Maria. The island is without power for what officials estimate could be a year, and endured extensive structural and infrastructure damage from the storms.

Princess Margaret Hospital, the sole hospital on the island of about 70,000 people, was seriously damaged but is still functioning. Medicines have been delivered to the country’s head pharmacist, and two more shipments are expected to go out to the country this week. One shipment contains and Emergency Health Kit that will provide the hospital with a wide-range of essential medicines and wound care items and chronic diseases meds. A second shipment is for roughly 40 dialysis patients on the island who need to keep potassium levels down while not receiving dialysis.

St. Maarten – Ten pallets of medications and supplies, including IV solutions, antibiotics, water purification systems, Direct Relief Hygiene Kits and durable medical tents, arrived in the Dutch Antilles on a free charter on Sept. 13. Ten pallets, valued at $477,000, were safely transported to the Sint Maarten Medical Center.

U.S. Virgin Islands – Direct Relief was approached by East End Medical Center, which serves St. Thomas, St. John and surrounding Virgin Islands. Working with staff from the center, Direct Relief assembled five pallets of antibiotics, medicines for chronic diseases and wound dressings valued at $1.2 million, delivered via FedEx, free of charge.