Days after Hurricane Dorian hovered over the Bahamas, destroying whole communities on the Abaco Islands and Grand Bahama, many of the storm’s survivors are still waiting for their wounds to be treated. They’re developing infections from access to contaminated water. And their access to even basic medical care varies widely.

That’s true at the best of times, said Dr. Warren Jones, the chief health officer at Hampton University, who studies public health in the Caribbean.

Even at the best of times, a patient in the Bahamas might go from “state-of-the-art care on Grand Bahama to having no care on some of the 700 islands,” Dr. Jones said. “When you get an interruption in the delivery of care…it really challenges the ability to get the right care at the right time for the people who need it.”

Grand Bahama

On Grand Bahama, Rand Memorial Hospital in Freeport is the primary public hospital available to 80,000 people. As of Friday afternoon, all its beds were damaged, as were 90% of its equipment and medicines, estimated Andrew MacCalla, Direct Relief’s vice president of emergency response.

The most critical patients have been taken by air or sea to Nassau, the Bahamas’ capital. They’re triaged upon arrival at Nassau’s airport, then taken to local hospitals, which are undamaged by the hurricane and able to care for them.

But both an outdoor tent at Rand Memorial and the indoor hallways were filled with people on Friday afternoon, McCalla said, some of whom had days-old lacerations or fungal infections. No operating rooms were available. Neither were OB/GYN services; instead, pregnant women and others were being sent over to Sunrise Medical Center Hospital Complex, a private facility.

The overwhelmed public hospital was “surface level clean,” MacCalla said, but needed to be fully cleaned and disinfected. “You walk in, and then the smell of the water, the standing water…it’s a funky, just a wet smell,” he said.

Still, energy was high, as overworked hospital staff tended to the patients waiting in and around the facility. “The staff are working their tails off…and the hospital administrator has military-like officiousness. She’s amazing,” MacCalla wrote via WhatsApp, a messaging service.

Many of those same staff members have lost their homes, MacCalla said. They were working nonstop anyway, despite needing everything from hospital beds to crash carts.

Abaco Islands

The public hospital at Marsh Harbour, on Grand Abaco, was similarly overwhelmed – until Thursday afternoon, said Luis David Rodriguez, who is coordinating Direct Relief’s response in the Bahamas and who arrived in Marsh Harbour with a shipment of medicines and other supplies.

“When I first got there, I would say…[there were] 200 to 300 people waiting for care,” Rodriguez said.

In addition, the hospital was serving more than one purpose. “They were also using it as a shelter, since there was power and security,” Rodriguez said. “It was one of the few buildings in the whole town that was actually standing.”

But things quieted down on Friday, as people were evacuated from the island or sent to a small ambulatory clinic that medical responders had set up at the airport.

In addition, shelter opened Friday, taking some of the pressure off the hospital. Medical staff seemed to have enough medication, Rodriguez said. Instead, he explained, medicines and supplies were “needed more around town.”

While patients were still being treated for wounds and infections – and dealing with what Rodriguez described as muggy air and a significant odor – the atmosphere was far from chaotic. “You understand that people are anxious and desperate,” Rodriguez said. Aside from one minor scuffle that required the hospital’s security to get involved, “for what they’re going through, it seems kind of calm.”

Nassau

At Nassau’s airport on Monday, arriving evacuees were sent to a makeshift clinic or, if their condition was more severe, to a triage tent erected in a corner of the airport.

“You see a little bit of everything,” Rodriguez said when asked about the mental state of new arrivals. “You see some people calm, some people trying to make the best of it…there are a lot of mental health needs.”

Rodriguez said those in need of further care were being sent on to Princess Margaret Hospital, a public facility in Nassau.

Asked about people medical needs, casualties, and other issues, Rodriguez said it was difficult to get reliable information.

“There’s a lot of hearsay, because communication is really bad,” he explained. “Everything’s destroyed.”