When the hallways began to flood, the hospital staff knew it was time to get their patients out.

Medical staff at Rand Memorial Hospital – a public hospital in Freeport, on the island of Grand Bahama – were forced to evacuate several patients in the middle of Hurricane Dorian’s assault on the island. Among them was a group of pregnant women – along with an OBGYN and a few other healthcare providers – sent out in an ambulance to seek new shelter.

But the ambulance flooded with its passengers still on board. Community members pushed the ambulance to a nearby church, which quickly flooded as well.

A good Samaritan took the women, one by one, in a small boat to a two-story house. There, on the second story (the bottom of the house was flooded) one of the women went into active labor and gave birth while Dorian raged around them.

The birth happened “without proper medical equipment. But [the OBGYN] made it work. She improvised,” said Winston Forbes, Rand’s deputy chief of medical staff.

The harrowing anecdote is just a taste of what medical staff, treating stranded, injured, and sick patients in the aftermath of the hurricane, have experienced.

Many of the sickest were sent to Nassau, the Bahamas’ largely undamaged capital, where the public Princess Margaret Hospital has treated an influx of evacuees.

But on the worst-hit islands, medical providers are continuing to provide care, in tremendously difficult circumstances, to those who remain.

Whether it’s a damaged hospital on Grand Bahama – with devastated and injured staff members – that’s continuing to provide care, or a doctor returning to his old stomping grounds to treat his former neighbors, there’s clear evidence that while many have lost their homes and possessions, they’re far from forgotten.

Direct Relief is working with the Bahamas’ Ministry of Health, hospitals, and medical groups to deliver $470,000 in medicines and supplies to communities affected by Hurricane Dorian.

“We’ve been improvising a lot.”

By the time the storm passed, Rand Memorial was significantly affected. A Direct Relief staffer who visited the facility estimated that 90% of equipment and supplies – and all the hospital beds – were damaged.

Dr. Forbes estimated that one-third of the medical staff lost everything in the hurricane. Worse, they had their own skin infections after hours spent standing in the floodwaters.

But patients – coming in with unmanaged chronic diseases, lacerations, skin infections, and even stroke symptoms – still needed help.

So staff members cleaned up and got to work, seeing patients who’d gone days without their medication or who’d injured themselves trying to repair their houses.

“We’ve been improvising a lot,” Dr. Forbes said.

They’re not doing it alone, luckily. Two field hospitals have sprung up on the island to handle some surgeries and inpatient care. Patients who need complex surgeries or other specialist care are being sent to Princess Margaret Hospital in Nassau, the Bahamas’ capital.

But Dr. Forbes was worried about both employees and patients.

When it comes to his staff, he said, “some people come to work because they have no other place to go.”  For patients, Dr. Forbes anticipates seeing increased mental health needs over the coming months.

“They’re my family.”

For six years, from 2005 to 2011, Dr. John Shedd had worked as a physician on the island of Green Turtle Cay.

When Dorian hit the Bahamas, Dr. Shedd didn’t hesitate. He flew to the island as part of a small medical team, carrying supplies that included a Direct Relief emergency health kit and backpacks, and set up shop in the island’s clinic, which was still standing.

“We went to the clinic and surveyed what we needed there. And what we really needed was a bunch of people with mops,” he said. “Everything below four feet had been soaked with seawater.”

The clinic was cleaned and prepped overnight, and last Saturday, the medical team treated their first round of patients – about 60 people who’d braved the detritus and extreme heat on the island to seek treatment.

“Most of it was primary care needs: people who hadn’t had insulin for a week, people who needed a tetanus shot,” Dr. Shedd said.

And a number of the clinic’s patients showed signs of depression. “There were a lot of people with acute symptoms, because of the hurricane,” Dr. Shedd said. “Everyone had that thousand-yard stare.”

Although Dr. Shedd returned home when more doctors showed up to relieve him, he’s confident that the clinic played an important role. “We were the first medical [group] to get in,” he said. “The clinic gave people great hope, which is what they needed.”

Asked why he’d made a difficult journey to practice primary medicine in punishing conditions, Dr. Shedd spoke simply: “I lived there for so long, I knew every single one of those people,” he said. “They’re my family.”