If there’s one thing physician Jim Hull has learned since beginning to operate a mobile bus, it’s this: It’s entirely possible to have an endless line of patients.

“If you tell them you’re not leaving until the last person walks in the door, they keep coming,” said the Canadian-born physician, who’s lived in the Bahamas for over 20 years.

Before Hurricane Dorian, Hull, a general practitioner with a subspecialty in skin cancer, treated patients in a private clinic in Marsh Harbour, on Great Abaco. “After we lost the clinic, my wife and I decided the best way to…rebuild the community was to go in a mobile bus” to treat patients, he said.

He secured funding, bought a used medical bus – “she needed a little tender loving care” – and started driving from community to community, offering his services.

Catching up with Direct Relief, he recalled what he’d seen that day: an infected finger, a baby with conjunctivitis, blood sugar checks, a sinus infection. Some of his patients were elderly people who hadn’t received care in weeks.

And always, there are the mental health issues: insomnia, depression, anxiety. “This island is suffering, big time,” Hull said. “There’s not a person who was in the storm, who walked the street afterward, that didn’t see a dead body…that wasn’t truly, truly afraid for their lives.”

At first, doctors who remained in or traveled to the Abacos or Grand Bahama were treating storm-related issues along with chronic diseases – injuries, amputations, infected wounds, dehydration.

But as affected communities in the Bahamas take stock of their loss and look to the future, doctors working on the Abaco Islands, on Grand Bahama, and in the capital city of Nassau, where many fled, all say they’re expecting to see more and more of the same challenges in weeks ahead: Mental health issues. Chronic health conditions, many of them untreated or worsened due to an interruption in care. And, as people increasingly return, clear out their damaged or decimated homes, and rebuild, construction-related injuries and ailments.

An Immediate Crisis

Immediately after the storm, doctors were in short supply in the storm-hit communities. “We lost a significant number of our health care providers” who left the area when their jobs, homes, and children’s schools were affected, said Dr. Delon Brennen, deputy chief medical officer at the Bahamian Ministry of Health. “We just didn’t have a complement of staff available and in place.”

Complicating matters, Brennen said, is the fact that Marsh Harbour’s government health care facility became “a de facto shelter,” housing between 1,500 and 2,000 people. “It renders a significant amount of clinical space unusable,” he said.

Dr. Elizabeth Greig, a Miami internist with a disaster response background, is overseeing the University of Miami’s deployment of volunteer physicians to the Bahamas. She said that the population movement that’s taken place as affected Bahamians first fled their homes, then returned has made health care delivery more difficult.

“Bahamian physicians have been working nonstop,” she said. “It’s sort of reached this now secondary crisis where everyone’s totally exhausted, and right at that time, all the patients come back.”

Greig said the volunteer physicians have seen a range of patients with serious illnesses “resulting from an interruption of primary care services.”

One patient, she said, came into an emergency room to get a refill of his blood pressure medication, only to find that his blood pressure was so dangerously high that he had to be admitted to the hospital.

Dr. George Charite, director of the Integrated Medical Center on Marsh Harbour, responded to patients throughout the storm. Although his clinic was destroyed, a local mortuary agreed to let them use their space.

Challenges Ahead

In both Marsh Harbour and Nassau, Dr. Charite said he’s seen a significant number of patients with chronic diseases whose access to medication has been disrupted by the storm. Cuts and bruises, along with mold-related respiratory illnesses, are also common.

And underlying it all, he said, are high levels of mental health issues like post-traumatic stress disorder. “A few weeks ago, we had a lot of rain. People were actually calling, scared that the storm was coming back again,” he recalled.

Rand Memorial Hospital in Freeport, on Grand Bahama, sustained so much damage from the storm that “most of the areas were mold contaminated,” said Dr. Winston Forbes, Rand’s deputy chief of medical staff. As a result, most inpatient services are being conducted in tents outside the hospital.

For patients with more severe mental illnesses, the damaged hospital has presented a challenge. “The psych ward had to be shut down for two weeks because of mold,” Dr. Forbes said. “You can’t keep aggressive patients in tents.” Instead, those patients were airlifted into Nassau.

And while Dr. Forbes said the Rand staff is seeing many of the same non-communicable diseases they always have, the conditions are making those conditions worse. Chronic stress, salty water, and a lack of healthy food are all contributing. “People were eating whatever they could get their hands on,” Dr. Forbes said.

On Green Turtle Cay, where anesthesiologist Pam Mobley has been manning the local clinic, debris cleanup is underway and “the dump is constantly on fire” as people burn what they’ve hauled away – conditions that are bringing compound fractures and respiratory ailments to her door.

Patients have fallen off roofs and maintained puncture wounds. “I’ve given a lot of tetanus shots,” she said, along with antibiotics for infected wounds. Hygiene on the island still isn’t where she’d like it to be.

And the mold and mildew are getting to her patients. “Everybody’s coughing and sneezing and sniffling,” she said.

When it comes to rebuilding health on the island, doctors know there’s a long road ahead.

“I don’t believe that within three months, six months, even a year” the Bahamas will recover, said Dr. Brennen, who explained that health care in the island nation will need to be reimagined to be more efficient and disaster-proof.

And both Dr. Brennen and Dr. Hull stressed the importance of ongoing humanitarian aid to the island. Aid groups have provided everything from medicines and supplies to clean water, and Dr. Hull said the Bahamas simply doesn’t have the infrastructure to recover without outside help.

“One of the things people are afraid of the most right now is that the world is going to forget about them,” he said.