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When Maria struck:  one year after the hurricane

Hurricane Maria knocked down 80 per cent of Puerto Rico’s utility poles and all transmission lines, resulting in the loss of power to essentially all of the island’s 3.4 million residents.

The scenery of total devastation

Ivonne Ramirez had experienced a few hurricanes in her life, but nothing prepared the Puerto Rican for the sheer destructive force of Maria that struck her island in the early morning of 20 September 2017 as a category 4 hurricane. When the power supply failed late the Tuesday night before, she huddled together with her family in the darkness, waiting for the storm to hit and hoping it would spare her house in the island’s capital of San Juan. “Around midnight we heard a loud bang and a pop. My son started screaming, and I ran to find out what had happened. It was like a scene from a horror movie,” recalls Ramirez. “We felt as if this hurricane wanted to wipe us off the island.”

As a gray and wet morning dawned, the full extent of the storm’s devastation became clear to Ramirez. The roads in her gated community were mostly impassable, blocked by trees and downed power lines. The whole island was without telephone or electricity. Ramirez knew what to do next: she had to get to Los Paseos, the island’s largest dialysis clinic operated by Fresenius Medical Care, where she worked, as quickly as possible, to check for any damage. As clinic manager at the facility, she knew that her patients’ survival depended on her ability to get things sorted out immediately.

Patient in a Fresenius Medical Care dialysis clinic

Employees at Fresenius Medical Care's dialysis clinic cared for around 200 patients after the devastating hurricane.


Ready to welcome patients after just 24 hours

“We had gotten ready as best as we could – giving patients the necessary resources like an emergency diet list, treatment orders and the support hotline number. We had covered all the machines and secured the unit. But we had not expected this amount of devastation, and I wanted to get the place up and running again.” Ramirez ran down her list of contacts for maintenance and clinic staff and managed to get in touch with them. By the morning of 21 September, Los Paseos was the only clinic on the island ready to receive dialysis patients.

“It was quite a sight,” Ramirez says. “More than 200 people were waiting to receive treatment. Luckily, we have 60 seats so we were able to give every person who was waiting a three-hour treatment. We started at around 8 am and worked through until 3 am the next day,” she says. The story of Los Paseos and how it saved the day by providing life-saving medical care to dialysis patients not only represented a rare beacon of hope in the grim aftermath of Hurricane Maria, but also points to the importance of having a well-laid-out disaster response plan in place.

Ivonne Ramirez, Clinic Manager, Fresenius Medical Care

Our lobby became the focal point for most dialysis patients on the island.

Ivonne Ramirez
Clinic Manager, Fresenius Medical Care
Fresenius Medical Care warehouse

Bob Loeper and a colleague stacking food and vital supplies at a Fresenius Medical Care warehouse.

Guaranteeing fuel and water supplies

As Puerto Rico struggled to get back on its feet, Fresenius Medical Care experts arrived on chartered planes to help respond to the disaster. They brought with them pallets of food and vital supplies, and worked with local staff like Ivonne Ramirez around the clock to guarantee water and fuel deliveries for the 28 clinics on the island. "The hardest thing to deal with was the total collapse of communications,” says Bob Loeper, Vice President for Operations Support and Business Continuity at Fresenius Medical Care, who arrived in Puerto Rico the following Monday. "It’s the one thing that took us by surprise.”

What struck him as he stepped off the plane from Miami was how eerie everything looked: "everything had been wiped out. On leaving the airport, I wondered why so many people were parked on a bridge. It turned out they were trying to get a signal from one of the few cell towers still working.” Once on the ground, Loeper requested water and fuel supplies for the Fresenius Medical Care clinics.

Loeper’s team faced two main challenges in the aftermath of the storm: on the one hand, they had to make sure the clinics were operational, to provide life-sustaining dialysis treatments. On the other, this required running generators and replenishing water supplies. When Maria struck, there were a total of 6,000 dialysis patients living on Puerto Rico, 4,200 of whom were treated by Fresenius Medical Care. The authorities had to evacuate an additional 89 patients from Saint Thomas, one of the US Virgin Islands, to escape Hurricane Irma, adding to the workload at Los Paseos.

village in Puerto Rico

Keeping in touch by satellite

According to official estimates, Maria had triggered 41,000 landslides that had blocked all but some 644 kilometres (400 miles) of Puerto Rico’s 27,000 kilometres (16,700 miles) of roads. The Federal Emergency Management Administration (FEMA), the US agency in charge of handling natural disasters, reported that the island’s entire population of 3.4 million was without power the day after and that 95 per cent of all cell towers were knocked out by the storm, not to mention land lines.

In the end, Fresenius Medical Care staff were able to communicate with clinics and staff members by various means. Equally urgent, though, was the need to help the 1,000 or so Fresenius Medical Care employees on the island and their families. Many had suffered wind or water damage to their homes or even lost them in the storm. The company flew in a total of seven charter cargo jets with dialysis supplies, water, food and scrubs. “We delivered all the things they needed to keep everyone fed,” says Loeper.

“Fresenius Medical Care truly excelled in its response to Maria,” Ramirez says, looking back. Based on the experience gained during Hurricane Maria, Fresenius Medical Care increased the number of personal generators on the island from around 100 to 370 units to supply power to the employees’ homes and shipped in two backup clinic generators on trailers.

The company also set up guarded gas cylinders throughout the island that hold around 350 gallons (1,300 litres) each so that staff could refill their cars and generator gas cans without having to wait for hours at the pumps. “We live by a simple motto,” Loeper explains. “We take care of our staff, so they can take care of our patients.” Loeper has also been working hard to ensure that the clinics are better prepared in case of a complete breakdown of communications networks. Besides satellite phones, Fresenius Medical Care facilities on Puerto Rico now have half a dozen amateur radio stations and staff are being trained to become licensed radio operators.

Fresenius Medical Care in Puerto Rico

Sharing best practices globally

Fresenius Medical Care has been sharing insights and best practices from Puerto Rico with its global team. “We have set up a worldwide pandemic planning team with members from Europe, North and South America and Asia-Pacific,” says Loeper. Rebuilding Puerto Rico will take a long time. FEMA has allocated 1.6 billion US dollars for emergency home repairs and another 1.4 billion US dollars for grants to homeowners to repair or rebuild their houses and cover the cost of temporary housing.

For Ivonne Ramirez, this latest hurricane to hit her island was one too many. In July 2018, she made the decision to leave Puerto Rico and take up a new job as a Fresenius Medical Care clinic manager in Miami. “I realised that personally, I couldn’t go through another situation like this again,” she says. “But I learned a lot in those weeks and months after Maria and I saw the happy faces of the people we helped. Nobody can take those memories away from me.”

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