WASHINGTON ― Water is rationed. Scabies is spreading. Grocery stores are lined with empty shelves, if they're open at all. People are fainting as they wait in lines for hours in sweltering heat, because they have to check into a FEMA hub to get small amounts of food and supplies being guarded by armed officers. That's if they can even make it to FEMA.
This is the jarring reality that greeted registered nurses Alicia Schwartz and Misty Richards when they arrived in Puerto Rico. They didn't know each other before last week, when they flew into San Juan from New York and Oregon, respectively, to volunteer to help with the humanitarian crisis on the island ravaged by Hurricane Maria. Now they spend every night together, camped out in a vacated baseball stadium locker room with other volunteers trying to aid 3.4 million fellow Americans in their moment of need.
FEMA and military personnel have been leading relief efforts, but from the looks of it, something isn't working. It's been more than three weeks since the hurricane hit, and 36 percent of people still don't have drinking water, according to a government website updated daily. About 84 percent still don't have power.
And that's if you think the data are accurate. In a phone interview, Schwartz and Richards laughed as HuffPost read aloud statistics from the government site. They say it's way worse.
"That's lies," said Schwartz, 54. "First of all, we don't even know if the water is drinkable. Where is FEMA collecting this information? This is not what we're seeing."
Schwartz said she's met people who haven't had much access to drinking water for weeks, so they keep filling up containers from rivers or mountain streams. But that water isn't clean and can cause bacterial diseases, including leptospirosis, which is spread by animal urine. Puerto Rico Gov. Ricardo Rossello said Wednesday that at least 10 people have suspected cases of leptospirosis, and four deaths may be tied to it.
"Who tells them that they cannot drink this water?" asked Schwartz. "We had to stop people on the side of the road to Utuado, one of the places where water rushes by, and stop people from getting water there and teach them how to disinfect water."
Richards, 47, said the idea that 86 percent of grocery stores are open, another statistic on the government website, seems off. In the towns she's visited all over the island, most markets are closed or in dire conditions. She and Schwartz have spent time in about 20 towns so far, including Humacao, Fajardo, Utuado, Rio Grande and the outskirts of San Juan.
"There are long lines and empty shelves. I have met tons of people with pictures of empty shelves," Richards said. "There is no meat to be had. Very limited amounts of dairy. That's even in San Juan, where people are better off in an urban area."
Neither of the nurses claims to have a full understanding of FEMA's operations. They've been on the island for just over a week. They have next to no internet service, and they aren't in regular contact with government officials. They just know what they're seeing, and it's nothing like President Donald Trump's picture of a successful recovery effort.
Richards and Schwartz hadn't even planned to come to Puerto Rico. Both spontaneously decided to do so when their union under the American Federation of Teachers issued a call to members earlier this month to volunteer. AFT, which has a health division, teamed up with the AFL-CIO to mobilize more than 300 members to the island. Most volunteers are using up vacation days to help.
A Typical Day
Every morning, they pile into trucks with other medical professionals and make their way into towns to see if, and how badly, someone needs medical attention. Richards said most of her patients are people who are too sick or weak to leave their homes. She said her team brings some medicine and supplies for the people they meet, but she worries about the high numbers of people she's met with hypertension and diabetes.
"They're being poorly controlled due to access to medication and access to proper food," Richards said. "Think about it: All you have is processed food. You're diabetic or have high blood pressure. The health conditions they have are exacerbated."
Schwartz, who grew up in Puerto Rico but moved to New York when she was 21, said she's seen a lot of cases of conjunctivitis, better known as pink eye, and scabies, a contagious skin infestation. Scabies is already difficult to treat; it requires thoroughly cleaning all sheets and clothing. But here, where people don't have much access to clean water, Schwartz said it will be particularly tough to stop its spread.
Both nurses are meeting with people who are living in squalor. In one coastal village, Schwartz said she met an older woman who had fungus growing on her arms and back. It was from sleeping on a wet mattress, still soaked in seawater from when the hurricane lashed the area weeks ago. In another town, Humacao, she visited two elderly people living in a house with no door and no roof over the living room. The windows were blown out, and the house smelled like mold.
"Even the doctor that was with us, he cried. Lightning was beginning, and you could tell they were going to get wet," said Schwartz. "They don't have any place to go."
There's also an absurd element. FEMA put up signs telling people to call them or sign up online for help. But most people have no electricity or cell service.
"There's been a flipping hurricane. There's FEMA posters everywhere that say, 'Call FEMA. Apply to FEMA online,'" said Richards. "It's laughable. But it's not."
The nurses convey a level of urgency that echoes San Juan Mayor Carmen Yulín Cruz, who has been begging for more help from the government and has criticized the Trump administration's response to the disaster. Trump has dismissed her as "weak," and FEMA Director Brock Long has followed his lead, saying that he "filtered out the mayor a long time ago" and that FEMA "is making progress every day in conjunction with the governor."
But there is clearly a disconnect between what the government is saying and what people on the ground are seeing. Beyond the government's statistics about water or electricity, the death count numbers don't seem to add up. The governor said Wednesday that the death toll has hit 45. But disaster experts say that seems low given the grave conditions, and Vox did its own investigation and found at least 450 reported deaths since the hurricane hit.
A request for comment from the Puerto Rico governor's office about how officials collect data on water and power, and on the accuracy of the death toll, since the hurricane was not returned.
"The Beach Is Hungry. La Playa Tiene Hambre."
Richards and Schwartz say locals are coming up with ways to survive on their own. They've seen people running cars for 20 hours a day as an energy source, rigging lines from the car battery into their homes. They met a woman who has been taking her granddaughter to a liquor store twice a day because a friend there lets her use their generator to power a nebulizer that she needs in order to breathe.
Some people have told them they've waited in line for hours for food from government workers and then walked away with just snacks. Yet locals offer the nurses what little food they have when they arrive to help them.
"We pull out our tables and set up a triage area, and they come out with food. They cook for us. They have their pride, and they want us to eat something. But I couldn't," said Schwartz. "In Humacao, I kept looking at a sign that says, 'The Beach Is Hungry. La Playa Tiene Hambre.' They put the sign up after the hurricane, so people would know they're hungry and people would do something."
Asked what they think is the most important thing the government could do right now to improve conditions, they said FEMA workers should be going to people's homes and bringing aid to them ― not requiring people to come to them at a hub that many can't get to. They said they've had to push hard to get supplies from FEMA to distribute, and if they get any it's not nearly enough. They fear water shortages will take their toll.
"As a nurse, we talk about people needing to drink a gallon of water a day. In this heat, if there's no A/C because of no electricity, we're asking you to drink more water," said Richards. "I have not seen yet people sick from waterborne illness, but we expect that to come as bottled water runs out. You would think they wouldn't run out, but there is tight control of the water supply by FEMA. Water has been rationed."
What Is FEMA Doing?
HuffPost reached out to FEMA's Puerto Rico office to ask why it is requiring hurricane victims to go to a hub for help, versus sending workers to people's homes, and why FEMA is telling people to call or go online for help when people don't have power or cell service.
A FEMA spokesman, who would only speak on condition of anonymity, said there are 10 staging areas set up on the island for local officials to pick up supplies for their communities. If people can't get to the stations, the spokesman said, FEMA teams are visiting towns and providing "support in delivering supplies" to those areas by air or by ground.
The spokesman also listed off statistics: As of Oct. 11, FEMA has distributed 7.6 million meals and 6.4 million liters of water, and it has received roughly 455,000 registrations for federal assistance from survivors. That's just one-seventh of the island's population that's been able to register for help in three weeks.
As for why FEMA is telling people to call or go online, the spokesman said, "We encourage those impacted by Hurricane Maria with phone and/or internet connectivity to register for disaster assistance. … Those with limited internet and phone access should get in touch with their local officials so they can work with our FEMA liaisons to offer registration services."
Neither of the nurses knows when she will head back home, but at some point they can't afford to miss work anymore. They already feel sick about what they'll be leaving behind when they go, if nothing changes.
"These people are going to have an epidemic. These people are going to die. A lot of them are," said Schwartz. "The help is not really there for them."