SAINT THOMAS, US Virgin Islands — First came Hurricane Irma, battering St. Thomas in the US Virgin Islands. Less than two weeks later as islanders were still barely recovering, Maria, another Category 5 storm, blasted through the region, further destroying its homes, infrastructure, and wrecking its two hospitals.
Surrounded by Army vehicles, massive piles of debris, and mangled palm trees, Schneider Regional Medical, like the rest of the island, looks like it weathered a bombing.
“People either survive or they don't in these situations,” said Dr. Brian Bacot, who has seen around 200 patients and has performed more than 15 surgeries since the hurricanes arrived. Bacot — an orthopedic surgeon who works in part at Schneider and at his own private practice — is now just taking anyone who comes to him in need.
Built in the early 1980s and the only hospital on St. Thomas, the facility was already struggling to pay its bills, obtain medication, and refurbish its aging wings before the storms tore off parts of its roof and ruined thousands of dollars worth of equipment. Now, a majority of its floors lie stripped and damaged, wires hang from the ceiling, and mounds of paperwork still sit piled atop dusty, wrecked desks.
Meanwhile, green Army tents are being set up outside to house displaced patients, perform operations, and help alleviate the flow of people seeking medical attention.
“It’s surreal looking,” he said during a break between seeing patients, describing a hospital that’s functioning under extreme circumstances with no plan yet in place to either repair or rebuild the dilapidated structure. The emergency room sees about 20,000 people a year.
“The entire hospital was drenched in water, the fourth floor dripping onto the third, the third dripping onto the second floor and pharmacy. It’s extensively saturated through and through,” Bacot said, and its sister facility, St. Croix Regional Medical Center, is even worse.
Officials estimate it could take up to two years to either repair or completely replace the 35-year-old building. Gov. Kenneth Mapp had said he expects both hospitals will have to be torn down and rebuilt.
“I have two essentially condemned hospitals," Bacot said. "Right now we don't have operating rooms I feel safe operating in and doctors are trying to find other places to see their patients because their buildings still don't have power."
Massive fans blow hot, stale air inside the ER’s waiting room, which was packed with people on Thursday afternoon. Doctors have lost two critical floors, its behavioral health floor, which houses patients with mental illnesses, and its medical unit.
When they need to operate, they are either evacuating patients on military and privately-sponsored flights to hospitals in the states or performing emergency operations in less-damaged areas on the first and second floors, where powerful winds still tore through, tossing equipment, ceiling tiles, and files across its rooms.
Tina Comissiong, the acting chief executive officer of the Schneider Regional Medical Center, said that while the situation is still an ongoing battle, the worn staff is actively treating patients, whose issues range from infected cuts and broken shoulders to diabetes and pregnant women — because there’s no other choice.
"It's us or nothing," Comissiong told BuzzFeed News. She touted the “heroic efforts” of the hospital's facility and staff, who she says have been working nonstop to treat people since Irma first ripped through almost a month ago.
“We prepared for Irma but Maria ruined us,” Comissiong recalled, describing the 165-mile winds that barreled into the hospital as nurses and doctors rushed to pull patients from their beds and get them downstairs before the windows burst open.
“Everyone from nurses to cafeteria workers to the security guys. They are working under insane conditions and have their own damaged homes and families in need. My daughter is sick. My home is ruined and we are here because people need us,” Comissiong said.
And while they praised the federal government’s response, the medical professionals are still in dire need of help and supplies, like tetanus shots, antibiotics, and insulin.
One doctor is running out of elastic bandages, gauze, alcohol prep pads, and shoulder arm slings. Bacot is down to the dregs of his cotton ball and surgical tape stashes. Families are still not getting baby formula and feminine products.
The hospital doesn’t have access to cancer-treating drugs, Comissiong added, and while it can still host operations and deliver babies, which doctors have since the hurricanes, they can only do so at limited capacities.
Then there are the people — exhausted, overworked doctors, nurses, and facilities workers, who need relief to sleep and care for their own traumatized families and homes, which for many are starting to fill with mold.
Bacot says that while he is happy to provide treatments and services for free to those in need, he doesn't know how long he can sustain it.
"Those treatments are expensive," he said. "And I'm worried about paying my staff of 60 people."
The strapped conditions of the territories’ two main hospitals is also a major concern for US Virgin Islands Senator Janelle Sarauw.
“Both hospitals are decimated on St. Croix and here on St. Thomas,” Sarauw said, dismayed at the lack of facilities and available relief. “You only hear about us when the storm hits. Aid should have been here a lot faster.”
Their concerns go beyond the hospital — with weeks-old water still pooling in hundreds of homes, restaurants, and other buildings, they now worry about the spread of disease.
“I'm growing mosquitos in back of my car,” Bacot said, "And you have to imagine that situation is happening to all of us. Everybody. It's on the entire island."
Rebecca Howe, a 32-year-old photographer, told BuzzFeed News that they are using a bucket of water to flush their toilet and mosquito larvae is now growing in it.
“Mosquitos are a big concern,” Sarauw also said. “They can bring Zika, dengue fever, and chikungunya, which is like dengue fever on steroids. These are big, crazy bugs that can carry a lot of shit."
What's more, she added, people can also become infected with cholera from contaminated drinking water, which is still hard to come by for hundreds of people unable to travel to distribution centers in town due to ravaged roads and lack of transportation.
Sitting in a clinic nearby, Keshorn Ferrari anxiously checked his phone. He's supposed to get a call at 2:30 p.m. informing him if his critical medication had arrived with one of the most recent aid shipments.
The 30-year-old had a kidney transplant about a year ago and the islands don't carry his expensive, specialized drugs, which, like much of the islands’ goods, gets flown in from another US Territory — Puerto Rico, which has been utterly devastated by Maria.
"I didn't leave after the first [hurricane] because I was still getting my stuff," he explained, noting that his father had been evacuated first to Puerto Rico after Irma and then to Miami, before Maria bore down on that island.
"Now it's like, ‘Oh my god, what do I do?’" Ferrari said. "I'm normally afraid to miss one day of these medications. I take eight of one twice a day so it's stressful."
He says he's gone seven days without both.
Ferrari, who works at a Westin hotel on the island of St. John, said he can get some care on the island but his doctors don't specialize in his condition and pharmacies don't stock his prescriptions.
"People here have conditions like me, like heart conditions, and they don't have those medications here and we have to rely on Puerto Rico,” Ferrari said, who said he even occasionally travels to Miami for intravenous immunoglobulin infusions because the procedure isn’t available in the US Virgin Islands.
"I'm just working to travel to Miami to get medicine and treatment. You have to go through so much here to get help sometimes," he said.
Apart from the physical needs of a safe place to operate, Bacot told BuzzFeed News of another pressing and invisible need on the island — the mental aspect to the tragedy.
“We have had a shortage of healthcare professionals with the ability to deal with psychological issues,” Bacot said. “We have an epidemic of people who have gone through significant psychological trauma, children to poor and elderly. The storm did not spare any demographic. The psychological scars will remain for a long time and need to be addressed acutely and chronically.”
As for Ferrari, he called BuzzFeed News a few hours later saying his medication did not come in and he was being evacuated to Jackson, Mississippi, immediately for care.
"I'm nervous because I'll be all alone and I don't know anyone in Jackson," he said. "I just have my one bag they told me to pack."
Talal Ansari contributed to this report from New York.