Perspective: From the Field in Puerto Rico; ENT’s Kinship among Chaos

October 2020 – Vol. 39, No. 9

Charles Juarbe, MD, AAO-HNS Board of Governors Member for the Society of Otolaryngology – Head and Neck Surgery of Puerto Rico

My ENT peers in Puerto Rico may not have been to war together, but after two major hurricanes in 2017—Irma and Maria—tropical storms, a major earthquake on January 6, 2020, and its ensuing aftershocks, Sahara dust thick as fog for days, and the COVID-19 worldwide pandemic, it has been like going to war. We have gone through death, destruction, landscape devastation, and human suffering, besides the lack of essential services like water and electricity for months.

Social media has been a source of help to us. Sometime just after Hurricane Maria, the Society of Otolaryngology – Head and Neck Surgery of Puerto Rico WhatsApp forum became the source of information sharing between us. Days became weeks and weeks became months. Who had electricity, the internet, or water? Where was gasoline or diesel available?

My ENT practice, back in the early days after the hurricane, was like it had been in the past. The office was only open in the early hours to catch the morning breeze with open windows, and we were using battery-powered otoscopes and headlamps and performing larynx examinations with mirrors. With no electricity and no internet, we were back to writing notes and paper charts.

The usual discussions of ENT problems in the practice became less important as we now shared how to do oil changes in our power plants and install electrical connections with transfer switches, as well as discussed how many watts the refrigerator consumed and how to fix the water tank pump. We exchanged information about which gas stations or grocery stores gave doctors the right to go straight to the front of the line without having to wait for hours for gas or getting into places for essential products and materials. All these things have made me more humble and more grateful for the gifts we have received.

Now again with the COVID-19 pandemic, we are sharing information like where to get wipes, surgical masks, face shields, and air purifiers. Who is getting COVID-19 tests for patients in the office for endoscopy or laryngoscopy? Are we using the same protocols and procedures for surgical patients? How frequently are we and our staff being tested for COVID-19?

We all agree that the practice of medicine has changed forever, but knowing that there is kinship among chaos with our ENT peers from within our society and around the globe, we address these challenges and what they present to our practice, our patients, and our community, one by one, together.