Nearly three weeks after Hurricane Maria devastated Puerto Rico, registered nurse volunteers on the ground continue to sound the alarm about dire conditions and countless numbers of residents still in desperate need for assistance amid a federal relief effort that has failed to reach many people in need.

NNU’s Registered Nurse Relief Network sent 50 RNs as part of a 300-member deployment led by the AFL-CIO in conjunction with the Puerto Rican Federation of Labor and the San Juan Mayor’s office.

They cite a continuing lack of food, water, and other supplies from FEMA and other relief agencies, people standing in line for hours waiting for help, multiple houses with roofs blown off and soaked interiors but people staying in those homes because they have no where else to go, and people still without medical aid.

“What our nurses witness daily is the harsh reality of a woefully inadequate government response and the brutal, inhumane impact on the Puerto Rican people. People are still without food and water. That poses an enormous humanitarian threat in terms of disease, life, and death and who succumbs first,” said Bonnie Castillo, RN, director of NNU’s RNRN program.

“No more disgraceful delays. The Trump Administration, FEMA, and Congress must act immediately,” Castillo said.

Eyewitness accounts from RNRN volunteers Monday:

Report from Kent Savary, RN, where on Monday the RNRN team was in San Juan, Playita near the Playita Community Center:

They went to a man’s home. He had no roof, all his belonging were soaking wet due to the rain and no tarp. He is living in a garage beneath where he's in a 3x3 area. It’s an impoverished area with no access to clean water. There's a lagoon behind the house where mosquitos frequent the area. There’s black mold built up in most of the houses on the second floor, which can cause upper respiratory infections, renal failure, and scarring of the lungs.

The community center had bottles of water, but it is not sufficient for everyone and most people are using the water in their homes. Though we worked with families on how to clean the water and the mold there is a lack of supplies to even clean the black mold. There is a lack of relief communication and no FEMA in sight. Nebulizers are needed for asthma patients, but there is nowhere to plug in. FEMA is demanding folks apply online or via their cellphone app and provide bank account info by November 30 or they get no aid. Most people don't have cell phones, cell service, power or lap tops.

Report from Natasha Sustache RN, who was with a group of 13 RNs and doctors, who went to Vega Baja, Pueblo de Naranjitos:

They made a plan. First they identified a central area where they could send patients and community members to get medical assistance and education on disease prevention. The community center is still not operating so the community market or "bodega" was volunteered as the center point for the community because it's the only location with a working generator.

From there nurses broke up into groups and spread out in the neighborhood. They worked with community members on how to disinfect the water and illness prevention information. Natasha saw a patient who lacerated his foot while submerged in the hurricane water, with a swollen leg that needed medical attention.  A man who had a midsternal incision hasn’t been able to get follow up care since he had surgery a month ago. Natasha gave him dressing supplies and told him how to redress the wound.

Community members said they get their water from mountain pipes that they created themselves and cistern trucks that don't go by regularly and come unannounced. Residents explained there was no way to treat or clean the water, and they have no water unless it rains, but even then the water would still need to be treated.

In desperation for FEMA assistance, the community wrote a "SOS agua" sign on the pavement written largely in white chalk/paint.  Natasha said "the solution is so simple, the people need water and prevention." Or as one community leader said, "no one is asking for air conditioning, no one is asking to evacuate. We are just asking for water."

From Erin Carrera, RN

“Yesterday we went to Utuado, a town up in the center of the island. We stopped many times along the way to educate people on water safety. It’s a mountain community with small pueblos all over, many cut off since Maria by fallen bridges and blocked roads. We stopped in the center of town at the National Guard. They had lists of all the areas that had been seen by medical groups. We went to an area that nobody had visited where roads were recently opened. People are somehow surviving with the food and medicine they had on hand. They have received NO provisions. There is no running water and no electricity. Nobody is aware of the risks of drinking untreated water. We went house-to-house teaching families and asking that they spread the word. We also provided urgent care where we could. These communities are at great risk of water borne illness epidemics. They need clean water that is safe to drink! There is a public health crisis coming to Puerto Rico that we could prevent with proper supplies and support from the US government. These conditions would not be tolerated in the 50 states. It is outrageous that we are leaving our fellow Americans with essentially no aid. Many more will die if we don't step up."

RNRN volunteer nurses have cared for thousands of patients during disaster relief and humanitarian assistance deployments that include the South Asian tsunami (2004); Hurricanes Katrina and Rita (2005); the massive earthquake in Haiti, and Typhoon Haiyan, among other disasters. RNRN is powered by NNU, the largest organization of registered nurses in the U.S.