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Hurricane Maria knocked down 80 percent of Puerto RicoĢ����ý�s utility poles and all transmission lines, resulting in the loss of power to essentially all of the islandĢ����ý�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 September 20, 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 islandĢ����ý�s capital of San Juan. Ģ����ý�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,Ģ����ý� recalls Ramirez. Ģ����ý�We felt as if this hurricane wanted to wipe us off the island.Ģ����ý�

As a gray and wet morning dawned, the full extent of the stormĢ����ý�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 Ģ����ý� she had to get to Los Paseos, the islandĢ����ý�s largest dialysis clinic operated by Ģ����ý, where she worked, as quickly as possible to check for any damage. As clinic manager at the facility, she knew that her patientsĢ����ý� survival depended on her ability to get things sorted out immediately.

Ready to welcome patients after just 24 hours

Ģ����ý�We had gotten ready as best as we could Ģ����ý� 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. Ģ����ý�Ramirez ran down her list of contacts for maintenance and clinic staff and managed to get in touch with them. By the morning of September 21, Los Paseos was the only clinic on the island ready to receive dialysis patients.

Ģ����ý�It was quite a sight,Ģ����ý� Ramirez says. Ģ����ý�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 a.m. and worked through until 3 a.m. the next day,Ģ����ý� 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.

Employees at Ģ����ý's dialysis clinic cared for around 200 patients after the devastating hurricane.

Bob Loeper and a colleague stacking food and vital supplies at a Ģ����ý warehouse.

Ensuring fuel and water supplies

As Puerto Rico struggled to get back on its feet, Ģ����ý 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 ensure water and fuel deliveries for the 28 clinics on the island. "The hardest thing to deal with was the total collapse of communications,Ģ����ý� says Bob Loeper, Vice President for Operations Support and Business Continuity at Ģ����ý, who arrived on Puerto Rico the following Monday. "ItĢ����ý�s the one thing that took us by surprise.Ģ����ý�

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.Ģ����ý� Once on the ground, Loeper requested water and fuel supplies for the Ģ����ý clinics.

Keeping in touch by satellite

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

In the end, Ģ����ý 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 Ģ����ý 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. Ģ����ý�We delivered all the things they needed to keep everyone fed,Ģ����ý� says Loeper.

Sharing best practices globally

Ģ����ý has been sharing insights and best practices from Puerto Rico with its global team. Ģ����ý�We have set up a Worldwide Pandemic Planning Team with members from Europe, North and South America and Asia-Pacific,Ģ����ý� says Loeper. Rebuilding Puerto Rico will take a long time. FEMA has allocated 1.6 billion U.S. dollars for emergency home repairs and another 1.4 billion U.S. 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 Ģ����ý clinic manager in Miami. Ģ����ý�I realized that personally, I couldnĢ����ý�t go through another situation like this again,Ģ����ý� she says. Ģ����ý�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.Ģ����ý�