Manhattan doctor Lucy Doyle has done stints with the global medical relief organization Doctors Without Borders in the Democratic Republic of Congo and Kenya. But her latest assignment is a real eye-opener: New York City.
In the wake of Superstorm Sandy, Doctors Without Borders has set up its first-ever medical clinic in the United States, and Doyle finds herself on the front line of disaster just miles from her day job.
"A lot of us have said it feels a lot like being in the field in a foreign country," said Doyle, who specializes in internal medicine at New York's Bellevue Hospital, now closed by Sandy's damage.
A week after Sandy swept through New York City, knocking out power and public transportation for days, Doctors Without Borders established temporary emergency clinics in the Rockaways - a remote part of Queens that faces the Atlantic Ocean - to tend to residents of high-rises that still lacked power and heat and had been left isolated by the storm.
"I don't think any of us expected to see this level of lacking access to healthcare," said Doyle.
Sandy's death toll in the United States and Canada reached 121 after New York authorities on Wednesday reported another storm-related death, this one in the Rockaways. Tens of thousands are thought to be displaced in New York City.
Dire situation, 15 floors up
The situation in the Rockaways is dire: high-rises don't have working elevators, street lights are dark and until a day or two ago, pharmacies had either been destroyed or were shuttered. The almost complete absence of police, coupled with the constant darkness, has left residents fearful of leaving their apartments.
"Their pharmacies are closed. Their doctors' offices are closed. They need a way to get refills of the medicines they take all the time," said Danya Reich, a physician at Beth Israel Medical Group in Manhattan, as she waited to see patients in a first-floor laundry room that was serving as a medical clinic.
In one squalid building on the ocean's edge that has been without power and heat for 11 days, the stairwell reeked of vomit and urine. And yet a steady stream or residents made the trek, some joking that at least they were getting exercise.
One case was especially concerning to the doctors was a couple living on the 15th floor. Victor Ocasio, 46, has chronic bronchitis, asthma and has been throwing up blood. His wife Lorraine Bryant, 42, is diabetic and obese and uses a walker. Both have been complaining of chest pains and wooziness.
"I'm scared to walk down those steps. I fell before and I'm scared I'll fall again," said Bryant. But she was resisting the idea of going to a shelter, where the doctors said she and her husband could get regular medical treatment.
"I'm scared to go into a shelter. Bad things happen there," she said.
John Josey, 72, who has been bed bound since having a stroke some years ago, suffers from diabetes, high blood pressure and arthritis.
A home health aide who tends to him said the pharmacy where she normally fills his prescriptions washed away in the storm, and a family member had asked that a Doctors Without Borders volunteer visit to fill out new prescriptions.
A CVS pharmacy opened a few days ago in the Rockaways, but patients who have never been there have no records on file.
As David Horne, a dermatologist volunteering with Doctors Without Borders, tended to his patient, Josey's family recounted what it had been like the night of the storm. The water had nearly come up to second-floor windows and at one point had reached 11 feet high.
Horne said that with so many prescription requests, the doctors were trying to stay vigilant. One patient had asked to have a prescription for a very potent narcotic that had not been filled in months and for which there was no obvious need. He declined to fill it.
In many ways, this side of New York City is much like the war zones or disaster areas where Doctors Without Borders normally works.
"Every night we spend in the dark, somebody's life is at risk," said Rejelio Arnold, 25, who has spent the last week delivering water and other essentials to his sick and elderly neighbors on higher floors. "Mostly it's just food and water and candles that people are trying to get."