An elderly woman in Puerto Rico is helpless as her husband's body becomes a patchwork of ulcers and sores from Parkinson's disease. Another woman risks respiratory disease from a mold-infested bedroom and destroyed roof.
The snapshots come from American volunteers on the devastated island who are working with the American Federation of Teachers. The union has sent 40 nurses to Puerto Rico, where the natural disaster of Hurricane Maria and neglect from the Trump administration has created a perfect storm of death, disease and decay across an island of 3.4 million American citizens.
"This disaster is caused by neglect by the federal government," union president Randi Weingarten told Newsweek. "That's why this is such a tragedy. For President Trump to say they're safe is cruel and an abstention of responsibility."
Puerto Ricans are fighting to live with that failure. The elderly woman is in her 70s and caring for her grandchildren while also trying to relieve her wheelchair-bound husband’s pain. There are wounds covering his body and an infection that's festering on his foot. The couple lives in Yabucoa, on the southeast edge of Puerto Rico, and hopes to join family on the U.S. mainland soon. 
“He’s got pressure ulcers on his back and feet, and she can barely lift him,” Maureen Upton, a 12-year nurse practitioner, told Newsweek. “She was just in tears. She didn’t know what she was going to do.”
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Nurses from the American Federation of Teachers visit citizens in their homes in Puerto Rico.COURTESY OF THE AMERICAN FEDERATION OF TEACHERS

'There is no help' for Puerto Rico

Misty Richards, a registered nurse from Oregon who volunteered with the teachers union, worries there will be a slow increase in deaths, as people in rural communities lack medicine and nutrition.
Those with the money and resources to leave are able to head to the U.S. mainland, but not everyone is so fortunate. As well-off citizens leave the destruction behind, that leaves fewer people in the community to aid those who have nothing, creating a resource drain, Richards said.
“I wish I could say that I thought it wasn’t a socioeconomic caste system, but it absolutely is,” Richards told Newsweek. “These Puerto Ricans are being treated like they are disposable. It's been inhumane.”
Richards met a woman and her 8-year-old granddaughter while searching rural municipalities outside San Juan. The woman beamed at her from the decimated shell of her kitchen and welcomed her into their home.
In the woman's bedroom, everything is molding from water damage. Richards worries that the woman will develop respiratory problems the longer she lives in the room. There is no roof over the house and no sign that she'll have shelter anytime soon, but the woman smiles and advises Richards of which neighbors need help more than she does.
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Misty Richards, a registered nurse with the American Federation of Teachers, said Puerto Ricans are living in mold-infested rooms, which will cause respiratory problems after prolonged exposure.COURTESY OF THE AMERICAN FEDERATION OF TEACHERS

'There's not enough FEMA workers' in Puerto Rico

The Federal Emergency Management Agency (FEMA) is struggling to respond to simultaneous natural disaster relief efforts and is desperately in need of local workers. It's seeking local temporary employees to help as crisis counselors, registered nurses and insurance specialists.
FEMA officials allow Puerto Ricans to apply for financial aid online, but a majority of the island lacks internet and electricity. FEMA visits towns, providing spots for people to sign up for money to offset the damage to their homes, which ranges from ripped-off roofs to fully gutted structures. Waiting for FEMA aid brings lines down the street. The agency takes who it can, and the rest are left waiting for their own internet to return.
Water bottles are guarded by FEMA officials and local police to prevent raiding. Officials distribute five bottles of water per person each week to ration the resources. The nurses in Puerto Rico are collecting donations to buy food and water to deliver to rural communities without access to the city. They know five water bottles won't be enough in the humid climate as Puerto Ricans struggle to clear roads and rebuild.
Tin roofs ripped from Puerto Rican homes remain wrapped around trees. Uprooted electrical poles lay exposed on the ground, and telephone lines are toppled. Dead trees and debris cover roadways, cutting neighborhoods in half.
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In Puerto Rico, citizens lack the resources and aid to rebuild the island after Hurricane Maria hit in September.COURTESY OF THE AMERICAN FEDERATION OF TEACHERS
“There is not enough of them [FEMA workers], and they can only do so much,” Richards said. “I’m sure this is just breaking their hearts. You can’t look in the face of these people and not have compassion, but they’re being kept on a very short leash.”

'It will get worse before it gets better'

On the island, families are draining savings accounts and running out of resources. Health care professionals warn that illnesses and diseases on the island will only increase with the standing water and poor sanitation.
"The storm surge washed farm manure into towns, which completely ruined spring water," Upton said. "I was in the Peace Corps [30 years ago], and it reminds me of a developing country. I think it's going to be several years for recovery. It's not getting better."
As citizens work to clear up yard debris and open roads, they get abrasions and cuts. The open sores are infected in dirty water, Upton told Newsweek. With limited running water in some municipalities, citizens are trying to rig their own makeshift plumbing. Pumps to clear the water from towns are broken, so the water sits, attracting mosquitoes in the humidity. 
The House of Representatives on Thursday approved disaster funds for Puerto Rico. The $36.5 billion in relief money will need Senate approval, which could take several weeks. 

Hurricane Maria deaths expected to rise

The official death count in Puerto Rico for Hurricane Maria is 45, but communication difficulties from remote areas mean additional deaths go unreported. Experts say the actual number is likely much higher, and volunteers worry it will spike in coming weeks as mosquito-borne illnesses rise and clean water runs out.
Most pharmacies are still closed, and citizens are out of desperately needed medicine. They are unable to get nutrition and water, distorting the count of Hurricane Maria deaths as people suffer and die slowly, Richards said. She doesn't think the people of Puerto Rico can wait a few more weeks for help.
“A man is dying of renal failure while he couldn’t get to his dialysis,” Richards said. “But that won’t look like a hurricane-related death on a certificate. It looks like natural causes.”