It’s been more than a month since Hurricane Maria devastated Puerto Rico.

Dozens of deaths have been attributed to the storm. Clean-up and recovery efforts continue. But for millions still living on the island, concerns over long term health issues have only just begun, says University of South Florida physician Dr. Asa Oxner.

"I think the long term health concerns are going to continue for patients who have chronic diseases like diabetes and high blood pressure, especially," Oxner said,

"They’re going to continue to have shortages of those medicines because the supply chain has been disrupted."

Oxner just returned from spending a week in Puerto Rico. She was part of a group of USF physicians who delivered donated medical supplies and treated patients at a hospital located in a rural, central area of the island.

The delivery included donated medications, IV bags and fluids to help with basic healthcare needs. In Puerto Rico, the rate of diabetes is higher than in any state, according to the most recent data from the Centers for Disease Control and Prevention.

"There was, of course, initial trauma but most of those patients are already being treated and most have recovered," Oxner said, "Now what we’re seeing is people who have chronic conditions who are having trouble accessing care.”

Oxner says she’s concerned about the potential for serious outbreaks due to the large number of island residents who are being exposed to contaminated water.

"Contaminated water is already starting to spread some water-born diseases," Oxner said, citing reports of leptospirosis. It's a bacterial infection spread when people consume water from the same source as rats, she said.

She's also concerned about a potential outbreak of Zika, because of the amount of standing water left on the island, and cholera, a diarrheal disease that can be deadly.

"Whenever there is flooding and people are using water that isn’t safe ... it becomes a problem," she said.

To date, USF has delivered more than 1,500 pound in donated medical supplies and medications. But getting those items to the island is the easy part, according to Don Mullins, safety & preparedness director for USF Health.

"They’re still dealing with some infrastructure challenges," he said. "Getting supplies from where they come into the area and getting them distributed out to the community is always a challenge.”

Last week the President appeared to put Puerto Rico on notice when he insisted in tweets that the federal government can't keep sending help "forever" and suggesting the U.S. territory was to blame for its financial struggles.

Oxner says the physicians with USF are prepared to help in Puerto Rico as long as they are needed, which could be for several more months. Oxner says she and other colleagues plans to make a return trip soon.

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