By Anastasia Moloney
SANTO DOMINGO, Feb 22 (Thomson Reuters Foundation) - When hurricanes Irma and Maria hit the Dominican Republic last year, 21-year-old Roseli de los Santos pulled people from floodwaters and helped families to evacuate flooded homes.
The country lies in the path of seasonal hurricanes and on two fault lines. So de los Santos, a civil defence volunteer, said it is a question of if - not when - the next hurricane or earthquake strikes the Caribbean nation.
"The more prepared we are, the more we can save lives," she told the Thomson Reuters Foundation at the training and operations centre of the National Emergency Commission (CNE) in the capital Santo Domingo.
"We are trained. I know what to do in the next disaster. I'm proud I can help others."
De los Santos is part of an 8,200-strong volunteer network whose role is to protect 11 million Dominicans and ensure the tourism-reliant nation is better prepared for disasters.
At the National School of Disaster Risk Management, de los Santos is one of thousands of volunteers and officials who have received free training in first aid and emergency response.
Being better prepared is a priority as extreme weather linked to climate change will occur more often, scientists say.
The Dominican Republic continually improves its early warning system, carries out frequent quake drills in hospitals and schools, and ensures locals monitor river levels.
It also uses social media and text messages to warn people and advise on safety, and uses WhatsApp for emergency response officials to communicate.
Although much has been done, experts say more is needed.
The Caribbean's annual hurricane season runs from May to November, and those most at risk are poor Dominicans living by rivers and on steep mountain slopes, experts say, as they are vulnerable to landslides and flooding.
The risk of a sizeable earthquake is also a constant. That was highlighted in 2010 when Haiti - with which the Dominican Republic shares the Caribbean island of Hispaniola - was struck by a magnitude 7 quake that killed more than 200,000 people.
The CNE coordinates emergency response teams and can activate 3,000 shelters that hold up to 2 million people.
"We have people in each small corner of the country ready, and who know what to do," said Colonel Puro de la Cruz, deputy director of the civil defence agency.
"Hurricanes can come any time. We learn each time a hurricane happens," he said, standing behind three television screens that monitor weather patterns.
Public health facilities must also be ready. Nearly seven in 10 hospitals in Latin America and the Caribbean are in disaster-prone areas, according to the Pan American Health Organization (PAHO), the World Health Organization's regional arm.
Under PAHO's Safe Hospitals Initiative, hospitals are graded on an ABC index that ranks how resilient the facility is to disaster - with an A-ranking being the highest.
Measures include the safety of staff and patients, and the hospital's ability to provide critical services.
In the Dominican Republic, with funding from the European Union and Spain, it aims to prevent damage to hospital buildings and equipment and ensure hospitals keep operating during and after disasters.
Dozens of hospitals have been assessed on their ability to cope. Most are rated only B or C.
Among these is the Ramon Matias Mella hospital in the city of Dajabon - five hours northwest of Santo Domingo and just yards from the Haitian border - which has made several improvements as a result of the Safe Hospitals Initiative.
Outside the hospital, Haitian boys shine shoes for small change. Inside, several Haitian women are recovering after caesarean deliveries. Most patients are road accident victims.
Hospital director Victor Moya pointed out changes made since 2010: a generator for emergency electricity, new fire extinguishers, loudspeakers and exit signs, a larger emergency room, and repairs to a leaking roof.
"We hope to move from B and become an A hospital ... there's much work to be done," said Moya.
There is much to be done elsewhere too: nearly a decade after the initiative started, progress is slow.
To date, just 84 of 184 public hospitals have undergone a safety assessment, said engineer and earthquake expert Leonardo Reyes, and 70 percent of those would not be operational in the event of a disaster.
"We need to take action, to go from studies to action ... we are talking about life or death," said Reyes, who heads the Dominican Society of Seismic Engineering and Seismology.
The health ministry said 15 to 20 hospitals were being reviewed each year, with 50 undergoing repairs or construction.
"We're on the right track ... we want to improve the ratings of safe hospitals," said Mariam Montes de Oca, the ministry's director of emergencies and emergency care.
Reyes said the risk extends to the country's 8,000 schools, which are "highly vulnerable".
A government programme started last year to improve schools' safety - including reinforcing buildings to withstand shocks - and to ensure they can serve as shelters during a disaster. So far 60 have undergone an initial review.
Meantime, said Reyes, the country remains at risk of a major quake that could cause a tsunami with nine metre-high waves.
"We're an island exposed to big earthquakes. We're waiting for an earthquake to come at any moment," Reyes said.
(Reporting by Anastasia Moloney @anastasiabogota, Editing by Robert Carmichael and Katy Migiro. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)
Our Standards: The Thomson Reuters Trust Principles.