Melted medications. Surgical procedures conducted in sweltering 95-degree heat. Malfunctioning X-ray machines.

This is the reality doctors in Puerto Rico are facing almost four weeks after Hurricane Maria devastated the island.

“We’re practicing disaster medicine in real life,” said Dr. William Kotler, a senior resident in emergency medicine with Florida Hospital in Orlando, who spent two weeks volunteering on the island earlier this month. “We improvise if we have to, with very little resources.”

Kotler and four other emergency physicians from Florida Hospital in Orlando, just wrapped up a two-week volunteer mission in Puerto Rico. Arriving one week after Hurricane Maria made landfall, they were the first medical relief team the hospital sent to the island. A second team arrived on Oct. 8 and will stay for two weeks.