Nearly two months after hurricanes slammed the U.S. territory of Puerto Rico, efforts to reestablish the healthcare system have started to have an impact. Physicians are reopening their offices; medicines and supplies are starting to reach these providers; and surgeons are less likely to be operating by cellphone flashlight.
But the long-term impacts of the destruction — including the lack of dependable power, water, and other services– — are only beginning to emerge, according to a group of New Jersey providers who are part of an ongoing effort to restore public-health services in several island communities.
The widespread stress of the disaster, anxiety about the future, and fear of dangers lurking in the dark are likely to lead to significant mental health issues, providers warned. Smoke from thousands of diesel generators could exacerbate asthma and other cardiovascular conditions, they said, and standing water could result in more mosquito-borne diseases. Some residents have already developed skin and eye disorders as a result of contamination, and too many are still struggling to get nutritious food and clean water.
“It may as well be Saigon,” during the Vietnam War, lamented Gina Miranda-Diaz, a nurse and the health department director in West New York, who has family on the island. “I think it’s going to get a lot worse before it gets better.”
These concerns have fueled efforts by private organizations nationwide who have rallied to supplement government efforts, including a Garden State team led by, which operates 29 nursing homes and other care facilities for Medicare patients. The group — which has made two trips to the island and is planning a third, possibly this week — involved more than three-dozen volunteers, including physicians, nurses, and other providers from , the state’s largest healthcare provider.
Miranda-Diaz, who leads the state’s chapter of the, has also collected thousands of pounds of supplies ranging from insulin to diapers to headlamps — to avoid more iPhone-lit surgeries — and is working with other organizations to get herself and her goods space on a plane to Puerto Rico later this week. She will also visit a clinic and a nursing home in a town on the west coast, near her family home.
“I just had to do something,” Miranda-Diaz said. “It was my second home as a child. The area where we used to ride bicycles — all the houses are gone.”
For CareOne, the mission was motivated in part by concern for the staff and patients at InnovaCare, its sister organization, which serves 250,000 Medicaid and Medicare patients on Puerto Rico, explained Patricia Chiorello, the vice-president of communications at CareOne. “It really was a calling,” said Chiorello, who had spent time on the island in the past.
“It will be an ongoing effort,” she said — one CareOne expects to last at least six months. “There really is no end date for us.”
Michellene Davis, EVP and chief corporate affairs officer for RWJ/Barnabas, who joined one of the visits, said thewith her organization’s global health goals. “Many of our employees have friends, family, and even hail from the island itself,” she added, noting it seemed like their “rightful duty” to get involved.
Puerto Rico, with a population of 3.4 million, was slammed by Hurricane Maria on September 16 — less than a week after Hurricane Irma left the island in its wake. The second storm knocked out power for some 90 percent of the island and left more than half the population without access to drinking water. Reports suggest that at least 50 percent remains without electricity and it could be months before power is restored island wide.
While services are slowly being restored, continuing concerns about the power grid are a major problem for residents, according to Dr. Ernani Sadural, director of global health for RWJ/Barnabas. The darkness presents practical challenges, he said, but also plays a large role in the fear and mental strain he witnessed. “And that’s just a cumulative stress that’s hard to measure,” he said.
The group visited two hospitals and also ran pop-up clinics at community centers in two separate towns outside of San Juan. Sadural described treating a pregnant woman, just two weeks from her due date, whose first attempt to have a baby ended at 7 months in a tragic car accident. The patient was worried about how she would get to the hospital this time, whether the roads would be passible, and if enough staff would be on hand if she went into labor at night, he said.
“These things that we take for granted become a dark cloud over people,” Sadural said.
The group brought medicines, surgical supplies and medical equipment, like a hand-held ultrasound scanner, that proved useful in any ways, Sadural said. While these types of visits will likely continue, the group is also looking at ways it can make long-term, sustainable impacts on the medical infrastructure, he noted. For example, they are talking to someone about connecting a solar panel to the community center to provide power next time the grid goes down.
“This is something we want to promote,” Sadural said. “It comes back to the community aspects of resiliency and planning for future disasters.”
Chiorello, with CareOne, said their role was not limited just to traditional healthcare. In fact, the group also offered haircuts for residents and hosted community meals, music, and children’s games. “It was a day not just to have your medical needs met, but to come together with your community,” Chiorello said.
Most important, they agreed, is not to lose sight of the island’s long-term needs. “People are already forgetting — and we can’t forget,” Miranda-Diaz said.