America, Puerto Rico still needs your help

Doug, a retiree from the American mainland, wandered into our hotel 10 days after Hurricane Maria made landfall on September 20 inquiring where he could get medicine and see a doctor. In his 70s and suffering from back pain, he needed immediate medical care. Having been with Americares Emergency Response team to all four hospitals in Ponce, Puerto Rico’s second largest city, I was able to tell him which ones were open.

Then he asked if anyone could get a text message out yet. My phone worked intermittently, but I couldn’t make calls; only the occasional text message would go through. He dictated a message to his family, and I punched it in. No luck.

After a long day of preparing to receive an airlift of medical aid to the island, I found Doug waiting for me later back at the hotel. He wanted to know if the message had reached his family on the mainland. I checked my phone again. It had not gone through. I tried again. Still no response.

Late that night, on the fourth try, I received a response almost immediately. “Who is this? And is Doug really OK? We didn’t know if he was alive or dead,” his brother Drew responded. Before this disaster, it never occurred to me that two places in the United States could be completely cut off from one another for more than a week. In the midst of the chaos caused by Hurricane Maria, it was a joy to alleviate the anxieties of one family.

The challenges of sending a single text message illustrate just how trying life has become in post-Maria Puerto Rico, with cell towers down and electricity still scarce a month after the storm. The few cell towers left standing require expensive generators to power them.

Stores without electricity only accept cash, and the only way to get cash is to wait in ATM lines for hours. During my time in Puerto Rico — I arrived three days after the storm and was there for more than two weeks — I saw people standing outside, waiting to use ATMs long after the 7 p.m. curfew (which has now been extended to midnight), when the risk of carrying cash is high. The next day, they had to wait in line for many more hours to buy gas and then in another line to buy food or ice.

But the hospitals are faring a little better. They had priority on fuel in the first few days, including diesel for their generators. Most had enough power to run the lights and fans but not air conditioning in the muggy, 90-plus degree weather, making it difficult to maintain sanitary standards. In Ponce, only half of the operating rooms were functioning in the immediate aftermath. By the time I left, FEMA was reporting 41 of the island’s hospitals were back on the electrical grid, while 23 remained on generator power.

Some health facilities lack refrigeration space for temperature-sensitive blood products, insulin and vaccines. Many diabetic patients desperately need a fresh supply of insulin. Americares is delivering medicine and supplies, including insulin, to hospitals and primary care clinics. But they can’t arrive fast enough.

As a public health expert, I see an impending wave of health issues that demand attention now. In areas without safe drinking water, waterborne diseases are going to increase, compromising people’s health, especially children and the elderly. Already we are hearing alarming reports of desperate survivors collecting water from potentially contaminated water sources. Americares is working to supply containers that can filter out bacteria, viruses and parasites. We also plan to distribute water purification supplies that remove debris and environmental contaminants.

Meanwhile, patients with chronic diseases can tolerate going without medication for a few days — not weeks — before their conditions turn critical. And mosquito-borne diseases like dengue, chikungunya and Zika are likely to explode, with hurricane debris and rain puddles forming a perfect breeding ground, and homes open to the burgeoning mosquito population.

There is an ongoing debate about how long FEMA, the US military and first responders will stay in Puerto Rico. From a health perspective, it is far too early to put a timeline on how long the federal response will be needed. It is clear that this is an active emergency requiring ongoing assistance and response and we need them now. Nongovernmental organizations and the everyday heroes in Puerto Rico who are responding to others need the help of federal agencies to do their work effectively.

I went out with the US National Guard to hard-to-reach communities that were cut off by mudslides and impassable roads after the storm. There are remote health facilities that Americares teams would not have reached without a military escort. We are prioritizing mobile medical teams in remote communities, in part, because the US Department of Health and Human Services is already providing surge support at the hospitals and care for fragile patients in field medical shelters.

My organization has flown multiple airlifts of medicine and supplies into Puerto Rico, plus a planeload for battered Dominica in recent weeks. We have delivered $20 million in medicine and supplies for Maria survivors, we are providing training in disaster medicine and we are deploying mental health experts to address expected health consequences.

And while there are other organizations working in Puerto Rico, there are not nearly enough — particularly the farther outside of San Juan I went. In fact, when I first arrived, I was the only NGO representative from outside the island participating in coordination meetings with the Department of Health in Ponce.

Though many are tired, the Puerto Rican people are remarkably resilient and patient. They are helping one another and collaborating in ways I haven’t seen in other disasters. They — like the aid workers assisting them — are fiercely determined to rebuild Puerto Rico as quickly and efficiently as possible.

Louisiana took more than a decade to heal from Katrina; the recovery in Puerto Rico will be at least as long. Even when the trees grow back, looking fresh and green, the Puerto Rican economy and people will still be healing from deep wounds.

Having watched their power grid disintegrate as the storm swept through, Puerto Ricans are working to turn this disaster into an opportunity to build stronger, more stable infrastructure. We need to step up our response to help them and reaffirm to our fellow Americans that they are not abandoned. They deserve to have access to the same necessities that we would expect. We can and should provide quality health services, including mental health care, to ensure dignity and prosperity, not just stability.

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