Mobilizing disaster response for community health needs

A red flag immediately came up when volunteer doctors treating members of an isolated community in Utuado realized an inordinate number of patients had gone without their high blood medication for months after Hurricane María. To their dismay they also found that diabetics were not on their medications.

“There was surprise and concern,” explained Dr. Nélida Rivera, who is the Executive Director of the Medical Directors Academy of Puerto Rico (ADMPR, Spanish acronym), a nonprofit organization established in 1985 to improve health services on the island. ADMPR was one of a handful of health organizations who were in Utuado, a central mountain in Puerto Rico, on April 21 at a health fair for this community. Not only had Utuado been hard hit by Hurricane María, its residents had continued to suffer harsh living conditions due to months without power service.

The fair was held in the Barrio Mameyes community clinic, now called the Corporación de Servicios de Salud Primera y Desarrollo Económico del Otao. The clinic was set up just after Hurricane María by Dr. Antonia Novello, the former U.S. Surgeon and Fajardo native who had arrived on the island to provide disaster relief shortly after the hurricane.  Due to the isolation of Barrio Mameyes, she had convinced the National Guard to run the clinic during the extended emergency period. A few months later, a group of community leaders led by Francisco “Tito” Valentín had taken on the responsibility of running the operation. For the health fair that day in April, the community had joined forces with ADMPR and volunteer medical students and doctors from the island’s three medical schools, the Medical Reserve Corps, VOCES, a nonprofit group that promotes vaccination and preventive care, and volunteers from United from Puerto Rico to tend to the preventive healthcare needs of nearly 500 people. Dr. Novello, who now lives in Florida, made the trip to Utuado to administer vaccines.  She serves as a spokesperson for VOCES.

United for Puerto Rico, a foundation created to channel disaster aid, took the opportunity of the fair to distribute donated supplies to 600 people with the help of its volunteers. It was also an opportunity for its board members, employees and volunteers to witness the work of three organizations that it had supported through its grants, the Utuado clinic, ADMPR and VOCES.

Health outreach services essential in the wake of Hurricane Maria

In the wake of Hurricane María, health has been one of the most serious areas of concern for organizations working on disaster relief and recovery. United for Puerto Rico identified health as one of five areas that it addresses with disaster relief and recovery funds, along with shelter, food and water, social well-being and economic development.

As of the first week of May, United for Puerto Rico has channeled $7.2 million, or 23%% to organizations responding to community health relief and recovery.   Those funds have allowed numerous organizations to expand their services and provide preventive care, mental health screenings and facilitate the continuum of care for patients with chronic conditions after Hurricane María. 

Early on, funds went to the American Cancer Society to transport patients to continue treatment, to the MS Foundation for the transport of patients to their treatments and, among many others, to Iniciativa Comunitaria to purchase a mobile health clinic. United for Puerto Rico also contributed to the partial funding of a massive vaccination campaign that seven months after the hurricane has reached 240,000 people through the Puerto Rico Health Department, VOCES and Dr. Novello’s efforts.

“As we followed the work done by the organizations active in health, we understood there were numerous lessons to share with the larger community that could help us improve disaster response for this critical area in the future,” said Mariely Rivera, Executive Director of United for Puerto Rico.  On April 20th, United for Puerto Rico organized a forum to share the experiences of four organizations who have worked in health outreach campaigns. Rivera moderated a panel that included the participation of businessman and community leader Francisco “Tito” Valentín, who now runs the community clinic in Utuado, Dr. Gustavo Laabes, a primary doctor in Aguada, Dr. Rivera of ADMPR, and Dr. Novello. Each shared the lessons learned from the months of addressing community health concerns created by the devastation of Hurricane María.

Dr. Laabes, for example, had to improvise a health clinic when he realized that the town’s surrounding health facilities were severely affected and would be unable to meet the demand for healthcare after the hurricane.  He set up a rudimentary clinic in the town’s Catholic Church, initially only with a piece of paper and a pen to try to set up records for patients seeking care. Concerned about the lack of communications and disruptions in supply, he quickly contacted pharmacies in town. “I was concerned with the supply of antibiotics in the event of outbreaks,” he told the crowd of health professionals that attended the health forum.  Because of his harrowing experience, he founded Beige Caps, a nonprofit organization with the aim of organizing better disaster response to health needs.

Dr.  Rivera, of ADMPR, contributed her organization’s experience in organizing health clinics and pulling together resources from other entities, such as the island’s medical schools to tend to the population.  Since Hurricane María, the organization she leads has organized or participated in a total of 10 health clinics, three in Ponce, three in Arroyo, two in Guayama, one in Utuado and one in Morovis.

While Dr. Novello, a pediatrician by training and a doctor in public health, brought to the panel the perspective of a health professional who mobilized quickly to set up disaster relief. She arrived shortly after the hurricane to find authorities and organizations overwhelmed by the magnitude of the disaster.

On her first disaster response trip to the island, she was able to bring 2,000 pounds of medical supplies and five doctors. One of her first stops was at Buen Samaritano Hospital in Aguadilla, a nonprofit community institution that suffered heavy damages, including loss of water service for 40 days. The five doctors who accompanied Dr. Novello relieved doctors working in the hospital’s ER who had been unable to sleep for three days. (United for Puerto Rico has granted the hospital funds to set up an industrial generator and a water well, to help the institution be prepared for future emergencies.)

Since then, Dr. Novello has focused most of her disaster response on organizing massive vaccination campaigns through VOCES.  One of the many organizations that Dr. Novello helped was Dr. Laabes’ improvised disaster operation in Aguada. Through senator Marco Rubio’s office and the Department of Health and Human Services, he was able to obtain a tent equipped with medical supplies and PACIV Foundation donated six stretchers. Pharmaceutical products were purchased with donations from the U.S. mainland, mostly from the Puerto Rican diaspora, especially from doctors in Jacksonville.

Lessons learned

What emerged from the forum was the need to plan for outreach of community health services in the event of another hurricane. The participants agreed it was important to have advance knowledge of the needs of the community, identify patients who need special care, whether it is dialysis, respirators, insulin or other services.  One of the greatest difficulties was matching demand for much needed medical supplies with donations. Forum participants also saw the need for more education to patients in helping them manage their medications, for example, the proper handling of insulin when there is no power.

Health facilities need to prepare for greater resiliency in terms of power, telecommunication services and access to water. And, more importantly, they recommended that health groups working disaster relief formalize accords that promote greater collaboration among entities to leverage resources available.  By chance, all four participants in the forum had found each other as they were delivering aid services throughout the island. They ended up collaborating, which helped extend the critical care services at a time of great need. 

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