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A public health crisis in Puerto Rico, post-Hurricane Maria

Dr. Breeda McGrath (a resident of San Juan, Puerto Rico and TCSPP's online dean of academic affairs) was attending meetings in Chicago when Hurricane Maria hit. When she finally made it home a month later, the devastation for her was shocking.

The noise was deafening—like a freight train continuously passing right outside of the windows of people’s homes. Buildings were shaking, screeching, and swaying back and forth. Roofs were ripped off houses and apartment buildings. Flooding was everywhere. Roads and bridges were torn up. Trees were ripped from the ground. Electricity in every neighborhood, town, and city shut down. The electricity in the Marriott lost its power and left the entire neighborhood in darkness.

More than 95 percent of the island was still without power, and many cell phone towers were still being repaired. Towns and neighborhoods across Puerto Rico are still dealing with the kind of severe challenges that make public health programs even more significant.

The even darker side of Hurricane Maria

On Wednesday, Sept. 20, Hurricane Maria made landfall in the early morning hours near Yabucoa Harbor in Puerto Rico. According to the National Weather Service, maximum sustained winds were 155 miles per hour, making Maria the first Category 4 cyclone to hit the island since 1932. Parts of Puerto Rico dealt with 30 inches of rain in one day, equal to the amount that Houston received over three days during Hurricane Harvey. The hurricane battered the island for more than six hours before finally moving north.

Weeks after the hurricane, families were still trying to get in touch with loved ones and couldn’t get calls through because the communication and power systems were destroyed.

Dr. Breeda McGrath

“Many towns and neighborhoods were inaccessible for weeks because the roads and bridges were broken and impassible,” Dr. Breeda McGrath says. “Communities were completely isolated, cut off from relatives, local support networks, and essential supplies like food, clean water, and fuel. While the island waited for the electrical grid to be repaired, fuel supplies were sent first to emergency support systems such as hospitals, emergency shelters, and hotels hosting FEMA staff, aid workers, and security personnel. People waited for more than six hours at gas stations for $20 worth of fuel. Grocery stores had lines of people waiting to buy their dwindling supplies. The noise and smoke of diesel generators was all over the island, drowning out the familiar sweet sounds of the coqui and the lapping waves of the ocean.”

According to Dr. McGrath, the temperature during the day was approximately 85 degrees, lowering only slightly to 80 at night. At sunset, shortly after 6:30pm, every neighborhood went dark, with the only light coming from buildings with backup generators. Local governments instituted curfews as a safety measure. Residents were forced to figure out how to get through each day without running water, electricity, and communication systems.

Those who had backup generators quickly began to run out of diesel, and supply chains were delayed and disrupted by broken roads and bridges. Food began to rot in refrigerators, and essential medication quickly dwindled. Even when neighborhoods were reconnected to the electrical grid, the hurricane season wasn’t over and frequent heavy rains knocked out the power until the weather warmed up.

The power still isn’t fully back on across the island. The Electric Power Authority (AEE) plans to have electricity in at least one sector of each of the 78 municipalities of Puerto Rico. Currently, there are still nine municipalities that are completely off: Maunabo, Naguabo, Patillas, Morovis, Jayuya, Adjuntas, Ciales, Rio Grande, and Yabucoa. Rebuilding the power plants and repairing the lines are taking place with the assistance of the Army Corps of Engineers and teams from New York and Florida.

The unpopular conversation Puerto Rico had to have with the government

The immediate response to Hurricane Maria has been grim due to a lack of emergency assistance from the U.S. government. Approximately half of Americans don’t understand that Puerto Rico is a part of the United States and should be entitled to governmental assistance. There was already a continuous decline in food stamp assistance even before Hurricane Maria. Trade issues with the Jones Act required that Puerto Rico only accept goods from vessels that are solely owned, operated, and built by the United States.

With food, shelter, and electricity already an obstacle course, Puerto Ricans were shocked by the scathing remarks from President Donald J. Trump, who declared to officials and relief workers, “I hate to tell you, Puerto Rico, but you are throwing our budget out of whack.” Trump also declared that Puerto Ricans should be “proud” that (at the time) only 16 people died during Hurricane Maria in comparison to the death toll after Hurricane Katrina (approximately 1,833 people).

While the governmental budget was debated, the human reality was neglected. There was no discussion about the villager—who was dependent on dialysis treatment—who had to travel by water barrel, pushed across the river by neighbors, and loaded onto an ambulance. This was the only way for him to survive the usual 15-minute drive to his nearby hotel. Why? The two-lane concrete bridge that isolated residents could travel on was destroyed. For 95-year-old Rosa Maria Torres, a skin ulcer on top of her anemia and thyroid put an even bigger strain on her finding a safe and easier way to receive proper medical attention.

Even when FEMA was given permission to fix the electric grid, repair damaged infrastructure, and rebuild roads, there has been major controversy about why FEMA has treated Puerto Rico so differently than the Virgin Islands, which received reconstruction aid two weeks after Maria.

Despite the political and financial debates, the complications caused by the Jones Act (that could allow countries outside of the U.S. to help assist local residents) and the real-life fear for basic safety, Dr. McGrath has been able to find the silver lining.

Not all bad news for the community

“One of the most important things about Puerto Rico is the strength of family and community in this culture,” Dr. McGrath says. “No matter where or who you are, someone will come for you. Your neighbor. Your sibling. Your family member. Someone who hears you. People have tremendous loyalty to one another and the strength to power through any difficulty, making sure that everyone is taken care of, no matter what.

“If one family has food, they cook for everyone around them. People work together tirelessly to make sure they are doing everything they can. Resilience, persistence, and positive attitude are a part of Boricua culture, and that is why Puerto Rico will rise. The death toll wasn’t huge because so many people looked after each other.”

While more than 900 people have been cremated since Hurricane Maria from “natural causes,” reportedly 51 died as a direct result of the hurricane. Many residents were able to survive the aftermath by taking refuge in shelters set up by the Red Cross in stadiums and shelters, according to Dr. McGrath. The day after, wherever homes were not completely destroyed, families and neighbors supported each other and provided shelter to one another. Even with roads that were destroyed, landslides, broken bridges, and massive flooding, they teamed up together to make the best of it. Locals worked with FEMA to provide thousands of meals to those whose homes were devastated.

While Dr. McGrath emphasizes how familial Puerto Rican families, friends, and strangers have been in assisting each other, outside assistance is always needed after a natural disaster.

“It will take years for the island to recover, but this is an opportunity to improve for the better, using new technology and rapid response systems,” Dr. McGrath says.

Friends of Dr. McGrath’s who were asking where to contribute were directed to Unidos por Puerto Rico (United for Puerto Rico), a fund set up by Beatriz Rosselló, the wife of Gov. Ricardo Rosselló.

“The increased vulnerability in a community requires a strong response to shore up secondary and tertiary response mechanisms,” Dr. McGrath explains. “In the immediate aftermath of Hurricanes Maria and Irma, people who had disaster preparedness and relief training were able to join with emergency services to begin addressing immediate needs. It is very challenging to train volunteers after a disaster has occurred, so the greatest impact in terms of support is provided by those with expertise in public health systems management and disaster recovery.”

Why Public Health programs are so important after natural disasters

“Public Health systems are often very context dependent and must also match the culture of the community in order to be effective,” Dr. McGrath says. “Therefore, some of the most sustainable interventions are those that are implemented by local community members who understand the needs and strengths of the community, and how to leverage them.”

Students who study Public Health management benefit from opportunities to learn about global systems to advance their knowledge and skills. For example in TCSPP’s Master of Public Health program, students are required to complete a variety of applied projects during their degree program, including practice in the field and applied research projects based on a specific community need.

“Given the large impact of the recent hurricanes across a broad area of the Caribbean and the U.S., our students would benefit from hands-on experience where they can support those who are most impacted, understanding the essential benefits of public health systems, and learning by doing,” Dr. McGrath says. “One of the most positive impacts for Public Health students is the opportunity to help rebuild communities.”

While programs such as the Red Cross train all year round, and organizations such as Unidos Por Puerto Rico are helpful for funding, natural disasters have no monetary limit nor expiration date. Students who enter Public Health programs will have experience that will serve themselves and their communities indefinitely.

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