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Volume 51 Number 2
Written by David W. Lounsbury, Albert Einstein College of Medicine, Bronx, New York
To be frank, things were not going so well for my in-laws in Puerto Rico even before Hurricane Maria struck. The elderly parents of my husband, Rafael, had been housebound for more than a year prior, requiring 24-hour homecare. The family house in San Juan, a Caribbean-style three-bedroom cement structure – built in the Fifties to withstand up to 140 MPH winds when the Americanization of the island’s economy was still powering up – was now in need of serious refurbishments to roof, baths and kitchen. Then came 2017 Atlantic hurricane season. On September 7th Hurricane Irma, a Category 5 storm with intense tropical rains and winds topping 180 mph, clipped Puerto Rico and damaged an already extremely fragile power grid. Just two weeks later Maria hit, the first Category 4 storm to make landfall on Puerto Rico since 1932. Tracking southwest of the San Juan, from Arecibo to Humacao, Maria wiped out homes, roads, and bridges across the island. Nearly the entire population was without electricity and running water with thousands rendered homeless. A humanitarian crisis unfolded.
From New York City, where Rafael and I live, we did what we could. We communicated intermittently with his sisters and the caregivers via cell phone, service for which was extremely limited at this point. Thankfully, the family house survived, but power and water were out. Rafael shipped special care packages for food, toiletries, and flashlights to his home. We transferred cash, too, to cushion the impact of delayed pension and SSI checks, though there were complications and bank fees that added to our general sense of helplessness. Flying to the island in the weeks following the storm was not a viable option. Flights into and out of San Juan were dramatically cut back, booking fees were nearly double typical fares during this period, and being on-site would ostensibly add to the burden of the fledgling relief effort.
Delivery of routine care and daily meals for Rafael’s parents rapidly become very difficult to provide, given no light and no running water, unrelenting tropical humidity, and mischievous biting mosquitos. On November 2, Rafael learned that his father, 91, was suffering a fever. Rafael immediately booked a flight home. By the time he arrived, his father had been admitted to the palliative care service at the VA Caribbean Healthcare System, an impressive, modern hospital that was well-functioning despite Maria’s impact. The same week, Rafael and his sisters arranged to move their mother to a nursing home, which had generators running full time for power. She did not want to leave her home but agreed to do so at least until power was restored in their neighborhood. She has been there ever since.
On November 7 at 11:42pm, Rafael’s father passed away. The cause of death was sepsis. His body was taken to the Medical Examiner’s Office in San Juan, where there was literally a backlog of hundreds of deceased persons to be processed and released to grieving families. I delayed flying to Puerto Rico until plans for the funeral were set. Finally, it was scheduled for Sunday, November 26, three weeks after his death. It was to be held at his father’s beloved church, the day before we would have celebrated his 92nd birthday. I arrived in San Juan the day before, only to learn that the body still had still not been released to Rafael and his sisters. So, we had the funeral without his father’s remains. The ceremony was simple, pleasant and well attended, despite challenges in getting the word out to friends and family.
We know now that the official death toll attributed to Maria stands at 64, though other reports estimate that as many as 1,052 persons perished due to the impact of the storm. Rafael, who helped his sisters apply for support from Federal Emergency Management Administration (FEMA), reported his father’s death as a Maria-related event. Indeed, we feel that his father’s passing was likely hastened by the physical and mental stressors he was subjected to in the days and weeks following the hurricane.
What I have shared is just a glimpse of what one family, my family, has experienced since Maria struck. In the wake of this destructive storm, my personal connection to Puerto Rico inspired the possibility of doing more to help. In early October, on behalf of the Community Health Interest Group (CHIG) leadership, I initiated a dialogue with colleagues in community psychology, public health, medicine, anthropology, natural resource management and systems science who have interest in to exploring ways of supporting community-based approaches to recovering from events like Hurricane Maria. In San Juan, we reached out to colleague, Dr. Blanca Ortiz Torrez, Professor of Psychology at the University of Puerto (UPR), who openly invited additional support and collaboration from CHIG and SCRA.
During the week after Rafael’s father’s memorial, Rafael and I met in person with Blanca at her UPR office. Power was still out on campus although the university had, surprisingly reopened to students by this date. Blanca informed me that she had, in fact, already mobilized her students to start to address the needs of multiple communities in the San Juan area. At this juncture, Blanca and her UPR psychology students had already worked with community leaders to complete an initial, jointly conducted community needs assessment and designed a 5-point action plan for one particularly hard-hit community in the San Juan area. To support these impressive efforts, I agreed to work with CHIG to champion a request for SCRA funding to help seed the implementation of the action plan.
In February 2018, we happily learned that SCRA had approved spending up to $1,000 to support a post-Maria community action recovery partnership with the Blanca and her students in the Department of Psychology at UPR. CHIG leadership is committed to collaborating with UPR’s psychology students to support their community recovery work, acknowledging the hardships they face. Despite severe damage to many of its structures and lack of power and running water in many facilities, UPR reopened all 11 of its campuses in December. One report by the interim president of UPR put damages at $118 million. Reopening campus was a means to help restore some sense of community and normalcy among students who are eager to make progress toward the completion of their degrees.
Currently, students face daily hassles getting to and from campus, where traffic light malfunctions create added travel time and where public bus service has been limited. Many students have left Puerto Rico, sometimes to transfer to mainland universities, as many stateside institutions have started to offer tuition waivers or in-state tuition rates to students from Puerto Rico. These institutional policies are well-intentioned but may ultimately be accelerating a ‘brain drain’ that will further undermine recovery on the island.
These SCRA funds and the partnership with CHIG will help recognize the important efforts of students in Puerto Rico and reinforce the message that Puerto Rico can and will recover. Exactly how to expend these funds has been yet been finalized, although there is agreement that funds should be used to cover costs incurred in organizing and conducting community meetings as well as tangible expenses of being a research team member, such as accessing Wi-Fi, setting up charging stations, and local transportation. We will be seeking recommendations of the Department of Psychology, UPR student groups and participating community stakeholders, and we will be looking for ways to collaborate with faculty and students on different campuses across the UPR system. Most importantly, CHIG hopes to create a platform for on-going communication with faculty like Blanca and her students, to learn about their academic needs, and to leverage these funds to find ways to create sustainable community research partnerships with UPR and communities in Puerto Rico.