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Can Puerto Rico Recover From Maria Before the Next Storm Hits?

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"Children, hungry and sick, clinging to their crying mothers, who were begging for food to feed their families. Frail elders exposed to excessive heat and rain, desperate for drinking water and forced to make terrible choices to either suffer from severe dehydration or drink from contaminated rivers and streams that could also lead to death," Cathy Kennedy, registered nurse and Vice-President of National Nurses United, recounting what she and others saw on the island of Puerto Rico.

Vann R. Newkirk II has an interesting overview in The Atlantic on how the health care system in Puerto Rico, and the USVI, has fared since Hurricanes Maria and Irma barreled over the islands during last years hurricane season. Newkirk notes that the health care system has improved somewhat since Maria. Health care providers certainly learned a lot on what needs to be in place before another hit comes, such as staging medicines throughout the island, but it is the unreliable power supply that continues to haunt all aspects of recovery including the medical sector.

In June, hurricane season begins anew. Hopefully, the Caribbean will catch a break this year and they will not be struck by such powerful storms, because the power grid is extremely fragile and as we have seen from recent blackouts is that even a low end tropical storm could wreak havoc island wide once again.  

Puerto Rico was in the grip of a public-health crisis well before Maria barreled ashore in September. Zika had become endemic in the humid, tropical climate over a year before, and like many of the illnesses emerging on the island, it took advantage of a health-care system that lay in shambles. The major—and ongoing—financial and energy crunch that forced Congress to pass a bailout bill in early 2016 also hamstrung many health-care facilities. During his visit to Puerto Rico in May of that year, then-Treasury Secretary Jack Lew toured a major hospital with leaking ceilings, faltering electricity, supply delays in life-saving medications, and a backlog of dialysis patients. It was emblematic of a health-care system hobbled by crumbling infrastructure and evaporating municipal funds.

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In all, what Hurricane Maria encountered was a system perched only a small disaster away from complete chaos. But the hurricane was a very large disaster. The lackluster and slow federal response, the lack of coordination between different levels of government, the Puerto Rican Power Authority’s complete failure, and the ongoing Congress-imposed austerity plan all contributed to a months-long power outage and a drawn-out, patchwork recovery—one punctuated by a total blackout last week. Even in the best of circumstances, Maria would have created a public-health catastrophe, but what ensued was worse than it needed to be.

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A comprehensive analysis released yesterday by the Kaiser Family Foundation finds evidence of significant progress since last winter, but also some lingering problems settling in. A series of interviews with residents and other stakeholders found a heavy reliance on temporary shelters and tarps among many Puerto Ricans, continuing financial instability, and disruption of daily health care. The sole constant for many people is that there are no constants; no real ability to set health-care routines and engage in healthy behaviors.

The most recent blackout again disrupted lives, while exposing thousands to hazardous pollutants. “I was in Ponce and the sewage water was flooding the area,” recalled Ruth Santiago, an environmental lawyer at the Inter American University Law School in San Juan. “Schools are out. Courts are closed. The big mall is closed … The water pumps stop working because there’s no electricity, so raw sewage [was] backing up.”

Inside Climate News reported on the climate change enhanced fury of Irma and Maria and how nurses described the health impacts of the storms weapons of heavy rainfall and storm surge that creates new challenges going forward. 

The studies, published in the Journal of Nursing Scholarship by The Honor Society of Nursing, Sigma Theta Tau International, addressed a multitude of challenges that health providers face worldwide.

One study focused on the health impacts of climate change–related water disasters: cyclones, hurricanes, and flooding events that have increased in frequency and severity due to rising global temperatures. The study, a comprehensive review of prior research, looked at a wide array of health effects, including mental health, and compared the psychological impacts in flooded and non-flooded homes following disasters. The people whose homes were flooded reported higher psychological distress and post-traumatic stress disorder symptoms up to six months after the incident and were eight times more likely to exhibit symptoms of depression than those whose homes didn't flood.

"Climate change–related water disasters endanger our health by effectively destroying or contaminating our food and water sources, the weather we experience, and our interactions with the built and natural environments," the authors wrote. "The increasing frequency and intensity of climate change–related water disasters pose new challenges to the control of environmental toxic exposures and emerging infectious diseases, and gradually increase the pressure on the natural, economic, social and health systems that sustain health."


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