I am a Puerto Rican surgeon living in Massachusetts and a member of several groups of Puerto Rican physicians in the United States. I am writing this letter on behalf of physicians and the public health community to raise concerns and questions about the resources and planning for rescue and relief by the government of Puerto Rico and FEMA in the aftermath of Hurricane Maria. While the damages sustained by Puerto Rico and the underlying vulnerabilities of the population and infrastructure are admittedly unprecedented, the lack of an adequately robust and organized response from the combination of the government of Puerto Rico and the federal government/FEMA is not adequate to prevent unnecessary mortality and morbidity. In the wake of several devastating US hurricanes in the last 10 years, including hurricanes Katrina, we have gained experience in what happens when the federal government response is inadequate in vulnerable, remote low-income and people of color communities. We are desperately hoping to avoid neglect of the predictable core needs of the Puerto Rican people. The following are some of our concerns: 1) Lack of comprehensive and distributed needs assessment and response. Puerto Rico has 78 municipalities. The disaster has greatly affected all of them, some much more than others. Some areas have suffered destruction of bridges and obstruction of main roadways, core government buildings and hospitals, and some are completely uninhabitable due to flooding. Many are likely to face critical shortages of food, water, shelter and medical care. As of Sunday, September 24, the governor freely admitted in a press conference that he is not in contact with 6 of the municipalities. Further, some of these municipalities are unable to access or communicate with whole communities within their municipalities. In the absence of clean water, food, shelter and medical assistance, this could immediately cause deaths. On an island that is 100 x 35 miles (the size of the state of CT), there should be no areas that are completely lost to contact on day 5. As the richest country in the world, the US has the transportation capacity via helicopters, vehicles, and ships, to reach all of these areas. If the government of Puerto Rico lacks the resources to adequately respond to all areas of the island, FEMA and/or the federal government should contribute the necessary resources to perform these core functions. 2) Lack of support for healthcare facilities. Via social media on a 1500+ Puerto Rican physician group, we have received several distress calls. We have heard from physicians that even in Centro Médico, a tertiary center and one of the largest and most critical hospitals on the island, the hospital generators were running out of diesel, the electricity went out, the hospital was running low on water, the staff and family members of patients were going without food despite days in the hospital. We are hearing of hospitals operating beyond staffing and physical capacity with no concrete plans communicated to set up staff relief, new temporary hospitals, and with no organized plans to send patients to the United States for care if Puerto Rico cannot address the demand for care. In this situation, physicians from all corners of the US are attempting to respond by arranging for transfer and care for individual patients. Many are trying to arrange individual travel or volunteer delegations to Puerto Rico. This is a credit to all the individual healthcare personnel that are responding, but it is shameful that we lack a coordinated response. This is a core function of public health response and the government authorities of the United States and Puerto Rico to provide adequate medical staffing to Puerto Rico in the wake of this disaster. 3) Lack of planning or communication of a plan for the healthcare needs of the island’s people in the aftermath of the storm. How will people in remote areas access medical care after this disaster? What alternatives to 911 can be established in a situation with no telecommunications? In our social media groups, we watched as hours passed as several elders were reported in remote areas to have severe medical problems including being unconscious, chest pain, etc, requiring medical attention and without access to medical transportation or in-home care. If a message can reach social media, surely there should be capacity in each municipality to address these emergencies. 4) Signs of medical distress in easily identified priority areas: shelters, nursing homes Why are we receiving distress calls from established shelters where there is no medical care? All shelters should have at least daily access to nearby medical professionals who can get patients appropriately triaged to care. If the capacity does not exist locally due to disaster conditions, the resources exist in the mainland US to deploy the necessary medical personnel in person or by telemedicine assisted by local volunteers. Elders and disabled people in nursing homes represent a high risk and vulnerable patient population. 5) Demand for Primary Care Many primary care locations were destroyed and personnel cannot reach people in distant towns who need medical care. Many people lost their critical medications. What is the plan to address these issues? Failure to address these issues now will mean emergencies and deaths in days to weeks. 6) Meeting Demand for Medical Personnel Will the government of Puerto Rico accept reciprocity of licenses from other jurisdictions in the United States? So far only DHHS and emergency management personnel have this clearance. Volunteers, telemedicine, and distributed response can all help address capacity issues. People should not die in Puerto Rico for lack of medical care when the capacity to meet their needs exists in the US. Further, Cuba has offered to send volunteers. If the US is unwilling to address the medical personnel needs of Puerto Rico, help should be a...

The American Citizens of Puerto Rico, some of whom are family members of mine, are in dire need of food, medical and sanitary supplies now!! The Merchant Marine Act of 1920, aka the Jones Act, no longer serves its original purpose. If the United States has ANY interest in the hurricane-battered people of Puerto Rico, it needs to remove this law off their necks....NOW !

Immigration experts believe that the decision to require all DACA recipients whose permission expires in the next six months to have their renewal submitted by October 5 is a deadline that is arbitrary, unworkable, and cruel. It will result in tens of thousands of current DACA holders losing their protection from deportation and ability to work legally and contribute to our nation. We must ask Sec. Duke, Acting DHS Secretary, to meet with immigration advocates to discuss several policy recommendations, extend the deadline, and restore some measure of sanity to this process. 154,000 DACA beneficiaries have expiration dates between September 5, 2017, and March 5th, 2018. The actual effect of this Oct. 5 deadline is that there must be 5,133 applications filed every single day, including weekends, if the 154,000 current DACA holders whose permissions expire over the next six months are to be able to apply to renew their DACA. This would mean 214 applications must be filed every single hour, all night long, for 30 days. This is a mess. Furthermore, many DACA recipients will not have saved for the unexpected $495 expense. The result of this artificial Oct. 5th deadline is that tens of thousands of DACA recipients could lose their status, their jobs, their homes, and their security and be pushed back into the shadows. We urge DHS Secretary to take swift and immediate action to extend the DACA renewal deadline to January and meet with immigration legal experts immediately to hear other ways to rectify the current chaos created by Trump's decision.

We Must Stop Letting Mr. Trump use his Presidency for Foul and Racist things. We Want The Media to Stop giving him a Pass and to Call him Out Now! Nancy Pelosi, and The President of The NAACP Demand an Apology Now!

Congress will only create bipartisan workable healthcare if they have to have the same as the rest of us.

As a naturalized citizen, I'm horrified that the Department of Homeland Security could even muster the thought of proposing such a far-reaching piece of crap (legislation, sorry). To include millions under DHS watch is simply unthinkable and negates the personal liberties Americans value and hold dear. This simply can. not. stand.

A new White Mountain National Park would: 1) Protect our celebrated White Mountains from the degradation of Northern Pass. 2) Strengthen, diversify, stabilize, and boost the local economies. Reports confirm that economies around national parks are stronger than those that rely on boom and bust resource extraction. 3) Provides the flexibility to accommodate the current usages (e.g. all the current recreational activities) of the White Mountain National Forest through appropriate zoning. In other words, nothing is lost, and everything is gained. 4) Preserve vast standing forests which would absorb and store large amounts of carbon to help fight what is becoming undeniable climate change. 5) Provide habitat for wildlife that require large undisturbed expanses of forest and waters, which are increasingly rare in New England. 6) Recognize, at long last, the historic role that the Weeks Act and White Mountain National Forest has played in laying the groundwork for our National Park System. This groundwork has inspired the creation of national parks in over 100 nations beyond our shores. See more here: http://www.concordium.us/stewardship/

I'm angry and feeling complicit myself as we all see the choices Facebook has made, yet continue using and supporting them day after day. I think at the very least we should consider a three-day moratorium.

Through the 19th, 20th centuries, and now into the 21st century, America has pioneered Humanity's scientific and technological advancements. Our innovative spirit and grit has always made us a forward moving country. But after 15 years of funding stagnation and a proposed federal budget with devastating cuts to research, the United States risks ceding its scientific leadership and delaying medical cures and technological advancements. Sign our petition to make Congress see that Science Makes America Great!

I have never done an online petition. But flood conditions in Puerto Rico and US Virgin Islands are becoming an humanitarian crisis. Did you know that the 3.8 million people of Puerto Rico and US Virgin Islands are American Citizens too? As we support flood survivors in Texas and Florida, human decency requires that we also support US Citizens in the Caribbean too. These territories have given so much to develop our country. They and all people deserve a chance to live. The richest country in the world can do much more to help. Please sign this petition to insist that our country provides help to all American flood victims--not just those living on the mainland.

With hurricane Maria's devastation of Puerto Rico, the Jones Act does hurt recovery and the rebuild effort. Written 100 years ago, it does not apply to todays circumstances. The infrastructure of the Electric grid and the Puerto Rican debt is caused by this act. Its time to behave like its 2017 and not 1917. Make the change now and do what is right by the elimination of the Jones Act and our U.S. Territory for our Puerto Rican Families.

Our special needs children cannot speak, cannot defend themselves. They need someone to advocate while in class away from parents! We need to help our children communicate what is going on with them. Have you ever sent your child helpless and defenseless to school, not know what is going on or what is happening? Then when you get a phone call and don't know what is going on, you only hear the teacher's side. What about our children? What about their side? Help me get cameras in our special needs classrooms.