HELP PUERTO RICO OBTAIN DISASTER RELIEF POST HURRICANE MARIA

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...