The challenges and our response
Like the rest of the United States, Puerto Rico is facing a significant strain on its healthcare system posed by the novel coronavirus and the disease it causes, and COVID-19. Because International Medical Corps already has a team on the ground helping communities affected by natural disasters that recently have struck the island, we have been able to quickly provide emergency medical field units, personal protective equipment and other supplies, and clinical staff to hospitals dealing with surges in demand caused by the pandemic.
Following a 6.4-magnitude earthquake that hit the southern edge of the island on January 7, 2020, and a series of strong aftershocks that lasted for weeks, International Medical Corps worked closely with national and municipal authorities to provide mental health support, nutrition services and medical supplies to the thousands of people who were affected.
Our experience providing aid to Puerto Rico began in September 2017, when the Category 5 Hurricanes Irma and Maria delivered a one-two punch to the island, making landfall within weeks of each other and leaving millions without power and in need of a range of healthcare services.
Both storms were catastrophic—levelling homes, destroying health facilities and damaging critical infrastructure. It took nearly a year to restore electric power to all the homes and businesses following the storms, which took out 80% of all power lines and flooded most of the island’s generators.
International Medical Corps arrived in Puerto Rico within days of Hurricane Maria and today continues its work, in collaboration local partners, including La Asociación de Salud Primaria de Puerto Rico (ASPPR), a network of 76 health clinics focused on providing care to low-income families across the island. We are currently working on a long-term project to strengthen the island’s emergency response system. We also help Puerto Ricans access healthcare through mobile medical units, which provide home visits for patients in hard-hit communities who are unable to travel to health facilities for treatment.
Primary Healthcare: Primary healthcare became harder to access in the aftermath of the hurricanes, as demand for urgent care spiked, crowding out time for treatment of more routine chronic conditions. International Medical Corps addressed this gap by partnering with five federally qualified health centres in Puerto Rico to increase community outreach in remote areas. In total, we deployed 20 volunteer doctors and nurses in six teams to support mobile medical centres across the island, providing consultations for nearly 1,000 patients in 46 municipalities, known as barrios. This support also helped give local health workers—many of whom had been responding nonstop since the storms hit—a break.
Disaster Recovery: Puerto Rico’s power supply was fully restored only recently, nearly a year after Hurricane Maria hit—and it remains fragile. Many health clinics have resorted to limiting their hours of operation or providing care in smaller spaces that can be powered by a portable generator. International Medical Corps has provided generators to seven clinics and San Juan-area hospitals that would otherwise have had severely limited operating capacity, or would have closed down completely. The generators provided an additional 1,800 clinic hours of service.
Maintaining adequate refrigeration for life-saving medications, especially those for chronic care and critical vaccines, has been an ongoing challenge. Our team continues to support the supply of medications across the island, especially those that require cold storage and transport.
Water, Sanitation and Hygiene (WASH): Without electricity, Puerto Rico’s residents were unable to pump water into their homes for cooking, bathing or toilet-flushing. Though water services have largely been restored, significant health concerns remain, due to a lack of reliable drinking water in several municipalities. International Medical Corps has provided 500-gallon capacity water bladders to six health facilities to help increase access to potable water. We have also distributed nearly 15,000 hygiene kits, as well as wound care kits, solar lights and other supplies, to help families stay healthy in the aftermath of the hurricane.
Nutrition: The damage to Puerto Rico’s power and water infrastructure hit nursing women with infants and young children particularly hard. To address these concerns, International Medical Corps worked with the Department of Health to launch a program promoting healthy infant and young-child feeding (IYCF) practices. Through our two local partners, La Liga de La Leche and Alimentacion Segura Infantil, we have provided individual breastfeeding counselling and facilitated mother support-group sessions. To increase community support and adoption of IYCF practices, International Medical Corps is raising awareness in the community through workshops, radio spots and social media content that focus on the life-saving effects of breastfeeding.
Long-Term Capacity Building: International Medical Corps continues to support the health and medical needs of Puerto Ricans still struggling to recover from the hurricanes, working to ensure a stronger, safer island. Together with the Primary Care Association of Puerto Rico (ASPPR), we have embarked on a $1.3 million, 13-month program to integrate community health centres into the island’s emergency response system, as a critical step to reduce the deaths and injuries that could occur in future disasters. We are assisting ASPPR with funding to hire full-time emergency managers who can create an emergency preparedness program that will benefit all member health centres and deliver mental health training to healthcare workers.
Mental Health and Psychosocial Support (MHPSS): Following Puerto Rico’s hurricanes, International Medical Corps completed an MHPSS needs assessment to identify existing services and evaluate the extent of mental health needs. International Medical Corps found that local staff in Puerto Rico had limited training on how to provide MHPSS to distressed populations in post-disaster contexts.
Subsequently, the Federal Emergency Management Agency (FEMA), the Puerto Rico Department of Health and government stakeholders in San Juan municipality requested that International Medical Corps lead psychosocial support training. These training sessions teach mental health professionals and non-professionals how to provide compassionate emotional and practical support for people who have been exposed to a distressing event. To date, International Medical Corps has trained hundreds of people throughout Puerto Rico, including health staff and community members, about how to provide psychological first aid (PFA).
Using a community-based approach, International Medical Corps also conducts awareness sessions focused on psychoeducation for emotional regulation, suicide prevention and crisis-coping skills, and supports referrals when higher levels of care are needed. To date, International Medical Corps has reached 121 individuals, including older adults, community leaders and youth through this program.
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