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Puerto Rico

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.

Colombia is second only to Brazil in the overall number of COVID-19 cases in Latin America. The movement of Venezuelan migrants in and out of the country has directly influenced levels of COVID-19. There likely is underreporting of COVID-19 levels in rural, hard-to-reach areas and along the border, given that more than 2 million migrants cross into Colombia cyclically, seeking food, clothing, medicines, healthcare and education. 

The Colombian government said that 782,301 doses of vaccines have been applied nationwide in the first stage of the country’s National Vaccination Plan, and that it plans to vaccinate more than 35 million Colombians against COVID-19 in 2021.

Though Bogotá and Cúcuta have sufficient health services available to respond to COVID-19, the eastern areas of the country that border or are near the border with Venezuela—such as the departments of Guajira, Santander, Aracua and Vichada—have limited capabilities to support the large number of migrants and internally displaced persons. 

For the local governments in charge of vaccination, logistics and the lack of skilled caregivers in the vaccination process is a challenge. The constant movement of migrants also is a challenge, as it hinders tracing and application of second doses. 

Migrants are at increased risk of contracting COVID-19 because they are exposed to high population densities and poor sanitation, and often cannot effectively follow social distancing guidelines due to improper or limited housing. Additionally, preventative isolation measures impose disproportionate hardships on migrants. According to a rapid assessment conducted by the Interagency Group for Mixed Migration Flows, known as GIFMM, 84% of Venezuelan migrant households do not have enough food for three meals per day; paid work as the primary source of financial support plummeted from 91% to 20% of households during lockdown.

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

The January 2020 earthquakes in Puerto Rico devastated a significant geographic area, with 33 municipalities included in state and federal emergency declarations. With homes damaged and thousands displaced, evacuation shelters and informal camps were set up—but they lacked safe access to water, sanitation and proper hygiene. International Medical Corps reached 9,143 disaster-affected women, men and children with services and relief supplies, and served 610,306 persons in Puerto Rico through community awareness and outreach. As relief turned to recovery, our teams provided access to safe water via water survival boxes, and addressed problems at community wells to help people meet their own basic needs in future emergencies.

In the aftermath of Hurricane Maria, International Medical Corps began working with L Asociación de Salud Primaria de Puerto Rico (ASPPR)—a network of more than 70 federally qualified health clinics focused on providing care to low-income families across the island—to ensure that health facilities could keep their doors open to serve the vast influx of patients affected by the disaster. With electric power down across the island, our support included supplying generators and water bladders to six health facilities, enabling them to restore electricity and provide clean drinking water at the health centres. To reach remote communities, International Medical Corps deployed physicians and nurses alongside ASPPR staff, providing mobile clinical care in hard-to-reach areas and reaching about 1,000 people. International Medical Corps medical teams also worked to address underlying health needs exacerbated by the storm, including hygiene and nutritional care.

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 also have 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 natural disasters.

Nutrition

During Hurricane Maria, our teams partnered with two local organizations—La Liga de la Leche and Alimentación Segura Infantil—to implement nutrition activities, including counselling on breastfeeding and on infant and young-child feeding (IYCF) practices for new and expectant mothers. Together, we reached 771 women with counselling and education, while distributing more than 1,060 breastfeeding-support items. In response to the 2020 earthquakes, our teams mobilized these existing relationships to provide training on IYCF in emergencies, and supplies for new and expectant mothers, including food support, electric and manual breast pumps, and baby kits.

Both the earthquakes and COVID-19 disrupted proper nutrition channels, with households experiencing unemployment and food insecurity. Our nutrition teams provided training and capacity-building to parents, caregivers, and health and social workers with courses on “Healthy Shopping on a Budget” and “Management of Chronic Disease in Emergencies.” We addressed immediate and long-term recovery needs with food gift cards, so that parents could practice health shopping and cooking. We also provided solar upgrades to fix electricity-reliability problems at a nursing home that frequently experienced brownouts, despite being home to 18 vulnerable patients, several of whom relied on enteral feeding.

Mental Health and Pyschosocial Support (MHPSS)

Using a community-based approach, International Medical Corps 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. In the aftermath of the earthquakes, our mental health teams—assisted by 49 local volunteers—provided psychological first aid to about 1,000 individuals, including 134 children suffering with emotional distress.

When COVID-19 began spreading in March 2020, our mental health teams pivoted from in-person events to virtual training, and turned to traditional and social media to address suicide and mental health openly and directly. A series of media campaigns that included television, radio, newspaper and social media messaging combatted the myth that talking about suicide could provoke self-harm, and provided tools for stress management and emotional regulation for community members overcome with the loss and uncertainty caused by repeated disasters. In addition, we donated technology to enable four psychiatric facilities to transition their outpatient services to telehealth, and provided 34 mental health workers at these facilities with training on suicide prevention as well as a therapeutic art activity to relieve stress and facilitate emotional expression.

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