Mainland providers lead relief efforts as Puerto Rico fights public health crisis
It was around 11 p.m. on Sept. 27 when the plane carrying Dr. Julian Trivino, an emergency medicine physician at Florida Hospital Orlando, arrived in Puerto Rico.
One of the first things Trivino noticed as the plane made its approach was the vast darkness that enveloped the island, with the exception of a long line of lights about 2 to 3 miles long.
“The line of lights was actually cars waiting at gas stations to fill up,” Trivino said.
Trivino was one of five emergency physicians who recently returned to Florida after spending two weeks providing medical relief on the island. About 30 of Florida Hospital Orlando’s clinicians have either visited or are currently in Puerto Rico or the Virgin Islands as part of a humanitarian relief effort that began after two hurricanes severely damaged much of the region’s healthcare infrastructure in late September.
Immediate attention remains focused on providing emergency medical care to residents and getting Puerto Rico’s 69 hospitals fully operational. Just 25 were connected to the electrical power grid as of Oct. 10, according to updates provided on the website of the Puerto Rico governor’s office.
Approximately 40% of residents still have no access to potable water, according to the Federal Emergency Management Agency, with the death toll reportedly at 43 as of Oct. 10.
House lawmakers last week passed a proposal to provide $36.5 billion in emergency funding for hurricane and wildfire relief as requested by the Trump administration, which includes a $4.9 billion loan to Puerto Rico.
The measure includes $18.7 billion to go toward FEMA’s disaster relief fund and another $16 billion to fund the nation’s flood insurance program.
Overall, the federal government’s response
For more on policies that could help Puerto Rico, see the editorial on p. 26
to the disaster in Puerto Rico has been roundly criticized for being too slow compared to its efforts in Texas after Hurricane Harvey or Florida after Hurricane Irma. And late last week, President Donald Trump continued his Twitter war with island officials: “Electric and all infrastructure was disaster before hurricanes. Congress to decide how much to spend...” Followed by, “We cannot keep FEMA, the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!”
Sidestepping the political show, the urgent need for relief has prompted mainland healthcare providers to take a lead role in providing support.
Kaiser Permanente last month announced it was contributing $1 million to the Centers for Disease Control and Prevention Foundation to assist in its public health efforts on the island.
Along with Florida Hospital, providers based in New York have been among the leaders in the relief effort. With more than 700,000 residents of Puerto Rican descent, New York City has the largest Puerto Rican population in the mainland U.S.
“The bond between New York and Puerto Rico has been long and strong,” said Kenneth Raske, president of the Greater New York Hospital Association. The group has raised $5 million in donations toward funding its relief efforts.
In addition, the GNYHA led a series of medical supply missions over the past two weeks resulting in the direct delivery of thousands of medical and non-medical supplies to several hospitals on the island.
The organization, with the help of the humanitarian aid group Afya Foundation, delivered more than 29,000 pounds of supplies over the course of 10 missions with the use of personal aircraft loaned to them by wealthy private citizens.
The experience of performing disaster relief during Superstorm Sandy in 2012 helped to make the organization more nimble in its response to aiding Puerto Rico, said Lee Perlman, president of GNYHA Ventures, the association’s business arm. Perlman said assembling each shipment and delivering it to the island takes 24 to 48 hours.
“Our model was to deal directly with providers in Puerto Rico and try and take care of what they need,” he said, adding that three more shipments were scheduled to be delivered this week, with an emphasis on supplying providers with more medications, such as insulin for diabetics.
But the continued lack of electrical power has been one of the greatest challenges for both island providers and for those visiting to help with the relief effort. A number of hospitals and clinics have been left to rely on a single generator that can only power parts of their facilities. Trivino said those facilities are likely to see a spike in deaths once their generators begin to give out.
Trivino recalled when the doctors first arrived in Puerto Rico, they had received word that a hospital in the northwestern town of Aguadilla, about 70 miles from the island’s capital of San Juan, was close to shutting its doors due to a lack of electricity, diesel fuel and drinking water.
Trivino and his fellow physicians drove two hours to the hospital to try help keep the facility running.
With the use of satellite phones, they were able to communicate with federal emergency relief officials and got supplies to the hospital within 24 hours.
“If you don’t have a generator, you have no hospital,” Trivino said. His team’s work in providing medical care as well as delivering supplies they brought from Florida Hospital was hampered due to a number of logistical concerns.
Despite such relief efforts, questions linger as to the fate of the island’s hospitals after the current situation subsides.
“The real question is what is going to be the long-term relationship between the hospitals in New York and the hospitals in Puerto Rico,” Perlman said.
For its part, GNYHA is currently developing an “adopt a hospital” program in coordination with the American Hospital Association and the Healthcare Association of New York State to form partnerships that would allow mainland providers to assist with island hospitals’ long-term needs.
Though plans are still in development, Perlman said he envisioned an initiative that would have stateside healthcare organizations making regular visits to Puerto Rico to help provide logistical, engineering and clinical expertise for the purpose of creating a new care model as the island rebuilds.
“It’s really matching facilities around the states and New York that have specific (capabilities) in areas and trying to match them to see how we can be helpful,” Perlman said.