Health and Social Services in Puerto Rico Before and After Hurricane Maria: Predisaster Conditions, Hurricane Damage, and Themes for Recovery

Abstract

On September 19 and 20, 2017, Hurricane Maria severely damaged the island of Puerto Rico. Coming just two weeks after Hurricane Irma, the storm significantly damaged local infrastructure and interrupted the provision of services essential to the people of Puerto Rico. In the aftermath, the president signed a Major Disaster Declaration for Hurricane Maria on September 20, 2017 (DR-4339) under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act). 1 As attention turned from response to long-term recovery, Congress enacted a Supplemental Appropriation Bill authorizing funding for rebuilding efforts. The Act required the governor of Puerto Rico, in coordination with the Federal Emergency Management Agency (FEMA), the Department of Treasury, Department of Energy, and other federal agencies having responsibility under the National Disaster Recovery Framework, to submit within 180 days of enactment of the legislation a report to Congress that describes Puerto Rico's 12-and 24-month economic and disaster recovery plan.The plan was developed in coordination with the Federal Oversight and Management Board (FOMB) established under the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA), the federal interagency, and key partners from private and nongovernmental entities using an agile process to identify recovery solutions. Under contract with FEMA, the Homeland Security Operational Analysis Center (HSOAC) provided substantial support in developing the plan by soliciting and integrating inputs from a wide variety of stakeholders, contributing analysis where needed, and drafting the plan. The plan included an overview of damage and needs, courses of action (COAs) to meet those needs, costs of the courses of action, and potential funding mechanisms for those costs.The governor's team finalized the economic and disaster recovery plan for Puerto Rico, and the Governor submitted Puerto Rico's final plan to the U.S. Congress on August 8, 2018. The plan defined priorities, goals, and expected outcomes that address both immediate needs and provide a foundation for longer-term sustainability.The planning effort was organized into 12 sectors (reflecting the National Disaster Recovery Framework). The purpose of this report is to describe the development of plan elements for the health and social services sector via the Health and Social Services (HSS) Sector team, including analytical material that was not included in the recovery plan but informed the planning process. We also describe the methodology behind the damage and needs assessment and discuss themes for recovery. Long-form COAs that provide greater detail than found in the plan (e.g., cost estimations, implementation considerations) can be found at the end of this report. As described

Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma

“…To our knowledge, this study is the first quantitative assessment of the availability of mental health crisis services in Puerto Rico. Despite the impact of Hurricanes Maria and Irma and other recent major public health emergencies on Puerto Rico's health care system, 36–38 we did not find that the availability of crisis services at mental health facilities decreased meaningfully on the island between 2016 and 2020 in absolute terms or relative to the US states. However, when limiting our analyses to indigent care facilities, we found less mental health crisis service availability in Puerto Rico than the US states, and that the size of this difference increased after Hurricanes Maria and Irma.…”

“…25,29,30 Very little mental health services research has focused on Puerto Rico and the few studies focused on the topic were conducted more than 20 years ago. [31][32][33][34][35] Qualitative studies have documented health care system disruptions on the island following Hurricanes Maria and Irma, 36,37 but little of this work has focused on mental health services. 38 Quantitative studies have characterized trends in the offering of mental health services, [39][40][41][42][43][44] including crisis services, 39,45 in the United States, but these studies have excluded Puerto Rico and have not generated Puerto Rico-specific estimates.…”

Assessing the Emergency Response Role of Community-Based Organizations (CBOs) Serving People with Disabilities and Older Adults in Puerto Rico Post-Hurricane María and during the COVID-19 Pandemic

“…This was a life-threatening issue for individuals with complex medical needs such as those requiring ventilation machines, dialysis treatment, or refrigerated insulin. Furthermore, there continues to be a lack of appropriate medical services for people with serious physical and mental health conditions and disabilities, including services related to an emerging mental health crisis, which was underscored by a steady rise in suicide rates and suicide ideation following the hurricane [ 19 , 21 ].…”

Rebuilding Caribbean Environmental Health Post-Crisis Programs: Case Study for Virtual Mentorship

“…3 Puerto Rico faced several challenges prior to the 2017 hurricanes, emphasizing the need for EH preparedness and recovery plans. These challenges include environmental hazards, such as water and air quality, wastewater management, structural risks, vector-borne diseases, chronic illness, and healthcare access 4 The USVI is not unlike Puerto Rico in its challenges as an isolated island community. These risks impacted these Caribbean islands' capacity to respond to and recover from the 2017 hurricanes.…”

“…1 Climate change has a demonstrated impact on the frequency and intensity of hazardous events for coastal and island communities. Since 1979, the frequency of Category 3,4,and 5 tropical cyclones has increased by 5% per decade. 2 With hurricanes projected to increase in severity and frequency, a trained and prepared workforce will be essential for hurricane recovery efforts and ensuring preparedness for response to future emergencies.…”