“An old man told me to give this place a chance. That they would help me. And because of that advice, I am now here in Fondita,” said Maysonet, who is now a volunteer and Board member at the community-based nonprofit organization.

For 38 years, La Fondita de Jesús has worked to meet urgent needs in Puerto Rico. The organization focuses on support and care for people experiencing homelessness, seniors, and other vulnerable groups.

Located in the San Juan area, their site serves as a hub addressing gaps in primary, preventive, and mental health care, including treatment for substance use disorders. Case managers and social workers connect people to services and resources.

The site also offers daily meals, shower facilities, clothing, job placement assistance, recreational activities, and transportation.

Homeless Outreach

Dr. Josué Segarra Lucena, who has been at LFDJ for almost two years, joined because he wanted to work with unsheltered patients.

“I wanted to be the person—alongside the team—to connect homeless individuals with healthcare services,” Segarra explained. Because so many of his patients feel neglected and abandoned, reaching out — and eliminating the barriers that keep people from accessing medical care — is vital.

“We like to receive them as they are, because [we know that] being homeless disrupts everything from physical to mental health,” he added.

Some patients have not received medical care in over 10 years, so LFDJ staff begin by providing a comprehensive evaluation. Hypertension, high blood pressure, and ulcers often need to be addressed immediately.

While they provide health care support no matter the circumstances, they face some limitations. For example, since Dr. Segarra is a general practitioner and La Fondita does not have contracts with insurance companies, he can’t be a primary physician for their participants.

“That doesn’t limit us in providing preventive healthcare, linking them with primary and even specialty physicians. We always try to ensure that the patient receives the attention they need,” Segara said.

Helping patients navigate Puerto Rico’s healthcare system is a high priority. An unsheltered or underserved patient who needs medical insurance may be asked for documentation they don’t have, which means that many LFDJ patients can’t access public support without the help of social workers and case managers.

Mobile Health Care

When Hurricane María struck Puerto Rico in 2017, many of the hardest-hit communities were in more rural areas, where help was harder to reach.

LFDJ staff, offering outreach to devastated patients in the storm’s aftermath, “were able to see up close — even though we were aware — that there was a population that needed more. Even though they had a home and a roof over their heads, they lacked everything from essential services to much-needed physical and mental health services,” recalled Josué Maysonet Colón, the organization’s executive director.

That on-the-ground view sparked a new focus on preventive care in vulnerable communities across the island, which LFDJ has continued and expanded over time. In 2022, Direct Relief donated a mobile medical unit for this work.

Every two weeks, LFDJ and Direct Relief embark on a mobile care circuit, visiting six communities at least twice to deliver health care services, hygiene kits, and solar-powered lights.

“This is one of the most important things Fondita provides to Puerto Ricans,” Maysonet said.
Dr. Segarra also provides care from the mobile unit, focusing on vulnerable communities and unsheltered individuals. Through mobile outreach, LFDJ has provided versions of their on-site care to 37 municipalities across the island, including Vieques and Culebra, both smaller islands off of Puerto Rico’s east coast where hurricane devastation has created long-term needs.

Direct Relief’s medical advisor in Puerto Rico, Dr. Pedro Juan Vázquez, travels with the mobile clinic. He goes from house to house, visiting patients who are immobile or confined to bed alongside LFDJ’s social workers, frequently working on the spot to connect patients to providers or alert a patient’s doctor to an acute issue.

While most patients in these communities have medical insurance, Dr. Segarra observes that this isn’t always enough. Particularly among older adults, he’s seen an increase in care lapses and patients who skip their medications.

For this reason, the mobile unit, which enables an on-the-ground presence, is key: “We provide them with orientation regarding the importance of visits to their primary doctor and the importance of treatment adherence. I am an advocate for orientation and prevention; it’s the key for a healthy population,” Dr. Segarra said.

The goal isn’t to impose on patients, but to invite them to the table. LFJD staff encourage patients to share their needs and perspectives, which in turn inform the organization’s approach to community health.

Changing Landscapes

Homelessness has a devastating impact on health, so addressing it is key to LFJD’s work. With federal funding from the Department of Housing and Urban Development (HUD), the organization has long provided housing support for unsheltered people and groups vulnerable to housing insecurity, including members of the LGBTQIA+ community and older adults.

When a new patient undergoes an assessment process, housing needs are part of the picture. If the person is considered eligible and housing is available, they are placed in a unit.

“I began receiving treatment and help and was placed in a housing unit. I am now stable, healthy, and I’m one of the volunteers that works here,” said Maysonet, who is also a member of the Board of Directors.

A 2024 report estimated that 2,096 people are homeless in Puerto Rico. While that number is slightly lower than 2022 estimates, the number of people living on the streets has increased, representing more than 55% of the unhoused population.

People cited unemployment, consequences from natural disasters, drug and alcohol use, and family problems as the main reasons for homelessness. Additionally, more than 10% of unsheltered individuals reported experiencing gender violence.

Last year, the organization implemented a new program called Las Familias de la Fondita, or Families of La Fondita, to expand assistance and cover basic needs of families with children 18 years or younger who are unsheltered or at risk of losing their homes.

In the first 30 days of the program, more than 60 cases were referred to them. Many families were escaping from gender violence. Parental fear of having their children removed by state agencies further exacerbated the problem, staff said.

Some families seeking housing support have been evicted by landlords. A number have reported that their rents were nearly doubled, or landlords decided to convert residential housing into short-term rentals.

Maysonet reports that needs have changed: Until recently, most patients who needed housing support were unsheltered adults. Now, they work with all ages and with people fighting to keep a roof over their heads.

The increased demand brings new dangers. Before the pandemic, it might take two weeks to place someone in housing. Now it can take as long as a year. “During that time, many things can happen. Someone whose mental and physical health was stable” may experience rapid deterioration, Maysonet said.

A changing landscape of health and housing demands that LFDJ adapt. But staff say they’re up to the challenge.

“All of these things we’ve been learning along the way…give us an outlook into emerging needs that these populations have. We continue creating programs that address those needs,” Dr. Segarra said.

Since 2021, Direct Relief has provided La Fondita de Jesús with more than $300,000 in medicines and supplies and provided $350,000 in grant funding to support community outreach efforts across the island.

The post A Puerto Rico Community Hub Meets Urgent Need for Health and Housing appeared first on Direct Relief.

Monthly free clinics, which Ponce Health Sciences University (PHSU) offers in communities across southern and central Puerto Rico, address several issues at once, from reducing pressure on emergency services to combating an island-wide shortage of medical providers. 

But the most important goal is to make sure people in hard-to-reach communities, where the nearest clinic is often impossibly far away, are getting the health care they need, for free, in a place where it can be easily accessed. 

“Puerto Rico does not have an effective public transportation system, and we have an elderly population lacking transportation,” said Dr. Malynie Blanco, a family medicine practitioner and director of the Family and Community Medicine program at (PHSU). “You can have 10 specialty medical offices, but if the patient is unable to go to the appointment, well then, you need to move to the community.” 

For medical students, the clinics are an opportunity to build hands-on expertise. Students are responsible for logistics and operational management. They also provide medical, dental, and mental health services, overseen by faculty supervisors. 

These roving community clinics have been providing free care since 2022, and they’ve reached more than 1,400 underserved patients thus far. 

Since 2017, when Hurricane Maria killed thousands and caused unfathomable damage across the island, Puerto Rico has experienced an ongoing loss of medical providers, adding pressure on an already hardworking medical system. 

For some students, the clinics offer a unique exposure to the health care challenges that face Puerto Ricans, and an opportunity to see firsthand the positive impact their work can have. 

“Everything that I learn in the classroom, I see it in the communities. The clinics have helped expose the problem to the students,” said Paola Rullán, a second-year medical student at PHSU. “I see that there are a lot of students who wish to stay in Puerto Rico and who want to work here.” 

Making the Rounds

The clinics go far beyond triage. Students and faculty supervisors from nursing, dentistry, family medicine, psychology, public health, and dermatology departments each contribute their expertise, providing patients with comprehensive care. 

Students interact one-on-one with patients, record demographic data, supervise the taking of vital signs and laboratory specimens, and discuss medications and approaches to treatments together. Others are charged with escorting patients through multiple consultations and documenting their medical histories. 

The collected information is presented to supervisors, who oversee treatment planning and follow-up strategies. 

Social workers also participate to ensure follow-up, helping patients secure health insurance, find food assistance programs, and obtain transportation, among other support measures. 

These clinics have been a safety net for patients who have fallen through the cracks or are in danger of doing so. Both Dr. Blanco and Rullán said that the most prevalent conditions observed during these clinics are high cholesterol, hypertension, and diabetes. Sometimes these conditions aren’t being managed well, and there’s a lot of misinformation on how to store and administer insulin. 

“We have seen many patients that get used to having the symptoms. They modify their lifestyle because of the symptoms they show, and that is something that they gradually get used to without knowing and is mostly because they don’t visit the doctor,” Dr. Blanco said. 

Dr. Joan Colón, an assistant professor at PHSU, supervises the psychology students at the clinics. She notes that depression and anxiety are common, exacerbated by stressors like lack of transportation and food insecurity. 

Clinical interventions are necessary, but they’re not enough: A major focus for Dr. Colón’s team is to provide education and coping strategies while also working with social workers to meet the socio-economic needs that worsen mental health issues. 

Stigma is a major obstacle to mental health care, as is the case around the world: Patients are sometimes unwilling to seek it out and hesitant to accept it if offered. At the free clinics, the mental health station is an integral part of the clinic layout. The goal is to treat it like any other component of health care. 

Community Solutions, Island-Wide Problems

There’s no question that Puerto Rico’s health system, like the rest of the United States more generally, is under pressure. 

Long wait times to see a specialist or mental health provider are a growing problem. The number of available specialists is expected to decrease, as an older generation retires and smaller numbers of students in training stay on the island. These problems have the potential to increase medical emergencies as health care issues go undiagnosed or unmanaged for long periods. 

“Many professionals are leaving. It’s not just the difficulty of finding appointments: The issue is that there are too few providers available, and those who are available are overwhelmed,” said Rullán. “On the one hand, we are contributing to training future health professionals and on the other, we are expanding access to much-needed health care services.” 

The student-run clinics are an important piece of the puzzle: They foster prevention by addressing symptoms at a primary care level and creating a path to continuous care for precisely the people who are least likely to have one. 

“A patient with high blood pressure might avoid a stroke and a trip to the ER if community clinic doctors can assess and begin treatment early, preventing complications,” Dr. Blanco explained. 

No one intervention can solve every problem, of course. But the PHSU clinic is unusual in the way it’s taken different priorities, from health care access to hands-on training, and found a way to make them work together in the communities where the need is greatest. 

Direct Relief has awarded $52,000 in grant funding to the Ponce Medical School Foundation to support the student-run free clinics. Additionally, the organization has donated $443,000 in medical products to support clinic operations. 
 

The post In Rural Puerto Rico, A Roving Free Clinic Provides Access and Training in One Place  appeared first on Direct Relief.

“The truth is that if you need to go to a doctor, it takes about a 45-minute drive. If it’s an emergency, the nearest hospital is about a 50-minute drive across winding roads. That has always been a great problem for us,” said Yesenia Medina, who was born and raised in Utuado.

Located in the central western region, Utuado – as its name derived from the Taíno word “Otoao” suggests, is perched “between the mountains.” For as long as Yesenia can remember, her remote community has existed isolated and removed from accessible healthcare services.

With this in mind, community residents joined efforts to help bridge healthcare access gaps and foster socio-economic development in the region. Established in 2013, the Corporación de Servicios de Salud Primaria y Desarrollo Socioeconómico El Otoao, or COSSAO, began from this grassroots effort.

The organization, which translates to Corporation of Primary Healthcare Services and Socio-economic Development El Otoao, serves residents from five communities in Utuado and two other communities in the municipalities of Jayuya and Ciales.

Neighbors mobilized to salvage and refurbish a nearby abandoned building, setting up a small medical office staffed by volunteers. Little did they know that a few years later, Hurricane María would serve as a catalyst that would forever change the region.

In the aftermath of the storm, as medical brigades and aid from international organizations deployed to remote areas such as Mameyes, community leader and COSSAO’s executive director Francisco “Tito” Valentín saw an opportunity to transform their small operation into a fully developed community clinic that would permanently broaden access to essential medical services.

For many, the idea seemed impossible. However, during her visits to the island after the hurricane, Dr. Antonia Coello witnessed the community’s commitment and understood Valentin’s vision, joining his mission.

As both the first woman and the first Hispanic person to serve as U.S. Surgeon General, Dr. Coello gathered support from the University of Puerto Rico’s School of Public Health and Direct Relief, among other organizations, to help shape what would become the Antonia Coello Community Clinic, which opened its doors in April of 2018.

In 2021, Direct Relief awarded COSSAO a $587,680 grant to expand the clinic and improve its facilities.

A Community Effort

During the past six years, COSSAO’s community-based workforce has been pivotal in serving over 18,000 patients, effectively breaching gaps in care. For Tito Valentín, it was important that this effort also served to promote the socio-economic development of community residents.

“Health is not only pills and vaccines. Community health is a holistic concept that ensures all our communities have the necessary resources and support system to feel that they are in a place where they can raise their family,” said Valentín.

COSSAO’s clinic has created close to 20 job opportunities in construction and healthcare roles. “All of these workers are young professionals, many of whom [if it wasn’t for the clinic] would have left because of the lack of opportunities here,” said Valentín.

Yesenia Medina, who was COSSAO’s first employee and currently works in human resources, has witnessed first-hand the immense impact the clinic has had on its people. She remembers when the clinic first opened, helping people who had never seen a dentist, women who had never received reproductive healthcare, and individuals who had never visited a doctor.

Medina recalls a family of eight members, some homebound and others living with disabilities, who were cared for by their 90-year-old mother. “They don’t go anywhere. We bring them dental and medical services and diapers, because we [at COSSAO] know they need all of this.”

This personalized treatment from the staff, especially from health promoters, has contributed immensely to the clinic’s success and has ultimately improved their patients’ quality of life. “Having the clinic here has changed the lives of a lot of people,” said Medina.

Currently, COSSAO has seven health promoters who are residents from each of its seven communities. Zulma Robles has been working as a health promoter in COSSAO for five years. She lives in the Frontón community in Ciales – one of the largest communities with a population of 1,500.

As part of her role, she regularly sets out to visit each of the 600 households that make up her community to educate patients about health-related topics and identify resources to address the social determinants of health. Having community members in such roles allows them to advocate for their fellow residents to find local solutions.

During one visit, health promoters identified a family with six children who lacked almost all the basic living essentials, including a refrigerator and stove. Most of the children and their parents needed glasses and medical evaluations. The team quickly coordinated medical visits with dentists, ophthalmologists, and pediatricians and reached out to partner organizations for donations of scholastic supplies and construction materials for repairs.

“There is a true commitment with our people, which is an incredibly isolated population. Our communities are extremely impoverished. We know what it is like to not have healthcare services. If it weren’t for the clinic, unfortunately, many of them would not have any medical attention or services,” said Robles.

“Lives are saved here,” said Robles. She shares that during the pandemic lockdown, her father suffered two small heart attacks requiring treatment in Centro Médico in San Juan. In order to be discharged, he needed access to oxygen therapy. COSSAO stepped in to provide an oxygen concentrator which has dramatically improved his quality of life.

A Model to be Replicated

As part of their efforts to address community needs, COSSAO has created a community census with a socio-economic and demographic profile of each household member. This information facilitated their response efforts during both the Covid-19 pandemic and Hurricane Fiona, making it easier to identify those most at risk. From this census, across all seven communities, health promoters have identified close to 30 homebound individuals and nearly 100 individuals living with disabilities.

Since its inception, COSSAO has received guidance from medical and public health academic institutions. With their support and expertise, the clinic has been able to leverage resources to address service gaps. Collaborative efforts with residents and trainees from NOVA Southeastern University and the University of Puerto Rico’s School of Medicine, among others, have provided physical and occupational therapy, dental care and specialty gynecology and pediatrics services.

“Everybody that arrives at COSSAO falls in love with the project,” said Robles.

Dr. Ralph Rivera Gutiérrez, a professor at the University of Puerto Rico Graduate School of Public Health, has been working with COSSAO since 2015. For him, COSSAO’s model, particularly the element of community health workers (health promoters), presents an important alternative that should be replicated to combat the ongoing health crisis, particularly in remote areas.

“This is a project that begins with and from the community. It is a valuable model. Seeing the dream of a community and seeing it achieved, it is spectacular,” he said.

The post In the Mountains of Utuado, Puerto Rico, a Community Clinic Becomes a Lifeline for Residents appeared first on Direct Relief.

Manuel Alberto, as his mom calls him, is entirely dependent on his parents. Unable to walk or speak, “we are his eyes, ears, and hands,” said Torres.

Although Manuel attended school until the age of 28 under the special education program, his parents felt the system did not provide the services he needed. Inclusion, they quickly realized, would never be possible.

To fill those gaps, Lina and her husband took matters into their own hands, seeking advice from the National Association for Child Development, or NACD, an organization that designs individual programs to support parents in helping their children achieve their innate potential.

For the last 17 years, Lina and her husband have been practicing the daily exercises and activities suggested by NACD. While he is still unable to walk, Lina celebrated that these activities have allowed them to ambulate him throughout the house with the help of assistive devices. “He is able to do two or three steps,” said Lina, and for them, that is an achievement on its own.

Doing these exercises requires great physical strength, and as the years go by, it becomes harder. Lina has recently faced numerous health problems, which have forced them to reduce the intensity and frequency of these activities.

She said prioritizing Manuel’s needs has factored into her and her husband putting off their medical appointments. “Our main concern [now] is taking care of ourselves so we can last longer for our son and provide him with quality of life, but we also need quality of life.”

Being a full-time caregiver can take a backbreaking toll on a person’s physical and emotional well-being. These families are often encumbered by onerous medical bills and lack of skilled care for their loved ones, given the often complicated medical issues that require a high level of expertise in handling specialized equipment such as tracheostomy tubes, ventilators, and gastric feeding pumps, among others.

According to the Puerto Rico Ombudsman for People with Disabilities, 22% of the population identifies as living with one or more disabilities. Children who have a disability in Puerto Rico are eligible to receive benefits under the Social Security Disability Insurance, which can help ease the economic burden for the family, even as they transition into adulthood. Additional economic assistance is available for children living in the continental U.S. under the Supplemental Security Income. However, those living in Puerto Rico are ineligible.

Providing Much-Needed Respite

Many studies have demonstrated that respite services can improve resilience among caretakers and their families. These services, however, are scarce in Puerto Rico. One of the few organizations addressing this dearth of resources is the nonprofit organization Apoyo a Padres de Niños con Impedimentos, or APNI, which translates to “Support for Parents of Children with Disabilities.” For 46 years, APNI has provided parents like Lina with information, training, orientation, and support services to uphold their children’s rights.

APNI has implemented a respite care program that trains and certifies assistants to provide a much-needed break for the families they serve. Celia Galán, APNI’s executive director, said that it has been challenging to obtain funding to maintain this type of project that is beneficial to these families. Direct Relief awarded APNI a $250,000 grant to expand respite services for families with children with disabilities.

Funding allows APNI to provide up to 30 hours per family for 12 months, and families can distribute them according to their needs. Respite care service assistants support families at home or at the Neonatal Intensive Care Unit.

APNI tries to find respite workers with similar experiences to better assist parents. Parents who have been through the difficult process of having their children in NICU are best able to guide and support other parents going through such stressful circumstances.

Impact Beyond Measure

Providing respite services, whether at home or in the hospital, can also be difficult as these parents ache to spend every waking moment next to their children. Through their program, APNI helps parents get to know these caregivers so that they feel comfortable taking some time for themselves. “It’s wonderful to see the beautiful comments parents leave in the evaluations after they decided to try the service, that they finally deposited their trust in someone and what it meant for them the break they received,” said Galán.

Carmen Rivera, 47, who asked that her name and that of her son be withheld to protect their privacy, has a six-year-old diagnosed with autism and attention deficit disorder. He currently attends the mainstream school system and receives five therapies after school. While Carmen’s situation differs from Lina’s, she has also received respite services from APNI.

Both Carmen and her husband work from home in marketing and event planning. They have been working hard to recover from the Covid-19 pandemic, which disrupted their jobs and significantly affected their income. “We are aware that we are in a stage where we need to be financially stable, and we want to ensure that [our son] also has a stable future,” she said.

Due to her son’s condition, self-employment was the best way to dedicate time to caregiving. She picks him up from school at 3 p.m. and then takes him to therapy. Respite services have allowed Carmen and her husband to continue working. “Sometimes I’m on a call or tending to clients, and my son comes to me and interrupts me, so in that sense having these services during those few hours to finish the work is invaluable.”

She added that APNI has been incredibly accommodating in finding respite personnel who are active and able to manage her son’s needs. The two caregivers assigned to their family have formed a strong bond with him. To facilitate their work, Carmen leaves them a daily work plan to help him with his summer reading or reviewing school lessons, among other things.

To date, APNI has provided respite services to more than 30 families. For Lina, respite services have allowed her to go to medical appointments, enjoy some free time with her husband and even rest. “I felt so tired that I just told the lady who was helping me, ‘I’m just going to rest.’ And I spent a couple of hours resting because the body feels it.”

The post For Caregivers of People Living with Disabilities, Respite Care Provides Room for Rest appeared first on Direct Relief.

After numerous evaluations, Victoria was finally diagnosed with autism. “It was not easy understanding the diagnosis and thinking that your daughter is not going to be an independent person…,” said Patricia. “Because in the end, as a parent, all you want is for your kid to lead an independent life.”

The number of students with autism in Puerto Rico has doubled over the last decade, reaching 7,575 in 2022, according to the Autism Alliance of Puerto Rico. However, there is an island-wide shortage of special education teachers and therapists.

“Like any other parent, I didn’t know where to go or what options were available to us,” explained Patricia, until she discovered the Centro de Aprendizaje del Niño (CAN), or “Children’s Learning Center” at the Hospital del Niño. CAN is an intensive learning and therapeutic center specializing in developing academic, social, behavioral, and communication skills for children aged 2-5 with autism diagnoses and various learning challenges.

CAN provides individualized therapy services through an interdisciplinary team incorporating Montessori methodology, enabling each child to learn at their own pace, strengthening and stimulating academic growth.
Jacqueline Giannoni, Director of Speech and Language Therapy at CAN, celebrated the progress made by children like Victoria, who no longer carry an autism diagnosis thanks to the program. “Victoria was one of the girls that came in with a diagnosis of autism spectrum disorder. Thankfully, as a result of her last evaluation in 2022, she no longer meets the criteria for the diagnosis, which for us is the biggest achievement.”

Once children reach five years of age, they transition to other schools. Children like Victoria enter the regular school system, while those requiring ongoing services continue to receive support from schools tailored to their needs, supplemented with therapies from the Hospital del Niño.

Centers like CAN are rare finds, and Patricia considered the support she received as a blessing. She emphasized the importance of actively involving parents and maintaining open communication throughout the process, advocating for more centers like CAN to address the existing service gap. “I feel like there should be more centers like this one, because it works and is exactly what’s missing,” she added.

Currently serving 50 children, CAN is expanding its facilities to increase capacity. However, there remains a pressing need for more such institutions in Puerto Rico, where services are severely limited, stressed Gianonni.

Direct Relief awarded a $107,000 grant to Hospital del Niño to subsidize the salaries of six trained professionals who will provide educational therapies for children with disabilities.

School Disruption in the Aftermath of Disasters

To bridge gaps in service access, Hospital del Niño also provides outpatient therapies to nearly 2,000 students under the Special Education Program of the Puerto Rico Department of Education. The Covid-19 pandemic brought additional challenges and exacerbated the shortage of therapists and professionals in schools. The organization has taken measures to train special education teachers and recreational therapists to work with special education students and help them thrive.

Although there has been a rise in the number of children diagnosed with autism, Jacqueline Gianonni raised awareness about another group of cases where children may appear to fall within the autism spectrum, but are actually experiencing delays in social skills due to the isolation imposed by the Covid-19 pandemic.

To address this, the Hospital del Niño is collaborating with the Department of Education to expand its “Avanzando Juntos” or “Learning Together” program. This early intervention initiative identifies early signs of autism and developmental disorders in children aged 0-3, providing parents with an individualized plan to help children progress and gain independence. Additionally, they are conducting training sessions for service providers in five different school regions, equipping them to recognize specific needs among children.

For Patricia González, her experience with Victoria’s diagnosis made her more attuned to early signs when her second daughter, Aurora, was born. At 18 months old, Aurora was diagnosed with autism and is now a student at the Centro de Aprendizaje del Niño (CAN).

Patricia emphasizes the importance of early intervention, celebrating Aurora’s remarkable progress and her promising future, much like her sister Victoria. “Every day, she surprises us even more. She is on the same path as her sister, Victoria. We see her progress each day. This is why early intervention is important,” said Patricia.

The post Going Above and Beyond for Children in Puerto Rico appeared first on Direct Relief.

Since Hurricane María struck the island in 2017, leaving parts of the island without power for up to a year, and causing massive economic and health consequences, Puerto Ricans have faced a number of back-to-back emergencies: earthquakes, flooding, the Covid-19 pandemic, and most recently, Hurricane Fiona.

These events have resulted in what experts describe as a severe mental health crisis, including mounting cases of post-traumatic stress disorder, anxiety, substance use disorder, and depression.

But even before the hurricane, there weren’t enough mental health providers, and an exodus of physicians and clinical therapists from the island took place in its aftermath.

“People are looking for services, but are not finding them. We have a demand crisis,” said Dr. Karen Martínez, a psychiatrist and director of the University of Puerto Rico’s Center for Study and Treatment of Fear and Anxiety.

As clinicians struggle to meet the growing need, appointment wait times have stretched – up to seven months, in some cases. Even in her private practice, Martínez and her colleagues cannot take on new patients.

Amid the rising need and shrinking pool of providers, local nonprofits are stepping up to provide essential mental health services.

Over the last four years, Direct Relief has supported 13 local groups focused on mental health, thanks to a $50 million donation from global biopharmaceutical company AbbVie. To bridge gaps in access and provide targeted mental health services to vulnerable populations, projects include telepsychiatry sessions, school-based healing programs, psychosocial support for patients with chronic conditions, grief counseling, and counseling for communities embattled by violence.

“You belong here”

One of those groups is the Stefano Steenbakker Foundation, a nonprofit providing grief counseling for bereaved families. The group was formed after the tragic death of a teenage boy killed in a carjacking, and the organization receives mental health referrals from the state crisis hotline and the Puerto Rico Department of Justice. The founder of the organization – and mother of Stefano – Zorimar Betancourt, explained that the foundation provides “psychological help, social work, support groups, and healing workshops.”

With a Direct Relief grant of $107,000, the Stefano Steenbacker’s Foundation has expanded its scope of services to include social workers, psychologists, and thanatology specialists – who focus on the loss created by death – as well as conducting support groups for victims of loss experiencing complicated grief.

The foundation complements services with art and dance classes, field trips, and concerts, and encourages participants to offer workshops to their peers. Social workers and psychologists are involved in these activities to provide support. “People are happy, they feel as if they are family. They know that we offer a safe space,” said Betancourt.

Tina Terado, a psychologist at the organization, said it provides a feeling of belonging that separates it from traditional mental health services. “Validating their emotions and saying to them, ‘You belong here,’” is vital to the process, she explained.

If the Stefano Steenbakker Foundation didn’t provide these services, Tirado said, “there would be around 500 people without specialized help with their grieving process, and who would not find the necessary tools to manage their loss in a healthy way.”

Play Time

After Hurricane María, Fundación Atención Atención, a nonprofit organization that received funds from Direct Relief, tailored their artistic programs to develop and teach healthy coping skills to children. This approach aims to prevent the negative effects that such a traumatic event can have on children’s lives.

Paula Rivera, the group’s executive director, explained that they must work in settings where children can receive regular, uninterrupted care. “That is why we like working with schools because it’s a way of involving social workers and school psychologists to follow up on things our psychologist has identified.”

Fundación Atención Atención received a $180,000 grant to implement their “Play Time” initiative across 30 schools and communities in Puerto Rico. They’re using play and dance as therapeutic tools to help children cope, as well as offering meditation, breathing, and socialization skills.”

Their project, “La Hora del Juego,” which translates to “Play Time,” provides crisis management tools taught through song and play for children and their parents, as well as teachers and other adults within the schools and communities they serve.

Caonabo Canales, a child psychologist from Fundación Atención Atención, said the group also trains parents, teachers and community leaders on how to identify and manage emotions. “We recognize that both adults and children carry emotions that must be managed,” he said. The idea is to teach both to learn when emotions “present as a risk factor causing stress or anxiety attacks that [they] can’t manage, and what strategies we can integrate to avoid that.”

He recalled when, days after the hurricane, the organization visited a community in the municipality of Yabucoa, which didn’t have water or power to implement Play Time. “I received a boy who wasn’t more than seven years old, and every time he lost, he would become very aggressive. The effect that Play Time had on him was incredible: He developed empathy, emotion management skills, and adequate communication skills,” Canales said.

“We get old because we stopped playing”

Both organizations have taken traditional mental health services and combined them with hands-on holistic practices. Betancourt, who experienced the sudden death of her 17-year-old son, explained that during her grieving process, “I realized that it is not only just going to the psychologist…You also need holistic healing in your life to be able to face the big trauma of losing a child.”

“The way to approach mental health with children is through play, through healthy socialization, providing safety, that is what all pedagogues will tell you,” Rivera said.

She had an additional piece of wisdom to offer for the adults with whom her organization works: “We must help adults remember that we don’t stop playing because we get old; we get old because we stopped playing. If we can understand that, we will have happier children.”

The post Amid Puerto Rico’s Mental Health Crisis, Using Play, Dance, and Other New Solutions appeared first on Direct Relief.

Wilfredo Cruz Avilés has lived in Playita Cortada, Santa Isabel, for the past 25 years. His entire neighborhood, including his oceanfront house, was completely flooded. Weeks after the hurricane, Wilfredo still finds it hard to fall asleep. The once calming sound of waves crashing feels more menacing. “This is no longer livable. You can lose your life here and lose the things we built with much sacrifice. I’m no expert, but climate change is advancing, [because] many years ago, it wasn’t like this. It is now time to leave and live a peaceful life,” he said, with tears in his eyes. Along with other area residents, Cruz Avilés will now relocate to a new home, aided partly by government assistance.

A short drive south, in the municipality of Salinas, there is a beach town called La Playa (literally, The Beach). Magdy Setzler recalls growing up there, where she “loved when it rained.” Her house is built on higher ground and, before Fiona, water had never entered. But this time, it was different. “When we got out of our houses, the water was up to our chests.”

These are a few of the many stories that came out of communities surrounded by oceans and rivers, where most residents suffered extensive losses, often surpassing those from 2017 during María.

Mobilizing healthcare services

Immediately after shelter-at-home orders were lifted, Direct Relief’s team in Puerto Rico set out to assess the damage and determine needs. Emergency supplies and medications were delivered to community health organizations, and displaced individuals received hygiene kits to help during those first uncertain days. Cleaning crews were dispatched to help communities salvage whatever possible from flood-damaged homes.

Recent natural disasters have added further barriers to medical care for those most in need. During the past five years since Hurricane María, Direct Relief has supported federally qualified health centers and local organizations with donated mobile units and off-road vehicles to expand outreach services. Conceived after María, this project proved invaluable after Hurricane Fiona hit, allowing healthcare workers to deliver uninterrupted care to patients in remote locations or those with limited mobility.

After Fiona, Direct Relief organized a series of health fairs in various municipalities to ensure patients received care for any urgent needs and follow-up care for chronic illnesses. Health centers including MedCentro, COSSMA, and Migrant Health Centers staffed their mobile units with primary and specialty care physicians, serving hundreds of patients who would have otherwise postponed seeking care. Such activities were held in Salinas, Santa Isabel, Guayanilla, Hormigueros and Yabucoa, some of the areas most affected by the storm.

As expected, the trauma experienced by community members gives rise to increasing mental health conditions. With support from Direct Relief, Ponce Medical School Foundation used their donated vehicle to provide mental health screening and treatment to areas in the south.

From their visits, Dr. Laura Domenech, Senior Medical Officer at the Ponce Medical School Foundation pointed out that “people’s health is poorly treated.” She recalled a particular case in the municipality of Guánica where they encountered a woman with a lesion that indicated melanoma. The woman had told them she had a “spot” on her skin since the 2020 earthquakes. She had scheduled a visit to see a doctor, but due to the earthquakes, she could not attend. The next available appointment is in six months.

Cases like this one are common. The increasing scarcity of healthcare professionals on the island, an ever-growing aging population, and the instability of the power grid, have made it almost impossible for certain patients to receive medical care. For this reason, Dr. Domenech stressed that mobilizing outreach clinics has allowed them to “rescue patients that have been lost in the system, so they have better health.” Case in point: they got the woman an appointment with a dermatologist to diagnose and treat her lesion.

Aggravated by ongoing natural disasters

Prolonged power outages caused by Hurricane Fiona led to water and food insecurity, which in turn reactivated the trauma for many from Hurricane María, creating “emotional and psychological instability,” explained Dr.Viviana Hoyos, a psychologist at the Ponce Health Sciences University.

“Trauma never ceased to exist,” said Dr. Hoyos. “We have tired individuals, who have not stopped struggling ever since María.” Symptoms of depression, suicidal thoughts and anxiety attacks are among the most common diagnoses during their visits to storm-impacted communities. Anxiety has been particularly prevalent among the coastal communities where rains and floods have continued.

Even residents in the larger community have taken notice, too. Harold Martínez lives in La Playa in Guayanilla, where he has worked as a community leader for nearly seven years. Like its neighboring communities in Santa Isabel and Salinas, it was heavily flooded after Fiona. Martínez said, “there is also a great need in the psychological area. [Mental health] has been greatly affected by everything that has happened. It’s a matter of talking and listening to them; you can perceive it.”

The common denominator among these communities is the mostly elderly population who rely on family members or neighbors for transportation to medical appointments and even to access food. Based on these findings, Dr. Viviana Hoyos emphasized the importance of community healthcare outreach initiatives.

“For these communities, the norm is that these services come to them.” Before these initiatives began, many patients did not even have health insurance: “many told us, ‘Why should we need it if we don’t have a way to go to the doctor.” She stressed that if funding for these projects were to stop, it is very likely that patients would stop receiving services.

In response to Hurricane Fiona, Direct Relief delivered more than $400,000 of requested medical supplies and medications to Puerto Rico.  More than 7,146 lbs of requested medications were donated, 600 personal care kits were delivered to displaced people, and more than 400 families have received healthcare services. 

The post Hurricane Fiona: Responding Where the Rivers Met the Sea appeared first on Direct Relief.

• More than $400,000 worth of requested medical supplies and medications were delivered to Puerto Rico. 
• 7,146 lbs of requested medications were donated.  
• 600+ personal care kits were delivered to displaced people. 
• 400+ families have received healthcare services. 
• 200+ volunteers deployed to community health fairs.
• 126 emergency medical backpacks were distributed to first responders in Puerto Rico, the Dominican Republic, and Honduras. 
• Nine power generators were delivered to patients relying on life-sustaining medical equipment. 

Aid from Puerto Rico’s Emergency Response Hub reaches Caribbean countries

The situation: After Hurricane María in 2017, Direct Relief established a regional disaster response hub with warehouse capabilities in Puerto Rico, where relief supplies are kept in stock and emergency response personnel are ready for immediate dispatch during emergencies in the Caribbean region. 

The response: Before the 2022 hurricane season, 28 tons of emergency response supplies and equipment were pre-positioned at Direct Relief’s warehouse in Puerto Rico, including 11 hurricane preparedness packs, which contain commonly requested medicines and medical supplies.

The impact: After Hurricane Fiona, Direct Relief immediately shipped 30 emergency medical backpacks from Puerto Rico to the Pan American Health Organization in the Dominican Republic. Additionally, a hurricane preparedness pack and 36 emergency medical backpacks were shipped to COPECO in Honduras in response to Hurricane Julia. 

Mobilizing Health Services to Communities in Puerto Rico

The situation: In Puerto Rico, patients residing in remote and isolated communities often lack transportation to access healthcare services. This was further exacerbated by Hurricane María and, more recently, during Hurricane Fiona. Prolonged power outages also forced many providers to interrupt healthcare services, including the prescription of medications. 

The response: Over the last five years, Direct Relief has donated 66 mobile units and off-road vehicles to federally qualified health centers and other community organizations to mobilize health outreach services to remote communities and expand access to care. To further ensure adherence to medications, Direct Relief delivered essential medicines to bolster the supply. 

The impact: After Hurricane Fiona, Direct Relief, alongside MedCentro, Migrant Health Center, and COSSMA, organized health fairs for affected communities in the south and western region. Mobile units served as on-site clinics to provide primary, specialty, and mental healthcare services to over 400 patients. 

Doctor Laura Domenech, Senior Medical Officer at Ponce Medical School Foundation, said that Direct Relief provided medications that allowed them to help patients “that lost everything, including medications such as insulin. [Others] didn’t have their prescription refills and could not get doctor’s appointments because they were scheduled for months after the hurricane.”

Reliable Power Sources for Healthcare and Water Access

The situation: Hurricane María marred Puerto Rico’s power grid, causing an island-wide power outage that spanned for more than six months. 

The response: Since 2017, Direct Relief has been equipping community health centers and non-PRASA communities (those not served by the main aqueduct authority) with solar panels and battery storage for uninterrupted access to healthcare and water.  

The impact: After Hurricane Fiona, while the island experienced power outages, all nine community health clinics with solar-powered systems remained operational. Additionally, all 25 community wells provided clean water without interruption. 

Noemí Calderón, Facility Manager at COSSMA (one of the health centers with a Direct Relief-funded solar power system) said that “it has been a huge help to maintain our critical loads during emergencies. It allows us to serve our patients in the areas of dental, pharmacy and, with water and power utilities, we can maintain our services.” 

Program Highlights

Since 2013, the community-based organization COSSAO has provided essential services to seven geographically isolated communities in Jayuya, Ciales, and Utuado. After Hurricane María, the organization expanded its scope to create a free health clinic for residents in these underserved areas. 

Direct Relief awarded a $587,680 grant to COSSAO to improve the clinic’s infrastructure. This expansion will allow new programs to be developed and contribute to the clinic’s long-term viability. 

The post Hurricane Fiona Update: Puerto Rico appeared first on Direct Relief.

“I could not handle the pain,” said Torres, who lived on the streets for a year. “That’s when I began using fentanyl to relieve the pain.” Before that, he hadn’t used drugs for 14 years.

Torres sought help and was referred to the organization Hogar del Buen Pastor – which translates to “Home of the Good Shepherd.” Since then, he said, “They have been a blessing. This is my family. This is my home.”

Founded in 1993, Hogar del Buen Pastor offers a two-year program for people who are experiencing homelessness or substance use disorders. The organization provides these individuals with temporary shelter and rehabilitation services while helping them obtain health care, seek stable employment, and secure adequate housing.

Tere Beard, Hogar del Buen Pastor’s executive director, said the majority of the residents at the center have some type of addiction or mental health condition, while a smaller number have lost their housing due to economic distress.

“Our work goes beyond finding housing,” Beard emphasized. “We have seen people who have completed other programs, have found housing, and months later are back on the streets because their psychological and emotional shortcomings remained unattended, or the trauma that triggered them, causing them to lose their home once more.”

A holistic approach

Focused on a holistic approach, Hogar del Buen Pastor works to ensure that their therapies work for everyone. Since its foundation, the center has integrated alternative therapies such as acupuncture into its work, and aimed to further spiritual growth while respecting individual religious affiliations.

Direct Relief has been supporting Hogar del Buen Pastor’s work for several years. In 2019, the center received a grant of more than $370,000 to recruit psychologists, case managers, psychiatrists, and other health professionals to expand their services. In 2021, Direct Relief provided a second $400,000 grant to allow Hogar del Buen Pastor to both continue its work and expand its offerings to include chiropractic medicine and functional neurology, among other treatments.

Creating new opportunities

Hogar del Buen Pastor doesn’t just aim to address patients’ underlying issues. It also works to help them make a livelihood going forward through its microbusiness program.

Composed of an embroidery store, a cafeteria, two thrift stores, a bookstore, a moving company, and a soon-to-open carpentry shop, these trades offer residents the opportunity to acquire new skills and gain experience for future employment.

Direct Relief’s grants have also extended toward Hogar del Buen Pastor’s rehabilitation and reintegration programs. Funding has been used to provide investment seed funding for residents who complete the program, as well as stipends for residents who work in the businesses or who participate in job search and budget training.

Along with identifying the best therapies for each individual patient, staff members work to find a fitting business match for residents.

These combined services have had a great impact on residents. “Within a year, we are seeing a positive change,” Beard said. 

Mind, body, and spirit

Torres is an example of precisely that. He recently finished high school while working at Hogar del Buen Pastor’s embroidery microbusiness. As a recent graduate of the center’s program, he’s in the process of moving into an apartment, but he’ll continue working at the embroidery store for the next six months.

“I like to learn,” he said. “I have learned about embroidery and I am thankful because it will help me set up my own business.” His ultimate goal? To go back to school to become a graphic designer. He’s confident that his experience at the embroidery store will help him achieve it.

Hogar del Buen Pastor’s success “lies in the combination of mind, body, and spirit,” said Daisy Montes Cardona, one of the case managers recruited through Direct Relief’s funding. “I am very proud of the work we do here.”

Montes’s work focuses on identifying the best therapies for each resident and helping them complete documentation for drivers’ licenses, health insurance, and other elements of life outside of Hogar del Buen Pastor. Her role as case manager is pivotal in transitioning recovering patients to independent living.

“Sometimes we become their mothers, fathers…their confidants,” she said. “There is a trust that they build with us.”

The post For People Experiencing Homelessness in Puerto Rico, A New Approach to Treatment, Reintegration appeared first on Direct Relief.

This was a serious problem for community health centers trying to respond to the storm and provide care to patients.

For example, if a health center “needed fuel for a power generator, it needed to begin a lengthy process of mobilization to the Center for Emergency Operations in San Juan – a task that could take hours,” explained Alicia Suárez, executive director of the Puerto Rico Primary Care Association (PRPCA), which represents 22 health centers with 67 sites across the island.

The PRPCA wanted to ensure that this didn’t happen again, even if Puerto Rico’s fragile power grid was hit by another disaster. That meant developing a safe, reliable alternate communications system that could kick in even if the power was out.

In 2018, after Hurricanes Irma and Maria, pharmaceutical company AbbVie donated $50 million to Direct Relief for the recovery and strengthening of community healthcare services.  As part of this donation, Direct Relief procured 69 specialized radios, valued at more than $288,000. These radios were the foundation for a new Interoperable 330 network between 67 community health centers and the PRPCA.

This particular radio technology, the P25, is used worldwide by first responders and public safety officials – including federal agencies like the Department of Homeland Security. An encrypted radio system offers privacy and security; the radio is also backed by the SAFECOM program, endorsed by the U.S.’s Cybersecurity and Infrastructure Security Agency.

Dr. Darielys Cordero, director of Special Projects and Clinic Quality in the PRPCA, said that the equipment will help health centers promptly report their status – and any immediate needs – to the government during a disaster or other emergency. The community health centers will be able to communicate with their satellite clinics, one another, and the PRPCA as well.

“We will be able to draw attention to what happens in the communities where the 330 centers are located, guaranteeing the continuity of operations and access to healthcare services,” Cordero said.

Since the aftermath of 2017’s Hurricanes Irma and Maria, Direct Relief has supported primary health care centers and the PRPCA with the necessary equipment and training to respond urgently to a future emergency. The organization has helped procure medical mobile units and off-road vehicles, installed resilient energy systems, repaired infrastructure, and implemented programs to support the island’s vulnerable communities.

In April, the lights went out across Puerto Rico once again. This time, however, it was an opportunity to test the new radios and streamline the communications plans – part of the process of strengthening what Cordero calls an “emergency management culture.”

According to Cordero, the communications network will “save time when communicating a need” and allow participants to “redirect resources to address continued needs,” making it more likely that community health centers will be able to continue responding to the emergency.

It will also make reporting to government entities easier.

After Hurricane Maria, “we had to visit each of the clinics,” Cordero said. Now, with reports coming in from across the island, “the information process flows quicker.”

The post Puerto Rico’s Newest Disaster-Fighting Tool Works Even When the Power Goes Out appeared first on Direct Relief.

But in her spare time, she’s also a volunteer paramedic with Puerto Rico’s First Response Emergency Medical Services (FREMS). “Once you get a taste of it, you can’t leave,” she said of her volunteer work.

FREMS began as a group of paramedics and emergency medical technicians (EMTs) scanning emergency response radio frequencies in and around San Juan, with the goal of responding to accidents. Today, this 30-year-old institution is a nonprofit organization of first responders donating their time (and often their resources), to help those involved in car accidents, traumatic injuries, fires, floods, and other emergencies.  

Bonnin first joined on the suggestion of a colleague. After a “test run” with several team members, she was hooked. “Anyone who works in this field cannot do it for the money because we are underpaid. You don’t do this because you like it; you do it because it is your passion,” she said. 

José Nieves Rivera works full-time as a Lieutenant for the Special Operations Division of the Puerto Rico Fire Department. His other passion, working as an EMT and paramedic, prompted him to join FREMS 18 years ago.  

“Even though the fire department is a specialized unit, and we assist on medical cases, it is more targeted to certain specific tasks, and I wanted to provide my clinical and trauma management expertise, so here I am,” said Nieves who is currently the group’s president.  

Composed of 25 EMTs and paramedics, every FREMS volunteer is certified and trained in advanced pre-hospital medical response and treatment services. Their Advanced Life Support (ALS) rescue units allow them to respond quickly and effectively to provide urgent treatment in various medical emergencies, including advanced cardiac resuscitation.  

Fitting into the local landscape

On a recent night on the field with the Direct Relief team, FREMS left their base at 8 p.m. on a Friday night as the first call came in. A woman was unconscious in her house. She had mixed drugs and alcohol.

FREMS volunteers, the first on the scene, stabilized her and called an ambulance to transport her to the hospital.

It was only the beginning of the night’s shift. Over the next eight hours, the group responded to car accidents, an overdose, and multiple injuries.

Many agencies see FREMS as competition, which can occasionally make it difficult to coordinate with the local emergency response system. The group’s goal is to be seen as an aid organization that supplements the existing system, providing lifesaving expertise and equipment when they’re needed.

Over the past few years, they’ve made progress: FREMS currently has collaborative agreements with the municipality of San Juan, the state emergency management agency, and the 911 system. These agreements allow FREMS to deploy members to provide rescue.

Unlike in the mainland United States, 911 officials in Puerto Rico don’t dispatch help directly. Instead, they request aid from public safety and emergency response agencies.

These collaborative agreements allow FREMS members to conduct rescue work in the field, where they perform rescue missions and stabilize patients in life-and-death situations, such as victims of gunshot wounds or severe falls. Once stabilized, most patients are transported by ambulance to the Puerto Rico Trauma Center.

The “golden hour”

This short period of time, in which fast initial treatment is needed, is called the “golden hour” by people who work in trauma or emergency care. That’s because it significantly impacts a patient’s likelihood of survival and clinical outcomes. By reducing the time from trauma to initial treatment, FREMS plays a pivotal role in the overall prognosis of the people they serve.

Part of that means doing it faster. In 2020, as El Vocero reported, the average emergency response time in Puerto Rico was roughly 25 minutes. A year later, EFE announced that wait time had decreased to approximately 9 minutes. 

FREMS is even faster. Group members have measured their response time in over 200 documented cases since September of 2021. The result? “Our [average] response time is 6 minutes and 52 seconds. Those two minutes are life,” said Eliel Báez, one of the group’s founders and its current executive director.

To continue expanding their emergency response capacity in Puerto Rico, Direct Relief, as part of AbbVie’s $50 million donation, awarded a $350,000 grant to FREMS to purchase a new rescue unit and medical equipment such as complex cardiac monitors.

The new smaller, more agile vehicle will add flexibility to the existing fleet, allowing for rescue missions in steep and remote locations.  

“In the end, our work and our dedication make it so that others can live,” Nieves said.  

The post In Puerto Rico, Volunteer First Responders Save Lives in Their Spare Time appeared first on Direct Relief.

“I wasn’t sure I was going to get picked because of my age. I was aware that this was a program aimed at women entering the workforce and…I am happily retired,” she explained. But her 30 years of specializing in soil and water conservation made her an ideal candidate. “Capturing the sun’s energy was for me the next logical step; they didn’t have to convince me.” 

The Mesa Multisectorial del Bosque Modelo de Puerto Rico is a nonprofit organization focused on promoting sustainable development in Puerto Rico’s rural communities. Since 2019, they’ve been recruiting women from the communities they serve to learn the ropes of installing renewable energy systems.

Hurricane Maria’s destructive passage through Puerto Rico severely affected the island’s grid, leaving many communities without electricity. For communities that are not connected to Puerto Rico’s central water utility, and that rely on wells with electric pumps, the storm was a double blow, leaving them vulnerable to ongoing power and water outages.

Bosque Modelo worked alongside communities to improve their water quality, infrastructure, and energy capabilities as part of their strategy to promote resiliency and sustainability in the face of global climate change.

The goal wasn’t just to develop renewable energy and an uninterrupted water supply; the organization also wanted to create employment opportunities in the region.

“Like reading another language”   

In the last few years, the program has evolved, with a new focus on training women from local communities. Dariana Mattei, program coordinator for Bosque Modelo’s renewable energy project, has seen a “wide range of profiles”: young women, retired women and community leaders. She believes that the program has had a positive impact on them and their communities.

Mattei is a firm believer that women are instrumental in the fight against climate change. If “we want to have renewable energy by 2030 in Puerto Rico, collaboration with the communities, inclusiveness, and gender perspective” is important.  

Today, Bosque Modelo’s ecological footprint spans across 32 municipalities along the center, western and southwestern regions of the island.

They’ve had to contend with more than the aftermath of Hurricane Maria. In 2020, Puerto Rico’s southern and western regions experienced a series of large-scale magnitude earthquakes that caused widespread structural damage, especially in the municipality of Guánica.  

Guánica’s Fire Station remained unscathed, but power outages were recurrent. As part of AbbVie’s $50 million donation to Direct Relief, a $277,000 grant was awarded to Solar Responders, a nonprofit organization, to install solar panels and battery storage systems at the station.  

Direct Relief had previously funded Solar Responders to install solar panels on the Cataño EMS and fire station. But this new grant included stipends for 21 women from Bosque Modelo, who are interning at Solar Responder’s project sites in the Guánica and Ponce fire stations.  

Robledo is part of this cohort. Training included installation theory, maintenance and design, and at least 20 hours of practice at the stations under the supervision of the electrical engineer. At first, “it was like reading another language,” she laughed.  

“I went to the station three times a week to get as much practice as possible,” she recounted. Every time she was there, she climbed up the ladder to the roof to do her work.

“You can advocate for your community”

As part of this grant, both organizations will provide additional paid training to between six and 12 women graduates from the internship program. The training will teach them to conduct maintenance on Direct Relief’s solar storage systems, which are installed on Federally Qualified Health Centers (FQHCs) throughout Puerto Rico, and Solar Responder’s installations on fire stations.  

With this additional training, the goal is to register participants at Puerto Rico’s College of Electricians and certify them as Apprentice Electricians. The apprenticeship requires them to work under the supervision of an experienced electrician, but Hunter Johansson, CEO and Founder of Solar Responders, believes that this is a move toward empowering Puerto Rican women to care and stand up for their communities.

“It is going to require more training. [But] This is the first step in a long-term investment. When you are informed about a trade like this, you can advocate for your community to protect it, and it shows women that they can do this,” Johansson said.  

In Puerto Rico, as La Perla del Sur reported, there are 5,390 expert electricians, only 21 of whom are women.  

“I am used to working in male-dominated environments. [This program] I think is fabulous,” Robledo, the retired agronomist, said. 

For Johansson, this is a call to action: “Inclusiveness builds long-term success and recovery. It helps communities thrive,” he said.

The post On Puerto Rico’s Roofs, Renewable Energy Brings Employment for Women appeared first on Direct Relief.

“There was a lot of sadness and loneliness” among the people she spoke to on the phone, she said. Dealing with that was part of the landscape, along with teaching patients how to manage Covid-19 and avoid transmission between family members.

Another person might have shrugged it off. Martínez, on the contrary, picked up a backpack and started heading out into the field to care for patients in their homes.

There’s no disputing the success of Puerto Rico’s vaccination efforts. The island is more than 80% vaccinated at this point, thanks in part to widespread vaccination sites, events, and outreach. But omicron cases have spiked nonetheless, making outreach work more essential than ever, and there’s also no question that some people, most notably bedridden patients and older adults, have been left behind.

The organization Puerto Rico Salud, a grassroots organization founded by health workers, has been bridging the gap, doing vaccinations and outreach work in hard-to-reach communities across the island. Martínez is one of their members.

For many of those who haven’t received a vaccine, a lack of transportation or overall mobility is often the problem. For Martínez and her colleagues, vaccinating these individuals at home is often the solution.

Through the Puerto Rico Department of Health, Direct Relief donated 40 emergency response backpacks to first responder organizations on the island including Puerto Rico Salud, to ensure first responders are fully equipped to address health needs in the field.

Making the journey

On a recent Tuesday, Martínez drove up to Felicita Nieves’ house in the community of Cacao Centro in Carolina. Nieves lives with her two adult sons, and cares for both them and herself. Alfredo, her younger son, has several disabilities, including limited mobility.

And while their community isn’t as remote as some, “doctors don’t want to come here, and [Alfredo] doesn’t walk,” Nieves said.

Families like Nieves’s “are part of my everyday,” said Martínez. It’s not part of the job, but she collects donations to bring groceries to patients she knows need them.

Nieves was glad to receive the groceries and have her two sons vaccinated without leaving home. She had been able to visit a vaccination site in Carolina using public transport, but it would have been too difficult to prepare Alfredo for the journey.

Finding people, earning trust

Identifying patients who need help is challenging. So is coordinating visits. Martínez begins by calling patients on lists provided by Puerto Rico’s Department of Health, and tries to schedule visits to the same municipality close together to maximize her time.

But getting to the patients is top priority. Martínez regularly overcomes scheduling hiccups and searches out patients who can’t accurately tell her where they’re located.

Martínez recalled speaking to a patient who didn’t believe she would actually show up to administer a vaccine. He’d heard such promises before, but no one showed up. “I guarantee you I will come,” she said. And she did.

“I always say to myself, ‘I have to get there. I gave the patients my word’,” she said.

Even if she arrives at her destination, some people won’t answer the door or don’t trust her. Most aren’t vaccinated. “There is a lot of misinformation,” Martínez said. But if the patient agrees, she has the vaccine ready – and she’s happy to give willing family members the jab as well.

Martínez emphasized that this outreach effort goes beyond vaccination. “That time you stay with the patient… you give [them] support and company,” she said. “The happiness that person felt because someone heard his claim” is hard to overestimate.

While the Covid-19 vaccination has been the focus of Puerto Rico Salud’s efforts, the organization is also collaborating with other grassroots organizations to provide primary healthcare services in marginalized communities across the island.

For Martínez, having one of the Direct Relief-issued emergency medical backpacks means feeling safer. “We go on these outings by ourselves, so if there was an emergency, I have all the equipment I need to manage the situation,” she said. “It’s a treasure.”

The post In Puerto Rico, Bringing Covid-19 Vaccines on the Road appeared first on Direct Relief.

But historically, cancer care has only been available on the mainland – a journey that requires a plane or ferry and an expensive taxi to San Juan or Fajardo. In general, Vieques, which has about 9,000 residents, has only a handful of health care services. “We don’t have specialty providers. We depend on primary care doctors for referrals,” said Sandra Meléndez, a long-time resident of Vieques and president of the organization Vieques en Rescate (VER).

VER was formed to address precisely these kinds of health problems. Zaida Torres Rodriguez, who has lived in Vieques for 77 years and is a part of the grassroots organization Alianza de Mujeres Viequenses (Vieques Women’s Alliance), explained that community activism on the island comes from a desire to “be part of the fight against military occupation and the health of the people in Vieques.”

The military occupation to which Torres refers is the U.S. Navy’s use of Vieques as a site for military training and bombing. As The Atlantic reported in 2016, some believe that the military’s presence contributed to widespread illness on the island, including high cancer rates – although it’s proven difficult to pinpoint a cause for Vieques’s health issues.

Caring for cancer patients

To address health issues on the island, Alianza de Mujeres Viequenses founded VER in 2013. The goal of the nonprofit was to “rescue cancer patients in Vieques,” Torres said. The organization focused on providing patients with supplies like diapers and nutritional supplements – and on transporting patients to their medical appointments on the main island of Puerto Rico.

To date, VER has helped over 60 Vieques patients with cancer.

With funding from AbbVie, Direct Relief is supporting VER with a $75,000 grant to cover transportation costs for Vieques’s cancer patients and to provide nutritional supplements and diapers for more than 60 patients. The funding will also subsidize salaries for a part-time coordinator and driver.

A typical transfer involves taking the ferry from Vieques to Ceiba, where patients are met by the driver who will take them to their appointments in San Juan or neighboring municipalities. For patients undergoing chemotherapy, this can be taxing.

“It’s a difficult process,” said Torres, who has had cancer. “Sometimes I wouldn’t have the energy.” She remembers having to lie down at a nearby aunt’s house after receiving treatment before taking the ferry back to Vieques.

VER also has a new plan in place to increase cancer are on the island. In collaboration with Puerto Rico’s Department of Health, VER is coordinating for an oncologist and oncology nurse to see patients locally once a month. Currently, around 15 patients a month are benefiting from these consults. In the future, they are hoping to expand their offerings to include chemotherapy services.

Responding to challenges

Caring for Vieques’s cancer patients means adapting to the situation. In the aftermath of Hurricane María, when the island experienced power and communications outages for nearly six months, VER’s facility became a de facto community health center, powered by solar energy.

“In case of any event, we have the capacity to attend to various needs for our patients and the community,” Meléndez said.

While María was challenging, Covid-19 has caused even more significant disruptions. Patients have been hesitant to risk exposure; a lack of comfort with technology has made it challenging to implement telemedicine, and maritime transport is limited due to capacity restrictions. That last hurdle has forced patients to spend weeks at a time away from Vieques – and their families – while undergoing radiotherapy.

And Torres isn’t just worried about cancer. She knows that, on Vieques, primary and preventative care have vital roles to play. As a former nurse, she is on the board of directors for the federally qualified health center Health Pro Med, representing and voicing fellow residents’ needs and ensuring access to health services.

To support health services, Direct Relief and AbbVie provided Health Pro Med with more than $510,000 in grant funding to outfit their Vieques, Carolina and Cataño’s clinics with specialized equipment. In Vieques, funding was allocated to purchase clinical laboratory equipment, a state-of-the-art dental clinic, and vehicles to facilitate patient transport and mobilize personnel for community outreach programs.

The newly inaugurated clinic will offer primary and preventive healthcare services, including pediatrics, gynecology, and, for the first time in the island’s history, optometry. These additions will significantly improve access to care for residents and curtail the need for travel to receive essential services.

Doctor Ivette Pérez, medical director of Health Pro Med’s Vieques clinic, explained that they can support patients through referrals for specialized medicine and keep the patient’s medical history updated – an essential component of successful cancer care.

Additionally, without the patient transport offered through Health Pro Med, there’s a risk of patients not getting to appointments – and thus receiving much-needed care.

The post On the Island of Vieques, Finding New Ways to Care for Cancer appeared first on Direct Relief.

There are authorizations for imaging studies and special medications. Referrals for physician subspecialist evaluations. The dialysis, three times a week, on which their child’s life depends.

Getting listed for a kidney transplant involves numerous time-sensitive steps, and costly resources when a long-awaited organ becomes available. The patient, their family, and their medical team must be ready to move quickly, seizing a narrow window of opportunity.

Parents must sometimes leave their jobs to tend to their children full-time. And for single-parent families with multiple children, the situation is even more complicated.

That’s where Valeria Méndez comes in. A renal care coordinator at Puerto Rico’s University Pediatric Hospital, it’s her job to help families navigate the complexities of medical appointments, transportation, and procuring equipment and medications. She stays on top of transplant-list requirements and helps families keep and maintain the essential documentation.

Méndez is accustomed to working with chronic illnesses, having worked as a case manager for a health insurance company. But when she was offered the chance to improve the lives of children in need of a kidney transplant, she couldn’t resist.

“If I can do my part to improve those children’s lives, it’s something that fills me with joy and makes me happy,” Méndez said.

A stepped-up timeline

By all accounts, they’re happy to have her too. Before she came to the hospital, parents were burdened with the tasks of coordinating all appointments and referrals themselves. Although there were staff members available for guidance, the sheer magnitude of the work involved was causing delays. It was taking an average of one year to clear patients for transplant.

To streamline the enlistment process for children needing a kidney transplant, Direct Relief awarded a grant of more than $100,000 to the University Pediatric Hospital Foundation to subsidize two years’ salary for a renal care coordinator.

Now, “my goal is to enlist patients [on the transplant list] in six months,” Méndez said.

Her efforts are appreciated. “Valeria has changed these families’ lives. She has been a blessing,” said Dr. Nilka de Jesús, a nephrologist and director of the Transplant Center at the Auxilio Mutuo hospital.

Wishes come true

Xhiany, a 10-year-old girl, was one of Méndez’s first patients. Xhiany’s mother had died of end-stage renal disease, leaving her grandmother as her caregiver. Even though her grandmother worked at night, Xhiany never missed an appointment.

“When I told Xhiany that they were ready to do the transplant, she said, ‘I’m finally going to make my mom’s wish come true,’” Méndez recalled.

Pediatric transplants have been performed in Puerto Rico since the early 1980s, but in 2013, transplants on the island stopped entirely. There were no surgeons on the island who could perform them. Transplants finally resumed in 2017 – but were halted almost immediately, when Hurricane Maria made landfall. Although they were reinstated the following year, Covid-19 has slowed the rate of transplants.

But Méndez, who started her work in September of 2020, is changing that. She’s already overseen the successful transplant of six children and the enlistment of another three.

One boy, Méndez recalled, was particularly excited to eat a pizza after his transplant was complete. “His happy face marked me,” she said. “Seeing him eat a pizza with so much joy gave me a lot of satisfaction.”

Meeting costs

Paperwork isn’t the only stalling point. To qualify for the transplant list, patients need at least $3,000 in an escrow account to cover any post-transplant costs.

But many children awaiting transplants come from low-income families and rely largely on the Puerto Rican government health insurance – the equivalent of Medicaid. The money is a huge hurdle. “Not many families have that amount of money in their accounts,” Méndez said. Some families “come from municipalities that are far away, and some are single mothers with other children who are limited in terms of family and community support.”

Recognizing this additional barrier, Direct Relief joined forces with the Extra Bases Foundation, a nonprofit led by the former major-league baseball player Carlos Delgado.

Through a $75,000 Direct Relief grant, Extra Bases is able to provide each patient on the transplant list with the necessary $3,000. Another $50,000 grant helps fund other associated expenses – specialists’ evaluations, medical procedures, equipment that isn’t covered by insurance.

Méndez’s work “has been what we have dreamed for so long for our patients,” said de Jesús. Being able to provide both the coordination and financial support “helps improve the quality of life of these kids.”

The post Meet the Renal Care Coordinator Working Miracles for Pediatric Transplant Patients appeared first on Direct Relief.

It might sound like an obscure sub-specialty, but interventional radiology is actually the standard of care in many institutions. Compared to traditional surgeries, these minimally invasive procedures guided by medical imaging are faster and less painful for the patient. They’re also less expensive for the health care system overall.

Interventional radiologists diagnose and treat renal disease and cardiac malformations, obtain tissue biopsies, place needles and catheters, and treat blocked blood vessels. However, these procedures require specialized equipment such as an ultrasound, X-ray fluoroscopy, computed tomography, and magnetic resonance.

And while interventional radiology for children is widely practiced, there are currently no procedural suites dedicated to their care in Puerto Rico. That means that a child who needs one of these procedures must transfer to an adult hospital or travel to the U.S. mainland. Both options are financially costly – and compromise the safety of these young patients.

A much-needed resource

Llorens trained at the Children’s Hospital of Pittsburgh of UPMC, intending to return home to Puerto Rico eventually. “When [the hospital] recruited me, I let them know of my interest in developing a pediatric interventional radiology service” in Puerto Rico, he said.

Today, when a child is determined to be a candidate for a procedure, Llorens first has to make sure that he has the right equipment and that the interventional suite at the adult hospital is available. These hurdles often mean delays in diagnosis and treatment.

Direct Relief provided a $1.6 million grant to the Pediatric Hospital Foundation to construct a Pediatric Interventional Radiology Unit. It will be the first one in Puerto Rico – and the Caribbean.

The new unit “will elevate patient care to national standards,” Llorens said.

HOPU, the only public children’s hospital on the island, will be home to the unit. The hospital serves 8,500 patients annually, from infancy to age 21. Most patients are from low-income households and qualify for Medicaid. Because it is the only medical institution on the island that can provide 24/7 sub-specialty care and houses a pediatric dialysis center, it receives patient referrals from all over Puerto Rico.

Treating pediatric patients in a unit dedicated to their care will dramatically reduce stressors that children and their families experience while receiving care in an adult hospital environment, such as being surrounded by strangers or needing nurses trained in pediatric care.

New opportunities

Puerto Rico doesn’t lack interventional radiologists. But none of them specialized in pediatrics before Lloren arrived. Now, a unit devoted to caring for children is a necessity.

“Being able to offer this service provides an added value to the health of pediatric patients in Puerto Rico,” said Dr. Francisco Arraiza, an interventional radiologist and board member of the Pediatric Hospital Foundation.” He explained that the unit would mean a faster recovery time for patients – and lower cost since children won’t have to stay as long in the hospital.

Rebeca Quiñones, executive director at the Pediatric Hospital Foundation, indicated that the new pediatric interventional radiology unit would position the hospital as a state-of-the-art medical facility with “world-class advanced medical technology.”

There’s more reason to be hopeful. HOPU serves as the pediatric teaching hospital for the University of Puerto Rico’s School of Medicine and trains physicians in several disciplines. Doctors are optimistic that the new unit will appeal to other pediatric interventional radiologists who might practice or train on the mainland but be interested in returning home.

The unit may also help Puerto Rico prevent more doctors and other health workers from leaving the island, as they have in significant numbers in recent years.

Arraiza also thinks the state-of-the-art new addition could elevate medical tourism in Puerto Rico, providing an economic boost. Due to the island’s geographical position, “we could become a medical hub, and provide treatment to neighboring islands” in the Caribbean, he said. “If you build it, they will come.”

The post For Children in Puerto Rico, Elevating the Standard of Care appeared first on Direct Relief.

“No se necesita un desastre natural para sentirse estresado”, dijo Nancy Ruiz, una de las facilitadoras del Centro de Medicina de la Mente y el Cuerpo de Puerto Rico. “Los problemas cotidianos se acumulan a medida que avanzamos, y nuestro cuerpo, como un vaso lleno de agua, lo sigue tolerando hasta que un día se desborda”.

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Esas preocupaciones existentes, combinadas con dos huracanes destructivos, ejercen una presión significativa en la salud mental de los puertorriqueños.

Durante los últimos 27 años, el Centro de Medicina de la Mente y el Cuerpo ha estado trabajando con comunidades de todo el mundo para abordar el trauma psicológico en toda la población.

Tras el paso mortal del huracán María, recurrieron a ayudar a la población de Puerto Rico a aprender técnicas del cuidado personal diseñadas para aumentar su resiliencia y ayudarlos a sanar, con la ayuda de Direct Relief y la compañía farmacéutica AbbVie.

En 2019, Direct Relief otorgó una subvención de más de $160,000, financiada por AbbVie, al Centro de Medicina de la Mente y el Cuerpo.

La subvención les permitió implementar Sanación a Puerto Rico tras el Huracán, un programa para toda la isla diseñado para abordar los efectos psicológicos de los huracanes Irma y María.

UN EFECTO DOMINÓ

El programa utiliza un modelo de “capacitación de capacitadores”, entrenando a profesionales de la salud mental, líderes comunitarios, maestros y otros en técnicas de meditación, imágenes guiadas, movimiento, escritura de diarios y ejercicios de respiración.Estas técnicas ayudaron a los líderes comunitarios a lidiar con su propio trauma y estrés, y luego a transmitir esas habilidades a sus estudiantes. La esperanza es a causar un efecto dominó en las comunidades a las que sirven, aumentando la resiliencia y la curación a mayor escala.

Dulce del Río Pineda, una de las facilitadoras del centro, trabaja en su ciudad natal de Culebra. Ella ha hecho capacitaciones similares, pero dijo que un elemento del Centro de Medicina de la Mente y el Cuerpo es único: “Te brinda conocimientos que no solo fortalecen a uno mismo, sino que también, como miembro de la comunidad, pueden contribuir a empoderar a otras personas”.

NIÑOS, PADRES Y VETERANOS

Ruiz, una psicóloga, ha trabajado anteriormente con el Departamento de Salud de Puerto Rico, ofreciendo capacitaciones a los profesores en varias de las escuelas de la isla. “Estaban asombrados cuando practicamos las técnicas con ellos, y querían que todos aprendieran esas técnicas”, dijo. Actualmente, ella trabaja en la Escuela Vimenti, la primera escuela pública autónoma de la isla, ubicada en la comunidad Ernesto Ramos Antonini, que alberga a un grupo demográfico de alto riesgo.

Ella está trabajando para implementar y enseñar habilidades de cuerpo y mente a profesores, estudiantes y padres. Es esencial trabajar con los padres, dijo Ruiz. Los niños pueden desarrollar todas las habilidades necesarias para lidiar con sus emociones, pero si regresan a casa en un ambiente tóxico, esas habilidades pueden no ser de mucha ayuda. Del Río Pineda ha trabajado con Head Start, un programa de desarrollo de infancia temprana, durante los últimos 20 años.

Después de aprender las habilidades de la mente y el cuerpo, comenzó a implementarlas con los niños en Culebra. Ella modifica los entrenamientos para los niños pequeños, por ejemplo, utilizando canciones infantiles conocidas como base para los ejercicios de respiración, para que recuerden cómo hacerlos. El Hospital de Veteranos de Puerto Rico también se beneficia del programa.

Tina Fischer, directora senior de programas del Centro, explicó que el hospital observa mucho estrés postraumático, y que el uso de técnicas como el dibujo y la meditación está “construyendo esa resiliencia, dando [a los veteranos] las herramientas que necesitan para superar un noche de insomnio o estrés en el trabajo”.

NUEVOS DESASTRES, NUEVOS DESAFÍOS

El Programa de Sanación Después del Huracán fue diseñado, en parte, para preparar a las personas traumatizadas por desastres pasados para futuras emergencias. Los entrenadores simplemente no esperaban que la isla encontrara un nuevo desastre tan rápido.

Pero a principios de 2020, Puerto Rico se enfrentó a una serie de terremotos a gran escala que afectaron las regiones sur y suroeste de la isla. Se destruyeron casas, se interrumpió la atención médica y la experiencia resultó traumática para muchos. Los aprendices del centro respondieron visitando refugios para ofrecer talleres a personas en las áreas más afectadas de la isla, tales áreas que incluyen Guayanilla, Guánica y Ponce. “[Los niños] necesitaban esos momentos de calma. Ellos no tenían sus casas”, dijo Ruiz, quien trabajó con niños desplazados en los albergues. “Combinamos las habilidades con el juego para trabajar con niños”.

Poco después, la pandemia de Covid-19, otro tipo de desastre, trajo nuevos desafíos. Mientras las personas permanecían en sus casas, los facilitadores sabían que tenían que idear formas creativas para continuar brindando las habilidades necesarias para enfrentar esta nueva emergencia. Muchos de ellos comenzaron a ofrecer talleres de cuidado personal y meditación en línea para llegar a la mayor cantidad de personas posible, ya que sabían que la emergencia de salud pública estaba afectando la salud emocional de las personas.

Ruiz dijo que trabajó con maestros y padres que se sentían abrumados al trabajar con el aprendizaje virtual. Para Ruiz, los beneficios de este programa son innumerables.

“Es muy agradable ver que esto se aplica a niños, adultos y maestros. Todos aprenden algo, todos se curan en su propio tiempo y a su manera”, dijo.

The post “Momentos de Calma”. En Puerto Rico, Desarrollando las Habilidades Emocionales para Hacer Frente al Desastre. appeared first on Direct Relief.

“You don’t need a natural disaster to feel stressed,” said Nancy Ruiz, one of the facilitators of Puerto Rico’s Center for Mind-Body Medicine. “Everyday problems accumulate as we carry on, and our bodies, like a glass full of water, continue to tolerate it until one day it overflows.”

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Those existing concerns, combined with two destructive hurricanes, put a significant strain on Puerto Ricans’ mental health.

For the past 27 years, the Center for Mind-Body Medicine has been working with communities around the globe to address population-wide psychological trauma. In Hurricane María’s deadly wake, they turned to helping Puerto Rico’s population learn self-care techniques designed to increase their resilience and help them heal – with help from Direct Relief and the pharmaceutical company AbbVie.

In 2019, Direct Relief awarded a grant of more than $160,000, funded by AbbVie, to the Center for Mind-Body Medicine. The grant allowed them to implement Post-Hurricane Healing for Puerto Rico, an island-wide program designed to address the psychological tolls of Hurricanes Irma and María.

A Ripple Effect

The program uses a “train-the-trainer model,” coaching mental health professionals, community leaders, teachers, and others in techniques for meditation, guided imagery, movement, journal writing, and breathing exercises.

These techniques helped community leaders to deal with their own trauma and stress – and then to pass those skills along to their students. The hope is to cause a ripple effect in the communities they serve, increasing resilience and healing on a larger scale.

Dulce del Río Pineda, one of the center’s facilitators, works out of her hometown of Culebra. She’s done similar trainings, but said that one element of the Center for Mind-Body Medicine is unique: “It provides you with knowledge that not only empowers you, but also as a member of your community you can contribute to empower other individuals as well.”

Kids, Parents, and Veterans

Ruiz, a psychologist, has previously worked with Puerto Rico’s Department of Health, offering trainings to faculty in several of the island’s schools. “They were in awe when we practiced the techniques with them, and they wanted everyone to learn those techniques,” she said.

Currently, she is working at the Vimenti School, the first public charter school on the island, located at the Ernesto Ramos Antonini community, which houses a high-risk demographic. She is working to implement and teach mind-body skills to faculty, students, and parents.

Working with parents is essential, Ruiz said. Kids can develop all the necessary skills to deal with their emotions, but if they’re heading back home to a toxic environment, those skills might not help much.

Del Río Pineda has worked with Head Start, an early childhood development program, for the last 20 years. After learning the mind-body skills, she began implementing them with the kids in Culebra. She modifies the trainings for young children – for example, using well-known children’s songs as the basis for breathing exercises, so that they’ll remember how to do them.

The Veterans’ Hospital in Puerto Rico also benefits from the program. Tina Fischer, a senior program manager at the Center, explained that the hospital sees a lot of post-traumatic stress, and using techniques such as drawing and meditation are “building that resilience, giving [veterans] the tools they need to get through a sleepless night or stress at work.”

New Disasters, New Challenges

The Post-Hurricane Healing Program was designed, in part, to prepare people traumatized by past disasters for future emergencies. Trainers just weren’t expecting the island to encounter a new disaster so quickly.

But in early 2020, Puerto Rico faced a series of large-scale earthquakes that affected the southern and southwestern regions of the island. Houses were destroyed, medical care was disrupted, and the experience proved traumatic for many.

Center trainees responded by visiting shelters to offer workshops to people in the hardest-hit areas of the island, including Guayanilla, Guánica, and Ponce.

“[Kids] needed those moments of calmness. They didn’t have their homes,” said Ruiz, who worked with displaced children in the shelters. “We combined the skills with play to work with children.”

Shortly after, the Covid-19 pandemic, another kind of disaster, brought new challenges. As people remained in their houses, facilitators knew they had to come up with creative ways to continue providing much-needed skills to face this new emergency.

Many of them began offering self-care and meditation workshops online to reach as many people as possible, since they knew the public health emergency was taking a toll on people’s emotional health. Ruiz said she worked with teachers and parents who felt overwhelmed when working with virtual learning.

For Ruiz, the benefits of this program are countless. “It’s very nice to see that this applies to kids, grownups, and teachers. Everyone learns something, everyone heals in their own time and in their own way,” she said.

The post “Moments of Calmness.” In Puerto Rico, Building the Emotional Skills to Cope with Disaster appeared first on Direct Relief.

Hospitals and clinics closed. So did dialysis centers. For Puerto Rico’s kidney patients, who already experienced physical and psychological issues related to their medical conditions, the impact was catastrophic.

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Alexia Suárez, a clinical psychologist who was tasked with providing mental health services to dialysis patients after the earthquake, recalled a patient suffering from renal insufficiency who lived in a car with his brothers.

It’s just one scenario among many that complicate access to dialysis and other necessary treatments. Many providers had trouble tracking down patients who had been displaced to shelters and camps. Other patients had to be relocated to other treatment centers.

And Suárez saw a greater need for mental health services for both healthcare providers and patients as health care services were interrupted and aftershocks continued.

For many providers serving patients in stressful conditions, it was the first time they spoke to mental health professionals since the hurricane. They can be equally compromised and vulnerable as their patients.

In general, Suárez said, mental health services are instrumental during emergency response and recovery efforts. That’s especially true for patients with ongoing chronic conditions who already experience related physical and mental health issues.

After emergencies, Puerto Ricans typically flock to help one another, as they did after Hurricane María and the earthquakes. But for all the generous gestures Suárez is accustomed to seeing, she said that professional mental health services were not always as available as they are now.

In part, she said, the increased availability resulted from Hurricane María, which had resounding mental health consequences across the island.

Weathering new storms

The Consejo Renal de Puerto Rico is a nonprofit organization working to reduce chronic kidney disease on the island through education, protection, and prevention.

But after observing Hurricane María’s psychological impacts, they knew a piece of the puzzle was missing. They implemented the Renal Patients’ Emotional Assistance program, designed to improve renal patients’ quality of life, as well as that of their families, caretakers, and health care providers.

Through a $50 million grant from AbbVie to rebuild and strengthen Puerto Rico’s healthcare system, Direct Relief has further awarded a $100,000 grant to Consejo Renal to offer free mental health services to address emotional distress, depression, post-traumatic stress disorder, and other mental health conditions.

It’s part of an ongoing effort to provide support to Puerto Rico’s renal patients.

To date, more than 900 hours of free psychological services have been provided through the program.

A greater need

Renal patients are prone to suffer from clinical depression and anxiety due to their condition, severely affecting their physical health. Suicide rates among this population are higher than those associated with other life-threatening health conditions and the general population.

Suárez explained that this is often due to multiple, compounded factors such as physical and psychosocial conditions, impacts on social support and financial well-being, isolation; and machine and medication dependency.

Rosa Estarellas, a psychologist with the organization, explained that the Renal Patients’ Emotional Assistance program is part of a greater effort to empower patients by giving them hope. Their health is already compromised, and any catastrophe is a danger to their physical well-being. Building the mental resiliency to weather new storms is an important tool.

“The biggest challenge is to take the patient into normalizing his or her condition and to have a good quality of life even with the condition,” Estarellas said.

After the quakes

Because these patients depend on dialysis treatment to survive, a sense of helplessness and dependence is common, Suárez said.

These feelings are exacerbated when natural disasters strike.

After the earthquakes, many houses and structures suffered severe damages. Suárez noted that about half of the patients and health care providers she worked with were displaced and forced to live in shelters, outdoor camps, and cars.

One patient suffering from renal deficiency depended on his wife, who had a heart condition of her own, to care for him. She was able to get him to safety during the earthquake, but both were concerned about their safety in light of future disasters.

Stories similar to this one are not uncommon, Suárez said. She noted that patients frequently shared experiences showing signs of trauma, conflicted loyalties, and survivor guilt.

These concerns continued, as did the aftershocks of the quake – some of them reaching magnitude 5.0, a significant event in itself. Psychologists fretted about whether they should be directing the patients to medication to control their anxiety or implement an evacuation protocol. They wanted to help patients achieve a state of peace – but also to remain alert.

And it wasn’t just the patients who were feeling the effects. Services needed to be available for nurses, doctors, social workers, and others as well.

Suárez said providers and their patients “are both survivors.”

If you are experiencing thoughts of suicide, please call the National Suicide Prevention Lifeline in the United States at 1-800-273-8255 (TALK).

The post After Puerto Rico’s Earthquakes, Renal Patients Feel Mental Health Effects appeared first on Direct Relief.

Hospitales y clínicas cerraron. También los centros de diálisis. Para los pacientes renales de Puerto Rico, que ya han vivido con problemas físicos y psicológicos relacionados con sus condiciones médicas, el impacto fue catastrófico.

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Alexia Suárez, psicóloga clínica que tenía la tarea de brindar servicios de salud mental a pacientes en diálisis después del terremoto, recordó a un paciente que padecía insuficiencia renal y vivía en un automóvil con sus hermanos.

Este es solo un escenario entre muchos que complican el acceso a la diálisis y otros tratamientos necesarios. Muchos proveedores tuvieron problemas para localizar a los pacientes que habían sido desplazados a refugios y campamentos. Otros pacientes tuvieron que ser trasladados a otros centros de tratamiento.

Y Suárez vio una mayor necesidad de servicios de salud mental tanto para los proveedores de atención médica como para los pacientes, ya que los servicios de atención médica se interrumpieron y continuaron las réplicas sísmicas.

Para muchos proveedores que atienden a pacientes en condiciones estresantes, fue la primera vez que hablaron con profesionales de salud mental desde que ocurrió el huracán. Pueden estar igualmente comprometidos y vulnerables como sus pacientes.

En general, dijo Suárez, los servicios de salud mental son fundamentales durante los esfuerzos de respuesta a emergencias y recuperación. Eso es especialmente cierto para los pacientes con enfermedades crónicas que ya experimentan problemas relacionados con la salud física y mental.

Después de las emergencias, los puertorriqueños suelen acudir en masa para ayudarse unos a otros, como hicieron después del huracán María y los terremotos. Pero a pesar de todos los gestos de generosidad que Suárez está acostumbrada a ver, dijo que los servicios profesionales de salud mental no siempre estuvieron tan disponibles como ahora.

En parte, dijo, la mayor disponibilidad se debió al huracán María, que tuvo graves consecuencias para la salud mental en toda la isla.

Superando nuevas tormentas

El Consejo Renal de Puerto Rico es una organización sin fines de lucro que trabaja para reducir la enfermedad renal crónica en la isla a través de la educación, la protección y la prevención.

Pero después de observar los impactos psicológicos del huracán María, sabían que faltaba una pieza del rompecabezas. Implementaron el programa de Asistencia Emocional para Pacientes Renales, diseñado para mejorar la calidad de vida de los pacientes renales, así como la de sus familias, los cuidadores y los proveedores de atención médica.

A través de una subvención de $50 millones de parte de AbbVie para reconstruir y fortalecer el sistema de salud de Puerto Rico, Direct Relief también otorgó una subvención de $100,000 al Consejo Renal para ofrecer servicios de salud mental gratuitos para abordar la angustia emocional, la depresión, el trastorno por estrés postraumático y otras enfermedades mentales.

Es parte de un esfuerzo continuo para brindar apoyo a los pacientes renales de Puerto Rico.

Hasta la fecha, se han brindado más de 900 horas de servicios psicológicos gratuitos a través del programa.

Una mayor necesidad Los pacientes renales son propensos a sufrir depresión clínica y ansiedad debido a su condición, afectando gravemente su salud física. Las tasas de suicidio entre esta población son más altas que las asociadas con otras condiciones de salud que amenazan la vida y la población en general.

Suárez explicó que esto a menudo se debe a múltiples factores compuestos como las condiciones físicas y psicosociales, los impactos en el apoyo social y el bienestar financiero, el aislamiento; y dependencia de máquinas y medicamentos.

Rosa Estarellas, la psicóloga de la organización, explicó que el programa de Asistencia Emocional para Pacientes Renales es parte de un esfuerzo mayor para empoderar a los pacientes dándoles esperanza. La salud de los pacientes ya está comprometida y cualquier catástrofe es un peligro para su bienestar físico. El desarrollo de la capacidad de recuperación mental para superar nuevas tormentas es una herramienta importante.

“El mayor desafío es llevar al paciente a normalizar su condición y tener una buena calidad de vida incluso con la condición”, dijo Estarellas.

Después de los terremotos

Debido a que estos pacientes dependen del tratamiento de diálisis para sobrevivir, es común una sensación de impotencia y dependencia, dijo Suárez.

Estos sentimientos se exacerban cuando ocurren desastres naturales.

Después de los terremotos, muchas casas y estructuras sufrieron graves daños. Suárez señaló que aproximadamente la mitad de los pacientes y proveedores de atención médica con los que trabajaba fueron desplazados y obligados a vivir en refugios, campamentos al aire libre y automóviles.

Un paciente que sufría de insuficiencia renal dependía de su esposa, que tenía una condición cardíaca propia, para que lo cuidara. Ella pudo llevarlo a un lugar seguro durante el terremoto, pero ambos estaban preocupados por su seguridad a la luz de futuros desastres.

Historias similares a esta no son infrecuentes, dijo Suárez. Señaló que los pacientes con frecuencia compartían experiencias que mostraban signos de trauma, lealtades en conflicto y culpa del sobreviviente.

Estas preocupaciones continuaron, al igual que las réplicas del terremoto, algunas de las cuales alcanzaron una magnitud de 5.0, un evento significativo en sí mismo. Los psicólogos se preocuparon con respeto a si deben dirigir a los pacientes a la medicación para controlar su ansiedad o implementar un protocolo de evacuación. Querían ayudar a los pacientes a alcanzar un estado de paz, pero también a permanecer alerta.

Y no solo los pacientes estaban sintiendo los efectos. Los servicios también debían estar disponibles para enfermeras, médicos, trabajadores sociales y otros.

Suárez dijo que los proveedores y sus pacientes ambos son sobrevivientes.

Si tiene pensamientos suicidas, llame a la Línea Nacional de Prevención del Suicidio en los Estados Unidos al 1-800-273- 8255 (TALK)

The post Después de los Terremotos de Puerto Rico, los Pacientes Renales Sienten los Efectos a su Salud Mental. appeared first on Direct Relief.

José Fernández ha sido bombero por 24 años. Estaba trabajando en la estación de bomberos en Cataño, Puerto Rico, cuando el huracán María causó estragos en la isla. Cataño está en la costa, y Fernández recuerda haber estado en riesgo de mareas de tormentas durante el huracán.

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Cuando terminó la tormenta, los bomberos como Fernández se encargaron del trabajo de rescate y recuperación, que incluyó la remoción de escombros de las calles. La estación en sí tuvo daños menores, pero las comunidades vecinas fueron mucho más afectadas.

Y en las semanas posteriores al huracán, los incendios causados por generadores de energía no eran algo fuera de lo normal.

Fernández recordó haber respondido a una llamada de una mujer que perdió todo cuando su casa se quemó en un incendio relacionado con un generador. “Para mí, aparte de la emergencia, cada vez que vemos a alguien perder algo debido a un incendio, es devastador”, dijo.

SIN AYUDA

La falta de energía provocó los incendios después del Huracán María en Puerto Rico. También hizo más difícil al responder.

Las comunicaciones fueron interrumpidas en gran parte de la isla, por lo que, aunque los bomberos podían responder rápidamente a un incendio, no podían pedir refuerzos si lo necesitaban. Con solo siete bomberos y cuatro paramédicos para cubrir dos turnos separados, estaban sin ayuda. «Éramos solo los que estábamos trabajando ese día», recordó Fernández.

Como gran parte de la isla, las estaciones de bomberos utilizaron generadores diésel por meses. “Básicamente éramos los únicos [en la comunidad] que teníamos electricidad gracias al generador de energía”, dijo Fernández.

La estación de bomberos en Cataño se convirtió en refugio y punto de contacto después de la tormenta. Los vecinos acudieron a la estación para cargar sus teléfonos, conectar sus equipos médicos e incluso almacenar sus medicinas.

Fernández describió a los miembros de la comunidad devolviéndoles el favor, llevando comida a los bomberos mientras hacían su trabajo.

Sin embargo, el menciono, la estación de bomberos continuaba sin electricidad aproximadamente seis veces al mes.

ENERGIA NUEVA

“La energía lo es todo para los socorristas, y una gran razón se debe a las comunicaciones”, dijo Hunter Johansson, fundador y director general de la organización sin fines de lucro Solar Responders.

Johansson vio el impacto que el huracán María tuvo en la isla y el papel indispensable que los bomberos y otros socorristas tuvieron en los esfuerzos de recuperación. Quería ayudarlos a ellos, y a sus comunidades, asegurándose de que tuvieran los recursos necesarios para responder a futuros desastres.

Para que eso suceda, equipó la estación de Cataño con energía renovable, con el apoyo de Direct Relief.

La energía garantizará que los 10 bomberos y los ocho paramédicos de la estación puedan hacer su trabajo, y pedir refuerzos, incluso si otro desastre compromete la energía y las comunicaciones en Puerto Rico.

Como parte del compromiso de Direct Relief y AbbVie de apoyar a los socorristas, se otorgó una subvención de más de $90,000 a Solar Responders para instalar los paneles solares y el sistema de almacenamiento de baterías que necesitaba la estación en Cataño.

Con el apoyo de AbbVie, Direct Relief ha proporcionado energía renovable a los centros de salud en todo Puerto Rico, lo que les permite seguir atendiendo a los pacientes incluso en caso de un desastre natural u otra emergencia.

“La instalación de sistemas de energía renovable y resistente en ubicaciones estratégicas como estaciones de bomberos y clínicas de salud en la isla no solo permitirá la continuidad de las operaciones después de una emergencia, sino que también capacitara a los socorristas”, dijo Ivonne Rodríguez-Wiewall, asesora ejecutiva de Direct Relief en Puerto Rico.

Para Johansson, poder proporcionar energía renovable a los socorristas “es una reafirmación de que puedan hacer su trabajo”.

Fernández está seguro de que el sistema de energías renovables les ayudará a estar mejor preparados para otra emergencia. “Para nosotros, es un alivio poder contar con ese recurso”, dijo.

The post Después del huracán María, estos bomberos respondieron sin energía. Ahora tienen una fuente renovable. appeared first on Direct Relief.

José Fernández has been a firefighter for 24 years. He was working at the fire station in Cataño, Puerto Rico, when Hurricane María wreaked havoc on the island. Cataño is on the coastline, and Fernández remembers being at risk of storm surge during the hurricane.

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When the storm was over, firefighters like Fernández were tasked with rescue and recovery work, which included removing debris from the streets. The station itself had only minor damage, but neighboring communities were harder hit.

And in the weeks following the hurricane, fires caused by power generators were not uncommon.

Fernández remembered responding to a call from a woman who lost everything when her house burned down in a generator-related fire. “For me, aside from the emergency, every time we watch somebody lose something because of a fire, it’s devastating,” he said.

On their own

A lack of power caused Puerto Rico’s post- María fires. It also made it harder to respond.

Communications were down for much of the island, so although firefighters could respond quickly to a blaze, they couldn’t call for backup if they needed it. With only seven firefighters and four paramedics to cover two separate shifts, they were on their own. “It was just those of us who were working that day, Fernández recalled.

Like much of the island, fire stations relied on diesel generators for months. “We were basically the only ones [in the community] who had electricity because of the power generator,” Fernández said.

The firehouse in Cataño became a shelter and point of contact in the aftermath of the storm. Neighbors went to the station to charge their phones, connect their medical equipment, and even store their medicines.

Fernández described members of the community returning the favor, bringing food to the firemen while they did their work.

However, he said, the fire station continued to lose power approximately six times a month.

New energy

“Power is everything for first responders, and a big reason is because of communications,” said Hunter Johansson, the founder and CEO of the nonprofit organization Solar Responders.

Johansson saw the toll Hurricane María took on the island, and the indispensable role that firefighters and other first responders played in recovery efforts. He wanted to help them – and their communities – by making sure they had the resources necessary to respond to future disasters.

To make that happen, he outfitted the Cataño station with renewable energy, with support from Direct Relief.

The energy will ensure that the station’s 10 firefighters and eight paramedics can do their jobs – and call for backups – even if another disaster compromises power and communications in Puerto Rico.

As part of Direct Relief and AbbVie’s commitment to supporting first responders, a grant of more than $90,000 was awarded to Solar Responders to install the solar panels and battery storage system that the Cataño station needed.

With AbbVie’s support, Direct Relief has provided renewable energy to health centers across Puerto Rico, allowing them to continue caring for patients even in the event of a natural disaster or other emergency.

“Installing renewable and resilient energy systems in strategic locations such as fire stations and health clinics on the island will not only allow for continuity of operations after an emergency but will also empower first responders,” said Ivonne Rodríguez-Wiewall, executive advisor for Direct Relief in Puerto Rico said.

For Johansson, being able to provide renewable energy to first responders “is a reaffirmation that they can do their work.”

Fernández is certain that the renewable energy system will help them be better prepared for another emergency. “For us, it is a relief to be able to rely on that resource,” he said.

The post After Hurricane María, These Firefighters Responded Without Power. Now, They Have a Renewable Source. appeared first on Direct Relief.

“Solíamos viajar mucho”, dijo Ramos. “Ahora, simplemente salgo de casa para ir a la iglesia y al supermercado. [Del Valle] no sale”.

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La pareja está jubilada, pero durante la pandemia, han estado cuidando a su nieto y actuando como tutores informales durante el año académico virtual.

“Trabajamos con él hasta altas horas de la noche”, dijo Ramos. El gran volumen de asignaciones, y los desafíos de navegar a través de la tecnología virtual, fue abrumador. “No estábamos preparados para esto”.

El Departamento de Salud de Puerto Rico ha establecido 11 sitios de vacunación a gran escala alrededor de la isla. El objetivo es inmunizar a más de 620.000 personas para fines de junio. Según la Guardia Nacional de Puerto Rico, más de 320,000 dosis de la vacuna Covid-19 han llegado a Puerto Rico. Más de 160.000 personas han recibido su primera dosis.

Ramos y Del Valle estaban entre esos 160.000.

“Esperamos hacer un viaje pronto”, dijo Del Valle.

LAS ORGANIZACIONES LOCALES AVANZAN

Gladys Cisneros y su hija Betsy Suárez recibieron la vacuna Moderna en el Centro Cultural Yolanda Guerrero en Guaynabo, donde VOCES, la principal coalición de inmunización de Puerto Rico y socio de Direct Relief desde hace muchos años, administra un sitio de vacunación.

Cisneros, que vive sola, no ha podido ver a su familia. Ella solo se ha estado comunicando con ellos por teléfono. “[La vacuna] nos dio esperanza”, dijo Suárez. “Podemos ver la luz al final del túnel”.

Lilliam Rodríguez, directora ejecutiva de VOCES, espera expandir su iniciativa de vacunación para aumentar el ritmo de la inmunización y llegar a más personas.

Al igual que VOCES, los centros de salud comunitarios de la isla han encabezado la lucha contra COVID a través de sitios de pruebas, rastreo de contactos y monitoreo de pacientes que dieron positivo. Ahora están administrando vacunas.

Direct Relief ha apoyado a los centros durante toda la pandemia, principalmente a través de la provisión de subvenciones, EPI, donaciones de carpas y servicios de telesalud. Direct Relief también equipó todos los centros de salud de Puerto Rico con refrigeradores de grado médico para aumentar la capacidad de las clínicas de almacenar medicamentos y vacunas sensibles a la temperatura.

Un centro de salud, Health Pro Med, ya está inmunizando a 300 personas por día, según su directora ejecutiva, Ivonne Rivera.

“Todo está funcionando sin problemas”, dijo.

The post En Puerto Rico, las vacunas Covid-19 están en plena marcha appeared first on Direct Relief.

“We used to travel a lot,” Ramos said. “Now, I just leave the house to go to church and the supermarket. [Del Valle] doesn’t go out.”

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The couple is retired, but during the pandemic, they’ve been taking care of their grandson – and acting as informal tutors during the virtual academic year.

“We worked with him until late at night,” Ramos said. The sheer volume of assignments – and the challenges of navigating virtual technology – was daunting. “We were not prepared for this.”

The Puerto Rico Department of Health has set up 11 large-scale vaccination sites around the island. The goal is to immunize more than 620,000 people by the end of June. According to the Puerto Rico National Guard, more than 320,000 doses of Covid-19 vaccine have arrived in Puerto Rico. More than 160,000 people have received their first dose.

Ramos and Del Valle were among those 160,000.

“We are hoping to take a trip soon,” said Del Valle.

Local Organizations Step Up

Gladys Cisneros and her daughter Betsy Suárez received the Moderna vaccine at the Yolanda Guerrero Cultural Center in Guaynabo, where VOCES, Puerto Rico’s main immunization coalition and a longtime Direct Relief partner, is running a vaccination site.

Cisneros, who lives alone, has not been able to see her family. She has only been communicating with them by phone.

“[The vaccine] gave us hope,” Suárez said. “We can see the light at the end of the tunnel.”

Lilliam Rodríguez, Executive Director of VOCES, hopes to expand their vaccination initiative to both increase the pace of immunization and reach more people.

Like VOCES, the island’s community health centers have spearheaded the fight against COVID through testing sites, contact tracing, monitoring of patients who have tested positive. Now, they’re administering vaccines.

Direct Relief has supported the centers throughout the entirety of the pandemic, mainly through the provision of grants, PPE, and tent donations, telehealth services. Direct Relief also outfitted all Puerto Rico’s health centers with medical-grade refrigerators to boost the clinics’ capacity to store temperature-sensitive medications and vaccines.

One health center, Health Pro Med, is already immunizing 300 people per day, according to its executive director, Ivonne Rivera.

“Everything is running smoothly,” she said.

The post In Puerto Rico, Covid-19 Vaccinations Are in Full Swing appeared first on Direct Relief.

Dr. Celia Lozada, a family physician from the community health center, MedCentro, said that one of her patients, a woman in her 50s who had undergone a stroke and was placed in a senior living center, relishes her telehealth access.

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“She can contact me more consistently, rather than waiting to be taken to the appointment,” Lozada said. “This gives her more independence.”

Community health centers like MedCentro are widely used in Puerto Rico, where a significant proportion of the population is medically underserved.

But for people living in rural communities, transportation is often a barrier to receiving timely health care. Coupled with the mass exodus of health care providers from Puerto Rico, which has been ongoing for years, this lack of access means real, sometimes serious delays for primary and specialty care.

Some patients have waited as long as eight months to see a doctor.

In addition, most community health centers don’t have specialists on staff. That means that residents living in the island’s more remote, often mountainous communities have to travel to urban centers, like Ponce and San Juan, to receive consultations.

A natural disaster can severely affect road travel – which, in turn, affects the continuity of health care services across Puerto Rico.

For example, the January 2020 earthquakes, which caused serious damage in the municipalities of Yauco and Ponce, halted specialty care in those areas. Even those not in the quake-affected zones couldn’t travel to their specialists.

Increasing Access to Healthcare

To broaden access to these essential services in rural communities, Direct Relief awarded grants to the Puerto Rico Science, Technology, and Research Trust, or PRSTRT, and to the Ponce Medical School Foundation, or PMSF, to provide specialty and mental health care, respectively.

In collaboration with doctors from the University of Puerto Rico’s School of Medicine, the PRSTRT is providing telemedicine consultations with specialist doctors to patients in clinics in the municipalities of Castañer, Jayuya, and Arroyo.

This access has made an essential difference to patients, said Dr. José Rodríguez, medical director at the Hospital General in Castañer. The clinic can now provide once-a-week consultations with a pneumologist and an ophthalmologist.

“We don’t have nephrologists, or psychiatrists [because] they are hard to find. With the telemedicine equipment we can have all the specialist doctors we need,” said Rodríguez. He expects the clinic to offer these specialty services starting early next year.

In addition, the technology allows hospitalized patients to access remote services.

Ongoing emergencies after Hurricane María continue to strain the mental health of many Puerto Ricans. Dr. Laura Domenech, Senior Medical Officer for the Ponce School of Medicine Foundation, reports that the earthquakes and the Covid-19 pandemic have resulted in a broad demand for behavioral therapists and psychiatrists.

And providers of mental health services are in short supply, particularly in remote communities.

Domenech said telemedicine has bolstered their capacity to provide mental health services in over 40 municipalities. At the same time, it’s helped them overcome some of the stigma of seeking mental health care.

“Since people don’t have to visit a doctor’s office, it is easier for patients to speak from the comfort of their own house,” Domenech explained.

Dr. Virgen Quiñones, a psychiatrist from the Ponce School of Medicine, oversees the treatment of these patients. In particular, she said that patients with substance use disorders have benefited from access to telemedicine.

She described two patients in particular, both of whom are now in remission after more than 10 years of substance use.

“Telemedicine has been a blessing. Their situation would have been different otherwise because of accessibility issues,” Quiñones said.

Looking into the Future

In addition, building on assessments made after Hurricane María and in response to the Covid-19 pandemic, Direct Relief awarded $1 million among 16 health centers to implement an island-wide telehealth network designed to deliver primary and preventative care.

While the immediate goal is to protect patients and healthcare workers during the public health emergency, the organization sees telehealth as a sustainable solution to the island’s scarcity of healthcare professionals and transportation barriers.

Physicians, too, maintain that telehealth has been paramount in monitoring their patients’ health in general, particularly for those with chronic conditions.

In the wake of the earthquakes, many patients lost their homes and had to relocate – interrupting their treatment in the process. Since the pandemic, too, some patients with chronic conditions have gone unmonitored because they were afraid to visit health care facilities.

Telehealth is changing that. Lozada, the MedCentro physician, said she’s been able to nearly double the number of patients she sees, and to provide more frequent monitoring.

“Follow-up is easier,” she said. “By providing them with telehealth access, they are motivated to seek care, since they can contact us from wherever they are.”

Since Hurricane Maria made landfall in Puerto Rico, and with the support of AbbVie, Direct Relief has provided $84.2 million worth of medical aid and more than $17 million in financial assistance for emergency response and ongoing support of the island’s health system.

The post Telemedicine is Sweeping Puerto Rico, and It’s Here to Stay appeared first on Direct Relief.

La Dra. Celia Lozada, médica de familia del centro de salud comunitario, MedCentro, dijo que uno de sus pacientes, una mujer de 50 años que había sufrido un derrame cerebral y fue internada en un centro para personas mayores, disfruta de su acceso a telesalud. “Puede comunicarse conmigo de manera más constante, en lugar de esperar a que la lleven a la cita”, dijo Lozada.

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“Esto le da más independencia”. Los centros de salud comunitarios como MedCentro se utilizan ampliamente en Puerto Rico, donde una proporción significativa de la población está médicamente desatendida. Pero para las personas que viven en comunidades rurales, el transporte suele ser una barrera para recibir atención médica oportuna.

Junto con el éxodo masivo de proveedores de atención médica de Puerto Rico, que ha estado ocurriendo durante años, esta falta de acceso significa retrasos serios, a veces graves, para la atención primaria y especializada. Algunos pacientes han esperado hasta ocho meses para ver a un médico. Además, la mayoría de los centros de salud comunitarios no cuentan con especialistas en el personal.

Eso significa que los residentes que viven en las comunidades más remotas y a menudo montañosas de la isla tienen que viajar a centros urbanos, como Ponce y San Juan, para recibir consultas. Un desastre natural puede afectar gravemente los viajes por carretera, lo que, a su vez, afecta la continuidad de los servicios de salud en todo Puerto Rico. Por ejemplo, los terremotos de enero del 2020, que causaron graves daños en los municipios de Yauco y Ponce, frenaron la atención especializada en esas áreas. Incluso aquellos que no se encontraban en las zonas afectadas por el terremoto no pudieron acudir a sus especialistas.

AUMENTAR EL ACCESO A LA ATENCIÓN MÉDICA

Para ampliar el acceso a estos servicios esenciales en las comunidades rurales, Direct Relief otorgó subvenciones al Fideicomiso de Ciencia, Tecnología e Investigación de Puerto Rico, o PRSTRT, y a la Fundación de la Escuela de Medicina de Ponce, o PMSF, para brindar atención especializada y de salud mental, respectivamente. En colaboración con médicos de la Facultad de Medicina de la Universidad de Puerto Rico, la PRSTRT está brindando consultas de telemedicina con médicos especialistas a pacientes en clínicas de los municipios de Castañer, Jayuya y Arroyo.

Este acceso ha marcado una diferencia fundamental para los pacientes, dijo el Dr. José Rodríguez, director médico del Hospital General de Castañer. La clínica ahora puede brindar consultas una vez a la semana con un neumólogo y un oftalmólogo. “No tenemos nefrólogos ni psiquiatras [porque] son difíciles de encontrar. Con el equipo de telemedicina podemos tener todos los médicos especialistas que necesitamos”, dijo Rodríguez. Espera que la clínica ofrezca estos servicios especializados a partir del próximo año.

Además, la tecnología permite a los pacientes hospitalizados acceder a servicios remotos. Las emergencias en curso después del huracán María continúan afectando la salud mental de muchos puertorriqueños. La Dra. Laura Domenech, Oficial Médico Superior de la Fundación de la Escuela de Medicina de Ponce, informa que los terremotos y la pandemia Covid-19 han dado lugar a una amplia demanda de terapeutas cognitivo conductuales y psiquiatras.

Y los proveedores de servicios de salud mental son escasos, particularmente en comunidades remotas. Domenech dijo que la telemedicina ha reforzado su capacidad para brindar servicios de salud mental en más de 40 municipios. Al mismo tiempo, les ha ayudado a superar parte del estigma de buscar atención de salud mental.

“Dado que las personas no tienen que ir al consultorio de un médico, es más fácil para los pacientes hablar desde la comodidad de su propia casa”, explicó Domenech. La Dra. Virgen Quiñones, psiquiatra de la Facultad de Medicina de Ponce, supervisa el tratamiento de estos pacientes. En particular, dijo que los pacientes con trastornos por uso de sustancias se han beneficiado del acceso a la telemedicina. Describió a dos pacientes en particular, quienes ahora están en remisión después de más de 10 años de consumo de sustancias. “La telemedicina ha sido una bendición. Su situación habría sido diferente de otra manera debido a problemas de accesibilidad”, dijo Quiñones.

MIRANDO AL FUTURO

Además, sobre la base de las evaluaciones realizadas después del huracán María y en respuesta a la pandemia de Covid-19, Direct Relief otorgó $1 millón entre 16 centros de salud para implementar una red de telesalud en toda la isla diseñada para brindar atención primaria y preventiva.

Si bien el objetivo inmediato es proteger a los pacientes y los trabajadores de salud durante la emergencia de salud pública, la organización ve la telesalud como una solución sostenible para la escasez de profesionales de la salud y las barreras de transporte en la isla. Los médicos también sostienen que la telesalud ha sido primordial para monitorear la salud de sus pacientes en general, particularmente para aquellos con enfermedades crónicas.

En la estela de los terremotos, muchos pacientes perdieron sus hogares y tuvieron que reubicarse, interrumpiendo su tratamiento en el proceso. Desde el principio de la pandemia, también, algunos pacientes con enfermedades crónicas no han sido monitoreados porque tenían miedo de visitar los centros de salud. La telesalud está cambiando eso. Lozada, la médica de MedCentro, dijo que ha podido casi duplicar el número de pacientes que atiende y proporcionar un seguimiento más frecuente.

“El seguimiento es más fácil”, dijo. “Al brindarles acceso a telesalud, se sienten motivados a buscar atención, ya que pueden contactarnos desde donde se encuentren”.

Desde que el huracán María tocó tierra en Puerto Rico, y con el apoyo de AbbVie, Direct Relief ha proporcionado un total de $84.2 millones en ayuda médica y más de $17 millones en asistencia financiera para la respuesta de emergencia y el apoyo continuo al sistema de salud de la isla.

The post La telemedicina está arrasando en Puerto Rico y llegó para quedarse appeared first on Direct Relief.

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Para los afortunados cuyas casas o departamentos no sufrieron daños, García Ortiz los visitó en su domicilio. Para las mujeres que fueron desplazadas, iría a los refugios. Después del terremoto, su día comenzaba a las ocho de la mañana cada mañana y terminaba a las 10 de la noche, cuidando a más de 100 mujeres diariamente en la región gravemente afectada al suroeste de la isla.

El terremoto causó daños significativos y extensos, dejando muchas casas inhabitables. Aproximadamente 3.000 personas fueron a refugios al aire libre administrados por el gobierno, según el Departamento de Estado, mientras que otros crearon sus propios refugios improvisados en campos de béisbol y parques.

Incluso las personas cuyas casas no sufrieron daños eligieron quedarse en refugios, por temor a que las réplicas sísmicas pudieran golpearles después. La salud mental en Puerto Rico, que ya era frágil después del huracán María, experimentó un revés adicional. Aunque los hospitales de la región no sufrieron daños, establecieron protocolos de seguridad y establecieron hospitales portátiles con carpas en sus estacionamientos como medida de precaución.

Mientras la mayoría de los servicios médicos aún estaban disponibles, el acceso a la atención prenatal era más difícil de conseguir, dijo García Ortiz.

CUIDADO PRENATAL Y MÁS ALLÁ

Incluso antes de los terremotos, dijo García Ortiz, muchos de sus pacientes no recibían suficiente atención prenatal, o tenían otras condiciones de salud monitoreadas, dado que vivían lejos de un consultorio médico y tendrían que esperar muchas horas para recibir tratamiento.

Pero a raíz de las circunstancias elevadas a causa de los terremotos, García Ortiz vio la necesidad y dio un paso al frente, desempeñando un papel crucial en el apoyo a las mujeres embarazadas de la región. No es ajena a las situaciones difíciles. Partera y trabajadora social voluntaria, no solo se ocupa de las mujeres durante el embarazo.

Si las mujeres y las adolescentes embarazadas con las que trabaja necesitan ayuda para encontrar una fuente de alimento, ella las ayudará a hacerlo. Si experimentan violencia por la pareja íntima, ella los acompaña a través del proceso legal y encuentra los recursos de asesoría adecuados.

Después del huracán María y los terremotos de 2020, García Ortiz y otros colegas notaron que las mujeres estaban experimentando partos prematuros debido al estrés, la depresión y otros problemas de salud mental. Al visitar a las mujeres en sus hogares, García Ortiz notó condiciones insalubres e incluso niños desnutridos.

“Los desastres naturales causan mucha inseguridad, especialmente si hay perdida de trabajo”, dijo. “Esto generó mucho estrés. Muchas mujeres tenían dificultad al sentir a sus bebés”.

UNA NUEVA FORMA DE ATENCIÓN A LOS PACIENTES

A menudo, García Ortiz siente que los bajos ingresos y la falta de información sobre lo que está disponible se interpretan como barreras para los servicios de atención médica. Para superar esto, ha comenzado a colaborar con el Centro Familiar Cristiano, una iglesia en Sabana Grande. Durante el huracán María y los terremotos, la iglesia ofreció apoyo emocional, alimentos y suministros de emergencia para mujeres embarazadas y niños.

Ahora, trabajando con García Ortiz durante la pandemia, han ayudado a más de 300 familias con alimentos y han brindado a más de 40 mujeres embarazadas la atención prenatal y posparto que necesitaban. Además, para asegurarse de que las mujeres tengan un lugar confiable para encontrar atención de salud materna incluso durante tiempo de emergencias, García Ortiz y el Centro Familiar Cristiano decidieron equipar un área de las instalaciones de la iglesia con el equipo necesario.

Cuando no haya emergencia, el área se utilizará para brindar clases gratuitas de parto y lactancia a las mujeres en las zonas de la isla afectadas por el terremoto. Ahí es donde entra Direct Relief. La organización, con el apoyo financiero de AbbVie, donó una máquina de ultrasonido portátil y un monitor cardíaco fetal portátil al recién establecido Centro de Salud Familiar Cristiano, lo que permite a las parteras cuidar a las mujeres tanto en la iglesia como, en caso de que la situación lo requiera, en sus hogares, refugios o en cualquier otro lugar donde se necesite ayuda.

Para García Ortiz la portabilidad, que incluye la capacidad de moverse y tratar a los pacientes en casi cualquier lugar, es la mayor fortaleza de una partera. Y en una isla donde los ginecólogos y obstetras ya son muy escasos, está convencida de que las parteras tienen un papel vital que desempeñar, ya sea que haya un desastre o no.

Desde que el huracán María tocó tierra en Puerto Rico, Direct Relief ha proporcionado un total de $75 millones en ayuda médica y apoyo financiero a proveedores de salud y organizaciones locales en la isla, incluyendo a las que respondieron a la serie de terremotos de este año. Este apoyo equivale a más de 600.000 libras de ayuda médica y 10,6 millones de dosis diarias precisas de medicamentos.

The post Conozca A La Partera Que Cuida A Algunas De Las Mujeres Más Vulnerables De Puerto Rico appeared first on Direct Relief.

For the lucky ones whose houses or apartments were undamaged, García Ortiz visited them at home. For women who were displaced, she’d go to the shelters. In the quake’s aftermath, her day would begin at eight each morning and end at 10 at night, caring for more than 100 women daily throughout the severely affected southwest region of the island.

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The quake caused widespread and significant damage, leaving many houses uninhabitable. About 3,000 people went to government-run outdoor shelters, according to the State Department, while others created their own impromptu shelters in baseball fields and parks.

Even people whose homes weren’t damaged elected to stay in shelters, fearing that the significant aftershocks might hit them next. Mental health in Puerto Rico, already fragile in the aftermath of Hurricane Maria, experienced an additional setback.

While the region’s hospitals were undamaged, they nonetheless established safety protocols and set up portable hospitals with tents in their parking lots as a precaution. While most medical services were still available, access to prenatal care was more difficult to come by, García Ortiz said.

Prenatal care and beyond

Even before the earthquakes, García Ortiz said, many of her patients did not receive sufficient prenatal care – or have other health conditions monitored – because they lived far from a doctor’s office and would have to wait long hours for treatment.

But in the heightened circumstances created by the earthquakes, García Ortiz saw the need and stepped up, playing a crucial role in supporting the region’s pregnant women.

She’s no stranger to difficult situations. A midwife and voluntary social worker, she doesn’t just care for women throughout their pregnancies. If the women and pregnant teenagers she works with need help finding a food source, she’ll help them do it. If they experience intimate partner violence, she accompanies them through the legal process and finds appropriate counseling resources.

In the aftermath of both Hurricane Maria and the 2020 earthquakes, García Ortiz and other colleagues noticed that women were experiencing premature births due to stress, depression, and other mental health concerns. When visiting women at their homes, García Ortiz noticed unsanitary conditions and even malnourished children.

“Natural disasters cause a lot of insecurity, especially if there is a job loss,” she said. “This generated a lot of stress. Many women had difficulty feeling their babies.”

A new way to care for patients

Often, García Ortiz feels, low income and a lack of information about what’s available translate into barriers to health care services. To overcome this, she has begun collaborating with Centro Familiar Cristiano, a church in Sabana Grande.

During Hurricane Maria and the earthquakes, the church offered emotional support, food, and emergency supplies for pregnant women and children. Now, working with García Ortiz during the pandemic, they have helped over 300 families with food and provided over 40 pregnant women with the prenatal and postpartum care they needed.

In addition, to make sure that women have a reliable place to find maternal health care even during emergencies, García Ortiz and Centro Familiar Cristiano decided to outfit an area of the church’s facility with the necessary equipment.

When there’s no emergency, the area will be used to provide free birthing and lactation classes to women in the quake-affected zones of the island.

That’s where Direct Relief comes in. The organization, with financial support from Abbvie, donated a portable ultrasound machine and a portable fetal heart monitor to the newly-established Centro de Salud Familiar Cristiano, allowing midwives to care for women both in the church and – should the situation call for it – in their homes, shelters, or wherever else help is needed.

For García Ortiz, it’s that portability – the ability to move around and treat patients almost anywhere – that’s a midwife’s greatest strength.

And on an island where gynecologists and obstetricians are already in short supply, she’s convinced that midwives have a vital role to play – whether or not there’s a disaster.

Since Hurricane Maria made landfall in Puerto Rico, Direct Relief has provided $75 million worth of medical aid and financial support to health providers and local organizations on the island, including those responding to this year’s series of earthquakes. This support equals more than 600,000 pounds of medical aid and 10.6 million defined daily doses of medication.

The post Meet the Midwife Caring for Some of Puerto Rico’s Most Vulnerable Women appeared first on Direct Relief.

Los daños críticos a la infraestructura del hospital, causados por fugas y vidrios rotos, dejó al cuarto piso como pérdida total. Hasta el día de hoy, FEMA continúa evaluando partes del hospital, generalmente conocido como HURRA.

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Cuando comenzó la reconstrucción, los líderes de HURRA estaban enfocados en preparaciones para tormentas futuras, no una pandemia. Pero cuando golpeó Covid-19, el hospital, uno de los tres pertenecientes al Departamento de Salud de Puerto Rico, estaba preparado para el golpe.

Mientras Direct Relief continúa protegiendo a los trabajadores de primera línea durante la pandemia global al proporcionar equipos de protección individual (EPI) y otros suministros vitales, la organización sigue enfocada en reforzar el sistema de atención médica de Puerto Rico, fortaleciéndolo a largo plazo.

Al mismo tiempo que mejoran la infraestructura, la organización ha proporcionado equipos médicos esenciales, que incluye videolaringoscopios, máquinas portátiles de rayos X, ventiladores y otros equipos al hospital HURRA, así como al Centro de Trauma de Puerto Rico y al Hospital Universitario Pediátrico.

CASOS CRÍTICOS

El hospital HURRA, como instalación pública, ya atendía a los pacientes independientemente de si podían pagar, tenían seguro o estaban documentados.

Cuando apareció Covid-19, el hospital se designó como una instalación de apoyo, una que recibiría pacientes en caso de que otros hospitales se saturaran. Pero los centros de diagnóstico y tratamiento cercanos, que no tienen las instalaciones para hospitalizar a los pacientes, rápidamente comenzaron a enviarles pacientes.

Durante los últimos siete meses, las salas de aislamiento de HURRA han permanecido casi llenas. En mayo, durante un aumento en los casos, incluso tuvieron que desviar a los pacientes a otros hospitales.

Para tratar con el flujo entrante de pacientes, el hospital adquirió nuevo equipo médico para lo que, antes de la pandemia, eran salas de aislamiento en gran parte sin uso, equipándolas con ventiladores y otros equipos. Para los pacientes con enfermedad renal, agregaron estaciones de diálisis a las habitaciones.

Incluso siete meses de que comenzara pandemia, las guías de tratamiento cambian continuamente, dijo Giselle Van Derdys, directora ejecutiva del HURRA. Sin embargo, Covid-19 les ha brindado la oportunidad de adquirir equipos que no tenían, lo que les permite brindar una mejor atención a los pacientes.

El tratamiento de la enfermedad ha hecho gran impacto, dijo Van Derdys. «El miedo y la incertidumbre que genera esta pandemia se refleja en los empleados», dijo. El EPI fue particularmente difícil de conseguir en los primeros días de Covid-19.

“TRAUMA Y COVID”

El Centro de Trauma de Puerto Rico, parte del Centro Médico en San Juan, se utiliza para tratar casos críticos. Diariamente, ven a las víctimas de accidentes, tiroteos y apuñalamientos.

Hasta ahora han tenido suerte. El centro resistió el embate del huracán María, y los terremotos que han sacudido el suroeste de Puerto Rico están afortunadamente lejanos, aunque al Dr. Pablo Rodríguez Ortiz, director del Centro de Trauma y cirujano, le preocupa que el Centro Médico no pueda resistir un terremoto más grande.

Pero Covid-19 es otro asunto.

“Durante los primeros meses [de la pandemia], me sentí orgulloso de decir que no teníamos ningún caso”, dijo Rodríguez Ortiz.

El Dr. Rodríguez Ortiz vio el centro de trauma como una forma de juzgar la situación más amplia de Covid-19 en la isla. “Al recibir gente de todas partes [de la isla], pudimos obtener una idea de lo que estaba pasando”, dijo.

Pero mientras las salas de emergencia atendían a pacientes con síntomas exacerbados de la enfermedad, tal como dificultad para respirar, el Centro de Trauma se ocupaba principalmente de las lesiones físicas, no de los casos graves de Covid-19. Rápidamente se dieron cuenta de que, para mantener seguros a sus empleados, tendrían que hacer pruebas a todos los pacientes que llegaran.

“Todos los pacientes son positivos para Covid hasta que se demuestre lo contrario”, dijo el Dr. Rodríguez Ortiz. “Los pacientes llegan con trauma y Covid. Eso significa que el número de infecciones ha aumentado” a medida que los pacientes asintomáticos se presentan con lesiones físicas.

UNA HISTORIA DE AYUDA

En los tres años transcurridos desde que el huracán María devastó Puerto Rico, Direct Relief ha proporcionado más de $100 millones en recaudamiento de fondos y ayuda financiera a la isla, en estrecha colaboración con la compañía farmacéutica AbbVie.

El apoyo de la organización ha variado ampliamente. Los centros de salud que atienden a los más vulnerables de Puerto Rico han recibido instalaciones solares que les permitirán mantener sus puertas abiertas durante futuras tormentas y unidades móviles para ayudarlos a llegar a las comunidades remotas de la isla, incluso si las carreteras están dañadas. Se organizaron paquetes de preparación para huracanes y se distribuyeron mochilas de emergencia en toda la isla.

Los refrigeradores y congeladores de vacunas han ampliado enormemente la capacidad de almacenamiento en frío de la isla. Se han construido pozos en comunidades remotas, proporcionando una fuente confiable de agua limpia incluso durante tormentas sucesivas.

Direct Relief también recaudo fondos para una variedad de programas en la isla que tratan problemas de salud mental y trastornos por uso de sustancias ilícitas, los cuales aumentaron a raíz del huracán María.

Más recientemente, la organización ha proporcionado EPI, equipo de quirófano y de emergencia, ventiladores y máquinas de rayos X para los pacientes que reciben tratamiento por Covid-19.

“UN INSTRUMENTO VITAL”

“Direct Relief … nos ha ayudado mucho … Hemos podido proporcionar EPI a nuestros empleados y algunos pacientes”, dijo Van Derdys. Además, los monitores hemodinámicos y los analizadores gasométricos de sangre han permitido una detección más rápida del estado de un paciente y proporcionan un tratamiento más preciso.

El Dr. Rodríguez Ortiz dijo que los video-laringoscopios eran “asombrosos” y explicó que el Centro de Trauma no tenía acceso a ellos antes de la donación de Direct Relief. Ahora el dispositivo es “parte de nuestra estrategia de intubación de pacientes debido a Covid, o en mi caso, debido a un trauma”, dijo. “Ha sido un instrumento vital” para intubaciones de alto riesgo. Tanto Van Derdys como el Dr. Rodríguez Ortiz esperan que los casos de Covid-19 aumenten en los próximos meses.

Pero ambos dijeron que el EPI y el equipo proporcionado por Direct Relief los ayudaría a sobrellevar esta nueva tormenta, y los haría más resistentes y capaces de ayudar a los pacientes en el futuro.

The post Mientras Covid-19 Arrasa en Puerto Rico, Los Hospitales de la Isla se Preparan para Reaccionar en Respuest appeared first on Direct Relief.

Critical damages to their infrastructure, caused by leaks and broken glass, had made their fourth floor a total loss. To this day, FEMA continues to assess parts of the hospital, which is generally known as HURRA.

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When rebuilding began, HURRA’s leaders were focused on being prepared for future storms, not a pandemic. But when Covid-19 hit, the hospital – one of three belonging to Puerto Rico’s Department of Health – was braced for the blow.

While Direct Relief continues to protect frontline workers during the global pandemic by providing PPE and other vital supplies, the organization remains focused on bolstering Puerto Rico’s health care system, strengthening it for the long haul.

As well as improving infrastructure, the organization has provided essential medical equipment, including video laryngoscopes, portable x-ray machines, ventilators, and other equipment to the HURRA hospital, as well as Puerto Rico’s Trauma Center and Pediatric University Hospital.

Critical cases

The HURRA hospital, as a public facility, already cared for patients regardless of whether they could pay, had insurance, or were documented.

When Covid-19 appeared, the hospital as designated a support facility – one that would receive patients in case other hospitals became saturated. But nearby diagnosis and treatment centers, which don’t have the facilities to hospitalize patients, quickly began sending patients their way.

Over the last seven months, HURRA’s isolation rooms have remained mostly full. In May, during a spike in cases, they even had to divert patients to other hospitals.

To treat the incoming flow of patients, the hospital acquired new medical equipment for what had been, before the pandemic, largely unused isolation rooms, outfitting them with ventilators and other equipment. For patients with renal disease, they added dialysis stations to rooms.

Even seven months into the pandemic, treatment guides change continuously, said Giselle Van Derdys, HURRA’s executive director. However, Covid-19 has given them an opportunity to acquire equipment they didn’t have, allowing them to better care for patients.

Treating the disease has taken its toll, said Van Derdys. “The fear and uncertainty that this pandemic generates is reflected in the employees,” she said. PPE was particularly hard to come by in the early days of Covid-19.

“Trauma and Covid”

The Puerto Rico Trauma Center, part of Centro Médico in San Juan, is used to treating critical cases. On any given day, they see the victims of accidents, shootings, and stabbings.

They’ve been lucky thus far. The center withstood the onslaught of Hurricane Maria, and the earthquakes that have rocked southwestern Puerto Rico are mercifully far away– although Dr. Pablo Rodríguez Ortiz, the director of the Trauma Center and a surgeon, worries that that Centro Médico may not be able to withstand a bigger earthquake.

But Covid-19 is another matter.

“During the first months [of the pandemic], I felt proud to say that we didn’t have any cases,” said Rodríguez Ortiz.

Dr. Rodríguez Ortiz saw the trauma center as a way to judge the larger Covid-19 situation on the island. “By receiving people from all over [the island], we could have an idea of what was happening,” he said.

But while emergency rooms were seeing patients with exacerbated symptoms of the disease, such as difficulty breathing, the Trauma Center primarily dealt with physical injuries, not with severe Covid-19 cases. They quickly realized that, to keep their employees safe, they would have to test every patient that arrived.

“Every patient is Covid positive until proven otherwise,” Dr. Rodríguez Ortiz said. “Patients arrive with trauma and Covid. That means that the number of infections has increased” as asymptomatic patients show up with physical injuries.

A history of help

In the three years since Hurricane Maria devastated Puerto Rico, Direct Relief has provided more than $100 million in aid and funding to the island, working closely with the pharmaceutical company AbbVie.

The organization’s support has varied widely. Health centers serving Puerto Rico’s most vulnerable have been supplied with solar installations that will allow them to keep their doors open during future storms and mobile units to help them reach the island’s remote communities, even if roads are damaged. Hurricane Prep Packs have been staged, and emergency backpacks distributed, throughout the island.

Vaccine fridges and freezers have vastly expanded the island’s cold storage capacity. Wells have been built in remote communities, providing a reliable source of clean water even during successive storms.

Direct Relief has also funded a range of programs on the island that treat mental health issues and substance use disorder – both of which increased in the wake of Hurricane Maria.

Most recently, the organization has provided PPE, emergency and operating room equipment, and ventilators and X-ray machines for patients being treated for Covid-19.

“A vital instrument”

“Direct Relief…has helped us a lot…We have been able to provide our employees and some patients with PPE,” said Van Derdys. Also, the hemodynamic monitors and blood gas analyzers have allowed a quicker screening of a patient’s condition and provide a more accurate treatment.

Dr. Rodríguez Ortiz called the video laryngoscopes “amazing,” explaining that the Trauma Center didn’t have access to them before Direct Relief’s donation. Now the device is “part of our strategy of intubating patients because of Covid, or in my case, because of trauma,” he said. “It has been a vital instrument” for high-risk intubations.

Both Van Derdys and Dr. Rodríguez Ortiz expect Covid-19 cases to rise over the next few months.

But both said that the PPE and equipment provided by Direct Relief would help them weather this new storm – and make them more resilient and able to help patients in the future.

The post As Covid-19 Sweeps Puerto Rico, The Island’s Hospitals Are Braced to Fight Back appeared first on Direct Relief.

“Estamos lidiando con un virus que, mientras se transmite, estamos aprendiendo a tratar, controlar y [comprender] las implicaciones que tiene”. Al comienzo de la pandemia, el Dr. García Goubern notó una disminución en el número de visitas a la sala de emergencias de su hospital. Al mismo tiempo, observó un aumento en la mortalidad de pacientes con enfermedades crónicas.

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“En los primeros meses, los pacientes tenían miedo de acudir a la sala de emergencias”, recordó. “Desafortunadamente, algunos de los que tenían enfermedades crónicas que se agravaron no salieron de sus casas por miedo, y lamentablemente murieron”. El Dr. Jesse Alemán Ortiz, jefe de la unidad de cuidados intensivos del Hospital Damas de Ponce, vio efectos similares. El Dr. García Goubern enfatizó que muchas de las muertes por enfermedades crónicas pueden prevenirse si las personas buscan ayuda a tiempo.

La clave es el diagnóstico precoz y la continuidad del tratamiento. “Hay algunas condiciones en las que no puedes dejar pasar 3 días”, dijo. Pero los puertorriqueños se han adaptado a vivir con Covid. En los últimos meses, dijeron ambos médicos, los pacientes se han sentido más cómodos al continuar con su atención primaria y especializada.

También han aumentado sus visitas a la sala de emergencias, lo que, si bien puede ayudar a reducir las muertes relacionadas con enfermedades crónicas, también ejerce más presión sobre el personal médico. Ambos médicos admitieron que su mayor temor es llevar el virus a casa.

“Mi miedo es llevar el virus a mi casa e infectar a mi esposa e hijos que han estado aislados [durante el cierre] y saben que [yo soy] su única exposición al virus”, dijo el Dr. Alemán Ortiz.

Como parte de la estrategia continua de Direct Relief para proteger a los trabajadores de primera línea durante la pandemia, la organización ha donado 124 respiradores motorizados purificadores de aire (PAPR), equipos no desechables que protegen contra el aire contaminado, a centros de salud comunitarios y hospitales en todo Puerto Rico.

Los PAPR fueron donados por 3M, socio de Direct Relief desde hace mucho tiempo, y fabricados por Ford. 3M se se puso en contacto con Direct Relief para ofrecer los respiradores y la organización rápidamente comenzó a distribuirlos a los proveedores de atención médica que atienden a pacientes durante la crisis de Covid-19.

Según los CDC, este equipo puede usarse para protección durante procedimientos de atención médica en los que los profesionales de la salud están expuestos a mayores riesgos de patógenos en aerosol, como intubaciones, resucitación cardiopulmonar, autopsias, ciertos procedimientos de odontología y pruebas de función pulmonar.

Se entregaron tres PAPR al Hospital San Lucas; dos fueron ingresados en la Unidad de Cuidados Intensivos y uno en la sala de emergencias. Los intensivistas, que atienden a pacientes críticamente enfermos, estarán entre los que usarán el equipo, dijo el Dr. García Goubern.

“Hacemos una serie de procedimientos en los que estamos en contacto directo con el paciente. [Con este equipo] podemos protegernos. Se puede reutilizar, por lo que lo desinfectamos como lo haríamos con cualquier otro equipo. Nos brinda seguridad, confianza y movilidad”, dijo. El Dr. Alemán Ortiz, cuyo hospital también recibió tres respiradores, dijo que “ha sido increíble”.

En el Hospital Damas, los PAPR fueron entregados a la sala de emergencias y la unidad de cuidados intensivos, donde los médicos estuvieron más expuestos. El Dr. Alemán Ortiz explicó que los trabajadores de la salud inicialmente sintieron una gran resistencia al tratamiento de pacientes sospechosos de Covid. Pero con este equipo, dijo, “ahora se sienten seguros”.

A la luz de la reciente orden ejecutiva que permite la reapertura de la mayoría de los establecimientos comerciales, ambos médicos esperan que los casos positivos sigan aumentando. De hecho, ambos dijeron que esperan que las condiciones empeoren a menos que las personas sigan las pautas de distanciamiento social y continúen el uso de las máscaras. Pero confían en que los PAPR ofrecerán la protección que necesitan para resistir los próximos meses.

The post Protegiendo A Trabajadores De Salud Al Frente De COVID-19 En Puerto Rico. appeared first on Direct Relief.

“Everybody is waiting on a magic pill that, when you take it, will eradicate Covid. Unfortunately, that will not happen,” said Dr. García Goubern, an emergency room doctor at San Lucas Hospital in Ponce. “We are dealing with a virus that, while it is being transmitted, we are learning how to treat, manage, and [understand] the implications it has.”

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At the beginning of the pandemic, Dr. García Goubern noticed a decrease in the number of visits to his hospital’s emergency room. At the same time, he observed an increase in mortality in patients with chronic conditions.

“In the first months, patients were scared to come to the emergency room,” he recalled. “Unfortunately, some of those who had chronic conditions that became acute did not leave their houses due to fear, and unfortunately died.”

Dr. Jesse Alemán Ortiz, chief of the intensive care unit at Ponce’s Damas Hospital, saw similar effects.

Dr. García Goubern emphasized that many of these chronic condition’s deaths can be preventable if people seek help on time. The key is early diagnosis and the continuity of treatment. “There are some conditions where you can’t let 3 days go by,” he said.

But Puerto Ricans have adapted to living with Covid. In recent months, both doctors said, patients have felt more comfortable continuing their primary and specialty care. They’ve also increased their visits to the emergency room – which, while it may help to reduce chronic disease-related deaths, also places more strain on medical staff.

Both doctors admitted that their biggest fear is bringing the virus home. “My fear is to take the virus to my house and infect my wife and kids who have been in isolation [during the lockdown] and know that [I am] their only exposure to the virus,” Dr. Alemán Ortiz said.

As part of Direct Relief’s ongoing strategy to protect frontline workers during the pandemic, the organization has donated 124 Powered Air Purifying Respirators (PAPRs), non-disposable equipment that protects against contaminated air, to community health centers and hospitals across Puerto Rico.

The PAPRs were donated by the 3M, which is a longtime partner of Direct Relief’s, and manufactured by Ford. 3M approached Direct Relief to offer the respirators, and the organization quickly began distributing them to health care providers caring for patients amid the Covid-19 crisis.

According to the CDC, this equipment can be used for protection during healthcare procedures in which health care professionals are exposed to greater risks of aerosolized pathogens such as intubations, CPR, autopsies, certain dentistry procedures, and pulmonary function tests.

Three PAPRs were delivered to the San Lucas Hospital; two were placed in the Intensive Care Unit and one in the emergency room. Intensivists, who care for critically ill patients, will be among those using the equipment, Dr. García Goubern said.

“We do a series of procedures where we are in direct contact with the patient. [With this equipment] we can protect ourselves. It can be reused, so we disinfect it as we would with any other equipment. It provides us with safety, trust and mobility,” he said.

Dr. Alemán Ortiz, whose hospital also received three respirators, said that “it has been amazing.”

At Damas Hospital, the PAPRs were delivered to the emergency room and intensive care unit, where doctors were most exposed. Dr. Alemán Ortiz explained that health care workers initially felt a great deal of resistance to treating suspected Covid patients. But with this equipment, he said, “they now feel safe.”

In light of the recent executive order allowing most commercial establishments to reopen, both physicians expect that positive cases will continue to rise. Indeed, both said that they expect conditions to worsen unless people follow social distancing guidelines and continue the use of masks.

But they are confident the PAPRs will offer the protection they need to weather the next few months.

The post Protecting Health Workers on Puerto Rico’s Covid-19 Frontlines appeared first on Direct Relief.