• As St. Vincent’s La Soufrière volcano repeatedly erupts, Direct Relief works to meet needs on the ground.

• Direct Relief provides 50 grants of $50,000 each to organizations around the world to help them continue their work amid the pandemic.

• As opioid overdoses increase, Direct Relief receives an additional 1 million doses of the overdose-reversing drug naloxone.

• A new program is helping Puerto Ricans prepare for future disasters by focusing on emotional resilience.

Top Stories

St. Vincent’s La Soufrière Volcano Has Repeatedly Erupted. Direct Relief Is Providing Medical Aid.

The situation: An active Caribbean volcano began erupting on April 9, one day after an imminent threat was declared.

The response: After discussing needs in the region with long-term partners, Direct Relief sent shipments of medical aid to the Pan American Health Organization and the Organization of Eastern Caribbean States.

The impact: These groups will have respiratory medications, N95 masks, burn creams, first aid kits, hygiene supplies, and other essential medical items to aid communities affected by the eruption.

Direct Relief Receives an Additional 1 Million Doses of the Overdose-Reversing Medication Naloxone

The situation: Opioid overdoses are on the rise, with over 87,000 drug overdose deaths occurring in the 12 months ending in September 2020 — the most ever in a 12-month period.

The response: Since 2017, Direct Relief has distributed naloxone to 725 organizations in 51 states and territories. Now, a longtime Direct Relief partner is donating an additional 1 million doses.

The impact: Clinics, public health departments, harm reduction organizations, and other organizations fighting the opioid epidemic will be able to distribute naloxone to people who use drugs, their families and communities, and first responders.

As Organizations Around the World Fight Covid-19, Direct Relief Supports 50 with $50,000 Grants

The situation: Groups providing everything from maternal health care to cancer treatments are dealing with increased costs, sick staff members, malnutrition among patients, and other challenges.

The response: Direct Relief is supporting organizations ranging from a midwifery group in Haiti to a Syrian association caring for refugees with $50,000 grants to help them meet increased needs.

The impact: The funding will buy PPE, pay staff members’ medical costs, and help these groups continue their vital work.

Repeated Disasters Have Worsened Mental Health in Puerto Rico. A New Program Is Increasing Resilience.

The situation: Mental health was already an issue in Puerto Rico. Then Hurricane Maria and a series of earthquakes caused widespread devastation.

The response: Puerto Rico’s Center for Mind-Body Medicine began a new program designed to increase Puerto Ricans’ emotional resilience – and to prepare them for future disasters. Direct Relief is supporting their efforts with a grant of more than $160,000.

The impact: Participants have learned skills to help them through Puerto Rico’s devastating 2020 earthquakes and the ongoing pandemic.

In Brief

The United States

• Over the past two weeks, Direct Relief has delivered 827 shipments to 577 health facilities in the U.S., totaling more than $11.4 million in value (wholesale).
• During that time, Direct Relief has issued more than $8.3 million in grants.
• After storms brought tornadoes and flooding to the southern United States, Direct Relief provided ongoing medical aid.
• Modeling by Direct Relief’s Research and Analysis team shows Covid-19 case counts climbing over the next two weeks.

Around the World

• In the past two weeks, Direct Relief has delivered 37 shipments to 35 international healthcare providers, totaling more than $53.9 million in value (wholesale).
• More than $670,000 in grants were distributed over the same two weeks.

The post Global Update: Volcanic Eruption; Overdose-Reversing Medication; Global Grants 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.

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.

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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.

And these days, all three are highly in demand.

“It’s been nonstop since Covid,” MacCalla said. “We get asked to respond to almost everything now, so we’re all trying to manage how much time we can put into each thing.”

It’s been one of the worst fire seasons on record in California, and severe wildfires have devastated swathes of Oregon and Washington as well. The Gulf Coast has seen an active storm season, with Hurricane Delta now poised to make landfall later this week. Puerto Rico has experienced a series of earthquakes, a drought, and most recently, flooding. And that’s just in the United States.

On top of a Covid response that has included $53.6 million in funding, medicines, and supplies, and nearly 7,000 shipments thus far, Direct Relief has also mounted an active response to the wildfires, providing $1.4 million and 117 shipments to more than 30 organizations. After responding to the year’s storms, including Hurricanes Laura and Sally, with approximately $2.5 million and 202 shipments, the organization is poised for response to Hurricane Delta.

In addition to funding testing initiatives and a telehealth program and providing emergency and operating-room equipment, tents, and PPE to frontline health care providers in Puerto Rico, Direct Relief has also provided additional aid in response to the earthquakes and flooding. Since January 1, the organization has dedicated about $6.4 million to Puerto Rico.

All in all, 2020 has been Direct Relief’s most active year thus far.

For a society used to treating disasters as discrete events – Hurricane Katrina, Superstorm Sandy, the Camp Fire – overlapping disasters, especially piled atop a devastating pandemic, may be overwhelming, even confusing.

And worse, when multiple disasters break out at any one time, they strain much-needed resources, from manpower to medicine, making it harder to respond effectively – and harder for communities to recover.

An unusual season

During a standard season, California has enough resources to handle its own fires, said Brad Alexander, assistant director of crisis communication’s at California’s Office of Emergency Services. If help is needed, Oregon and Washington are usually among the first states to provide it.

This year has been considerably more challenging. California hosted firefighters from Canada, Mexico, and Israel, along with less usually called-upon states like Montana, Texas, and New Jersey.

“We have thousands of firefighters in the state, and we’ve essentially put every mutual aid engine on the street,” Alexander said, speaking in mid-September. “As soon as the firefighters are off one engine, we put them on another to fight another fire…They’re just getting the minimal amount of rest, and then back out to duty.”

That description likely wouldn’t surprise Tricia Wachtendorf, a sociology professor and director of the Disaster Research Center at the University of Delaware.

Multiple disasters make “the ability to rely on mutual aid agreements much more difficult,” she said. “If we have multiple events that are taking place in surrounding areas, that surge capacity has to come from further away.” That means emergency responders may take longer to get there and be less familiar with the terrain or situation when they arrive.

In addition, when it comes to overlapping events, like the wildfires and the Covid-19 pandemic, “you may still be in the middle of a response, and your response to the next event might be complicated by the fact that that other event has not yet been completed,” Wachtendorf said.

That’s been especially complicated during the pandemic because its demands often contradict those of emergency response.

“We have fairly proven ways of dealing with population during protection,” said James Schultz, a professor at the University of Miami’s medical school and director of its Center for Disaster and Extreme Event Preparedness. Evacuation – which Shultz explains means gathering people together – is a part of that. “Where we have more equivocal evidence is how you safeguard them once they are together,” he said.

For Shultz, living in hurricane-prone Florida, the question of how best to respond to concurrent disasters is a personal one. “This is not so academic. This is literally in my hometown,” he said.

Living through disasters

It’s not just first responders and NGOs that are strained by multiple disasters. First and foremost, they’re hard on the people who live through them – although researchers are still learning precisely how.

Although a lot is known about individual traumas, “we don’t have something similar at the collective level,” said Lori Peeks, a sociology professor and director of the University of Colorado, Boulder’s Natural Hazards Center. “What about when people live through multiple collective traumas where their entire communities have been evacuated multiple times?”

For one thing, researchers already know that disasters aren’t equally destructive to all. They’re more likely to devastate those who are already vulnerable – people who are low-income, Black or brown, elderly, already ill, not speakers of English.

And new research, Peek said, suggests that multiple disasters “exacerbate those existing inequalities and make them worse.” There’s even evidence that, while multiple disasters can cause financial devastation for poorer Black Americans, higher-income white Americans may experience an increase in wealth over time.

Multiple disasters also endanger people’s ability to get the support they need, Peek said. She pointed to Hurricane Sally, which despite being a destructive, major hurricane, “was barely in the national news for a day,” she said. “If you don’t garner the national media, you’re not going to garner the resources and support…
More and more communities are just feeling overlooked, left behind.”

Recovery may take longer and place more stress on the people who experience multiple disasters, Wachtendorf said: “People just get exhausted. Those support networks may be frayed,” meaning that it’s harder for them to receive informal assistance or support, to recover property losses, and to rebuild their lives.

And they may be less likely to evacuate if another disaster occurs – whether from exhaustion or lack of available resources.

Concurrent or recurring disasters – for example, Butte County, already devastated by 2018’s Camp Fire, is currently confronting the vast North Complex Fire – also have significant mental health impacts, said Emanuel Maidenberg, a clinical professor of psychiatry at UCLA who focuses on disasters.

“We have more stressors…and on the other hands, we have limited sources for positive emotions” when one disaster after another occurs. “We kind of find ourselves in this one-two punch of more stress and fewer coping possibilities.”

Some good news: Wachtendorf said that many disaster-prone communities may develop a “disaster subculture” over time, making them more knowledgeable, organized, and prepared for future events.

A non-discrete event

It may feel like disasters are coming harder and faster than ever. In ways that’s true, as disaster seasons grow more active or severe, and everything happens against a background of Covid-19. But disasters have always been compounding events, Peek said.

She used the example of Hurricane Katrina. Primarily famous as the storm that breached levies and brought catastrophic flooding, Katrina also caused a series of devastating oil spills off the Gulf Coast and a tornado outbreak that reached as far as Pennsylvania. A few short weeks later, Katrina was followed by another major Gulf Coast storm, Hurricane Rita.

For a long time, researchers and policy makers often treated disasters “as though they were discrete events,” Peek said. “Our moment is obviously teaching us how important it is to think about people and systems when there are multiple disasters that are unfolding simultaneously.”

A natural disaster, for example, may lead to a cholera outbreak, as the 2010 Haiti earthquake did. It may not always be clear which of these events is whose responsibility.

But we’re going to have to figure it out, according to Peek.

“The world that we are living in right now, emergency managers haven’t even finished their one deployment…and then another disaster happens,” she said. “There’s a layering that is happening with disasters that is outstripping our resources.”

The post Multiple Disasters Strain Response Systems, Slow Recovery, and Deepen Inequity appeared first on Direct Relief.

By the time he was a year and a half, Emilio had lost the ability to grasp toys or turn around. He began having seizures.

Now three years old, Emilio has a rare genetic anomaly – FRRS1L – that significantly affects his ability to function. He relies on medical equipment to help him eat and breathe, which means that he needs a continual, reliable supply of electricity.

And in Puerto Rico, still recovering from Hurricane Maria, which hit the island in September of 2017 and knocked power out to large parts of the island for months on end, reliable power isn’t always easy to come by.

A series of earthquakes that hit the island beginning in late December of last year have caused repeated power outages.

When Maria hit, Emilio, still a baby, only needed one machine to help him manage his respiratory secretions. To help him breathe with the power out, Bonilla would turn on her car and use an inverter to give her son the therapy he needed.

Now, it’s harder. Since the earthquakes, Bonilla said, the electricity has been irregular. A nearby power box keeps “exploding,” cutting off electricity to her neighborhood. And when that happens, she worries that Emilio is going hungry.

A Fragile Situation

There are a number of children in Emilio’s position, explained Serafin Soto Caban, who coordinates the Department of Health’s Technology Dependent Youth Registry. Children – which in Puerto Rico, means under the age of 22 – who need a breathing machine, feeding machine, or other electronic resource to survive have had a difficult time since Maria hit the island.

“Since there was no power at their house, they were visiting the hospitals as a shelter and a way to get power to treat their condition,” Soto said. But some hospitals weren’t admitting these children because they didn’t know how they were going to get paid, and some ambulances weren’t picking them up, he said.

In the aftermath of the hurricane, Soto was asked to begin a registry of children throughout the island who depended on an electronic device.

“The government thinks the best place for [these children] in a disaster situation like a hurricane is in the home,” he said. It was just a question of making it possible for them to stay there.

Soto’s department is working with the families of these children to develop an emergency plan that will work whether or not a disaster will allow them to remain in their home. The mayors of the communities where they reside know which families need extra help and can follow up with them.

But a vital part of preparedness for a child who needs a breathing or feeding machine is a generator, to provide a reliable supply of electricity when the power goes out. For many families, a sufficiently powerful generator, which costs several hundred dollars, is an unmanageable expense.

“These are very humble families, low-income families, that are going through all these disasters in Puerto Rico for the last three years,” said Luis David Rodriguez, a Direct Relief staff member in Puerto Rico.

“Power in Puerto Rico is still very fragile,” Rodriguez said. Providing these children with reliable generators “is definitely a no-brainer.”

Less Fear, Greater Certainty

Direct Relief, with the support of AbbVie, is working closely with Puerto Rico’s Department of Health to provide generators for 32 Puerto Rican children under the age of 22.

The generators will mean a reliable source of power during the outages that regularly dot Puerto Rico. Greater safety during a hurricane or tropical storm. Less fear and uncertainty for children and parents alike.

For both Ariam Nicole Calderon, 20, and her brother Luis Enrique Calderon, 19, a generator will mean continuous access to much-needed ventilators.

The siblings – both of whom have a form of muscular dystrophy – couldn’t be more different, said their mother, Marta Rivera. Ariam, who likes to listen to classical music and nature sounds, is reserved and selective, while Luis is “more of a party boy” who loves to do the chicken dance, Rivera said in Spanish.

But both were placed on ventilators after inhaling food shortly after Maria, and need continuous access to oxygen. The new generators are “a huge help” in ensuring the siblings can breathe safely, Rivera said.

Almost all the generators are the same size – 3,500 watts.

But one larger one will go to support Alison de León, a 17-year-old girl whose immune disorder and chemical sensitivities require her to stay primarily in her room, where two purifiers run full-time and she has continuous access to oxygen.

Alison is so sensitive to chemicals in the air that she can be in her family’s living room for no more than half an hour at a time, said her mother, Sara de León.

The sensitivities also require her to eat a careful diet of fresh, organic foods, which means that the family’s refrigerator has to keep working, no matter what.

But Alison hasn’t let her health issues prevent her from developing a deep love for playing and composing music, de León said. She loves the flute and ukulele, and has additional interests in digital art and painting.

She’s even written a song about her immune condition.

But even with the generator, de León worries about Alison. There’s mold in the house, and even a neighbor outside without a mask poses a danger to her daughter. The stress of the earthquakes has exacerbated Alison’s illness.

A small solution

Even in the most straightforward of cases, there’s more to be done, Soto said.

Because of the pandemic, he hasn’t been able to do a full assessment of the needs of children in Puerto Rico, which range from breathing devices to specialized beds. It’s an island-wide problem, he explained.

The Department of Health doesn’t have the funds to purchase all of these things anyway, according to Soto. They rely on donations.

And the demand keeps growing. “Every day, there are more and more children” who need specialized equipment, Soto said.

But for Bonilla and Emilio, a generator will make all the difference in the world.

“Now I can be more at ease if I have a power outage at home,” Bonilla said. “Now I know that [Emilio] won’t be starving. He won’t have any trouble with his breathing.”

The post Families in Puerto Rico Find a New Source of Power appeared first on Direct Relief.

Most recently, aftershocks in early May – the largest was magnitude 5.4 – caused damage in the municipalities of Guánica and Guayanilla and near the larger city of Ponce.

The quakes devastated La Luna. “We had never experienced a thing like this,” William Ducós, a La Luna resident, told Direct Relief staff in Spanish. “It felt like everything was falling. You could not walk. You could not even move… Everything was dark when I went out and one of the balconies of one of the houses had fallen down in the middle of the road. My neighbors were crying because they had lost their house.”

Direct Relief staff members traveling to the neighborhood in mid-May found that many of the community’s houses had either been destroyed or were badly damaged and surrounded by debris.

“It’s house after house after house, completely collapsed,” said Ivonne Rodriguez-Wiewall, Direct Relief’s Puerto Rico advisor.

Most of those houses were marked with a spray-painted red X, indicating that the house was structurally unsound and people should no longer enter. Less-destroyed houses were marked in yellow, indicating “Enter with caution.”

And a number of people were living in tents or temporary wooden structures in front of their damaged homes. Others were sleeping in cars or nearby parks, or had moved in with family elsewhere – all in the midst of the Covid-19 lockdown. (The lockdown is now lifting on various aspects of Puerto Rican life.)

Living outside or in cramped conditions was concerning enough during the pandemic, Rodriguez-Wiewall said. “But now hurricane season is starting,” she pointed out. “They cannot be inside their house. They cannot be outside their house. These people are not safe.”

Rafael Gómez Román, a resident of La Luna, built his house himself, beginning with a small wooden structure that evolved over time into a sturdy cement home. His three daughters were born there. When the quakes hit, Gómez’s house was for sale – his wife, who has Alzheimer’s disease, needed care and could no longer live there.

Asked about living through the earthquakes, Gómez said, “Painful. In six seconds, losing everything one has.”

Rafael Espinoza Hijo’s house was marked with a yellow X. Espinoza lived there with his father and grandmother until the quakes. In front of the house was a small wooden module where Espinoza’s father, who uses a wheelchair, now sleeps. “We had to make the little house outside…because here it shakes every day,” he said in Spanish.

Espinoza still sleeps inside the house, reasoning that he can evacuate more quickly if needed. And his days are spent taking care of his father. “Now because of the earthquakes, I cannot travel to work because I am taking care of him. It’s not easy,” he said. “[Hurricane] Maria, earthquakes, and now Covid.”

Ducós had retired from Puerto Rico’s Department of Natural and Environmental Resources in December of last year. “I said to myself, ‘Now I have my retirement and my house.’ And then, on January 7, I didn’t have a house,” he said.

Even in Puerto Rico, Rodriguez-Wiewall said, the people affected by the most recent earthquakes aren’t top of mind. “It’s forgotten and the news has already moved on to Covid,” she said.

According to Rodriguez-Wiewall, when the quakes were extensively covered in local news, large numbers of people and organizations brought aid to the south. Between the lockdown and the news cycle, the picture has changed.

Traveling to La Luna to assess the needs of the people living there, she said, “they are just happy…just to have us there and have somebody to talk to. Just to have somebody to listen to them.”

But despite the loss of his house, Ducós was optimistic. “I am a person who tries to help others,” he said. “The important thing is that we are alive. It takes [a lot] to start everything from scratch. We have no other choice.”

Ana Umpierre contributed reporting to this story.

In response to the Covid-19 pandemic, Direct Relief, with support from companies such as Amazon, is providing PPE, tents for triage and testing, intensive-care unit supplies, and equipment such as ventilators and video laryngoscopes to hospitals and health centers throughout Puerto Rico.

The organization is also funding testing initiatives, including in senior care centers and drive-through testing sites. 

Responding to both the pandemic and the earthquake, the organization is coordinating a new telehealth initiative aimed at connecting 200,000 patients to safety net providers.

Direct Relief is also supplying “go bags” for emergency needs to employees of health centers in southern Puerto Rico. The organization is continuing to monitor the situation and is considering further interventions.

The post Neither Inside or Out: A Puerto Rican Neighborhood Devastated by Earthquakes Confronts Covid-19 appeared first on Direct Relief.

At least 50 families were dislocated by the quake, according to the Associated Press.

Shocks were felt in the wake of the event, according to Ivonne Rodriguez-Wiewall, Direct Relief’s Puerto Rico advisor.

“It’s bad. There’s a lot of structural damage, a lot of houses completely destroyed, a lot of people living outside in tents. Again,” Rodriguez-Wiewall said, referring to quakes that rattled the island earlier this year.

A number of displaced people formed impromptu camps, one in an unused baseball field. Some of them, Rodriguez-Wiewall explained, lack even basic supplies – including sufficient food.

“Some of them are not even eating three times a day. Some lost their jobs,” she said.

On May 6, Direct Relief staff distributed hygiene kits, solar and battery-operated lights, and other essential supplies to people – many of them elderly – displaced by the quake.

Puerto Rico is currently on lockdown due to the Covid-19 crisis, which has made it harder for people affected by the earthquake to receive aid.

In response to the pandemic, Direct Relief has been providing personal protective equipment,  intensive-care unit supplies, and tents for triage and testing to hospitals and health centers. The organization is also providing hospitals with ventilators, video laryngoscopes, and other requested equipment.

In addition, Direct Relief is working to fund testing initiatives, including in senior care centers and drive-through testing sites; providing tents and PPE to Puerto Rico’s Department of Health; and coordinating a telehealth initiative designed to connect 200,000 patients remotely to safety net providers.

The earthquake is just the most recent in a spate of seismic activity that has roiled the island since late December of last year. In particular, a magnitude 6.4 earthquake on January 6 caused power outages and a lack of running water, and damaged more than 8,000 houses.

That quake and associated seismic activity displaced thousands of Puerto Ricans, many of whom slept in their driveways, in shelters, or in impromptu camps.

In the wake of that event, at the request of Puerto Rico’s Department of Health, Direct Relief provided essential medicines and supplies to outfit 10 medical provider teams, and worked to coordinate medical services in Guánica.

During the distribution of supplies on May 6, Rodriguez-Wiewall encountered a number of families who have been living in tents since January.

They told her that, while they had seen an outpouring of aid when the quakes began, it has slowed since.

The lockdown is partly responsible, Rodriguez-Wiewall said. So is a lack of media attention.

“In January and February, there was a lot of news about this. You would see the highway going towards Ponce bumper to bumper with people bringing aid to the south,” she said. “But now with the lockdown, the help stopped.”

According to the United States Geological Survey, the most recent activity was actually an aftershock of the 6.4-magnitude earthquake. “The earthquake is part of a vigorous sequence in the same region that has included hundreds of small earthquakes,” USGS said in a survey.

Because the Richter scale is logarithmic, a 6.4 earthquake is actually about 10 times as large and 32 times stronger than the magnitude 5.4 earthquake that took place on Saturday, as determined by a USGS calculator.

Nonetheless, Saturday’s quake and the following shocks caused significant damage, briefly cutting power and damaging a number of homes and other structures. Houses in affected towns were marked with red, yellow, or green spray paint to indicate their relative level of safety, Rodriguez-Wiewall said.

Direct Relief is committed to helping people affected by the earthquakes, both with immediate needs and long-term recovery. The organization will continue to monitor the situation and respond as needed.

The post Earthquake Roils Southern Puerto Rico, Displacing at Least 50 Families appeared first on Direct Relief.

Rodriguez, a pastor at Iglesia Pentecostal de Jesucristo in Yauco, said that, after smaller quakes began to cause damage to the southern part of the island, she wanted to be prepared in case something worse happened.

Rodriguez and her husband headed straight for their car and drove to a site they’d chosen in advance. Neighbors saw them on the move and followed.

That exodus was the beginning of what became an approximately 280-person tent camp in Los Indios, a neighborhood in the southern Guayanilla municipality, where a number of buildings, including a church, were damaged.

The camp became an impromptu community – an outdoor shelter where evacuees of all ages cooked together, sang together and cared for one another for more than two weeks. A nurse who was among the evacuees kept track of blood pressure and other health issues.

A number of the people at Los Indios had fled houses that, while only slightly damaged, no longer felt safe.

“They did not want to return to their homes in case another big earthquake happened,” said Ivonne Rodriguez-Wiewall, a senior advisor in Puerto Rico for Direct Relief, who brought a team to the camp to provide medical supplies.

“What was amazing was that they didn’t know each other but they all worked together,” said Laura Domenech, a pediatrician at Clinica del Sur, which sent a mobile unit to the camp from Ponce to provide medical and mental health care.

Dr. Domenech was particularly struck by a woman who was brewing coffee for other evacuees, using a car battery connected to an inverter. “I’ll never forget her,” she said.

Los Indios wasn’t the only temporary community that cropped up after a series of earthquakes damaged structures and distressed residents, many of whom experienced lasting depression, anxiety, and post-traumatic stress after Hurricane Maria hit in 2017.

Instead, Dr. Domenech said, she came across several communities after Los Indios where Puerto Ricans had banded together – in open places a safe distance from trees and electrical lines – to care for one another.

This wasn’t the case when Maria hit, according to Dr. Domenech: During the hurricane, people primarily sought out established shelters. But the suddenness of the earthquakes – the strongest to strike Puerto Rico in a century forced people to move quickly to find safety. “The earthquake is something that was new to all of us,” she said.

In addition, during the earthquakes, Dr. Domenech explained, some didn’t trust that the official shelters would stand up to the shaking. “What is good for Maria is not good for an earthquake,” she said.

At Los Indios, Rodriguez, the pastor, acted as the community’s informal leader, rising before dawn to prepare coffee, care for evacuees, and plan for community needs. “I couldn’t stop thinking about ways to help my neighbors, our elders,” she said.

After a few days, help – including supplies and medical care – began to arrive. Direct Relief organized a mobile health outpost, with health care providers checking in on chronic health conditions and providing psychological support.

What the people at the camp most needed, Rodriguez said, were mental health providers. “We were all scared,” she said. “When you are scared, you cannot be OK.”

Despite the uncertainty of the situation, Rodriguez-Wiewall and Dr. Domenech were impressed by the sense of calm and community they found.

“Kids were playing around while some adults rested. Others were chatting or playing cardboard games,” Rodriguez-Wiewall recalled. “They [were] all a big family.”

“They knew about other people’s needs, and they would make sure that I went to that person and nobody was left behind,” Dr. Domenech said.

The camp has since disbanded, as the earthquakes grew milder and people began to return to their homes. But Rodriguez is proud of the improvised group effort she headed.

“We built a community,” she said simply. “Our needs were met.”

– Alejandra Rosa Morales contributed additional reporting from Puerto Rico.

The post As Quakes Rocked Puerto Rico, Impromptu Communities Formed appeared first on Direct Relief.

But during the most recent earthquakes in Puerto Rico – even as power and water were shut off to parts of the island – the community’s new solar-powered pump kept on working.

Cidra, a community of approximately 96 households, is located in Puerto Rico’s mountainous central region. It’s one of 242 communities that can’t get its water from the island’s municipal source.

It’s an issue of gravity: Puerto Rico’s water authority can’t efficiently pump water upward to these small mountain hamlets, according to water systems expert Alex Rodriguez, a member of the nonprofit group Por Los Nuestros.

That means these communities need to provide their own water, by either harnessing nearby streams or pumping water from a well.

For both of those, you need electricity. Without electricity, there is no water.

After Maria, mountain communities throughout Puerto Rico’s more remote areas were cut off from running water – in some cases for months.

But as shocks have rocked the island and driven Puerto Ricans from their homes into driveways and shelters, communities like Cidra that have been outfitted with solar-powered pump systems have been able to get back to life as usual – quickly.

Blue Planet Energy, a company that offers solar energy storage for what they call “unreliable” grids, has supplied approximately 30 communities with solar-powered batteries for their water pumps, some of them with Por Los Nuestros.

Since the earthquakes, not one of those communities has reported a problem with running water.

By contrast, Por Los Nuestros has found approximately 30 different communities who haven’t received support and who have gone without water for at least three days.

Water First

“When I first came [to Puerto Rico after Hurricane Maria], I thought just turning lights on” would be the most important thing, said Gregg Murphy, Blue Planet Energy’s vice president of business development. Instead, “the issue was water first.”

“There were a lot of people for up to nine months without water” after Maria hit, Rodriguez said.

Although Cidra went four or five days without running water, Amaro recalled, the community was lucky: They acquired a generator within a week.

But there were downsides. “We had to guard the generator because we were scared it was going to be stolen,” Amaro said in Spanish through a translator. To protect it, residents took the generator back and forth from a house to the well each day.

And while they had water, their neighbors were going without – for up to five months in some cases. Cidra became a local oasis, providing water for people in nearby communities.

Clear and Hidden Hazards

Rodriguez saw mountain communities going without water – and saw reports of Puerto Ricans dying of leptospirosis after drinking from contaminated sources. He wanted to help insulate people against future disasters – and quickly realized that the best way to do that was by creating solar-powered pump systems that would continue to function even if Puerto Rico’s fragile grid went down.

He joined Por Los Nuestros, then a fledgling nonprofit a friend had started to help Puerto Ricans recover from Maria, to build what he calls “more robust, more resilient” water systems.

Working with Blue Planet Energy – and through a grant from AbbVie – Por Los Nuestros has developed solar-powered water systems for 14 communities thus far. Direct Relief has committed to funding 25 of these systems in Puerto Rico.

Rodriguez stresses that going without running water is far from a mere inconvenience. There’s the increased likelihood of drinking, bathing in, or washing clothes using unsanitary water, which can cause a myriad of health problems.

But there are other, less obvious concerns. “People go more to the refuge centers, people want to stay away from their households” when water isn’t available. “That problem is creating other problems.”

Indeed. In crowded shelter conditions, people are at greater risk of contracting infectious conditions and of having chronic conditions, like diabetes or high blood pressure, go untreated. Housing, feeding, and clothing people in shelters can place tremendous strain on a community.

Good Neighbors

“Everybody felt it,” Amaro said, speaking of the 6.4-magnitude earthquake that hit Puerto Rico in the early hours of January 7. “Everybody woke up from their beds, and it was a traumatizing experience, because none of the people in the community have felt something like that before.”

The quakes have continued into this week, a fact that has left many Puerto Ricans in a state of anxiety. “I’ve had some people tell me that it feels like it’s worse than Hurricane Maria, because it doesn’t stop,” Murphy said.

However, Amaro said, life in Cidra quickly returned to normal – thanks in no small part to a continual flow of running water.

“We had the worst-case scenario after this emergency,” he explained. “There was no sun, there was no [municipal] power, and it worked. We never lost water.”

José Oyola, president of the Pedro Calixto community in central Puerto Rico, said he’s happy that he can be a good neighbor to nearby residents who don’t have the luxury of running water in the wake of the earthquakes.

After Hurricane Maria, Pedro Calixto also served as an oasis, providing drinking water to about 1,500 people in addition to its own 180 people, Oyola explained.

“Now we don’t have the limitation of telling people we cannot offer you so much water,” he said through a translator. “Now we can help people, because [the system] is designed to do that.”

The post As Quakes Rock Puerto Rico, Water Flows for Mountain Communities appeared first on Direct Relief.

Widespread power outages, a lack of running water, and ongoing tremors with the ability to potentially take down more structures are the most pressing issues facing the U.S. territory, in addition to about 2,000 evacuees who have left their homes in the southern part of the island, according to the Ivonne Rodriguez-Wiewall, head of Direct Relief’s Puerto Rico office.

“People are still very scared,” she said, while traveling with physicians and mental health care providers between four shelters around Guayama, Guánica, and Ponce.

“In Ponce, you can see the earth literally cracked.”

Dozens of homes collapsed in Guánica, according to that city’s mayor, and images of heavily damaged structures have emerged from locales throughout the southern part of the island.

“They’re moving into open spaces now, the earth is still shaking,” Rodriguez-Wiewall said.

The U.S. Geological Survey reported that over 500 earthquakes of magnitude 2 and above have hit Puerto Rico since December 28, 2019, including a 5.8-magnitude temblor on Monday.

“People didn’t know if it’s okay to drive, so they’re staying together… Authorities are evacuating everyone from buildings, including nursing homes and hospitals, more than two stories high.”

Rodriguez-Wiewall said close to 2,000 people have moved into open spaces and will be sleeping in FEMA and military-provided tents with cots.

Along with hundreds of other structures, yesterday’s earthquake caused damage at three major hospitals in the south, which are being powered by generators. After visiting various shelters, Rodriguez-Wiewall said fear of structural damage and uncertainty about aftershocks have deterred some people from seeking out medical attention at hospitals and health care clinics in the area, making the mobile units and jeeps, donated by AbbVie after Hurricane Maria, key to medical response efforts.

Another resiliency measure — solar-powered water pumps — has also proved to be beneficial. The pumps, which were installed in communities located in the center and southeastern parts of the island with the help of Por Los Nuestros, have held up and allowed locals to maintain access to potable water, which was one of the most pressing issues after Hurricane Maria, and is currently a major concern in the aftermath of the earthquakes, especially in the south.

In response to the earthquake, Direct Relief is sending essential medicines and supplies to Puerto Rico to supply 10 medical health provider teams at the request of Puerto Rico’s Department of Health.

Rodriguez-Wiewall said her team’s next steps are to continue planning a hub of medical services in Guánica, which is one of the biggest centers for displaced people, while responding to requests from local mayors.

Comparing this disaster response to Maria, Rodriguez-Wiewall said major improvements have been made with regard to communication.

“We are much more organized now. As soon as everything happened, everyone knew where to go,” she said. “Everyone knows everybody, and everybody has everybody’s number.”

The post As Puerto Rico Reels from Latest Earthquake, Medical Care Reaches Evacuees appeared first on Direct Relief.

The organization has offered support to healthcare providers across the island, in coordination with the Puerto Rican Department of Health, the Puerto Rican Hospital Association, the Puerto Rican Medical Reserve Corps, and the Puerto Rican Primary Care Association. Direct Relief is also coordinating relief efforts with the Mayors of Guanica and Guayanilla, which were the hardest hit areas.

With support from local organizations like VOCES, University of Puerto Rico, and Federally Qualified Health Centers, Direct Relief will be organizing teams of doctors, nurses, and mental health counselors to offer medical and mental health services to residents and those staying in the shelters of these hardest hit areas, and who are still suffering from the impacts of Hurricane Maria.

Direct Relief is also sending overnight to Puerto Rico an Emergency Health Kit with over 200 essential medical items, and has made available its cache of medical inventory to hospitals and health centers treating patients.

Materials include: respiratory medications, blood pressure medications, diabetes oral medication and insulins, wound care, antibiotics, IV fluids, and neurological and psychiatric medications. In the aftermath of Hurricane Maria, there was a lack of medicine available, especially for those with chronic conditions like diabetes, hypertension and heart disease.

Direct Relief has also published a live earthquake incident map detailing the severity and location of the earthquakes that will be updated as damage reports come in.

Direct Relief has extensive experience responding to earthquakes and other emergencies worldwide, including in Puerto Rico.

Since Hurricane Maria struck the island in 2017, Direct Relief has supported nonprofit healthcare providers and community-based organizations with more than $100 million in material and financial resources to strengthen their ability to withstand and recover from disasters.

Direct Relief has also equipped the entire 350-person Puerto Rican Medical Reserve Corps team with Emergency Medical Backpacks, and has purchased over 30 mobile medical units and off-road vehicles to get to patients who cannot access services.

The post Earthquake Strikes Puerto Rico, Direct Relief Mobilizes Response appeared first on Direct Relief.