September 2022 marked the fifth anniversary of Hurricane María, Puerto Rico’s worst storm in decades, but instead of remembering that event, Puerto Ricans experienced an unwelcomed “deja vu” when a weaker (but much wetter) Hurricane Fiona ravaged the southern and central regions of the island. Over 30 inches of rain and historic storm surges caused severe flooding that led to the collapse of roads, bridges, and many homes. A fragile power grid failed again, leaving most of the island without electricity, an eerie repeat of María’s aftermath.
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.
