HOPE works in more than 35 countries worldwide. Please enjoy our blog as we document the successes and challenges of our work to provide Health Opportunities for People Everywhere.
The Project HOPE team was out in the cattle paddocks and mountain homes above Villalba in southwest Puerto Rico. Building on previous collaboration with the Villalba municipality the day was well coordinated and efficient. The municipality guided our medical, pharmaceutical, and mental health team in to the elevated barrios of Caonilla Arriba, Cubones, and Los Chivos. Psychiatrist Dr. Lisa Fortuna was engaged in many productive sessions, especially so was her conversation with a group of children as they returned home from their first week back at school.
“What was your first reaction after the storm, what do you remember?” Dr. Lisa asked the six neighborhood children.
“The trees were all broken and bare” came a reply. “We were surprised and bothered. Normally when we walked outside everything was green and full. Then every day we would wake up to a foreign landscape.”
Dr. Lisa continued the discussion in the thin shade of a breadfruit tree stripped of its bounty. She reminded them that the sudden loss of possessions, work, and routine such as in the case of a natural disaster is hard on adults and children alike. She coached them in self-care and anxiety relief exercises. As a group they imagined a delicious hot pizza pie in their hands, together they took a deep breath in … and a steady breath out. Anytime they feel overwhelmed this is one exercise they can do to reestablish control of the situation.
“Think of the trees that are still standing, what did they do during the storm to survive?” asked Dr. Lisa.
“They flexed and bent, but didn’t break,” replied the pupils.
“Right! And like a strong tree that is what we should do when we feel a lot of stress” Dr. Lisa affirmed, then introduced a light yoga exercise where everybody raised their arms in the air and stretched from side to side repeating the mantra, “Soy flexible, soy flexible, soy fuerte.”
People we meet are evidently disheartened if not devastated by the mudslides and 160 mph winds that ripped through their homes, the professional support that Project HOPE offers in the outstretched country roads of Villalbas is impressive. It is a confirmation that in this time of isolation, of no running water, of no power they can get through it and a reminder that they are not alone. The children beautifully concluded their unintentional metaphor of any post-disaster community:
“We are happy to see the green leaves growing back.”
When Hurricanes Irma and Maria hit in September, they ravaged the medical systems that aid those who face challenges seeking medical care. Project HOPE is reaching out with remote medical units in coordination with municipalities and the Department of Health, to target and assist the isolated, indigent and vulnerable populations.
Homebound, bedridden and terminal patients have gone months without professional medical assistance and in this aspect, the pre-Maria system is behind in recovery. Families we visited have proven resilient. However, without electricity, access to prescriptions, or needed medical interventions, even the most diligent family caretakers will become overwhelmed. The remote medical units bring hope and a reminder that family caretakers and patients are not alone.
The daughter and primary caretaker of a patient we saw summed it up well when she said, “She will die in time, but I want to make sure she is comfortable and lives with dignity. She is my mom, I have to take care of her like she did (for her parents), but without the nurse I don't know if what I do is right.”
The remote medical units are an impressive collaboration of inter-agency action.
In order to get to homebound patients, HOPE collaborates with local agencies to identify those in need and how to reach them.
- At FEMA events, local leaders collect the names of homebound patients.
- Local hospitals and the Department of Health coordinate with Project HOPE to plan house calls.
- Local municipality representatives help provide transportation to get HOPE volunteers to the people in need of medical care.
Visiting homebound patients is a logistical challenge because patients are spread out over miles of treacherous mountain roads, but the value is irreplaceable. One patient the team met was cared for by her daughter and neighbor. “They have done a great job since the storm” HOPE nurse Olinda Spitzer said. “Without running water or electricity they kept everything clean and the patient without bedsores.”
However, it wasn’t until Project HOPE’s team arrived that the caretakers were able to get needed refills on prescriptions and help relieving one of the patient’s issues. When Dr. Elisabeth Poorman arrived with the remote medical unit, she assessed that the strength of steroid cream being used to treat the patient’s pressure ulcers was too strong and actually burning her fragile skin. A simple, but needed correction brought relief and comfort to a mother and daughter.
As acute emergency medical needs wane in Puerto Rico, HOPE’s approach to providing care for chronic needs is helping bring a return to normalcy on the island. “Our hospitals and pharmacies are good again, but we do not have the resources to reach all of the communities in the mountains,” a Department of Health official said recently. “That is why we are very thankful to work with Project HOPE.”
WASH for Health
Two months after Hurricane Maria, many Puerto Ricans are still living without easy access to potable water and electricity. As Project HOPE medical volunteers continue to bring needed care to people living in still hard to reach locations, a newly implemented WASH program is helping to ensure long-term health for Puerto Ricans learning how to live in a changed environment after the massive storm.
A water, sanitation and hygiene (WASH) education team is now working alongside HOPE’s mobile medical unit team to help Puerto Ricans stay healthy by offering convenient education opportunities on treating drinking water, the importance of continuing to follow healthy hygiene habits, and preventing vector-borne diseases that are on the rise after Hurricane Maria.
“The incorporation of the WASH program into to the mobile medical units is ideal,” said Daniel Halpert, Project HOPE’s WASH expert in Puerto Rico. “People can seek medical care, visit our pharmacist for needed medicines but also learn how to make sure their water is safe to drink, learn the importance of continuing great hygiene habits, and reduce the risk of vector borne illnesses – all in one place.”
Halpert, who has coordinated WASH programs for the Peace Corps in Panama, said tailoring WASH programs to specific needs after disasters is very important.
“In Puerto Rico, most people already know the importance of accessing clean water and using preventative hygiene habits like handwashing, but because of the hurricane, they have lost all of their infrastructure, especially the access to clean water,” he explained. “All of a sudden, they can’t turn on the faucet and have potable water coming out of the tap.”
“Living with limited amounts of clean water is now forcing people to face unfamiliar decisions like, ‘Do I really need to use my scarce amount of water to wash my hands before cooking?’ But forgoing those important habits can lead to larger and devastating health issues.”
Without easy access to unlimited clean water, people are also dealing with other challenges, including proper water storage and how to use chlorination and purifying kits properly.
“Many people have been given water purification kits and chlorine tablets, but without experience using these treatments, many are not certain on what the proper usage is,” said Halpert. “Project HOPE is providing handouts that let people know how to properly purify a bucket of water, or even a milk jug of water, so that everyone can feel confident and safe in the water they are drinking and using.”
Flood damaged homes and piles of decaying vegetation after Hurricane Maria are also contributing to the increase of fly and rodent populations. “Rodents and flies have dramatically increased near and in people’s homes,” said Halpert. “Now anytime people put food out, it attracts rodents and flies that can greatly increase the risk of vector borne illnesses. Part of our WASH training is teaching people how to make home-made fly and rat traps with materials they have in their own home to help combat this problem.”
Hundreds of people have attended the WASH education workshops since they were added to the mobile medical units last week. “There is a real interest for this type of knowledge. People know they need help,” said Halpert. “Community members are very engaged in our trainings, and despite having already seen our medical staff and receiving their medications, they are eager to stay and listen to the hygiene promotion for 30 plus minutes, often lingering even after the training is over to ask follow-up questions and talk about their experiences since the storm. Many people also take flyers home to hand out to their neighbors.”
One participant, an older woman who is dealing with a fly and rodent issue for the first time in her life, was especially interested in learning how to make the homemade traps Halpert said.
Children are also getting in on the education.
“You have to start training young. If we can help kids adopt good hygiene habits, they carry these behaviors with them for the rest of their lives."
"We’re targeting a number of behaviors that all children must learn – handwashing, dental hygiene and trash management. Inviting parents to accompany their kids in these workshops is also great reinforcement for the adults.”
The Project HOPE team is working with volunteers and students from the University of Puerto Rico’s Graduate School of Public Health in Rio Piedras to grow the WASH education programs. In addition to the education courses being offered after each medical clinic, the WASH program is also providing participants with hygiene kits filled with soaps, towelettes, toothbrushes, and toothpaste, among other items. Project HOPE recently received a pallet of chlorine tablets through the Puerto Rico Department of Health, which will be distributed through the WASH program.
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Puerto Rico is starting to return to a sense of normalcy Hurricane Maria ravaged the island in late September. Electricity is slowing being restored throughout the island and schools have started reopening after being shuttered for over a month. Still, it’s a very different normal from what Puerto Ricans were accustomed to before the storm; a new normal that presents daily challenges to the health of many on the island.
Take Edgardo, a teacher in Ponce, a low-income community where resources are still scarce. He spends his days searching for clean water and gasoline, both of which are still in limited supply in many parts of the island. “Right now I worry about the health issues with the water,” he said, noting that he’s dealt with gastritis after the storm.
Getting food is still a challenge as well. Although most grocery stores are back in operation, challenges with distribution have driven up costs and made it more difficult to keep food fresh. “When I want to buy food on the supermarket there are a lot of empty shelves,” he said. “The produce in the stores are out of date in Ponce.”
Recently, Eduardo was able to visit Project HOPE’s Mobile Medical Unit to get treatment for his gastritis and hypertension. He was finally able to get medical care after weeks of struggling to find relief after the storm.
While he was able to find relief, he also has other people to worry about. His parents, who work as farmers, lost nearly everything in the storm. “Their house was completely ruined by the hurricane except for one room that is still standing,” he said. “They don’t want to leave their house because they have livestock.” His mother also faces challenges due to hypertension.
He also has concerns for his students, including those who are still at shelters because their houses were destroyed in the storm. The lack of clean water has contributed to conjunctivitis and scabies outbreaks, which are difficult to contain in the close quarters of a shelter.
Worries about his parents and students, on top of his own challenges, have made things stressful for Eduardo as well as many others struggling to cope with the new daily realities of life after Hurricane Maria. “I have a hard time sleeping,” he said.
Project HOPE is continuing to address the most pressing health needs in Puerto Rico. The team is using a mobile medical clinic model equipped with a stocked pharmacy and a multi-disciplinary team of doctors, nurse practitioners, nurses and pharmacists to provide care to hard-to-reach areas of the island like Ponce. The team was also recently joined by a mental health professional to support the growing need for mental health services among clinic patients.
Edgardo, like many on the island, is eager to see things return to the way things were before the storm. While it will still take time for that to happen, he sees how HOPE’s response is helping accelerate the recovery process. “This makes people feel secure and gives inspiration to move forward and to help,” he said.
Arlene has been suffering from migraine headaches for three years. After Hurricane Maria struck Puerto Rico in September, the stress of coping with no electricity, rationed clean water and limited access to health care caused by the storm only exacerbated Arlene’s condition.
When Project HOPE volunteers brought medical services to her community through a weekend clinic, Arlene’s discomfort was dramatically lightened. “After the Hurricane, I have felt so isolated and alone,” she said. “The Project HOPE team listened, and provided me with quality care, with such warmth.”
“Our medical volunteers are going community to community, reaching isolated and hard to reach areas that have still received little help since Hurricane Maria,” said Andrea Dunne-Sosa, HOPE’s Regional Director of the Americas and Volunteer Programming. “We were able to provide Arlene with a consultation, medicines and a referral letter for additional medical care. But almost as importantly, we were able to let Arlene know that we have not forgotten her and others like her who still need medical support after Hurricane Maria."
"Arlene was so relieved to see us and receive care, she expressed her gratitude through a tearful hug.”
Project HOPE’s Medical team continues to set up clinics in the communities most hard hit and difficult to reach in Puerto Rico, providing children, women and families with needed medical and psychological care and critical medicines, all while also helping to restore a sense of HOPE.
Since arriving in Puerto Rico after the storm, Project HOPE volunteers have
- Treated more than 1,500 patients
- Distributed 1,500 vials of insulin
- Coordinated the delivery of 2,600 water purification kits
- Transported $500,000 of medicines and hygiene kits to regions in most need
Volunteers are scheduled to continue working in Puerto Rico at least through December or as long as they are needed. Please support Project HOPE’s continuing work in Puerto Rico.
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