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.
Today, we set out in two teams with two different objectives.
One volunteer team headed to the convention center to meet with other organizations to find new partnerships and more opportunities to provide medical care to Loiza or other communities around the island.
Our team started the day at a senior community center to see a few patients and then we went out into the community to visit patients in their homes.
You have to see the video to believe how cool these seniors were. Absolutely no comparison to what we see at home. As we walked in we heard singing and clapping enthusiastically with your hands up in the air. When they saw us, they reached out their arms and pulled us instantly into their dance routines! It was incredible to see such joy and enthusiasm in their eyes and how welcoming they were to new people in their environment.
A few of them had minor medical problems that we treated, and afterwards, we danced again before leaving to continue our day’s work.
We visited people in several homes. None of their medical issues were urgent but each of them needed to be seen. The first home was very small, the top floor was completely blown away. Several members of the family lived in what remained of the bottom floor. The refrigerator was open and had two or three half-filled bottles of water, a container of sugar, a few aged condiments and what looked like some old pieces of meat. There was an elderly woman that slept in a mosquito-net covered bed. She was frail and cachectic but was doing well despite the conditions. We filled the refrigerator with water, gave them some food items and moved onto the next home. Basically, that was the course of our day. We left each person feeling cared for and acknowledged with a little bit of water and food to hold them for a few days. It is sweltering hot here and the humidity is unbearable. I can't imagine the long term health effects on the people of Loiza from complete boredom in their small, sweltering, lightless homes.
I have no doubt that the medical issues will increase as time goes on from people drinking dirty water and eating food that has not been refrigerated for days and weeks on end.
In my last blog I mentioned a patient that asked me to go to her home to see the condition it was in after the hurricane. She told me she had 22 cats and was very concerned about their welfare. Today, after our home visits we went to her house. The outside was old and dilapidated and clearly was in disrepair before the hurricane. There were many cats sitting in the window and walking around the driveway. The smell of cat and dirt and mold could be recognized as soon as we got out of the car. I promised her I would bring her several things from her room. She wanted her robe, her papers with all her bills and her perfume.
The inside of the house was damaged by the hurricane. The ceiling in the hallway was caved in and in her bedroom was a large wooden plank hanging from the roof and laying across her bed. I think if she had been there during the Hurricane she would not have made it out. We gathered as many things as we could, took some pictures to show her of her cats as well as took a few family pictures off the walls and wrapped them up for her. We returned to the shelter and delivered on our promise.
It was a satisfying day and at the same time it is very frustrating to know that so many people are in need of medical care but there still is not a solid way to deliver it to the community. Every day we are working with different partners to try and establish the best plan to help this community as well as look at other communities and other needs and opportunities on the island.
Back at the Jewish Community Center, where the volunteers are staying, tonight was Sukkot. My husband, and fellow volunteer doctor, Neil, as well as Dr. Larry were asked to join in the service and then we were invited to say a blessing in the Sukkot. This Jewish connection was unexpected on this mission but served as a wonderful undertone.
The best part of the day was being able to eat real food from Burger King – not a place I ever go to, but it felt like French cuisine compared to all the nuts and granola bars we've been eating all week.
More than two weeks since Hurricane Maria struck Puerto Rico, Project HOPE continues to respond to urgent health needs as fears of a deepening health crisis grow. HOPE medical volunteers are going door-to-door to visit residents who are still unable to access care and the HOPE team is also setting up mobile clinics in towns in need of health services and support.
"The sense of desperation is growing each day," said Chris Skopec, HOPE’s executive vice president for global health and emergency response with Project HOPE.
Many areas of the island, particularly in the interior, remain in extreme need of aid ranging from drinking water and food to hygiene items and medical supplies. There are also significant disparities in electricity and clean water access across geographic zones.
"Our medical volunteers are treating a range of chronic illnesses, like diabetes, hypertension, skin rashes and there has been a significant outbreak of conjunctivitis,” said Skopec. “They're also seeing increasing rates of gastrointestinal disease, most likely caused by people drinking river water as they're not to access clean water."
Health officials in the country are preparing for a spike in infections due to poor hygiene and water contamination which are causing gastrointestinal outbreaks, skin rashes and conjunctivitis. Flu outbreaks are another major concern since there is still a lack of flu vaccines ahead of what is expected to be a very significant flu season. The outbreak risk of mosquito-borne illnesses like Zika and Chikayunga is also high due to standing bodies of lingering floodwater that are breeding grounds for the insect.
"An epidemic can spread fast in these kinds of conditions," Skopec said.
Thanks to your support there is HOPE. In the past two weeks, Project HOPE has
- Supported a 20 person emergency response team in Puerto Rico, including volunteer RNs, nurse practitioners and doctors
- Continued to provide health services and conduct health and hygiene awareness in the high-need municipality of Loíza
- Treated prevalent ailments include hypertension, diabetes, conjunctivitis and skin rashes
- Distributed a 40 foot container of desperately needed supplies to the municipality of Vega Baja
- Taken the lead in logistics operations at the University Pediatric Hospital, which will act as a hub for the distribution of medicines and supplies for facilities across the island
Project HOPE’s support of health care, health awareness outreach and delivery of supplies and medicines in Puerto Rico will continue in the coming weeks and months.
Zika, Chikungunya and Dengue Fever Looming
Before going to sleep last night we listened to the Mayor of Puerto Rico give her plea for help for the people of Puerto Rico. It was amazing to be listening to her from here, versus my comfy bed at home. It felt pretty cool to know we were here trying to answer her plea. A nice feeling.
Three more nurses and another physician joined our team. It's fascinating to see the work that goes into this effort from a simply logistical perspective. The Project HOPE team is incredible and they take so much care in ensuring their volunteers are safe and taken care of.
Today we returned to Loiza to set up a clinic. We are bringing food and hygiene packages that we prepared yesterday. The need goes far beyond medical and we are trying to meet as many needs as possible. Our container of supplies has arrived at port so we are hoping to improve our inventory of medical supplies in the next few days.
Our clinic was set up at one of the two shelters in Loiza. The shelter is at an elementary school. Different sections are designated for shelter residents with separate areas for those who are bedridden. We set up our clinic in a classroom. We designated areas for three providers to see patients, an area for wound care, our pharmacy and another area for our personal hygiene giveaways. Most of the people there have been at the shelter since the hurricane hit the island nearly two weeks ago.
There is no running water, electricity or air conditioning. You flush the toilet by filling a bucket from a rain barrel and pouring it fast down the toilet.
One of my patients today was a diabetic amputee. She was evacuated from her house in her wheelchair with the clothes she had on her back and has not returned since. Her chief complaint was that she was feeling stressed. She explained that she had bills to pay, laundry to put away and 22 cats that she was deeply concerned about. I asked her for her address and she gave detailed directions to her house. We told her that our team will go there tomorrow morning on the way to clinic. We have no idea what the condition of her house will be or if it will be there at all.
We will stop at Walmart and pick up cat food before we leave, just in case we can find the cats. She gave us specific directions where to find her clothes and specifically where to find her perfume. She said this is a very important item because she had not showered since the hurricane!
We also started a diabetic clinic were we evaluated the needs of the many diabetic patients. Most are on insulin and are concerned about refrigeration of their medication and refilling their prescriptions. Most of the diabetic patients were in the general shelter area - each of them made quaint little living areas for their cots and their minimal belongings. I noticed that one area made use of a mosquito net and I came to realize that mosquito nets were donated to everyone at the shelter but most were not being used. So my husband, Neil, who is also a volunteer physician for HOPE in Puerto Rico, and I talked to each of the families and explained the importance of using their mosquito nets. Most of the families were resistant because it is so hot and uncomfortable, they feel the mosquito nets are making them feel claustrophobic and unable to breathe.
Unfortunately, in this area Zika, Chikungunya, and Dengue fever are prevalent.
One can easily see that the future does not look good for this community. The potential for failing health care and growing poverty is obvious. There is no employment and people are struggling to get along with the donations they are given. When the attention is off of Puerto Rico, I fear for what will happen to these people.
Despite the conditions, the Puerto Rican community is strong, friendly, welcoming and most importantly exceptionally grateful for the help they are getting.
I still have not seen any federal officials on the streets in San Juan or in Loiza. I am hoping they are here but just not in our view.
Tomorrow we will make our routine visit to Walmart to pick up some gift items for those at the shelter that who are immobile. Some of the requests we have are for Sensodyne toothpaste, sausage and a foam bed pad. Such simple items, but for them they mean a world of difference.
Tomorrow we will return to Loiza and begin our community visits. Part of the team will work in the clinic and the rest of us will walk the streets and make home visits to people who cannot get to the clinic. I am looking forward to that because I love seeing the families, children, their pets and the community.
This continues to be an extraordinary mission for Neil and I. We are deeply moved by the efforts made by everyone at Project HOPE and all of the incredible passionate, caring volunteers. We are so grateful to have been given the opportunity to participate as the first team.
We are still staying at the Jewish Community Center, and grateful for the accommodations. This is a conservative synagogue so we have to be up and out early before their 7:00 morning services. It is nice to hear the praying in the background. It kind of adds a spiritual component that a few of us connect to. Many of the congregants have been affected and we are trying to help them out as well with food and medicine.
HOPE on the Ground in Puerto Rico
Dr. Lori Shocket and her husband, Emergency Room Physician Dr. Neil Shocket are volunteering for Project HOPE in Puerto Rico. The Shockets helped bring a lifesaving leukemia drug to a patient in desperate need of the medicine. They also arranged for the donated housing and facilities at the Jewish Community Center where the Project HOPE medical team is sleeping after long days of providing health care to people in need.
On Friday, just one hour before we boarded our plane to Puerto Rico, we successfully received the leukemia medication that we were asked to deliver to a 59-year-old patient, who was in desperate need of this lifesaving drug. The Project HOPE team, already on the ground, learned about the patient while going door to door in Puerto Rico checking on the health status of people isolated in their homes after days of no electricity and gasoline shortages. The Department of Health asked Project HOPE if they could obtain the needed drug along with transport approvals and have it delivered to the patient immediately.
Without the drug, the father of three would die.
When Neil and I walked off the plane in Puerto Rico, we were greeted by the nephew of our patient waiting to receive the leukemia medication for his uncle. He was incredibly grateful. What a day!
Listen the patient's nephew.
The next morning we started out the day with a trip to the local Walmart to pick up supplies. Some stores are open but as we see on the news, there are extraordinarily long lines. The line to enter to this store was 200 people. They were allowing 50 people in at a time. We were allowed to enter right away when we showed them our medical IDs. Inside it was a completely crazy story. I have never seen so many people in one place at one time! It was not just crowded but packed like sardines. There was little fresh food and no meat available. Still, everybody was friendly, helpful and patient.
Our intention for the trip was to purchase antibiotics. Our supplies had not yet arrived and we needed some prescription medications for our day. The pharmacist allowed Neil to write all the prescriptions he needed, with proof of his medical license. We also bought supplies and tons of food to make gift bags for our patients.
The streets of San Juan are filled with debris and dead trees. Most have been pushed to the sides of the road, but it's clear to see that just about everyone was affected. On the main highway there is an electrical pole that is still lying over all lanes of the freeway. The cars just drive under it. Funny, as we drove under, everyone in the van ducked as if to avoid being hit in the head - I guess it's just a natural reflex.
Traffic is rough, mostly because of the long lines for gas. The wait is five or six hours and there are what look like armed civilians guarding the driveways. There are also long lines of people with gas cans.
Other than the gas stations, Walmart and a Walgreens, little is open for business. It’s like living in an abandoned city. There are a lot of people on the streets but everything is closed. At night the skyline is pretty dark except for the few lights on because of generators.
After gathering supplies, we set off to the community of Loiza, a town heavily damaged by Hurricane Maria, yet so many people have still not been helped.
Every structure in the town was affected. There is no infrastructure.
NO electricity, NO phone service, NO stores open for business.
Besides us, we did not see any other agencies around.
Dr. Sanjay Gupta and his CNN crew followed us for the entire day as we went door to door, walking through the barrios of Loiza and reaching out to people in their homes, providing health care. We saw several patients, most with chronic issues who have not been able to see their doctor since before Irma. They were all in need of medical attention but I think their need for emotional support and food and water was greater.
Starting today, Project HOPE will be providing medical services at a clinic/emergency room, supporting local medical teams who are working limited schedules.
It was an emotional and eye-opening day for all of us. The Project HOPE team is amazing as is the impeccable organization and professionalism of this NGO.
The health crisis caused by Hurricane Maria is mounting by the hour. Massive flooding will cause the number of water related illnesses to spike quickly and there are patients with chronic diseases which have been exacerbated by the situation and their diseases are now becoming acute. People are standing in line for gas for eight hours a day to fill their containers with $10 of gas and they’re getting exhausted, overheated and it’s causing complications for people with diabetes and high blood pressure.
People are drinking and washing clothing in contaminated water and we’ve seen a lot of skin rashes and significant outbreaks of conjunctivitis. The hygiene situation across the board is causing a lot of concerns about outbreaks of infectious and waterborne disease. Moreover, there are dead animals lying around in residential areas, exacerbating poor hygiene conditions. People here are waiting to hear if there are any vaccination campaigns planned.
The biggest logistical issue right now is the shortage of gas. Until it becomes widely available, none of these problems will be solved. The lack of gas for vehicles to transport water and medicines and the basic things that people need in hard hit communities is making matters worse. The scarcity of gas also means we can’t even assess the real humanitarian scope of the disaster because it’s not yet possible to reach all communities. Many people are still cut off and may need help. There’s a strong likelihood that anyone with a serious illness, for example, someone on dialysis, will likely not make it beyond a few days and this is mostly related to the gas situation.
What makes matters worse is that we’re coming into flu season in Puerto Rico and with the close proximity of people in shelters and the absence of vaccinations there is going to be a significant flu season.
The geographical challenge
I have responded to disasters from Nepal to Haiti. The fact that Puerto Rico is an island makes this situation a little bit unique. Trying to get access to resources from outside has been extremely challenging. I think the gas situation is also somewhat unique in this context. I have never seen it on this scale before. People just can’t run generators and the intense heat is really becoming a problem.
The trajectory of the hurricane, which roared diagonally across the island, is also a factor that is worsening the crisis on an island that was not prepared to deal with a disaster of this magnitude. There is literally not a corner of the island that was untouched. Everywhere you look, everywhere you go, you can very clearly see the impact.
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