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 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.
The American citizens of Puerto Rico were dealt a devastating blow when Hurricane Maria pummeled the island last week, smashing its infrastructure and leaving millions of people short of food and reliable supplies of drinking water.
In the early hours and days after Maria struck, health workers worked tirelessly to care for the sick and injured in damaged hospitals, clinging to the hope that the generators that powered lifesaving equipment would hold out until FEMA could deliver urgent assistance and NGOs like Project HOPE could begin rolling out their planned responses to the disaster.
Transportation links were severed for days after Maria struck on September 20 and when HOPE’s emergency response team managed to land in recent days, Maria’s impact was felt everywhere.
“The distress is palpable. People are in lifesaving mode, especially Puerto Rico’s doctors and nurses who are working around the clock, while other first responders are trying to reach affected communities as much as they can,” said Chris Skopec, Project HOPE’s Executive Vice President for Global Health and Emergency Response Programs.
Mental health needs are particularly acute in a situation like this but HOPE’s first priorities, Skopec said, are safety, security, and access to basic services. “Of course, we’re mindful of people with pre-existing mental health conditions that have lost their medications and access to care providers, but our focus at this point in time at this acute phase of the response is saving lives and relieving suffering,” he said.
HOPE has a robust roster of medical volunteers prepared to address the needs of communities and health facilities in need of their specialized skills.
Skopec says that the destruction and humanitarian needs are so enormous and will take colossal efforts to help Puerto Rico address the enormous needs created by this disaster.
“It’s all hands on deck time. It’s really going to take a colossal effort on everybody’s part. Puerto Rico will need substantial private sector support and public-private partnerships can play a crucial role after a disaster like this,” said Skopec.
HOPE team plays vital role to restore overburdened health infrastructure
Vanessa Santiago knows what it’s like to be a part of a disaster response team. In 2016, she deployed with Project HOPE to Haiti to assist in rebuilding after Hurricane Matthew. However, even with that experience in hand, she was nervous at first about responding to Hurricane Harvey in Texas.
“Going in, I was really terrified because all you know is what you see in the news,” she said.
Anyone who saw coverage of Hurricane Harvey can certainly understand why. The unprecedented flooding from Harvey took its toll on the Houston area. Dozens of people lost their lives, and many thousands more had homes severely damaged in the storm.
Vanessa was part of HOPE’s emergency response team which worked to address health challenges created by the flooding. She helped with many of the logistical aspects of the response, including where to deploy medical volunteers to have the most positive impact, developing partnerships with local health providers and coordinating interpreters to assist patients who spoke a foreign language. When it came to those patients, she explained, “If you don’t have an interpreter, you might as well not even have a doctor.”
Vanessa is fluent in Spanish and Portuguese, so when she had a spare moment, she also assisted with interpretation efforts. During one of her interpretation sessions, she was especially moved by one of the patients she met.
“I was interpreting for one man who was having shoulder pain. He works in construction and he couldn’t lift his arm above his head. The nurse practitioner said he couldn’t wait any longer, that he needed to go to San Jose Clinic and see a doctor. She told him ‘If physical therapy doesn’t work, you might have to have surgery.’
His eyes opened up wide, because of course to him that means a lot of money. And I just started crying, it just seemed so unfair that he might have to go through surgery or physical therapy, where he’s not making a lot of money and he has this pain.”
The patient’s story was not uncommon. Houston settles more refugees than any other city in the United States, including many from Venezuela who were affected by the flooding from Harvey. “Some of their stories were just absolutely devastating,” she said. “They had houses, and cars, and businesses that they started up from the ground, and they were wealthy in their country, but they had to leave. One woman told me ‘I came here with $300 in my pocket’ because of the restrictions of the government there.”
Vanessa believes that Project HOPE has been able to make a long-term impact on the community. Not only was the HOPE team able to provide vulnerable populations with emergency care, but they were able to refer those in need to providers like San Jose Clinic where they can get ongoing care for health needs.
HOPE also worked to address the serious strain the storm put on the local health professionals, who were dealing with the aftereffects of flooding just like the patients they were treating. “There was a lot of stress where it was just one thing after another,” she said. “Some of them also had family members in Florida that they were worrying about with Hurricane Irma.”
As part of the effort to help overburdened doctors and nurses, Vanessa detailed how the team was able to do “something beautiful” for local health staff. Dr. Nancy Miller, a mental health therapist who was part of HOPE’s relief team, held a “Lunch and Learn” session with local staff on how to alleviate stress from the impact of the storm.
As Vanessa reflected on her time in Texas, she was struck by how different things were from what she had initially expected. “Everybody in Houston was so generous, with open arms,” she said. “There was never a shortage of churches that wanted to welcome us in. We would just be eating outside and people would pick up our tabs, or give us discounts on rental cars, because people were just so grateful.”
In the registration area of the medical clinic set up at Our Lady of Guadalupe Catholic Church in Rosenberg, Texas, Project HOPE volunteer Dr. Nancy R.F. Miller, a licensed mental health therapist, uses the wait time to slowly introduce herself to storm-weary patients recovering from Hurricane Harvey.
"People coming into the clinic to seek medical attention have lost everything to Hurricane Harvey,” said Dr. Miller. “As a therapist, I cannot sit behind a desk in a room and wait for people to come in to talk to me. Rather, providing outreach, eases the initial contact and assists in raising their comfort level and willingness to approach for counseling support.”
To ease the apprehension, Dr. Miller has been conducting health education sessions for everyone in the waiting room. “I talk about basic health care after a hurricane, about the water and disease borne illnesses, the need to clean with a bleach solution and the importance of having an up-to-date tetanus shot and then I move into talking about the effect of disasters on one’s emotional and mental health.”
Prepared with culturally sensitive brochures on coping with disasters written in several languages and an interpreter, Dr. Miller discreetly canvases the room, letting people know where she is located, if they want to come and talk.
One by one, they begin to trickle in and begin to tell their stories.
In Texas, Dr. Miller was a first-time volunteer for Project HOPE, but working in disaster situations is one of her specialties. “I responded to Haiti’s 2010 devastating earthquake, in Uganda I worked with refugees. I served after Katrina, and was part of the therapy team that provided services after the Virginia Tech shooting. Just recently, I returned from Charlottesville, Virginia helping people cope after the domestic violence that occurred.”
Dr. Miller says one of the important roles of counseling after a disaster is being able to connect and refer people to other needed services. “People may have long term mental health illnesses before a disaster strikes and disasters can intensify those illnesses,” she said. Soon after the Hurricane Harvey, when Dr. Miller first arrived in Texas, a family brought their son in to see her. Their son suffered from an untreated chronic mental illness. The stress of the hurricane exacerbated his symptoms. With Dr. Miller’s help, the family was able to access the resources needed in order to receive the ongoing care that he required.
A mother of grown children visited Dr. Miller in the early days after the hurricane. Her ex-husband, a shop-owner and the father of her children, was tragically killed during the flooding in Houston while trying to protect his business. Her children were devastated by their father’s sudden death and Dr. Miller was able to provide consolation and advice to the mother on how to comfort her children through their grieving process and in the future.
Weeks after Hurricane Harvey, Dr. Miller says many of the clients are now past the acute emotional impact of the monster storm, but now other emotions are sinking in including helplessness, depression and anxiety.
“After a disaster like this, where people lose everything they own, many are feeling fatigued, irritable, confused and not able to make decisions. I attempt to provide a safe and calm environment while assessing their stability, and then they begin to tell their stories. As we progress we address the ways on how they can cope with their stress,” she said.
Disasters are taxing on children as well. “We often see regression in behaviors of children after major disasters like this one. Sometimes there is increased fighting with siblings, disturbed sleep patterns, and fear of being separated from family members. I always advise parents to reduce media watching, be more patient and try to get the children back on schedule,” she said. “For example, schools opened last week in Rosenberg providing a more normal routine for the children and families.”
In addition to helping direct survivors of Hurricane Harvey, Dr. Miller also worked with staff at the church, volunteers and other community health professionals in the area, monitoring morale, listening to their experiences and providing lunch and learn trainings. “As a disaster mental health specialist, I not only provide services to victims and families, but also work with local staff and volunteers to make sure their needs are met. I do what I can to inspire and support the workers as they assist those impacted by the disaster” she said.
“It is important to promote an individual’s resilience after a disaster. What I have noticed in the Rosenberg community, they are survivors. Many of these people just went through recovery with Hurricane Matthew last year, and other flooding earlier this year. And now Harvey. The populace we are working with in Rosenberg are Hispanic, lower income families with limited resources. When dealing with such complex trauma, I try to foster their protective factors such as the strength they receive from their faith, family and friends.”
In fact, it is the community resilience that helps inspire Dr. Miller. “This community is exceptional in the way they have just come together, turned their multipurpose room into a warehouse and set up a medical clinic. The government, private organizations, spiritual communities and NGOs are all collaborating and supporting each other as well as the community members -- it’s amazing to see,” she said.
Dr. Miller returned home this week, and as relief efforts in Texas continue, HOPE is now also responding to the devastating impact of the Hurricane Maria in Puerto Rico, where addressing mental health needs will be an important part of overall recovery. “Physical medical care is essential after a disaster like this, but mental health is just as important. In fact, mental health is now a component of the UN Sustainable Development Goals,” she said. "There is no health without mental health. Project HOPE understands the connection and has integrated mental health into primary care of disaster response efforts.
At the Our Lady of Guadalupe Catholic Church in Rosenberg, Texas, those impacted by Hurricane Harvey can find a little respite.
The Church’s multipurpose room is filled with clothes, linens, diapers, kitchen supplies, cleaning materials and other essentials people need after losing everything to the monster storm that hit Texas two and a half weeks ago. But elsewhere in the church, Project HOPE has set up a clinic where survivors of Hurricane Harvey receive care for their families in the aftermath of the devastating storm.
Project HOPE volunteer, Dr. Harry Owens, or Harry as he prefers to be called, has been at the site all week long, treating anyone who shows up, filling critical lost prescriptions for chronic illnesses and sometimes just offering a little bit of comfort to the hurricane’s youngest victims.
School started up again in Rosenberg this week, a small sign of normalcy for the children in this region heavily impacted by the storm. “We have seen several families, who have lost everything - their housing, their medicines and their transportation. All they have are the clothes on their backs. They come into the church to pick up donated necessities, and also come to see me,” Harry said.
“Because school is starting back up, several people have brought their young children, children who are starting kindergarten who need to have a medical exam to go to school. We do the exams for them and fill out the school forms.”
Working with children is one of Harry’s specialties. A longtime medical volunteer for Project HOPE, including a stint on the SS HOPE in the 1970s, Harry understands the nervousness children feel when undergoing a medical exam under normal circumstances. Throw in a disaster situation, and even a routine school check-up can quickly turn teary.
“In addition to the necessities the church and community are providing to the families that need help after Hurricane Harvey, they are also handing out stuffed animals to children visiting the clinics,” Harry said.
Harry uses those stuffed animals to his advantage. “I had a 5-year-old who was hesitant for me to listen to her heart, so I instead asked her if I could listen to her unicorn’s heart,” he said. To Harry’s surprise, the young girl also wanted to hear the unicorn’s heart. “I had to admit to the girl, “I can’t really hear the unicorn’s heart, but maybe we can hear yours instead.””
The exam went well and Harry was able to give the young girl’s mother the signed medical form to present at school the next day. A small comfort for a young mother who has much heavier problems on her mind.
A family practice and emergency medicine doctor from Oregon, Harry has been on the ground in Texas for Project HOPE since August 31. “I was part of the Project HOPE advance team for the Hurricane Harvey disaster,” he said. He has already worked at several different medical locations.
“While at this point, we are not seeing many serious illnesses or medical situations, we are seeing patients with chronic illnesses like diabetes and high blood pressure that has gone untreated because people lost their medications in the storm. We are also seeing people who have infected cuts and scratches, from wading waist deep in flood waters and we are administering lots of tetanus shots.”
Harry is working alongside other HOPE volunteers, community members and volunteers from other NGOs.
“We are not only working with patients suffering from Hurricane related injuries, illnesses, loss of medicines, we are also working alongside staff that are also going through the heartache, going through all the stress of the hurricane or worrying about their relatives who have lost their homes, he said.
“In addition to medical care, Project HOPE also offers the services of Dr. Nancy Miller, a licensed therapist who is seeing patients who are reporting heart palpitations, anxiety, not being able to sleep and other mental health stress from Hurricane Harvey.”
Harry will continue volunteering in Texas until the end of the month, but this is an experience he won’t soon forget. “These are people who have gone the through a community level stress, their community, their towns have been destroyed and damaged. Still there is so much resiliency. In fact, many of the more recent patients I have seen are actually those seeking treatment for aches and pains and cuts as they work hard and long, trying to clean out and rebuild their flooded homes. I have to remind them to slow down.”
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