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.
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.
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.”
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