On our first day trip into rural Puerto Rico, we traveled to Yabucoa, one of the poorest towns in the region. Francisco Rodriguez is the director of Coalicion de Coaliciones, the organization that Dr. Haack has been working with since the storm, and he was our guide and educator for the day. As we drove out of San Juan, he told us about Yabucoa: a low-lying valley in the heart of the sugar cane-producing region of southeast Puerto Rico that suffered a massive economic decline in the mid-20th century as the result of an effort to transform the country from an agricultural to an industrial economy. Unfortunately, this drastic shift spurred a wave of migration into the cities, leaving Yabucoa with little means of supporting itself. In terms of access to healthcare, the nearest hospital is in neighboring Humacao, a 30-minute drive when the roads are clear and transportation is available. But when the storm hit, Francisco said, the water poured down from the mountains and rose in from the sea, trapping the people of Yabucoa for over two weeks. Flooding in the valley utterly isolated those in the surrounding mountains, cutting off communication and transportation with neighboring towns.
Then, after the water receded, the people of Puerto Rico suffered from la desastre despues de la desastre – the “second disaster” of the sociopolitical crisis that engulfed the island in the aftermath of the storm. The confluence of these factors mean that, close to two years later, rural communities across Puerto Rico are still recovering.
Our first stop was at the residence of Giña, an elderly woman that suffers from Alzheimer’s dementia. Giña was born in Puerto Rico and is an American citizen. However, due to the peculiarities surrounding Puerto Rico’s status as a territory of the United States, Americans born in Puerto Rico are not always eligible for Social Security benefits in the same way they might be in the 50 states. Therefore, currently, Giña can only obtain Medicare Part A and depends on income earned by her children to pay for medications and treatments not covered under this plan. Indeed, family bonds in this community form a safety net: Giña’s children said they were taking turns raising the funds to pay out-of-pocket for office visits to her neurologist and to pay for the seven different medications she was prescribed. As we spoke with her family and worked on finding her a neurologist that would take her insurance, questions arose: which of these medications is making an impact on the course of this woman’s disease? What are the specific benefits that are worth the cost incurred by obtaining them? How can we alleviate the obstacles to care for this woman? And for this group, with the comparison of Haiti always in the back of our minds, we wonder how we can improve the ways American citizens in rural areas gain access to medical care.
We continued visiting homes in the area and experienced just how difficult it is to get from one place to another in hilly areas with narrow (through well-paved) roads; getting from one home visit to another took 30-45 minutes, and while we were fortunate enough to enjoy some beautiful countryside vistas, we could see and hear echoes of Hurricane Maria everywhere we went—torn awnings, downed trees, rooves under various stages of renovation—and we could imagine the isolation and desperation many of these people felt during and after the storm. As we continued our trip through Yabucoa, we learned that one of the patients Francisco had seen a year ago was currently hospitalized, and two had since passed away.
We ended our day with a visit to two neighboring families. We first visited Buenaventura, an 82-year-old man with Parkinson disease who had excellent family support, but required the basics of elderly care: adult diapers, gloves, lotion and antibiotic cream for skin breakdown. Across the street, we visited Iris and Joaquin, a couple whose home had been completely destroyed by the storm. For over a year, they lived across the street with Buenaventura and his wife while they rebuilt their house.
Leaving Yabucoa, I felt like I was starting to see Hurricane Maria and its aftermath in a different light: as a great equalizer that tested the resilience of all. Today’s stories showed me that a person’s ability to recover from the storm was not measured by their family wealth or access to healthcare, but by the strength of their bonds with friends and family. We’ll return next week with supplies in hand to do our part for this community and to get to know its members better.
--Brian Pettitt-Schieber, MS3