Health Center Resilience and Community Recovery in Puerto Rico

(Header Image: Ralph Alswang) RCHN CHF President & CEO Dr. Feygele Jacobs moderating the Resilience and Recovery panel.

With the six-month anniversary of Hurricane Maria nearly coincident with this year’s National Association of Community Health Center’s Policy and Issues Forum, the closing session was devoted to learning about the crisis, and recognizing the essential role of Puerto Rico’s twenty  health center organizations in response and recovery. RCHN Community Health Foundation President and CEO Dr. Feygele Jacobs moderated a roundtable that considered resilience and community recovery in the aftermath of the hurricanes from the CHC perspective.  

Panelists included Jay Breines, Chief Executive Officer, Holyoke Health Center (Holyoke, MA),  Allan Cintron, Executive Director, Consejo de Salud de Puerto Rico, Inc. –  MedCentro (Ponce, PR),  Paloma Izquierdo-Hernandez, President and Chief Executive Officer, Urban Health Plan (Bronx, NY), Ivonne I. Rivera Hernández, Executive Director, HealthProMed (San Juan, PR), and Javier Jiménez Jirau, Director, Puerto Rico Primary Care Association Network, Asociación de Salud Primaria de Puerto Rico, Inc. (ASPPR).

Community health centers – which historically have served more than 10% of the island’s population of 3.5 million Americans – have been at the front lines of community-level response. The panel discussion centered on the immediate response of the health centers and the PCA to address community needs, the ongoing challenges, and the lessons learned for emergency preparedness and resilience in the face of future disasters.

The panel began with Puerto Rico colleagues describing the events, which began when Hurricane Maria slammed the island on September 20 following an earlier blow by Hurricane Irma. The impact was immediate and fierce, wrecking facilities, homes and the island’s key infrastructure. Allan Cintron, whose health center operates 10 sites in the southernmost part of Puerto Rico, including a main location in Ponce, described the health centers as “the retaining wall in the crisis,” essential to immediate public health response across the island. The center expanded its reach even with limited supplies and capacity. Cintron stressed the importance of addressing the needs of staff and community survivors who experienced the trauma of losing homes and continued to struggle with the new reality on the island. Ivonne Hernández explained that HPM’s main site supports the Barrio Obrero district, in the San Juan capital. The San Juan area was least affected, but the center’s satellite clinics, on the islands of Culebra and Vieques, were cut off from communications and bore the brunt of the storm. Getting assistance through any means necessary meant being able to identify geographic coordinates for remote locations to direct relief teams.  HPM continues to fly doctors to those remote sites to provide care. At both health centers – and across the island – the hurricanes brought more patients, as many other local sources of care were shuttered.

With no phones and no internet capacity, communication was an immediate challenge. Health centers relied on What’sApp, and most immediately on person-to-person contact, going out directly to the affected areas to check on staff, neighbors, and facilities, and offer care in remote locations. Panelists stressed the need to develop alternate channels of communication between key staff members in emergencies.

Throughout the crisis, the ASPPR, the Primary Care Association representing the 93 health center sites operating  across the island, served as the fulcrum, collecting data and interacting with government agencies, relief organizations and corporate and community philanthropy to coordinate their efforts and  get help to where it was most needed. Reflecting on this experience, Javier Jiménez Jirau described the importance of upcoming initiatives to provide low-bandwidth internet solutions that would allow health centers to maintain essential communications in the event of extreme disasters, and provide connections to government officials, relief services and the public.

The hurricanes took down power lines, and the electrical grid on the island remains unstable, compromising efforts to keep medications and vaccines viable. An initiative to provide solar power to 40 sites and offer solar-power battery solutions is underway, with the support of several philanthropies. These efforts will take advantage of the island’s abundant sunshine to provide a cost-effective solution that will equip health centers in Puerto Rico for the future.

Stateside, colleagues with ties to the island rallied in support. Paloma Izquierdo-Hernandez described how her personal and family connection to the island motivated her to jump in, reaching out immediately to colleagues at NACHC and HRSA, fundraising to support community health center employees in Puerto Rico who had lost everything, and collecting a range of materials and supplies, from diapers to medicines, which were stored at the health center’s distribution center in the Bronx until they could be transported to Puerto Rico. She lamented that some donations remain in San Juan ports, still awaiting distribution to those in need. Jay Breines explained that Holyoke, in Western Massachusetts, has the largest concentration of Puerto Ricans as a percentage of the total population of any U.S. city, and nearly 100% of the health center’s patients and staff are Puerto Rican. He described the efforts of Holyoke staff who visited the island to provide relief teams, and the importance of understanding how to identify needs and organize access to resources in the aftermath of a disaster.  Ultimately, said Breines, we are one health center family.

To prepare for the future, panelists recommended that every health center review existing disaster plans, conduct needs assessments for every clinic site, assess critical infrastructure and develop data and communication redundancy plans. This effort to rebuild better, and stronger, so that Puerto Rico is once again la Isla del Encanta – the island of enchantment –  is a commitment shared by those on and off the Island.  Alicia Suárez Fajardo, Executive Director of the ASPPR, closed the session with a short video memorializing the events, and recognizing the extraordinary leadership of the health centers and the importance of collaboration.

While the road ahead may be long and rocky, Dr. Jacobs aptly reminded us, “Hurricanes are powerful, but the force of community health centers is powerful, too.”

Community health center staff and leaders from Puerto Rico at the Resilience and Recovery panel (Image: Ralph Alswang)