When Hurricane Maria struck Puerto Rico it left behind a massive trail of destruction. Whole homes were levied, roads were washed away by floods, the power grid and water table were completely incapacitated, and thousands of Puerto Ricans were displaced – putting many at risk for illness, injury and death. Despite communication and transportation challenges, Puerto Rico’s Community Health Centers became first responders in Hurricane Maria’s aftermath, even as health center staff also worked to recover.
For Gloria del C. Amador Fernández, DrPh(c), MHSA, Chief Executive Officer of Salud Integral en la Montaña (SIM), Inc., the loss of communication was the biggest challenge in reaching staff and coordinating between sites. The ability to communicate with staff—to understand how they were doing and what they needed—in the chaos following such a major natural disaster was key to getting the health center back up and running.
SIM, which operates eight sites, including four emergency rooms, and offers homebound and hospice care, prepared employees and equipment to mitigate damage and provide continuity in service via its emergency plan.
“We communicated instructions to all employees for the preparation of our sites and to report to every health center immediately after the storm,” said Amador. “As soon as the storm passed the majority of the employees came back to work.”
The health center had also made a staffing plan for its emergency rooms that included 12-hour shifts. To accommodate the long shifts, the health center prepared spaces in the facility with enough food, water and other items staff would need to get through the storm. When Amador arrived at the main health center site the next day the emergency room was still running but the health center was already on generator power and without any water.
A head count was done as employees arrived to determine who was able to make it in, and who had communicated that they were ok but couldn’t make it. The health center’s engineers—essential employees in the plan—also arrived and assessed damage to the sites.
The health center soon found that 40 employees had lost everything in the storm. Recognizing that their employees needed to also manage their own losses, SIM’s board donated to those employees to help them begin rebuilding their homes and allowed them to take unscheduled leave.
“They were the first ones who [arrived] at the health centers to collect debris and clean,” said Amador, about the health center’s dedicated employees. “Because, they told us, of their need to help other people.”
With communications down, SIM had to get creative to share information between its eight sites and 504 employees.
“We lost all communication mechanisms because we are all digital. As soon as we lost the antennas, we didn’t have a telephone, any satellite phones, any internet so there was no way to contact any of the health centers,” says Amador. “So we introduced runners into the process.”
Amador needed to know if health center sites needed water, diesel, food, and medications, and if patients were arriving to be seen. She also needed information from other places SIM was helping, like the local shelters. Runners were instructed to collect that information and more, and then arrive to the main health center location in Naranjito. Runners were sent back out to the sites with instructions and supplies.
“It was necessary to maintain open, constant communication and give clear and direct instructions to restore services as soon as possible,” says Amador.
As a result of the lost communication during the storm, SIM is now investing $25,000 in the development of a HAM radio communication system. HAM radio does not rely on the internet or cell phone networks to send a communication, making it much more reliable during or after a disaster. SIM hopes it will help them maintain communication between health center sites and with the Department of Health of Puerto Rico.
“The roads were so difficult to travel.”
Transportation was another challenge the health center faced. Gas and navigable roads were hard to come by after the hurricane, so SIM used its fleet of corporate cars to establish a carpool. Staff schedules were arranged so that they would meet in a designated spot and ride together to the health center. The health center had also made arrangements with local gas stations to give their clinical staff and corporate cars priority.
It’s impossible not to learn something new from an experience like Hurricane Maria. The events have the health center rethinking emergency management and where they can improve. They’ve already identified areas of improvement and divided them into preparation, response, recovery and mitigation categories. But even with the trauma that comes with an event like Hurricane Maria, SIM’s staff had a resilient spirit, says Amador.
“I have to recognize our staff that worked long hours, even with a lot challenges within their own houses, they put service to community and to our patients first. We are very grateful for it.”