The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators

Abstract Background After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article ad...

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Autores principales:	Sheilla L. Rodríguez-Madera, Nelson Varas-Díaz, Mark Padilla, Kevin Grove, Kariela Rivera-Bustelo, Jeffrey Ramos, Violeta Contreras-Ramirez, Sergio Rivera-Rodríguez, Ricardo Vargas-Molina, Jose Santini
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Health care system Post-disaster Health care providers Resilience Puerto Rico Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/abbbd1cb4da749fe9c42b29ddb7c1f7f
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spelling	oai:doaj.org-article:abbbd1cb4da749fe9c42b29ddb7c1f7f2021-11-14T12:27:34ZThe impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators10.1186/s41256-021-00228-w2397-0642https://doaj.org/article/abbbd1cb4da749fe9c42b29ddb7c1f7f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s41256-021-00228-whttps://doaj.org/toc/2397-0642Abstract Background After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system’s collapse and the strategies used by them to meet their communities' health needs. Methods Data were collected between September 2018 and February 2020. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes. Results Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico’s health care system, responded to the crisis after Maria. The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Participants reported a sense of abandonment by the government and feelings of mistrust. They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. In such circumstances, they developed resilient responses to meet communities’ health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies). Conclusions Participants’ narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster’s impact. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed ‘the collapse before the collapse,’ alluding to the structural deficiencies that presaged the catastrophic event. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.Sheilla L. Rodríguez-MaderaNelson Varas-DíazMark PadillaKevin GroveKariela Rivera-BusteloJeffrey RamosVioleta Contreras-RamirezSergio Rivera-RodríguezRicardo Vargas-MolinaJose SantiniBMCarticleHealth care systemPost-disasterHealth care providersResiliencePuerto RicoPublic aspects of medicineRA1-1270ENGlobal Health Research and Policy, Vol 6, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Health care system Post-disaster Health care providers Resilience Puerto Rico Public aspects of medicine RA1-1270
spellingShingle	Health care system Post-disaster Health care providers Resilience Puerto Rico Public aspects of medicine RA1-1270 Sheilla L. Rodríguez-Madera Nelson Varas-Díaz Mark Padilla Kevin Grove Kariela Rivera-Bustelo Jeffrey Ramos Violeta Contreras-Ramirez Sergio Rivera-Rodríguez Ricardo Vargas-Molina Jose Santini The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
description	Abstract Background After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system’s collapse and the strategies used by them to meet their communities' health needs. Methods Data were collected between September 2018 and February 2020. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes. Results Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico’s health care system, responded to the crisis after Maria. The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Participants reported a sense of abandonment by the government and feelings of mistrust. They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. In such circumstances, they developed resilient responses to meet communities’ health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies). Conclusions Participants’ narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster’s impact. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed ‘the collapse before the collapse,’ alluding to the structural deficiencies that presaged the catastrophic event. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.
format	article
author	Sheilla L. Rodríguez-Madera Nelson Varas-Díaz Mark Padilla Kevin Grove Kariela Rivera-Bustelo Jeffrey Ramos Violeta Contreras-Ramirez Sergio Rivera-Rodríguez Ricardo Vargas-Molina Jose Santini
author_facet	Sheilla L. Rodríguez-Madera Nelson Varas-Díaz Mark Padilla Kevin Grove Kariela Rivera-Bustelo Jeffrey Ramos Violeta Contreras-Ramirez Sergio Rivera-Rodríguez Ricardo Vargas-Molina Jose Santini
author_sort	Sheilla L. Rodríguez-Madera
title	The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
title_short	The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
title_full	The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
title_fullStr	The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
title_full_unstemmed	The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
title_sort	impact of hurricane maria on puerto rico’s health system: post-disaster perceptions and experiences of health care providers and administrators
publisher	BMC
publishDate	2021
url	https://doaj.org/article/abbbd1cb4da749fe9c42b29ddb7c1f7f
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The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators

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