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Assessing the impact of 2017's hurricanes on Puerto Rico and the US Virgin Islands

June 19, 2018
by Hoffman, Christopher

The healthcare systems in the U.S. Virgin Islands and Puerto Rico were already stressed when two monstrous hurricanes slammed into them last September, Marcella Nunez-Smith, MD, MHS, told listeners at a forum during Yale School of Medicine’s alumni weekend.

The ferocious storms killed (officially) dozens, led to an uptick in diseases like dengue fever and destroyed health infrastructure, including the Virgin Islands’ only two hospitals, said Nunez-Smith, a Virgin Islands native. Nunez-Smith, whose mother and family live on St. Thomas, is an expert on Caribbean health care who helped found the Eastern Caribbean Health Outcomes Research Network (ECHORN).

More deadly than the storm was the health crisis created by shortages of medicine and lack of access to care, especially pressing for people suffering from diabetes or kidney ailments, Nunez-Smith said.

“We personally had close friends who could not get insulin and access to dialysis,” Nunez-Smith said. “Those numbers are not official hurricane casualties, but were it not for the storms, I would say they would not be dead. The most vulnerable people are quite at risk of loss of life after a hurricane.”

Severe shortages of fresh, healthy food after the storms exacerbated the danger to chronic disease sufferers, Nunez-Smith said. She told of her mother, a nurse and medical researcher, having to resort to eating salt-laden, unhealthy TV dinners after the price of chicken breasts soared to $16 each.

“My mother is highly resourced and highly educated, and she can’t access fresh food,” Nunez-Smith said. “Think about somebody without resources who turned to canned chicken with all that salt load.”

Nunez-Smith said that ECOHORN is collecting funds for hurricane relief in the two U.S. territories and trying to keep track of the residents taking part in its studies and programs. It is a challenge as many have moved to other parts of their islands or to the mainland, she said.

Before the hurricanes, the U.S. Virgin Islands and Puerto Rico shared similar and significant healthcare challenges, Nunez-Smith said. While residents of both territories receive Medicare and Medicaid, reimbursement rates are lower and certain services, including skilled nursing facilities, are not covered. An early ECHORN study found that hospital patients with diabetes, cancer and other ailments on the two islands and in the other U.S. territories of Guam, American Samoa and the Northern Marianas have higher mortalities rates than those stateside. Nunez-Smith said she believes the discrepancy is likely due to leaner government healthcare benefits.

Concern over public health In the Caribbean, especially high levels of diabetes, high blood pressure and heart disease led to the founding of ECHORN in 2011, Nunez-Smith said. The group, which has received National Institutes of Health funding, works in Puerto Rico, the Virgin Islands and the independent nations of Barbados and Trinidad and Tobago.

Nunez-Smith, who understood on an anecdotal level the depth of the problem, was initially “gung ho” to initiate projects. But she soon learned from local health officials and professionals that there wasn’t enough basic data to start anything ambitious. The group set out to build a database, eventually convincing about 30,000 people to fill out extensive questionnaires, submit to a physical exams and engage in regular follow ups, she said.

Having established a baseline, ECHORN has initiated various programs, including lifestyle coaching, early diabetes detection and 24-hour blood pressure monitoring, to combat the regional scourge of chronic diseases, she said. Today, the group partners with about 65 organizations as well as governments and universities in its four target areas, she said.

Nunez-Smith said visiting the Virgin Islands and Puerto Rico is an excellent way to help the islands recover and urged her listeners to go. Their economies are tourism based so any dollars spent there will have a positive impact.

“They are open for business,” she said.

Submitted by Adrian Bonenberger on June 19, 2018