How Puerto Rico managed the medical crisis of the hurricanes

Only 22% of us can meet the 2008 physical activity guidelines and only 12% meet the guidelines for fruit and vegetable intake. But if you had a heart attack, stroke or diabetes diagnosis in 2017 or 2018, is it President Trump's fault? That's what the Puerto Rico hurricane blame reminds me of. Dr. Myriam Allende-Vigo wrote an article for the August 21 JAMA about her practice and patients in Humacao. Here's what she reveals:

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• 1) Most of the people are poor--they live in rural barrios even though there are big, high-end resorts in the area.
• 2) Because of their poverty, they didn't have generators, or the money to pay for diesel.
• 3) After the storm, there was no power, no electricity, no refrigeration, no ice.
• 4) Most of her patients have diabetes--they fhrew their insulin away unaware that it lasts a few days.
• 5) Relief organizations and other pharmacies in other cities supplied insulin. Four distribution centers set up free insulin stations.
• 6) Volunteer endocrinologists went to shelters and community centers to provide care.
• 7) Within one week there were 10,000 federal relief workers in Puerto Rico.
• 8) Within a few days, she had cell phone service (after hurricane Ike in 2008, some residents of Columbus, Ohio were without cell phones and electricity for 8 days). She with volunteers was attempting to contact her patients to educate them about eating, insulin and taking care of their feet. For reasons she didn't explain she couldn't get ahold of her staff for several weeks. By word of mouth, the patients began coming to the office.
• 9) No EMR, so they went back to paper records and prescriptions.
• 10) She never believed the death "official total" of 64.

Now what else did she say about the P.R. preparedness and local response?

• 1) "We get hurricane warnings every year. But we never thought that we would be hit so hard and that it would take us so long to get back to normal."
  2) The U.S. government response was too slow. . . she admitted it takes a few days to get there by ship with supplies.
  3) Supplies stayed in the ports too long; "they" couldn't figure out how to distribute them. Whoa Nellie! That means the governors and mayors didn't know how to distribute the supplies the U.S. sent.
  4) While people were suffering "they" took a lot of time to get organized.
  5) P.R. needs infrastructure, a better power and communication system (this was a problem before the hurricane).
  6) Hospitals and her practice are now back to normal (mid-2018); most of her patients (whom she said were poor and rural) fared well and had ample medications and were able to buy generators.7
• 7) Many physicians worked outside to take advantage of light--she is very proud at how the medical community responded.
• 8) She thanked all the volunteers who came to the island to help and she would appreciate calls of encouragement.
  9) She did not thank FEMA, the President or the people of the U.S.A. for billions appropriated which the government of P.R. has been unable to organize and use