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    Lessons in the Current Puerto Rican Disaster

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    A man tries to repair a generator in the street after the area was hit by Hurricane Maria in San Juan, Puerto Rico September 25, 2017. REUTERS/Alvin Baez

    Those who have worked in disaster areas know that coordination and transport can be difficult, but with the USS Comfort leaving Puerto Rico after admitting less than 300 patients when there is unmet need isn’t a great sign of success. Hurricane Maria made landfall on September 20, 2017. The Comfort, which is essentially a floating specialty hospital arrived in Puerto Rico on October 3rd.  November 8th, the Comfort was restocked with supplies but then departed shortly thereafter for “no apparent reason” after providing outpatient services to somewhere around 1500 patients, according to the DOD.

    …”I know that we have capacity. I know that we have the capability to help. What the situation on the ground is … that’s not in my lane to make a decision,” he said. “Every time that we’ve been tasked by (Puerto Rico’s) medical operation center to respond or bring a patient on, we have responded (Captain of the USS Comfort to CNN).”

    The death count is still hazy, and there is difficulty in confirming how many died during- or as a result, of the disaster.  One group is doing a funeral home count because information is difficult to obtain. CNN has found through a recent investigation that the death toll appears to be more than 9 times the official government report. 

    Coordination on a micro, mezzo and macro level must come from multidisciplinary sectors to problem solve. There are many good people working to rebuild Puerto Rico, but there is far too much apathy, throwing up of hands, and of course, corruption.  Many of the Social Work Grand Challenges are highlighted in Puerto Rico alongside the UN Global Goals.

    The Whitefish linemen are making $41-64 per hour to restore power to Puerto Rico’s Grid, but the US government is being billed for more than $319 per hour. Whitefish just called a strike because they have not been paid. This, of course, is having a terrible impact on those who are in the most need.

    Where do you come in?  We tend to think of trauma on a psychological level: family members and friends who are missing, grief, anxiety, and depression due to home and job loss as well as connecting with those close to you, each processing the trauma differently.

    On the mezzo level, we are working with smaller groups and institutions, of which there are many in disaster or mass casualty events.  Local churches, schools, nonprofits and local chapters of larger scale organizations attempt to unite in the local area to help speed services to those that need it most.  Often this is where many of the challenges lie.  Each organization has their own protocols which may not match up with larger scale efforts of the government or international organizations.

    On a practical level, resources are often short on a disaster scene- there are not enough clinicians to meet with clients individually, at least not for more than a few minutes at a time. We revert to what the American Red Cross refers to as “Psychological First Aid”.  Human networks through nodes (like shelters) provide a sense of community and belonging when all is lost, with individuals acting as brokers between networks that previously didn’t have ties.

    Ground efforts can be supported by a drone equipped with a camera to see if there is a possibility of reaching a scheduled neighborhood by car, saving countless minutes that matter.  The aerial shots from 3 days ago may no longer be relevant. The water may have receded but now a home has landed there, blocking road access.

    The volunteers mapping from satellite images can instantly beam their work from anywhere (tracing homes, schools, possible military vehicle parking areas or temporary helipads) while teams on the ground stare at a water covered road, unsure of what is beneath. Life saving choices are made with options and all levels working together. This is how neighborhood Facebook groups saved lives- they were the eyes on the ground in their own neighborhood that identified who was in the most danger.

    Facebook may no longer be the hippest new technology (we are nearing the decade and a half mark) but it is arguably the most ubiquitous and well supported (crashes rarely). Many survivors could make a post but were unable to call or text from the same device. An important component to the multi-level view is the understanding that macro tools like mapping serve micro and mezzo levels.

    Being a survivor in an active disaster can quietly morph into anxiety, depression and survivor’s guilt.  Being able to participate in practical support efforts can boost the well being of survivors as well. Friends of friends of friends and influencers in social networks have proven to be incredibly powerful.  It’s what happens when “mixed networks” collide.

    As we move to a macro level, there’s a realization that there is a great deal of organic movement in even the best planned days for rescue effort workers.  Do you stop here where the need is great (and went unreported) even though it’s blocking you from reaching the mapped area that your team has already scheduled? This is where technology for good can make the difference.  Depending on your training and background, you may make a different choice.  Who is in charge of the government response, and how do we help change course if it is failing?  How do we know if the efforts match our resources?

    The simple answer is that we are there to communicate it with others, on all levels—including the virtual one. This may mean volunteering for rescue efforts, collecting tampons in your hometown, or using your own technology for good by mapping for workers on the ground that are not sure what lies beneath—you are helping to ensure their safety and mental well being.  In turn, you get to pass that knowledge into your own networks.

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    Kristie Holmes, PhD, LCSW, specializes in topics related to global health, gender and media, as well as technology’s impact on relationships. She has spent a significant amount of time in the past eight years working on projects related to the United Nations Sustainable Development Goals with the United Nations.

    Emergency Management

    How Social Workers Play A Role In Disaster Relief

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    Federally declared disasters have increased by 40% over the last 15 years, according to the Clinical Social Work Journal, and internationally, those numbers are higher. Over just the last two decades, natural disasters have doubled.

    In the past, the term “disaster” was poorly defined, leading to emergency response plans that were a one-size-fits-all solution to multifaceted problems. This approach left survivors with fewer options for critical care, especially in the area of mental health.

    The National Center for PTSD recently redefined disaster as “a sudden event that has the potential to terrify, horrify, or engender substantial losses for many people simultaneously.” It went on to further define disasters based on type, differentiating between natural and man-made disasters. If more widely accepted, this definition opens the door to opportunities for mental health care in these urgent situations, giving social workers a vital role in relief, recovery, and community resiliency.

    Responses in Disaster Relief Social Work

    Social workers can offer a variety of mental health services in the immediate aftermath of disasters. Traditional psychotherapy performed by therapists is known for its long-term approach involving session work and trust building, allowing patients to share their trauma narratives. However, when social workers are called up for active disaster relief, their critical and immediate intervention skills are far more necessary for psychological triage. Among them are:

    • Psychological first aid (PFA): PFA assists those in crisis in the aftermath of disaster. It relieves initial distress in an effort to promote short- and long-term coping. This sometimes includes crisis intervention and counseling.
    • Family care: Family social workers help families during crisis. They aid survivors in locating the services they need to overcome post-disaster challenges and repair their lives.
    • Mental health media communications: This field provides voices and vital points of view for under-represented or disadvantaged populations.
    • Resilient community capacity building: This includes creating response plans for various groups.

    Above all, the pledge to “do no harm” is the first aspect of every skill.

    Assistance During Disaster

    Disaster relief programs typically consider the short-term needs of survivors in order to identify the best allocation of resources and promote beneficial coping in the aftermath of tragedy. Social workers assist in these programs in a number of ways, including:

    • Case management: Social workers locate appropriate resources for clients, making sure they receive the services they most require.
    • Case finding: Case finding involves providing survivors with information about the programs available to them. Many are unaware that such services are available or fear stigmatization for participating in them.
    • Outreach: Social workers performing outreach increase program locations in order to allow services to be more accessible.
    • Advocacy: Using connections within various relief organizations, social workers advocate on behalf of clients to qualify them for additional services.
    • Brokering: When acting as a broker, social workers link client systems to the resources they need, fulfilling client needs throughout a multiplicity of programs.

    Ultimately, all these methods allow social workers to disseminate information, refer clients to services, and assist them in qualifying for resources in disasters.

    Disaster Relief Social Work in Practice

    In the U.S., the American Red Cross and the Crisis Counseling Assistance and Training Program have provided almost half of all social workers participating in disaster relief programs. Depending on the type, duration, and severity of disaster, the challenges and requirements of social work change. When preparing ahead of an impending calamity, social workers may be identifying and organizing supplies, assisting with area and hospital evacuations, or even determining which patients can or should be moved.

    During an actual emergency, the needs of the afflicted tend to take precedence over one’s own needs. Moment-to-moment changes in operational requirements contribute to the notion that social workers must remain flexible. They must be able to go where they are needed when they are needed there. The following are some real-world examples of social workers in the midst of disaster.

    HURRICANE HARVEY

    The residents of Beaumont, Texas, were witness to devastation on a massive scale. In the fall of 2017, Hurricane Harvey descended on Texas and Louisiana, and with it came ruined homes and wrecked lives.

    In the end, the storm caused over $125 billion in damage and took 107 lives. The end of the storm was nowhere near the end of the damage. Long-term psychological trauma is a reality for many survivors, especially children. According to a recent survey in the aftermath of a hurricane, nearly 3.4% of respondents were found to have suicidal thoughts. The assessment, response, and counseling of suicidal behaviors were critical concerns that social workers on the ground were able to address.

    HURRICANE MARIA

    In September 2017, the USNS Comfort, a hospital ship, was deployed to Puerto Rico in the wake of Hurricane Maria. The crew included social workers and mental health providers for inpatient and outpatient mental health services. These providers developed protocols to educate the ship’s staff in treating psychiatric patients in addition to treating patients on board.

    NORTHERN CALIFORNIA WILDFIRES

    The Wildfire Mental Health Collaborative was established in Sonoma County after the devastating Tubbs fire to offer survivors tools for dealing with trauma. In the wake of the fires, The Guardian reported that many social workers were funded by grants from FEMA, which allowed them to connect with nearly 70,000 people in Sonoma County alone. These social workers were able to identify and refer thousands to much-needed mental health services.

    Research Applications

    Further study of the impact of disasters on the mental health of survivors is critical to the practice of disaster relief social work. The National Association of School Psychologists (NASP) has emphasized that children are especially vulnerable in disaster conditions, as they take their emotional and behavioral cues from adults.

    Anxiety and startle responses, typical symptoms in children that have survived hurricanes, require therapeutic activities to help them cope in healthy ways. According to NASP, other disasters can prompt separate trauma responses. Tornadoes can cause survivor’s guilt due to their suddenness, whereas wildfires, given their advance warning, can cause anxiety. Negative effects stem from displacement, property destruction, and the concerns associated with biological threats to one’s health.

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    Business

    Work Together to Prepare for the Next Big Storm

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    Year by year, hurricanes are growing stronger and more frequent. We are witness to these changes as we watch two catastrophic storms devastate the southeastern United States in as many weeks.

    This month, Hurricane Michael slammed the Florida Panhandle, southern Virginia, and the Carolinas. The massive storm killed at least 16 people, flooded cities, highways, and rivers, and reduced much of the region to rubble.

    Barely two weeks ago, Hurricane Florence killed at least 36 people in three states, forced thousands to evacuate their homes, dumped record floodwaters on North Carolina, created power outages for hundreds of thousands, and killed millions of farm animals. The most recent damage estimates put the economic toll at a staggering $100 billion, once accounting for property damage, medical costs, and lost wages.

    Natural forces emboldened by climate change continue to overwhelm our outdated stormwater management practices and inadequate urban planning, putting us in a precarious position. Short-term economics have often driven development where considering long-term environmental impact was needed instead. When it comes to handling the effects of more storms, we’re not as prepared as we think.

    As we assess the damage done by Michael, Florence, and other storms, the shrewdest move is to prepare for the next big storm — and the one after that. Municipalities, businesses, and individuals can brace for the next storms by focusing on the following areas:

    Additional Pollution Prevention

    Florence and Michael disrupted two of North Carolina’s biggest industries: coal power and hog farming. This created environmental trouble and the potential for health problems. Duke Energy officials in North Carolina said slope and landfill erosion caused stormwater with coal ash — containing heavy metals such as arsenic, lead, and mercury — to spill into Sutton Lake. Watchdog groups have expressed concern about the effect on water quality.

    Floodwaters also breached multiple hog lagoons, designed to keep solid waste from polluting sources of drinking water, in at least two North Carolina counties, causing varying degrees of damage. The North Carolina Pork Council says the state’s other 3,000 hog lagoons are holding up, but the state’s Department of Environmental Quality will have to perform inspections.

    The landfills, dams, and lagoons containing pollutants need to be stabilized and reinforced. Cities can reduce landfill washout by using gravel stabilizers, terracing, drainage diversions, and other measures to safeguard their slopes against erosion. To avert overflow of detention ponds like hog lagoons, companies can add pond depth, secure the perimeters, and place impervious barriers around the site.

    Adjusted Damage Estimates

    Because of climate change, we can count on heavier rain and shorter intervals between storms increasing flooding risk. Data is still being gathered for Michael, but we know that for Florence, greenhouse gas emissions and warmer weather made for more intense rainfall. When Hurricane Harvey hit Houston last year, the city matched its annual rainfall (typically 50 inches) in a matter of days.

    Cities, businesses, and infrastructure planners need to set new damage expectations, as “500-year storms” arise with increasing regularity. Adequate planning and preparation may seem expensive overall, but it’s more expensive to deal with damage in the aftermath of flooding. It’s important to remember there’s no immediate fix or silver bullet. Instead, we need long-term solutions first acknowledging the problem and then planning for it.

    Broader Public Education

    Weathering the next storm requires a public education process that touches all sectors on the solutions available to help protect communities against floodwater. In my hometown of Houston, the community has come together with a discussion on the web, in public forums, and in community meetings.

    The Houston Green Building Resource Center provides a public resource at the permitting building, providing engineers, architects, contractors, and homeowners with techniques on how to reduce flooding on the macro and micro levels, including information on building codes, permeable and sustainable materials, and engineering technologies to incorporate. Examples include elevated construction, or raising buildings above the rising floodplain, and permeable paving techniques that can reduce the extreme weather’s impact on the earth’s surface. Both are cost-effective improvements worthy of broader public education.

    The intensity of storms like Michael and Florence raise the bar for planning and preparation. Governments, businesses, and communities must plan ahead and work together during the quiet times before the storm returns.

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    Emergency Management

    How Not to Be a Victim When Natural Disaster Strikes

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    How people on the East Coast fare as Hurricane Florence reaches landfall will depend in large part on what they have done to themselves to prepare in advance, says Beth Gazley, professor in the Indiana University School of Public and Environmental Affairs.

    Disaster resilience begins, she said, by understanding how environmental change has kicked up the force of these storms, by making them bigger, slower and wetter.

    “That means your past experience with storms — or your house’s past experience — may no longer be valid,” Gazley said. “Climate-induced hurricanes are a different animal.”

    Beth Gazley

    It also means residents should think in terms of elevation rather than just wind speed when they consider their risk. “Rain flows downhill,” Gazley said. “Most of Hurricane Harvey’s victims in Texas were flood victims. Evacuating low-lying areas, regardless of your distance to the coast, will be crucial.”

    Disaster resilience also requires acknowledging our collective responsibility as citizens to prepare for major storms, said Gazley, a co-founder of Indiana University’s Environmental Resilience Institute.

    “Ask any emergency responder what he or she wants from us,” she said, “and you’ll get the same answer: ‘Make a plan and assemble an emergency kit. We can help you best when you help yourself.’ Each of us needs to start that planning effort in advance of a storm. How are you going to charge your cellphone if the power is out for days and possibly weeks? Think through these questions in advance.”

    One of the most active Red Cross campaigns, Gazley said, is about family and workplace emergency preparedness. The Federal Emergency Management Agency has excellent resources at www.ready.gov.

    But even in the best of circumstances, and even when we implement good emergency plans, some people will need help.

    “Fortunately it’s a natural human inclination to help others,” Gazley said. “So give. Give today, not next week — in fact, I just made a gift on the www.redcross.org website. Make an unrestricted gift so the charity can use it where it’s most needed.

    “Then renew that gift next year, and the year after, even when a disaster is not happening. The most successful charities depend on long-term support. That kind of financial stability gives them the chance to train and retain the kind of experienced professional emergency response staff we all need.”

    Gazley said people who don’t give to established charities like the American Red Cross because of their high reported overhead costs are making a mistake.

    “For heaven’s sake, don’t give to the disaster charity with the ‘lowest overhead,'” she said. “The nonprofit research is pretty clear that charities with low overhead may fail to thrive in other important ways, like investing in fundraising or in experienced senior staff.”

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