Lessons in the Current Puerto Rican Disaster

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.

Rescue to Recovery Stages in a Red Cross Disaster Deployment

Roy was my partner for most of our deployment with Red Cross on the Disaster Mental Health Team in Texas. We spent many hours on the road mostly on our own, with the exception of “ride to the office” or “back to the shelter” caravans, which could be quite crowded as there were few available cars to ferry us all from the staff shelter to Headquarters for the day.

Conversations stayed rooted mostly in the present, even with kids occasionally Face-timing us in the car when a signal would pop up. I know that he’s been a social worker since 1970 and that he has been married nearly as long. Getting to know each other on a disaster mental health deployment is a different way of knowing someone, but knowing them well regardless. Similar relationships are built with the people you sleep a couple of feet from in the staff shelter.

Roy: “Wasn’t there a band people used to like called the Dead Heads? People liked them but I think they’re dead.”

Roy, In response to a question about breakfast: “Right I’ll give you another rotten orange in the morning.

Kristie: “No thank you; that coffee was sufficient.”

Roy, just go ahead and get in the wrong lane again for this right turn.” (Texas “turnarounds” can be a nightmare).

There was the normalcy of the city center recovering, demonstrated through open shops and Home Depot’s parking lot was nearly at capacity. Starbucks opened, there was a carafe in HQ for one of the lucky teams.

Vulnerability and exploitation were visible not far from the city center. Compounding issues plague those who struggled prior to the disaster. Living paycheck to paycheck when there is suddenly no paycheck creates a domino effect of financial disaster. You can only call the companies to beg for mercy if your phone works, if there are enough bars available to connect you. The smell is rising in neighborhoods, and the question, “What is that smell?” was more frequent today. Mold grows rapidly, and you can smell it from the street.  Weeks have passed since the initial disaster, but it is just beginning to unfold for many people do not have flood insurance.

I ended up making a call to the Attorney General’s office regarding landlords who are refusing to remediate damage and demanding rent from those who cannot pay (or live in their home), with the threat of their things being sent to the dumpster. The police were empathetic but said that it’s a civil issue and in a disaster needs to go to the AGs office. So the wet carpet stays with children living inside, and they lack healthy food- maintaining on what looks like a vending machine diet.

There are contractor company scams that further exploit the exploited, and many workers are being brought in from surrounding areas without protective gear (notable lack of face masks) and clearly without reasonable hours or meal contracts.

On the other end of helplessness and anger, I felt in awe of all of the volunteers and what they do. They respond at the crack of dawn to Headquarters to work with a team using colored post it’s on the wall to map progress and hot spots for the day. Knowing that it’s likely that at the end of the day, they will have gotten sidetracked from the need that was directly in front of them, feeling regret for not making it back to the places they know are in desperate need but are now blocked by factors beyond their control.

Headquarters experienced an evacuation- someone screamed, “Get out! Get out of the building!” It turned out to be some off-gassing cones, but everyone went right back to work outside while standing outside the building waiting for clearance entirely unfazed.

Volunteers will talk it out with each other back at the shelter late at night, eating cold leftovers from the ERV (feeding) vehicles. Informal meetings run from their cots which will make a difference the next day in how resources are allocated because drivers are sleeping next to mental health, nurses, and those doing communications assessments. If you end up both eating and securing a space in line at the shower trailer behind the civic center before it’s too late, it’s something of a miracle. With a lot of contamination and illness going around, it’s best to just throw away the shoes on your way out.

As for the people we served, we realized the depth of desperation that is held for those in areas without good water. Your clothes were washed away or were contaminated, and even if you could wash them, you can’t because your washer and dryer is flooded (one family had some kind of snakes in theirs) as is the laundry mat down the road.

We brought restaurant workers wearing their last items of clothing and shoes serving people in the only community restaurant to open back up in Port Arthur in a certain radius, knowing that those clothes too, would soon be dirty. So what then? How long will this all take? While you may see signs of recovery in the city center, it’s clear that this is going to take so much longer for others, and the rural areas are barely touched by “helpers”.

The depth of this disaster isn’t something that we are used to covering, Katrina taught us a few things that are applicable, but each disaster is its own, and this scale is unimaginable. Puerto Rico is now unfolding as we watch on our screens, in some sort of mass denial of scale.

Most of us can sit comfortably behind our devices and all caps “GET TRUCK DRIVERS!” and while I can personally imagine the barriers that they have in distribution as we just experienced them in Harvey, you just can’t know unless you’re there and are using all of your five senses.

NBC Nightly News Headline on the American Red Cross is Deeply Misleading

Photo Credit: @Redcross Twitter

Recently, NBC Nightly News with Lester Holt headlined a story entitled “American Red Cross Fails to Pay Funds Promised to Many Harvey Victims”. The report discussed the failure of the American Red Cross to disburse funding to the victims of Hurricane Harvey. As a volunteer with Red Cross, this report raised my concerns for several reasons, and I immediately contacted them in order gain some insight into the causes preventing the Red Cross from distributing emergency funding.

According to the American Red Cross website, the primary function of the charity is “providing relief to victims of disaster, blood to hospital patients, health, and safety training to the public, or emergency social services to U.S. military families.” For more information on how the American Red Cross spends its donations, you can visit their website. After speaking with staff, I am now able to provide some clarity on the issues causing the delay with the disbursements.

Website Crashed

The website crashed from the 1 million displaced people trying to access it (plus repeat tries). Not only is the Red Cross attempting to aid those displaced by Hurricane Harvey, they are also handling an equally major crisis in Florida due to Hurricane Irma. Both Hurricanes have left a destabilized communications infrastructure with limited wifi and cell phone access in which to process aid. Everyone in flood areas is also still fighting the shaky access and embattled communication infrastructure in place. Many residents were showing up at the Red Cross HQ in hopes of gaining connectivity through the Red Cross. Unfortunately, the office has been experiencing the same connectivity issues.

Headlines about “High Overhead” feed into Confusion for Donors

When donors don’t understand that upgrading systems and IT staff, hiring volunteer coordinators and trainers, and other administrative staff duties are necessary to make it possible to handle 1 million plus displaced victims in multiple disasters at the same time, it breeds confusion and misinformation. The American Red Cross is not a governmental agency, but it is responsible for the bulk of relief efforts when a disaster happens. With Congress continuous cuts to FEMA, the American Red Cross will not be able to continue mass scale relief if they are denied donor support due to misinformation. This is a dangerous way to share information about life-saving charities. Without the American Red Cross, who else is equipped to handle natural disasters on this scale?

Emergency Funding

The $400 funds allocation from the Red Cross is an attempt to fill the gap that insurance and governmental delays create for desperate families. However, the reality is that it is dangerous to have volunteers standing on street corners handing out cash. However, this crisis may help the Red Cross identify innovative ways to distribute funds to help expedite funding to families. Currently, funds are being distributed to local centers like Wal-Mart for a more orderly disbursement. However, each disbursement center in affected areas is also still dealing with their own infrastructure issues.

At the end of the day, the American Red Cross is an organization run by 90% plus volunteers working at least 15 hours per day in harsh conditions because they want to help others. More paid employees would help with consistency and efficiency (deployments are only weeks long), but it would also create higher overhead in which donors don’t want.

With all of the disaster pile-ons we are experiencing with even more looming in the distance, we need to take a good look at our charities and how we expect them to function like a governmental agency or corporation while relying on donor support. How does the Red Cross run operations that cover a million people in a single disaster without the funding to hire people at salaries that will attract those with the talent and the willingness to risk such public scrutiny?

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