Originally published in the September issue of the Notes on Antiracism, Justice, and Equity newsletter.
Hispanic Heritage Month is underway and so is hurricane season in the Caribbean. Hurricane Fiona hit the island of Puerto Rico as a category 4 hurricane on Sunday, September 18, just two days before memories of Hurricane Maria resurfaced in the minds and bodies of thousands of people who experienced its devastation five years ago.
I grew up in Puerto Rico, amidst coffee trees and the nightly songs of the mighty coquí. When Maria landed in 2017, I resorted to social media to search for my relatives like many Puerto Ricans in the diaspora did, but all forms of communication were disrupted throughout the island. Roads were blocked, bridges had collapsed, cars were stranded or stalled as gasoline was hard to get, and neither electricity nor water were available. And the story repeats itself, with some variants, with Fiona.
Natural events such as hurricanes bring significant stress to the public health infrastructure of any nation, and the stateless nation of Puerto Rico is no exception. The island has been a U.S. territory — in effect, a colony — since 1898 when Spain ceded the island they invaded in 1493 to the U.S. after losing the Spanish-American War. Considered a socio-structural determinant of health, colonialism has created the conditions in Puerto Rico for a slow and ineffective response to natural disasters (Perez-Ramos et al., 2022). Chronic underfunding, privatization of local healthcare systems, the loss of healing practices rooted in culture and intergenerational knowledge, draining of local resources, lack of political power and economic decision-making, and suffocating policies are among the legacies and current realities of colonialism (Perez Ramos et al, 2022; Rodriguez-Diaz &Lewellen-Williams, 2020; Laureano-Ortiz, 2017; Tiley 2016). Puerto Rico’s colonized system is unable to bounce back with the velocity needed to provide an immediate response to the needs of the population; health and well-being are further compromised as disruptions to the infrastructure hinders people’s ability to access lifesaving treatments and medications, clean water, and other public health and medical services (Michaud & Kates, 2017).
Yet, as I follow the Facebook posts about Fiona that are coming from the island, I see neighbors, friends, and families coming together to clean roads, rebuild homes, heal the sick, mend the injured, cook meals, and care for each other. Community action was organized, fast, assertive, and local. Why not fortify what is already there? We know that community health workers are an effective strategy to address many public health needs, from immunizations to diabetes management. Why not expand this concept to hurricane preparedness and form brigades of community members to manage the aftermath of hurricanes? They may provide a more effective response to the existing disaster management strategies that remain dependent on bureaucratic processes. Community members know the physical terrain and the local infrastructure, they know where families with children and elderly live and are aware of what needs are present, they know who lives alone and may need assistance, and they can be mobilized to respond to acute and immediate needs. Local brigades of community health workers and hurricane respondents can be supported through non-profit and private entity partnerships, local and in the diaspora, to get the training and equipment they need as hurricane season approaches. And while the colonial status of the island will require a longer conversation, we can focus on how partnerships and communities can come together to rebuild after a hurricane and lift the wings of community resiliency.
Associate Professor, Division of Epidemiology and Community Health
UMN School of Public Health
Pérez Ramos, J. G., Garriga-López, A., & Rodríguez-Díaz, C. E. (2022). How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico? AMA journal of ethics, 24(4), E305–E312. https://doi.org/10.1001/amajethics.2022.305
Rodriguez-Díaz, C. E., & Lewellen-Williams, C. (2020). Race and Racism as Structural Determinants for Emergency and Recovery Response in the Aftermath of Hurricanes Irma and Maria in Puerto Rico. Health equity, 4(1), 232–238. https://doi.org/10.1089/heq.2019.0103
Laureano-Ortiz, R. (2018). Puerto Rico y CARICOM: apuntes para la historia de una relación. Ámbito de Encuentros, 11(1), 86-131.
Tilley, H. (2016). Medicine, Empires, and Ethics in Colonial Africa. AMA journal of ethics. 18. 743-753. 10.1001/journalofethics.2016.18.7.mhst1-1607.
Michaud, J., & Kates, J. (2017). Public health in Puerto Rico after Hurricane Maria. KFF. Retrieved September 22, 2022, from https://www.kff.org/other/issue-brief/public-health-in-puerto-rico-after-hurricane-maria/
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