unfolding humanitarian crisis in Puerto Rico after Hurricane Maria
barreled over the island is only getting worse. Alarm bells are being
rung from humanitarian organizations on the ground that the
deteriorating conditions are seriously impacting human health and
survival. Warnings from the front lines are summarized in the
an emergency that a month in should not be an emergency--but it is,”
said Thompson, presenting a series of real-life scenarios that Puerto
Ricans have been grappling with since driving rain and winds of 155
miles per hour took down the island’s entire electrical grid on
Sept. 20. Without electricity, a great deal of daily life grinds to
a halt: there’s no light at night, no fans or air conditioners to
cool sweltering rooms, no easy way to charge phones or access the
internet, no reliable way to keep hospitals running--the list goes
would you do, Thompson asked, if your elderly mother, wheel-chair
bound and desperately needing food and water, was stuck on the 17th
floor of an apartment building in San Juan with no working elevator?
what if the hurricane had drenched everything inside your house
including all the mattresses, forcing you and your children to sleep
on the floor where rats could be scampering? Or what if you lived in
the countryside, stuck on the far side of a collapsed bridge, and you
had no way to get drinking water because the storm knocked out your
community’s delivery system? There’s no bottled water anywhere
and a relief convoy hasn’t visited in days. What would you do?
everyone is suffering, Thompson pointed out. Those with money have
options: They can get a hot meal in a restaurant; they can buy fuel
for their cars and generators; they can purchase dry sheets and
towels for their homes--and their homes, better built to begin with,
may still have their roofs.
hard to describe the complexity of it,” said Thompson. “Parts of
San Juan look normal; parts look ravaged.”
to the National Institute of Health (Clinical Microbiology Rev. July
2003; 16(3):497-516. Mycotoxins. By J.W.Bennett and M. Klich),
“Mycotoxins are secondary metabolites produced by microfungi that
are capable of causing disease and death in humans and other animals.
Mycoses range from merely annoying (e.g., Athlete’s Foot) to
life-threatening (e.g., invasive Aspergillosis). Primary pathogens
affect otherwise healthy individuals with normal immune systems.
Opportunistic pathogens produce illness by taking advantage of
debilitated or immune-compromised hosts…… The majority of human
mycoses are caused by opportunistic fungi.”
are frequently acquired via inhalation of spores from an
environmental reservoir. Skin contact with mold-infested substrates
and inhalation of spore-borne toxins are also important sources of
exposure.” (Bennett and Klich, ibid).
associated with inhalation of spores include toxic pneumonia,
hypersensitivity pneumonia (characterized by inflammation of the
lungs which can lead to scarring of the lungs, an irreversible
condition that decreases lung capacity), sinusitis, tremors, chronic
fatigue syndrome, kidney failure, biofilm, hair loss, skin
conditions, vision disturbances, neurologic disturbances, diarrhea,
nausea, vomiting, internal hemorrhaging, and abnormal liver levels.
Exposure to mold, according to the Florida Department of Health, can
cause cognitive problems such as memory loss and mood swings. In some
individuals, these can lead to depression, fatigue and loss of
interest in everyday activities. Mycotoxins can cause sleep
disturbances and if left untreated, can lead to neurological problems
such as impaired balance and difficulty walking.
are desperately needed right now,” said Thompson, noting that one
rural woman she encountered had relied on her sister in the Dominican
Republic, where more than 40 percent of the population lives in
poverty, to send her one. “Some kind of lighting system is badly
needed. There are all kinds of things you can’t get--insect
repellent, [a type of ] batteries.”
with the rainy season here, tarps top the list for some community
leaders who are doing all they can to help ensure people have
shelter. Thompson described the efforts of one woman who has been
trying to get tarps for about 800 homes in different communities
outside of San Juan: The woman approached the Federal Emergency
Management Agency, or FEMA, which sent her to speak to the mayors of
the communities. The mayors didn’t have tarps, so she went back to
FEMA. No luck again. So next she called the tarp manufacturing
companies in the US, and hit a dead end there, too.
has been up and down for these communities and has not been able to
get these tarps,” said Thompson.
efforts are playing out against a new worry for families whose homes
have been exposed to the elements: mold.
lot of times in hurricanes people forget to talk about just how hard
it is to clean out your house, and the mold,” said Thompson. “It’s
an increasing problem. People are just beginning to realize it.”
Chlorine is what people need to try and tackle the problem, but the
supplies are restricted.
need a whole kit to take mold off,” said Thompson. “You need to
educate people about that. And so how do you do that when there is no
communication?” She said the public health department will need to
organize a full effort to address the mold issue.
seems everywhere you come up against another insurmountable problem,"
Centers for Disease Control and Prevention (CDC) reports that just
under 8% of all people in the United States currently have asthma.
However, for residents of Puerto Rico, that percentage jumps to as
high as 19% of the population according to some studies.
those with asthma, managing their condition with treatment options
from their healthcare provider and avoiding asthma triggers are all
important steps for their well-being and long-term health.
Unfortunately, due to all the damage caused by Hurricanes Maria and
Irma, there are now countless residential, commercial and
institutional properties across the islands that have considerable
mold contamination. This is due to water damage and elevated indoor
humidity levels, exacerbated by a lack of air-conditioning and
mechanical ventilation caused by power outages.
to elevated levels of mold can act as an asthma trigger for many who
suffer from the condition,” said Harry Pena, President of Zimmetry
Environmental. “We are coming across mold and other microbial
issues in many of the properties we are called upon to inspect and
provide our expertise. Recognizing the full extent of contamination,
writing remediation protocols, overseeing mold removal activities,
and performing post remediation clearance testing are all important
activities we are currently involved with. These actions help to
ensure mold and other indoor air quality issues don’t become a
problem a few months from now for people living, working or going to
school in these damaged properties.
What was the situation on the ground?
Many homes in Puerto Rico were destroyed or severely damaged, some
roads remain impassable, electrical power is unavailable across most
of the island, food, potable water and basic amenities are scarce,
and communication by phone, text, or email is difficult or
addition to the immediate need for food, water, shelter and
communication, this situation has profound implications for the
health and wellbeing of 3.4 million of our fellow Americans. Diabetes
and hypertension are highly prevalent in Puerto Rico and are readily
treatable with medication. But what if you can’t reach your doctor
to prescribe a medication because the phones don’t work? What if
you can’t fill a prescription, because you’re not receiving your
paycheck, the ATMs aren’t functional and you can’t afford your
prescription co-pay? What if you do obtain your insulin, but you
can’t keep it cold, because refrigeration requires electricity and
you don’t own a generator?
What are the long-term consequences of that lack of infrastructure?
As the days and weeks pass without the restoration of electrical
service and communications, Puerto Ricans are running out of
medications for myriad treatable conditions. Over time, the
population burden of preventable illness, including the long-term
complications of diseases such as diabetes and hypertension —
blindness, neuropathy, kidney failure, heart attack, and stroke –
will increase. While we were there, in the very early days of this
crisis, we were already seeing the harbingers of this looming health
care crisis - systolic blood pressures above 250 and blood sugars
above 500 in patients who simply ran out of medication. The impact of
this catastrophe on the health of Puerto Ricans will be felt for
What kind of care do people with these chronic illnesses need?
Many people require home health services to stay alive. Home
ventilators and oxygen concentrators require electricity. Patients
dependent on tube feedings require a reliable source of specialized
food and medical equipment. Patients with end stage kidney disease
require regular dialysis. How will these services be provided? In the
face of a collapsed infrastructure, public health agencies in Puerto
Rico have been stretched thin in their attempts to meet these needs.
because there is no power, most hospitals in Puerto Rico remain in
service only with the electricity generated by diesel generators.
Fuel delivery remains erratic, and generators that were never meant
to operate for more than a few days have been running, sometimes
continuously, for weeks. Not surprisingly, generators fail
sporadically, abruptly removing entire hospitals from the health care
grid and leaving acutely ill patients with limited options until fuel
can be delivered or repairs can be completed.