Forty-five days after Hurricane Maria slammed into Puerto Rico, Deidre Orriola, a USF College of Public Health (COPH) faculty instructor, health educator and alumna, traveled to the municipality of Vega Baja on the island as part of a nongovernmental disaster medical team (DMT).

The interdisciplinary team consisted of Dr. Jessica Gordon, a pediatric nurse practitioner and assistant professor in USF’s College of Nursing, as well as other health care workers, including a medical technologist, street medic, lactation consultant and a physician living and practicing in Puerto Rico. Driven by the community, the team set up pop-up health clinics in five different neighborhoods of Vega Baja. They also made visits to those who were homebound.

All in all, the group spent five days in Puerto Rico providing medical care to nearly 300 residents.

That was in 2017.

Today, their experiences have been turned into a research paper recently published in the journal Disaster Medicine and Public Health Preparedness entitled, “Lessons Learned from a Medical Response Team 45 Days Post Hurricane Maria in Puerto Rico.”

“Some things worked, and some didn’t,” said Orriola. “We wanted to share our experience with future DMTs.”

And what worked, said Orriola, was letting the community and its leaders take charge of the disaster-relief efforts. “We found it was really important to let this effort be community driven and led,” explained Orriola. “They know best what kind of help they need. We just provided the supplies, technical support, personnel and donations they asked for and helped where we could.”

In the paper, Orriola and her colleagues shared four important lessons that could be valuable to future DMTs, like those traveling to the Bahamas in the wake of Hurricane Dorian.

1. Be adaptable. According to Orriola, that means letting the community tell you what they need and where it’s needed most―not the other way around. The pop-up clinics adapted to the circumstance of mass school closures by using local teachers to provide educational activities for children at the clinics. This gave parents time and space to meet alone with a medical provider while their children could engage in learning activities for the day.
2. Be creative. It’s natural to assume that health care is only dispensed at a clinic or hospital. But when those are inaccessible or without electricity (and many were in the aftermath of Hurricane Maria), other sites have to be explored. “We set up a pop-up clinic at a restaurant,” commented Orriola. “It was central, well known and large enough, and the people working there provided free food every Tuesday to people who visited.”
3. Be flexible. Orriola describes a time when she and her team visited a homebound woman. While the medical team tended to the woman, Orriola asked her what she could do to help. “She was worried that her house hadn’t been cleaned in a while because her son, who took care of her and the home, was working in another area of Puerto Rico. So I cleaned her home,” said Orriola, who noted that the team provided as much social support as medical care.
4. Be innovative. Orriola and her team knew they were only reaching a fraction of the community with their pop-up clinics. When people came in for care, the team would ask if anyone at home needed services. The needs assessment determined a significant number of homebound residents. As a result, clinics closed at 3 p.m. each day so the team could go out in the community and provide care to homebound residents, bringing items like over-the-counter medicines, nebulizers, diabetic supplies and ointments. “Innovation is meeting people where they are,” noted Orriola. “In public health, we know access to health care can be a problem.”

Noting that science shows storms are intensifying, Orriola says preparedness is key for Puerto Rico and other vulnerable areas.

“When you add climate change in with the fact that Puerto Rico is still recovering, that as an island it is isolated and that it is hindered by policies imposed by the U.S., there’s the potential for [the devastation that occurred after Hurricane Maria] to happen over and over again. Let’s be ready with a plan,” she urged.

Story by Donna Campisano, USF College of Public Health