At a time when Puerto Rico is still in crisis, and entering into a new hurricane season — people still without power. The death toll is being investigated, and now there is more potential bad news for people on the island.
Governor Rosselló, in conjunction with the federally appointed Fiscal Control Board (aka ‘The Junta’) is attempting to push through cuts that would close about 20 community health centers — CDTs (Centers of Diagnostics and Treatment), on the island.
Mayors of towns whose heath services are under the axe are outraged and dismayed and this news is making headlines in PR. The President of the Association of Mayors, Rolando Ortiz, is furious:
Rolando Ortiz truena contra los recortes a los CDT
(translation) Rolando Ortiz thunders against cuts to CDT: The budget presented by the Board leaves zero funds for these health centers:
The "severe cuts" imposed on funds for services to the Centers for Diagnosis and Treatment (CDT) "will cause more deaths" in Puerto Rico, "particularly in rural and low-income populations," said several mayors whose municipalities will suffer cuts.
"We’ve come through a national tragedy of huge proportions where there were thousands of deaths throughout the country after the passage of two hurricanes and Ricardo Rosselló’s solution is to take away health services for those who need them most". said the president of the Association of Mayors, Rolando Ortiz.
According to a document published by WAPA TV, about twenty centers, in dozens of municipalities, would likely close. Among these is also the Castañer Hospital, in a community where most residents use this health center. According to the document, there would also be no budget for dialysis services contracted for Vieques.
These community health clinics are critical to public health on the island.
To get a sense of what they have been through, how sorely needed they are, and what cuts would do to the local community, read this piece written by Dr. Jose Rodriguez, the chief medical officer of Castañer General Hospital (which is on the list of closings), which he posted two months after Maria hit:
How my small hospital in rural Puerto Rico survived Hurricane Maria
Volunteers from the hospital traveled to outlying town such as Indiera of Maricao and Rio Pietro to treat patients who had been cut off from health care by roads damaged by landslides and blocked by debris. Our team often worked in buildings lit with lanterns. The team also brought water, supplies, and formula for infants.
Many of the people in our community are agriculture workers. Maria ravaged the farms in the area, putting most of these people out of work. Yet they are helping where they can, providing our clinicians with coffee, bananas, plantains, oranges, and other foods, and working to clear the mess that Maria left behind.
They are also trying to recover from the hurricane, but it isn’t easy. They have limited or no electricity or drinking water, no telephone, internet, television, radio, mail service, gasoline, newspapers, or garbage collection. People can’t buy food or anything else unless they have cash because without electricity the machines that process credit or debit card transactions aren’t working.
It is easy to develop post-traumatic stress, anxiety, or depression when seeing lost crops and devastated homes, and living with no money, no food, and little help. That’s why my colleagues and I are now focusing on mental health issues. Our mental health team began that work five days after the hurricane, visiting shelters, treating patients, and giving workshops to hospital employees.
How is it possible to announce that the government is prepared for the upcoming hurricane season, while proposing to severely slash health facilities?
Why are we here on the mainland not hearing about this?
I happened to see the tweet posted below, which included a screenshot of the list of centers under the budget axe— and immediately called Daily Kos blogger Bobby Neary in Puerto Rico. He gathered the news, translated and helped me write this story. Thank you Bobby.
What is really maddening is the fact that mainland journalists assigned to covering Puerto Rico haven’t said a word about any of this. The English language news media is silent — as another travesty unfolds on the island.
Mayors of the affected towns are up in arms, predicting more deaths:
Alcaldes advierten habrán más muertes con recortes a CDT
(Mayors warn there will be more deaths with cuts to CDT)
The article details the different effects to municipalities. Loiza’s center would have to close emergency room services from 7AM to 11PM. The island of Vieques would lose dialysis services.
The least that can be expected from Rosselló is that he comes to his senses and returns to the municipalities the $350 million he has taken from the municipalities. Leaving the country without health services, when La Fortaleza has increased its budget exponentially, and closed hundreds of schools without due process is certainly an attitude that hurts the entire country"
The following report and interview with two of the island’s mayors, Marcos "Turín" Irizarry, the mayor of Lajas and Miguel “Papin” Ortiz, mayor of Sabana Grande, is in Spanish. Apologies to non-Spanish speaking readers — there is no translation.
In it, Irizarry, stated that he found out about the projected cuts and closings on facebook! He would be losing $250,000 needed for monthly operating funds.
Alcaldes reaccionan al cierre de los CDT Mayors react to the closings of CDTs
Even powerful members of Rosselló’s own party are unexpectedly denouncing the cuts. Thomas Rivera Schatz, a Republican and President of the Puerto Rican Senate, has fervently denounced them. (One might wonder if he’s positioning himself to run against Rosselló in 2020)
Rivera Schatz cataloga de "insostenible" que dejen a los CDT sin fondos
Rivera Schatz categorizes the CDTs being left without funds as unsustainable"
"It is untenable, we saw that some private hospitals closed operations (during the emergency of Hurricane Maria), because they could not serve the public, so the government is going to close their hospitals? The alternative is that there are no places to go for an emergency?" questioned the senate leader in an aside with the press at the end of a hearing
To get a sense of the importance of the centers, here is what The Kaiser Foundation wrote in March
With devastating force, Hurricane Maria hit Puerto Rico on September 20, 2017 as a category 4 storm, wreaking havoc on the island’s residents and its infrastructure. Six months after the hurricane hit, the island’s health care system is slowly recovering. Community health centers are a critical part of the health care system—20 federally funded health centers provide primary and preventive care services at 93 urban and rural sites across the island. In 2016, health centers in Puerto Rico served 352,172 patients, over one in ten residents, and provided more than 1.5 million patient visits, including over 84,000 oral health visits and over 68,000 visits for mental health and addiction services. Six months after the hurricane, these health centers have seen improvements but still face many challenges.
The Harvard Business Review just published an in-depth piece on the island’s health care:
What Hurricane Maria’s Death Toll Reveals About Health Care in Puerto Rico
Unlike U.S. states, Puerto Rico has not had access to many benefits of the Affordable Care Act (ACA). It has neither a state-run nor a federally facilitated individual insurance marketplace. Between the inability of individuals to buy subsidized individual health insurance through ACA marketplaces and its high poverty rate, Puerto Rico relies more on public programs like community health centers, Medicaid, and Medicare. But because it is a territory, it gets less money and resources from the federal government for Medicaid than it would if it were a state.
The bottom line is that when Hurricane Maria hit, Puerto Rico could not meet the emergency, health, and other needs of its population. The inadequacy of FEMA’s response worsened the situation, resulting in the alarmingly high mortality rate.
Lessons to Mitigate Future Hurricanes’ Impact on Health
As Sandro Galea, the dean of Boston University’s School of Public Health, wrote recently, the lessons from Hurricane Maria include a need for communities to be better prepared to handle the full range of health consequences of disasters. Improvements to basic infrastructure and investment in human capital must take place well before hurricanes hit.
Governing Republican elites — whether here on the mainland or on the island, have a complete and total disdain for the poor, the elderly, people with pre-existing conditions, and the disabled.
While Democrats are calling for an investigation of Maria related deaths,
— we need to call even more loudly for the prevention of unnecessary deaths to come, if health services on the island are compromised.
Help save lives in Puerto Rico. Call your Senators and Congresspeople.