How Puerto Rico and the US Virgin Islands rebuilt public health after catastrophic hurricanes

How Puerto Rico and the US Virgin Islands rebuilt public health after catastrophic hurricanes

By Melanie Padgett Powers, writer

In 2017, Hurricanes Irma and Maria devastated Puerto Rico and the US Virgin Islands in the Caribbean, forcing public health professionals to rebuild their infrastructure and programs. In a September 29 APHL 2020 Virtual Conference session, “A Step Ahead of Threats: Rebuilding Public Health Systems,” attendees learned how public health departments in the two US territories tackled the massive challenge.

“Rebuilding requires a pretty strong commitment,” said presenter Brett Ellis, PhD, MSPH, the territorial laboratory director for the US Virgin Islands Territorial Public Health Laboratory. “This is long-term; it’s not short-term, and we have to build capacity, resiliency and sustainability.”

Rebuilding infrastructure

Irma severely damaged the hospital on the island of St. Thomas, but it is salvageable with extensive rebuilding, Ellis said. The St. Croix hospital was condemned after Maria hit, but with few other options, both hospitals are being used during the COVID-19 pandemic. The territory’s public health department and public health laboratory was on St. Croix in one building, which was also condemned.

The rebuilding project was funded through US federal disaster emergency appropriations that included a two-year, $15.1 million cooperative agreement awarded to APHL to provide technical assistance to the US Virgin Islands, Puerto Rico and Houston, Texas. The scope of the project in the US Virgin Islands was quite broad and included environmental health, immunizations, suicide and mental health care, and process management. The funding also allowed for cross-cutting opportunities that were useful to address needs specific to the local community.

“Cross-cutting for us was extremely important for a small lab and our ability to respond to the next threats,” he said. “In a small lab, we have persons who have to fill multiple roles … and there may be times when they do have to [provide] support outside their specific funding area, and that can be tough to juggle.”

After the storms, St. Croix had less than 1,500 square feet to build a biological safety level 3 (BSL-3) and BSL-2 public health laboratory, so the team purchased a two-story modular laboratory. Built in the US, it was reassembled on the island in less than 40 days in 2018. Next, the laboratory was equipped, supplies were purchased and staff were hired and trained in 2019. In February 2020, the laboratory received its federal certification.

Strengthening existing systems

In Puerto Rico, the hurricanes interrupted multiple public health services, including childhood vaccinations, environmental health inspections, public health laboratory testing and public health messaging because of lack of electricity and phone and internet service, said Carolina Luna-Pinto, MPH, CHES, deputy branch chief of the Emergency Preparedness and Response Branch in the Division of Preparedness and Emerging Infections at the Centers for Disease Control and Prevention. She is the former senior public health adviser for Puerto Rico.

After an assessment of the situation, programs and areas that were restored and enhanced focused on electronic death registry and training, surveillance and laboratory capacity, healthcare-acquired infections, vector-borne disease control and children with special needs, Luna-Pinto said.

The public health department was also able to improve specific areas of public health infrastructure such as digitizing environmental health inspections, installing backup power for vaccines and laboratories, and improving the department’s overall structure and business processes.

In addition, the department held several table-top exercises with local communities to assess and plan for future risks, developed a network of 575 trained volunteers for a Suicide Prevention Volunteer Network, implemented a geocoding app for sexually transmitted infections surveillance and implemented a mobile app to view patients by remote video.

“This infrastructure has … not recovered all the way,” Luna-Pinto said. “It’s still in progress, but these same resources and infrastructure framework have been used for other events, including the earthquakes and recently with COVID.” She credits the achievements with public health professionals and their partners working together “with one vision and one commitment to rebuild Puerto Rico.”

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

 APHL 2020 Virtual Conference is being held online September 22-October 15, 2020. View the final program and follow #APHL to join the conversation.

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