One Year After the Hurricanes, Health Centers in Puerto Rico and the U.S. Virgin Islands Report Treating More Patients with More Complex Needs

WASHINGTON, DC and NEW YORK, NY (Sept. 25, 2018) – One year after Hurricanes Maria and Irma made landfall in Puerto Rico and the U.S. Virgin Islands (USVI), community health centers report a surge in patients and patients who are more likely to present with serious physical and mental health problems. Nearly three quarters of community health centers report a growing demand for services, with some reporting an increase of more than 10 percent in the number of people seeking care. 

The report, issued by the Kaiser Family Foundation, is a follow-up study to an earlier survey that examined the experiences of Puerto Rico and USVI health centers in the wake of Hurricanes Irma and Maria. The research, based on a comprehensive survey of the islands’ health centers, was conducted by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, which conducts extensive research into community health centers and the populations they serve as part of the George Washington University Milken Institute School of Public Health’s (Milken Institute SPH) Geiger Gibson Program in Community Health Policy.

The new report and survey also complement a study released in August by another team of researchers at Milken Institute SPH, which found an estimated 2,975 excess deaths in Puerto Rico in the six months following Hurricane Maria.

“This report underscores that although the early mortality studies, such as the one published by our school, provide absolutely critical understanding of the most extreme near-term consequences of the disaster, of vital importance will be ongoing epidemiologic and public health research that can measure changes in health over time,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, one of the authors of the report. “In this regard, the experiences of health centers in the wake of the storm offer invaluable insight into the nature of problems to come.”

Reflecting the hurricanes’ long-lasting impact, nearly all health centers (86 percent) reported that patients are more likely to present with depression and anxiety, including post-traumatic stress disorder, compared to before the hurricanes. A substantial percentage also reported that patients were more likely to have poorly managed chronic conditions, respiratory conditions such as asthma, alcohol or other substance use disorders, and suicidal thoughts or attempts.

Most health centers report being able to maintain or increase essential staffing since the hurricanes, but ten percent or more report losing physicians, nurses, mental health staff, substance use disorders staff, dental staff, outreach workers, and other enabling services staff. Health centers were particularly likely to report care shortfalls with respect to dental care, offsite and mobile care, mental health care and substance abuse services.

Referrals for specialty care, always a problem, have become more difficult, particularly with respect to mental health. Among health centers that refer patients for services, two-thirds of health centers reported referral challenges for mental health care and 63 percent indicate that the shortages have gotten worse since the hurricanes.

Even as health centers rally to meet growing, and more complex, patient care needs, they face ongoing recovery challenges. Most report that they have returned to full operational status, but many continue to face critical infrastructure challenges including building and facilities in need of repair, ongoing electrical power shortages, internet and telephone service disruption, as well as challenges with restoring electronic health records, maintaining onsite diagnostic equipment, and having dental and vaccine supplies available at all sites. Because health centers in both Puerto Rico and the USVI rely heavily on Medicaid and federal grant funding, both sources of financing emerge as critical to the survival of the island’s primary care system for its poorest communities. 

“What is clear from the new report is that in both Puerto Rico and the USVI, community health centers are continuing to respond to local needs, and those needs have intensified and deepened in the wake of the storms, reflecting the difficult conditions across the islands,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program. “It is also clear that these health centers are financially vulnerable and that sustained and enhanced funding is absolutely crucial to ensure that communities continue to get the care they need.”

The survey report, “The Recovery of Community Health Centers in Puerto Rico and the U.S. Virgin Islands One Year after Hurricanes Maria and Irma,” can be accessed here.

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The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The RCHN Community Health Foundation is the only foundation in the U.S. dedicated solely to community health centers. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.