Puerto Rico could become a public health catastrophe

Dead horses lay on the side of the road after the passing of Hurricane Maria.
Dead horses lay on the side of the road after the passing of Hurricane Maria. AP

In the days since Hurricane Maria ravaged Puerto Rico, conditions on the island continue to deteriorate and become a humanitarian and public health catastrophe that could rival the damage caused by Hurricane Katrina in New Orleans.

The fact that the power grid failed creates many obvious problems and some that are not so evident. When the sewer system stops working, wastewater—aka human feces and urine—and seaborne bacteria contaminate the water supply.

This leads to bacterial infections — such as cholera, dysentery, E. coli and typhoid — that can be disastrous. The typical treatments, like tetanus shots or powerful antibiotics, are not readily available on the island, where medical supplies are quickly running out.

According to the Federal Emergency Management Administration (FEMA), 58 of Puerto Rico’s 69 hospitals are without power or fuel for their generators.

No fuel also means that people cannot readily boil water for drinking or bathing. Danger is imminent with nearly 1.5 million people having no access to clean drinking water, according to U.S. military sources.

Contamination isn’t limited to microbial agents either; exposure to chemicals and pollutants like lead and mercury is a major issue when infrastructure fails.

For example, in the wake of Hurricane Harvey, scientists in Houston are analyzing toxicants in water samples in vulnerable areas surrounding 13 locations contaminated by hazardous materials known as Superfund sites.

The same must happen in Puerto Rico, which has 18 Superfund sites on the Environmental Protection Agency’s National Priorities List (NPL), and six sites that have been completed. The EPA adds sites to the NPL when mismanagement of contamination threatens human health and the environment, and deletes the sites once the cleanup is done.

The Battery Recycling Company, Inc. in Puerto Rico’s coastal area of Arecibo was added to the list as recently as August. The toxicity seeping into daily life from this facility alone could be off the charts.

I urge Congress to consider that more than 3.4 million U.S. citizens are facing overwhelming odds, and effective management of public, environmental and mental health is crucial to preventing the spread of disease. Congress recently appropriated funds for FEMA to work on hurricane relief. But with three major hurricanes having wreaked havoc this summer, the money will surely be spent quickly and on the mainland. Additional funds must be earmarked specifically to stabilize and help Puerto Rico recover.

With more than 40 percent of the island living below the poverty level, residents must also be able to evacuate without having to fully repay transportation costs to the federal government.

According to the State Department’s website, evacuees boarding U.S. government aircraft or other vehicles to evacuate have to put up promissory notes. The situation in Puerto Rico is dire and this policy must be waived to save lives.

I encourage our political leaders to engage with the public health community as the nation treads through this high-stakes period of post-disaster decisions.

Local, state and federal officials can and should look to us in the public health and social welfare community for support and coordinated responses.

We follow the maxim that public health is a right and not a privilege; we are here to serve our communities near and far.

Tomás R. Guilarte is the dean of Florida International University’s Robert Stempel College of Public Health and Social Work.

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