This week marked the one year anniversary since Hurricane Maria made landfall in Puerto Rico, bringing with it winds as high as 155 miles per hour and heavy rainfall.
Incompetence on the part of the Federal Emergency Management Agency and the Puerto Rican government were partly to blame for the lackluster disaster response efforts. It took nearly a year to get an accurate death toll and to restore power to the island. But lost in most of the coverage of Maria was its impact on women's health—already an area in need of improvement on the island.
To better understand how Maria devastated Puerto Rico's response to women's health, Pacific Standard talked with Blanca Cuevas, the director of Family Planning Association of Puerto Rico (or Profamilias). Profamilias is a non-profit organization that had provided reproductive and sexual health care in Puerto Rico since 1954. The organization has two clinics in San Juan and eight family planning education centers scattered across the island.
How did Hurricane Maria affect Profamilias?
Fortunately, Profamilias clinics and centers only suffered minor [structural] damages. Nevertheless, our organization suffered the aftermath of Hurricane Maria by not being able to offer our services immediately. Profamilias had no electric power, no access to telecommunications or the Internet, and many employees, clinical staff, and patients were unable to access the clinics and the offices due to the lack of access through many roads that were covered with electrical poles, cables, debris, trees, leaves, garbage, wood, zinc, and whatever the hurricane lifted. Urban streets and countryside roads were blocked and for the first weeks were very dangerous to drive on.
Did you have to close?
Profamilias, like many health clinics and hospitals, was closed. Nevertheless, conscious of the need of our patients and of our role in the provision of sexual and reproductive health services, we started offering services, without any electricity, two weeks after the hurricane. During limited hours of the day, contraceptive counseling and distribution of contraceptive methods were offered to our patients in our clinics and centers. At the same time, many efforts were made to obtain in Puerto Rico a power generator with the necessary capability to energize both of our clinics. The difficulties in access to this equipment forced the organization to acquire two small generators that enabled us to restore the pharmacy services on October 28th and the clinical services on November 16th.
What services have you noticed the biggest needs for?
Uninterrupted access to contraceptive methods; provision of abortion and post-abortion services; prevention and treatment of survivors of domestic violence; continuous medical treatment of persons living with HIV; continuous syndromic management of sexually transmitted infections; and the protection of medical and blood supplies.
What has the last year of recovery been like as a health clinic, for your staff, your patients?
It has been an extremely difficult year. In order to be able to work, many employees and myself had to move to other workplaces (such as the Law School of the Inter American University of Puerto Rico, among others), that had electric power plants and generously offered office space and electricity to charge cell phones and laptops in order to continue our work. Many employees and patients were—and still are—dealing with the aftermath of the hurricanes, due to personal losses and damages to their homes. The recovery process has been slow. We are still recovering from the lack of income due to the inability to offer clinical services due to the lack of electricity. Many supplies were damaged due to the lack of refrigeration and some we were able to return to manufacturers. A number of patients have not been able to return to the clinics, and some have left Puerto Rico.
What do you think is the most important thing for people outside the island to know about women's health care in Puerto Rico?
There are still many unmet health needs, especially in the areas of sexual and reproductive health care. While these needs continue to be a challenge, many community-based organizations have had to deal not only with the crises created by the 2017 catastrophic events, but with the economic crisis in Puerto Rico that has been aggravated by a fiscal oversight board—[and] imposed by PROMESA—that requires the local government to comply with the austerity measures and budgetary cutbacks it orders. This affects the most vulnerable people in our country such as children, students, women, retired persons, and the elderly. Many people are in the process of losing their homes because they are unemployed due to the closure of workplaces that were unable to recover after the hurricanes.
Unfortunately, the government priorities are very far from the fulfillment of the unmet health needs as well as other fundamental needs of our population, such as the lack of adequate housing, employment, and economic development opportunities.
What's the best way to help places like Profamilias?
Currently, there are some proposed bills under consideration in our legislature affecting women's sexual and reproductive rights. For example, Senate Proposed Bill 950 seeks to further affect access to safe abortions by requiring unreasonable, legally indefensible, and medically unsound restrictions that are clearly part of a fundamentalist agenda. Another proposed bill to amend the Puerto Rico Civil Code, among many other things, seeks to establish that pregnant women can be declared legally incapable for the protection of the potential life of a fetus and allow guardians to be appointed to represent these over a competent woman's right to her bodily autonomy.
One of the best ways to help Profamilias is by supporting our mission and joining the movement in opposition to the restriction of sexual and reproductive health rights in Puerto Rico. Another way is by donating economic resources to extend our services to participants that have no access or very limited access.
This interview has been edited for length and clarity.