Epilogue: ‘Sobre las conciencias de los hombres’: A medical ecological view on post-Maria Puerto Rico (Part 4)

One year has passed since two major hurricanes struck the Caribbean, devastating the islands of Puerto Rico. In the first three blogs in this series I discussed what was happening in communities across Puerto Rico through the lens of medical ecology, a view of the world where we are all part of an integrated ecosystem. In this blog I follow up on the long term damage and recovery of the environment, the islands’ infrastructure and the lives of the people who live there.

The Environment

Immediately post-hurricane, Puerto Rico felt apocalyptic. The green canopy and land was gone. One of the main regions of ecological diversity, the El Yunque Rain Forest, was devastated, wiped out. The ecological services the environment provided – fresh water, habitats, shade, protection – were destroyed.

The man-made environment of Puerto Rico that supported thriving urban centers and a strong network of rural, mountain, and coastal towns, was destroyed alongside the natural ecosystem. The electrical grid was wiped out, water and food storage and sources damaged, and roadways blocked. Puerto Rico came to a standstill.

But slowly the country started to recover, initially with temporary solutions as more permanent ones were devised.

San Juan, October 2017
El Yunque National Forest, September 2018

In time the landscape and ecosystems of Puerto Rico started to recover as well, at least on the surface. Trees regrew quickly, birds and animals returned, and the landscape started looking like Puerto Rico again. El Yunque has regrown, with the injuries of the hurricane evident if you look, but otherwise life is green and flowing again.

The man-made environment has recovered differently. Gone are many of the destroyed buildings, roads are cleared of debris, the detritus of the hurricane removed. Many homes have new roofs; but many more are still protected by blue tarps. In marginalized and remote areas, people have lost their homes altogether.

One of the core lessons of this hurricane is the differential impact the hurricane’s wake left on people and communities depending on their socio-economic status. It was obvious: wealthier communities rebuilt their man-made environments much quicker than less wealthy communities. Marginalized people in particular had, and continue to have, challenges with water, electricity, and shelter. The hurricane exacerbated existing social inequities at the time of the storm, but also continually as the man-made environment and systems are rebuilt.

The People

The people of Puerto Rico are at the center of thinking about the hurricanes’ impacts. While the destruction of the environment is an obvious consequence of the hurricanes, it is the human tragedy that is the main concern in medical ecology.

From several estimates, it seems that more than 3,000 people died directly or prematurely due to the circumstances brought by the hurricanes. The vast majority of deaths happened in the context of a devastated infrastructure and a systems response that did not happen fast enough, or completely enough, to reach all who needed it.

Everyone in Puerto Rico was impacted; everyone I know there was personally affected and everyone knows someone who became sick or injured, or died. Complex human societies are ecosystems in themselves, with people working interdependently to keep society going as a unit. This is never clearer than in an emergency when societies can no longer function as an entity because the entity has been broken.

As the island and its communities reeled from the post-hurricane chaos, aid and resources struggled to arrive soon enough and weren’t distributed equitably for the entire human ecosystem to recover. The political history of the island and its colonial relationship with the United States confounded a global response. The island’s dependency on the US as a provider and gatekeeper for recovery was clear and devastating; the needs were too great and too complex for the existing US-Puerto Rico response to be effective.

One year on, Puerto Rico has rebuilt much of its infrastructure, at least in temporary ways, and the recovery of the natural ecology has supported a sense of re-emergence. Many people have resumed their lives, adapting to a “new normal” of how they and their communities move forward. Hundreds of thousands of people have left the islands altogether, opting instead to join the diaspora of Puerto Ricans living in the United States.

Less apparent but of absolute priority is the impact of the post-hurricane chaos on peoples’ well-being. I have not met anyone for whom this experience has not been traumatic; there is a palpable difference in the stress and mental health of people I know.

The survival-related trauma at the point of the hurricane seems not to predominate when I talk with people about where they are at now; instead, they talk about the stress and disruptions they currently face. Peoples’ sense of security has changed; many hold feelings of abandonment in a time of great need; and talk about the anger, frustration, and exasperation of hearing unsupportive statements from some leaders in the United States. They talk about the fractures that became more visible in a country that struggled with chronic, repetitive major catastrophes one-after-another in recent years.

Rene Dubos, one of the founding influential thinkers in Medical Ecology, spent his entire career writing and thinking about how humans live in a complicated social, man-made, and natural world. The relationships of societies and environments are convoluted, non-linear, multidirectional, and are sustained, stressed, and re-created continually. Dubos’ quote from The Mirage of Health that “Man not only survives and functions in his environment, he shapes it and he is shaped by it” confirms that Puerto Rico continues as a critical civilization of the Western Hemisphere, its path perhaps redesigned by these global climate, economic, social, and political events, but its future open to new approaches that strengthen and support its people.


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