Sobre las conciencias de los hombres: A medical ecological view on post-Maria Puerto Rico (Part 2)

In the second blog in his post-Maria Puerto Rico series, Timothy Dye, Editor-in-Chief of Maternal and Child Health Journal, discusses how the communities in Puerto Rico can adapt and recover from trauma and how rapid assistance can reduce the unnecessary pain and disruption from this process.

The drive from San Juan into the mountains in the middle of Puerto Rico was stunning in that the green we’d seen so many times before was gone, completely. The vegetation left was mangled, with trees stripped bare, sometimes leaving just a stalk.

How could people survive what must have been an incredibly traumatic 10-hour blasting of this storm? What must that have been like inside one of these homes clinging to the mountainside? How could anyone recover from such a trauma?

The truth is, people and communities are remarkably durable and adaptive. My friend Emilio – who’s a bird expert in Puerto Rico – tells me how the endemic birds of Puerto Rico are “generalists” rather than “specialists”. Meaning, they are more adaptable to changes in their environment since they are not, generally, specialized to just one niche. Because of this, it is anticipated that the birds of Puerto Rico will recover from Hurricane Maria quite quickly, and in fact there are already signs of the rejuvenation of their populations. Indeed, my friend Angie recently had some small parrots – the national birds of Puerto Rico –  in her yard in San Juan, a place they’d not before visited.

Barbara Ward and René Dubos note in their classic report Only One Earth: The Care and Maintenance of a Small Planet that “Man not only survives and functions in his environment, he shapes it and he is shaped by it.” It’s all about adaptation, the basic process of ecosystems. When a shock (or “stressor”) hits, communities and their members are destined to try to rebound, forcing themselves and their environments to adapt.

We use the term “resilient” quite frequently these days to describe a range of human adaptations: to mental and physical trauma, to environmental and social disruption, and in our medical and biological responses to disease. In fact – like the generalized species of birds in Puerto Rico – human beings are very adaptive.

But, just because we are compelled to adapt doesn’t mean it’s easy or guaranteed. The process of trying to emerge, itself, can cause new stressors and new requirements for change. The process of providing aid from external sources helps communities adapt faster and with, hopefully, less trauma then they might otherwise face. Helping communities access water, food, shelter, and health care helps the community transform to its post-stressor reality.

Delivering water filters and supplies to Camuy

Often new or renewed sicknesses come in the wake of such community trauma, as vectors (insects, rodents) have new habitats and they too adapt to their new environments, introducing new stressors to the communities. The cycle is continuous, broken through deliberate effort focused on community strengthening. An inability to adapt brings disease and death.

We know from the work of many urban social scientists and even biologists that as human populations become more urban people become specialized, taking on specific roles supporting the community demands of living in a city. However, this creates a delicate system at great risk of creating social and actual chaos when the grocer (who provides access to food), the doctor (who provides access to medicines), or the service station (that provides access to fuel and automobile repair) become disabled from a traumatic environmental event.

Hurricane-damaged home in Loiza, Puerto Rico

In rural, mountain communities, though, the situation is quite different. There frequently aren’t enough people, nor the need, to occupy very specialized niches. The communal life of mountain villages can sometimes prove to be more resilient and adaptive to crises. The structure of the rural village sustains smaller human populations spread out in more isolated geographies through social and economic relationships. That is, until things happen that break it apart.

Hurricane Maria devastated both the urban and mountain communities of Puerto Rico. Water, electrical, transportation systems ended, likely not to recover in their past form. Relief resources don’t reach these rural areas as quickly – or at all – because the roads and communications aren’t there to help coordinate. People are compelled to do what they can to adapt, that includes improvising, compromising, and leaving.

We delivered medical and water supplies to two mountain, two coastal, and two outer island communities recently. All were lacking supplies, electricity and water on a consistent basis. People are stressed, and that stress (as we know from previous research) can relate to all kinds of health problems later on: from mental health to preterm delivery. Children are at a special risk for these impacts; indeed, it has been shown that environmental traumas can act as – or at least magnify – Adverse Childhood Experiences (“ACES”). These are the dynamics of human populations.

With some help, though, both rural and urban communities can recover and rebuild with perhaps limiting, to some degree, suffering and loss. Without it, communities and their people will suffer disease, social disruption, and disintegration of neighborhoods as they group and regroup trying to adapt to a traumatic event.

Like Puerto Rico’s endemic birds, the human populations of Puerto Rico will always persevere and will adapt to a shifting environment, but without more effective and rapid tangible assistance, this adaptation will be unnecessarily painful and disruptive.

Still, as we drove through San Juan – late at night after a long day in the mountains – we heard the song of the coquí, the song of the country.

“Think globally, but act locally.” René Dubos

You can read part 1 of Timothy Dye’s series here.

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