By Laszlo Madaras, MD, MPH, Chief Medical Officer

In the second week of March 2020, I had the privilege of traveling to Puerto Rico for the first time, and visiting our Migrant Clinicians Network office in San Juan. MCN has been involved with primary care in Puerto Rico for many years and especially after Hurricane Maria devastated the island in September 2017. In the months following the hurricane, the people of this land had to contend with lack of water and electricity for months, unusually slow relief efforts, government corruption and inefficiencies, both local and federal. Despite all of that, they began to slowly rebuild roads, infrastructure, and lives.

Then, in January 2020, the island, mostly in the south, was hit with a series of large earthquakes, followed by regular aftershocks for many weeks. During my meetings with health care workers from that part of the island, I saw pictures they showed me of homes before and after, and listened to stories of families who moved out of their unstable homes to another part of the island, but still had lasting fear for the safety of their children, as the aftershocks persisted for what seemed like never-ending sleepless weeks. Many health workers are also parents of young children, and have been unable to sleep soundly at night for fear of another aftershock or an even higher magnitude earthquake. I would imagine after just a few days of sleep deprivation, I would feel challenged to continue to provide health care to the community, yet they did it. And they continue to do it, meanwhile recovering slowly just as they did from the hurricane. During one of our meetings, the psychological effects of the earthquake were discussed as a health issue. They also dove into the impact of sleep deprivation on the weakened immune system's ability to fight coronavirus infection.

The goal of my visit had been to meet with health officials who have worked with MCN, and to coordinate with my excellent MCN staff from Texas, Maryland, Massachusetts, and San Juan. I also aimed to further our collaborations with Puerto Rico Community Health Centers (here called 330's), help train community mobilization strategies for frontline workers, and further our goals of farmworker safety, primary care, and generally to be a steadfast force for health justice.

By the end of February, the goals of the trip had morphed additionally into updating health workers on the topic of infectious diseases, including influenza, mycoplasma, and of course, COVID-19,  the new coronavirus that came to dominate our discussion during this week in March. With new information coming nearly every hour, I kept updating my planned talk on coronavirus, and it was ultimately cancelled because of ....coronavirus. There was a ban on large public gatherings, and many clinicians had to fulfill emergency obligations as the threat of outbreak on the island required their participation in other important meetings. The week of work in Puerto Rico was shortened by some of my staff due to the events of the local, federal, and global officials as the epidemic was declared a pandemic, and Puerto Rico’sfirst case of COVID-19 was confirmed in a visiting health professional from a nearby Central American country. Nevertheless, during the week, we strengthened our ties with our partners in Puerto Rico and promised to continue supporting their efforts to improve the health of the people.

We also went straight to work to support clinicians in the way they needed it most. During my time in Puerto Rico, our MCN staff worked to support health centers to activate community mobilization plans around risk communication for coronavirus. Under our project, “Mobilizing Communities in Puerto Rico to Meet the Needs of Vulnerable Populations Before, During, and After a Natural Disaster,” a multi-year project funded by the Bristol-Myers Squibb Foundation, several health centers in Puerto Rico have already built extensive house-by-house plans for emergency response. In January, the health centers used the plans to check in on community members after the earthquakes and ensure that the most vulnerable community members could get the care they needed. Now, the health centers are once again leaning on their community mobilization plans in order to best distribute information on risks around the coronavirus, in order to keep the most at-risk community members safe.

As I returned to the mainland and left my MCN colleagues in Puerto Rico, I was amazed by the hard work and resilience of the people I have met. They continue to rebuild after hurricanes, earthquakes, and now, viral epidemics. They have been hit hard and have limited resources to respond. MCN will continue our strong commitment with our long-term partners here. It is part of our mission. "Somos una fuerza dedicada a la justicia en salud."

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