Day 9: Humacao, Part 2

Today, our group split up: some of us went to Ponce to work in the Suboxone clinic there, and the rest returned to Punta Santiago. I was in the Punta Santiago group, so I’ll write about that.

Punta Santiago is a beautiful place with rows of houses only a few hundred yards from the beach, and it was one of the first areas to be hit by Hurricane Maria almost two years ago. Flooding from the ocean and the nearby river destroyed many homes, and recovery efforts are ongoing. We visited here last week to meet with a nonprofit called P.E.C.E.S. (El  Programa de Educación Comunal de Entrega y Servicio). At its inception, P.E.C.E.S. began as a nonprofit organization focused on promoting economic growth. However, since Hurricane Maria, it has expanded its efforts to provide housing, in-home social work care for elderly community members, and fills in the gaps for whatever else is needed in the region. At our meeting with P.E.C.E.S. last week, we learned more about the community, the storm’s lasting effects, physical and emotional, continuing recovery efforts, and current needs. We also outlined the capabilities of our team and the supplies we had with us.

Today, we returned to implement some of the outreach activities that came out of last week’s meeting. The Punta Santiago group split in half, with some staying in a local community center to run a primary care walk-in clinic. The other half went on home visits to see people who, for various reasons, were unable to come to the walk-in clinic. The group going on home visits consisted of fourth-year medical students, two social workers, and a Medicare specialist who worked as both an interpreter and a resource for families on how to take advantage of their healthcare plans.

I want to highlight two patients from the morning home visits. The first was a pleasant gentleman from Brooklyn, New York who had chronic lower extremity swelling (lymphedema), a condition that can be life-limiting. When we arrived he was sitting in a big plush chair, cracking jokes and watching a huge TV screen. His left foot and lower leg were swollen, tight, and bright red. His right leg was covered. He told us about his leg swelling, how it had started 10 years ago on the right and then two years later on the left, how a wound care nurse came every other day to change the bandages, how even with her help he never had enough bandaging material, how no matter how much he scrubbed his leg wispy cotton remnants of bandaging would get stuck in the crevices. 

He told us to prepare ourselves to see his right leg. I was skeptical that I would need to prepare myself, after spending time on the burn unit and vascular surgery. But his leg was one of the most painful-looking, devastating limbs I have ever seen: his right leg was extremely large, swollen, and tight. Lymphedema, an abnormal accumulation of lymphatic fluid that helps fight infection, had distorted it to twice or three times its normal size. Some regions looked like cobblestones, and green mold was growing in between the cracks. There was an open ulcer along the back of his calf as big as my hand, oozing fluid. He had a prescription for naproxen, a medication similar to ibuprofen, which he tried to take only every few days when the pain was unbearable. He told us how during hurricane Maria his house had flooded with five feet of water, and I tried to imagine how he had managed his legs. Soon, he returned to chatting about his favorite sports teams, and told us anytime we wanted to come to Puerto Rico, we had a place to stay.


The second notable patient was a 90-something year old, tiny lady who lived alone. She had asthma, had had a few falls, but couldn’t tell us much about them except that she had hurt her shoulder. What she really wanted to talk about was her son, who had died after Hurricane Maria. He had suffered some type of fall, had been unable to get adequate medical care due to the storm’s aftermath, and had died. She was currently living in her son’s house, which brought back her memories of him. She did have a local daughter, but her daughter had cancer. We tried to take her blood pressure, but she became tearful and did not want to stay still. We gave up on the blood pressure cuff, and instead focused on learning more about her son, and listened to her talk about her family and life.

As we walked out of her house, we talked with the social workers and Medicare expert about options available for elderly people whose families were no longer able to provide medical attention and in-home care. We learned that there are assisted living facilities that government-issued insurance must help pay for, but most elderly people are reluctant to leave their communities and their land--having now traveled around this region of Puerto Rico, being welcomed by the various communities we have engaged with, we can understand this reluctance to leave. Also, unfortunately, much of the care in these facilities is inadequate for the myriad needs of patients with diverse medical problems. Our patient, left alone after multiple falls and mourning her dead son, had devised several ways to stay safe on her own: she wore a whistle around her neck, and demonstrated how she would use it if she needed help; she had close relationships with her neighbors, who stopped by regularly and sometimes helped her with groceries.

It’s a challenge trying to summarize stories like these into a concise take-away. For those who are curious, the first patient will be evaluated by our surgeons tomorrow to explore treatment options. The second patient is working with P.E.C.E.S and other organizations to find opportunities for housing and home care. 

​I’ll close with a few reflections. First, it was an amazing learning experience to see the process of meeting with a nonprofit, assessing the needs of a local community, and attempting to meet some of those needs. Being able to attend the meeting last week and the outreach today helped me understand the work involved in making a meaningful outreach activity. Second, the outreach and work done by the local Puerto Rican community is impressive. Their patience, care, welcoming nature, and dedication to educating people and connecting them to resources is truly inspiring. Finally, being welcomed into other people’s stories and homes is a privilege. These experiences are reinforcing that sitting, listening, and connecting with other people is a therapeutic intervention that can always be done, even in the most difficult of circumstances.

-- Bonnie Stedge, MS4