Jun 12, 2018

Rebuilding a Safe Haven for Future Crises

In Puerto Rico "rebuilding" is still counted by how any families have access to electric power and potable water... and it's been more than 8 months.  Yet, the untold story is the very real trauma of not only having survived two major hurricanes in the month of September 2017, but the lack of support to many sectors by both the local and the US Federal Government.  It has been the non-governmental sector that has kept the most vulnerable alive and in relative health.  Here at Intercambios we have not stop working to make sure our mission continues to be fulfilled: to promote the social integration of marginalized groups, including drug users, homeless, and sex workers by working from a scientific harm reduction perspective through service provision, education, advocacy, and research.  It has been a real challenge to continue forth while the health sector is being disregarded and the death toll of more and more people on the island continues to rise, and especially the lives and health of those who are chronically marginalized in our society.  The "rebuilding" or "reconstruction" of Puerto Rico that you hear in the news, certainly does not include “them”. Yet, our determination has bear fruit in this tumultuous landscape and we are now more ready than last year for this hurricane season which has already begun (June 1st marks the official beginning...) and we are now able to open our door with an additional service, as a safe haven for homeless individuals, if/when a hurricane comes close.  Armed with a power generator, water filter, inflatable beds, and reinforced doors in our Fajardo offices we feel apprehensive about the closeness of September 2018 (as that is the year anniversary of Hurricane Irma and Maria), yet we know that our participants have more and better services than last year, as we are now embarking in a new journey to make our organization even more focused on outreach and health services.  Specifically, we are adding a nurse and a case manager to our staff to come closer to a multidisciplinary outreach team that provides harm reduction services (physically and emotionally) where our "participants are at".  All of this as we pay particular attention to the need to address the trauma of surviving and resisting here in Puerto Rico.  

Feb 9, 2018

Recovery Update

The past few months have been incredibly challenging for Puerto Rico, which is still reeling from the impact of the hurricanes in the fall. During the first few days after Hurricane Maria, Intercambios Puerto Rico began assessing the damage from the storm and focused on establishing communications with our staff, our clients, and other local community organizations. We partnered with volunteers to begin offering basic relief items to community members, regardless of whether they receive other services at Intercambios.

Within just one week we resumed our core harm reduction services to clients who use injection drugs. We focused on establishing contact with every one of our clients. Sadly, some did not survive the storm or its aftermath, as the resulting chaos increased the risk of overdose for many. However, we engaged most other clients and reintroduced stability into their lives.

Though badly damaged, the Intercambios office served as a safe haven for clients who were previously homeless or displaced due to the hurricane. It was fully functional within weeks, after we installed a new water pipe to replace a pipe that burst during the storm. We added a portable power generator and replaced a door destroyed by the powerful winds. Core utilities such as Internet, water, and provisional power were also restored.

During this time, Intercambios received over 3,000 bottles of drinking water and tremendous quantities of hygienic supplies, including 600 soaps, 100kg of laundry detergent, 50 reusable sanitary napkin kits, 50 flashlights, 100 multiple-use cotton cloths, 50 water buckets, 600 cloth pins and drying lines, and 100 liters of liquid shampoo/body soap. We began distributing these to community members immediately. We also provided food to over 35 families. This relief work was conducted in addition to our ongoing HIV and hepatitis C prevention efforts, which reach over 1,000 participants in 19 communities in eastern Puerto Rico. The areas we serve sustained the most damage from the two Category 5 hurricanes, and they have a long way to go before fully returning to normalcy.

As we rebuild our office, we have also focused on preparing for future storms and taking the necessary steps to ensure disaster preparedness. We plan to install a cistern as a consistent water source, a water filter, and a larger generator for power outages, as well as purchase the supplies needed to transform the office into a makeshift shelter for clients and community members. We are strengthening our collaborative relationships with neighboring nongovernmental organizations and other community-based organizations and clinics in eastern Puerto Rico to ensure that future relief efforts reach all community members.  

In recent months, we have also increased our advocacy efforts for more health services in the most marginalized communities of Puerto Rico. Since the hurricanes, Puerto Rico has been the subject of international news, and there has been greater visibility of the limitations of the health care system—especially for marginalized populations. Prior to the storms, our clients struggled to access evidence-based treatment and prevention services. After the storms, the barriers to accessing these supports have amplified, including lack of transportation, inconsistent access to telecommunications and ongoing power outages. Over four months later, a disappointing 30–40% of all residences in Puerto Rico still lack power, and many people are living in dangerous conditions, such as houses with unrepaired roofs. The government has been slow to resume HIV prevention services, which were lacking even before the storms. The overdose crisis has also worsened, with many of our clients overdosing on fentanyl.

The international focus on Puerto Rico has created an opportune time to advocate for evidence-based treatments for problematic drug use. As the island begins to slowly rebuild, we are hopeful that the health care system will restructure to better serve marginalized communities. As part of our goal to ramp up our clinical services, we will recruit a doctor or registered nurse to accompany staff on the syringe exchange route. Intercambios will also offer low-threshold case management and mental health services to our underserved communities, specifically targeting individuals who are homeless, drug users, and sex workers.

Intercambios is serving a greater number of participants at our headquarters in Fajardo than ever before. Since the hurricanes, we have opened our office to the public, allowing community members to drop in for coffee, a shower, clean socks and underwear, or a hygiene kit. We use these opportunities to engage with our participants and connect them to the free harm reduction services we have always offered.

Intercambios is committed to remaining responsive to the needs of our clients at all times. By offering these additional supports and planning for future storms, we can reduce the impact of these disasters on the clients we serve and the community.

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