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Rebuilding a Safe Haven for Future Crises

by Intercambios Puerto Rico Inc
Rebuilding a Safe Haven for Future Crises

The last three months have been extremely challenging for everyone around the globe. In Puerto Rico, as, in much of Latin America and the United States, the reality of a COVID-19 pandemic hit us in march 2020 as we heard about the first reported cases, and by March 15th the governor of Puerto Rico had issued an executive order instituting a mandatory curfew from 7pm thru 5am, which stayed in effect until just a week ago. That is almost three months, where all government operations came to a stop and everyone was mandated to stay at home with very few exceptions for essential services. The process for defining essential services in Puerto Rico was fraud with errors and lack of careful understanding of the social/health dimensions of this crisis. For example, the Department of Health failed to name Syringe Exchange, Homelessness and HIV services as essential services. The executive orders were vague in their definitions, and the department of Health was not proactive in ensuring service provision to most vulnerable communities. Most syringe exchange programs interrupted their services in the first days of the curfew, however Intercambios Puerto Rico led the way by keeping its mobile services up and running with all necessary precautions despite risking being subject to arrests and towing of its vehicles. Our staff understood that our participants were ever most vulnerable to this pandemic than others giving their living conditions (a large number lack proper access to housing and cleaning/hygiene facilities), have multiple health conditions and as visible drug users are bound to receive poor health care or be deemed less worthy of health care if resources are scarce. Our organization pushed the administration to name syringe exchange and HIV health/housing services as essential services and advocated with other syringe exchanges that they could/should continue provision of services despite the vagueness of the executive order on this respect. Our team did not stop providing services even for a week. We have been on streets providing services and advocating for those who most needed since day one of this epidemic.

We are excited and want to thank our new partners in health, Doctors Without Borders. The internationally renowned health organization, Doctor Without Borders, decided to begin working in Puerto Rico because of the new COVID-19 pandemic. They felt their expertise could be of use in the island. Intercambios PR was selected as one of its partners in the island and feel honored to have access to their expertise and partnership. In the last two months, Doctors Without Borders already trained all our staff in COVID-19 PPE measures and protocols, helped designed our COVID-19 intervention and personal safety protocols, and trained our staff as Teacher of Trainers. Intercambios PR is now able to multiply this COVID-19 safety knowledge by providing “Teach the Trainers” workshops for community-based organizations, besides proving accurate COVID-19 safety information to our participants. In addition to the sharing of safety and hygiene knowledge, Doctors Without Borders is helping us upgrade our mobile units with hygiene stations that include access to hand washing and showers for our participants, many of whom are homeless individuals or don’t have adequate access to clean water and soap. Furthermore, this partnership is working to implement access to medical doctors (in partnership with Doctors Without Borders) via telemedicine through our mobile units and when possible in person.

Other news we wanted to share with you, our donors and partners, is that we recently recruited an additional staff member that is going to provide services’ participant navigation in order to reduce the high threshold for access to services that faces our population.   Our participants face discrimination and poverty everyday which makes accessing adequate health and social services more difficult. The island privatized and bureaucratic health system places a high threshold for accessing services to individual who most needed. Our staff member, a social worker, will be able to help our participants navigate these hurdles and increase their chances of meeting their immediate health and social needs.

These are extremely challenging times. As the pandemic continues, we know that consequences of business closings and increasing unemployment will exacerbate the already thin support systems in place for those without means. Your help and that of our partners will be even more important as the emerging social consequences of the COVID-19 pandemic become more visible. We count on you to be able to be there for our participants every day, pandemic, or no pandemic.

A heartfelt Thank you and hoping that you are well. Stay safe and protect yourself and others.

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In the last three months, we at Intercambios Puerto Rico have continued our work by supporting participants through harm reduction strategies and defending the dignity and rights of individuals who have problematic drug use and individuals who are homeless.  Our syringe exchange program continues to impact communities in the eastern side of the island by removing from circulation used syringes and providing new syringes to those who need them.  By doing thin s exchange, we reduce the risk of HIV and Hepatitis C via injection among drug users and to the community at large.  Between November and January, our program collected 60,561 used syringes and distributed at least 93,822 sterile syringes.  Our services now extend to a new community, Yabucoa.  We are also excited to share our success in implementing opioid  overdose prevention interventions among our partiicpants.  In the last three months we have distributed at least 164 dosis of Naloxone, a prescription medicine that helps revert an overdose and has saved many lives. 

We continue to work as well with our project "Grant for the Benefit of Homeless Individuals" (GBHI) that targets 12 municipalities, mostly in the eastern side of the island and also San Juan.  This project's goal is to provide psycho-social services to individuals who are homeless and may or may not have problematic drug use or severe mental health disorders.    This work is carried out by a mental health counselor, a substance use counselor, a social worker and a case manager that are providing direct services to at least 40 partiicipants on a regurlar basis.  Through this project participants have been referred to and enrolled in Medication Assisted Treatment with Buprenorphine or Metadones, have received primary medical care, mental health attention and have been connected to permanent housing/or in the process of.

Recently we hired a social worker who is has been working in developing natural disaster emergency protocols for attention to homeless individuals and persons who have problematic drug use.  Giving the recent earthquakes experienced in the south of the island it is evident the need to have these protocols in place and share them widely with elected officials and government institutions in charge of responding to emergency situation and natural disasters.  Although the earthquakes did not occur in the eastern side of the island, it is a reminder that emergency response protocols and prevention plans are a priority in the evolving context that Puerto Rico finds itself. 

A new mobile unit equiped with physical examination rooms was recently outfitted and put into the road in Humacao, Puerto Rico.  We are very excited for these new stage of our organization.  Our goal is to be able to provide mobile primary medical service, mental health services including buprenorphine treatment for compulsive drug use, HIV rapid testing to the most vulnerable populations, compulsive drug users, homeless individuals and sex workers.  You support is ever as important in order to help us reach our goals of providing high quality medical and harm reduction services, improving the quality of life of our partiicpants and champioining their rights to education, health and housing.  Thank you for accompanying us in this journey and for your continued support.


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At Intercambios Puerto Rico, we are happy to share with you our progress over the last three months as continue to provide support to the homelessindividuals and problematic substance users in the northeast of Puerto Rico. Our syringe exchange project has impacted the community by collecting and delivering clean syringes as well as other safe injection and personal hygiene items. We are currently providing these services in the 9 municipalities of the Northeast and we have recently added the town of Yabucoa. Between the months of August and October, 50,209 syringes were collected and 65,408 syringes were delivered to program participants. These data demonstrate the number of participants who have benefited from work focused on harm reduction and that has an impact on the well-being of the overall population. The syringe exchange project allows the reduction of transmission of HIV, hepatitis C and other bacteria that can be contracted due to not having safe injection equipment to use intravenous drugs. Also, we have managed to link participants to other social and medical programs such as medication-assisted treatment and primary health care.

In addition to the syringe exchange team is also accompanied by a nurse and a case manager provided individual case managing services to a total of 50 participants between the months of August to October 2019. This project has offered preventive services and liaison to other social organizations and primary medical care. A total of 50 rapid HIV tests have been performed on participants from the northeast area of Puerto Rico including the town of Yabucoa. It should be noted that our staff also participated in a health fair in the town of Loíza aimed at people with problematic substance use and the community in general. We specially want to highlight the addition to our organization of a crisis/emergency coordinator with a social work background who has undertaken the development of an emergency protocol in the face of atmospheric phenomena such as hurricanes and floods and coordination with municipal emergency offices to ensure addecuate attention to the population we serve.  This is project was made possible thanks to the contribution of and is allowed us to better prepare in the event of future natural disasters as an organization and to help our community navigate its aftermath.

Finally, our GBHI team funded by SAMHSA is working in the community and offering psychosocial services to homeless individuals with problematic substance use and mental health disorders. Several communities in the municipality of San Juan have been impacted and we have begun to provide services in the town of Humacao. The team consisting of a mental health counselor, a substance counselor, a community outreach worker and a case manager have directly supported a total of 30 participants from August to October 2019. These services are based on providing counseling once a week, support with peers and link to different services according to the needs identified until obtaining permanent housing for this population. It should be noted that participants have been linked to medication-assisted treatment, primary medical care and mental health treatment.

Our entire team appreciates the support you provided us to continue the projects in the communities affected by the lack of access to services related to human rights.  This work would not be possible without the support of people like you and we hope you continue to be our partners in bringing about social change and justice for our communities! Thank you!

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In the past three months, our team at Intercambios Puerto Rico has continued its mission to provide life saving harm reduction services to vulnerable populations in the eastern side of the island of Puerto Rico. Life in the island has slowly recovered a sense of normalcy after two years of post-recovery work, however life continues to be a struggle for those who live in the streets and who have problematic use of illegal substances. Puerto Rico has in the last two year witness the implementation of a myriad of austerity measures imposed by a fiscal oversight board, whose priorities have been to recoup monies for the island’s creditors and has continuously disregarded the consequences such measures are having on the island essential services such as health and social welfare among others. These have simply created a greater vacuum of services for those most disenfranchised groups, including homeless and drug users. Most recently the island has been the object of much press coverage as evidence of rampant corruption and disregard for the wealth being of its citizens was revealed in a series of social media scandals. This evidence prompted a level of local outraged and protest never seen before in Puerto Rico. The island and its people are ready to see a new way of doing things and are tired of the same old political and social discourses.

This is a time where exciting ideas are gaining momentum and local citizens are wanting to seek social justice in many areas. Intercambios’ work and vision for social justice for marginalized communities has the potential to gain track in this new and exciting context where every week people are getting together in different municipalities across the island to map out their vision of a future for Puerto Rico that is steered by the people and for the people. At this historic moment, Intercambios is gearing to become a stronger voice and advocate for a harm reduction approach to mental and physical health for marginalized communities and offered up an agenda for how to attend to homeless and drug user community not only in times of crisis but in regular times. In order to do so, our team is working hard to hire a social worker with experience in dealing with crisis and disaster preparation that will advocate and work closely with municipal governments to ensure their crisis preparedness protocols include measures that specifically attend to homeless and drug using individuals’ needs in times of crisis and natural disasters. This new team member will also be working with our clients to help navigate obstacles that they may still have related to Hurricane Maria and Irma aftermath. It is our understanding that no other organization in the island serving these populations is working to develop crisis preparedness protocols, capacity and kits for its participants, as we are. We are not satisfied with simply covering immediate needs and always work to develop individuals’ capacity as well as expand services and infrastructure as our resources allow, in order to provide a wholistic harm reduction approach to improving our participants’ and their communities’ lives.

We also continue to provide sterile injecting equipment, rapid HIV testing, nursing assessments and referrals to permanent housing for homeless individuals, motivational interviewing and referrals to treatment for problematic drug use for individuals who request it. Among the projects down our pipeline are to be able to set up a mobile clinic with access to a medical doctor, Hepatitis C testing and treatment, and ambulatory drug treatment assisted with Buprenorphine/Suboxone for opioid users.

Our team is excited about what the future holds for us, and we hope you are too and continue to be our partners. Our work would not be possible, were it not for social justice minded individuals like yourselves who believe a better and more just world is possible. Everyday we invest ourselves in the belief that every single effort helps make someone’s life more meaningful and has a ripple effect onto the communities we live in. Help us continue to demonstrate that it is possible to approach drug use and homelessness in a different way that is cost-effective, humane and socially just.

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Unfortunately, more than a year after the hurricane’s aftermath, social and health services for drug users continue to be limited. There continue to be many barriers to access medication-assisted treatment (i.e. Methadone and Buprenorphine) for people with problematic opioid use. In addition, there still limited availability and accessibility of syringe exchange services around the island. The declaration of an opioid crisis in the USA allowed for the distribution of the drug naloxone at a large scale in order to prevent opiate’s overdoses, however it is extremely difficult for people in the island to access this antagonist. The government of Puerto Rico has not yet established micro and macro-structural strategies to allow access to Naloxone. The lack of sensitive public health policies has perpetuated the disastrous health and life consequences of problematic use of substances (heroin).

In response to this reality, Intercambios Puerto Rico continues its mission to strive for social justice and provide social and health services for people who are homeless and people who use drugs by meeting them where they are and in their own communities. The syringe exchange program continues to work from a harm reduction perspective in 12 communities in the northeast side of the island. Our regular outreach team includes a service coordinator, two community outreach workers, a case manager and a nurse who attend to the social and health services needs of our participants. Our participants lack access to primary care centers. However, through our mobile street outreach, they are able to access life-saving services for free on a regular basis such as: HIV tests, health evaluation by a certified nurse, linkage to medication-assisted treatment for problematic substance use and other essential services.

In addition, we recently added a new team to our staff that includes a professional mental health counselor, a professional substance-related disorders counselor, a community outreach worker, a case manager and a service coordinator. This new team will carry out mental health interventions from a harm reduction model with the purpose of supporting individuals who are homeless and had problematic substance use in their recovery process. We are excited to inform you that this new project will be working not only in the communities we serve in the northeast of the island but also in the metropolitan area. This guarantees a greater number of marginalized people will be able to access much need health and social services. And more importantly, we will be able to link homeless inviduals with/without problematic substance use to permanent housing programs. According to the Homeless Count of Puerto Rico (2017), it is estimated that there are over 3,501 homeless individuals in the island. This number is bound to increase due to the devastation caused by Maria and Irma’s Hurricanes. At least 30.6% of individuals identified as homeless reported the main reason for being on the street was problematic substance use.

We are extremely grateful to all those who have donated and supported our work in the past and hope to have your continue support as we engaged in Post-Hurricane Recovery Work in our communities. This work is more challenging for Puerto Rico given that is government finds itself in the midst of a bankruptcy and has implemented harsh austerity measures that undermine the provision of essential services, such as health and education, to its population. Thank you for keeping up with the hard work carried out by our team at Intercambios Puerto RIco. We are committed to promoting public policies and direct service that may positively impact our vulnerable populations and ensure that we are better prepared to face similar natural disasters in the coming future.

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Organization Information

Intercambios Puerto Rico Inc

Location: Fajardo - Puerto Rico
Facebook: Facebook Page
Twitter: @Descrimina
Project Leader:
Debora Upegui
Fajardo, PR Puerto Rico
$4,462 raised of $50,000 goal
72 donations
$45,538 to go
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