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.
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.
Here at Intercambios Puerto RIco, we continue our efforts to aid in the reconstruction of Puerto Rico in the aftermath of Maria and Irma through our committment to serving our participants. We are happy to report that the provision of our clinical and harm reduction services to participants in the eastern side of the island have not only continued without being negatively affected by cuts in local government funding to the department of health, but actually have increased thanks to the support of private foundations and our individual donors. In addition to harm reduction and life saving services, we now have a nurse and a social worker that are able to provide first aid care to participants and connect them to social and health programs that they so desperately need. Connecting to social and medical services is more challenging in the aftermath of the Irma and Maria due to the shrinking availability of doctors in the island who have migrated and the ever-increasing budget cuts resulting from the island's bankruptcy. Finding housing and connecting to medical services requires that many participants travel everyday long distances to other municipalities because they are not available where they live.
However, we still very much need your help in raising the funds to create storm survival kits (that contain water filters, solar portable lights, toilettres, and first aid iterms) that can be distributed to our participants especially as we geared towards a new water rationing season (due to lack of rain in certain areas of the island) and the upcoming hurricane season. Although our modest main office is back in shape and is better prepared to weather a hurricane, we still need to make upgrades that will make it self-sufficient in the event of a major weather disaster and outfitted, so it can serve as a refuge to participants who do not have a safe place to weather the storm. We need your help to continue our efforts to be resilient and effective in the event of a new disaster.
It has now been exactly one year since the devastation of Hurricanes Maria and Irma. Thanks to our supporters, Intercambios was able to quickly rebuild and be more prepared for future storms. We have been able to repair the damage to our office and resume our lifesaving services. Our clients have been able to attain greater stability, as they are no longer faced with ongoing power outages and lack of access to communications. The support from our generous donors and foundation partners made it possible to purchase a generator, cistern and water filter. These items will greatly help our clients stay safe in the event of future storms!
Although we have recovered from the immediate damage wrought by the hurricanes, we now look to the future to achieve full disaster preparedness. In the coming months, Intercambios will seek to create an emergency supply of essential items such as batteries, a convertor, and a power generator. In addition, we are raising resources to conduct an organizational needs assessment and establish written policies and procedures to implement in future storms, which will ensure a systematic and highly coordinated response that will save the lives of our constituents. We are also seeking support to purchase client survival kits, which would be equipped with canned food, bottled water, detergent, hygiene items and LED lamps.
Last but not least, we are excited to report that we are in the process of ramping up our clinical operations to address any barriers to treatment our clients face. Intercambios is deeply grateful for our individual and foundation donors, whose support in these difficult times has allowed us to rebuild to be stronger than ever!
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.
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