October 10, 2017 01:00 AM

Healthcare providers answer the call to lead relief efforts in Puerto Rico

GNYHA Ventures President Lee Perlman, center, Danielle Butin, executive director of humanitarian group aid group Afya Foundation, to Perlman's right, and an army of healthcare workers assembled supplies for relief missions to Puerto Rico. They have delivered more than 29,000 pounds of relief items to the island in 10 missions.

Updated Oct. 13, 2017.

It was around 11 p.m. on Sept. 27 when the plane carrying Dr. Julian Trivino, an emergency medicine physician at Florida Hospital Orlando, arrived in Puerto Rico.

One of the first things Trivino said he noticed as the plane made its approach was the vast darkness the enveloped the island, with the exception of a long line of lights about 2 to 3 miles long.

"The line of lights was actually cars waiting at gas stations to fill up on gas," Trivino said.

Trivino recently returned to Florida after spending two weeks providing medical relief along with a team of five of his fellow emergency physicians. Around 30 of the hospital's clinicians have either visited or are currently in Puerto Rico or the Virgin Islands as part of a humanitarian relief effort that has carried on since two hurricanes severely damaged much of the region's health infrastructure in late September.

Immediate attention remain focused on providing emergency medical care to residents and getting Puerto Rico's 69 hospitals fully operational. Just 25 were connected to the electrical power grid as of Oct. 10, according to updates provided on the website of the Puerto Rico governor's office.

Approximately 40% of residents remain without access to drinking water, according to the Federal Emergency Management Agency, with the death toll reportedly at 43 as of Tuesday.

The aftermath of Hurricane Maria on a street in the town of Manati, Puerto Rico.

Many have criticized the federal government for being slow in its response to Puerto Rico compared to its efforts in Texas after Hurricane Harvey or Florida after Hurricane Irma. The immediacy of the need for relief has prompted healthcare providers to take a lead role in providing support.

Kaiser Permanente last month announced it was contributing $1 million to the Centers for Disease Control and Prevention Foundation to assist in its public health efforts on the island.

Along with Florida Hospital, providers based in New York have been among the leaders in the relief effort. New York City has the largest Puerto Rican population in the mainland U.S.

"The bond between New York and Puerto Rico has been long and strong," said Kenneth Raske, president of the Greater New York Hospital Association. The group has raised $5 million in donations toward funding its relief efforts.

In addition, GNYHA has led a series of medical supply missions over the past two weeks that have resulted in the direct delivery of thousands of medical and non-medical supplies to several hospitals on the island.

Dr. Julian Trivino (center) arranges supplies he helped to deliver to a hospital in Puerto Rico.

The organization, with the help of the not-for-profit humanitarian aid group Afya Foundation, has delivered more than 29,000 pounds of supplies over the course of 10 missions with the use of personal aircraft loaned to them by wealthy private citizens.

The experience of performing disaster relief during Hurricane Sandy in 2012 helped to make the organization more nimble in its response to aiding Puerto Rico, said Lee Perlman, president of GNYHA Ventures, the association's business arm. Perlman said assembling each shipment and delivering it to the island takes 24 to 48 hours.

"Our model was to deal directly with providers in Puerto Rico and try and take care of what they need," he said, adding that three more shipments were scheduled to be delivered this week, with an emphasis on supplying providers with more medications, such as insulin for diabetics.

Dr. Julian Trivino (right) treats a patient along other members of the emergency medicine team of Florida Hospital Orlando that went to help with relief efforts in Puerto Rico.

But the continued lack of electrical power has been one of the greatest challenges for both island providers and for those visiting to help with the relief effort. A number of hospitals and clinics have been left to rely on the use of a single generator that they can use to power only parts of their facilities. Trivino said those facilities are likely to see a spike in deaths once their generators begin to give out.

"If you don't have a generator, you have no hospital," Trivino said.

Despite the relief efforts, questions linger as to the fate of the island's hospitals after the the current situation subsides.

"The real question is what is going to be the long-term relationship between the hospitals in New York and the hospitals in Puerto Rico," Perlman said.

GNYHA President Kenneth Raske, right, joined New York Gov. Andrew Cuomo to talk about efforts healthcare providers in the state are taking to help in Puerto Rico, including sending 100 to 200 clinicians to provide direct medical care.

For its part, GNYHA is currently developing an Adopt a Hospital program in coordination with the American Hospital Association and the Healthcare Association of New York State to form partnerships that would allow mainland providers to assist with the long-term needs of island hospitals.

Though still in development, Perlman said he envisioned an initiative that would have stateside healthcare organizations making regular visits to Puerto Rico to help provide logistical, engineering and clinical expertise for the purpose of creating a new care model as the island rebuilds.

"It's really matching facilities around the states and New York that have specific (capabilities) in areas and trying to match them to see how we can be helpful," Perlman said.

An edited version of this story can also be found in Modern Healthcare's Oct. 16 print edition.