by Larry Floersch
Jason Serota-Winston looks solemn. And maybe just a bit angry. He returned to Vermont on October 18 from a two-week stint as a relief worker in Puerto Rico helping with the recovery from Hurricane Maria. Maria struck the island on September 20 as a near-category-5 storm, and his work there in the relief effort left a powerful impression.
“I felt very emotional when I got off the plane in Burlington,” Serota-Winston said, “because my life was about to go back to normal. But life for the people of Puerto Rico is not going to go back to normal anytime soon, if ever.”
Serota-Winston, 45, lives in Montpelier and is a nurse in the intensive care unit at the UVM Medical Center in Burlington. He is the son of Andrea Serota and Rick Winston, the former long-time owners of The Savoy Theater.
Union Members Answer the Call for Help
This was Serota-Winston’s first time as a relief worker.
The City of San Juan had put out a call for help through its affiliation with the AFL-CIO. The American Federation of Nurses, of which Serota-Winston is a member, is part of the AFL-CIO.
The call was for help from union members in about thirty professions–including electricians, carpenters, heavy equipment operators, people who could repair electric generators, and similar trades–in addition to doctors, nurse-practitioners, and nurses.
Serota-Winston completed a questionnaire about his skills and the work he was willing to do and joined a team of about 100 medical professionals and 200 volunteers from the trades.
By the time they flew into San Juan airport on October 4, two weeks after the storm, the city was up and running with intermittent electricity supplied by generators.
He noted that there was a lot of publicity about the team going down there because of the political fight between the Mayor of San Juan and President Trump. “We were taken to the Roberto Clemente Coliseum in San Juan where there was heavy security and a lot of resources just sitting around. We slept on cots,” he said.
The first thing they had to do was assemble in the 100-degree heat for a press conference. “That heat was a rude shock to those of us from Vermont,” he noted.
The teams were given their assignments. The next day they were doing relief work.
Vacation Destination Devastated
Serota-Winston had been to Puerto Rico on a family vacation this past March. The differences were dramatic.
“It definitely is a surreal feeling to be in a place where you’ve been on vacation just months ago and now there is debris everywhere. A lot of the roads were impassable or were only one lane. And this changed from day to day—one day a road would be open and the next day it was closed. Some of the teams were carrying lots of supplies and heavy equipment and heavy vehicles and couldn’t get through because the roads were not safe.”
“San Juan seemed a normal tourist area, but 20 minutes outside San Juan there were hundreds and hundreds of people in shelters and flooded-out homes,” he said.
No Centralized Control
Many of the other nurses had been on relief missions in the past, including ones to Cuba. They told Serota-WInston that Cuba has a robust disaster relief response and a robust primary care system and they regularly drill and practice. While Serota-Winston does not claim to be an expert on Puerto Rico, it was clear to him that there was little centralized command and control and little ability to gather data or track the recovery. He saw no indications of a robust public health infrastructure.
“Everything is disrupted,” said Serota-Winston.
“Everything feels like it takes longer than it should,” he added. “A medical triage process that should take 4 hours takes 16 because of bad roads, finding the needed resources, and problems with coordination.”
And getting the aid to where it is needed is a major problem because of the variability. Relief is well organized in some towns and very poor or nonexistent in others.
“One of my big concerns is that people are relying on drinking water being delivered by aid groups,” he said. “But what if that does not continue as robustly in the days to come? There is already an outbreak of leptospirosis [a disease caused by animal urine in the water; 76 cases had been reported at the time Serota-Winston left Puerto Rico].”
“Most people are using contaminated water only for washing clothes or bathing and not to drink. As time goes on what happens to those people without reliable sources of clean water or electricity in a tropical climate?” he added.
‘Entrepreneurial’ Disaster Relief
“When we arrived we found that the greatest needs were not in San Juan,” said Serota-Winston. “The greatest needs were out in the countryside. But where to begin? So we began asking municipal employees in San Juan if they had family on the island and what were they hearing.”
If a team heard a story of a community in need, they would send out two or three people to investigate to see what the community needed and then send a bigger team with more resources out the next day. “It was inefficient and based on hearsay,” he said.
That can be rife with problems he pointed out. “But the good part is that it is really up to you to say, okay, this is not the best disaster relief scenario. Once you’ve accepted that fact, you say ‘What can we do?’ We were all working together; doctors, nurses, truck drivers, carpenters, and we all used those specific skills at different times, but mostly it was the willingness to listen to the people in these communities about what they needed and try to find ways to get it there. It was, for want of a better term, ‘entrepreneurial’ disaster relief.” he said.
Direct Medical Impacts of the Storm
Serota-Winston identified three categories of medical issues that were of concern to the medical professionals. There were health-related issues directly related to the hurricane. There were health issues from the breakdown of the health care system. And there was the psychological trauma of the disaster.
He said that they were there two weeks after the storm, so mostly they were dealing with the aftermath rather than injuries directly caused by the storm.
But he gave as an example of a health issue linked directly to the hurricane communities that were downstream from a dam. Authorities thought the dam was going to fail because the alarm malfunctioned, and they released the water in the reservoir. This is an area with a lot of cattle, and water with cow manure flooded the houses downstream.
Everyone was trying to clean up as best they could, but it was clear that they were living in this filthy area and people were starting to get sick. They didn’t really have access to the resources they needed to prevent communicable disease.
Breakdown of the Health Care System
The official death count from Maria is 16. Serota-Winston takes issue with that because of the second medical issue, the breakdown of the health care system.
“Many people in Puerto Rico have chronic health problems,” he said. “There are high rates of diabetes, high rates of hypertension. It is not dissimilar to rural areas around Vermont.”
And in many cases those health issues are well managed. “People have a primary care physician, they have appropriate prescriptions. But now all of a sudden the doctor’s office is gone. And their prescriptions are running out. So suddenly someone who was able to control their diabetes with oral medication can no longer do that. What happens to them?” he said.
He went on, “Or somebody suffers heat exhaustion just because they cannot get enough clean water to drink or they cannot get into air conditioning—this is often a problem with the very young and the very old. We were seeing a lot of that.”
He added, “And we were hearing anecdotally that as pharmacies were reopening they were only accepting cash because electronically they could not run credit cards or they could not fill prescriptions because they could not connect with the health insurance systems.”
He pointed out that there is a lot of poverty, so if people can’t get the insurance companies to pay for the prescriptions, they probably are not going to get the medications.
A lot of what his team was doing was trying to find people the appropriate medication or a give them a new prescription they could get filled. “So really it was basic primary care stuff where the system is not up and recovered yet, “ he said. “I think that if people suffer from that or die of their condition because of that it is definitely hurricane related.”
Storm-related Psychological Trauma
Then there was the psychological trauma. According to Serota-Winston the most common issue was that people just wanted to get checked out. They knew that their son or daughter had had some disease in the past year and they wanted to make sure it hadn’t come back, or they had a history of diabetes or hypertension and they wanted it checked out to make sure they were okay.
There was also a lot of surprise among people that there was anyone there at all who cared. “I would say that was one of the more common reactions,” he said. “Shock from the residents on the island that there was anyone who would come there to express concern about them, to check on them.”
And what about FEMA? “I really don’t know about FEMA,” said Serota-Winston. “I did see a couple of FEMA people and tried to talk to them to find out what their perspective was, and I did see some FEMA posters.
“To say it was unclear to me what FEMA was doing is the most charitable I can be,” he said.
He noted that one of the things you saw driving around was that most cell phone towers were out, so anywhere there was cell service there would be hundreds of cars parked along the road because people could contact their families.
“FEMA has a 15-page application for aid that they prefer people to fill out online, and that seemed a remarkably bad systems design for a place that has suffered such a collapse of infrastructure,” he said.
He pointed out that, to be fair, FEMA had gatherings where people could fill out applications. His team went to many of these gatherings to look for people who needed help. “But your hope for a situation like this is that you are going to see FEMA everywhere, and that really wasn’t the case.” he said.
Concern for the Future
Serota-Winston is concerned about Puerto Rico in the immediate future.
“I think it will get worse,” he said. “If fatigue sets in over the relief effort, or there isn’t a steady stream of bottled water, or the infrastructure doesn’t get repaired in a timely manner so there is clean drinking water, the potential is there for things to get worse.”
He met one family whose house only had the bathroom left standing. He met an old man who was living in a shed because his house was knocked down. He met others who were better off and had managed to buy a generator so they had air conditioning.
“But these are all variations on what the new normal is,” he said, “Because things are no longer the same as they were before the storm. And that is true for almost everybody. I definitely felt a lot of empathy for the people there.”
The Human-to-Human Connection
Something that surprised Serota-Winston in doing relief work is that it is not just providing needed medical treatment.
“I think one of the things I didn’t appreciate before I went there was that if you work in the emergency room or the intensive care unit, you focus on what the person needs first and you triage—you know, airway, breathing, circulation, and so forth. I really felt that showing caring to the people down there, giving them emotional support, giving them food, giving them water, not only because they needed it but simply because they deserved it as human beings was equally important to anything else we were doing. That I did not expect.”
And many of the residents made it clear to him that the caring was just as important to them as anything else. “That made a real impression on me—that human-to-human connection of respect and caring, of being deserving simply because you are alive and you are a person,” he said.
“My politics are definitely on the left side of the spectrum, but while I was there I felt very unpolitical because political views are irrelevant. I think all the relief workers felt that way regardless of what their politics were. We wanted to go to where the people had the least and needed the most and get whatever we could to them. And it wasn’t a political critique. It wasn’t a political point. It was just a very human impulse.”
Disaster is Preventable
After his two weeks in Puerto Rico, when he got off the plane in Burlington, Serota-Winston said he felt emotional and angry. And he continues to feel that way.
“I am angry because everything you are seeing in Puerto Rico is preventable,” he said.
The hurricane is not preventable, but, he added, “The infrastructure damage and recovery are under human control. It’s all a matter of where we put our resources and how we use them. None of the logistics are beyond the resources of this country. It is unnecessary for the suffering to be prolonged and for the recovery to be inefficient. It’s about our country figuring out how to accomplish it as quickly and efficiently as possible and paying the necessary amount. I don’t think we are there yet.”
Appreciation for Logistical Expertise
Would he do it again?
“I have never done this before but I wanted to,” said Serota-Winston.”
Some of the people at his hospital have gone on other relief trips. There is in fact a nurse-based disaster response network, The Registered Nurse Response Network, and many of the people who were in Puerto Rico belong to that network.
“I was very impressed with them,” he said. “So if I went again, I would probably apply to be part of their team. It’s part of the California Nurses Association. It’s a separate nongovernmental organization. You apply ahead of time. They train you, and they keep a database of people’s experience.”
He did not know how long the network has been around, but he heard they have deployed 20,000 nurses. “They went to Sandy, they went to Houston, they went to Standing Rock; they’ve gone both inside and outside the country, Serota-Winston said. “I like the idea of an ongoing organization. My understanding is that this is the first time my union tried to mobilize health care professionals to go on relief efforts. I think that is a good thing, but I respect organizations that do it all the time and have logistical expertise.”