Rebuilding a Safe Haven for Future Crises

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.