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Preparing for the Next Big One: Mobilizing the Community in Puerto Rico

Destroyed road in PR

By Claire Hutkins Seda, Writer, Migrant Clinicians Network, Managing Editor, Streamline

Over one year later, Hurricane Maria continues to haunt Puerto Rico. Blue tarps still top homes in villages and towns across the island, as residents struggle to afford the necessary roof and structural repairs. Yet something else hangs on tightly to Puerto Rico since Maria, the opposite of the physical destruction that is still so evident: Puerto Rico’s resiliency and determination, which define the post-Maria era.

“These communities were isolated after the hurricane — but there were strong people there, who showed resilience, and who were the key to developing the capabilities to work through [the aftermath],” recalled Marysel Pagán Santana, MS, DrPHc, MCN’s Program Manager in Puerto Rico. “Through it, they were protecting the health of the community — and that’s something anyone can be proud of.”

It’s also something important to replicate and advance, to assure health centers will be ready and mobilized, when the next disaster strikes. Migrant Clinicians Network’s project, “Mobilizing Communities in Puerto Rico to Meet the Needs of Vulnerable Populations Before, During, and After a Natural Disaster,” is a multi-year effort supported by the Bristol-Myers Squibb Foundation that seeks to apply a community mobilization framework to emergency preparedness and to reinforce, replicate, and institutionalize the leadership efforts that community health centers showed after the disaster, in preparation for the next one.

In the first year, MCN is piloting the project with two community health centers in Puerto Rico, Hospital General Castañer and Corporación de Servicios Médicos. Both health centers have partnered with MCN before on several initiatives and programs, including environmental and occupational health, and Zika prevention. Now, the two community health centers will lead the way in this new effort. After the initial pilot year, the project will launch in additional health centers.

Meeting with Hospital general castaner

“We developed this project in close coordination with our partners in Puerto Rico, in response to requests from frontline clinicians after Hurricane Maria,” noted MCN’s Amy Liebman, MPA, Director of Environmental and Occupational Health. “We are confident that this Puerto Rican-led effort will further fortify the amazing resiliency that health centers have shown in the event of another disaster.”

In November, Pagán Santana joined Liebman and Alma Galván, MCH, Senior Program Manager, to facilitate the first in-person trainings of clinicians from the two partner health centers. The cross-sectional group of clinicians, including outreach workers, gathered to assess their community resources, networks, and skills that they used after Maria, and can further develop in preparation for the next big disaster.

“We look forward to our continued collaboration with our Puerto Rico community health center partners to address emergency preparedness through the lens of community mobilization,” Liebman added. “We have so much to learn from their resiliency and leadership.”

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MCN's emergency preparedness initiative in Puerto Rico is supported by the Bristol-Myers Squibb Foundation.


Health Network and PRAPARE
In 2016, just as PRAPARE was set to launch, Migrant Clinicians Network was beginning to develop its new database to better serve patients enrolled in Health Network, MCN’s bridge case management program. Over the course of the following year, MCN configured the new database to allow for the integration of PRAPARE data, in which one health center’s PRAPARE data can be transferred to the next health center, as a mobile patient moves.
“When we started thinking about that data and [Health Network] case management work, so much of case management isn’t just ‘are you taking your medication every day?’ It’s more about, ‘How can I help you access care and manage your health in general?’” explained Anna Gard, RN, who assisted MCN in the development of the new database. “One piece of this is: ‘Let me help you find a health center.’ But the larger pieces around effective case management are, ‘How are you going to get there? Is there public transportation? How are you going to pick up your medications if you live in a hostile community and you’re afraid of leaving the house?’ PRAPARE gives a structured format to capture [these] data, in a form that’s been tested and validated.”
As more health centers provide case management and chronic care management to address the social determinants of health, Gard noted, integration of the PRAPARE data with Health Network, a virtual case management, seemed to make sense. Now, the Health Network team is working to fit PRAPARE into their own workflow.
Saul Delgado, Health Network Data Specialist, who has been integral in building and launching Health Network’s new case management system, notes that asking such personal questions over the phone, when a patient doesn’t have transferrable PRAPARE data from a previous health center, can be challenging. “When we call, the patient doesn’t know you. They’re very scared to answer these kinds of personal questions, whereas when you go the clinic, you at least see the nurse or case worker face-to-face,” he explained. But he recognizes the utility of the data, and has developed the PRAPARE data screens within the database to be easily accessed from the main patient information screen. With drop-down menus, Health Network Associates can populate the information they hear from patients, like how many people live with them in their household, or if they’re worried about losing their home. The information, either attained from a previous health center or inputted by a Health Network Associate, will be transferred when the mobile patient gets to his or her next destination, just as the basic medical records do.
“Health centers are doing more to integrate social and behavioral determinants of health, and we’re recognizing that all of those things have to be integrated with care management. So we’re on the forefront,” Gard concluded.

MCN Streamline Winter 2019

Read this article in the Winter 2019 issue of Streamline here!

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