Msw 521 Discussion 1 (Module 1)

Phases of Emergency Management Two agencies were responsible for emergency management in the case of Hurricane Maria. The Puerto Rico Emergency Management Administration (or Spanish acronym AEMEAD) was responsible for disaster management at the local level, and the United States Federal Emergency Management Agency (FEMA) was responsible at the federal level. Both agencies failed to aid the Puerto Rican population at four phases of emergency management, including mitigation, preparedness, response, and recovery (Rivera, 2019).

Results of Lacking Emergency Management Rivera (2019) concluded that both AEMEAD and FEMA were accountable and responsible in ways for disrespecting the potential impact of Hurricane Maria on Puerto Rico. It is clear that the lack of mitigation, preparedness, response, and recovery were interrelated in the case of Hurricane Maria, and that taken together they resulted in many negative outcomes. Those outcomes include mortality, health/mental health issues among vulnerable, and migration.

Hurricane Maria: Negatives Outcomes

Roads destroyed by Hurricane Maria in September, 2017 and by the resulting flooding and soil saturation.

Mortality. Kishmore, Marques, Mahmud, et al. (2018) surveyed 3299 randomly identified households in Puerto Rico and found the death rate was 14.3 deaths per 1000 persons, which resulted in 4645 deaths in the four months post hurricane. That number was nearly two-thirds more than in 2016, the year before the hurricane. It is estimated that 33% of those deaths were attributed to the lack of needed continuous health care before, during, and after the hurricane. In turn, this also necessarily resulted in many survivors migrating to the United States.

Health. Ramphal (2018) examined the use of a community health clinic in Toa Baja, Puerto Rico after Hurricane Maria. Among the 4941 visits residents in the area made to the clinic, elderly persons who had chronic conditions, such diabetes and hypertension, were seen more often than younger persons. It is noteworthy that transportation to and from the clinic impacted those residents who lived in the surrounding and needed medical care.

Mental Health. Orengo-Aguayo, Stewart, de Arellano et al. (2019) examined the impact of exposure to disaster on the mental health of high school students in Puerto Rico from five months through nine months after Hurricane Maria. The researchers invited 226,808 high school students to participate in the study with the intent of identifying disaster related stressors, post-traumatic stress disorder (PTSD), and depressive

symptomatology. The 96,108 students in grades 3 through 7 who completed the questionnaire reported seeing (a) houses destroyed (84%), (b) a friend or family member leave the island (58%), (c) damage to their own homes (46%), (d) shortages of food or water (32%), (e) their own lives at risk (30%), and (f) no electricity for 5 to 9 months after the hurricane (17%). Seven percent of the youth reported symptoms of PTSD that were significant at the clinical level, and that number was greater for females.

Outmigration. As a result of Hurricane Maria, it is well documented that there was considerable outmigration, especially to Florida. However, Cloos and Ridde (2018) make the case that outmigration is not just a matter of climate change and health, but rather, they argue that outmigration is an outcome of social inqualities in many small island countries. A Doctors Without Borders report one week after Maria highlighted various medical and sanitation issues (Cloos, Tremblay, Sameien, & Van Diest, 2017). Those included: health facilities were no longer functional due to structural damage, no clean drinking water, isolation of residents due to landslides, no electricity or phone lines, raw sewage, and debris of all types.

Although Cloos and Ridde (2018) noted that most public health research indicates that these conditions are a matter of climate change and health, they proposed that the conditions are a matter of climate change, health, and social inequities. More specifically, they argued that climate change is a social justice issue wherein it disproportionately impacts low income countries and states relative to existing social and health inequities. This is especially true in small developing island countries, such as Puerto Rico, that are most vulnerable to climate change due to low and middle income. This proposal suggests that mitigation may be a very important phase of emergency management that minimizes outmigration and displacement of the populations.

Social Work and Hurricane Maria There is a paucity of research in the literature when "social work" and "Hurricane Maria" are used as descriptors in combination. However, social justice is a key construct in the practice of social work at all levels of practice, and it seems that the social workers should consider how to be involved in disaster situations domestically and globally. This lesson suggests that social workers can play a key role in mitigating the impact of a hurricane in the Caribbean/other developing island countries by understanding how to reduce loss of life and property by recognizing "environmental justice" (Hayward & Joseph, 2018). This can be accomplished when social workers recognize the social inequities that exist before a disaster as a means to help residents prepare for, survive during, and adapt after a disaster.

In helping vulnerable populations, social workers must begin to think about social justice in terms of environmental justice. For example, the immediate and ongoing mortality associated with Hurricane Maria indicates the need for residents in the developing island countries to be prepared psychologically for loss and grief as a result of a hurricane. In the case of Maria, social workers could have conducted action research before the disaster to identify the needs of elderly residents for particular medications in

the case of disaster. Likewise, social workers could have insured in advance that schools be trauma informed post Hurricane Maria and that students have the opportunity to share their narratives about the disaster (de Jesus et al., 2019).