Asuncion Delgado’s shy eyes hide behind the wrinkles of her face. Sitting on her house’s patio, the 76-year-old lady relishes a cold juice she made by mixing Tang, lemons and guavas. She shakes the glass in timid circular movements and smiles with relief. She has not moistened her lips with a homemade cold juice in 10 months. Since August 30th, 2017, when hurricane Irma hit Puerto Rico and left her house without power.
Asunción has had type 2 diabetes for 25 years. Ever since she was diagnosed, every morning she takes an insulin pen out of the fridge, washes her hands and starts the procedure: she lifts the pen’s cap, leaving out the naked needle; she regulates the dose, twisting the neck of the injection with her fingers. Then, with her left hand, she pinches the flesh around the belly button and sinks the five millimeter needle deep into the skin. Ten seconds later, which she sometimes counts out loud and sometimes in her mind, she pulls the needle back out, lets go off the pinch and relaxes the body.
Asunción Delgado , 76, sits outside her home in Yabucoa. June 11, 2018. Photo by Diego Marcano.
After hurricane Irma, the house’s white fridge with double doors went dark, hot inside, unable to refrigerate food, or the insulin that Asunción injects herself with every morning and every night, which must be kept at temperatures of between four and eight degrees Celsius.
The lack of electricity affected all the island. Hurricane Irma roughly left 1,093,643 people without power, a number that represents 68 percent of the total number of users of the Electric Power Authority. On September 20th, hurricane María left all the island of Puerto Rico without power.
Six months after María, the Electric Power Authority assured that 98.5 percent of their clients had recovered the service, but a survey sent by El Nuevo Día to all Mayors in Puerto Rico, showed that only 25 percent of the island’s towns had recovered from 90 to 100 percent of power. The recovery has been even slower in the central area of Puerto Rico: 43 percent of Adjuntas, 35 percent of Morovis and 35 percent of Oricovis were still without power at the time.
A study by Harvard University, published on May 30th, 2018, estimates the number of deaths related to hurricane María in a total of 6,645. The study considers the disruption caused by the power shut down on health services as an important factor associated to those deaths.
The lack of power especially affected patients with chronic conditions such as diabetes and cancer, whose treatment consists of medicine that requires adequate refrigeration. Also, the difficulties to preserve food have had a negative impact on the diet that chronic patients need to follow to prevent their condition from worsening.
Asunción used to go from her house in Ingenio to the center of Yabucoa to buy ice. She brought it back and put it inside the fridge with her insulin. She resisted the first couple of weeks after the hurricane doing that. Slightly less than two months later, her daughter Besaida brought her a power plant. She would turn it on from 8 pm to 2 am to preserve her insulin.
Asunción and her 79-year-old husband, Feliciano Soto, live with money from social security and Food Stamps. Keeping the power plant on for six hours a day represented a cost of $20 daily.
According to the Office of the Procurator of the Elderly (OPPE), 81 percent of the population over 65 years old in Puerto Rico have social security as their only income.
Three miles away from Asunción and Feliciano’s home, a young man from North Carolina has a prototype installation that seeks to improve the situation of patients with chronic conditions or special care needs. Zach Sprau is the manager of the Puerto Rico Solar Energy Program, an initiative from the organization Samaritan’s Purse, to help cover the electric power demand with solar energy.
Through local churches, the program identifies households with elder people, single mothers with children, or patients with special conditions and chronic diseases. The goal is to install a system of solar panels in these homes, with capabilities to charge a 2500 hours watt battery. The system also includes a small refrigerator to preserve medicine and food.
“This project seeks to help the most vulnerable people of the community. We work through local churches because they know the communities better than we do and because we want to empower the community. They will remain here when Samaritan’s Purse is gone,” Sprau says.
For doctor Vilma McCarthy, geropsychiatrist and associate professor at the Recinto de Ciencias Médicas de Puerto Rico, the main challenge that the State faces when trying to assist patients with chronic diseases and special conditions in the aftermath of a natural disaster is the lack of a database. “We as a country need to have records of where the elderly live. We must know how many are bedridden, how many need an oxygen machine, all the special needs, to be able to help. But we have no idea,” McCarthy says.
According to Sprau, the solar panels system costs around $3,000 and it has been one of the best and fastest ways to provide a sustainable solution to the problem of the lack of power in Puerto Rico after hurricanes Irma and María. The program’s goal is to bring solar energy systems to a hundred households. So far, they have covered 25 homes and they expect to reach the goal by the end of September.
As part of the project, Sprau’s team is conducting workshops in which they teach electric basics, how to obtain the most of the solar panels and they also show the program’s beneficiaries how to dismount the panels in case hurricane winds could threaten the system.
When a house does not have a person physically available to maintain the system, they must identify a family member or another person from the community that commits to assist in keeping the solar system in shape.
Aixa Hoyos drives through the narrow roads in the mountains of Utuado, in the center of Puerto Rico. She uses a green jeep to get to the homes of six to eight patients a day, which the home health services agency San Lucas assigns her and another visiting nurse. Most of her patients are elderly citizens. Many of them are bedridden.
For the most part, her patients are covered by Medicare. Those who only have the local government health plan hardly ever are approved into this home health service provider.
In this occasion, Aixa is going to the Roncador neighborhood in the sector of Quebrada Fría, where Octavio Vélez lives. He is a bedridden patient who she has been serving for 12 years, two times a week.
- June 13, 2018 – Aixa Hoyos, a visiting nurse, treats Octavio Vélez’s bedsores at his home in Utuado, Puerto Rico. Photo by Diego Marcano.
“It’s only me and another nurse for all Utuado’s rural area. Most of them are elderly without family or with family living in the U.S. Others do not have the resources to travel into town to receive these treatements. That is why we go to their homes,” says Aixa Hoyos.
Octavio Vélez, a sturdy man with a short mustache and a bald head that has been pushing hair to the sides, is laying on the bed face up. Twenty years ago he lost mobility. He suffered a fall that caused him a fracture in the spine. Since then, he has to change positions every two hours, embedding pillows in different parts of his body to avoid the weight of his bones from diminishing the blood flow and causing bedsores on his skin.
His wife, Lydia Vélez, a thin woman with a pointy nose and flimsy lips, is standing in the bedroom’s door. Just a few steps away, Aixa Hoyos wears surgical gloves and a medical mask to treat Octavio’s skin ulcers.
-Aixa, how are the ulcers? – Lydia says. –Are they improving?
-Oh Lydia – Aixa sighs – They are worse.
The hurricane kept them without electric energy for 10 months. The heat, not being able to use the electrical bed and the lack of a constant fan caused the spread of Octavio’s ulcers on the left side of his hips. His bedsores have become deeper and the secretions have increased.
Without power, Lydia and Octavio’s home was left without an operating fridge. Sometimes Lydia managed to buy a chicken and she preserved it with ice. But it would melt after one day. The rest of the week they couldn’t eat more proteins. Octavio was weakened and it made him more prone to develop skin ulcers.
“From six patients that I can visit a day, at least four of them are elderly people with their sons and daughters outside, in the United States, or with relatives that live outside of Utuado. These patients that live in remote areas rely mainly on their neighbors,” Aixa Hoyos says.
Doctor McCarthy argues that elderly people need to move wherever their children live in the case of a natural disaster. “It is not reasonable that someone who is 78 years old or 80 years old, with several health conditions, remains without electric power or water. The potential for this type of patient to have a crisis is too high,” McCarthy affirms.
Sometimes, Asunción and Feliciano travel to the U.S. to see their sons and daughters in New York and Arizona. They all gather the funds and make it possible. But they do not want to leave their house in Yabucoa.
“I already lived many years in Rochester, Connecticut and Massachusetts, enduring the cold,” Asunción asserts. “When you have your house, you go to bed at whatever time you want and you wake up whenever you want. This is my house and I won’t leave it.”
- June 13, 2018 – Feliciano Soto, 79, had two valves from his heart replaced with pork’s tissue and endured 10 months without power at his house in Yabucoa, Puerto Rico. Photo by Diego Marcano.
Feliciano has had a major surgery. Years ago, he had two valves from his heart replaced with pork’s tissue. Now, he only works on a small crop in his house’s garden.
He climbs a small wall that divides the yard from the sown area and enters the side where the fruit cultivation stands. He makes his way through the plants and points proudly at the diversity of his crop: acerolas, avocado, juicy soursop; lemons, sour guavas, peas and pickles. Across the crops, red and orange flowers blossom. His harvest occupies most of his time. It gives him the certainty that he does not get from anything else. And he does not want to leave it.
Feliciano gathers a handful of sour guavas. Takes one in his left hand, looks at it as if he was measuring its size and says: “I am 79 years old and I’ve been with my wife for 60 years.” He pauses. “Well, not yet. We will celebrate our anniversary in October. If we get there.”