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PUERTO RICAN SCIENTIST AND CIENCIAPR CO-FOUNDER RECEIVES MULTI-MILLION DOLLAR AWARD IN RECOGNITION OF HIS PIONEERING STUDIES

By admin | October 3, 2018

NEW HAVEN, CT – Dr. Daniel Colón Ramos, a Puerto Rican scientist, associate professor at Yale University and a co-adjunct professor at the Institute of Neurobiology at the University of Puerto Rico, was selected last month to receive two important recognitions from of the National Institutes of Health (NIH), one of the leading scientific agencies in the United States.

The first prize given to Dr. Colón Ramos is the NIH Director’s Pioneer Award, which supports highly innovative scientists who lead bold research projects with an exceptionally broad scientific impact. The prize is awarded in recognition of the advanced studies carried out by Dr. Colón Ramos in the area of ??neuroscience. The second prize received is the Landis Mentoring Award for Outstanding Mentoring, a new award that recognizes excellence and leadership by professors who have distinguished themselves by training new scientists and serving as mentors. In the ten years that Dr. Colón Ramos has been a member of the faculty at Yale, he has trained 27 scientists, most of whom have continued into impressive careers related to science. Altogether, the prizes reach a sum of $3.6 million, which Colón Ramos will use to continue his research in neuroscience, specifically to understand how the brain works and how memories are formed. The grant will also be used to promote the professional development of future young scientists in his laboratory.

“It moves and deeply honors me that the laboratory has been recognized with these awards. We seek to create an environment where new ideas flourish and challenge the way we think, not only in terms of the scientific paradigms we study, but also in terms of those who belong to science, and to whom science must serve,” Dr. Colón Ramos asserted. “I dedicate these awards to my country, Puerto Rico, where I had my first mentors and my first encounters with science, and a place that has influenced my interests and the way I think to this day.”

Dr. Daniel Colón Ramos was raised between Barranquitas and Guaynabo, Puerto Rico. He completed his baccalaureate at Harvard University, his doctorate at Duke University and his postdoctoral training at Stanford University. His laboratory at Yale University studies how brain cells, neurons, make precise connections—called synapses—with each other and how that architecture serves as the basis for the behavior of animals and humans. Outside the lab, Dr. Colón-Ramos has also sought connections, specifically between scientists and Puerto Rico. He is trustee of the Puerto Rico Science, Technology and Research Trust and co-founder and president of the Board of Directors of Science Puerto Rico (CienciaPR), the largest network of Puerto Rican scientists in the world and a non-profit organization that takes advantage of the knowledge of its rich and diverse community to democratize science, transform scientific education, and promote the development of young scientific leaders.

“We are extremely proud of these recognitions that Daniel has received. Our organization is a living example of his innovative vision, and his commitment to the development of future Puerto Rican scientists and science,” commented Dr. Giovanna Guerrero-Medina, Executive Director of CienciaPR.

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4 Takeaways On Puerto Rico’s Death Toll, In The Wake Of Trump’s Tweet Storm

By admin | September 14, 2018

President Donald Trump took to Twitter on Thursday morning to challenge the official count of the number of people who died in Puerto Rico in the aftermath of Hurricane Maria, which struck nearly a year ago.

“3000 people did not die” in Puerto Rico, the president tweeted.

The death toll from the Sept. 20 storm, a Category 4 hurricane, has been a point of contention between officials and residents who live there. George Washington University (GWU) researchers released the findings of an in-depth investigation commissioned by Puerto Rico’s government. They estimated 2,975 people died as a result of the storm.

The president questioned that report’s credibility, insinuating that the count was a ploy by his political opponents and that it included people who died from causes unrelated to the storm.

“This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico,” he tweeted. “If a person died for any reason, like old age, just add them onto the list.”

The tweets prompted a sharp rebuke from Puerto Rico Gov. Ricardo Rosselló, who called for recovery efforts to remain above the political fray.

“The victims and the people of Puerto Rico do not deserve to have their pain questioned,” the governor’s statement said.

Here is a brief look at the issue of casualties and Puerto Rico’s response to Hurricane Maria.

How many people died?

Calculating a death count is not an exact science. Estimates are influenced by a variety of factors including the period analyzed and the definition of a disaster-related death, according to Columbia University professor John Mutter.

The Puerto Rican government accepts GWU’s estimate of 2,975 deaths as the official count. Local officials had originally said 64 people died in Hurricane Maria, counting only fatalities directly attributable to the storm, such as drowning deaths or mortal injuries caused when buildings collapsed. During the summer they acknowledged that toll had risen to more than 1,400.

The GWU researchers calculated their estimated death toll, which is about double that tally, by comparing the number of people who died in the six months after Hurricane Maria to historical averages in previous years.

The university issued a statement Thursday, disputing Trump’s comments. The investigation was “carried out with complete independence and freedom from any kind of interference,” according to the press release.

Prior to the GWU study, other researchers and one newspaper released estimates that also garnered media attention.

One study, published in the New England Journal of Medicine, put the number of excess deaths at 4,645 in the three months following the hurricane. A studyby The New York Times used vital records from the government to calculate an excess of 1,052 deaths in the first 42 days after the disaster.

Still, the numbers are important, said Mutter, who researches disaster management and worked on collecting the number of deaths in New Orleans after Hurricane Katrina. These death counts are a key way the public measures a disaster and perception drives donations for relief, he said.

Why was it so confusing getting a death toll?

When Hurricane Maria made landfall in Puerto Rico, it devastated the island’s infrastructure, which can limit access to health care and impact mortality, especially among residents who are frail or dealing with chronic health issues.

The storm knocked out electricity for the entire island, which took nearly a year to restore fully. At least 80 percent of communications towers were not operational, crippling phone services. Medical centers across the island relied on generators for power, which sometimes failed and jeopardized patients. Some medical facilities in Puerto Rico were irreparably damaged, like the only hospital on the island of Vieques, which housed its only dialysis center. Residents must now leave the island three times a week for treatment.

Many roads on the island were impassable because of debris or erosion. Roads near rivers, like those in the mountainous, rural province of Utuado, washed away. Bridges also fell, leaving some communities isolated and unable to access assistance.

Hurricane Maria also cut off drinking water to more than half of Puerto Rico. The lack of electricity meant water pumps could not work. Some people turned to other sources, like natural springs and rivers, for drinking water. At least 26 people died of leptospirosis, a bacterial infection caused by exposure to water or soil contaminated with the urine of infected animals, according to reportingfrom CNN and the Centro de Periodismo Investigativo, a nonprofit group that promotes investigative journalism.

In addition to the physical disruption, the GWU researchers noted that officials in charge of certifying deaths did not have a process that automatically noted when a death was a consequence of the hurricane or its aftereffects.

How did the federal government do in its response to Hurricane Maria?

According to the federal government, not very well.

report released earlier this month by the U.S. Government Accountability Office (GAO) details how the Federal Emergency Management Agency (FEMA) struggled to meet the needs of Puerto Rico and the U.S. Virgin Islands after the storms.

The agency didn’t provide adequate staffing to the disasters on the islands, according to the GAO. It faced a 37 percent staffing shortage as of Sept. 1, 2017. Of the personnel deployed to the islands, some “were not physically able to handle the extreme or austere environment of the territories,” the report said. The lack of bilingual employees also led to delays since many Puerto Ricans speak Spanish.

Transporting materials to the island was also an issue for the agency, as both islands are located more than 1,000 nautical miles from the mainland, the report said.

FEMA Administrator Brock Long addressed some of those issues Tuesday in an interview on CNN. “We threw as much as we could towards Puerto Rico,” he said.

He added that FEMA’s prime concern is preventing deaths from natural disasters, but also that “there’s a difference between direct deaths of, you know, the winds, water, collapsed buildings, things that kill people directly versus the indirect deaths. Indirect deaths are always higher than the direct deaths after many events. … But what I really believe is that we have to concentrate on the pre-disaster mitigation, fix the infrastructure that was crumbling before the storms in the commonwealth, so that we prevent this from ever happening again.”

He noted that FEMA is now the largest employer in Puerto Rico as repair efforts continue.

What has the Puerto Rican government done in response to the death counts in Hurricane Maria?

After the GWU findings were released, Gov. Rosselló changed the official death count and accepted responsibility for the territory government’s failure to adequately respond to residents’ needs. He also said he would form a commission to consider the recommendations suggested in the GWU study on how to improve the island’s response to disasters.

However, how many changes the territory’s government can make remains to be seen. Puerto Rico’s purse is under the control of a fiscal oversight board put in place by Congress to address the island’s debt crisis, which stands at more than $70 billion.

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Why we can’t let the GOP upend a key part of McCain’s legacy

By admin | September 3, 2018

BY DANIEL E. DAWES, OPINION CONTRIBUTOR — 

Today, we laid to rest arguably one of our country’s most notable war heroes, Sen. John McCain (R-Ariz.). The past week has been filled with a number of moving tributes and in-depth coverage of his legacy on the battlefield and on the Senate floor.

While our political views differed in many areas, I gained a new level of respect for Sen. McCain the night he saved ObamaCare with a simple thumbs down. It is a gesture that now serves as a bookend for his Senate career and one that saved the health coverage for millions of Americans, particularly those with mental health and substance use challenges.

While the rest of the country pauses to honor his legacy, many on Capitol Hill are already focused on undoing it by urging the governor of Arizona to appoint a senator to McCain’s seat who they can trust will repeal ObamaCare. While we are having no shortage of political issues that we need to mobilize behind, I urge mental health advocates to keep up the fight against those looking to strip away care that took more than a century and a half to obtain.

Contrary to how it’s viewed, mental health is not a fringe issue. An estimated 44 million Americans experience mental health conditions every year and approximately 350,000 people die prematurely from mental illness and substance use.

Furthermore, one in two individuals will be diagnosed with a mental illness or disorder in their lifetime, suicides are rising across the United States, opioid overdoses are the leading cause of death for people under 50 (one in five individuals struggling with opioid addiction can’t get behavioral health services and treatments) and depression is projected to be the leading cause of disability in the next 20 years. The economic burden to the United States for failing to adequately address this issue each year is a staggering $467 billion.

The passage of ObamaCare marked the first time in American history that federal law mandated that mental health and substance use disorder benefits should be an essential health benefit along with rehabilitative, habilitative, and prevention and wellness coverage.

It expanded parity protections, promoted the integration of behavioral health and primary care within delivery and payment system reforms, prioritized depression and substance use screenings as preventive services at no cost to the consumer, and provided other opportunities for behavioral health prioritization.

This coverage victory was the result of a hard fought battle that started more than a century and a half before ObamaCare was passed. Dorothea Dix, teacher, activist and humanitarian, began a movement to advocate for health reforms to address the issues surrounding those with mental health challenges in the early 1800s. She spent years lobbying state legislatures to provide adequate institutions for treatment and care, until she determined it was only the federal government that could effectively carry this national crusade.

Dix’s initiative eventually landed on President Franklin Pierce’s desk in 1854 where it was vetoed. And so the federal role in mental health care — extremely limited federal participation or non-participation — stood for a century until administrations starting in 1942 began enacting piecemeal legislation on mental health culminating in comprehensive care being granted by the passage of ObamaCare.

We must not go backwards. If the GOP purports to care about the opioid epidemic and Mitch McConnell says they will be considering a bipartisan opioid bill in late September, then it goes without saying that keeping McCain’s legacy of saving ObamaCare is the only way to do this. There is no way that the GOP can be both for helping those with opioid addiction and for repealing ObamaCare.

So, I call on mental health champions and regular Americans to channel the spirit of Dix and others. Definitely take this time to mourn the legacy of John McCain. Then get right to work on stopping those hellbent on upending the gains seen under ObamaCare.

Fight to protect the legacy of a Senator who saw past the pressures of his party to do what is right for the American people. And the legacy of millions of Americans with mental challenges who have benefitted from the Affordable Care Act and millions of others still yearning for that help and support.

If mental health advocates care about achieving equity in behavioral health, then we must speak up and act now. Because if we don’t, I fear that a century from now we’ll still be fighting the never-ending battle for a more accessible, equitable and inclusive health system.

Daniel E. Dawes, JD, is the author of “150 Years of Obamacare” and serves as the senior adviser to the Satcher Health Leadership Institute at Morehouse School of Medicine and Associate Professor at Nova Southeastern University. He founded and chaired the National Working Group on Health Disparities and Heal

 

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Hurricane Maria: Death toll in Puerto Rico much higher, estimated at 2,975, new study finds

By admin | August 30, 2018

SAN JUAN, Puerto Rico–  Hurricane Maria killed far more people in Puerto Rico than initially thought, accounting for an estimated 2,975 deaths on the island from September 2017 through February 2018, according to a new analysis. The study found that those in low-income areas, and elderly men, were at greatest risk of dying.

The independent analysis was commissioned by the governor of Puerto Rico and conducted by researchers at George Washington University’s Milken Institute School of Public Health. CBS News obtained a report on the findings from Carlos Mercader, executive director of the Puerto Rico Federal Affairs Administration.

To arrive at the 2,975 figure, the study looked at historical death patterns from 2010 to 2017 to estimate how many people would have died had Hurricane Maria not hit the island. That figure was then compared to the actual number of deaths from September 2017 through February 2018 — obtained in records provided by the Puerto Rico Vital Statistics Records division of the Puerto Rico Department of Health — to determine what the report describes as the “estimate of excess mortality due to the hurricane.”

The study found that while all age groups and social strata were affected by the hurricane, the risk of death was “45% higher and persistent until the end of the study period for populations living in low socioeconomic development municipalities.”

It also found that men age 65 and older were at heightened risk of death through February, the end of the study period.

“Overall, we estimate that 40% of municipalities experienced significantly higher mortality in the study period than in the comparable period of the previous two years,” the report says.

In the aftermath of the devastating storm, which barreled into Puerto Rico last September, Puerto Rico’s government initially reported 64 deaths blamed on the hurricane. Since then, several studies have indicated the actual death toll was much higher, though researchers have arrived at a range of different figures.

In May, a Harvard University study said Maria was likely responsible for more than 4,600 deaths from the day of the storm, September 20, until December 31, 2017 — a figure that was based on results of a door-to-door survey of 3,299 randomly selected homes across the island. Earlier this month, Puerto Rico said in a report to Congress there were 1,427 more deaths “than normal” in the four months after Hurricane Maria and Hurricane Irma, which churned on a path just north of the island two weeks before Maria hit. That report said, however, those 1,427 deaths “may or may not be attributable to the hurricanes.”

The latest study says that from the period ranging from September to December 2017 alone, there were an excess of 2,098 deaths, and 2,975 from September 2017 to February 2018.

The report offered insight as to why the initial count of 64 was so much lower than this new figure.

“The official government estimate of 64 deaths from the hurricane is low primarily because the conventions used for causal attribution only allowed for classification of deaths attributable directly to the storm, e.g., those caused by structural collapse, flying debris, floods and drownings,” the report says. “During our broader study, we found that many physicians were not oriented in the appropriate certification protocol. This translated into an inadequate indicator for monitoring mortality in the hurricane’s aftermath.”

The report goes on to say that “physician unawareness of appropriate death certification practices after a natural disaster and the Government of Puerto Rico’s lack of communication about death certificate reporting prior to the 2017 hurricane season substantially limited the count of deaths related to Maria.”

The report, which analyzed processes related to death certification, says that physicians and forensic physicians are among those in Puerto Rico who are authorized to complete death certificates, but that most physicians have no formal training in how to do so. They are therefore unaware of “appropriate death certification practices, especially in a disaster setting,” the report found.

“Those interviewed said they did not receive information about how to certify deaths during, or in conditions created by, a disaster,” the report says.

It also says there was a communication problem between the Puerto Rico Vital Statistics Registry and other government agencies and those involved in the death certification and registration process.

“Many stated that the Puerto Rico Department of Health (DoH) and the Puerto Rico Department of Public Safety (DPS) did not notify them about the CDC special guidelines for correct documentation of cases, on the importance of correctly documenting deaths related to the hurricane or on an emergency protocol for handling these cases,” it says.

 

https://www.cbsnews.com/news/hurricane-maria-death-toll-puerto-rico-2975-killed-by-storm-study-finds/

 

 

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Suggested resources

By admin | August 20, 2018

Greetings,

The list of suggested site came from an 13 year Puerto Rican, who requested we added to our site so that we can provide information to help “Hispanic people who are trying to get healthy.”

Thank you Isabel!

–Jaime Torres

Here they are:

http://blog.unidosus.org/2017/09/29/state-latino-childrens-mental-health/

https://www.holisticprimarycare.net/topics/topics-o-z/traditions/210-a-guide-to-hispanic-healing-herbs.html

https://www.medicareadvantage.com/latino-health-resource-guide

https://www.cdc.gov/vitalsigns/hispanic-health/index.html

http://www.latamesothelioma.com/mesothelioma/

http://www.diabetes.org/in-my-community/awareness-programs/latino-programs/hhm/

 

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Puerto Rico’s Wounded Medicaid Program Faces Even Deeper Cuts

By admin | August 2, 2018

by Sarah Varney–KHN

Blue tarps still dot rooftops, homes lack electricity needed to refrigerate medicines, and clinics chip away at debts incurred from running generators. Yet despite these residual effects from last year’s devastating hurricanes, Puerto Rico is moving ahead with major cuts to its health care safety net that will affect more than a million of its poorest residents.

The government here needs to squeeze $840.2 million in annual savings from Medicaid by 2023, a reduction required by the U.S. territory’s agreement with the federal government, as the island claws its way back from fiscal oblivion.

Overall, Puerto Rico faces a crushing debt of more than $70 billion — much of it due to the territory’s large Medicaid expenses. That’s on an island where the average household earns $20,000 annually and diabetes and hypertension are widespread.

But physicians, health insurers and former government officials say the drastic cuts demanded provide far too little money to care for a population still traumatized by Hurricane Maria.

The cutbacks do nothing to address the underlying fiscal imbalance at the root of Puerto Rico’s health care woes, which stem from the fact that the federal government already contributes a much smaller fraction of the U.S. territory’s Medicaid budget, compared to what it contributes to the 50 U.S. states.

“We are rearranging the chairs on the Titanic,” says Dr. Jaime Torres, whose jurisdiction included Puerto Rico when he served as a regional director of the Department of Health and Human Services.

Already health plans have been forced to lay off social workers and nurses like Eileen Calderón, who once visited dozens of chronically ill Puerto Ricans each month, finding them specialists, supervising medicine compliance and arranging rides to doctor appointments.

“These people who have been under our service for the last four or five years — all of a sudden I have to abandon them,” says Dr. José Joaquín Vargaspresident and chief medical adviser for VarMed, the Bayamon-based company that operated the program that employed Calderón.

Health care crippled by debt

If Puerto Rico were a state, the federal government would pay 83 percent of its Medicaid costs. (It pays upward of 70 percent of Medicaid expenses in 10 states, according to a formula that takes a state’s economy into account.) But because of a 1968 law capping the amount of Medicaid money Washington sends to U.S. territories, the federal government pays only about 19 percent of Puerto Rico’s Medicaid costs, and as a fixed annual payment, or block grant.

In February, Congress approved $4.8 billion in additional funds to help pay the island’s Medicaid bills. But the additional payments are widely viewed as a stopgap measure; health economists say that extra money is likely to run out in September 2019, a grim estimate shared by the territory’s fiscal oversight board. That’s a federal control board established by Congress in 2016 to oversee Puerto Rico’s budget, negotiate with its creditors and help restructure at least some of the island’s debt.

Gov. Ricardo Rosselló’s administration aims to reduce Puerto Rico’s Medicaid spending and improve access to care by putting an end to years of regional monopolies by private health insurance companies. The insurers have locked patients into narrow networks of health care providers. Later this year, under Rosselló’s plan, the companies will be forced to offer island-wide insurance plans and compete for customers.

“We do not have the luxury” of continuing to spend inefficiently, says Ángela Ávila Marrero, executive director of Puerto Rico’s Health Insurance Administration.

If Rosselló’s overhaul fails to achieve adequate savings — as most observers predict — drastic cuts are in the offing. Among those cuts: Some 1.1 million of the 1.6 million Puerto Rico residents on Medicaid are at risk of losing coverage next fall, their health held hostage to the island’s need to pay back its crippling debt.

Puerto Rico’s government effectively defaulted on more than $70 billion in debt. Economists blame a decades-long recession, a corporate tax break that ended in 2006,and reckless spending by a bloated government.

But also to blame, they say, and largely unnoticed in discussions of the debt, is Puerto Rico’s staggering Medicaid burden.

Poverty is so pervasive here that nearly 50 percent of residents qualify for public health insurance; Medicaid expenses in 2016 totaled $2.4 billion.

Residents suffer from higher rates of chronic conditions like diabetes and asthma, and the percentage of people who are elderly is quickly rising.

Footing medical bills without the kind of federal assistance dispensed to states has effectively doomed the island’s fiscal health, health economists say.

Researchers of health care say that, putting aside interest on Puerto Rico’s debt, the territory’s primary fiscal deficit would have been erased had Congress paid the same share of Medicaid bills that it pays the 50 states and Washington, D.C.

“The main issue is that we are not yet a state,” says Rep. Jenniffer González-Colón, the territory’s nonvoting member of Congress. The island must pay for Medicaid, she adds, “with local funds that we don’t have.”

Battered even before the storm

Puerto Rico’s health care system was already convulsing in September 2017 when Hurricane Maria struck. The federal government had issued warnings that the island would soon run out of additional Medicaid funds provided by the Affordable Care Act, and that 900,000 Puerto Rican residents would lose coverage.

Insurance companies, hospitals and physicians complained that the government was chronically late paying its bills. That frustration forced hospitals to defer maintenance and investments in new technology, and fueled the exodus of thousands of physiciansto the mainland in search of better incomes.

Today, Medicaid patients face long waits to see doctors on the island.

“If your kid needs a neurologist, for example, the waiting period is around six to 12 months,” says Dr. Jorge Rosado, a pediatrician in San Juan. “For a genetics specialty, it’s two to three years.”

The $4.8 billion in relief funding from Congress is propping up Medicaid while the Rosselló administration negotiates new contracts with health insurance companies and enacts other measures mandated by the fiscal oversight board. Those include a new Medicaid fraud detection system and enhanced data collection.

There is little time to waste

Barring the unlikely passage of bills that would eliminate the cap on federal Medicaid spending in Puerto Rico, the disaster relief fund is projected to run out in the fall. González-Colón also has authored a bill calling for statehood, which would eliminate the federal government’s unequal treatment toward the island’s Medicaid program.

The fiscal control board established by Congress openly acknowledges the impending disaster. In an April 19 report (p. 97 of “New Fiscal Plan For Puerto Rico: Restoring Growth and Prosperity”) the board projects monthly costs per Medicaid patient will rise nearly 40 percent over the next six years, barring any changes, and that Puerto Rico “will hit a ‘Medicaid cliff.’ ”

Beginning this fall, Medicaid patients in Puerto Rico will be able to pick from at least four insurers, instead of being assigned to the one that had covered their ZIP code.

Puerto Rico has long capped the monthly payments insurers receive for Medicaid patients regardless of how many medical services they use — a form of managed care.

But the government in San Juan believes that the insurers — without their regional monopolies — will be forced to compete, offering better care and more efficient delivery. They could save money by reducing unnecessary emergency room visits or hospital stays and by negotiating discounted payment rates to providers.

The island’s government has vowed to pay private insurers extra money to care for those patients that have expensive or chronic medical conditions. Insurers have cautiously welcomed the changes.

“I support the government on what they’re trying to do, but they didn’t price it properly,” says Dr. Richard Shinto, the president and chief executive of InnovaCare, an insurance company that sells plans in Puerto Rico.

“The oversight board is fixated on cuts,” he says, “but we’re never going to improve health care unless more money is put into the system.”

Government health officials argue that their changes mean Medicaid patients, especially those outside the San Juan metropolitan area, will gain access to more specialists, who are concentrated in the capital. But staff at the island’s clinics and hospitals fear they will be squeezed by insurers seeking to reduce costs, even as the clinics are still reeling from hurricane-related expenses.

For example, Hospital General de Castañer spent $5,000 every five days for gasoline to power the generators at its three sites for seven months; Health Pro Med, a community health center, spent at least $2,000 a day in added expenses, including private flights to ferry doctors to the storm-battered island of Vieques.

Many experts are skeptical that managed-care companies will hire the army of social workers and nurses needed to trudge up hillsides, knock on doors and do the tedious work that entails solving the daily problems of poverty.Viewed through a narrow lens, with an eye for cutting expenses, such problems can seem far outside the purview of medicine.

Many people displaced by the storm haven’t yet been able to return home, and that, too, can complicate health care delivery. Carmen Ramos, executive director of Redes del Sureste, a conglomerate of 22 medical groups in Puerto Rico, says 60 percent of the letters she recently sent to patients on her mailing list were returned.

“The managed-care companies need to produce revenue,” says Victoria Sale, a senior director at Camden Coalition, a pioneer of social and health programs for the chronically ill. “That’s a setup for concern.”

Bottom line? The economic overhaul doesn’t rectify Puerto Rico’s fundamental problem — it can’t sustain its Medicaid program so long as Congress treats the territory differently than it treats states.

“Next year, we will go back to Congress demanding the funding we deserve as U.S. citizens,” says Torres. But, he adds, “it’s time the local government started thinking about a Plan B.”

Kaiser Health News, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and not affiliated with Kaiser Permanente.

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FEMA Report Acknowledges Failures in Puerto Rico Disaster Response

By admin | July 17, 2018

FEMA acknowledged for the first time it failed to properly prepare for last year’s hurricane season and was unable to provide the support victims needed in the wake of an unprecedented season of catastrophic storms, according to an internal report released this week by the federal agency.

Most of the shortcomings focused on the response to Hurricane Maria in Puerto Rico, and many of those outlined in the report — a lack of key supplies on the island before the storm, unqualified staff, and challenges with delivering emergency supplies — were detailed in a recent FRONTLINE and NPR documentary Blackout in Puerto Rico, slated to re-air July 17.

The FEMA report found that its warehouse in Puerto Rico was nearly empty when Hurricane Maria hit last September, without cots or tarps, and very low levels of food and water, as most of the supplies had been rerouted to the U.S. Virgin Islands following Hurricane Irma.

It also found the agency as a whole had been understaffed going into the hurricane season, leading to personnel shortages as well as problems with “workforce certification.” FRONTLINE and NPR examined internal documents that found nearly half the staff on the island after the storm was “untrained” or unqualified.”

By the time Maria hit Puerto Rico, the report found, most specialized disaster staff had already been deployed to the other storms.

The initial response was also hampered by huge communication challenges, the report said. Almost 95 percent of cell towers were down after the storm. But FEMA did not have enough working satellite phones to adequately spread to the island’s leadership, making it difficult to get a handle on the scope of the damage.

As emergency supplies arrived, the report found FEMA faced a major hurdle: it lacked visibility into what was being shipped by other government agencies or private sector partners, further hampering response decisions.

“Shipping containers often arrived in Puerto Rico labeled simply as ‘disaster supplies,’ requiring FEMA staff to unload and open containers to determine their contents,” the report stated.

The report also found FEMA struggled to track supplies from the mainland to the island and through distribution, saying the agency experienced “business process shortfalls.” FRONTLINE and NPR found serious flaws with many of the agency’s supply contracts. 

According to the report, the agency had not prepared enough supply contracts in advance and ran out of key items like tarps before Maria even hit. The result was a flood of new contracting that overwhelmed agency staff. In each of the three years before 2017, FEMA’s contracts totaled $1.3 billion. But in responding to the three storms, FEMA issued more than $3.9 billion in contracts.

That lack of planning proved one of the agency’s biggest stumbling blocks to the response. The report found that the last FEMA disaster planning assessment for Puerto Rico was from 2012 and “underestimated the actual requirements in 2017.” In particular, the plans “did not address insufficiently maintained infrastructure (e.g., the electrical grid)” or the “financial liquidity challenges” facing the bankrupt Puerto Rican government.

FEMA’s report also acknowledged that the agency should have better anticipated the need for federal intervention on the island. The report said that in 2011, a separate report on a FEMA preparedness exercise in Puerto Rico “anticipated that the territory would require extensive federal support in moving commodities.”

One of the most critical of those commodities in the weeks after the storm were generators. But the agency didn’t have enough and was unable to quickly acquire more. While the agency ultimately installed more than 2,000 generators on Puerto Rico — a record number — FEMA only had 695 generators in stock when Maria hit and only had 31 on the island three days after the storm.

FEMA administrator Brock Long acknowledged in a foreword to the report that FEMA had work to do to improve its disaster response capability. “With this report, FEMA and the emergency management community have an opportunity to learn from the 2017 Hurricane Season and build a more prepared and resilient Nation,” Long wrote.

https://www.pbs.org/wgbh/frontline/article/fema-report-acknowledges-failures-in-puerto-rico-disaster-response/

 

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¿Qué es la diabetes y cómo se puede prevenir?

By admin | June 26, 2018

Más de 30 millones de personas en los Estados Unidos tienen diabetes y su incidencia ha alcanzado proporciones epidémicas en la comunidad hispana.

 OPINIÓN
JAIME R. TORRES,  Presidente de Latinos por Equidad en el Cuidado de Salud.

La diabetes es una enfermedad en la que el nivel de glucosa sanguínea (también conocida como azúcar en la sangre) sube demasiado. Más de 30 millones de personas en los Estados Unidos tienen diabetes, y la mayoría de esas personas tienen el tipo 2. Antes, la diabetes tipo 2 era más común en las personas mayores de 45 años, pero ahora las personas más jóvenes, incluso los niños, tienen la enfermedad, debido a que muchos tienen sobrepeso o son obesos.

La diabetes puede llevar a problemas tales como enfermedades del corazón, ataque al cerebro, pérdida de la visión, enfermedades de los riñones y daño a los nervios. Una de cada cuatro personas no sabe que tiene diabetes.

La diabetes ha alcanzado proporciones epidémicas en la comunidad hispana. Las primeras etapas de la diabetes pueden no causar ningún síntoma. Esta enfermedad es una silenciosa asesina en nuestra comunidad. Debido a que la diabetes puede ser una condición peligrosa y potencialmente mortal, es importante que se diagnostique lo antes posible

Muchas personas logran evitar los problemas que la diabetes puede causar a largo plazo, tomando los cuidados adecuados. Colabore con su equipo de profesionales de la salud para lograr los niveles de glucosa sanguínea, presión arterial y colesterol indicados para usted.

¿Qué es la prediabetes?

Se calcula que unas 84 millones de personas en los Estados Unidos mayores de 20 años tienen prediabetes. Por lo general, antes de desarrollar la diabetes tipo 2, las personas tienen “prediabetes”. Esto quiere decir tienen niveles de glucosa en la sangre más altos de lo normal, pero aún no lo suficientemente altos como para llamarse diabetes. Las personas con prediabetestienen más probabilidades de desarrollar diabetes dentro de 10 años y son más propensas a tener un ataque al corazón o al cerebro.

Tome pasos pequeños para prevenir la diabetes

Pero la buena noticia es que la diabetes puede ser controlada, y en muchos casos prevenida si se hacen simples cambios en nuestro estilo de vida. Se ha comprobado que la prevención de la diabetes es posible y es muy poderosa. De acuerdo con el Programa Nacional de Educación en la Diabetes, estudios demuestran que las personas con alto riesgo de desarrollar diabetes pueden prevenir o retrasar el comienzo de la enfermedad perdiendo del 5% al 7% de su peso, si tienen sobrepeso. Esto quiere decir de 10 a 14 libras para una persona que pesa 200 libras. Hay dos cosas claves para el éxito:

  • Hacer por lo menos 30 minutos de actividad física de intensidad moderada cinco días a la semana.
  • Comer una variedad de alimentos que sean bajos en grasa y reducir el número de calorías que consume por día.
La diabetes es una enfermedad peligrosa pero no tiene por qué arrebatarle la vida a nuestros seres queridos. Con ayuda médica, y la cooperación de la familia usted puede garantizar que esa persona con diabetes que usted conoce, pueda –paso a paso — tener una muy buena y larga vida.
***
Dr. Jaime R Torres, es presidente de Latinos por Equidad en el Cuidado de Salud, una organización que trabaja para impulsar la equidad en salud en nuestro país.

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Harvard study estimates thousands died in Puerto Rico because of Hurricane Maria

By admin | May 30, 2018

Washington Post-

 Miliana Montanez cradled her mother’s head as she lay dying on the floor of her bedroom here, gasping for air and pleading for help.

There was nothing her family could do. It took 20 minutes to find cellular reception to make a 911 call. Inoperative traffic signals slowed down the ambulance struggling to reach their neighborhood through crippling congestion.

Ivette Leon’s eyes bulged in terror as she described to her daughter the tiny points of light that appeared before her. She took one last desperate gulp of air just as paramedics arrived. Far too late.

More than eight months after Hurricane Maria devastated Puerto Rico, the island’s slow recovery has been marked by a persistent lack of water, a faltering power grid and a lack of essential services — all imperiling the lives of many residents, especially the infirm and those in remote areas hardest hit in September.

A new Harvard study published Tuesday in the New England Journal of Medicine estimates that at least 4,645 deaths can be linked to the hurricane and its immediate aftermath, making the storm far deadlier than previously thought. Official estimates have placed the number of dead at 64, a count that has drawn sharp criticism from experts and local residents and spurred the government to order an independent review that has yet to be completed.

The Harvard findings indicate that health-care disruption for the elderly and the loss of basic utility services for the chronically ill had significant impacts, and the study criticized Puerto Rico’s methods for counting the dead — and its lack of transparency in sharing information — as detrimental to planning for future natural disasters. The authors called for patients, communities and doctors to develop contingency plans for such disasters.

Researchers in the mainland United States and Puerto Rico, led by scientists at the Harvard T.H. Chan School of Public Health and Beth Israel Deaconess Medical Center, calculated the number of deaths by surveying almost 3,300 randomly chosen households across the island and comparing the estimated post-hurricane death rate to the mortality rate for the year before. Their surveys indicated that the mortality rate was 14.3 deaths per 1,000 residents from Sept. 20 through Dec. 31, 2017, a 62 percent increase in the mortality rate compared with 2016, or 4,645 “excess deaths.”

“Our results indicate that the official death count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria,” the authors wrote.

Carlos R. Mercader, executive director of the Puerto Rico Federal Affairs Administration, said in a statement Tuesday that the territorial government welcomes the new Harvard survey and looks forward to analyzing it.

“As the world knows, the magnitude of this tragic disaster caused by Hurricane Maria resulted in many fatalities,” Mercader said. “We have always expected the number to be higher than what was previously reported.”

He said such studies — including a forthcoming George Washington University probe into hurricane fatalities — will help Puerto Rico better prepare for disasters and prevent the loss of life.

Maria, which caused $90 billion in damage, was the third-costliest tropical cyclone in the United States since 1900, the Harvard researchers said.

They also said that timely and accurate estimates of death tolls are critical to understanding the severity of disasters and targeting recovery efforts. And knowing the extent of the impact “has additional importance for families because it provides emotional closure, qualifies them for disaster-related aid and promotes resiliency,” they said.

The researchers noted that the Centers for Disease Control and Prevention says that deaths can be directly attributed to storms such as Maria if they are caused by forces related to the event, whether it is flying debris or loss of medical services.

“The worst part was knowing I could do nothing to help her,” said Leon’s daughter, Montanez, a 29-year-old mother of two. “Knowing she didn’t die peacefully means I will never have closure.”

The uncounted

Puerto Rico’s government faced immediate scrutiny after initially reporting that 16 people had died as a result of the storm, which strafed much of the island Sept. 20. That number more than doubled after President Trump visited in October, when he specifically noted the low death toll. The number kept rising until early December, when authorities said 64 had died.

The official toll included a variety of people from across Puerto Rico, such as those who suffered injuries, were swept away in floodwaters or were unable to reach hospitals while facing severe medical conditions. One was a person from the city of Carolina who was bleeding from the mouth but could not reach a hospital in the days after the storm. After arriving, the patient was diagnosed with pneumonia and died of kidney failure. Another, from Juncos suffered from respiratory ailments and went to the hospital — only to be released because of the coming storm. That person later returned, dead.

The new study indicates there probably were thousands more, like Leon, who died in the weeks and months that followed the storm but were not counted. Their deaths have long raised questions about the manner and integrity of the Puerto Rico government’s protocols for certifying hurricane-related deaths.

Gov. Ricardo Rosselló’s administration did not immediately release mortality data, nor did officials provide much information publicly about the process officials were using to count the dead. But officials and physicians acknowledged privately that there were probably many, many more deaths, and bodies piling up in morgues, across the island.

After pressure from Congress and statistical analyses from news organizations that put the death toll at higher than 1,000, Rosselló enlisted the help of George Washington University experts to review the government’s death certification process. He promised that “regardless of what the death certificate says,” each death would be inspected closely to ensure a correct tally.

“This is about more than numbers,” Rosselló said at a news conference in late February. “These are lives — real people, leaving behind loved ones and families.”

Lynn Goldman, dean of GWU’s Milken Institute School of Public Health, expects an initial report to be released in coming weeks. The school’s findings will include the first government-sponsored attempt by researchers and epidemiologists to quantify Hurricane Maria’s deadliness. Experts are assessing statistical mortality data and planned to dive into medical records and to interview family members of those who have died.

Some cases are obviously storm-related, Goldman said, such as someone dying after a tree branch falls on his head while clearing debris, or someone who suffers a heart attack during the storm and is unable to get help. But death certificates bearing the phrase “natural causes” will require further investigation.

The Center for Investigative Journalism in Puerto Rico has gone to court in an effort to seek the island’s mortality data for the months since November, the last month the government of Puerto Rico shared mortality data publicly. The Puerto Rico Institute of Statistics also announced in recent weeks that it would perform an independent death count and use subpoena powers to retrieve the data.

Spokesman Eric Perlloni Alayon said in a statement that the government is still trying to verify the death toll and does not plan to release any new data.

The Harvard researchers reported that there are several reasons the death toll in Puerto Rico has been drastically underestimated. Every disaster-related death, they said, must be confirmed by the government’s Forensic Sciences Institute, which requires that bodies go to San Juan or that a medical examiner travel to the local municipality.

“As the United States prepares for its next hurricane season, it will be critical to review how disaster-related deaths will be counted, in order to mobilize an appropriate response operation and account for the fate of those affected,” the authors wrote.

‘Natural causes’

Many families here are awaiting clarity on what happened to their loved ones when “natural causes” became the only explanation. That is what was written on Leon’s death certificate. The Puerto Rico Department of Justice’s Yamil Juarbe said in a statement that it is customary for local officials in these cases to review bodies for any signs of trauma and talk to relatives to learn about the deceased’s medical history. That information is collected and sent to the central office of the Forensic Sciences Institute.

Leon’s family said that her name was misspelled on the death certificate and that her death was incorrectly attributed to diabetes; they say she did not have any known chronic diseases. Officials later corrected the documents.

After falling ill while delivering donations to people who lost their homes in a nearby city, Leon sought treatment at Auxilio Mutuo, a private hospital in San Juan. The hospital never lost water service or electricity, said hospital spokeswoman Sofia Luqui, and the 600-bed facility experienced higher-than-usual patient volume after several other hospitals were forced to close.

Leon was diagnosed with diverticulitis and was sent home with prescription drugs, but she did not improve. Montanez said that at 7 a.m. the following morning, her father summoned her to the family home because Leon was short of breath. She died not long after.

Montanez tried for days to have an autopsy performed, but she said no government agency or private medical organization had the capacity to conduct one. Per her wishes, Leon was cremated a few days later in a rushed ceremony because the funeral home was damaged by the storm and was facing an influx of bodies.

Montanez stays awake many nights replaying her mother’s last days. She tries to remember the woman who loved to make wry jokes, who gave each of her neighbors a whistle to call for help in an emergency during the prolonged blackouts, who organized trick-or-treating by lantern light for the children in the barrio after the hurricane.

But mostly Montanez thinks about the storm. The darkness. The lack of services.

“Everything failed. From Day One, everything was failing,” Montanez said. “There are many stories like ours.”

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Coordinated Care Is More Than a Buzzword for Hospice Providers

By admin | May 10, 2018

April 24, 2018

 

By Edo Banach, JD
President and CEO

National Hospice and Palliative Care Organization

 

As much as we talk about “coordinated care” in health care today, it is regrettable that most people still contend with an uncoordinated, inefficient and stressful system at the end of life.

Often, health care professionals are singularly focused on eliminating illness and find themselves ill-equipped to provide the comfort and guidance needed when a person’s illness requires care rather than, or in addition to, a cure. Families who don’t know that there’s an alternative stand helplessly by as the last months of life get swallowed up by costly, sometimes unnecessary treatments that can hurt more than they help.

Health care consumers and policymakers must be aware that it doesn’t have to be this way. In an increasingly broken and fragmented health care system, hospice care – the nation’s first coordinated care model – shows how health care should and can work at its best for patients at the end of life.

A grassroots movement that began over 50 years ago, the success of the hospice model led to its adaptation into Medicare in 1982 — a mere four years after it began as a demonstration program. Today, an estimated 1.7 million Americans receive hospice services each year, with 1.4 million Americans choosing to utilize hospice through their Medicare benefit.

Expert medical care, pain management, emotional and spiritual support services are all provided and tailored to the patient’s and family’s needs. Hospice caregivers represent a comprehensive, interdisciplinary team of physicians, nurses, social workers, chaplains, volunteers and other professionals that ensures the patient is cared for beyond just his or her medical needs. Hospice respects the dignity of the patient’s life, honors his or her choices and provides a care plan reflective of a patient’s values. This philosophy of care is illustrative of hospice’s legacy and commitment to the best care for every hospice patient.

It’s a system that thrives because hospice providers understand how to balance the patients’ wishes with their health care needs – and coordinate care accordingly. This investment in care actually saves Medicare money – by one estimate, as much as $2,300 per patient — not at the expense of the patients, but rather by allowing the patients and their caregivers to guide decisions that can reduce their use of hospital-based treatments, resulting in fewer complications and side effects.

Despite more than 35 years’ success in the Medicare program, inevitable changes in our health care system could threaten hospice’s effective, original system of coordinated care. A rash or untested policy shift could lead to care delays, limitations on patients’ ability to select their preferred provider or a loss of autonomy for the hospice medical directors.

Change is inevitable and can often be good, but it must be incremental change that does no harm and respects patient and caregiver choice for more, rather than less, options for addressing serious illness.

While the goal of hospice care is not to save lives, it is still often called “lifesaving” by patients’ families. After experiencing the confusion and frustration of fragmented care, many are overwhelmed by the quality, compassion and personalized service that hospice care delivers. The hospice model exemplifies these principles of quality, compassionate and personalized care that beneficiaries, payers, policymakers and their constituencies want.

No patient or family should suffer needlessly at the end of life – and that includes either physically or emotionally. America is getting older, but members of the hospice and palliative care community are prepared to meet the growing need for more hospice care. And we are ready to do so in a way that is driven by our patients and their families.

Doing so demands that any health care reform allows hospice to continue to build on our successful foundation – and expand our patient and family-centered model across the care continuum. Protecting that continuity is essential to care for all patients with serious, advanced and life-limiting illness.

Rather than just trying to make hospice more like the rest of the health care system, how about making the rest of the health care system more like the original coordinated care model? Coordinated care should be more than a popular health care buzzword. It should be the driving force for all health care everywhere – just as it currently is for hospice.

It’s the model and philosophy that have driven hospice’s success and changed lives for the better. It is a model that we will continue to fight for and for policies that support peace, comfort and quality at the end of life.

https://www.nhpco.org/press-room/press-releases/op-ed-coordinated-care

 

 

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