Help for the Most Vulnerable

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With power out across Puerto Rico in the aftermath of Hurricane Maria, the strongest storm to hit there in nearly 100 years, it was a challenge to immediately determine the full impact. Direct Relief reached out to health partners across the island to determine the status of their facilities, staff, and patients. The organization also worked with contacts at Puerto Rico’s Emergency Operations Center to gather and fulfill lists of specifically requested medicines and medical supplies. The center requested that all donations go through their official channels, which Direct Relief was uniquely positioned to handle through its pre-existing representative agent for product clearances and coordination with the Department of health.

On October 4, 2017, Direct Relief delivered a critical shipment of nearly 16,000 doses of insulin to public health agencies in Puerto Rico, which was distributed to health clinics and hospitals treating patients with diabetes across the island. With refrigeration on the island limited, storing temperature-controlled medicines like insulin was a challenge. FedEx coordinated deliveries to multiple governmental agencies. Testing strips, needles, and syringes needed to manage diabetes were also shipped to the island. At HealthProMed in San Juan, the need for insulin was higher than ever, and much of the insulin donated by Eli Lilly and Company was bound for the clinic. Pharmacists at Florida Medical Center taught patients tricks to preserve their insulin, including how to use ice packs and cold water to keep it cool.

In isolated areas such as Utuado and the island of Vieques in Puerto Rico, helicopters helped deliver medicines to clinics such as the Corporacion de Servicios Medicos. Shipments arriving there in mid-October 2017 amounted to more than $120,000 in donated medicines and supplies. Utuado had limited road access since daily rains washed out many of the roadways and bridges connecting it to the rest of the island. The helicopter journey took only 45 minutes, a distance that would’ve been an all-day drive from San Juan, even with operable roads. Direct Relief also secured transportation with the U.S. Coast Guard, shipping essential medicines to a clinic in Vieques operated by HealthProMed.

Extending the Reach of Relief

In the weeks after the storms, Direct Relief delivered shipments to the hardest-hit areas, from Puerto Rico to Dominica and locations throughout the Caribbean. The response was a complex operation, spanning multiple countries and territories, many of which had severely limited communication and power in the storms’ aftermath. The organization coordinated deliveries of pre-packed kits and other services with several government agencies in Puerto Rico, including the Administración de Servicios Médicos, which runs eight hospitals and eight primary care clinics.

In September 2017, Direct Relief committed $300,000 in cash for community health centers in Puerto Rico to aid recovery efforts in Hurricane Maria’s aftermath. The organization committed an additional $50,000 to the Puerto Rico Primary Care Association, representing 20 member nonprofit corporations operating 62 clinical sites in 53 municipalities, caring for nearly 350,000 patients annually. Satellite phones were also shipped to the organization, enabling the members to communicate urgent medical needs in their communities.

Direct Relief also coordinated with the National Association of Community Health Centers, the National Association of Free and Charitable Clinics, and the National Voluntary Organizations Active in Disasters.

Direct Relief’s reach extended across the Caribbean, connecting health professionals with much-needed supplies. In Anguilla, a FedEx charter plane delivered an Emergency Health Kit, as well as three pallets of antibiotics, pain medication, hygiene kits, and tents. In Antigua and Barbuda, Direct Relief coordinated with the Ministry of Health, shipping an Emergency Health Kit to treat Barbuda residents who’d evacuated to Antigua.

Direct Relief shipped a Hurricane Preparedness Pack to Peebles Hospital in Tortola, including pallets of specifically requested medical items, such as antibiotics, IV solution, oral rehydration salts, hygiene kits, and durable medical tents. An additional $15,000’s worth of medicines were purchased to support 70 dialysis patients at the hospital, whose treatments went from daily to twice a week to conserve water and make use of fewer undamaged machines in the storm’s aftermath. The medication helped keep potassium levels down to extend the time patients could go between dialysis treatments.

In Dominica, Princess Margaret Hospital, serving the island of about 70,000 people, was damaged but still functioning. More than 95 percent of buildings and infrastructure on the island was destroyed or damaged by the hurricane. Direct Relief delivered shipments to the country’s head pharmacist, including an Emergency Health Kit and medication to help about 40 dialysis patients on the island keep potassium levels down while not receiving dialysis.

In St. Maarten, 10 pallets of supplies and medications—valued at $477,000 and including IV solutions, antibiotics, water purification systems, hygiene kits, and durable medical tents—were transported to the St. Maarten Medical Center.

And in the U.S. Virgin Islands, at East End Medical Center, Direct Relief delivered 5 pallets of antibiotics, medicines for chronic diseases, and wound dressings, valued at $1.2 million, via FedEx. The center serves St. Thomas, St. John, and surrounding islands.

Bolstering Front-Line Responders With Supplies

When Hurricane Maria hit Puerto Rico, four shipments of antibiotics, wound care supplies, and other medical supplies were already en route to the island municipalities of Culebra and Vieques for relief from Hurricane Irma, which had struck just days prior. Shipments responding to Hurricanes Irma and Maria also went out to St. Maarten, the U.S. and British Virgin Islands, Anguilla, Haiti, St. Thomas, and the Dominican Republic. Direct Relief received requests for medical aid from multiple medical distribution centers, maintaining contact with organizations including the Puerto Rico Primary Care Association, a network of federally qualified health centers.

Needs on the island included dialysis care, as Puerto Rico was caring for about 120 dialysis patients from other parts of the Caribbean. These patients were housed in hotels, but were likely to be placed in special-needs shelters and require long-term care. Direct Relief coordinated with a physician from the U.S. Public Health Service and Puerto Rico’s Emergency Operations Center to compile a list of insulin needs for those patients.

On September 25, Direct Relief shipped out Emergency Health Kits for Hurricane Maria relief, with 600 hygiene kits and 12 medical backpacks included to equip first responders with medical supplies. Direct Relief staff arrived in San Juan, Puerto Rico, later that week with requested critical medicines, including antibiotics, inhalers, and hemophilia treatment medications. The last arrived via FedEx temperature-controlled transport from Bioverativ, which donated the drugs, just hours before the hospital anticipated running out. At the time of delivery, staff at University Pediatric Hospital in San Juan estimated they had between 24 and 72 hours until their supplies of Factor VIII and IX blood-clotting drugs were depleted. Running out of the medication could have endangered the life of a young patient with hemophilia, who was being treated for renal bleeding before the donation arrived.

Direct Relief also delivered multiple Emergency Health Kits, each containing enough essential medicines to treat 100 patients for 3 to 5 days. These went to the Puerto Rico Department of Health, as well as to a medical team of 75 doctors and nurses who met in San Juan to pick up supplies, then fanned out to 15 towns across Puerto Rico to provide medical care. All told, nearly $2 million in medical material aid was delivered in those early days to the Puerto Rico Department of Health.

Leveraging Technology

Direct Relief expanded its analytics and mapping capacity by activating the Digital Humanitarian Network, a confederation of digital volunteers and professionals working in humanitarian aid, data analytics, and information technology. The network connected humanitarian agencies to Planet, one of the world’s leading remote sensing companies, which provided one of the first sources of data for accurately assessing post-hurricane conditions in Puerto Rico.

The network also connected Direct Relief with GIScorps, a group of geographic information systems professionals who volunteer, especially during crisis response events, to improve use of spatial information by humanitarian agencies. Within 24 to 36 hours of the initial request, the organization was connected with 7 remote-sensing professionals. They followed a workflow to identify clinic locations and available imagery, then assign probable damage levels to each area.

DigitalGlobe produced high-resolution satellite photos, and the Puerto Rico Wing Civil Air Patrol flew a series of small planes over the island, taking photos of critical areas of interest.

Preparing for Emergencies Every Day

Direct Relief is the only nonprofit licensed to distribute prescription medications in all 50 U.S. states. Between the 2016 and 2017 hurricane seasons, Direct Relief delivered 5,000 shipments to its network of more than 1,400 nonprofit clinics and health centers nationwide, making it the largest charitable program in the U.S. providing free medications and supplies to health centers treating low-income patients without insurance.

At the end of October 2017, Direct Relief airlifted 152,604 pounds of medical resources to the Department of Health, hospitals, and community health centers in Puerto Rico. The MD-11 cargo jet departed Miami for San Juan with $21 million’s worth of medications and supplies, including intravenous solutions, nutritional supplements, insect repellent, and prescription medications for acute conditions and chronic diseases. Donations from 44 health-care companies were included among the 300 items in the shipment, all of which were specifically requested by 19 tertiary hospitals and emergency centers, 20 nonprofit community health centers, and the Puerto Rico Department of Health. That month, Direct Relief’s emergency response in Puerto Rico included 54 shipments to 27 facilities totaling $3.6 million’s worth of supplies. The Clinton Foundation helped coordinate and advise the team at Direct Relief during the organization’s response to the 2017 hurricane season.

Among critical items sent were 565 vials of blood-clotting factor for children with hemophilia, 15,600 vials of insulin, 35 emergency medical packs containing a broad range of prescription medications and supplies, 1,500 solar lights, and more than 4,000 bottles of insect repellent to protect against Zika virus. Direct Relief’s response in Puerto Rico was concurrent with extensive responses to preceding Hurricanes Harvey and Irma.

In November 2017, Direct Relief committed up to $5 million in cash grants to assist health facilities in Puerto Rico as they address ongoing health needs in the wake of Hurricane Maria. By the time of the commitment, Direct Relief had made more than 126 shipments of emergency medical aid, totaling $29.7 million, to facilities and teams throughout Puerto Rico. All told, Direct Relief had provided more than $39 million in medical aid to facilities in the affected countries to that point.

In December 2017, another Direct Relief–chartered aircraft landed at Luis Muñoz Marín International Airport in San Juan, bearing 79,365 pounds of items for medical aid requested by government bodies, associations, hospitals, and clinics across the island. The airlift’s contents included nearly 40 tons of medications and medical essentials, amounting to $20.6 million’s worth of donated items.

Subsequently, in spring 2018, Direct Relief coordinated with nonprofit VOCES to provide more than 40,000 doses of influenza vaccine donated by pharmaceutical manufacturer Sanofi. Direct Relief was the first nongovernmental organization to provide vaccines to Puerto Rico after Hurricane Maria.

Direct Relief is committed to responding to ongoing needs in Puerto Rico throughout the recovery process.