An Ethnographic Review of Rescue, Recovery, Climate, and Social Justice in Puerto Rico improve the health and well-being of the individuals and communities where they occur. All healthcare professionals are bound by common ethical principles that should be respected while interacting with individuals, families, and communities during short-term medical missions (STMMs). Those principles include autonomy and self-determination (respecting the wishes of the patient, even if you do not agree), beneficence (being compassionate and following through based upon a desire to do good), non-malfeasance (competent practice), justice (equal and fair treatment), veracity (truth in all communications), totality and integrity (considering the entire person), and fidelity (honoring commitments) (Muse, 2018; Silva & Ludwick as cited by Esposito & Sollazzo, 2018). The World Health Organization (WHO) (2018) declared the following ethical principles for healthcare professionals on STMMs: integrity, accountability, independence and impartiality, respect, and professional commitment. Global health ethical activities include respecting different cultural norms, avoiding unintended harms, protecting privacy, working within one’s scope of practice, and managing resource constraints and priority setting. Volunteer healthcare personnel who participate in STMMs have ethical duties and special obligations to advocate for sustainable, mutual benefit; a fair and equitable distribution of resources; and partnership with and respect for the individuals and communities they serve (DeCamp, Soleymani, Jaeel, & Horwitch, 2018).
Safety Implications STMM volunteers may face physical risks from damaged infrastructure, unsafe roads, water and food shortages, security concerns, the sustained effort required throughout the mission, the effort required to reach survivors, and the effort required to deliver care with limited resources. Emotional risk should not be minimized, because, by definition, STTMs address most emergent needs with little or no ability for follow-up care, death, catastrophic injury, and/or disabilities. While debriefing of mission participants may not be possible during rescue operations, debriefing sessions should take place whenever possible to maintain cohesiveness and an interdisciplinary approach to medical care.
The Mental Health of the Puerto Rican Population Post Storm The damage caused by Maria—which included destroying much of the island’s electrical grid, wiping out communications infrastructure, and knocking out water supplies for up to a year in some places, affected an island already dealing with a decade-long economic crisis and high unemployment (Vincens, 2018). The storm’s effect on mental health and suicide rates was the subject of a New York Times mini documentary (2018), which followed a separate Times piece (2018) examining the mental health crisis predicted after the hurricane. Many Puerto Ricans reported intense feelings of abandonment, anxiety, and depression for the first time in their lives, along with fears that a disaster would strike again. Those who had mental illnesses before the storm, and who had been cut off from therapy and medication, saw their conditions deteriorate (Dickerson, 2017). For most Puerto Ricans, logistical barriers like
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scarce water and electricity, as well as closed schools and businesses, made any return to normalcy feel impossible (Dickerson, 2017). Vicens (2018) reported an increase in suicides. The total number of men who took their own lives in Puerto Rico saw a jump from 2016 to 2017 from 174 to 271, as did women from 22 to 36. Rates varied by age and location. Aguadilla had the highest increase, from 6% to 12%, followed by the metro area from about 4% to 6%. Suicides were more frequent in older age groups. Between 2016 and 2017, the rate of suicide went up from about 9–15 per 100,000 in those aged 55–59, up from 6–13 per 100,000 in those aged 65–69 from 4–12.5 per 100,000 in those aged 74–79, and up from 5–8.5 per 100,000 in those aged older than 85 (Vicens, 2018). Males accounted for the largest proportion of suicides (174–217) from 2016–17. In females the number also increased from 22–36 as compared to 2016–17 (Vicens, 2018). Ethnographic research entails intensive involvement with participants by immersion in their culture and world during fieldwork. Methodologies include participant observation and interviews (Terry, 2012). Traditional ethnographic research focuses on the meanings participants ascribe to their experiences, knowledge, behaviors, and activities gleaned during multiple interviews with participants over time (Ploegg, as cited in Terry, 2012, p. 91). Researchers live in the culture being studied for an extended period of time. In anthropology, folkloristics, and the social and behavioral sciences, emic and etic refer to two kinds of field research done and viewpoints obtained: emic, from within the social group (from the perspective of the subject, i.e., how members of the community perceive their world); and etic, from outside (from the perspective of the observer and how the observer perceives and interprets the behaviors of the subjects). The context of the culture is particularly important, and includes the social, political, and economic perspectives (Ploegg as cited in Terry, 2012, p. 91).
Theoretical Underpinnings of Structuring Care in Disaster Situations One approach to structuring care in disaster situations is to use the interrelated theoretical frameworks of Maslow’s hierarchy of needs (1970), Peplau’s conceptualization of levels of anxiety (1963), and crisis intervention theory by Aquilera and Messick (1986). Food, clothing, clean air, shelter, clean water, and sanitation are basic and foremost needs following a disaster (Maslow, 1970). Anxiety and depression are common psychological responses associated with disasters and are highly associated with reduced quality of life, psychological morbidity, increased risk of mortality, disability, increased medical care, and functional impairment in daily activities (Zarea, Maghsoudi, Dashtebozorgi, Hghighizadeh, & Javadi, 2014). Peplau developed a theory for purposeful nurse-patient therapeutic communications and treatment that can be implemented on STMMs in order to facilitate reducing anxiety and depression. Using Peplau’s theory, the registered nurse (RN) volunteer should assess the type of anxiety experienced by the patient and create a therapeutic care plan in accordance with the level of anxiety (see Table 1).
Journal of the New York State Nurses Association, Volume 47, Number 1
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