13 minute read
when the er is the real emergenCy
Eduardo Hilera, M.P.S. Eduardo Hilera, M.P.S.
Emergency Management and Homeland Security Expert Emergency Management and Homeland Security Expert
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When Going to the Emergency Room is the Cause of the Disaster The Storms of September
Insurance, healthcare coverage, accessibility to care—nearly synonymous, and arguably the root of the problem. In 2020, the first four hospitals listed in the ranking of the top ten hospitals in the world were U.S. hospitals. Those U.S. hospitals ranked above hospitals in Canada, Germany, Israel, Switzerland, Singapore, and Sweden.
When healthcare systems were ranked similarly however, the United States was eighteenth on the list.
Why? The countries that ranked the highest on the list all had one thing in common: they all had some sort of healthcare mandate that included free healthcare, health care provided via public/private partnerships, or mandatory insurance that was subsidized in several ways. In essence, everyone is covered. In addition, private plans are available to cover additional services. In comparison, access to healthcare in the United States is much more challenging.
Puerto Rico for instance, produces some of the finest doctors in the United States. Our medical school graduates are fully bilingual, are in tune with cultural sensitivities that are not even relevant in other parts of the United States, and regularly complete complicated specialties in top-level institutions such as the University of Pennsylvania, Mayo Clinic, Mass General and Cleveland Clinic. The first challenge Puerto Rico has, however, is drawing those professionals back to the island. What stops them from wanting to live in a Caribbean paradise? One thing—the pay! Insurance companies pay some doctors as low as eight dollars per patient. What? Why? How? How is this possible when insurance companies cost our patients, employers and even our government way more?
As Puerto Rico continues to lose more and more doctors, hospitals become packed with patients who seek medical care in the only way they know how, the emergency room. Throughout Puerto Rico emergency rooms are packed, many times with cases that could easily, efficiently, and quickly be served by an outpatient visit. It’s not the patient’s fault, however. It’s also not the hospital’s fault.
As our healthcare facilities and professionals started to take operational control of the COVID pandemic, the shortfalls in individual health facilities became evident. This happened throughout the entire country, including all the U.S. territories.
It wasn’t a problem that was exclusive to the United States either. Healthcare systems throughout the world were hurting then and are hurting now. COVID exposed challenges that nobody thought possible. As these problems grow, healthcare facilities become financially unsustainable, healthcare staff at every level leave their jobs due to exhaustion and mediocre pay, and patients lose access to care. In response, policymakers search for the responsible party and hospitals, hospital administrators, and doctors become easy scapegoats. Policymakers however, should focus on those who are profiting over the crisis and their role in causing an inability to foot the bill.
State legislators should focus on assisting and educating all their constituents so they are able to
The Atlantic hurricane season— the one that impacts Puerto Rico—runs from June 1 to November 30. The peak, however, occurs from midSeptember to mid-October, which has already started, folks.
The hurricanes permanently recorded in our memories all made landfall in September. Hugo on September 19, 1988; Hortensia on September 10, 1996; Georges on September 21, 1998; and Maria on September 20, 2017. There is a clear trend here.
Abraham Lincoln said: “If I only had one hour to chop down a tree, I would spend 45 minutes sharpening my axe.” Applying Honest Abe’s wise logic to hurricane season, we should do everything possible to get ready before a disaster. All it takes to get ready is a little creativity, logic and a few bucks. Being prepared makes our communities more resilient. The most basic emergency management concept is planning. Emergency managers agree that the first 72 hours after a disaster are crucial— it takes that long for help from first responders to reach those in need. In the spirit of planning, below is a checklist of the steps we can all take to be prepared for those first 72 hours. It doesn’t take advantage of all the medical coverage benefits they may have. Veterans in Puerto Rico for instance do not use all their benefits, many times simply because navigating the system is simply too hard. In Washington, Congress, the Senate in particular, should examine the efficiency and access to state and national platforms that allow patients to obtain healthcare directly. Lastly, at the state level, public/private partnerships may represent an opportunity for the government to conduct adequate oversight of insurance companies while ensuring that citizens get adequate care and facilities remain adequately equipped and staffed. involve sophisticated equipment, just a few things we can do by ourselves. Inspect Your Home—Look around your home at doors, windows, potentially hazardous objects, and anything easily repairable. Address whatever you find and can fix immediately. Look for loose doors, exposed windows, and non-tempered glass windows or panels. Fix or secure everything you can. Prepare Your Car—If you own a car, keep the tank full. Set a reminder on your phone. In an emergency, a full tank of gas will get you wherever you need to go. In addition, identify a safe spot where you can park your car. Medication—If you or your family take medications, make sure you have a full week’s supply. First Aid Kit—Most of us have first aid products but may not keep them all in the same place. Look through your home and store them all together. The Red Cross and others provide recommendations of specific items to have, such as bandages, topical antibiotics and ice packs. Emergency Phone Numbers— Modern times have made us drift away from it, but use pen and paper and write down your most important contacts. If your phone dies, this could come in very handy. This list will also serve as a reminder of the folks you should keep in touch with during the emergency. Cash at Hand—Electronic payment platforms, ATMS and banks can go out of service. Keep enough money on hand to pay for basics following the disaster.
Damage from Hurricane Maria in Sept. 2017 >Carlos Rivera Giusti, Archive Water—Keep enough drinking water to keep your family hydrated for 72 hours. In addition, keep containers full of tap water for basic household needs.
In fact, Food—Cook what you can and use perishables first. Make sure to keep non-perishable food as well. The hurricanes permanently recorded in our memories all made landfall in September. Hugo on September 19, Electronics Charging Routine—Make a list of all your electronics and keep them charged. Keep back-up and disposable batteries handy as well. However, the single most important electronic device is the flashlight. Keep it handy. 1988; Hortensia on Tool Kit—Just like your first aid kit, make sure your September 10, 1996; tools are organized and accessible. An all-in-one Georges on September tool kit, like many retailers carry, is a good idea to 21, 1998; and Maria on keep handy. September 20, 2017. There is a clear trend here. Stay Tuned—Identify and follow your preferred news sources. Make sure they’re reliable and frequently updated. In addition, pick up a basic battery-powered radio. Stay Calm—You have done the important work of getting ready. Now, the most important part is to remain calm, during and after the storm.
In fact, and their role in causing an inability to foot the bill.” As Puerto Rico Eduardo Hilera, policy advisor continues to lose more and more doctors, hospitals become packed with patients who seek medical care in the only way they know how, the emergency room.
Manuel Quilichini,
Lawyer
NaivetÉ and corruption
The media is flooded with news of the fall from grace of our former governor, Wanda Vázquez, at the hands of the corruption epidemic that has festered in Puerto Rican culture for decades, if not centuries.
A self-described “non-politician”, she portrayed herself as “fearless” in the face of public opinion and willing to take on the machine of traditional political parties. Many anticipated the winds of change, and some even hoped for a different future. Those hopes were short-lived. Unbeknownst to the public, Ms. Vázquez became infected with the politician’s virus shortly after swearing in as an unelected governor.
The main symptom of this selective virus is an unquenchable thirst for power and sudden blindness to what is good and what is not. For this virus to grow, it needs a dark environment, far away from the prying eyes of the public. It thrives on misinformation and distortion of the truth. A lack of personal integrity sprinkled with a good dose of greed speeds up its growth. Ms. Vázquez had shown signs of the infection prior to ascending to the governorship. As
Secretary of the Department of Justice, both Ms.
Vázquez and her husband (a judge) allegedly interfered with a criminal investigation related to their daughter. The trail of scandals and questionable decisions grew larger, including the scandal of the Ponce warehouse, the attempt to interfere with a corruption investigation about herself by the Office of Special Independent
Prosecutor’s Panel (OPFEI, for its Spanish acronym), the firing of a Secretary of Justice, and a high-ranking Health Department official. To top it off, she stands accused of firing a government official to favor a foreign bank. Ms. Vázquez’s campaign In fact, director, Jorge Dávila, has stated that she could only be guilty for being “naïve”. Really? An accomplished attorney, a wellregarded district attorney, and Secretary of Justice, it is doubtful that Ms. Vázquez was not aware of her questionable –if not It is doubtful that Ms. Vázquez was not aware of her questionable –if not illegal– actions and decisions. illegal– actions and decisions. She indeed was naïve in thinking that she would not be caught when she engaged in the traditional pay-for-play scheme. Now she must face the music and suffer the consequences of her actions. As expected, the press jumped on the news immediately, listing and analyzing each fact, uncovering who knew what, and the identity of her accomplices. And, as usual, questioned how this crime was possible. Indeed, one can only wonder if Ms. Vázquez was surrounded by blind, deaf, and mute government officials. We know that her Chief of Staff and her assistant knew that something wrong was going on. Others had to know, yet they kept silent. This, to me, is corruption’s Black Wall of Silence. We can expect the legislature to adopt new laws seeking to eradicate corruption as if these would have an impact on government officials that want to get rich from their malfeasance. Perhaps we can incentivize government officials to come forward when they think there is something awry in their office. Perhaps granting of some degree of immunity could also help. However, there is a more effective tool to hinder the growth of the corruption virus:
Puerto Rico’s former Gov. Wanda Vazquez leaves a court after she was released on bail, in San Juan, Puerto Rico, Thursday, Aug. 4, 2022. Vazquez, who was arrested Thursday, is accused of engaging in a bribery scheme from December 2019 through June 2020, while she was governor, with several people, including a Venezuelan-Italian bank owner, a former FBI agent, a bank president and a political consultant. >AP Photo/Alejandro Granadillo “Unbeknownst to the public, Ms. Vázquez became infected with the politician’s virus shortly after swearing in as an unelected governor.” / Manuel Quilichini, Esq. transparency. Koffi Anan, former United Nations Secretary-General, said that if corruption is the disease, transparency is an essential part of its treatment. But something is wrong with a government system that protects and shields the corrupt. Moreover, corruption is becoming so commonplace that we are losing our ability to feel indignant about this pillage, and see it as something normal. If we do not raise our voices in rage and clamor for just punishment, our government will be of the corrupt, by the corrupt and for the corrupt.
In this image provided by Annapurna Interactive, art from the “Stray” video game, developed by BlueTwelve Studio and released on July 19, 2022, is seen. The virtual cat hero from the new video game sensation “Stray” doesn’t just wind along rusted pipes, leap over unidentified sludge and decode clues in a seemingly abandoned city. The popular game has resonated with cat lovers and some of them are using the game to raise money for real cats. >Annapurna Interactive via AP ‘Stray’: How a virtual orange tabby is helping real cats
Thalia Beaty – The Associated Press
NEW YORK (AP) – The virtual cat hero from the new video game sensation “Stray” doesn’t just wind along rusted pipes, leap over unidentified sludge and decode clues in a seemingly abandoned city. The daring orange tabby is helping real world cats as well.
Thanks to online fundraising platforms, gamers are playing “Stray” while streaming live for audiences to raise money for animal shelters and other catrelated charities. Annapurna Interactive, the game’s publisher, also promoted “Stray” by offering two cat rescue and adoption agencies copies of the game to raffle off and renting out a New York cat café.
Livestreaming game play for charity isn’t new, but the resonance “Stray” quickly found from cat lovers is unusual. It was the fourth most watched and broadcast game on the day it launched on Twitch, the streaming platform said.
Viewers watch as players navigate the adventurous feline through an aging industrial landscape doing normal cat stuff — balancing on railings, walking on keyboards and knocking things off shelves — to solve puzzles and evade enemies. About 80% of the game’s development team are “cat owners and cat lovers” and a real-life orange stray as well as their own cats helped inspire the game, one creator said. “I certainly hope that maybe some people will be inspired to help actual strays in real life — knowing that having an animal and a companion is a responsibility,” said producer Swann MartinRaget, of the BlueTwelve gaming studio in Montpellier, in southern France. When Annapurna Interactive reached out to the Nebraska Humane Society to partner before the game’s launch on July 19, they jumped at the chance, marketing specialist Brendan Gepson said. “The whole game and the whole culture around the game,
In fact, it’s all about a love of cats,” Gepson said. “It meshed really well with the shelter and our About 80% of the game’s development team are “cat owners and cat lovers.” mission.” The shelter got four copies of the game to give away and solicited donations for $5 to be entered into a raffle to win one. In a week, they raised $7,000, Gepson said, with the vast majority of the 550 donors being new to them, including people donating from Germany and Malta. The company also donated $1,035 to the shelter. “It was really mutually beneficial,” Gepson said. “They got some really good PR out of it and we got a whole new donor base out of it.” Annapurna also bought out Meow Parlour, the New York cat café and adoption agency, for a weekend, as well as donating $1,000. Visitors who made reservations could buy “Stray” themed merchandise and play the game for 20 minutes while surrounded by cats. (The game also captivates cats, videos on social media show.) Jeff Legaspi, Annapurna Interactive’s marketing director, said it made sense for the game’s launch to do something “positively impactful and hopefully bring more awareness to adopting and not shopping for a new pet.”
Swann Martin-Raget, BlueTwelve gaming studio
Annapurna declined to disclose sales or download figures for the game, which is available on PlayStation and the Steam platform. However, according to Steam monitor SteamDB, “Stray” has been the No. 1 purchased game for the past two weeks. North Shore Animal League America, which rescues tens of thousands of animals each year, said it hadn’t seen any increase in traffic from the game but they did receive more than $800 thanks to a gamer.
In a happy coincidence, the shelter had just set up a profile on the platform Tiltify, which allows nonprofits to receive donations from video streams, the week the game launched. The player channeled donations to the shelter, smashing her initial goal of $200.
