![]() The US Congress has imposed several neoliberal policies on Puerto Rico that are directly relevant as background to the current analysis. It is against this colonial backdrop that Puerto Rico has suffered from the catastrophic effects of natural disasters. During the past decades, Puerto Rico’s economy has languished following the elimination of US-based tax protections, the privatization of critical infrastructure as part of neoliberal reforms (including the health care system), the accumulation of a $70 billion external debt without the right to bankruptcy, and local government mismanagement. Still, Puerto Ricans contribute economically to national health programs, including Social Security and Medicare, to which they have reduced access due to mandated restrictions on these benefits for residents on the Island. ![]() They cannot cast electoral votes in general presidential elections are subjected to federal laws but lack voting representation in Congress and receive fewer federal governmental benefits than other Americans, including those aimed to improve health care access. For example, Puerto Ricans, although US citizens, lack key rights enjoyed by citizens in the continental US. Since then, Puerto Rico has been marked by its colonial status, which has contributed to a history of systematic discrimination and exclusion in relation to the US. Puerto Rico, a Caribbean island with a Spanish-speaking population of 3.5 million, has been a United States (US) territory since it was ceded by Spain in 1898. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed ‘the collapse before the collapse,’ alluding to the structural deficiencies that presaged the catastrophic event. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster’s impact. Participants’ narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. In such circumstances, they developed resilient responses to meet communities’ health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies). They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. Participants reported a sense of abandonment by the government and feelings of mistrust. ![]() The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico’s health care system, responded to the crisis after Maria. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes. ![]() This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. Methodsĭata were collected between September 2018 and February 2020. This article addresses how health care professionals and administrators experienced the health care system’s collapse and the strategies used by them to meet their communities' health needs. After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms.
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