Introduction
Hurricane Maria slammed into Puerto Rico in September 2017, just two weeks of Hurricane Irma had passed through. The Category 5 Maria was bad enough—but the fact that it came on the heels of Irma, also a Category 5 storm made it all the more devastating. Puerto Rico had not even had time to recover from Irma, which had set it up against the ropes, when Maria entered and put the island territory into dire straits. This paper will discuss the impact of Maria on the Puerto Rico population, what aid and response was delivered in support of the community, the strengths and deficiencies of the cultural competency of the response, and what recommendations as a program manager could be made to enhance cultural competency.

Impact on Populations

Puerto Rico’s population was already in poor condition prior to Maria making landfall. Irma still had some 100,000 people without power when Maria hit, and the territory was deeply in debt and without many prospects of climbing out of that debt as new tax policies had been adopted that had caused many large corporations to flee (Baker & Dickerson, 2017; Sullivan & Feiser, 2017). When Maria struck, the hurricane destroyed what was left of infrastructure.

Maria completely obliterated the power grid of Puerto Rico, putting everyone out of power—except for hospitals with backup generators. Communications were gone, except for a handful of radio towers, which were almost impossible to reach because of flooding. Local leaders let the population know they may be without electricity for up to half a year. Energy was the least of problems, however. Locals were left without shelter, without food, without medicine and without clean water. In the aftermath of the hurricane, Puerto Ricans suffered significantly without any assurance that their most basic needs for survival would be met (De Arzola, 2018). Disease ran rampant through the population: people contracted pneumonia and emphysema. The most affected population was the elderly population. The elderly were hit by a wave of hopelessness and many of them took their own lives following stories that no water would be coming (Varney & Kane, 2018). The elderly population was the most vulnerable because they had no news but locally spread rumors, and since everyone was basically cut off from everyone else, they were vulnerable to fear and despair. Puerto Rico had already been plunged into poverty beforehand, so it was not as if there was anything for this population to fall back on.

The health care sector had planned in advance so as to be ready for these types of situations. Health care populations were trained on what to do and their training came into effect. The Public Health Emergency Preparedness Cooperative Agreement (PHEP) Program was in close communication with the CDC of the US. FEMA also had a presence in Puerto Rico. The health care population was the most prepared of any of the groups in Puerto Rico. It was the poor and the aged who suffered most because they had no one and nothing to look out for them.

Aid and Response in Support of Community

The Southwestern Regional Academic Medical Center had been set up in 2006, a decade prior to the hurricane, for the purpose of responding to hurricanes and other disasters. It now sprang into action to provide health support for those in need. Generators were in place to keep facilities going so that people could be treated with all the conveniences of modern medicine. The US sent the National Guard, and FEMA also joined in to help. The CDC collaborated with PHEP to get medicines and vaccines to people who were vulnerable to sickness. Because of flooding and food shortages and sanitation problems, diseases were feared and vaccines were distributed to prevent the risk of widespread outbreaks.

One of the most important needs of the Puerto Rico community, however, was the need to clear roads and get infrastructure restored. The Army Corps of Engineers was brought in to do this. Crops had been destroyed. Homes had been leveled. Shelters had to be installed. Flooding had to be dealt with. Getting electricity grids back up and running was important. But it would be a sometime before any of this happened, and emergency shelters would become permanent. Half the population continued to be without fresh water for months afterwards (De Arzola, 2018).

Or than focusing on infrastructure and medicine, the other key aspect to recovery and response was getting food, water and other supplies to the population quickly. Unfortunately, there was an outdated piece of legislation on the books in the US called the Jones Act that prevented ships from leaving American ports for the territory unless those ships were flying the US flag. This meant that even though there were many cargo vessels that could have quickly...…to safeguarding and helping their populations. They have an interest not in themselves but in their people, and they are the ones with the reputation of getting things done and keeping people together. They should be tapped as an integral force and source of support.

Reform should also be advocated as people come together to address the situation. Even after Maria struck, people in Puerto Rico were wondering what their political leaders would do to better prepare everyone for a future situation. Political leaders even still were hemming and hawing about policies and plans. Nothing was finalized and the can was essentially kicked down the road. Reform is needed in government to keep these kind of individuals from running away with political funds. They should be held accountable in the most severe way.

The key to it all will be creating a decentralized system in which local groups and agencies, local community leaders, non-government organizations, trained professionals and foreign aid services can work together in a meaningful way to make sure that the most vulnerable populations are supported in a time of crisis like that which descended on Puerto Rico after Maria struck in 2017. Such a decentralized system depends entirely upon communication and understanding the needs of the local and vulnerable populations. This means coordinating with and contacting people on the ground, working closely with church leaders and community leaders so that there is a sense of what the needs of different people and groups are and how those needs can best be satisfied. Unless this is approached in grassroots way, in a bottom-up manner, the success of the initiative will be lacking.

Conclusion

The need for people to understand how they can help in a time of crisis is based upon an assessment of who is vulnerable. The vulnerable populations of Puerto Rico were the impoverished and the elderly. They had little to no support system in place and no way of getting aid. Suicide rates soared as a result. There were agencies involved that provided medicine and vaccines, shelter and food and water wherever they could. But this was a limited approach. More needed to be done at the local levels, with local community leaders paving the way forward. Instead of relying on government officials with poor track records, the territory needs to have a decentralized network of support in place.