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When Hurricane Maria devastated Puerto Rico last fall, José Maldonado was heartbroken. Although he now lives in Maryland, he has strong ties to the island where he was born. But when his sisters tried to convince him to help with disaster relief, he was skeptical.

“In the beginning I told them they were crazy to have me down there,” he said. Maldonado survived a stroke 16 years ago, and walks with a cane because of partial paralysis. He wasn’t sure how much help he could be. But his sisters finally persuaded him, telling him, “You’re just what we need to convince people that there’s hope out there and that people care.”

In 2017, the U.S. was slammed by three major hurricanes that hit not only Puerto Rico, but also large areas in Texas and Florida, and caused over $200 billion in damage. These communities have scrambled to recover and then to prepare for a new hurricane season, which began June 1 and runs to Nov. 30. And while most of the focus is on the immediate devastation, health researchers are still investigating how superstorms impact communities long-term — especially minorities and low-income populations.

After a hurricane, it can be difficult to get to a doctor for a checkup as well as get medications. Stress and trauma also intensify, all leading to an increase in cardiovascular disease, said Dr. Ralph Sacco, chairman of the Department of Neurology at the University of Miami.

“Hurricanes acutely affect all kinds of basic support activities. … A hurricane is a stressor, and inequity in care can get amplified under that stressful situation,” Sacco said.

Two months after Puerto Rico’s hurricane, Maldonado arrived to find people still didn’t have electricity and other basic needs. He walked up to 6 miles a day through difficult terrain to bring supplies and Christmas gifts house-to-house.
 
“I’m a professional with a great job and medical benefits. You can imagine someone who doesn’t have these things. They usually fall through the cracks,” Maldonado said.

“I had no idea how bad things were,” he said. “And when it came to the stroke survivors, it was much worse.”

As Maldonado witnessed, hurricanes can cause the most damage among vulnerable populations. One of the focuses of Sacco’s research is why certain communities, especially African-American and Hispanic populations, suffer more strokes than others. As director of the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities, funded by the National Institute of Neurological Disorders and Stroke, he has seen firsthand how storms can increase those inequities in care.

Florida and Texas were able to recover more quickly than Puerto Rico, but Sacco said researchers don’t have enough data on the long-term effects of these system breakdowns. Initial studies suggest the consequences may be significant.

In New Orleans, there was a four-fold increase in the incidence of heart attacks in the 11 years after Hurricane Katrina, according to a recent study in the Journal of the American College of Cardiology. And the incidence of heart attacks increased 22 percent in the New Jersey area hit hardest by Hurricane Sandy, according to research in the Journal of the ľ¹ÏÖ±²¥.

While these statistics are dire, Sacco and others dealing with the effects of hurricanes emphasize that extreme weather events also reveal the resiliency of medical professionals and the populations they treat.

“We did very well during Hurricane Harvey when you compare its magnitude to other storms,” said Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, which leads the federal disaster preparedness and response program for 25 counties. It covers a population roughly comparable to the state of Missouri.

Although the hurricane was epic, he said hospitals pulled together, donating supplies and resources to each other. It’s important for Texas residents to be prepared, and to gather any medications they might need beforehand, but he also believes his network of “over 150 hospitals and nearly 1,000 extended care facilities is well positioned to manage another storm.”

Maldonado also was inspired by how Puerto Ricans pulled together to help each other through Hurricane Maria. The stroke survivors he visited had networks, friends and family helping them. “People were very willing to lend a hand, get food to them,” he said.

It was the kind of support that made all the difference during his stroke recovery.

“I was really lucky because [my family] didn’t give up on me even though I gave up on me,” he said. “The fact that I reach out [to others] is a tribute to them.”

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