Public health emergencies and natural disasters cause significant disruptions to our daily lives and quality of life. Compound emergencies -- experiencing more than one emergency at a time -- or consecutive ones can cause significant alterations of our environments, routines, and lifestyles, from which one cannot easily recover. Although these environmental stressors impact everyone in a community after a disaster, the impact is not of equal magnitude for everyone. Among the populations that exhibit the most vulnerability to disasters are children and low-income individuals. In rural Puerto Rico, these vulnerability factors converge among the children of low-income agricultural workers. This territory of the United States has been impacted by intense and catastrophic natural disasters in recent years, including Hurricane Maria (2017), the Southwest earthquakes (2019), and Hurricane Fiona (2022). The recovery and response phases of these events also coincided with the emergence of the COVID-19 pandemic in 2020. The burdens that these stressors have on the community may be exacerbated by the absence of protective factors such as a healthy school environment, particularly for children in rural farming communities whose families experienced lost income and additional exposures due to the nature of their work.
Migrant Clinicians Network carried out a research project to explore the impact that these disasters have had on the health of children of agricultural workers in Castañer, a small town in Puerto Rico. This isolated mountainous farming community is located in the west-central region of Puerto Rico between the municipalities of Yauco, Lares, Adjuntas, and Maricao. The region is a key agricultural area due to a large amount of arable land and crops of different products including oranges, coffee, bananas, plantains, and various root vegetables. In this region there are many small family farms or “fincas” and often the whole family, including the children, participates in some way in their productivity.1 Castañer, Puerto Rico, is part of an agricultural region that has been greatly impacted by natural and public health disasters. The region, with more than half of the population below the federal poverty level, is one of the poorest areas in Puerto Rico.1 During and after these events, these farming families have been affected due to substantial crop loss, destroyed or damaged homes, lack of resources, food insecurity, and interrupted education.
This region has faced the closure or relocation of schools, which reduces immediate access to education and other associated services such as meals.1 The remaining schools have suffered direct or indirect impacts from all these emergencies. Among the results obtained in the processes of focus groups and interviews, what was experienced by a particular community and its educational infrastructure, in this case, an elementary school, stood out. Physical damage to the campus dates to 2017, when flooding due to the copious rains from Hurricane Maria destroyed its security fence (Figure 1). Some of the students themselves were refugees at the time the school flooded, having to be rescued from what was once considered their safe haven. The damage caused the return of students to the classroom to be delayed until a preventive fence was placed to provide some type of security. Then in 2019, the school’s infrastructure was compromised by the earthquakes in the south, being temporarily closed. The school was relocated to another school with which it shares facilities. This requires students to travel twice as far to get to their schools and doubles the overall hours the student spends in school-related activities, leaving almost no time for extracurricular or recreational activities. When looking at the impact of these events, it is important to see beyond the damaged infrastructure. Although this may be the obvious result of an emergency, the social and emotional health implications that these events and decisions had on the children of this community, most of whom are children of farmers, are substantial.
Figure 1. Timeline of events and related impacts
Our research included focus groups with parents and teachers in the community and interviews with school administrators. We also interviewed personnel from Hospital General Castañer, a community health center that provides outreach and education to their community. The results of these interactions were not encouraging, since we observed a community emotionally and physically affected by a lack of resources and quick response to facilitate the return to what represents more than an educational center. The role of a school in such rural, isolated, and low-income communities goes beyond providing education in math or history. These schools are the central piece of community engagement. During an emergency, they often serve as shelters, and school personnel facilitate emergency response and recovery.
The effect of flooding on students' emotional health is still being observed by teachers, who report having to intervene to calm students at times when it starts to rain during the school day. All participants expressed a sense of loss and community disconnection after the school relocation. The faculty and students were located, and continue to be located, in a community that is not their own, and the school to which they have been relocated has its own post-disaster health concerns including mold and poor ventilation. One of the difficulties that arose most often within the community was the need for more resources to attend to emotional and behavioral health. After a disaster, communities often rely on these resources to provide outlets of emotion and community strengthening activities. The school’s gym and theater were both damaged by flooding; no new outlets were developed. Under the current conditions, the school lacks any resources to attend to the emotional and behavioral health concerns that they observe. In the case of the regions of Puerto Rico where farm families are located, not addressing these issues can deepen the social and economic immobility of this population. Similarly, as a social determinant of health, an unhealthy school environment will also deepen the health inequities we see today. However, the community has engaged in some protective activities after their disasters. Participating in cleanup and providing opportunities for students to catch up through dedicated class time are two ways the community has shown their sense of ownership to the land and their commitment to the students, both of which can build resilience and connection.
It is important that as programs get developed to attend to the health of children after disasters, the key elements for healthy school environments are present, including immediate school recovery, as schools are the center of community resilience. MCN will continue to work with the schools to connect them with our partners and resources to support them in improving the health and safety of their current school environment and advocating for their return to their community school once it is safe.
Pagán-Santana, Marysel, Amy K. Liebman, and Aníbal Y. López-Correa. "Looking at the gaps and program needs to address the impact on children of agricultural workers in Puerto Rico during and after public health emergencies." Frontiers in Public Health 10 (2022).