[Photo by Piron Guillaume via Unsplash]

Another Kind of Recovery: Post-Maria Puerto Rico and Health Care Critical Infrastructure

I was away most of the last several weeks because I was recovering from surgery. I was lucky, not only because surgery fixed a life-threatening problem, but because I had IV bags and tubing for saline and pain medication.

lt doesn’t seem like this should be a big thing but it is for many critical health care situations. Imagine having major abdominal surgery, followed by days of post-surgery care. The pain could be debilitating without a continuous drip pain medication. Imagine the extra labor required to administer pain medication if automated IV drip feeds aren’t available.

Now imagine caring for an unconscious influenza patient suffering from dehydration. Imagine a ward filled with these patients, including children and elderly who may be difficult to hydrate by mouth. Imagine not having enough IV bags and tubing for a severe flu season.

No need to imagine this; hospitals have been dealing with this very shortage for more than a month. Some hospitals are administering Gatorade by stomach tube because they don’t have enough IV bags for hydration.

I hate to think of the challenges for patients in treatment for cancer and other long-term illnesses.

Why the shortage? It’s because Hurricane Maria affected the largest U.S. manufacturer of IV products. Baxter International’s three Puerto Rican plants make 44% of IV bags used in the U.S.

Most Americans aren’t aware 46% of Puerto Rico’s economy is manufacturing. Pharmaceuticals represent the lion’s share, including IV products. This industry represents 18,000 jobs, $40 billion in pharmaceutical sales, and $3 billion in federal tax revenues.

Hurricane Maria may have caused other pharmaceutical shortages. If so, production increases in other locations or substitutions remediated the effect. But there aren’t alternatives given IV products’ manufacturing concentration in Puerto Rico.

The Trump administration has done a pissy job handling post-Maria hurricane recovery in every respect. It almost looks personal, as if he’s punishing the island for a Trump-branded golf course’s failure.

But here’s the kicker: the Federal Emergency Management Agency says it’s done with emergency response in Puerto Rico. It’s pulling out though many residents are still without water and lights. Chalk it up to more bad faith on the part of this administration.

Why hasn’t the administration treated Puerto Rico’s pharmaceutical industry as critical infrastructure? The National Infrastructure Protection Plan (NIPP) lists health care as critical.

Is it because former President Obama’s Presidential Policy Directive 21 (pdf) established the NIPP? Trump has systematically unwound 20 or more Obama policy directives to date.

Trump’s proven he could give a rat’s patootie about brown-skinned people. If Trump mentions Puerto Rico in his SOTU speech tonight he’ll call federal response a success. FEMA gave him a news peg with ample time for his speech writer to stuff it into tonight’s hypocritical bloviating. He counts on the mainland blowing off Puerto Rico now the way it has sloughed off the island’s thousand-plus hurricane-related deaths.

But with the IV products shortage and the ongoing flu season’s severity, this indifference isn’t affecting only Puerto Ricans. It may already have cost lives while increasing health care costs here in the continental U.S.

Heaven help the rest of us if we face a mass casualty event or a pandemic before we fix Puerto Rico — and Trump.

Blogger since 2002, political activist since 2003, geek since birth. Opinions informed by mixed-race, multi-ethnic, cis-female condition, further shaped by kind friends of all persuasions. Sci-tech frenemy, wannabe artist, decent cook, determined author, successful troublemaker. Mother of invention and two excessively smart-assed young adult kids. Attended School of Hard Knocks; Rather Unfortunate Smallish Private Business School in Midwest; Affordable Mid-State Community College w/evening classes. Self-employed at Tiny Consulting Business; previously at Large-ish Chemical Company with HQ in Midwest in multiple marginalizing corporate drone roles, and at Rather Big IT Service Provider as a project manager, preceded by a motley assortment of gigs before the gig economy was a thing. Blogging experience includes a personal blog at the original blogs.salon.com, managing editor for a state-based news site, and a stint at Firedoglake before landing here at emptywheel as technology’s less-virginal-but-still-accursed Cassandra.

19 replies
  1. Rayne says:

    And no, I am not watching that soft-handed slack-assed bewigged golf cheater reading from a teleprompter tonight.

    I’m going to watch Rep. Maxine Waters reclaim our time on BET instead.

    EDIT — 9:38 PM EST — From Bustle’s How to Watch Maxine Waters’ State of the Union Response:

    To see what Waters has to say about Trump’s first State of the Union, you can tune into BET at 10 p.m. ET on Tuesday. She’ll be up first on their show, so don’t wait. BET also has streaming apps on Chromecast, Roku, and AppleTV, so if you don’t have cable, you can watch it that way, too. The official Democratic rebuttal should be available on most major news networks, but you’ll have to go directly to BET in order to watch Waters give her national address.

    Counting the minutes here to Auntie Maxine’s hellfire…

    EDIT — 11:30 PM EST —
    Looks like BET had to reschedule Maxine Waters for tomorrow night, moving her to their 10pm program The Rundown with Robin Thede. One more irritating thing Trump has done — lying for so long he pushed rebuttals back.

    • Trip says:

      I’m glad you are okay. Trump doesn’t give a sh*t about anyone (aside from himself), but he does have very special contempt for non-whites.  I’m with you, I’m not watching the crapfest of lies, “presidential” teleprompter and masturbatory self-congratulatory speech.

      • Rayne says:

        Thanks. ‘Masturbatory’ is spot-on — what ever he’ll tonight say is purely for useless self-pleasure.

        I take that back, this won’t be entirely useless. As long as he is flapping his gums on camera, he’s not triggering World War III with his tweeting.

        • Trip says:

          Pretty funny:

          Trump Collapses From Exhaustion After Ninety Minutes of Faking Empathy
          Shortly after Trump spent a gruelling ninety minutes pretending to care about immigrants, the unemployed, and other people whom he normally dismisses as losers, aides noticed that he was turning from a bright orange to a slightly paler orange before crumpling to the ground in a giant heap.
          “If you have never spent a moment thinking about a human being besides yourself, imagine trying to pretend you are doing that for a solid ninety minutes,” Jackson said. “It’s physically punishing.”….Immediately following his collapse, Trump was rushed to the Walter Reed National Military Medical Center, where a brain scan showed that his brush with human feelings did no permanent damage.“I just visited with him, and he was sitting up in his bed, trashing Jay-Z on Twitter,” Dr. Jackson said. “It was such a relief to see that.”

          https://www.newyorker.com/humor/borowitz-report/trump-collapses-from-exhaustion-after-ninety-minutes-of-faking-empathy

  2. Jim White says:

    Welcome back. Sorry we didn’t get rid of Trump while you were recuperating.

    I’ve been saying Trump will leave most of Puerto Rico uninhabitable and then invite in developers to build a few megaresorts for the megawealthy. Just disaster capitalism at work. With a little inside help…

    • Rayne says:

      You’re killing me, Smalls, not enough antifa action while I was out of commission. LOL

      I’m still trying to figure out the angle Trump’s taken with Puerto Rico. It does look like a malicious shakedown, but the ploy for real estate seems almost too easy. I’ve wondered if it’s a shakedown of Big Pharma using Baxter as an example…but then perhaps strangling Baxter is a way to favor some other injectables/intravenous products company which might be interested in Baxter’s marketshare. I can think of two in the Middle East as well as Pfizer’s Hospira, Mylan (Netherlands), B. Braun (Germany), Fresenius (Germany), and Novartis (Switzerland). Makes me sick thinking somebody might die for lack of IV products just so Trump can make some petty point or line his own (or his family’s) pocket.

    • Rayne says:

      $130K is one heck of a lap dance. Or a blowjob.

      If I was Melania. none of this Stormy/Cohen stuff would mean dick to me at this point; I assume her marriage is enshrouded in a nasty pre-nup and an nastier NDA, compelling her to put up and shut up as long as he’s in office and not behind bars.

      The tension around her mouth is the tell. She is biting back fury every time she’s in public with him. Yeah, us, too, sister.

  3. Rugger9 says:

    On topic, when Maria hit this problem of IV tubing was well known, and since FEMA’s pulling up stakes without verifying that full production is back on line seems more than a little irresponsible to me.

    • Rayne says:

      I have yet to see any reporting indicating Baxter’s production is up to pre-hurricane capacity let alone up to additional capacity to make up for a backlog.

      “More than a little irresponsible” is putting it mildly. The administration’s handling of post-hurricane response has been grossly negligent.

  4. klynn says:

    Rayne,
    Continue to heal.
    I too faced the IV shortage while my dad was facing critical health concerns. It has been sickening to watch the President’s disregard.

    • Rayne says:

      Very sorry to hear your dad was ill, hope he is on the mend. I wonder how many people have been directly impacted by the IV product shortage to date; most of us probably know somebody who’s needed IV therapy within the last 6 months. One friend had an emergency appendectomy; she was in and out of the hospital in 24 hours sent with only opioid-based pills for pain management. Suspect this was one way of dealing with shortfall of IV product shortage and demand for beds due to uptick in flu-related hospitalizations.

  5. Winston B. Fifield says:

    My friend was doing a superfund project in P/R. The parking area had been used as a toxic waste dump. They(drug company) tried to  cover it with asphalt paving. It just kept bubbling   from heat.    It was excavated then bad earth removed and burned ,where? Then a pile of remaining earth was aereated. Tubes laid between layers of dirt to removed toxins by evaporation ? Imagine how many other areas  are like that because of regulations that are not enforced

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