Puerto Rico
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Aid for Displaced Puerto Ricans at Einstein

By on 01/09/2018

It could be a long time before Puerto Rico fully recovers from the large-scale damage inflicted by Hurricane Maria. While that effort continues, tens of thousands of Puerto Rican residents have fled to the mainland. Many of those who have sought refuge have ended up in Philadelphia—home to the second largest Puerto Rican population in the U.S. outside of the island—and many of them have unresolved health problems that require immediate help.

Case in point: a diabetic man who arrived in the city, having gone some time without insulin.

Bill Ryan, assistant vice president for Government Relations for Einstein Healthcare Network, heard of his plight.

“I was in Washington when I got a call from the Rev. Bonnie Camarda (director of partnerships for the Salvation Army of Eastern Pennsylvania and Delaware),” Ryan says. “She said he (the patient) had a prescription but it was written from a doctor in Puerto Rico and he’s now being told that it will take another two weeks to get it for him.”

For a diabetic, that kind of wait could be catastrophic. And he was not likely to be the only displaced Puerto Rican facing medical challenges, frequently compounded by difficult coverage issues. Camarda told Ryan that many of those who were taking up residence in Philadelphia, if only temporarily, were likely not to have their medical documents because they were lost in the storm.

Finding Help at Einstein

Camarda was looking for help. Fortunately, Ryan knew exactly where to go for immediate medical assistance: Einstein’s highly regarded Refugee Wellness Center.

Matthew Behme, MD

The center is intended to provide language- and culture-appropriate medical care for people from other countries, but given the political climate in the U.S., the number of refugees relocating to Philadelphia has been decreasing, says Matthew Behme, MD, chairman of General Internal Medicine and director of Einstein Healthcare Network’s Community Practice Center. Behme also directs the Refugee Wellness Center.

When Ryan contacted him, Dr. Behme knew the center would be a good match to meet the needs of displaced Puerto Ricans, who—although they are American citizens—also face language and cultural barriers on the U.S. mainland.

“We have an infrastructure built to handle people coming from abroad who have medical problems or high-intensity medical needs, who might face communications barriers and other things common to refugees,” Dr. Behme says. “We were looking for ways to sustain the services that we had built, to sustain the providers and the lab services available, and everything we needed to take care of those patients. Almost simultaneously, Bill called us, and we were very, very excited to be in a position to help.”

The center was able to see the diabetic patient quickly, deal with his immediate and urgent medical needs, but also work with the Einstein Pharmacy to get him insulin supplies to last him until he was able to work with the welfare office and social services for comprehensive care.

Ryan says he received good feedback following that encounter and learned from Rev. Camarda that more Puerto Rican residents in Philadelphia were also likely to need help, including a patient with a broken shoulder and another with a spinal injury. He met with the city Office of Immigrant Affairs, and began making arrangements for the Refugee Wellness Center to receive more Puerto Ricans fleeing the storm-ravaged Caribbean island.

Navigating Medical and Coverage Issues

“We’ve made sure that when they are thinking about health needs (of Puerto Ricans), they’re thinking of us,” says Ryan.

Since then, Dr. Behme says the center has continued to see Puerto Rican patients—15 to 20 during the past few weeks. Many are seeking care for acute illnesses—like stomach bugs, diarrhea, asthma and upper respiratory infections. But while they’re being seen for those issues, often chronic conditions are also coming to the surface that have been left untreated or poorly treated in the months since the storm.

The center also navigates complicated issues of medical coverage to try to get care for the patients.

“As U.S. citizens, they’re entitled to all the same medical insurance channels that anybody else is,” Dr. Behme says. “A disproportionately high number of the people of Puerto Rico are on Medicaid, far higher than any state. And through their Medicaid program, they end up getting their medical assistance serviced by companies, just as they would here in the States. However, the companies are different companies than what we have here. So while they have Medicaid, we don’t have a great channel to recognize their payer, and their payer isn’t recognizing us. It’s been one of the most interesting things to learn about them.”

Karla Curet, DO, is one of the physicians who see Puerto Rican patients, and she is in a unique position to assist that population—she was born in San Juan, Puerto Rico. She says patients are amazed and gratified to be receiving such prompt, responsive care.

“They’re grateful and amazed that they were able to get in so quickly and without a hassle,” Dr. Curet says. “And they bring other people. First the husband came … and then the wife came, and then the children came. That’s sort of the experience I’ve had.”

They’re also quite open to getting to know and receive care from medical residents, she says. “They get very excited about that, actually. They love to be able to participate in the medical training of a resident. That’s almost the same setting they have in medical centers in San Juan. It’s something they’re used to and they embrace.”

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