After a magnitude 6.4 earthquake rocked Puerto Rico in January, midwife Rebecca García Ortiz examined women in fire station backyards and a mall parking lot.
For the lucky ones whose houses or apartments were undamaged, García Ortiz visited them at home. For women who were displaced, she’d go to the shelters. In the quake’s aftermath, her day would begin at eight each morning and end at 10 at night, caring for more than 100 women daily throughout the severely affected southwest region of the island.
The quake caused widespread and significant damage, leaving many houses uninhabitable. About 3,000 people went to government-run outdoor shelters, according to the State Department, while others created their own impromptu shelters in baseball fields and parks.
Even people whose homes weren’t damaged elected to stay in shelters, fearing that the significant aftershocks might hit them next. Mental health in Puerto Rico, already fragile in the aftermath of Hurricane Maria, experienced an additional setback.
While the region’s hospitals were undamaged, they nonetheless established safety protocols and set up portable hospitals with tents in their parking lots as a precaution. While most medical services were still available, access to prenatal care was more difficult to come by, García Ortiz said.
Prenatal care and beyond
Even before the earthquakes, García Ortiz said, many of her patients did not receive sufficient prenatal care – or have other health conditions monitored – because they lived far from a doctor’s office and would have to wait long hours for treatment.
But in the heightened circumstances created by the earthquakes, García Ortiz saw the need and stepped up, playing a crucial role in supporting the region’s pregnant women.
She’s no stranger to difficult situations. A midwife and voluntary social worker, she doesn’t just care for women throughout their pregnancies. If the women and pregnant teenagers she works with need help finding a food source, she’ll help them do it. If they experience intimate partner violence, she accompanies them through the legal process and finds appropriate counseling resources.
In the aftermath of both Hurricane Maria and the 2020 earthquakes, García Ortiz and other colleagues noticed that women were experiencing premature births due to stress, depression, and other mental health concerns. When visiting women at their homes, García Ortiz noticed unsanitary conditions and even malnourished children.
“Natural disasters cause a lot of insecurity, especially if there is a job loss,” she said. “This generated a lot of stress. Many women had difficulty feeling their babies.”
A new way to care for patients
Often, García Ortiz feels, low income and a lack of information about what’s available translate into barriers to health care services. To overcome this, she has begun collaborating with Centro Familiar Cristiano, a church in Sabana Grande.
During Hurricane Maria and the earthquakes, the church offered emotional support, food, and emergency supplies for pregnant women and children. Now, working with García Ortiz during the pandemic, they have helped over 300 families with food and provided over 40 pregnant women with the prenatal and postpartum care they needed.
In addition, to make sure that women have a reliable place to find maternal health care even during emergencies, García Ortiz and Centro Familiar Cristiano decided to outfit an area of the church’s facility with the necessary equipment.
When there’s no emergency, the area will be used to provide free birthing and lactation classes to women in the quake-affected zones of the island.
That’s where Direct Relief comes in. The organization donated a portable ultrasound machine and a portable fetal heart monitor to the newly-established Centro de Salud Familiar Cristiano, allowing midwives to care for women both in the church and – should the situation call for it – in their homes, shelters, or wherever else help is needed.
For García Ortiz, it’s that portability – the ability to move around and treat patients almost anywhere – that’s a midwife’s greatest strength.
And on an island where gynecologists and obstetricians are already in short supply, she’s convinced that midwives have a vital role to play – whether or not there’s a disaster.
Since Hurricane Maria made landfall in Puerto Rico, Direct Relief has provided $75 million worth of medical aid and financial support to health providers and local organizations on the island, including those responding to this year’s series of earthquakes. This support equals more than 600,000 pounds of medical aid and 10.6 million defined daily doses of medication.