Even before Covid-19, telemedicine was poised to sweep Puerto Rico. But the pandemic fast-tracked its use across the island – and providers say it’s here to stay.
Dr. Celia Lozada, a family physician from the community health center, MedCentro, said that one of her patients, a woman in her 50s who had undergone a stroke and was placed in a senior living center, relishes her telehealth access.
“She can contact me more consistently, rather than waiting to be taken to the appointment,” Lozada said. “This gives her more independence.”
Community health centers like MedCentro are widely used in Puerto Rico, where a significant proportion of the population is medically underserved.
But for people living in rural communities, transportation is often a barrier to receiving timely health care. Coupled with the mass exodus of health care providers from Puerto Rico, which has been ongoing for years, this lack of access means real, sometimes serious delays for primary and specialty care.
Some patients have waited as long as eight months to see a doctor.
In addition, most community health centers don’t have specialists on staff. That means that residents living in the island’s more remote, often mountainous communities have to travel to urban centers, like Ponce and San Juan, to receive consultations.
A natural disaster can severely affect road travel – which, in turn, affects the continuity of health care services across Puerto Rico.
For example, the January 2020 earthquakes, which caused serious damage in the municipalities of Yauco and Ponce, halted specialty care in those areas. Even those not in the quake-affected zones couldn’t travel to their specialists.
Increasing Access to Healthcare
To broaden access to these essential services in rural communities, Direct Relief awarded grants to the Puerto Rico Science, Technology, and Research Trust, or PRSTRT, and to the Ponce Medical School Foundation, or PMSF, to provide specialty and mental health care, respectively.
In collaboration with doctors from the University of Puerto Rico’s School of Medicine, the PRSTRT is providing telemedicine consultations with specialist doctors to patients in clinics in the municipalities of Castañer, Jayuya, and Arroyo.
This access has made an essential difference to patients, said Dr. José Rodríguez, medical director at the Hospital General in Castañer. The clinic can now provide once-a-week consultations with a pneumologist and an ophthalmologist.
“We don’t have nephrologists, or psychiatrists [because] they are hard to find. With the telemedicine equipment we can have all the specialist doctors we need,” said Rodríguez. He expects the clinic to offer these specialty services starting early next year.
In addition, the technology allows hospitalized patients to access remote services.
Ongoing emergencies after Hurricane María continue to strain the mental health of many Puerto Ricans. Dr. Laura Domenech, Senior Medical Officer for the Ponce School of Medicine Foundation, reports that the earthquakes and the Covid-19 pandemic have resulted in a broad demand for behavioral therapists and psychiatrists.
And providers of mental health services are in short supply, particularly in remote communities.
Domenech said telemedicine has bolstered their capacity to provide mental health services in over 40 municipalities. At the same time, it’s helped them overcome some of the stigma of seeking mental health care.
“Since people don’t have to visit a doctor’s office, it is easier for patients to speak from the comfort of their own house,” Domenech explained.
Dr. Virgen Quiñones, a psychiatrist from the Ponce School of Medicine, oversees the treatment of these patients. In particular, she said that patients with substance use disorders have benefited from access to telemedicine.
She described two patients in particular, both of whom are now in remission after more than 10 years of substance use.
“Telemedicine has been a blessing. Their situation would have been different otherwise because of accessibility issues,” Quiñones said.
Looking into the Future
In addition, building on assessments made after Hurricane María and in response to the Covid-19 pandemic, Direct Relief awarded $1 million among 16 health centers to implement an island-wide telehealth network designed to deliver primary and preventative care.
While the immediate goal is to protect patients and healthcare workers during the public health emergency, the organization sees telehealth as a sustainable solution to the island’s scarcity of healthcare professionals and transportation barriers.
Physicians, too, maintain that telehealth has been paramount in monitoring their patients’ health in general, particularly for those with chronic conditions.
In the wake of the earthquakes, many patients lost their homes and had to relocate – interrupting their treatment in the process. Since the pandemic, too, some patients with chronic conditions have gone unmonitored because they were afraid to visit health care facilities.
Telehealth is changing that. Lozada, the MedCentro physician, said she’s been able to nearly double the number of patients she sees, and to provide more frequent monitoring.
“Follow-up is easier,” she said. “By providing them with telehealth access, they are motivated to seek care, since they can contact us from wherever they are.”
Since Hurricane Maria made landfall in Puerto Rico, and with the support of AbbVie, Direct Relief has provided $84.2 million worth of medical aid and more than $17 million in financial assistance for emergency response and ongoing support of the island’s health system.