Harvard Research Fellow Estimates Puerto Rico's Death Toll Following Hurricane Maria NPR's Ailsa Chang speaks with Satchit Balsari, a research fellow at Harvard Medical School and the T.H. Chan School of Public Health about his estimate of Puerto Rico's death toll following Hurricane Maria and recommendations for preparedness.
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Harvard Research Fellow Estimates Puerto Rico's Death Toll Following Hurricane Maria

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Harvard Research Fellow Estimates Puerto Rico's Death Toll Following Hurricane Maria

Harvard Research Fellow Estimates Puerto Rico's Death Toll Following Hurricane Maria

Harvard Research Fellow Estimates Puerto Rico's Death Toll Following Hurricane Maria

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NPR's Ailsa Chang speaks with Satchit Balsari, a research fellow at Harvard Medical School and the T.H. Chan School of Public Health about his estimate of Puerto Rico's death toll following Hurricane Maria and recommendations for preparedness.

AILSA CHANG, HOST:

Hurricane season is upon us again. And in Puerto Rico, health care leaders are gathering to take stock of how things look there after Hurricane Maria to see how prepared the island is for another potential natural disaster. Dr. Satchit Balsari of Harvard spoke at the conference. He's part of a team that's estimated a much higher death toll from Maria than the 64 the government had reported. Dr. Balsari joins us now from San Juan. Welcome.

SATCHIT BALSARI: Thank you for having me, Ailsa.

CHANG: So it seems like researchers are still trying to get a handle on how many people died as a result of this storm. I'm going to go through some numbers here. Your estimate, which was based on a household survey, put the death toll at anywhere between 800 and 8,500.

BALSARI: That's correct.

CHANG: And then a report out yesterday that was based on official death records put the toll somewhere around 1,100. So there's still a lot of discrepancy out there. Can you just tell us why it is still important to understand how many people died?

BALSARI: Well, it is important to understand how many people died because you want to be able to quantify the impact. You want to know not only how many people died but what they died of, what they died from so that preparedness efforts can be directed towards mitigating the factors that caused those deaths. What our study showed is that many of those later deaths - right? - we're not talking about people that died in the immediate aftermath from something falling on them or being electrocuted or drowning, but we're talking about a prolonged tale of sustained deaths that happened because of interrupted medical care.

CHANG: And what kind of interruptions? What kind of failures happened long after the storm was over?

BALSARI: The majority of those people that reported they had some kind of delayed access to care in our study come up with a variety of factors, not all unique. It was often just difficulty getting medicines, right? They ran out of medications and were unable to procure medications, unable to use their respiratory equipment at home because of the prolonged absence of electricity, a lack of access to water, unable to reach clinics, or their clinics were shut, or the doctors weren't there and so on and so forth. You know, this is a pattern that we have seen in disasters around the world but certainly in the U.S., certainly in Hurricane Sandy as well.

CHANG: I know that you had the chance to speak to health care leaders there this morning, including Puerto Rico's secretary of health. What was your message to them? What was your recommendation for how they could have handled Maria differently before the fact?

BALSARI: You know, the conversation that we had this morning was really focused on, what now? And the messaging was really focused on these community health centers that are responsible for the most vulnerable in our society and challenging them to think about, what is it that we can do to make communities participate better in their own preparedness and resilience efforts - you know, simple things like, can we make sure that our patients have a list of the medications that we need?

Can our community health centers, can our health care enterprises have maps of their needs in their communities of the medically vulnerable? Is it possible? Or should our health centers not know where people that are dependent on medications that need refrigeration are or folks that are dependent on respiratory aides in their homes are or where the dialysis patients are? Where are the patients that need chronic wound care, for example? And how do we match those needs when infrastructure breaks down with facilities that have those equipment still available and running?

CHANG: Did you get the sense that there are enough resources and people in Puerto Rico to put those recommendations into action?

BALSARI: I think there is a lot of resilience and determination in the room. There's an interesting mix of entrepreneurs, folks from the corporate sector as well as health care providers and administrators from the health care system. The short answer to, are there are enough resources - no. It has been underfunded for a very long time. But it certainly has the people and the grit that it will take to move forward.

CHANG: Dr. Satchit Balsari is with Harvard Medical School and with the Harvard T.H. Chan School of Public Health. Thank you very much.

BALSARI: Thank you, Ailsa.

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