Red tape, slow emergency, and chronic disease management in post-María Puerto Rico

ABSTRACT

This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health-sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n = 20) health care providers and administrators (n = 42), and policy makers (n = 5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as a manifestation of the colonial legacies of disaster management and health care. They describe a precarious existence in perpetual ‘application pending’ status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a ‘post-disaster future’ beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance.

KEYWORDS:

• Puerto Rico
• slow emergency
• disaster management
• health care system
• coloniality

Disclosure statement

No potential conflict of interest was reported by the author(s).

Lead author contact

Correspondence concerning this article should be addressed to Mark Padilla, Global and Sociocultural Studies, School of International and Public Affairs, Florida International University, 11200 SW 8th Street, SIPA #320, Miami, FL 33199 Email: [email protected]

Notes

1. The death count due to María was a political powder keg after the storm, as Puerto Rico was embroiled in international controversy surrounding the role of the USA aid to the island, the mismanagement of aid distribution by FEMA and other agencies, and the attempts by the Trump administration to minimize the impact of the hurricane. The Harvard-sponsored study we cite here represented an attempt to apply scientific assessment techniques to quantify the scope of the problem. The backlash that ensued against the study’s Puerto Rican collaborator and co-author is the subject of a documentary produced by the first four authors of this article, entitled ‘Collapse’ (Varas-Díaz et al., 2019).

Additional information

Funding

This work was supported by the National Institute on Aging of the National Institutes of Health, under Grant [1R21AG063453-01].