One year after Hurricanes Maria and Irma made landfall in Puerto Rico and the U.S. Virgin Islands (USVI), community health centers report a surge in patients, and a growing number of patients with serious physical and mental health problems.

A new report, issued by the Kaiser Family Foundation, is a follow-up study to an earlier survey that examined the experiences of Puerto Rico and USVI health centers in the wake of Hurricanes Irma and Maria. The research, based on a comprehensive survey of the islands’ health centers, was conducted by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, part of the George Washington University’s Milken Institute School of Public Health’s Geiger Gibson Program in Community Health Policy.

The new report and survey also complement a study released in August by another team of researchers at Milken Institute SPH, which found there were an estimated 2,975 excess deaths in Puerto Rico in the six months following Hurricane Maria.

“This report underscores that although the early mortality studies, such as the one published by our School, provide absolutely critical understanding of the most extreme near-term consequences of the disaster, of vital importance will be ongoing epidemiologic and public health research that can measure changes in health over time,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, one of the authors of the report. “In this regard, the experiences of health centers in the wake of the storm offer invaluable insight into the nature of problems to come.”

Reflecting the hurricanes’ long-lasting impact, nearly all health centers reported that patients are now more likely to present with depression and anxiety, including post-traumatic stress disorder, compared to the period before the hurricanes. Patients are also more likely to have poorly managed chronic conditions, respiratory conditions such as asthma, alcohol or other substance use disorder, and suicidal thoughts or attempts. And while most health centers have been able to maintain essential staffing levels, some report losing physicians and other professionals. Finally, referrals for specialty care, always a problem, have become more difficult, particularly with respect to mental health.

Even as health centers rally to meet growing, and more complex, patient care needs, they face ongoing recovery challenges. Most report that they have returned to full operational status, but many continue to face critical infrastructure issues including buildings and facilities in need of repair, ongoing electrical power shortages, internet and telephone service disruption, as well as challenges with restoring electronic health records, maintaining onsite diagnostic equipment, and having dental and vaccine supplies available at all sites. Because health centers in both Puerto Rico and the USVI rely heavily on Medicaid and federal grant funding, both sources of financing emerge as absolutely critical to the survival of the island’s primary care system for its poorest and most vulnerable communities.

What is clear from the new report is that in both Puerto Rico and the USVI, community health centers are continuing to respond to local needs, and those needs have intensified and deepened in the wake of the storms, reflecting continuing difficult conditions across the islands. It is also clear that these health centers are financially vulnerable and that sustained and enhanced funding is absolutely crucial to ensure that endangered communities continue to get the care they need.

The brief, “The Recovery of Community Health Centers in Puerto Rico and the US Virgin Islands One Year after Hurricanes Maria and Irma,” is now available on the KFF website.