My dad had an expression that he learned in the Marine Corps: “Going left is a choice. Going right is a choice. Staying put is a choice. And there is a cost to every choice.” The Canadian prog-rock band Rush put it this way: “If you choose not to decide, you still have made a choice.”
On September 20, 2017, the Category 5 Hurricane Maria hit Puerto Rico. Maria became the worst natural disaster on record in Dominica and Puerto Rico. It caused roughly $100 billion in damages. The island’s power grid was 95 percent destroyed, leaving millions without electricity and clean water.
The U.S. government response was slow – the U.S. Department of Homeland Security refused to allow non-U.S.-flagged vessels to give help and the government refused to release a billion dollars in aid earmarked for disasters like Maria.
President Trump didn’t visit until October 3. He said: “If you look at a real catastrophe like Katrina, and you look at the tremendous hundreds and hundreds and hundreds of people that died, and you look at what happened here with really a storm that was just totally overbearing, nobody has seen anything like this [. . .] What is your death count as of this morning, 17?” He also threw out paper towels in a staged photo-op and told residents: “I hate to tell you, Puerto Rico, but you’ve thrown our budget a little out of whack, because we’ve spent a lot of money on Puerto Rico, and that’s fine. We saved a lot of lives.”
A few days later, October 12, Trump tweeted: “We cannot keep FEMA, the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!” Since then, the death count has risen to 1,000 people and – at the time of this writing five months later – 40 percent of the island is still without power.
There are many theories about why the U.S. government’s response has been lacking. Personally, I see a pattern that’s been emerging for the last year: unless the victims of a crime or a disaster are white, Trump has no interest in helping, and the inaction in Puerto Rico seems to be part of that. Like his comment that nations in Africa are “shithole countries,” Trump sees nothing – and no one – worth saving in Puerto Rico, so he has taken almost no action.
However, a little-noticed statement at the time of the disaster warned of the dire consequences of doing nothing. On October 10, 2017, the head of the U.S. Food and Drug Administration, Scott Gottlieb, warned that the U.S. would start to see drug shortages within two or three weeks – because 10 percent of drugs prescribed in the United States are made in Puerto Rico. These include cancer drugs, IV bags and treatments for HIV and arthritis.
Flash forward to January 2018 – flu season – and U.S. hospitals suffering from acute shortages of IV bags are scrambling to keep their critically ill patients medicated through a patchwork of improvisations and workarounds. Baxter International – which provides the bulk of IV bags to U.S. hospitals – had all three of its factories in Puerto Rico shut down due to a loss of power. They’ve only just come back online.
That may seem like a horrifying statistic. For me, it’s personal.
The ripple effect
A few years ago I had a life-threatening blood clot. As a result, I’m on blood thinners. The drug I use – Xarelto – is produced in Puerto Rico. But I’ve got a decent supply of the drug and I’m not terribly worried about shortages, yet.
The same isn’t true for my friend’s husband, Gerhard.
Gerhard and Kris Gross are transplanted Canadians living in California. They are super-healthy, super-active young people who eat healthy and love cycling and snowboarding. They have an adorable toddler son. A year ago, Gerhard was diagnosed with stomach cancer and has been working hard to keep ahead of the disease. Here is what his wife wrote on Facebook a few days ago:
Remember the devastating storms that struck Puerto Rico? In particular, Hurricane Maria, which followed Hurricane Irma? Trump famously tweeted a bunch of insensitive stuff . . . I was outraged like many were at the time because how could you leave citizens of this country drowning in flood waters, without electricity, facing fears and losing everything?? I mean that’s bad enough. And now the ripple effect has found us once again. We’re up to three direct ways now.
1) The specialized 1L glass vacuum vials we need to tap Gerhard’s ascites build up are made in Puerto Rico in factories just now starting to come back online. There is a shortage around the country to the extent that our radiologist at the clinic was aware of the exact number in each hospital and care center. The number was nine at one point. In all of Los Angeles and surrounding area. To put that in perspective, Gerhard has been known to fill three at a time, sometimes four. Our team at the clinic did their best MacGyver impressions to make sure Gerhard got the relief he needed.
2) The IV bags that hold fluids we need to keep Gerhard hydrated are made in Puerto Rico. They are also in shortage.
3) And today, we learned that the proteins needed to fill TPN bags come from underwater factories in Puerto Rico. So our hospital has a shortage and must ration what they have across all patients needing this nutrition. They literally said the words “it’s not enough to meet your needs.”
By choosing not to fully help Puerto Rico, the U.S. government is putting lives in jeopardy not only on the island itself, but on the mainland as well – and potentially elsewhere. The President of the United States seems to believe that if a place is poor, or is home to people with brown skin, it is worthless. We are seeing proof right now that – in an integrated global economy – there is no such thing as “over there,” anymore. The smart people among us have long known – intellectually at least – that what happens in one part of the world affects all of us. Which is why the great Pax Americana has been so good for everyone – Americans included.
And now, as the President steps back from those obligations, and digs in his heels on humanitarian aid, and refuses to help victims of disaster, we’re finding out – all too personally and immediately – that doing nothing for people in need can come at a very high cost in very unexpected ways.
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