The Burden of Staying Alive in Puerto Rico

Last week, Justice Secretary Wanda Vázquez was sworn in as Puerto Rico’s new governor. After a week of chaos, the Supreme Court unanimously decided that Governor Ricardo Rosselló’s attempt to choose his successor was unconstitutional. Following that decision, Vázquez took her oath, and was almost immediately greeted with resistance.

In the history of my homeland, the concept of constitutionality is one that has shown up over and over again. In fact, it wasn’t until President Harry Truman signed Public Law 600 on July 3, 1950, that Puerto Rico was authorized to create its own constitutional autonomous government. Following a constitutional convention, Puerto Ricans overwhelmingly approved their constitution in March 1952. Congress ratified the document and President Truman made the ELA official on July 25, 1952 — the 54th anniversary of the United States’ invasion of Puerto Rico during the Spanish-American War.

The document approved by Congress however was not the same as the constitution approved by the voters of Puerto Rico. Politics would stand in the way of progress through the deletion of Section 20 of its Bill of Rights. Aligned with the United Nations’ Declaration of Human Rights and more progressive than even the Bill of Rights in the United States Constitution, Section 20 recognized “the right of every person to a standard of living adequate for the health and well-being of himself and of his family, and especially to food, clothing, housing and medical care and necessary social services.” A legislator who lobbied for the change called the language “too socialistic.”

While the Puerto Rican Constitution represented the political aspirations of my people, the reality of health and wellbeing in the Commonwealth has fallen far short. Of the 78 municipalities in the Commonwealth, 72 of them are classified as “medically underserved areas” by the U.S. Health Resources and Services Administration.

And yet, politics may stand in the way of progress once again for Puerto Rico. Roughly half of puertorriqueños depend on Medicaid for health coverage. But unlike in the mainland, federal funding for Medicaid in Puerto Rico is capped, resulting in fewer medical resources available for the Commonwealth. Puerto Ricans receive less preventive care and wait longer for the care they do receive, with a median wait time of 13 hours at facilities. Because doctors can find greater pay on the mainland, the remaining citizens are left with worse health outcomes.

Even before the horrors of Irma and Maria, the percentage of adults reporting fair or poor general health in Puerto Rico was nearly double that of the mainland. A temporary fix was passed in the wake of Hurricane Maria but is set to expire on September 30. Things would go back to “normal.” This is expected to only exacerbate outmigration, further burdening the health system with an older population and possibly fewer medical providers. Puerto Ricans need a permanent solution: correcting the imbalance in matching funding for the Commonwealth. But in the meantime, there is a great deal of work to be done.

I’ve been organizing medical missions to Puerto Rico since Hurricane Maria. In June, we arranged a trip for 31 medical professionals from Centro de Ciencias Médicas, Salud Integral de Montana, PRIDE School of Dental Medicine, College of Dental Surgeons, Department of Health, VOCES, Unidad de Control de Vectores, Revolution Dental Lab, and two pediatrician members of Fort Washington Collegiate Church: Dr. Karen Dorsey and Dr. Beverley Sheares. This extraordinary group of medical professionals said “yes” to our invitation to go up the mountains of Orocovis, Puerto Rico — a town known as “el corazón de la isla,” the heart of the island, because it is the most central town in the island. There, by virtue of its location and other social factors, resides a community that is olvidada — forgotten, with a dire need of dental care, audiology services, health education, and more.

It was moving to see the tears in the eyes of the patients who walked away with dentures, after years without any dental care. I walked house to house with Dr. Heriberto Marin and others, and observed as nurses and doctors took care of patients while Marin educated families on mosquito prevention and other health issues. This was the work of a small group of citizens in a small and remote community, working to restore a sense of dignity to our neighbors in the mountains.

I am a Christian minister, and my sacred text says, “For you were called to freedom, brothers and sisters; only do not use your freedom as an opportunity for self-indulgence, but through love become slaves to one another. For the whole law is summed up in a single commandment, ‘You shall love your neighbor as yourself’” (Galatians 5:13-14).

Paul wrote to early Christians that God intends them to be free. We hear constant reminders of the freedom that we have as Americans and the price that has been paid for our freedoms, but what does freedom really mean? Does our current medical system embody freedom? According to a recent survey, over 40 percent of Americans avoid necessary medical care because of cost. Often when they are sick, Americans fear the cost of the care needed more than the illness itself.

Over half of our citizens have faced serious financial consequences from seeking medical care, deflecting money from savings or retirement and increasing their debt. Is it freedom to wear such a heavy burden to continue to stay alive?

In the realm of health care, it seems that freedom is an idea — not a reality. When it comes to American citizens on the island of Puerto Rico, this medical system reminds us that our lives are worth less as citizens, therefore, our providers are paid less. I wonder what Governor Vázquez thinks about this side effect of our “freedom.”

Just as faith without works is dead, freedom not in the service of one another is hardly freedom at all. I think about this as I see expressions of cruelty shown toward migrants: lawyers arguing against the provision of basic sanitary needs for children; crowded and stifling cells filled with men and women who so desperately yearn to be free like generations who came before them; the denial or delay of medical services to babies and pregnant women. I think about this when I reflect on our ongoing mission trips to “medically underserved” communities in the mountains of Orocovis.

In Puerto Rico, we still fight for the standard of living promised in Section 20. We must use our freedoms to better the lives of others, and we must bear the cost through service. For God is calling on us to do so, and we haven’t a moment to waste.