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Table 1 Critical Medical Ecological Model: Identifying the broader factors that led to the precarious conditions before, during, and after the hurricane’s impact

From: Conducting an immersive community-based assessment of post-hurricane experience among Puerto Ricans: lived experience of medical ecology in an environmental disaster and migration

 

Sociocultural

Biological

Health Care

Abiotic

Community

Systems collapse (Water, electricity, food)

Disbalanced social and political relationships

Unemployment

Poverty

Limited access to and poor distribution of financial resources

Precarious infrastructure

Late federal/state response

External dependency

Infectious disease exposure (e.g. leptospirosis)

Shifting breeding grounds for vectors

Bacterial, flora, fauna change

Collapse of medical facilities

Limited health care personnel

Only one trauma center in the island

Limited medicines available

Poor surveillance

Traumatized health workers

Mountains

Wind

Rain

Flood

Debris

Temperatures and humidity

Mudslides

Elevation

Poor roads and bridges

Household

No communication

Weak building construction

Lack of home ownership documentation

Family income

Gender roles

Migration/relocation

Poor access to available aid and resources

Social and family networks disrupted

Exposure to Infectious Diseases

Stress/Trauma

Impact of trauma in chronic diseases

Increases in household risk

Increase in vector and vermin exposures

Crop loss/ loss of food sources

Isolation (unable to access medical facilities)

Limited assistance for bedridden family members

No reliable access to medication and treatment

New, important social determinants emerge

Housing Damage

Loss of material goods, appliances, and equipment

Individual

Unemployment

Denial about hurricane

Isolation

Loneliness, isolation, depression, and anxiety

Loss of social and family relationships

Loss of role identification

Pre-existing medical conditions

Weaken immune system

Stress response

Injuries

Unable to access healthcare facilities or treatments

Stigma related to mental health care

Loss of medication and therapeutic interventions

Lack of Protective clothing/footwear

Sleeping environment disturbed