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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