Health Care in Vieques: a look at the health opportunities and limitations for Viequenses

1. Health Care in Vieques:a look at the health opportunities and limitations for Viequenses Interviews and Research by Victoria Jones June 24, 2006

2. Project Goals • To better understand the past and present health care opportunities in Vieques • To understand the needs of the community and the challenges associated with accessing health care/treatment • To collect a diverse set of opinions about access to health care in Vieques • To provide El Comité with new information that will hopefully benefit future projects for the community of Vieques • To provide a list of suggestions and alternatives to the existing system, based on the recommendations by those interviewed

4. Sample Interview Questions: • Describe the health care system that is available in Vieques • Do many Viequenses have health insurance and/or accessible health care providers? • Explain the transportation system that people take to reach a hospital or clinic • What recommendations do you have, or what would you like to see change with regard to health care access?

5. Interviews: • Ranged from brief 5-10 minute informal conversations, to 20-30 minute formal interview • Talked with 3 members of the medical community and 3 residents of Vieques

6. 2003 County Business Patterns for Vieques http://www.census.gov/epcd/cbp/map/03data/72/147.txt

7. Background Research • Considerable changes since 2003 census conducted • Relatively vague numbers when trying to measure accessibility and health care services • At present, unable to confirm the number of health care providers on the island • Consulted phone book for more information • Phoned/visited medical offices to understand the services that they provide

8. Available Resources in Vieques: • 3 private Doctor’s Offices (Campos, Figueroa, Rivera) • a Chiropractic center in Esperanza • 4 pharmacies • 1 hospital: Centro de Salud Familiar Susana Centeno. • 2 health clinics • 2 dentists • 1 general orthodontist • 2 psychologists on the island (one at Centro de Salud Familiar Susana Centeno, another in Isabel II, Sra. Rivera, who works with youth)

9. How far would you go to get medical attention? • The Centro de Salud Familiar Susana Centeno: • outpatient care and an emergency room • general medicine, pediatrics, psychology and gynecology • Internal medicine physicians and dentists occasionally come to the island to see specific patients, or work temporarily at the hospital • Very few sub-specialists • those in need of specialized care must make the difficult trip by ferry or plane to Fajardo and even San Juan medical facilities

10. An Incredible Journey by Plane • 18 miles of ocean lie between Isabel II and Fajardo, on the Puerto Rican mainland • Isla Nena Air Service Inc. • Vieques to San Juan 3 times a day • Vieques Air Link • San Juan, Fajardo, Culebra and St. Croix • advertises that flights are flexible and can be made by appointment • Air fare: ~ $70 each way to San Juan

11. Average flight time between Vieques and San Juan: 30 minutes

12. An Incredible Journey: Ferry • The Vieques/Fajardo ferry • twice a day • 1.5 hours each way • The financial cost is far less • $4.00 roundtrip for ferry, $30-50 taxi ride to San Juan • the time and health costs can potentially leave a greater impact • In Fajardo, sufficient clinics and doctor’s offices there to meet most patient’s needs • In some cases, trip to San Juan or another hospital is needed to receive necessary treatment

13. Distance from Isabel II to Fajardo: 18 miles Ferry time:1.5 hours Fajardo to San Juan: 35.51 miles Taxi Ride:45-60 minutes

14. Ceiba • • Distance from W. coast of Vieques to Ceiba:6 miles • Proposed bridge between Ceiba and Vieques • reduce the stresses upon patients - easier to travel back and forth - opportunity for physicians to come to Vieques

15. Interview Comments Travel: It is a big sacrifice to come to Vieques and have two medical practices It makes more sense to go to the mainland for treatment, particularly because the health plans cover services provided there It is a big coordination process to go to the mainland for treatment One woman was taken to the clinic after a miscarriage, but the doctors there could not complete the procedure so she was flown to San Juan Hypothetically, a bridge to Ceiba would improve the access of doctors and others to come to and from Vieques

16. Health Services in Vieques: One woman only uses the clinic for emergencies; the rest of the time she goes to the mainland for treatment When visiting that facility, some residents have difficulty knowing what resources are available and/or what office to visit or person to talk to Increasing populations on the mainland and growing health problems there are keeping many of the doctors from coming to Vieques There are not enough incentives for doctors to come to Vieques and the costs to come and set up offices are not high priorities for many doctors There is little communication between those in the medical community and with the municipality It is unclear whether the government and doctors from Vieques and other municipalities are discussing alternatives or new systems of providing health care

17. Recommendations from Interviews: • Better communication between the municipality and those in the medical community about the needs of citizens • A forum or committee that would hear the concerns of community members and develop advocacy group to represent the community • Discuss with government/community whether incentives should be provided to medical staff from the mainland • Transportation improvements • Meeting, community forum to discuss necessary improvements • Develop a ride-share program that could potentially ease the stresses of traveling for medical treatment • Education to inform people about health care opportunities and services in Vieques • Fliers, information sessions • Development of a forum for women and others in the community, since Women’s Alliance isn’t presently as active

18. Conclusion: • Research recommendations • Develop a comprehensive research study that looks at the health system and can investigate the funding options, such as grants, municipality financial resources, etc. • Interview Betsaya McKenzie, members of PR Department of Health, members of the medical community, as well as a larger sample size of community members • Additional questions to pursue: • What alternatives can be implemented with regard to transportation? • What incentives can be created to bring more doctors to Vieques, either permanently or part-time? • Who will facilitate conversation between community members, the medical community and the municipality in order to bring about change/alternatives? • Increasingly, teens in Vieques are getting pregnant. In addition to WIC and other financial services, what programs are available for young women?