Hurricane Recovery Efforts: A Case Study of the Healthcare Sector in the US Virgin Islands

Background and Purpose: In September 2017, the U.S. Virgin Islands (USVI) were impacted by two Category 5 hurricanes, Irma and Maria. The size and destruction of this disaster was unprecedented, devastating all three main islands of St. Thomas, St. John, and St. Croix. Even six months after the storms, the hospitals were not fully restored and homes were still in need of repairs. Many of the critical health challenges predated the storms themselves. This included long-standing historical and political systems, such as the unequal distribution of resources to territories as compared to states.

This case study sought to explore if a post-disaster scenario was an opportunity for increasing collaboration amongst key healthcare stakeholders, leveraging common resources, and developing a shared vision for what the healthcare system to best meet community needs within the restrictions of territory status (as opposed to being a state). There is very little literature on the USVI in general, and limited published reports on USVI healthcare in a post-disaster scenario.

Methods: A case study method was used to better understand healthcare recovery efforts in the USVI. Documents were analyzed for recurring and emergent themes. These documents consisted of official USVI government documents, US Department of Health and Human Services federal records, as well as health plans and assessments created by the University of the Virgin Islands, health providers, and USVI government agencies. USVI Senate hearings related to the health and recovery efforts were also reviewed. Additionally, local Virgin Islands media outlets were tracked over time (newspapers and radio). A substantial set of documents were six months of meeting minutes from working groups focused on different aspects of healthcare recovery ranging from mental health to environmental health. Memoing of the researcher’s process and thoughts was also a key methodological tool.

Findings: The review of key documents revealed that there was very little coordination or communication prior to the hurricanes, as well as a low level of preparedness. Many critical players had never met one another or been in a meeting together before. The healthcare system was stretched thin with an impaired workforce and significantly financially challenged. An absence of data for planning and measuring impact was a common statement. The designation of territory became a recurring theme related to the limitations imposed upon the USVI by the federal government. A key theme of self-sufficiency was raised by non-governmental entities. Key areas of focused collaboration emerged related to developing a healthcare workforce, fostering care coordination and community-based models of care, and establishing data systems.

Conclusion and Implications: Hurricanes and other natural disasters can radically disrupt a fragile and vulnerable healthcare system like the one in the USVI. Collaboration and communication are key to successful recovery efforts, and these dimensions should be included in preparedness plans. Lessons learned from the USVI are applicable to remote and isolated parts of the country with limited resources.