Red tape, slow emergency, and chronic disease management in post-Maria Puerto Rico

This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health-sector representatives throughout the island during and after Hurricane Maria. We conducted participant observation and qualitative interviews with chronic disease patients (n = 20) health care providers and administrators (n = 42), and policy makers (n = 5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after Maria experienced bureaucratic red tape as a manifestation of the colonial legacies of disaster management and health care. They describe a precarious existence in perpetual 'application pending' status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance.

Automated summary

This paper utilizes the concept of slow emergency to analyze the challenges faced by Puerto Ricans with chronic conditions and health-sector representatives during and after Hurricane Maria. The study highlights the bureaucratic barriers and colonial legacies that hindered access to essential services for those coping with chronic diseases in Puerto Rico. The voices of Puerto Ricans shed light on the sustained, slow emergency of colonial governance, contrasting with traditional emergency management approaches.