? Resilience and Helpseeking in Health and Illness by and for the Elderly The devastating effects of Hurricanes Irma and Maria on Puerto Rico in September 2017 followed on a decades-long crisis in healthcare infrastructure, making that situation more severe. The situation was further exacerbated by long-term deterioration of the island?s electric grid and water supply, leaving the population without critical resources for months after the hurricane. The elderly within these communities were made even more vulnerable to the already existing public health infrastructure crisis. These conditions especially threaten the island?s older adults (>60, 22% of the population) who often suffer multiple chronic illnesses with shrinking resources for dealing with them. While research on immediate response to disaster and psychosocial resilience is growing, there is less focus on the social dynamics and organization of healthcare one and two years after the event. We propose an in-depth case study of resilience and medical helpseeking, post- Maria, in the Puerto Rican municipio of Cayey in the mountainous interior of the island, representing one of a series of areas hardest hit by Maria. For both lay persons and medical professionals, their initial, ad hoc solutions to medical problem-solving either prove effective and reliable, or they turn out to be transient and unreliable. Presumably, over time the former disappear, while the latter become stabilized, as people construct and define a ?new normal.? Our goal is to harness the powerful psychosocial concept of resilience to characterize the re-organization of medical helpseeking and coordinated treatment of the elderly, one and two years after Hurricane Maria. We propose to inspect at close range how these dynamics play out among families seeking help for their elders in post-Maria Cayey. We define medical helpseeking pathways as the social links that lay persons make to obtain information about, and access to, social assistance, pharmaceutical remedies, medical equipment, clinical diagnosis, physical or psychological treatment. This project has three specific aims: (1) extract how family members and neighbors (a) mobilized scarce material resources, (b) coordinated social networks, and (c) interfaced with health personnel to pursue effective helpseeking for the elderly in the aftermath of the disaster, (2) explore how health and social service professionals ?pressed and stretched? their local and extended professional networks to meet the medical needs of elderly patients, and (3) harness those situational and social factors that coalesce over time to forge effective helpseeking pathways, reliable access to resources, and social-structural resilience. Achieving these aims can provide the foundation for more effective and timely deployment of interventions to improve access to healthcare of elderly individuals caught in the long dure of post-disaster life while adding to a growing literature on the effects of disaster on the mental and physical health of older adults, with a unique contribution concerning the gradual solidification of a social and organizational new normal in the years after the disaster.
This study will reveal how individuals develop unplanned, yet stabilizing pathways to health care for their elderly family members one and then two years after hurricane Maria. Our proposed methodological innovations, including the use of social network analysis of narrative data, sociograms and correspondence analysis maps of helpseeking pathways, will offer an opportunity for close observation of the development of resilience and the emergent organization of ?new normal? in a variety of life-domains over a number of years. Through this study, we will harness the concept of resilience to characterize the re-organization of medical helpseeking and coordinated treatment of the elderly, one and two years after Hurricane Maria.
