By Deon Brown
New York:

It is a challenging task to care of an ageing population and their complex, multiple chronic health issues.

To care for thousands of them scattered across New York City as Hurricane Sandy roared ashore presented difficulties beyond measure and acts of heroism by their care-givers, many of them Caribbean nationals.

Approximately 100 deaths have been attributed to Hurricane Sandy in New York, New Jersey and Connecticut. Almost half of them were senior citizens, between ages 65 and 94.

The storm hit the sick and elderly, already a vulnerable population whose mobility was been compromised by age. The home health care business is a booming industry that attracts a large number of immigrant workers especially Caribbean women.

The majority are employed as home health aides (HHAs) where they take care of the daily needs of patients inside the homes. The complement of care also involves nurses and social workers who make scheduled visits and assist with the overall structure of home service.

But it is the home attendants who are the first line of defence for the patients and during Sandy, were literally their bulwark against death especially for those who are chronically ill, physically impaired or bed-ridden.

HARD HIT

It was a reality that was dramatised in the hard hit waterfront community of Far Rockaway where reports surfaced of a handful of home attendants staying watch over dozens of elderly citizens as the sea waters invaded their buildings.

Lelith Hill, a Jamaican who hails from Glengoffe, St. Catherine was the supervising attendant in the eye of the storm at the Sand Castles complex.

It was she who in fact asked several of her colleagues to come in for duty a day ahead of the storm to look after all their clients.The attendants are all employed to Partners in Care, an affiliate of the Visiting Nurse Services of New York (VNSNY), New York’s largest community healthcare agency.

Hill recounted the harrowing tale of watching boats, cars and household debris swirl in the sea outside as the waters quickly surrounded the 25-storey structure, rising to some 7-feet in the lobby, and trapping the 950 tenants in the darkness.

Hill along with some eleven other HHAs was in charge of about forty patients on different floors of the sprawling public housing complex.

However, they took it upon themselves to look after several other elderly tenants who are not part of their care system who lived alone and had no one to assist them.

What her staff was doing was being replicated by other aides across the city.

PITCH BLACK

“I was going from floor to floor with a flashlight because the building was pitch black to make sure the HHAs were okay as well as the patients,” Hill recalled.

“We had diabetics, amputees, COPDs (chronic obstructive pulmonary disease), mostly elderly folk.” A careful examination of published reports shows that many of them simply could not escape the floods, and were tragically drowned.

A handful of victims died after falling on wet surfaces in their dark apartments. Some died from hypothermia, others from fires caused by overturned candles or fallen trees that crashed through their houses; and a few from respiratory failure when their oxygen tanks stopped working as a result of the loss of electricity.

In most of these cases, the victims were alone. It is grim news no doubt but the death toll may well have been higher if not for the scores of home health aides who left their own families behind to look after the welfare of their elderly charges during the storm.

The small team of mainly Caribbean workers stayed with the clients for four days and assisted in evacuating most of them to facilities where they would get some comfort and warmth as by then the cold had set in and they were at risk of hypothermia.

WHEELCHAIR BOUND

“We had a lot of patients who were wheelchair boundÉ.we brought them down the stairs, from as high as the 14th floor, got transportation and evacuated them.

I personally sent out about 25. The ones that could go on their own, their families picked them up. We got their bags together and collected info’ on where they would be and followed up with the nurses and home health agencies for them,” Hill added.

But even as the home attendants were busy taking care of their clients’ needs, many of them would later learn that their own families were at risk when the sea water trespassed their homes.

Several of the aides including Hill lived near the beach in the Rockaways. Her home like so many others suffered the wrath of Sandy. One of the Jamaican aides on duty had left her mother home with her children, all of whom were trapped when the tidal wave surged into their first floor apartment.

They were rescued by a neighbour on an upper floor but lost everything. Some of the attendants also lost their cars which were parked on the streets and were immersed in flood waters.

Another Jamaican worker who was in fact off duty, also reportedly had a narrow escape and managed to flee with her husband to a nearby hospital as Sandy came knocking at her door.

They too lost their beach side house and all their possessions. But even as the hurricane wreaked havoc on people’s lives it also brought out a greater sense of community.

TURN AROUND

Ghislaine Chery, a Haitian-American nurse with VNSNY has worked in the Rockaways for more than ten years serving clients in the low income, crime-challenged neighbourhood with a deficit of trust for authority figures and outsiders.

Usually on her visits she’s accompanied by a guard, and for a long time, the residents were wary of her, thinking he might be working as an undercover cop. Sandy brought a turn around. “This time it was different,” Chery said.

“Being a nurse I was able to reach out to more peopleÉI brought them water. They knew I could help them, they trusted me.” She also mentioned that even family members who were seldom in contact with some of her sick clients had reached out during Sandy.

“I saw a lot of sharing and compassionÉa lot of closeness that wasn’t there before the storm. One sister would never visit her brother, my patient, not even for Christmas.

This time she did.” Chery like scores of other health care practitioners drove through flooded, debris strewn streets, avoiding power lines and braving dark staircases and hallways to see dozens of patients in the days following the storm.

There were wounds to be cleaned, medication to hand out and blood pressure to check. “In some cases, I was the only person who could assist them as some patients live on their own,” she stated.

VNSNY says some 5,000 nurses, aides and social workers were deployed to take care of about 36,000 patients in the city, and rendered assistance to persons who were outside their network as well.

The agency explained that it activated its emergency plan, putting safety measures into place several days ahead of the storm. On the weekend before the storm, nurses and nurse managers called patients to see if they would be evacuating, and to make sure those remaining at home had supplies-from flashlights and batteries to medication and oxygen tanks.

“Once we knew our patients were safe, we called far-off family members to let them know their loved ones would be cared for,” the agency said.

Before the subway and bus system was shutdown, Partners in Care sent home health aides to move in with high-risk patients so they would have food, medications, companionship and assistance with personal care throughout the storm and its aftermath.

Immediately after, the second tier of the plan was activated with teams of clinicians going out to visit patients to make sure they were safe and had supplies even as the workers themselves had problems with flooding, transportation, cell communication, and other inconveniences.

As state officials evaluate their disaster preparedness and emergency mechanisms in the wake of Sandy, it may well prove instructive to look at the response plans of agencies like the VNSNY in addressing the needs of vulnerable groups like the elderly, and the unique position of home attendants, often an ignored and low paid group of workers in the healthcare delivery system. Certainly their presence averted more tragedies.