The health care system collapsed and we saw that collapse on the almost 3,000 deaths associated with the storm, to the point that the system wasn´t even able to accurately count deaths and to properly handle the bodies with diligence and sensitivity.

If Hurricane María exposed the high incidence of preventable diseases among our population, the earthquakes showed some of their mental and emotional sufferings. Both instances reflected how sick we are, despite the thousands and thousands of funds the unsustainable health system absorbs.

Now, amid a pandemic, a leadership that lacks the skills to proactive and decisive management and to clear information joins these deficiencies, which increase risks. This undermines public confidence, which is essential in an emergency.

Until the last moment, health spokespersons denied that the island was at risk of contagion. Yesterday, they had not yet mapped out the logistics for testing on the island, even though they have the materials. Obstacles arise, partly, because the island depends on authorizations and restrictions imposed by the federal government. However, at the local level, there were no early efforts to coordinate the emergency response with the private sector.

Puerto Rico needs leaders with expertise, credibility, and clear data to be at the forefront of the coronavirus emergency. The island also needs to implement all the plans, resources, and protocols that are necessary to address and mitigate the spread of the disease. The change in direction and meetings with laboratories this weekend are positive signs in this direction.

The Department of Health needs to have experts to guide citizens in preventing the disease and the health sector to be prepared for a sudden increase of cases, such as those recorded in other countries.

However, not all deficiencies should be attributed to a single administration. Deficiencies reflect an underlying problem that the island will have to address as soon as the current crisis is over. It is urgent to transform Puerto Rico's health system, which, despite its problems, became a model for public health.

This is a decade-long need without governments willing to transform it at its roots. On the contrary, it has been used to move the political chessboard. Leaving the merit system behind to fill critical positions according to party interests has not contributed to it either. The health system needs those who lead to have the capacity, management skills, and vocation for service.

Inaction and indifference despite the deterioration of the people's health have allowed billions of Puerto Rican and U.S. taxpayer dollars to vanish in layers of administrative bureaucracy, while our doctors and nurses, whom we now need so much, were leaving the island.

The current emergency will force the entire health care system -public and private- to innovate in the sacred mission of saving lives. No other consideration can be powerful than joint action. Accurate and transparent coordination and communication are essential. Doctors' offices, emergency rooms, health centers, and hospitals have access to direct patient information and must be assumed to be part of the same ecosystem on which the health and well-being of all citizens depend.

No one would have wanted to reach the state of emergency the island is experiencing today, like the rest of the world. But this experience must lead to new ways of operating that open the door to a model of human and fair health care system that has the physical and mental well-being of the people as a priority.

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