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A Local Food Revolution in Puerto Rico

Food
Jaime Betancourt grows hydroponic vegetables in his Guaynabo, PR home for sale in local farmers markets. Preston Keres / USDA

A year has passed since Hurricane Maria first made landfall in Puerto Rico, destroying homes, roads and vehicles in its path—and taking thousands of lives. The island languished for months as an insufficient emergency response campaign attempted to restore basic services like water and power. After a recent independent study, the official death toll was raised from the initial 64 to 2,975; analysis done by The New York Times, citing malnutrition and other food-based ailments as possible culprits for surging mortality in the storm's aftermath, estimated that number could be more than 4,000.


How could this happen? By taking out the island's infrastructure like highways, trucks, gas stations and more, the storm also wiped out its agricultural supply lines. Puerto Rico imports about 85 percent of all its food, producing just 15 percent of what's consumed on the island.

In the wake of the storm, people stood in lines for hours and walked barely-stocked aisles looking for canned, non-perishable foods. Many relied on emergency responders and Federal Emergency Management Administration (FEMA) meals, made of packaged and processed foods that require little to no preparation, like the beef jerky and crackers you'd expect to find in a vending machine. In harder-to-service rural areas on the island, the threat of starvation loomed large.

"They say that during Maria, Puerto Rico only had enough food for one week," said Carmen Yulín Cruz, the mayor of San Juan, who became an international figurehead after calling out President Trump for his inadequate response to the crisis. "I hate to say anything positive about Maria. But what the hurricane did was force us to look at the realities of life here and how our dependency on the outside weakens our ability to ensure our people are taken care of. Maria made it evident that we need agricultural sovereignty."

The story of Puerto Rico's food production is also the story of the island's own colonial history. Large-scale plantations replaced native farming during Puerto Rico's days as a Spanish colony, resulting in the consolidation of agricultural land and landholding, as well as the number of crops being grown on it. When the U.S. took over the island in the wake of the Spanish-American War in 1898, economic restructuring meant that the remaining agricultural activity focused only on cash crops like sugarcane and coffee.

Then, in the 1940s, Congress launched Operation Bootstrap, a campaign to overhaul the Puerto Rican economy that focused on manufacturing and tourism—moving even further away from agriculture. Subsequent tax breaks and economic initiatives to encourage investment in these sectors solidified these moves. Deliberately, over the course of years, an import-driven food system was put in place in Puerto Rico, and all other farming fell by the wayside.

"Puerto Rico's economy has always been categorized by being an import economy: we produce things we do not consume but then we have to import things we do consume, especially in agriculture," noted Gladys González-Martínez, a professor of agricultural economics at the University of Puerto Rico.

Still, Puerto Rican local farming had been experiencing the beginning stages of a renaissance even before the storm hit, spurred by the economic crisis of 2006. According to statistics provided by the governor's office, farm income grew 25 percent from 2012 to 2014, while the number of acres under cultivation rose by 50 percent between 2012 and 2016, generating at least 7,000 jobs.

That progress was short-lived: 80 percent of the island's crops were destroyed in the storm. But, despite those losses, the seeds of a local agricultural had taken root. Some took the storm as inspiration.

At farms like Cosechas Tierra Viva in Las Piedras, run by Eduardo Burgos and Franco Marcano, where they grow kale, arugula, green beans and eggplant for local farmers markets, the storm kicked them into high gear. Just a month after Maria's landfall, they converted the farm to run exclusively on solar energy and shifted their irrigation system's source to rainwater. "Maria was the push we needed to execute the ideas we had to expand our production," Burgos told NBC News in July.

Aerial view of the Cosechas Tierra Viva farm in Las PiedrasCosechas Tierra Viva / Facebook

They're not alone. Agroecology—defined by the Food and Agriculture Organization of the United Nations as both a movement and practice of socially, economically, and environmentally sustainable development—is an approach to farming that promotes diversity through crop rotation, polycultures, or livestock integration, and uses natural systems and local knowledge like planting flowers to attract insects that keep pest levels under control. Using agroecology has allowed Puerto Rican farmers to envisage an agriculture system not reliant on external inputs from chemical companies and fossil fuels. And the idea is rapidly taking hold in farms, schools and community groups across the island. Already, organizations like the Puerto Rico Resilience Fund are supporting the movement by establishing sites like the student-run farm at the University of Puerto Rico's Río Piedras campus, while networks like the Organización Boricuá de Agricultura Ecológica de Puerto Rico are helping small farms like the Pachamama Bosque Jardín find their feet.

These projects are crucial for the island's food security, but also for its protection from storms that are likely to grow in intensity and frequency due to climate change. Surveys after hurricanes in the late 1990s in countries like Nicaragua and Cuba have shown that diversified, small-scale farms suffer less damage than bigger farms practicing conventional agriculture.

Already, the movement is making a noticeable difference. The Puerto Rican Department of Agriculture is aiming to have food imports down to 65 to 75 percent by the end of the year, which could represent as much as a 20 percent decrease on pre-Maria levels and a 30 percent drop from the island's post-Maria peak.

Ricardo Fernandez, CEO of Puerto Rico Farm Credit, sees signs of the transformation. People are flocking to farmers markets; university students are signing up for agricultural classes. "There's a resurgence now, because we have to re-invent ourselves," he says in a recent interview with NPR. For an island facing serious questions about its own colonial legacy and territorial status, local food may well be the first step towards a more independent Puerto Rico.

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Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Niq Steele / Getty Images

By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach

The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.

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We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.

Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.

What Is Guillain-Barre Syndrome?

Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.

Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.

To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.

Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.

The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.

Guillain-Barre Syndrome and Pandemics

As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.

Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.

Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?

The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.

Understanding the Association Between COVID-19 and Guillain-Barre Syndrome

While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.

It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.

Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.

Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.

Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.

Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.

Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.

Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Reposted with permission from The Conversation.


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Democratic presidential hopefuls Joe Biden and Senator Bernie Sanders greet each other with a safe elbow bump before the start of the Democratic Party 2020 presidential debate in a CNN Washington Bureau studio in Washington, DC on March 15, 2020. Mandel Ngan / AFP / Getty Images

By Jake Johnson

Unity Task Forces formed by presumptive Democratic presidential nominee Joe Biden and Sen. Bernie Sanders unveiled sweeping party platform recommendations Wednesday that—while falling short of progressive ambitions in a number of areas, from climate to healthcare—were applauded as important steps toward a bold and just policy agenda that matches the severity of the moment.

"We've moved the needle a lot, especially on environmental justice and upping Biden's ambition," said Sunrise Movement co-founder and executive director Varshini Prakash, a member of the Biden-Sanders Climate Task Force. "But there's still more work to do to push Democrats to act at the scale of the climate crisis."

The climate panel—co-chaired by Rep. Alexandria Ocasio-Cortez (D-N.Y.) and former Secretary of State John Kerry—recommended that the Democratic Party commit to "eliminating carbon pollution from power plants by 2035," massively expanding investments in clean energy sources, and "achieving net-zero greenhouse gas emissions for all new buildings by 2030."

In a series of tweets Wednesday night, Ocasio-Cortez—the lead sponsor of the House Green New Deal resolution—noted that the Climate Task Force "shaved 15 years off Biden's previous target for 100% clean energy."

"Of course, like in any collaborative effort, there are areas of negotiation and compromise," said the New York Democrat. "But I do believe that the Climate Task Force effort meaningfully and substantively improved Biden's positions."

 

The 110 pages of policy recommendations from the six eight-person Unity Task Forces on education, the economy, criminal justice, immigration, climate change, and healthcare are aimed at shaping negotiations over the 2020 Democratic platform at the party's convention next month.

Sanders said that while the "end result isn't what I or my supporters would've written alone, the task forces have created a good policy blueprint that will move this country in a much-needed progressive direction and substantially improve the lives of working families throughout our country."

"I look forward to working with Vice President Biden to help him win this campaign," the Vermont senator added, "and to move this country forward toward economic, racial, social, and environmental justice."

Biden, for his part, applauded the task forces "for helping build a bold, transformative platform for our party and for our country."

"I am deeply grateful to Bernie Sanders for working with us to unite our party and deliver real, lasting change for generations to come," said the former vice president.

On the life-or-death matter of reforming America's dysfunctional private health insurance system—a subject on which Sanders and Biden clashed repeatedly throughout the Democratic primary process—the Unity Task Force affirmed healthcare as "a right" but did not embrace Medicare for All, the signature policy plank of the Vermont senator's presidential bid.

Instead, the panel recommended building on the Affordable Care Act by establishing a public option, investing in community health centers, and lowering prescription drug costs by allowing the federal government to negotiate prices. The task force also endorsed making all Covid-19 testing, treatments, and potential vaccines free and expanding Medicaid for the duration of the pandemic.

"It has always been a crisis that tens of millions of Americans have no or inadequate health insurance—but in a pandemic, it's potentially catastrophic for public health," the task force wrote.

Dr. Abdul El-Sayed, a former Michigan gubernatorial candidate and Sanders-appointed member of the Healthcare Task Force, said that despite major disagreements, the panel "came to recommendations that will yield one of the most progressive Democratic campaign platforms in history—though we have further yet to go."

 

Observers and advocacy groups also applauded the Unity Task Forces for recommending the creation of a postal banking system, endorsing a ban on for-profit charter schools, ending the use of private prisons, and imposing a 100-day moratorium on deportations "while conducting a full-scale study on current practices to develop recommendations for transforming enforcement policies and practices at ICE and CBP."

Marisa Franco, director of immigrant rights group Mijente, said in a statement that "going into these task force negotiations, we knew we were going to have to push Biden past his comfort zone, both to reconcile with past offenses and to carve a new path forward."

"That is exactly what we did, unapologetically," said Franco, a member of the Immigration Task Force. "For years, Mijente, along with the broader immigrant rights movement, has fought to reshape the narrative around immigration towards racial justice and to focus these very demands. We expect Biden and the Democratic Party to implement them in their entirety."

"There is no going back," Franco added. "Not an inch, not a step. We must only move forward from here."

Reposted with permission from Common Dreams.