FOR- Programs - Puerto Rico

" Even when the bombing stops, the deaths from cancer won't stop"
- Dr. Cruz Maria Nazario

" Viequenses are an endangered species"
- Miriam Sobá, Alliance of Vieques Women

Sixty years of naval bombing on Vieques has had a devastating impact on the island and on the people. Now that the Viequenses have forced the most powerful military in the world to remove itself from the island, the very difficult task of rebuilding the island according to the needs and wishes of the people who live there is just beginning. Addressing the health needs of Viequenses is a central part of the next phase because the exposure to contamination has been so damaging:

• Vieques has a 27 higher cancer rate than the rest of Puerto Rico
• Cancers of the breast, cervix and uterus have increased 300% over the past 20 years
• Laboratory testing revealed that children on the island suffer poisoning from heavy metals such as arsenic, lead, mercury and bismuth.
• Viequenses suffer high rates of skin disease and respiratory problems
• Neurologists treating children in Vieques report relatively high rates of epilepsy, and development disabilities.

Zaida Torres of the Vieques Women's Alliance, also on the governor's Vieques Transition Committee

The Puerto Rican Department of Health, in response to repeated requests from the residents of Vieques, has been commissioned by the legislature to conduct a health study on the island. The aim of the study, as articulated by Dr. Juan Carlos Orango, Director of the Epidemiology Program of the Department of Health, is to study health issues in relationship to the environment, analyzing the Navy's impact and investigating potential sources of contamination. According to Dr. Orango, "Our hypothesis is that the Navy had an impact on the environment.. the point of the study is to lay the basis for prevention efforts in the future". The program is under design, protocols are being developed, the study has not yet begun.

In our delegation's meetings with physicians, epidemiologists, and professors of public health, there was universal support for the request from the people of Vieques for a systematic study of the health of the residents there. From the time that retired epidemiologist Dr. Rafael Rivera Castano first began to notice the high proportion of cancer deaths relative to the small population of Vieques (9,500), public health professionals have seen the need for an epidemiological study in order to provide early diagnosis and treatment. Discussions with faculty from the UPR, however, highlighted the highly political nature of such a study. Some forces obviously have a vested interest in reaching the conclusion that there is no additional health risk to Viequenses. "If the [Puerto Rican government] acknowledges a problem, they will be obliged to do something," said Cruz Maria Nazario, an epidemiologist at the UPR School of Public Health who coordinated an initial study of cancer in Vieques.

Mural on the inside wall of a former weapons bunker in western Vieques

There are also systemic problems that pose real challenges in conducting the epidemiological study. The first is the fact that the cancer registry in Puerto Rico stopped collecting data in 1994 as part of the "health care reform" on the island. This is a huge stumbling block to tracking morbidity and mortality rates for Vieques. The second obstacle is the fact that many Viequenses leave Vieques when they are faced with serious illness because access to medical care is extremely limited on the island. There is no cancer treatment available on the island. Cancer patients either have to take an hour-long ferry ride to Puerto Rico followed by a bus or car ride to the hospital for chemotherapy, an extreme hardship for someone who is in frail health, or stay with relatives or friends in Puerto Rico or the United States. Since many people leave Vieques when they are ill and die somewhere else, their deaths are not listed as a death on Vieques. This inaccuracy in data collection leads to a great deal of under-reported disease and artificially reduced mortality rates. A third concern in collecting accurate data has to do with the way death certificates are filled out. Physicians are asked to give both a cause of death and name underlying conditions. If the certificate is not filled out accurately, someone with cancer might be listed as dying of heart failure, which may have been the precipitating event but not the underlying cause. This can also lead to under-reporting of illnesses that could be attributable to contamination.

While everyone we spoke to supported the need for a health study on Vieques, there was also sentiment among many of the health professionals that early intervention efforts don't need to wait until all the data is in. Dr Rivera Castano detailed some of the many studies that have been done on Vieques, including studies on the food chain revealing the systematic presence of arsenic and studies of childhood asthma showing increased rates in Vieques. His conclusion, as a retired professor who taught epidemiology for decades, was that "all you need now is neurons working full time" to know what's going on in Vieques. Dr. Marta Bustillo, Professor at the UPR SPH explained her position, based on the precautionary principle. " We don't have all the data, but the data we have is enough to know that the exposure could be harmful… it's not up to the victim to prove it isn't harmful." Wary of the pitfalls of an epidemiological study that could be too narrow in its conception and subject to political agendas, Dr. Bustillo was offering a model of community-based "popular epidemiology" in which members of the community would be trained to document a broad range of diseases in Vieques and map the history of disease on the island. "You can use science, or the community's self-knowledge, but ultimately it's a political struggle."

- Above text and photos by Donna Willmott

From an Indigenous Alaskan Island to Vieques: A Testimony
The following account is by Jane Kava, a Yupik woman who is mayor of Savoonga and leader of efforts to address environmental health issues in her island community.

I traveled from St. Lawrence Island on the Bering Sea, February 7, 2003 and arrived to an island on the Caribbean Sea – Vieques.

I come from Savoonga, Alaska, which is located on St. Lawrence Island. There are two villages on St. Lawrence Island – Savoonga and Gambell. The population is about 1400 people almost equally divided between Gambell and Savoonga. Our island is located approximately 130 miles west of Nome, Alaska. The northwest end of the island is about 35 miles from Russia.

There are two formerly used defense sites on St. Lawrence Island. They are located at Northeast Cape, a traditional camping, hunting and fishing camp for Savoonga, and at Gambell, Alaska. The military camps were established during the cold war in the early 1950s and were used until the early 1970s. When the military left all debris was left, some of the debris was buried. Our people are suffering from cancer at alarming rates. We also have thyroid problems, diabetes, heart problems, low birthrate and premature babies and respiratory problems. There are no factories here, only the contamination from the formerly used defense sites.

Vieques is a truly beautiful island. I understood when I was invited on the peace and justice delegation that our problems would be similar. I didn't realize the extent of the similarity.

Because of the bombing of 63 years by the Navy and all the contaminants on Vieques, the people have the same health problems that our island has. Both of our islands' have to go to the mainland to see doctors or get treatment for illnesses. This causes hardships on having to leave family to go and get treatment, sometimes for extended amounts of time. There is limited 70 lbs. available and to go to the mainland is costly – even if air travel is paid, we have to worry about housing and food.

It is the hope of both our islands to hold the military accountable and have them clean up as much as possible so that our children and grandchildren will be able to grow up in a clean healthy environment. We will be able to again eat our traditional food.

- Jana Kava