Unimaginable Tragedy — Uncommon Opportunity

Until recently, the U. S.’s Federal Emergency Management Agency (FEMA) was only allowed to respond to disasters by replacing damaged infrastructure with nearly-identical pre-disaster equipment. So when Hurricane Maria crippled Puerto Rico’s fragile and outdated electrical grid in 2011, that vital service could only be replaced by newly-made fragile and outdated equipment. The result was as tragic as it was predictable with the island subsequently losing power after Hurricane Beryl (2018), Hurricane Dorian (2019), Tropical Storm Karen (2019), Tropical Storm Isaias (2020), Tropical Storm Laura (2020), and Hurricane Fiona (2022). Rather than envisioning and building a power grid that was hardened, distributed, and renewable, Puerto Rico’s power grid remains vulnerable, centralized, and only 3% renewable. [ 1 ]

Though there have been some recent changes to FEMA’s regulations [ 2 ], the urge –and sometimes the requirement– to rebuild what was damaged exactly as it was before is understandable. Governments don’t want to pay for gold-plated replacements and individuals can see such rebuilding as an act of strength and defiance.

Unlike the U.S., as far as I know, Ukraine is unfettered by regulations requiring disaster responses to be limited to replacement but not improvement. And not withstanding the tragic circumstances of the war and the personal costs to its citizens, rebuilding that nation’s health infrastructure could be an unprecedented opportunity; imagine designing a health care system that meets both present and future needs, is unburdened by the history of how western (or even Soviet) health care developed over the years, and incorporating technology to deliver better care to more of its people.

Ukraine and its many allied nations are already committing to rebuilding the nation’s damaged infrastructure. [ 3 ] This article will focus specifically on how Ukraine’s health care system, broadly defined, might be re-envisioned and rebuilt. Here are just a few ideas.

Integration of Mental and Behavioral Health
It is hard to imagine that anyone living in Ukraine today does not suffer from anxiety, depression, trauma, grief, survivor’s guilt, psychosis, suicidal thoughts, or any number of other, similar conditions. And it’s just as easy to imagine that many people suffering from…