1. Fauteux, Nicole


An expert in disaster nursing discusses COVID-19, Hurricane Maria, and emergency preparedness.


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The loss of her mother early in life has had a powerful influence on Abigail Matos-Pagan, DNP, ANPC. When she chose to become a nurse, she was following in her mother's footsteps, and the resilience she developed as a child sustains her to this day. A New York City native of Puerto Rican descent, she earned both a bachelor's degree in nursing and a master's degree focused on critical care before becoming an adult NP and joining the faculty at the University of Puerto Rico (UPR) at Mayaguez, one of her alma maters. In the early 2000s, she took a sabbatical to earn a doctor of nursing practice degree at Chicago's Rush University.

Figure. A little gir... - Click to enlarge in new windowFigure. A little girl greets Abigail Matos-Pagan in Puerto Rico, where she was deployed in the wake of Hurricane Maria. Photos courtesy of Abigail Matos-Pagan.

Today Matos-Pagan continues to teach and conduct research as director of the UPR Mayaguez Department of Nursing, but her passion-disaster nursing-regularly takes her beyond its walls. Since 2010, she has commanded Puerto Rico's Disaster Medical Assistance Team (DMAT-PR1), part of the nation's disaster response system. She also leads the Coalition of Nurses for Communities in Disaster, which she founded in 2003. She recently spoke with AJN about her experiences and her concerns for her community's health moving forward. Highlights of this conversation follow.-Nicole Fauteux


What led you to pursue a career in disaster nursing?


In 2001, when the towers came down on 9/11, I saw that we really needed to be prepared for anything. It's sort of a social responsibility. I am the director of a nursing program, but on the side, everything I do is disaster nursing-preparing nurses, training nurses, participating in and providing conferences. I give presentations, and with the students, I do simulations of disaster preparedness and response.


You also founded the Coalition of Nurses for Communities in Disaster. How does your organization support emergency preparedness and response in Puerto Rico?


We provide training and education for nurses and for other health care professionals-psychologists, medical professionals, paramedics, all kinds of multidisciplinary teams. I kept "nurses" in the name because a colleague of mine said, "There's not a lot of things that nurses lead, so let the name 'nurses' stay."


During the pandemic, the coalition was called on to help in vaccinating all the health care professionals. We were vaccinating 500 to 800 every week. Then the College of Physicians and Surgeons of Puerto Rico asked if I could go to a long-term care center to vaccinate 150 elders, and I said, "Of course, I can." When I went there, they told me they had already arranged with Walgreens to vaccinate residents, so I called the college and they said, "Take your vaccines wherever you think they'll be needed." That's how my nursing school colleagues and I started going to people's homes.


The patients were so happy that somebody was coming to their houses to vaccinate them. A lot of people didn't want to get vaccinated because they had a fear of the injection. One of the reasons patients called me the Queen of Vaccination was because, before I gave them the vaccine, I told them, "I'm going to do it in a scientific way." I bought my own needles-they were the thinnest, the shorter ones-and after the injection, patients were saying, "Oh, my God. I didn't even feel it!"


Before the COVID-19 pandemic began, Puerto Rico was still recovering from Hurricane Maria. How did you respond to that event?


When Maria hit, they needed someone who could help the federal agencies go into the mountainous areas and assess people's needs. We went to Orocovis, a town in the heart of Puerto Rico that was devastated. They had no way of communicating, no water, no food, nothing. When we landed, the people there started saying that they were not going to take anything from the army or from the Americans. They were refusing any help. It was just their pride, I guess. The people there are very nationalistic. But when I started talking to them in Spanish, they immediately changed. They took what we had for them, and they fed us beans and white rice and gave us a Puerto Rican flag. They were so grateful.


What types of missions have you been on in your role as commander of DMAT-PR1?


We get deployed nationwide, including Puerto Rico and all the territories, and even internationally to provide medical care in disasters. For example, during the humanitarian crisis at the U.S.-Mexico border, we were deployed to that area. One of the reasons was because a lot of the people spoke Spanish and they needed to get the story straight. We are also deployed for COVID and to assist hospitals to relieve their EDs.


When I started leading the team, there was a lot of resistance. Some of the men were saying that they were not going to be led by a woman, so I had a challenge to overcome. I started to be a model and demonstrated knowledge in the decisions I made. Soon enough, I got respect and a solid team. I care for my team members. They love what they do, and so do I.


How would you describe the health challenges Puerto Ricans face?


When I look around, I see the beauty of the island, and I also see the pain that people are going through. We have a lot of disparities. There's a large elderly population, and most of them have a lot of chronic diseases. The other day, I told an elderly woman she could go to the mall to get her second COVID-19 vaccine dose, but when she went, she had to walk from the parking lot to the mall entrance and then into the place where they were vaccinating. When she got there, she was very short of breath and her blood pressure was really high, so they said, "No, we can't vaccinate you." Those are little things, but they are big for a lot of people.


The pandemic was brutal to elderly people, being stuck at home with little or no contact with their families or other people. It was brutal to their mental health. Right now, we are seeing a lot of people with anxiety and depression. We've been dragging since Maria. I mean, sleeping under a tent, sleeping with water coming in. And with the earthquakes that we had in the south, a lot of people were sleeping in tents. As a result, we have more cardiovascular disease and uncontrolled diabetes.


What is your biggest concern for your patients and the community moving forward?

Figure. Abigail Mato... - Click to enlarge in new windowFigure. Abigail Matos-Pagan administers the COVID-19 vaccine to an elderly patient in the western part of Puerto Rico.

My biggest concern is the violence. I'm talking about domestic violence, drugs, alcohol, street violence. We're getting a lot of that. I'm worried for the elderly, that they've lost their quality of life. A lot of professionals are leaving the island because of the pandemic and the situation after Maria and the earthquakes. A lot of young people are not willing to stay and work for their country and their communities. I understand that they need to find a better life for themselves and their kids, but it's like leaving others behind when they need help.


What keeps you resilient and ready to face the next challenge?


I have grit, and I guess that goes back to my childhood. My mom died when I was nine, and I had to fight for everything. I think that gave me the courage to keep going, the flexibility and adaptability, so I learned how to survive and how to fight.


What would you like other nurses to know about disaster nursing?


Disaster nursing is hard work. You need to be focused on the mission, be resilient, and know that nurses can contribute in many ways just because they're nurses. I encourage nurses to respond in their own communities when there's a public health emergency or be available wherever they're needed, and they'll feel the appreciation. Everybody should do it. It makes you grow as a person and a professional.