Programs to “solve” poverty only reproduce structural violence by perpetuating colonialism and reliance on the government.

For all Puerto Ricans, but perhaps especially persons with chronic conditions, the consequences of the collapse of the island’s health care system contributed to an ongoing fragility that has been long rooted in colonial governance, economic extraction, and bureaucratic mismanagement (Bonilla, 2020). In practical terms, post-hurricane journalistic and scholarly reports told of the historic scope of the collapse of the Puerto Rican health care system, which included: 1) all 69 hospitals left without electricity (Zorrilla, 2017); 2) drug shortages and bureaucratic barriers to dispatching medications to patients (Thomas & Kaplan, 2017); 3) major hospitals unable to operate for extended periods (Michaud & Kates, 2017); 4) patients with common chronic illnesses (e.g., renal disease, cancer, HIV/AIDS, drug addiction) unable to access services for weeks (Alcorn, 2017), resulting in many of the country’s approximately 4,645 estimated deaths attributed to Hurricane María (Kishore et al., 2018).1 The impact of this catastrophe on morbidity, mortality, adherence to treatments, and medical complications for individuals living with chronic conditions is only beginning to be documented (Abbasi, 2018; Michaud & Kates, 2017; Roman, 2018). Social scientists and scholars in allied fields have been quick to emphasize that the crisis of María did not emerge sui generis from this singular “natural” event. Rather, the storm’s devastating impacts have accelerated a decades-long series of neoliberal policy reforms and dehumanizing colonial governance strategies that privatized critical infrastructure and weakened social safety nets (García-López, 2018; Garriga-López, 2020). One of the means through which these governing logics are manifested is through the formation of bureaucratic institutions that are the interface between the public and forms of government assistance, which become visible ethnographically through federal, municipal, and local procedures, forms, applications, the proliferation of low- and mid-level technocrats, and “approval processes.” As anthropological scholarship on “red tape” and the quotidian practices of aid bureaucracies demonstrates, the provision of “aid” alone may not function to alleviate suffering among the most vulnerable. Indeed, in his classic ethnography of “red tape,” Akhil Gupta (2012) attributes the persistence of poverty in India despite the proliferation of poverty alleviation programs to the corruption and fundamental arbitrariness of these programs, offering a corrective to the presumption of a benevolent or merely benign aid bureaucracy. Indeed, he argues that poverty alleviation programs reproduce structural violence through the arbitrary nature of their effects, trapping individuals in endless transactions that ultimately reproduce the mortal levels of inequality they presumably are designed to address (see also Auyero, 2012).