Editor’s Note: Brenda Rivera-García, DVM, MPH is senior director of Latin America and Caribbean Programs for Americares, a former US Centers for Disease Control and Prevention Dengue Branch-Guest Researcher and Puerto Rico Department of Health Territorial Epidemiologist. The views expressed in this commentary are her own. See more opinion articles on DailyExpertNews.
DailyExpertNews
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All over the world, mental health is having a moment, thanks in large part to the Covid-19 pandemic. Never before have we been so focused on emotional well-being. Months of isolation, fear and distance education have changed the way we define our health.
But here in Puerto Rico, we’d been through so much before the virus hit our shores.
The constant state of emergency that is life in Puerto Rico has taken a huge toll. Nearly 10% suffered from major depressive disorder before Hurricane Maria made landfall in 2017 — slightly more than the U.S. average — according to data analyzed by researchers from the University of Puerto Rico, Harvard Medical School and New York University. And in the months following the storm, mental health problems soared, with calls from people with suicidal thoughts or decompensated mental illness to the mental health hotline in Puerto Rico tripled — 3,050 calls from November 2017 to January 2018 compared to 882 over the same period the year before.
Maria hit Puerto Rico on September 20, 2017. It was the biggest shock our island has gone through in a generation. Millions were left in the dark, some for months. Thousands died, especially in the aftermath, as a result of the lack of communications, running water and electricity. Never before had we seen ourselves so vulnerable and helpless. We are resilient people, yes. But the storm really tested our mettle and showed us that we needed to rethink the preparation plans at every level. These conditions and ongoing restoration work seem to have wiped out the optimism that characterizes the Puerto Rican community.
Almost five years to the day since Maria hit our island, on September 18 this year, Hurricane Fiona delivered another knockout punch. With Maria we thought we were experiencing a flood of 100 years. But just half a decade later, it seems that a new century of water has enveloped us: Maria dumped more than a foot of rain in two days in some parts of the island, and last week Hurricane Fiona drowned us by 31 centimeters in a period of 72 hours. A week after the storm, nearly 20% of the island was still without drinking water and nearly 60% still had no power, according to Puerto Rico government data. Again, our air is filled with a familiar lullaby – the hum of generators.
More and more I hear from family, friends, neighbors and people on the street: “I’m tired. It’s one crisis after another. I can’t take it anymore.” With multiple generations often living together, family members have always been each other’s rock. But what happens when that rock is shattered?
What happens to people with mobility problems or conditions that weaken the immune system, who need access to water – for them, access to water is a life-saving necessity to prevent infections and maintain proper hydration. Or those who need electricity to power medical devices that allow people with respiratory diseases to breathe or cool life-saving drugs like insulin?
I can certainly understand and empathize. I was born and raised here and, after spending some time in the United States, I moved back nearly 30 years ago. In the months following Hurricane Maria, I led the relief effort for Americares and witnessed up close the physical destruction, loss of life and emotional toll.
By the time we heard of Covid-19, we had been in the recovery process for over two years, still struggling with frequent power outages and daily intermittent blackouts. A series of earthquakes in late December 2019 and January 2020 — more than 300, including 10 of magnitude 5.0 or greater, according to the US Geological Survey — had just shaken the southern part of the island, with families sleeping outside in tents for fear of trapped within the walls of their homes.
It’s no wonder that the need for mental health care continues unabated, especially for our first responders and caregivers. Health workers, firefighters, police officers and teachers are on the front lines of this new, steady state of recovery, while also being survivors of multiple disasters themselves.
Through Americares, we have established programs to help caregivers learn coping skills so they can take care of themselves and continue to help others. We bring psychological first aid knowledge and resources to first responders across the island. We recently launched a pilot program to train teachers and others in the school community to better help their students cope with the psychological impact of disasters and to connect these schools with local community health centers.
This empowers those in the school environment to provide that first aid, but also connects them to the next level of care, creating an avenue for those affected to receive much-needed services. We began training 154 school staff—teachers, counselors, social workers, psychologists, and more—in our first session this summer, and plan to continue these sessions throughout the school year. We are getting requests from schools, health centers and other health organizations across the island to implement the new program in their communities.
Our children are especially at risk. According to a study by the Medical University of South Carolina published in the Journal of the American Medical Association, more than 7% of children on the island meet clinical standards for post-traumatic stress disorder (PTSD).
The researchers found that in the months after the storm reported damage to their homes, 45% of public school students surveyed were short of food or water and nearly 30% believed their lives were in danger.
While mental health programs from aid organizations like Americares are essential to Puerto Rico’s recovery efforts, more can be done at every level — from government to local schools and health centers. This includes:
- Increase support for health centers, which play an important role in supporting local communities in the aftermath of emergencies. They need accessible tools and training to support their emergency response plans, taking into account the specific vulnerabilities of their patients through the lens of climate change-induced disasters and adverse health impacts.
- Ending the stigma surrounding mental health. We need to change our thinking to include mental health, developmental and social needs and support training as an integral part of primary health care.
- Incorporating concepts of trauma-informed care into training for primary care providers and first responders not only in Puerto Rico but in many areas around the world. We also need to work to make psychosocial and mental health support important elements of preparedness and response plans.
Puerto Ricans — and anyone at risk for climate-driven disasters, which is most of society in general — could never be more unprepared than when Hurricane Maria struck. As our changing climate helps create even bigger and stronger storms, droughts, heat waves, rising sea levels and epidemics of mosquito-borne diseases and other conditions, we need to rethink our emergency preparedness plans and gain a more holistic understanding of health.
A contingency plan should be more than folders full of plans that few know exist and even fewer are willing to carry out. And central to all these plans is the need for preparedness in the areas of psychosocial and mental health.