Publisher’s note: Brenda Rivera-Garcia, DVM, MPH is Senior Director of Programs for Latin America and the Caribbean at Americares, a former visiting scholar with the dengue branch of the US Centers for Disease Control and Prevention, and a territorial epidemiologist at the Department of Health of Puerto Rico. The opinions expressed in this comment are my own. View more opinion articles on CNN.
CNN
—
Around the world, mental health is having a moment, largely thanks to the Covid-19 pandemic. Never before have we focused so much on emotional well-being. months of isolation, fear Y remote education They have changed the way we define our health.
But here in Puerto Rico, we had already been through a lot even before the virus reached our shores.
The constant state of emergency that is life in Puerto Rico has taken a huge toll. almost 10% suffered from major depressive disorder before Hurricane Maria made landfall in 2017, slightly more than the US average, according to data analyzed by researchers from the University of Puerto Rico, Harvard Medical School and the University of Puerto Rico. from New York. And in the months after the storm, mental health issues escalated dramatically, with calls from people with suicidal ideation or decompensated mental health conditions to the Puerto Rico Mental Health Hotline tripling: 3,050 calls from November 2017 to January 2018 compared to 882 in the same period of the previous year.
María arrived in Puerto Rico on September 20, 2017. It was the biggest impact our island had suffered in a generation. millions were left in the darksome for months. thousands died, especially during the aftermath, due to lack of communication, running water, and power. We’ve never met before she is vulnerable and defenseless. We are resilient people, yes. But the storm really tested our mettle and showed us that we needed to review preparedness plans at all levels. These circumstances and the ongoing recovery work seem to have exhausted the optimism that characterizes the Puerto Rican community.
Almost five years after Maria hit our island, on September 18 of this year, Hurricane Fiona delivered another knockout blow. With Maria, we think we experienced a 100-year flood. But, after only half a decade, it seems that another century of water has engulfed us: Maria threw more than three dozen inches of rain in some parts of the island for two days and last week Hurricane Fiona drowned us with 31 inches in a period of 72 hours. One week after the storm, almost 20% of the island was still without drinking water and almost 60% was still without power. according to data from the government of Puerto Rico. Once 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 saying, “I’m tired. It is 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 breaks?
What about those with mobility issues or conditions that weaken the immune system, who need access to water? For them, access to water is a vital necessity to avoid infections and maintain good hydration. Or those who need electricity to power the medical devices that allow people with respiratory problems to breathe or refrigerate life-saving medications 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 almost 30 years ago. In the months after Hurricane Maria, I was leading the Americares relief efforts and saw up close the physical destruction, loss of life, and emotional toll.
When we found out about Covid-19, we had been recovering from the hurricane 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 magnitude 5.0 or greater, according to the US Geological Survey – had just shaken the southern part of the island, and families were sleep in tents outdoors afraid of being trapped within the walls of their houses.
It’s no wonder the need for mental health support continues unabated, especially for our first responders and caregivers. Health care workers, firefighters, police officers, and teachers have been on the front lines of this new and ongoing state of recovery, while also being survivors of multiple disasters.
Through Americares, we have launch programs to help caregivers learn coping skills so they can take care of themselves and continue to help others. We are providing psychological first aid knowledge and tools to first responders across the island. Most recently, we launched a pilot program to train teachers and others in the school community to better help their students navigate the psychological impact of disasters and to link these schools with local community health centers.
This is empowering those in the school setting to provide that initial assistance, but also linking them to the next level of care, creating a pathway for those affected to receive critically needed services. We began training 154 school employees (teachers, counselors, social workers, psychologists, and more) in our first session this summer, and plan to continue with sessions throughout the school year. We are receiving requests from schools and community health centers and other health organizations across the island to implement the new program in their communities.
Our children are especially at risk. In fact, more than 7% of children on the island meet clinical standards for post-traumatic stress disorder (PTSD), according to a study by the Medical University of South Carolina published in the Journal of the American Medical Association.
The researchers found that 45% of public school students surveyed in the months after the storm reported damage to their homes, nearly a third experienced food or water shortages, and nearly 30% perceived their lives to be in danger.
While mental health programs provided by aid organizations like Americares are essential to Puerto Rico’s recovery efforts, more can be done at all levels, from government to schools to local health centers. This includes:
- Provide more support to community health centers, which play an important role in supporting local communities after emergencies. They need accessible tools and training to strengthen their disaster response plans by considering the unique vulnerabilities of their patients through the lens of climate change-driven disasters and adverse health effects.
- End the stigma around mental health care. We need to change our thinking to incorporate training in mental health, social and developmental needs and supports as an integral part of primary health services.
- Incorporate concepts of trauma-informed care in the training of primary health care providers and first responders, not only in Puerto Rico but in many areas of the world. We must also work to make mental health and psychosocial support a key element of preparedness and response plans.
Puerto Ricans, and anyone at risk of climate-driven disasters, which is most of society in general, can never again be as unprepared as when Hurricane Maria hit. Like ours changing weather helps beat even bigger and stronger storms, droughtsheat waves, sea level rise, and epidemics of mosquito-borne diseases and other conditions, we need to redesign our emergency preparedness plans and have a more holistic understanding of health.
An emergency preparedness plan should mean more than folders full of plans that few know exist and even fewer are prepared to implement. And fundamental to any and all of those plans is the need for mental health and psychosocial preparedness.
.
