Opinion: The astonishing toll of this ongoing emergency

Editor’s note: Brenda Rivera-Garcia, DVM, MPH is Senior Director of the Latin American and Caribbean Programs for Americas, a former researcher with the US Branch of Disease Control and Dengue Prevention and a regional epidemiologist in Puerto Rico. The opinions expressed in this comment are their own. Opinion More opinion Articles on CNN.


Across the world, mental health is having a moment, thanks in large part to the Covid-19 pandemic. We’ve never had so much focus on emotional well-being. months of IsolationAnd the afraid And the online education It has changed how we define our health.

But here in Puerto Rico, we’ve been through a lot even before the virus reached our shores.

The ongoing emergency, that is, life in Puerto Rico, has taken a heavy toll. nearly 10% He suffered from major depressive disorder before Hurricane Maria made landfall in 2017 — slightly more than the average in the United States — 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 intensified dramatically, with calls from people with suicidal thoughts or irreparable mental health conditions to the mental health hotline in Puerto Rico three times – 3050 calls From November 2017 to January 2018, compared to 882 during the same period the previous year.

Maria struck Puerto Rico on September 20, 2017. It was the biggest shock to our island in a generation. was millions Leave it in the darkSome for months. Thousands diedEspecially in the aftermath, due to the lack of communications, running water and power. We’ve never seen ourselves before This is weak and helpless. We are a resilient people, yes. But the storm has already tested our strength and shown us that we need to revisit preparedness plans at all levels. These conditions and the ongoing recovery work seem to have sapped the optimism that characterizes Puerto Rican society.

Nearly five years since Maria hit our island, on September 18 this year, Hurricane Fiona has delivered another knockout punch. With Maria, we thought we had a 100-year flood. But only half a decade later, another century seems to have flooded us: Maria is on our backs More than thirty inches of rain In some parts of the island over the course of two days and last week we sank Hurricane Fiona 31 inches in a 72 hour period. A week after the storm, nearly 20% of the island was still without potable water, and nearly 60% was still without electricity, According to Puerto Rican government data. 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, “I’m tired. It’s one crisis after another. I can’t take it anymore.” With many generations often living together, family members have always been each other’s rock. But what happens when that rock crashes?

What happens to those with mobility issues or conditions that weaken the immune system, who need access to water – for them, access to water is a lifesaving necessity to avoid infection and maintain good hydration. Or those who need electricity to run medical devices that allow people with respiratory illnesses to breathe or cool life-saving drugs like insulin?

I can certainly understand and sympathize. I was born and raised here, and after spending some time in the states, I went back in time nearly 30 years. In the months following Hurricane Maria, I have been leading relief efforts for Ameris and have seen firsthand the physical devastation, loss of life and emotional toll.

By the time we heard about Covid-19, we had been over two years since recovering from the hurricane, and still had frequent power outages and intermittent daily outages. Series of earthquakes in late December 2019 and January 2020 – more than 300 including 10 of magnitude 5.0 or higher, According to the US Geological Survey – It just shook the southern part of the island, and the families were too Sleeping in tents outdoors Afraid of being trapped inside the walls of their homes.

No wonder the need for mental health support continues unabated – especially for our first responders and caregivers. Health 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 Software mode To help caregivers learn coping skills so that they can take care of themselves and continue to help others. We bring psychological first aid knowledge and tools to first responders across the island. 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 connect these schools with community health centers.

This empowers those in the school environment to provide that initial assistance but also connects them to the next level of care, creating a pathway for those affected to receive the services they need most. We started training 154 school staff – teachers, counsellors, social workers and psychologists – in our first session this summer, and plan to continue the courses throughout the school year. We are receiving requests from schools, 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 it meets clinical criteria for post-traumatic stress disorder (PTSD), according to a study by the Medical University of South Carolina and published in the Journal of the American Medical Association.

Researchers found 45% of public school students surveyed in the months following the storm reported damage to their homes, nearly a third of whom experienced a lack of food or water and nearly 30% realized their lives were in danger.

While mental health programs offered by 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:

  • Provide more support to community health centers, which play an important role in supporting local communities in the wake of emergencies. They need accessible tools and training to strengthen disaster response plans while taking into account the particular vulnerabilities of their patients through the lens of disasters caused by climate change and adverse health impacts.
  • Ending the stigma around mental health care. We need to shift our thinking to integrate mental health training, developmental and social needs and support as an integral part of primary health services.
  • Incorporating concepts of trauma-informed care into the training of primary health care providers and first responders, not only in Puerto Rico but in many regions around the world. We also need to work on making mental, social and mental health support elements essential to preparedness and response plans.

Puerto Ricans—and anyone at risk of climate-induced disaster, which is most of society as a whole—could not be as unprepared again as we were when Hurricane Maria hit. as ours Climate change It helps with bigger and stronger storms, DroughtWith heat waves, rising sea levels, epidemics of mosquito-borne diseases and other situations, we need to redesign emergency preparedness plans and gain a more comprehensive understanding of health.

An emergency preparedness plan should mean more than folders full of plans that little is known to exist and even less prepared to implement. Central to any of these plans is the need for psychosocial and mental health preparedness.

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