Puerto Rico after Maria: Trauma team returns


Ten months after Hurricane Maria pummeled into the island of Puerto Rico, things have begun to get better.

Dr. Judith R. Milner

Dr. Judith R. Milner

Leaves are appearing on defoliated trees; the devastated rain forest is slowly improving. Wildlife is returning. Homeless dogs are reappearing on the streets. But how are residents faring in the wake of Maria’s devastation?

Despite some signs of recovery, mental – and physical – health problems are ongoing. The official death toll was recorded at 64, but a recent study by the Harvard School of Public Health estimates that it is closer to 5,000 (N Engl J Med. 2018 May 28. doi: 10.1056/NEJMsa1803972). Some reports show that the suicide rate on the island has soared by nearly 30%. Other reports show that unemployment has increased as has crime, and some estimates show that up to 200,000 people have left the island. As of this writing, thousands of people still are without power. And the hurricane season has begun yet again.

Week-long training gets underway

A few weeks ago, I joined a team of mental health professionals affiliated with the International Center for Psychosocial Trauma at the University of Missouri–Columbia (UMICPT) that went to Puerto Rico for a week. Under the leadership of UMICPT founder Syed Arshad Husain, MD, our goals were train our colleagues and teachers how to help children suffering from posttraumatic stress disorder after Maria. Several months earlier, our team had traveled to the island to train doctors, psychologists, social workers, and other mental health workers in San Juan and Ponce, and we were eager to return to continue our work.

Dr. Syed Arshad Husain shares his expertise about how to help children with PTSD and other mental health problems. Courtesy Dr. Judith R. Milner

Dr. Syed Arshad Husain shares his expertise about how to help children with PTSD and other mental health problems.

Upon our arrival in late May, we heard anecdotal reports of children manifesting ongoing and escalating symptoms of PTSD. In 2014, the U.S. Census Bureau reported that 58% of the children in Puerto Rico lived below the federal poverty level, and there is reason to believe that this percentage is even higher after Maria. The reasons are many, including transportation challenges, impassable roads, gasoline shortages, and the difficulty of tracking appointments without cell phone service. Other explanations include a shortage of clinicians, and challenges of parents who are preoccupied with the daily struggle of mere survival. Another deterrent is the stigma of mental illness.

Carlos Sellas, PsyD, a faculty member and supervisor of child and adolescent mental health clinics at Ponce Health Sciences University, attended the training. Dr. Sellas reported that somatic symptoms among the children had escalated after the hurricane. One child, whose grandfather suffered a myocardial infarction after Maria, repeatedly complains of chest pain. Pseudoseizures also have been observed.

Dr. Sellas said he also is seeing increased suicidal ideation and behavior in children and adolescents. In addition, some children are reporting auditory and visual hallucinations, and phobic reaction to rainstorms and lightening – in addition to fears of the dark.

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