Villalba, Puerto Rico
Each time the clouds turn dark and a storm rolls in over this lush mountain village, Liz Torres’ mind flashes to that terrifying night last summer.
She sees herself huddling in her basement with her parents, the bloodcurdling howl of Hurricane Maria’s winds roaring outside. She remembers the storm ripping off the wooden roof of their house, then running upstairs again and again in the rain, trying to save whatever belongings she and her family could grab.
“I try to not think about it,” the 17-year-old said. “But it’s impossible because it was very traumatic.”
Eight months after the worst hurricane in decades pummeled this island territory, the stress left behind is still palpable. Uncertainty shrouds the commonwealth’s future as residents struggle to rebuild, the next hurricane season just around the corner.
While many mental health professionals are focusing their attention on adults, a group from the University of Minnesota is aiming to help children, too.
A half dozen doctors and medical students with ties to Puerto Rico are talking with administrators of the school here about plans to survey students to identify the scope and nature of their stress and determine ways to help.
“I think there is a lot of underlying stress in the whole situation on the island,” said Dr. Miguel Fiol, an associate professor of neurology who is leading the group.
With so many residents leaving for the mainland, Fiol pointed out, students have seen their friends uprooted and many schools are closing. While mental health advocates have called attention to the number of adults seeking help from suicide hotlines, children feel the stress, too, professionals know.
“Children don’t say ‘I am anxious,’ or ‘I am depressed,’ ” Fiol said. “Kids may not express it. Some do, but a lot of them don’t.”
Torres said teachers and administrators have encouraged students to talk in school about the strain, but many choose not to, pretending that life has returned to normal.
Torres got help by discussing it with a psychologist, she said, and she believes her classmates could benefit from talking more about it, too.
A couple of hours before the final bell was set to ring on a recent spring day at Torres’ school, Lysander Borrero Terry High, the lights went out — yet another power failure that afflicts the island intermittently.
Students immediately grew anxious to leave so they could rush to line up at gas stations to get fuel for generators, teachers said. They worried about powering computers at home to complete their homework, and charging their cellphones.
The anxiety is similar when a thunderstorm rolls in, English teacher Iliana Marrero said. Students run to the halls and look to the skies. They ask whether classes will be suspended.
Marrero gently reminds them that they are resilient and safe.
“I say ‘No, you’re not made out of paper,’ ” Marrero said, smiling.
But she and other teachers understand the reactions.
In the early days and weeks after the storm, Marrero recalled, teachers spread out to visit the families of the school’s 700 students. Some images will stick with her forever: Entire houses leveled, tree branches blocking roads and doorways, a 10-year-old girl searching storm debris for her shoes.
Even those who didn’t lose their houses lived without electricity for a while, Marrero said. Many had to resort to washing their clothes — and themselves — in river water.
“It smelled like fish,” Marrero said. “I hated it.”
When students returned to school in early November, Principal Zulma Ortiz called everyone to a central courtyard to pray and talk about the storm. Many wept.
“Everybody here suffered something,” Ortiz said.
Many students headed to the mainland with their families to start anew, Ortiz said.
Teachers have watched those who stayed struggle with changed living conditions as they try to manage homework and school activities. Several students have told Ortiz they won’t be going to college because they have to get jobs to help their parents rebuild.
One parent, Karla Merly, still sobs when she describes the hurricane destroying almost everything her family owned — their house and virtually everything in it.
A nurse, Merly was working a shift at a local medical facility and had sent her daughter and son to her parents’ house to wait out the storm. Now, they are all living there while they figure out what to do next. Merly had no paperwork to prove that she owned her house, which once belonged to her grandfather, so she can’t get federal help to rebuild it, she said.
Her daughter, Nashaly Colon, 16, said she saw all of her belongings scattered across her patio after the hurricane hit, and she still talks about the storm every day.
“All my mom’s effort was lost,” Colon said.
The mother and daughter said they think they could benefit from mental health assistance.
Ortiz, the principal, called the Minnesota doctors’ thought of creating a guide to help people talk about the storm “a great idea.”
Marrero, meanwhile, said she has had many conversations with students and tries to lend an understanding ear.
“But not all students have that trust in teachers, and they don’t open up,” she said. “Maybe learning a couple of strategies or techniques, we can be able to go further into their emotional status.”
Assisting from afar
Helping community members help each other — especially young people — might be the best way for Minnesota doctors to assist from afar, said Dr. Jordan Weil, who traveled to Puerto Rico this spring to meet with mental health professionals.
It was one of a few post-hurricane visits that Minnesota medical professionals have made, thanks to crowdfunding, a donation from El Fondo Boricua through the St. Paul Foundation, funds raised by the Puerto Rican Student Association and support from the Coalition of Puerto Ricans in Minnesota.
While the Minnesota group has yet to find statistics on children’s mental health in Puerto Rico, other studies have shown that children are particularly vulnerable to the effects of disasters.
A study released five years after Hurricane Katrina by the National Center for Disaster Preparedness found that more than 37 percent of children had received a clinical mental health diagnosis of depression, anxiety or behavior disorder, and children exposed to the hurricane were almost five times more likely than other children to exhibit serious emotional disturbance. Poor children were particularly vulnerable, the study found.
Teachers in Puerto Rico told Weil that students seem to be displaying more disruptive behavior, such as paying less attention to staff members, failing to turn in homework and getting into squabbles with other students more quickly.
“Right now, what we’re trying to do is identify the problem, get some idea of incidence or scope,” Weil said. “Hopefully from that we can develop some sort of intervention, whether that’s therapy or something else.”
Among the ideas: providing students with guidelines to host peer groups, Weil said.
Fiol said the group wants to work with professionals on the island and help any way they can, whether in school or outside it.
“We don’t want to be outsiders coming in to fix things,” Fiol said. “We want to be part of the effort and have them tell us how we can help.”
‘We could talk to teachers’
For Torres, a high school senior who wants to go to college to become an ophthalmologist, much of the stress comes from worrying about her parents, both of whom have had anxiety and high blood pressure. After the storm ripped off the top half of their house, her parents have been living in their basement while they rebuild, while she sleeps at her grandmother’s house.
The federal grant money that the family received wasn’t enough to make their house feel safe, Torres said. So they are using their savings as well as donations to remodel with the help of relatives and friends — this time building a cement roof better equipped to handle hurricane winds.
After she graduates, Torres said she will work while she goes to college so she can help her parents rebuild.
In the meantime, she has been using the coping methods that her therapist recommended: Distracting herself with hobbies such as drawing and painting, or going out with friends. Her parents and others have told her she’s proved to be a strong young woman. She credits the psychologist for helping her build resilience.
“Sometimes I think that I should have gone earlier,” Torres said. “A lot of students are scared to talk about [hurricane trauma] or they even feel ashamed.”