By Shreya Bansal
Medill Reports

Starting in late December, a series of earthquakes devastated southern Puerto Rico, forcing thousands to take shelter on the streets, in their cars and in government tents as their homes were destroyed. The situation left people on the island traumatized. At the time, many Puerto Ricans were still trying to recover from the shock of Hurricane Maria, a category five hurricane in September 2017.

When Maria hit, the island was already in the midst of an economic crisis, drowned in $70 billion of public debt. On top of that, the long history of living as a U.S. colony has worsened the natural disasters’ psychological impact. One disaster after another, along with the lack of mental health facilities, has led people to depression, committing suicide or drugs, according to leaders from various non-profit organizations who stepped up to help Puerto Ricans in lieu of adequate government measures.

COVID-19 has only added to the trauma, as the elderly population with a high proportion of underlying health issues lives in fear of getting the virus while also dealing with the economic impacts of the pandemic. Virus precautions have also made  seeking both mental health care and community support networks more difficult and complicated.

“It’s trembling every day, every night.”

The largest earthquake that struck Puerto Rico’s southern coast on Jan. 7 registered as a 6.4 magnitude and was followed by a 5.6 magnitude aftershock a few hours after. According to the Puerto Rico Seismic Network, the island has not seen this level of seismic activity since 1918.

Health and Human Services secretary Alex M. Azar II declared a public health emergency for Puerto Rico on Jan. 8 because of the quakes.

“Having seen your home and knowing that you can’t physically go in there is very traumatizing. You’re physically, emotionally, and mentally tired, and it’s trembling every day, every night,” said Helga Maldonado, regional director of the nonprofit ESCAPE, an organization that stepped up to help affected areas after the earthquake.

Maldonado, along with members of her organization, went door to door to find out how they could help. Mental health services were the top necessity people reported, she said. ESCAPE, along with the Association of Puerto Rican Psychologists and other non-profit organizations, provides free psychological services to the survivors of natural disasters.

“It’s trauma on top of trauma on top of trauma,” said Maldonado. The lack of action from the government left people anxious and helpless, she said. “After all natural disasters, all the societal issues are exposed and it’s basically like you’re undressing the country.”

The government provided shelters for the people affected by the earthquakes, but the arrangements were chaotic and created problems. According to Maldonado, women who experienced sexual violence were put in the same tents as their aggressors. People who had committed sexual assaults were allowed in these shelters with victims who had experienced sexual violence, Maldonado said. The government didn’t maintain a registry or survey the population to guard against continued victimization, she said. “If you go to one of these shelters and ask the director, what is your protocol if somebody experiences abuse within your shelter, they can’t show you anything because they don’t have a protocol,” said Maldonado.

“Drug addiction can occur, and you can’t imagine going through experiences that are so horrific.”

Members from another organization, Intercambios, in Fajardo, Puerto Rico, go around the streets talking to people and providing them counselling services and, if they struggle with addiction, various harm reduction strategies like providing them with clean needles. “After Hurricane Maria, there has been collective trauma,” said Intercambios director Rafael Torruella. “Maria only opened up so people can see how fucked up Puerto Rico is and always has been.”

The state doesn’t care about the poor people on the streets with a drug problem, said Torruella. “You need psychologists and doctors to help these people, we can’t just shout at them.”

Even as the mental health crisis causes many people to self-medicate with drugs and alcohol, a shrinking economy has led to fewer drug and alcohol treatment options in Puerto Rico. The island is a federally designated High Intensity Drug Trafficking Area due to its location in the Caribbean and status as a U.S. Commonwealth. The drug trade thrives in Puerto Rico in part because contraband can be transported to the mainland with much less scrutiny than at other ports, experts say. This has contributed to high crime rates and the abuse of illicit substances, especially heroin. Because of the economic crisis and what many call a lack of political will, the Puerto Rican government has been unable to do much to curb its drug problem.

“I think colonialism has traumatized us.”

The Caribbean island became a U.S. colony in 1998. Even though the U.S. granted citizenship to the people of Puerto Rico in 1917, individuals on the island cannot vote in presidential or congressional elections in the U.S. At the same time, the U.S. territory is primarily governed by federal laws, which limit the power of the island’s government.

“The U.S. government is the one that dictates the structure of your government. You can’t even vote or decide the structure of the society you live in, knowing that in many ways it is deeply corrupt. You don’t have a voice. You can yell and yell and yell, and then nobody gives a shit,” said Torruella. “Turning to drugs is a way to gain control.”

The people of Vieques

In addition to the effects of Hurricane Maria, half a century of military presence and bomb testing, which ended only in 2003, has put the people of Vieques, an island off Puerto Rico’s east coast, in a vulnerable position.

The economic and environmental devastation wrought by the Navy has a huge cultural and psychological impact on the people of Vieques, according to experts. “Depression, alcoholism, drug addiction, futility, fatalism, all of that can occur and you can’t imagine going through experiences that are so horrific,” said Monisha Rios, a clinical psychologist and U.S. military veteran, who recently moved to Vieques, where she has family roots. “A lot of my cousins who left say they will never come back. A lot of kids turn to drugs.”

“There’s also a lot of internalization of the oppression among the people on the island,” she said. “They blame themselves.”

Collective fear and stigma

“There are not enough therapists or psychologists. It is a collective fear and the therapists also need therapy,” said Carlos Jorge Guilbe Lopez, a University of Puerto Rico geographer with a focus on social issues.

Natural disasters lead many Puerto Ricans to leave the island. Younger people are leaving for the mainland U.S. They often don’t take their parents along because living in the U.S. is expensive. That means older people are often left behind with nobody to take care of them, and they get depressed. Suicides rates have risen since Hurricane Maria; Puerto Rico recorded 254 suicides in 2017, in the aftermath of Maria, a 28% increase from 2016.

“We either don’t have time to recover from the trauma, or we’re rejecting the new reality. The reality that we are nothing,” said Rios.

The stigma around mental health on the island also makes it difficult for people to work through their trauma. “It creates a barrier where you cannot even necessarily accept in yourself that you need to heal,” Rios continued.

A pandemic within a pandemic

The hospitals and health professionals weren’t equipped to handle a lot of things before COVID-19. With this new situation, there’s an added amount of stress and burden being put upon them, said Oscar Ojeda Cana, a student activist at the University of Puerto Rico who helps communities manage water systems.

A lot of health professionals and doctors have long been telling the government that there weren’t enough hospitals adequately prepared to handle trauma cases. Puerto Ricans had long asked the government to build new hospitals specializing in trauma care, Ojeda said. The lack of adequate healthcare only led to the feeling of anxiety, terror and isolation that many have struggled with during the pandemic.

Meanwhile, with a strict curfew in place for some time and the need to continue isolating, people in Puerto Rico are having trouble dealing with isolation and this new form of living, said Zoeli Ayala, a psychologist at Taller Salud, a community feminist organization that has also provides trauma-related psychological services, especially to women and children.

One of the most difficult things to overcome during the pandemic has been “the mistrust in the government,” she said.

Allegations against Puerto Rico Gov. Ricardo Rosselló and large scale protests against his administration across the island led him to resign in August last year, under the threat of impeachment.

On top of corruption charges against officials in his administration, the Puerto Rican nonprofit Center for Investigative Journalism released private chats between Rosselló and his officials that made light of Hurricane Maria fatalities, and various other homophobic and misogynistic messages, causing an uproar among the people.

“Anything they talk, say, or do, we don’t trust it,” said Ayala. After Maria, a lot of schools shut down and never reopened, and children had to transfer to new facilities. That shift was hard on children, said Ayala. With the pandemic, children are again finding it hard to adapt to changes in their education and daily routine. “There are a lot of behavioral changes in the students. One of the things (parents) are pointing out are panic attacks and anxiety. It has been difficult for them to adjust to this new environment.”

Amidst the coronavirus pandemic, Ayala says there lies another. “In Puerto Rico we call gender violence another pandemic,” she said. Ayala works directly with victims of gender-based violence. Because many women are stuck in their homes with their aggressors, there is increased concern for their safety. Taller Salud has started a 24/7 emergency help line and tried to constantly check in on these women.

More than 150 women have been killed by their intimate partners in the past decade in Puerto Rico, as reported by Types Investigation. There was a rise in intimate partner violence in 2018 in the aftermath of Hurricane Maria, according to Types Investigation, with at least 23 women on the island of 3.2 million killed by their current or former intimate partners that year.

“Women continue to get killed and affected by gender violence in many ways,” Ayala said. “The best thing that our government can do is declare (Puerto Rico) an emergency state to attend to the problem of gender violence.”

Ojeda said the failings in the government’s response, to the pandemic and past disasters, “obviously hurts but it doesn’t surprise” Puerto Ricans. After Maria, Puerto Ricans saw how the government mismanaged resources. People on the island have been forced to come up with different solutions with different ways of living. “After Maria, it became clear that we weren’t as developed as we thought we were. We weren’t as prepared,” said Ojeda.

Spreading light through theater

As Ayala noted, children have been particularly impacted by the recent succession of crises — Hurricane Maria, the earthquakes and the pandemic, on top of the debt crisis. “The children feel like they have no hope, they are going through trauma and loneliness,” said Julio Morales, one of the members of the theater company Teatro Y No Había Luz, or The Company of Theater and No Light.

The theater collective aims to help students express their emotions through art and performance and to provide resources to the schools and parents to help their children with anxiety. Established in 2005, the theater group uses an interdisciplinary approach to talk about social justice issues, build a sense of solidarity and encourage creativity and freedom of thought among children.

The members of the theater company themselves are also survivors of trauma from Hurricane Maria and the other challenges that have befallen the island. Travelling and performing around the island is also a way for them to heal, said Yussef Soto Villarini, one of the team members. “The message we want to give is that of solidarity and unity, a way of telling them we are here and we are feeling the same.”

Shreya Bansal covers social justice at Medill. You can email her at shreyabansal2020@u.northwestern.edu.