MUSC to help with psychological first aid in Puerto Rico in Fiona's aftermath

September 23, 2022
Colorful view of the earth from orbit as Hurricane Fiona swept through Puerto Rico.
This image from the National Oceanic and Atmospheric Administration shows Hurricane Fiona as it hits Puerto Rico.

On Monday, psychologists from the Medical University of South Carolina will hold a training session at a university in Puerto Rico via Zoom. They’ll coach participants on how to offer psychological first aid in the aftermath of Hurricane Fiona on an island still recovering from the devastation of Hurricane Maria’s 2017 strike.

Rosaura Orengo-Aguayo, Ph.D., an associate professor in MUSC’s Department of Psychiatry and Behavioral Sciences, grew up in Puerto Rico and will lead the training session. She knows firsthand what it’s like to recover from a big storm in the U.S. territory, which gets walloped every seven or eight years. She’s also getting reports about Fiona’s impact from family members on the island.

“My mom and my sister and my brother are all fine, physically. Their homes are intact. None of them have power, and water just returned today. But everyone there knows a direct family member or friend who had flooding damage or losses.”

Some of those people are still scarred by the effects of Hurricane Maria, the most catastrophic storm to hit Puerto Rico in decades. It led to around 3,000 deaths by some estimates and took out a lot of the island’s infrastructure, including the electrical system.

Monday’s training session is a continuation of MUSC’s involvement with Puerto Rico, a connection that began after Maria. In 2017, a friend in Puerto Rico told Orengo-Aguayo the education secretary was looking for people who could come up with a comprehensive plan to help teachers and students deal with Maria’s aftermath. Schools were closed, utilities were out and loved ones were leaving.

For Orengo-Aguayo, it was a no-brainer. “I think as professionals, we sometimes leave the personal out of the professional life. But in our team, we're the opposite. I’m Puerto Rican, so that will forever be my home.”

Rosaura Orengo-Aguayo Headshot 
Dr. Rosaura Orengo-Aguayo

She and her colleagues used a grant they already had from the Substance Abuse and Mental Health Services Administration to train Puerto Rican teachers in how to take care of their own mental health while also caring for the kids who weathered the storm.

Since that team’s first visit in October of 2017, the MUSC psychologists have been back multiple times to continue their work. “In the last four years, we trained Puerto Rican providers to do trauma-focused cognitive behavioral therapy,” Orengo-Aguayo said.

They also conducted one of the largest post-disaster screening projects in U.S. history. It found most of the so-called “Maria generation” kids saw houses damaged on an island roughly the size of Connecticut, about half had damage to their own home, almost 58% had a friend or family member leave Puerto Rico, about a third had to deal with a lack of food or water and more than 15% still didn’t have electricity several months after the September 2017 storm.

Clearly, Maria was life-altering for the island and its people. The MUSC team knew its work needed to continue. So Orengo-Aguayo and her colleagues recently got five more years of SAMSHA funding for their work in Puerto Rico.

She and another bilingual MUSC psychologist, Regan Stewart, Ph.D., had already scheduled another trip to Puerto Rico before Fiona. “October 13th through the 25th, this trip was very much to meet with our partners in Puerto Rico. We're going to have a team retreat to discuss our goals and next steps,” she said.

“We also have four days going to a small island off the coast of Puerto Rico. That's a municipality called Culebra. And this island does not have a single mental health professional. So we're partnering with grassroots organizations to start the first ever telehealth program there so kids can get access to psychologists in the mainland, in Puerto Rico, in the island. So that's part of our trip as well.” 

They’ll also meet with experts at the largest community mental health center in Puerto Rico to follow up on needs and next steps. But Orengo-Aguayo said their work probably won’t stop there. 

“I suspect we'll be doing some relief work as well. It'll likely involve meeting with leaders and stakeholders of agencies to assess, ‘How do we support our staff? How do we support our students going back to school?’”

Familiar questions for a woman working to help the island she loves develop the mental health services it needs. “My mission still as a clinical psychologist is that future clinical psychologists don't need to leave the island to get the best training, the best care. So for me, until my career's over, it will be about capacity building so that Puerto Ricans stay in Puerto Rico.”