Johnson & Johnson joined forces with Americares to support disaster response efforts in Puerto Rico in the wake of Hurricane Maria in 2017 and continues to fund MHPSS programs aimed at promoting health worker well-being and resilience and strengthening community-based primary healthcare systems.
When Puerto Rico went into lockdown in March after the first COVID-19 cases were reported, it was still recovering from Hurricane Maria, the Category 5 hurricane that battered the island in 2017, and a string of earthquakes between December 2019 and January 2020 that included 11 quakes that were of magnitude 5 or higher.
But picking up the pieces and helping each other cope is what people do in Puerto Rico. It is something Ivelisse Morales knows too well. A clinical psychologist with close to three decades of experience in the field, Morales had a private practice when Hurricane Maria tore through the island. “It was a very difficult time,” she recalls. “I lost my office due to the hurricane. At first it was shock, and then I started moving and looking for ways to help the community and get back to work again, and I found Americares.”
Morales joined the Americares Mobile Medical Units as a Mental Health and Psychosocial Services (MHPSS) manager delivering emergency health services, medicines and supplies to isolated communities across the island in coordination with the Puerto Rico Department of Health and municipal health centers. Following the acute phase of the emergency, she helped Americares implement MHPSS and Preparedness Resiliency Programs for health workers struggling to manage the emotional aftereffects of the disaster. Between 2017-2019, the program reached more than 7,000 health workers and first responders island-wide, helping them build stress-awareness knowledge and tangible individual and collective coping skills.
The success of these programs and ongoing engagement with organizations that serve Puerto Rico’s most vulnerable communities led to an expanded Americares partnership with four health centers (in Patillas, Cidra, Naranjito and Mayaguez municipalities) and 20 satellite clinics. This effort aimed to integrate emergency preparedness and response within a more comprehensive health systems strengthening goal to improve access to primary care services, including mental health, in the most vulnerable communities with high numbers of uninsured or under-insured patients.
It was during this time that the earthquakes hit, displacing more than 9,000 people from their homes into temporary shelters established by the government. “We had a double burden with the earthquakes,” says Morales. “You had people already displaced, living with relatives after Hurricane Maria who were trying to rebuild a way of life, and many of them were displaced again.”
This included health workers and first responders who were experiencing mental health challenges themselves, as many of them came from the same communities. Morales describes health workers as a segment of people who need help but are not seen a lot of the time—the ones on the front lines every day providing care and comfort to others while dealing with their own emotional burdens as survivors.
At the direction of ASSMCA (the Puerto Rico government mental health agency), the Americares mental health team provided psychological first aid to children and adults temporarily housed in emergency shelters, as well as to the emergency responders. The team also conducted psychological first aid training to staff at primary care health centers and worked to reestablish services at health centers in affected areas.
Since March, as COVID-19 began to take its toll, Americares has expanded its support for clinics to include technical and operational support to equip the health centers with specific needs, including for PPE equipment and testing, and to elevate their preparation and response capabilities.
In addition, the MHPSS team prepared a series of mental health training modules to provide health center staff with strategies to manage both the fear, anxiety and stresses on the front lines with patients as well as to support them with their responsibilities at home and in their communities.
While preparing the training, Morales says the team took into account all the roles health workers play in their daily lives, including as heads of families, parents, siblings and neighbors. “The fear is real,” reminds Morales. “You face the fear of not only getting sick yourselves but putting your family and your loved ones at risk whenever you go out in the field. It’s present every time a health worker goes out to work and they have to deal with this emotional burden.”
Morales is proud of the work Americares is doing in Puerto Rico supporting health workers and the health centers. Helping patients get quality health care and live more productive lives, she says, is making their communities stronger and more resilient.
“We have been healing since 2017. Not only from the material challenges that a disaster brings, but the emotional wounds as well. It is layer upon another layer upon another layer. But our work is helping our communities heal, and that makes it beautiful and meaningful.”