MED Psychiatrist Goes to Puerto Rico on Humanitarian Mission

MED’s Lisa Fortuna, who was born in Puerto Rico and spent childhood summers and a year of her medical residency there, volunteered with Project Hope on a humanitarian mission to the island.

On September 20, 2017, Hurricane Maria, a category 5 storm, hit Puerto Rico with devastating force. Months later, approximately 40 percent of the island’s residents still do not have consistent electricity and 10 percent do not have reliable access to clean water. A recent New York Times analysis puts the death toll at over 1,000.

Lisa Fortuna, a School of Medicine assistant professor of psychiatry and medical director for child and adolescent psychiatry at Boston Medical Center, recently returned from a two-week humanitarian mission to the island with Project Hope, an organization specializing in post-disaster medical missions. Fortuna has deep ties to the island: she was born in Puerto Rico, spent childhood summers there visiting her grandfather, and chose to spend a year of her medical residency there.

She spoke to BU Today about what she learned in Puerto Rico about loss and resilience, and bending like the trees. The interview has been condensed and edited for clarity.

BU Today: Why did you go to Puerto Rico?

Fortuna: After the hurricane, I heard that Project Hope was asking for volunteers. So I applied, and they got back to me pretty quickly and said, “We’re getting requests from Puerto Rico for mental health providers,” because they were seeing a lot of depression, anxiety, post-traumatic stress disorder. They definitely wanted a psychiatrist. So I said, “Great.”

I said, “If I’m going to go, I’ll take medications.” And Boston Medical Center said that they were willing to donate medications. There were some hospitals in Puerto Rico that needed things like insulin and cardiovascular disease medications and antihypertensives. And so they donated quite a significant amount of medications—about $27,000 worth—that I took in a very large bag with me.

Is that the picture of you at an airport with a suitcase? Is that full of medication?

Yes. The yellow suitcase is meds. My clothes were in the backpack, but the medications filled the yellow bag. And there’s also a box in that picture, and that was the cold pack with insulin.

By the time I left, a lot of the health care was kicking in again. But for a while, people were short on pretty critical medications like insulin. So we distributed all of that, as well as antibiotics like amoxicillin.

Did it still feel like a post-hurricane zone, the whole place? Or did some places, like San Juan, feel like business as usual?

It still feels in between. In San Juan, restaurants and things like that were open, even though a large percentage of the people who were coming in were disaster relief, humanitarian groups that were there, and then some of the locals. The big hotels in San Juan, like El San Juan Hotel, are still trying to repair, still trying to deal with their electricity and everything else. They’re not open for tourism yet.

And the more you go into smaller towns and the rural areas, you can see houses there with no roofs, and people trying to live in them.

We were mostly in the southern and western part of the island, and moving up into the middle mountain area. The places that really got messed up were some of the places where the hurricane hit more directly. Everyone kept saying that if you had a cement house, you had a better chance. But the wooden houses, which are where the poorer people live, some of those were just decimated. They were just flat out, with furniture all over the place, everything broken.

You posted a photo of a sign on a leaning telephone pole that says “Puerto Rico se levanta” and then something else, but I can’t make it out. What does it say?

Yes, it says: “Puerto Rico will rise again—or get up. But how about this pole?” And people were putting signs on all kinds of things that had fallen, like “How about this? When is this getting up?” It’s people being sarcastic: “It’s three months. No electricity. The pole is still here.”

How did you work?

Project Hope set up at least a week in advance where we were going to be on what day. Every morning, we would pack all of our medications, our blood pressure cuffs, everything we needed, and we would go to the sites, setting up these mobile clinics.

I was the only psychiatrist on the team. The other people were family docs and emergency medicine. So they did a lot of the medical care, looking at hypertension, the thyroid, diabetes, but I did all the psychiatry.

There was a picture of you set up with a chair. Is that what you were doing?

Yes. In the triage, some people said, “I do want to go talk with her.” So I would always have my little separate area, and they could openly talk about what was going on and how they were feeling.

That’s when I heard all kinds of stories about loss and a lot of depression, anxiety, a lot of older folks who were overwhelmed by being alone in their homes, because a lot of families have moved to the mainland or to San Juan. A lot of the conversations I had with patients were about being alone in the dark at night without electricity and feeling really anxious and overwhelmed.

Do you think you were able to help them by listening to them?

I think so. I think listening to them validated what they were experiencing. There was this one woman who was just really crying—on top of the hurricane, she’d had a recent death occur, a few months ago, to cancer. And she just was very tearful at the beginning. And then as we were talking about the things that she used to do, the things that energized her to move forward (she was an elderly woman), she was saying, “Well, I took acting lessons for a while and I was acting in some commercials.” And she used to write songs, and by the end of it, she was singing the songs. So I think it was sort of a reminding of self, too. What do I do that helps me? What do I still have, in all this loss? And I think that was helpful.

What was your sense of the biggest need?

Electricity. Consistent, sustained electricity, because that’s holding up a whole lot in terms of businesses and tourism and people getting on with their lives again. And the older people who were so isolated were stressing out, because they kept saying, “By 5:45, the sun goes down and it’s dark, and it’s miserable already.”

In the mountains, it’s water. People kept saying, “We can’t believe that they haven’t figured out a way to help us have a regular water supply. We’re going down to the river and trying to get water.”

Were there events or experiences that were particularly striking to you?

There’s one photo of me with the kids by a bus. That was a group of kids that I met with up in Villalba, in the mountains. Those kids had just started school that week, since the hurricane. And so they were kind of excited about it.

And we were doing a little bit of deep breathing—the kid version—and then we were also talking about some yoga stretches. And we were talking about trees, and which trees survived. They were saying that some trees broke, some trees fell down, and they were talking about the flexible trees that flex with the wind. So we talked about being flexible like those trees. And so we did these yoga stretches and flexed, and talked about being flexible, being strong. And it kind of went with the theme of the trees and resilience.

It’s a theme that I heard, talking with people, even in the sadness: how to be resilient, how to flex with this thing, and how to feel reconnected with the roots and the culture and the Earth and each other.

I think Puerto Rico is still beautiful, so there are shots like that, that are at least reassuring to the diaspora that it’s still beautiful. The green is back.

For those who want to help, Lisa Fortuna suggests donating to the Massachusetts United for Puerto Rico Fund, which is dedicated to relief and recovery efforts in Puerto Rico after Hurricane Maria and supports grassroots organizations helping Puerto Ricans displaced to Boston and the commonwealth as a result of the destruction.