Puerto Rico Prevention Leaders Take Action in Response to Hurricane Disaster

Transcription

1 Puerto Rico Prevention Leaders Take Action in Response to Hurricane Disaster On September 20, 2017, Hurricane Maria struck Puerto Rico, causing massive destruction. The Category 4 storm tore across the island with torrential rains and sustained winds of 155 mph uprooting trees, downing weather stations and cell towers, ripping off roofs, and levelling homes. Electricity was cut off for the entire island, and severe flooding made streets impassable. Entire communities were completely destroyed. It was the worst storm to strike the island in 80 years, taking scores of lives and leaving thousands homeless. An estimated 200,000 residents were forced to flee to the continental U.S.[1] Now, a year later, the island is still reeling from the effects of the storm. With a new hurricane season underway, Puerto Rico s substance misuse prevention leaders reflect on what they learned in the wake of last year s storm devastation. We knew we had to change the way we operated to help citizens affected by Hurricane Maria, says Juan Rivera Melendez, Deputy Administrator of Prevention and Health Promotion for the Mental Health and Anti-Addiction Services Administration (MHAASA), the island s state substance abuse prevention, treatment, and mental health organization. MHAASA receives funding from SAMHSA s Substance Abuse Prevention and Treatment Block Grant, Partnerships for Success (PFS), and other programs. How could substance misuse prevention remain relevant in the aftermath of such destruction, when so many residents were struggling to survive? How could it prepare for the future? These were the challenges faced by both MHAASA at the territory level and by the PFS-funded organizations in the island s communities. Together, state leaders and PFS grantees embarked on a process to learn how the hurricane had changed the prevention landscape and develop a strategy for moving forward. HEADING OUT INTO THE FIELD MHAASA leaders were committed to helping people devastated by the storm. But to do this they needed to re-examine community needs; reassess their substance misuse and mental health priorities, including prevention priorities; and support their prevention staff many of whom had personally suffered loss in the hurricane. To understand needs, MHAASA leaders headed out into the community to talk with local residents about their experiences. They visited people sheltering in emergency Stop & Go community relief centers. They met with community leaders to hear their stories. They saw the destruction with their own eyes trees and power lines down, flooded streets, collapsed. And

2 beneath the physical destruction, they were struck by the additional damage that could not be seen: the psychological trauma suffered by the disaster victims. We [substance misuse prevention leaders] wore the logo of our single-state authority agency (SSA), says Rivera Melendez. When people saw that, they didn t care that we were prevention. They saw us as representatives of the government and they asked for our help. They said, I need food. I need a prescription. I am in crisis. How can you help me? The landscape had literally changed overnight. Hundreds of buildings and homes had been destroyed or badly damaged, and thousands of people including many prevention workers were living in temporary shelters. We heard stories of death and loss firsthand, Rivera Melendez says. Conducting business as usual was no longer feasible. We knew our priorities and our strategy would have to change. We knew we had to switch gears. ASSESSING THE NEW REALITY To determine their new direction, MHAASA assembled a strategic planning team comprising substance misuse prevention, treatment, and mental health leaders working at the state and local levels. As a member of the MHAASA state staff, PFS Coordinator Yesenia Delgado Castillo served as a conduit between government leaders and the island s PFS 2015 grant subrecipients six prevention organizations representing both urban and rural communities. The state knew our local PFS organizations had a high sensitivity to the human toll caused by the hurricane disaster, Castillo says. They wanted to make sure these grantees felt empowered to be part of the state s planning process. Between November and December 2017, Castillo worked closely with these six community agencies to determine how they could best support their neighbors. To establish a foundation for their work, they consulted a literature review conducted by the University of Puerto Rico s School of Public Health on the impact of natural disasters on substance misuse. The review confirmed for them the reality that people who live through a disaster can experience emotional distress, and that the experience of surviving a disaster can exacerbate existing mental health and substance use problems.[2][3] Informed by these findings, the organizations set out to design and implement an environmental scan comprising more than 50 key informant interviews with PFS representatives, the communities they served, and the alcohol vendors with whom they had partnered in the past. The scan also included interviews with members of the island s PFS Prevention Advisory Committee, comprising community prevention leaders and partners.

3 The purpose of the scan was to refine the team s picture of current community needs. Questions explored the sub-recipients current conditions, including how the hurricane had affected organizational infrastructure and staff; the types of PFS relief efforts underway to address community needs, such as providing basic supplies, psychological support, and medical attention; how the hurricane had affected the alcohol vendors with whom the grantees had partnered; and observed changes in substance use patterns, including underage use of alcohol, controlled substances, and psychoactive substances. SHIFTING PRIORITIES The environmental scan was instrumental in shaping both the state- and local-level response to the hurricane. It revealed not only the physical destruction wrought by the storm, but the psychological trauma the island s citizens were continuing to experience. Specifically, anecdotal evidence revealed an increase in binge drinking, which had already been on the rise in Puerto Rico recent years. It also revealed that more people were using prescription drugs to control their anxiety and post-traumatic stress. On the state level, these findings led MHAASA to shift its immediate focus from underage drinking and tobacco use its pre-hurricane priorities to the escalating problems of youth binge drinking and prescription drug misuse. The findings also motivated the agency to broaden its definition of prevention. Months after the hurricane, many island residents were still without running water and electricity. In the wake of such widespread destruction, staff understood that effective prevention in the long term depended on their ability to promote survival in the short term. But addressing this level of need was new territory for many prevention staff members at both the state and community levels. Most of our prevention workforce doesn t deal with those kind of things, says Rivera Melendez, describing a state-level workforce more accustomed to preventing problems before they occurred. We needed to learn, in that moment, how to listen to people. We also needed to connect them with the services they needed to address issues they were confronting such as treatment and mental health services, Rivera Melendez says. To do this, we built relationships with emergency management teams on the ground, including the Puerto Rico National Guard, and with the police and fire personnel and mental health centers. To support their staff in this work, MHAASA provided trainings in crisis management, suicide prevention, and self-care. Our staff weren t immune from the storm s destruction, says Rivera Melendez. Many suffered great personal loss. We needed to make sure that our people took care of themselves, as well.

4 On the community level, the PFS organizations pulled together to make sure their existing prevention efforts could continue in the wake of the hurricane. In some cases, this meant one organization taking under its wing another that may have experienced more significant damage. Castillo extolled the resilience and willingness of community staff to support one another, to maintain their prevention infrastructures, and to keep the prevention work on the ground alive. I am very proud that we have good sub-recipients who are committed to their own communities and to themselves like a community of practice, she says. They re sheltering and supporting each other. If one organization lost its facilities, another would adopt it so staff could continue working. We take care of Puerto Rico s residents, and each other. PLANNING FOR THE FUTURE The 2018 hurricane season has begun. Rivera Melendez and other state leaders are being proactive as they prepare for what might lie ahead. Substance misuse prevention staff are part of local teams involved in training for natural disaster preparedness, response, and recovery. Important, cross-sector partnerships have been cemented. Community champions have also been identified to spearhead hurricane recovery efforts, communicate progress, and help plan for the future. In addition, Puerto Rico s state epidemiological leaders are preparing to conduct a formal data-collection study on how substance use patterns have changed in the wake of Hurricane Maria. These data will further inform and guide future prevention efforts. We are the prevention workforce, Rivera Melendez says. We have had to sit down, step back, and rethink our disaster plan. What are the skills we as prevention leaders need both individually and as an agency? How do we deal with the reality [of upcoming storms] in order for services to continue? The partnerships we have built in the communities, and the skills our prevention workforce have learned, have helped us prepare for what might come next. Prevention Solutions@EDC Training and Technical Assistance Provider Lourdes Vázquez has supported substance misuse prevention efforts in Puerto Rico for more than 20 years. For more information, contact Lourdes at lvazquez@edc.org. RESOURCES SAMHSA Disaster Preparedness, Response, and Recovery SOURCES 1. ReliefWeb. (19 January 2018.) Quick Facts: Hurricane Maria's Effect on Puerto Rico. Report from Mercy Corps. Available at

5 2. Substance Abuse and Mental Health Service Administration. (20 September 2017.) Disaster Preparedness, Response, and Recovery. Available at 3. Substance Abuse and Mental Health Service Administration. (24 September 2015.) Types of Disasters. Available at