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MUSC psychologists find way to reach more trauma survivors

Puerto Rican project grows substantially during trip to hurricane-ravaged island 

Psychologists working with teachers
Psychologists Rosaura Orengo-Aguayo, left, and Michael de Arellano, center, show Puerto Rican teachers, counselors and social workers how do a mindfulness exercise involving Hershey's Kisses. Image from a video by James Monk
Helen Adams | adamshel@musc.edu | November 8, 2017

A team of MUSC psychologists planned to train about 600 teachers in Puerto Rico in how to help students traumatized by the impact of Hurricane Maria. They ended up having a much bigger impact on the storm-ravaged island.

Psychologist Regan Stewart says after they arrived in the U.S. territory last month, leaders in Puerto Rico’s Department of Education told them that they needed to reach not hundreds, as they were expecting, but thousands, of teachers, social workers and other people involved with children through the public education system.

“We had to go back to the drawing board and think about what we could do,” Stewart says. “That’s when we came up with ‘train the trainer.’”

“Train the trainer” is a way to quickly spread information by teaching someone how to teach other people. The MUSC team from the Department of Psychiatry and Behavioral Sciences would now do that in addition to the trauma recovery workshops it had already scheduled.

Luckily, all of its work could be funded by a 2016 grant from the Substance Abuse and Mental Health Services Administration and the National Child Traumatic Stress Network that focuses on helping children who have been exposed to traumatic situations.

Going With the Flow

Carrying out the newly expanded mission was no easy task. Just getting around the island was a challenge. MUSC psychologist Michael de Arellano says it rained every day. “The bridges were getting blown out. One of the places we were on the west coast flooded while we were there. Within 15 to 20 minutes, there were two feet of water running through the street.”

Ironically, making sure they had enough drinking water wasn’t easy, either. “I bought a water filtration system because we couldn’t drink the water in our hotel or anywhere else we went,” de Arellano says.

But the MUSC team says its challenges were nothing compared to what many of the people they met were dealing with: empty grocery stores and pharmacies; damaged or ruined homes; weeks without electricity or running water; and spotty or nonexistent communication with some loved ones due to minimal cell service.

Personal Perspective

The team of three psychologists and one intern already had some idea of what it would be like, thanks in part to the fact that two of its members grew up in Puerto Rico and have relatives there. Before leaving Charleston, the team packed eight large bins with basic, medical, personal and household supplies. Delta Airlines didn’t charge them baggage fees on their flight to Puerto Rico.

MUSC team

A school director in Bayamon, left, meets the MUSC team's Rosaura Orengo-Aguayo, Regan Stewart, Freddie Pastrana-Rivera and Michael de Arellano in a cafeteria before a training session. Photo provided
Among the supplies was something that would have an immediate impact: antibiotics. Psychologist Rosaura Orengo-Aguayo’s grandmother was seriously ill, living in a home for the elderly in the mountains of Caguas.

 “The only antibiotics the home had were the ones that we brought, and that kind of extended her life,” Orengo-Aguayo says. “We didn’t have the intravenous kind of things they really needed. What we had was a pill they had to crush and mix with water so she could drink it.”

Orengo-Aguayo, who moved from Puerto Rico to mainland U.S. several years ago to pursue her doctorate and is now an assistant professor at MUSC, was able to talk with her grandmother. “She was lucid with me a couple of times and was so proud. It was really nice.”

Since that visit, her grandmother has been moved to hospice care. “It’s tough because there’s a moment where you think, ‘If she did pass, would a funeral home be open?’”

Teacher Training

Puerto Rico is filled with people dealing with stress and loss these days, including many of the almost 350,000 children who are part of the public education system. As the schools that weren’t too badly damaged reopen, teachers, social workers and counselors will have some students who have been traumatized by the huge storm and their island’s agonizingly slow recovery.

But before they can help their students, school personnel need to help themselves. They, too, have been through a lot. So that’s where the MUSC team started in its trauma recovery workshops, de Arellano says. The psychologists were there at the request of Puerto Rico’s Department of Education.

Teachers in audience

Teachers try a relaxation technique they can use with students traumatized by Hurricane Maria and its aftermath. Image from a video by James Monk
“We taught them some basic skills like how to center yourself, ground yourself, manage your anxiety and understand that what you’re experiencing is normal. Having PTSD symptoms after something like this is nearly ubiquitous.”

Orengo-Aguayo says they also asked the school personnel about their experiences in the storm’s aftermath. “We divided them in groups, and they broke down the basic needs they’ve identified in themselves and the community, and the emotional needs as well.”

The psychologists then taught them about trauma in easy-to-understand language. Stewart says that includes such basic concepts as what trauma really is. “We talked about what events are potentially traumatic and common reactions to trauma - how your body might respond, how your mind responds, what you might see in kids at different developmental levels.”

The MUSC team showed the school personnel how to translate coping skills such as progressive muscle relaxation, controlled breathing and visualization and into exercises children would understand. In one, called La Tortuguita, intern Freddie Pastrana-Rivera showed how children can be taught to scrunch their bodies as if they’re turtles retreating into shells, then slowly come out of their shells and relax.

Despite the conditions, the MUSC team says the teachers, social workers and counselors maintained their focus. Orengo-Aguayo describes the first session. “That was 90 minutes. It was in a school that had no power, no water, no microphone, no power point, in a cafeteria. It was hot, and you have to really kind of be flexible and in the moment and engaging.”

She says some of school personnel had gone through a lot to get there. “We had social workers show us pictures of their road to just get to the workshop, going through landslides, boulders falling, dangerous conditions.”

Stewart says that didn’t keep them from giving their full attention. “They were very appreciative. They could tell others outside of Puerto Rico knew what was going on and were thinking of them and were coming to help.”

After the teacher workshops, the MUSC team held four-hour training sessions with social workers who could train colleagues and reach more teachers, continuing the psychologists’ work long after they returned to Charleston. MUSC sent a photographer to videotape the sessions, and a training video is in the works.

After the team wrapped up its time with the teachers and social workers, Stewart and Orengo-Aguayo stayed a few extra days to give trauma recovery workshops in Puerto Rican churches. The team reached a total of about 800 people directly and hopes that through its newly trained trainers and upcoming videotape, it can reach many more.

What’s Next

Return trips are definitely in the works, Orengo-Aguayo says. “Everywhere we went, we made sure to say that our commitment is not just today. It’s a four-year, five-year term, whatever it takes. Regan and I are actively looking for grants. And some people clapped. It was like, ‘Oh, you’re not just helicoptering in.’”

Stewart says they still have four years left on the grant that funded their work. “But it can’t cover everything they need. The Department of Education has requested universal mental health screening for all 350,000 kids on the island, and some other things that are just really large scale. So we’re actively seeking funding to keep that partnership going and give them what they need and what they want.”

Orengo-Aguayo says people on the mainland U.S. need to be aware that their fellow citizens in Puerto Rico aren’t back to normal yet – not even close. “Puerto Rico needs medical supplies, access to clean water and basic supplies ASAP. It’s important to continue offering aid and assistance.”

She’s proud to be from the island. “I’m now eating all my food, drinking all my water and being very grateful for everything I have. I think this trip really grounded me in what matters in life. And I’m thankful for that.”


'New normal' for MUSC psychology intern's family in Puerto Rico (MUSC News, Nov. 8, 2017)

MUSC psychologists take trauma expertise to Puerto Rico (MUSC News, Oct. 11, 2017) 

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