For people new to the region from Puerto Rico, anxiety and depression often go untreated

WellSpan family doctor Paul Botros, based in Lebanon, said people new to the region from Puerto Rico face many of the same medical challenges as other adults — diseases like hypertension, diabetes and high cholesterol.

What may be less obvious, Botros said, is the incredible level of stress they endure after leaving behind their homes. He said he’s seeing high levels of stress-induced depression and anxiety among Puerto Ricans who came to the region after the September 2017 hurricane destroyed their homes and left them without jobs. “It’s a pretty tough situation. You lost your house. You lost your dog. You lost your family members. You’re in a whole new environment. You can’t find a job. It’s a very sad situation. That’s probably the chief complaint patients are coming in with.”

If that stress isn’t managed, it can lead to longer-term anxiety and depression, Botros said. However, mental health needs can be hard to focus on while trying to find food and shelter, care for children and hold down a job.

“Imagine losing your home and coming to a whole new place,” Botros said. “You’re with family for a couple weeks then it’s ‘this is my sandwich, this is my house, get out of my house, that kind of situation really builds up and makes the anxiety and the depression worse.”

That’s what happened to Carmen Carmona, whose story was featured as part of the Starting Over series. After Hurricane Maria, Carmona and her family spent three months in a shelter in Puerto Rico before making their way to Harrisburg to stay with a brother-in-law. Now, she says, her brother-in-law wants them out, and she’s been stressed out about finding a new home for her children.

“When we arrived, we thought my brother-in-law and his wife lived there,” she said, her words translated from Spanish by an interpreter. “But when we got there we found him, his wife, his mother-in-law, and ten more siblings. It’s been really hard. “

While problems of housing and employement come and go, stress often remains. Yesenia Colon-Lopez moved from Puerto Rico to Harrisburg 10 years ago. She said, although her situation has stabilized, she has been unable to get proper behavioral health and educational services for her son, Adrian Hernandez. When asked about her own life stress, she said she didn’t have time to think about it. 

Dr. Botros said it can be hard to convince people focused on survival to talk to a therapist about their stress. However, depression and anxiety can take an already challenging situation and turn it into a potentially life-threatening one.

“Stress increases cortisol in your body, which increases your blood pressure, which takes out your kidneys, which damages your heart, which with the high blood pressure causes a stroke. Stress is a killer. It’s really the worst thing you can have in your life.”

Though he can prescribe drugs such as anti-depressants, many people need cognitive behavioral therapy, and that’s not easy to facilitate if you don’t speak someone’s language and have to communicate over the phone through a translator. “Inflection, emotion is not really passed on to the translator. is lost in translation. The empathy is lost in translation as well. The patients sometimes feel very cold because we’re talking to a phone, they’re looking at a phone as well.”

Yesenia Colon Rivera is a psychologist at WellSpan Philhaven in Lebanon County. She said there are so few Spanish-speaking therapists in the area, she knows most of them by name.

“The common challenge that we share is that we’re booked,” she said. “We’re either going off a waiting list or referring them to other clinicians.”

However, people need therapists who speak their language and understand where they’re from, Colon Rivera said. “We were recently at a traveling resource fair promoted by the Commission of Latino Affairs, and I was just asking people, ‘How are you doing?’ in Spanish, and they were tearing up and wanting to give you a hug.”

Victor Rivera, originally from Puerto Rico, is a drug and alcohol counselor in Lancaster. He said the lack of Spanish-speaking mental health services isn’t a new problem, but Hurricane Maria has drawn attention to it “It has changed a lot. Because, you see, I have seen personally, there’s a lot of people who have came to Lancaster with more troubles, more situations, even financially.”

His program, part of the Spanish American Civic Association, includes seven Spanish-speaking counselors, some of whom focus on mental health issues, while others, like him, focus on addiction. He said many doctors and psychologists don’t have the resources to take on Spanish-speaking clients.

“They are not quite trained to work with diversity. In the addiction situation, you have a culture behind. And it’s different in every single group. And if you don’t address that… When you take a person, which is an addict, all that matters.”

Rivera hopes government agencies will pair up with churches and nonprofits to increase services for what he says is a heavy influx of people in need.

Yesenia Colon Rivera said that need is only going to increase.

“We are seeing great numbers of people coming in, but this is just the beginning. It’s estimated by 2020 that 14 percent of Puerto Rico’s population will be lost because people are staying here.

Despite the challenges they face, Doctor Botros says he doesn’t want to discourage people from visiting the doctor. He says, many offices, including his own, have social workers on staff who know how to connect people to the right resources in the local community.

As a note of disclosure, Transforming Health receives financial support from WellSpan.

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