House Calls Podcast

What Do Natural Disasters Mean for Our Mental Health?

With guest Dr. Rosaura Orengo-Aguayo,

Clinical Psychologist & Trauma Specialist

Hello and welcome to House Calls. I'm Vivek Murthy, and I have the honor of serving as U.S. Surgeon General. I'd like to introduce you to Dr. Rosaura Orengo-Aguayo, a clinical psychologist who specializes in trauma. We believe conversations can be healing. And today, we'll be talking about how natural disasters affect our mental health. In this episode, we explore how we can help each other in the face of hurricanes and other climate disasters. When Dr. Rosaura Orengo-Aguayo returned to Puerto Rico to see family after Hurricane Maria in 2017, she faced the devastating reality that we are living in a time of increasing natural disasters. For her, it was really personal. She found her father's psychiatry clinic destroyed. Roads ruined. And the power gone. The impact was not only on infrastructure, it was psychological, too. In Puerto Rico, people were scared and hopeless, and the official death toll had climbed to nearly 3000 people. Dr. Rosaura Orengo-Aguayo is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. She's also a specialist in trauma. Witnessing the psychological toll the hurricane took on children and adults, Orengo-Aguayo and some colleagues jumped in to help. They trained community members in psychological first aid, which gave storm survivors a way to recover from the fear and hopelessness that had set in. It also gave them a way to be better prepared for next time. Fast forward five years and we're reeling from the more recent devastation of Hurricanes Fiona and Ian. As news media and public attention starts to move on. We want to take a moment to refocus on the communities directly hit and still living with the catastrophic consequences of these hurricanes. What does living in a world of worsening natural disasters mean for our mental health? How can we better prepare ourselves in this shifting landscape? And most of all, how can we best help each other, especially those directly impacted? And how can we move forward from a place of despair to a place of hope? This conversation gives us an anchor. Lastly, the House Calls team is eager to hear from you. Please take a moment to rate and review the podcast and send us your ideas at HouseCalls@HHS.gov

Rosaura, thank you so much for joining me for this conversation. I'm just really looking forward to it.

It's my pleasure to be here. I'm very excited.

Well, the reason that I wanted to have this conversation was because it feels like in the last couple of years there have been so many extreme weather events that we have gone through in the United States and many more around the world, whether it's hurricanes or tornadoes that people have had to deal with, whether it's earthquakes, floods, forest fires, you name it, those experiences have come to our doorsteps. And while we we see the pictures of the physical toll that this takes on our lives and in our communities, the mental health toll is often quite underappreciated, and it often, often lingers long after the last home is rebuilt and the last camera crew has left. And so I wanted to have this conversation today with you, because this is your area of expertise and you've done such amazing work on looking at the impact of these types of trauma, you know, these types of events, rather, on our mental health and well-being. So I thought I would just start with what just happened, which is that you just got back from from Puerto Rico, which, as we all sadly know, was recently hit hard by Hurricane Fiona. And so tell us, how are people doing there and what did you see?

Yeah. So my team and I went down there about a week and a half ago and, you know, this was very difficult because Hurricane Fiona was a Category One storm. So we would have expected less damage than Hurricane Maria. But unfortunately, the southwest part of the region was just devastated. So some of my colleagues that work on my projects don't have electricity, don't have running water, and it's been a few weeks. And then if you go to the other side of the island, the east coast, we were in a municipality called Culebra, which is a small island off the coast of Puerto Rico. And they, too, are struggling with power outages and lack of water. So I think the first thing we need to understand about disasters like hurricanes in particular is that they're cumulative and people don't fully recover and it just adds one on top of the other.

Yeah, that's such a good point. They are cumulative. These aren't happening in isolation. And of course, five years ago, in September 2017, Puerto Rico was hit, of course, by Hurricane Maria. And there have been other challenges that the island has faced over recent years. Now, you're an expert in in trauma. And I'm curious how you define trauma.

So a traumatic event is something that ranges outside of the human normal experience of everyday day to life. I kind of explain it to my students as we all get in, you know, stuck in car traffic and maybe we're late for a meeting and our boss is mad and that's a very stressful event, but that's not traumatic. Trauma is when we feel like our lives, the lives of someone else are in danger or we're being violently attacked or we've been sexually abused. And it's an event that marks your life in such a way that not everyone, but some people, may not bounce back after a period of time, and they may have things like flashbacks and difficulty sleeping and feeling very jumpy and disasters can be a traumatic event, particularly when children or adults feel like their lives are at danger.

Exactly. And I think by that definition, it seems like what many people have experienced during these hurricanes in their aftermath would qualify as trauma. Would you agree?

Absolutely. To give you an example, about 5 to 9 months after Hurricane Maria in September 2017, our team partnered with the Puerto Rico Department of Education and conducted the largest mental health screening effort in history. Over 96,000 public school students were screened. And what we found was very, very concerning, that 5 to 9 months after Hurricane Maria, 30% of kids were reporting that they thought they might die during the event. And about one third of kids still had no access to food or water. And even more so, 56% of the kids reported that they had permanently lost a family member or friend due to forced migration. So there's a lot that we have showing that hurricanes, natural disasters, not only impact how safe we feel or not feel, but also disrupt who we have around that usually helps us get better.

I mean, those are extraordinary numbers you just mentioned. Not only are those extraordinarily high numbers, but as you mentioned, the time afterward, just seems extraordinary. I mean, what is your sense of, you know, if we were to follow those children if they did not have access to mental health support services or family and friends who could be there with them, what would you expect to see six months after the fact?

So we know from the literature that children who don't have social support or don't have basic needs met after a disaster or their parents are not doing well. And we know that caregivers are the number one source of calm, safety and support for kids. Over time, these kids are more likely to experience symptoms of post-traumatic stress disorder or depression or anxiety. You might notice their grades start declining. They might have thoughts that life is not worth living. So it's just really important to address this. And also, there's another component to this. In Puerto Rico, for example, it's not just Hurricane Maria. So prior to Maria, we had a Zika epidemic, an H1N1 epidemic. Maria hit after Irma hit two hurricanes, category four and five, back to back. And then a year later, earthquakes impact the island. A global pandemic starts and now Hurricane Fiona. So the cumulative exposure to disasters is what's really concerning about children's mental health.

Yeah, that's an extraordinary amount of trauma. And when I had served as Surgeon General some years ago, I had actually come to visit Puerto Rico during the Zika outbreak, and that even in the short time I spent there, it was so clear how many of these preceding challenges, whether it was outbreaks or natural disasters, were taking a toll on people in the communities, understandably. And to think about how much has been visited upon them since then is really heartbreaking. Now, I know that you you've been down there, you spend time down there, you talk to people about their actual stories of what it was like to live through that experience. I was wondering if you could help paint a picture for us of what it was like for those children and families who are living through especially these last two hurricanes, Maria and Fiona.

One of the most harrowing memories I have was actually as a storm as Maria was passing, social media was very concerning. So you see messages of people saying, if you hear this, please send help. Or the most common message you saw on social media was I, I can't with the sound of the wind, it sounds like a big roaring monster or the pictures of flooding. And so I remember my mom, and all my family lives in Puerto Rico and were there, sending me a message via WhatsApp. And my mom has been through a lot of hurricanes in her lifetime and she said, Honey, this one's bad. And then I never heard back from her until three days later. So it's during storms like this. It's not just the experience of those living it. It's also the family members who lose contact, who can no longer communicate. Kids often tell you that they're seeing their caregivers respond, and if their caregivers are anxious or worried or crying, they get anxious or worried or cry. And then you have the elderly that all of the sudden are concerned because they might not have access to their basic medical care or, you know, young mothers who are breastfeeding might not be able to store the milk that they need for sustenance. So it's just very concerning all around and personally, too, the other story that comes to mind was when we were organizing a trip to deliver supplies and do Psychological First Aid on the island, it was my first realization of, wow, an island nation is particularly vulnerable because airports were closed and you can't drive here and you can't take a boat here because everything is closed. So that complication of not only when you're dealing with a disaster, but a disaster in an already isolated, vulnerable community like Puerto Rico.

I mean, so much about this is heartbreaking. But I'm thinking in particular about you getting that message from your mom that this one seems worse than the other hurricanes she's dealt with. And then to not hear from her for three days, I mean, that I'm just trying to imagine what that was like for you. I mean, for you, this is very personal. It was about your mom. But this is the place where you grew up. And I know you probably had a lot of family and friends there. What was that experience like for you to have to to manage that stress and that tension of seeing a place you grew up in and the people you love so deeply impacted like this?

It was really hard. My entire career currently is not something I planned. So I'm a mental health disaster expert, not by choice, but by circumstance. And I have to reflect often on that. So to answer your question, that moment, I remember getting that WhatsApp message and talking to my colleague and good friend, Dr. Regan Stewart. We were doing supervision, clinical supervision of students and she just kind of stopped and said, Why don't we just take this time to check in? What's showing up for you? How are you feeling? Hmm. And then the next phrase really changed my life. She said, What are we going to do to help? And honestly, Vivek, that's the first time that I ever thought that I could merge my expertize and trauma with this world of disasters. And we got to thinking and within three weeks we were down on the ground using what we know to help. I think the other component of this, too, was something dawned on me with Maria that this was not going to be the last one. Climate change really just became at the forefront of my thoughts and how this impacts children's mental health.

And that is really the great worry, I think, for Puerto Rico, but for so many parts of the world, with climate change advancing that we may see more of these events. And I think it's worth saying here that we're talking about hurricanes, but clearly the trauma that you're expert in, that you observed in Puerto Rico can be extended to other natural disasters as well. But to see a little bit about that, when you think about the broader picture that's unfolding with extreme weather events, where do you see this going over the next few years? And how do we need to think about the collective trauma that people may be experiencing across our country?

Right now, we know that over 175 million youth worldwide are being impacted by climate disasters yearly. And we know that about a billion children experienced traumatic events yearly, in the world. If you translate that to the U.S., one out of two kids below 18 have experienced a potentially traumatic event. And now COVID just really showed us how there could be events that impact us globally that significantly alter our our day to day lives. So we have this problem of climate change not going anywhere. It's only getting worse. And you have this prevalence rate of trauma that already exists. So what happens is that if you imagine a bucket, right, and there's water dripping over the years and dripping and dripping, we're at a point where most kids in the United States are already three fourths of the way up with trauma, exposure. And then COVID just really was this massive drop in the bucket that started overflowing. And we see increases in depression, anxiety, loss of hope, suicidality. So if we keep adding more water to that bucket without creating the conditions to empty it, we're going to have a big problem. And those are the kids that will become the adults that become the next leaders. So this is a very important issue to address, and we all can play a role in helping it.

So well put in and very sobering. I want to get to the the question of what we can do about that trauma. But before then, I was wondering if you can walk us through the stages of experiencing a natural disaster. This is of interest to me, not only because I think it's relevant to our audience, but, you know, I myself lived through Hurricane Andrew in Miami, Florida, in 1992. And I remember just how just incredibly impressionable, traumatic, painful that experience was. It’s many years afterward. I still remember it like it was yesterday, sitting huddled up with my family in the house that we boarded up. We weren't able to evacuate. And just hearing at one or two in the morning, just the the howling of the wind, it was so loud and the whole house was shaking. And I was watching people's houses, parts of their carport and their porches just fly by, you know, like through the small cracks, you know, in the window through which we could view what was happening in the outside world. But we didn't recognize the world when we, when we emerged from that house. Everything was different. Trees were uprooted, traffic lights were gone. It was just a different world, but but take us through the stages of experiencing a natural disaster.

It's it starts before the disaster even happens, right. So listening to the news and if you put yourself in kids shoes, they're viewing the world through their parent's eyes are brothers and sisters eyes. So it's that anxiety about seeing mom and dad board up the house and that's if you get warning, right? In the cases of tornadoes and earthquakes, it's very limited. And when when you get through the actual experience of the event, the number one thing people report is what they're seeing with their eyes and what they're hearing. So any the flooding, the rain, the the sounds right. And then afterwards, when you go out and you see what once was your playground destroyed, what once was your school is no longer there, or maybe a building where you were going to have graduation the next day is gone. It's it's your entire worldview transforms in an instant. And it takes a while for your brain to catch up with that, because that's a traumatic event, right? We don't expect it. So the next days, it's a combination of survival, right? Where am I going to get food, water, shelter, safety? But it's also this sense of disruption in routines. Am I going to be able to return to school, to my job? Is there a job? And here's where it gets interesting. Most communities get a lot of attention the first few days from the media, from, you know, everyone trying to help. Or it gets really, really hard as when the press leaves, when the helicopters leave and the communities stay trying to recover and rebuild for months and years. So in the case of Puerto Rico, for example, it took if you were lucky, you got electricity in a month. If you were the average citizen, your power return in 4 to 6 months and the rest of the island, it took 13 months. So when you think about that, how do we got Internet? How do we get phone connection, communications? The average Puerto Rican child has not received regular schooling in the last five years because it's been so many disasters. And I think one last thing I'll say about what is this like, particularly for kiddos. Schools are the place where most kids get their meals. Most kids get to play. Most kids get identified when there's something wrong at home. So there's a common thread across disasters. Schools close. And so that sense of support and safety and calm is removed. And then for adults in general, it's a sense of desperation. Most adults can't sleep. Generators are horrible. You hear their hums, the smell of gasoline. So it's just this ripple effect. Everyone's buckets just become really, really full.

And the question is, how do we help? And I want to focus on Psychological First Aid, because this is a tool, a skill set that you brought to Puerto Rico and began applying it after Hurricane Maria. Tell us a little bit about psychological first aid. How does it work?

Well, first, I'll start with a personal story. I remember when, back to my story about Maria, my mom's last text message, one of our team members said, hey, we need a we need to contact someone who knows about disaster, mental health. And so we contacted Dr. Melissa Brymer. She's the Director of Disaster and Terrorism Program at the UCLA-Duke National Child Traumatic Stress Network program. She is the expert on PFA. And believe it or not, this amazing woman that I was terrified to speak to because I she sounded really like, Oh my God. Her first question to me was, Rosaura, how's your family doing and how are you doing? And I just started crying. I remember I was like, caught off guard, but I felt so seen and heard. No one had asked me that question. And that is the first step of Psychological First Aid. So Psychological First Aid, it really comes from literature showing us that there's five basic key early intervention principles that we need to focus on when a disaster has happened. Number one, safety. We need to make sure that people are safe, not only physically but emotionally. Number two, calm. We need calming presence through someone that can be there and say, hey, I've got you. Number three is connectedness. Human beings really need community and support and connection to heal. Number four, this one's interesting, self-efficacy. So studies show that even in crises, there are talents and strengths that survivors can contribute and and contributing to the recovery process actually helps them heal. Number five, hope. Psychological First Aid really is based on Maslow's hierarchy of needs, meaning Maslow is a psychologist in 1940 that published a really instrumental paper on the Theory of Human Motivation. And really what it shows us is that if you don't cover basic needs first food, shelter, water, you ain’t going to get someone to think about their future very much. So you need to do that, and then you need to make them feel safe. And the third one is you need to connect them with support. After all of that, people can get back on their feet. So Psychological First Aid takes all of this through eight core actions. And basically you show up, you gather information on needs. You connect people to needs. You offer them assistance. You teach them how to manage reactions in that moment. Grief coping skills. And you link them with future services should they notice that they need it.

Well, that's fantastic. And and I think what's powerful about Psychological First Aid is you don't have to have a medical degree or or a training as a nurse or a doctor in order to be able to apply this skill set to helping somebody in front of you. And I'm curious, what is the youngest that you've actually taught someone Psychological First Aid and are there any other limitations on who is able to use these skills to help others?

Thank you so much for mentioning that. Anyone can do it and I have a really cool story about this one. After earthquakes in Puerto Rico in January of 2020, my team and I trained graduate students, clinical psychology graduate students in Psychological First Aid. And I don't know, Vivek, if you know, much about earthquakes, but those you don't get much warning and the tricky thing about them is when they happen, they don't end. You get aftershocks. So for Puerto Rico, this was new and people were really scared about being inside buildings. They wanted to be outside. So the shelters were in baseball fields with kind of like tents. And so people felt comfortable. So when we show up, the there was like about a 14 year old teenager in the entrance and she was checking our IDs and making sure we were legit. And I asked her, Hey, what's your name? What are you doing here? And she's like, Oh, I'm living here. This is where my family is. I'm like, Oh, you're checking people in. That's amazing. She's like, Yep, greeting is my talent. Huh. It was so cool because someone had identified that and she was using self-efficacy. She was connecting with people. So even a 14 year old can engage in Psychological First Aid. And I personally have in the last three weeks after Hurricane Fiona, our team, the Mental Health Awareness Training Grant from Albizu University in Puerto Rico, we've trained over 3400 people in how to use this in their communities.

That is incredible, I think, especially because of what you shared earlier about the core components of Psychological First Aid that one of the things that sounds like from what you're saying that people really need is to develop a sense of self efficacy as part of their broader healing process and giving them these skills for a Psychological First Aid likely gives them the ability to go out and help others, which can only imagine how powerful that is for contributing to your sense of self-efficacy. We all may not be able to solve every problem in our life, but we can help other people and that can remind us of just how powerful we are. So I think that's incredible that you did that. I want to ask you, was there any resistance that you found to teaching people Psychological First Aid and what was the hardest part about it?

Yeah, so once you've been around the block for several disasters, you can contrast, right? So right after Maria, at least in Puerto Rico, there wasn't really a lot of Psychological First Aid knowledge or awareness. The word trauma wasn't really used. So there was resistance in the sense of how is this going to help? And what our team did was really embrace humility in that moment, because when you think about it, that makes sense. You have to pitch it in a way that meets their needs. And what people needed was food, water and shelter. So the way we went about it was, Hey, can we just set up spaces in communities, in schools where you and your teachers and your team can come get water, get coffee, get food, and we can talk. And over time, as more disasters happen and more awareness is created, Fiona was different. Everyone was requesting Psychological First Aid because this is what we need. So my dream is that we really take into consideration that all citizens can benefit from this. And the time to get trained is not when a disaster happens. It's now. It's part of our preparedness plan.

Well, I love that. And I couldn't agree with you more. This is the right time to do it. I want to touch on one other component that you mentioned with Psychological First Aid, and that's around the power of social connection. And we noticed from so much research about how powerful social connection is. But also these moments, though, of whether they're hurricanes or other natural disasters. These are times of disruption where people's social networks get disrupted and their opportunity to see one another may be compromised. When you think about what you observed in Puerto Rico, what did you learn about how people created spaces for connecting after these natural disasters?

One of the things that I am most proud of from my culture is this natural longing for hugging, kissing, embracing and saying, Aqui estoy para ti. I'm here for you. That's natural to Puerto Ricans. And I'll give you a vivid example of this. When we were there three weeks after Maria, my, my colleague and mentor, Dr. Melissa Brymer said, Rosaura I know you want to go in and teach Psychological First Aid, but let me tell you the best thing that you'll do is create space for them to embrace and let the healing happen. I remember we were in Ponce, which is a town in the south of Puerto Rico. There were about 500 people in this school, no electricity. We were just trying to get everyone in. For about an hour, teachers were hugging, saying, oh, my God, I'm so glad you're alive. I'm finally here. I remember teachers saying, look, I got dressed up for this. Finally an event where I can dress up because fashion's important to Puerto Ricans. And then someone saying, You look good, girl. I like it, you know? That's where the healing happened. It wasn't me teaching how to breathe deeply necessarily. The other thing, too, is from a research standpoint, right, because I'm a researcher, my goodness, every single study, it doesn't matter how you cut it, what the population is, the the size of the sample, the gender, the background, social support predicts recovery more than anything else. Hmm. Time after time. And that, to me, is really fascinating. And sometimes I get asked, Rosaura, if it's really that simple, like, how can we, like, use this in everyday life? Honestly, the best thing you can do as a person who's supporting someone through a disaster is saying, I'm here for you. You're not alone. Just those words. Checking in on them. And not just when the disaster happens, but the weeks months following. Or maybe it's when someone tells you I'm feeling really bad or sad, rather than solving the problem or giving advice, repeating back what they just said. Your’e feeling really sad. Being a mirror. And that really shows to decrease cortisol, which is our stress hormone. It has been shown to relax your muscles physiologically and feel and make you feel like your’e bonding. And you're not alone.

That’s so beautiful to hear. We truly are hardwired to connect, aren't we? And it's wonderful to hear that those opportunities for people to come together became such a powerful source of healing for them. I think when we're deprived of that, it makes even regular, you know, everyday adversity much harder to endure. And I'm curious when you think about the the social connection that people had in their life prior to those two hurricanes. How would you how would you describe this strength of social connection and the communities that you are a part of? Because as you mentioned, the ideal time to build these resources up is prior to a major event like a hurricane. So what was it like prior to the hurricane?

Yeah, prior to Maria in particular, at least in the context I work, which is Puerto Rico, social connections are part of the fabric of everyday life. So multigenerational families are the norm, right? So communities where really there's three generations of family members living close by. Sports is a big thing after school sports and having teams where kids can connect and interact is very important. But even just my experience of every time I land in Puerto Rico, it doesn't matter how long I've been gone. There's always a sense of, You're one of us. Welcome home. That's beautiful. So all these things are protective factors. Sadly, you know, we've seen a lot of forced migration and that's what climate change is doing across the world. And that disrupts social support networks. So I think we have we have a lot of work to do to create conditions where people can stay together and support each other as well.

I agree. The line that really touched me is when you said when you return to the island, people say welcome home. And it reminds me that this sense of belonging that I could just feel, in your words, as you said, that it feels so connected both to people and sometimes a place as well. And these forced migrations that you're talking about because of climate change seem so profoundly disrupting on both levels. They disrupt our relationships, but take us away from the places which we've come to know for generations, in some cases, and the places where we feel we belong. And I do think that creating that sense of belonging is really one of those powerful things that we need to do to contribute to resilience and to strengthen communities. I do want to ask you, though, about how people can helpwho are not there. You know, many people when these hurricanes hit, both in the United States and around the world looked on with horror at what was happening. And they wanted to do something to be helpful. What advice do you have for how folks who are not there can provide meaningful support?

I think the thing that comes most often to people’s mind, Is where can I donate? Right. And that's a very noble and needed help. But I would kind of want us to push the needle a little bit and suggest that maybe it's through social media when you see a news article from a reputable source report on what's happening, retweet it, share it with your friends, have a discussion about this and what worries you about it. Or if you know someone from that community, reach out and say, Hey, I'm here for you and I would love to donate, but what organization or what cause do you recommend? So making sure we check in because unfortunately we get a lot of scams and situations that the help never gets to the communities. Another way could be to help rather than saying, “Oh, this is so hopeless, I don't know what I can do,” is start reading. Get yourself educated on the impacts of climate change and disaster. Start talking in your communities to your kids or go online. So there is a free PFA course Psychological First Aid that anyone can take. You can go to: learn.nctsn.org So the National Child Traumatic Stress Network is a phenomenal initiative funded by SAMHSA, and it's been around since 2000. And its whole mission is to elevate the standard of care for children who's undergone trauma, and their website has free resources in every language you can imagine. So something you can do today is take a PFA training through: learn.nctsn.org

Well, that's great advice. And I love the fact that that is so freely available to anyone. And along those lines, you given that many other communities may potentially be at risk for extreme weather events, especially with the threat of climate change progressing. What steps do you think communities across the country should be taking to to ensure that they're prepared to ensure that if they do end up suffering one of these events, that they're able to to come back and to recover while minimizing the mental health effect, of these traumatic events.

There's many things that we can do. I would start, you know, even in your own family, what is your plan for evacuation or having supplies? What is your plan to have support in place? Right. Having conversations with children and teenagers is super important. And you can get resources through nctsn.org on how to talk to your kids about disasters and what we might need to do. But more broadly, I think, you know, I come at it from the angle of our mental health workforce. Right. So I didn't have a single class on disaster mental health. I didn't know this was a thing. That's a problem. I have a Ph.D. and I think we need to do a lot more work in our programing for how to train that workforce up in things like Psychological First Aid or skills for psychological recovery or trauma in general. And then also, I think we need to start teaching our kids to preserve nature and our environment. Our planet is reeling and I think we have the generation of kids who actually wants to do something different. My sister Natalia is amazing. I'm 12 years older than her and she's been talking to me about this since she was in sixth grade and I honestly didn't really understand why she was so concerned. And now I get it. See, our younger generation is wiser and we need to start bringing them to the table to come up with solutions, not us telling them what to do.

Well, I couldn't agree more that the passion that rising generations have in addressing climate changes is really remarkable. You know, at a time where I think sometimes we think that people have become cynical about everything, there is actually a level of optimism and hope paired with urgency and clarity that that they approach these challenges with around climate change. And I think that's incredibly, you know, encouraging. But it's really what we need and what we lacked in many ways and in prior generations, certainly in my generation. So I agree with you. I think that that certainly gives me hope. And from everything you're saying, what I one of the things I'm taking away is that, yes, there are profound impacts of these events on the mental health of all of us, but of particular of our children, and that the effects aren't just, you know, to in the immediate setting, in terms of leading to a sense of helplessness or perhaps contributing to depression or anxiety, but that they can last for months and they can impact a child's participation like at school and the quality of their education It can impact how they show up in the rest of their life. And so these are things we have to pay attention to and invest early to build resilience and make sure people have the tools they need from mental health care tp Psychological First Aid. But also, we've got to be attentive to those needs when they arise after the fact as well. I'm taking from this a hopeful message, though, that as difficult as the repercussions are, that help is is available and it's feasible. The goal is we've got to make it available to everyone who needs it. And so I so appreciate you as somebody who has tried to bring that help remarkably effectively to to Puerto Rico, having trained thousands of people in Psychological First Aid. Just what an incredible service. And I can only imagine how proud your family is of everything that you have done for the community with which you grew up.

Thank you. I think I'm here because of a great mom that gave me support and access to security and self-efficacy and hope. And now I get to do that for Puerto Rico. So it's really nice to see that play out, right? And I think to if that's okay, I wanted to mention one thing that you mentioned that's important. I think part of the solution, too, is not putting the onus on citizens to, quote, be resilient without the necessary conditions to thrive. And so how can we create communities that are healthy and safe and people have access to what they need, like education and basic needs and energy and food and water and safety to thrive?

That's absolutely right. Yeah, resilience isn't something that people learn from taking a course online. It's baked into the environment and the opportunities and the safeguards that we have around us. And everyone deserves those safeguards. And too many people are living without them right now, especially our children. And that that is a tragedy that we have to correct. You know, as we wrap up our time, Rosaura, I wanted to ask you to a couple of maybe quickfire questions. When you think about a moment of connection that you experienced in your life over the last few years, is there one that stands out as a connection that perhaps surprised you or brought you hope?

Yeah, there's many, but there's one in particular. You know, COVID was really hard for all of us, and it brought a lot of disruption. I myself experiences illness and loss and a lot of chaos. But in the midst of it, during COVID, I reconnected with one of my, my high school best friends and he is now my husband. Oh, my gosh. So I'm just really grateful for him. And he really helped me realize that I don't know, I guess all this all this time, I've thought of myself as not enough, not worthy. And he really brought out that hope that you can change the world. You can do this. And the second one is my best friend, who happens to be my colleague, Dr. Regan Stewart, I was not going to stay in academia. I really wanted to select out and be a clinician full time. And she told me, What do you love to do? And I said, I love training. I love teaching. She's like, Let's partner up. I'll write the grants. I'll help you write the papers. You train. And so she showed me that in team you can achieve great things and change the world. So those are my two biggest examples.

Oh, my gosh. What beautiful stories and how reassuring to know that one can find love in the time of COVID. So what a great story about your husband

We will write a book one day.

You should. And lastly, when you look to the future, despite all the challenges that we've talked about that are still there, what gives you hope?

Hmm? That one's easy. Hmm. I think of Natalia. I think of my sister's generation and Fernando, my brother's generation. I talk to young adults and kids, and they give me the solutions in 2 seconds that years of data have tried to corroborate. We need to bring them in to co-design, co-create and empower them. So we're in good hands. We just need to let the kids lead.

I love that. And what an inspiring note to end on. Rosaura, I want to thank you so much for being with us today, for sharing your expertise and your incredibly moving stories from your time responding to hurricanes in Puerto Rico. But I especially want to thank you for your service, for showing that one person really can make a profound difference in the lives of many others. When you show up with a full heart, with skills to share, and with the willingness to listen and be a part of people's lives. And you've done all of that. And through your example, as well as your words, you are teaching me for sure and hopefully inspiring many people who will listen to this podcast. So thank you for being with us today, Rosaura, and my best of luck to you and all the incredible work that I know you're going to continue to do.

Thank you so much. It was an absolute dream to be here and I appreciate all the work that you do.

That concludes this conversation with Dr. Rosaura Orengo-Aguayo. Join me for the next episode of House Calls with Dr. Vivek Murthy. Wishing you all health and happiness.