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After Hurricane Maria, Mental Health Specialists see Toll among U.S. Puerto Ricans

Posted: November 16, 2017

Orlando, Florida-based therapist Janera Echevarría was not surprised to see an upsurge in the number of Hurricane Maria refugees arriving from the island seeking treatment for anxiety, depression, and stress. After any disaster, the counselor explained, it’s par for the course. In the area, groups and agencies are helping provide services to those who fled the monster storm and its devastating aftermath.

“Even if you were unharmed and your house was okay, living an experience like this is emotionally traumatizing,” said Echevarría of the hurricane that hit Puerto Rico on September 20th. “In one way or another, after a disaster — manmade or natural — it is expected that people will suffer some kind of post traumatic stress.”

However, what has alarmed Echevarría, a twenty year veteran in the field of mental health, is how deeply the hurricane’s aftermath has hit islanders who live outside of Puerto Rico. “I have a client, a 60-year-old grandmother, who stopped eating because she feels guilty that members of her family might be going hungry,” Echevarría said. “I have another client, a woman in her 40’s, who is sleeping on the floor because she says that her sisters lost everything so she is in some form of solidarity with them. She has a perfectly comfortable bed but prefers to suffer and sleep on the cold concrete floor –it’s a form of flagellation.” These reactions may seem illogical to some, but for people who are not mentally resilient, it’s the only way they know how to cope with stress. Technically it’s a form of survivor’s guilt, she explained.

Nearly sixty days after the category five storm landed, millions are still without electricity and desperate for basic necessities such as warm food, water, and shelter. In Echevarría's downtown Orlando practice, she has begun seeing the toll such images are taking on the mental health of Central Floridians.

Echevarría, who was born and raised in the western Puerto Rican town of San Germán, has seen the strain in her inner circle. Discussions around the dinner table revolve around the latest news from the island. Family members and friends discuss having trouble sleeping, experiencing fears about the future of the island, sadness, and some, say they are unable to fully focus as they watch the latest news and hear from family members having a rough time.

The most vulnerable populations after disasters are children, who don’t have the capacity to understand the scope of the devastation. Echevarría also sees it in women, mostly mothers and grandmothers, who suffer doubly because they are not on the island to do what Puerto Rican mothers do best — nurture their loved ones.

Brain experts say that even witnessing images destruction from afar, such as scenes of strangers' lives ruined, wound the brain. But if it’s extended family, the wound is deeper.

Nancy Rosado is a veteran of disasters. She was in charge of a mental health unit helping NYPD officers cope with the aftermath of 911. She was already in Florida when the Pulse nightclub massacre happened. During the massacre, Rosado said she that she helped provide culturally competent training for local officials. Everyone grieves and mourns differently and Puerto Ricans are no exception. "It was important to let officials understand that culturally, we see loss and grieve in a unique way. Our language is different, even the forms of mourning expressions are unique,” she explained.

This time around, Rosado said she took a step back from the disaster, because she said that “even those trained to help others are also affected.”

Experts say that directly helping others is one of the ways to cope with stress. Another way is to take a break from the news cycle, as images do cause harm and humans are not built to take in so much suffering at once.

One of the most important ways to handle stress is to talk about it. “For Puerto Ricans, therapy is not the norm,” the mental health professional explained. “We are used to staying in the family. But this is something catastrophic and we have to be able to open up. My suggestion is that if you feel like you can’t handle seeing so much loss, to get help from a culturally competent professional.”

“It’s important for anyone suffering from afar to now that they are not alone," said Rosado. "Others are feeling the same way.”


How the Opioid Crisis is Affecting Native Americans

Posted: November 15, 2017

Last week on an NPR program, there was a conversation about how the opioid crisis is affecting African-Americans and Latinos. NPR felt that it was necessary because so much of the news coverage has focused on the white rural experience, which while important, is not the only one.  Now NPR's Michel Martin looks at how the crisis is affecting Native Americans. 

For some insight, he called Dr. Ron Shaw, the president of the Association of American Indian Physicians:

MARTIN: So, Dr. Shaw, it is a fact that white rural communities have been hit especially hard by this opioid crisis. But we were looking at a report from the Centers for Disease Control that said that, actually, the death rate of Native Americans from opioid overdoses was the highest of any racial demographic. Some 8.4 per 100,000 Native Americans died of opioid overdoses in 2014. Can you tell me more about that?

SHAW: Well, I believe that in any population where there are a depressed or a low socioeconomic status, any time you have those issues, people are more vulnerable to opiate overdose. Now for Native Americans, many Native American populations suffer from what is known as historical and intergenerational trauma, which has to do with historical events that have afflicted Native American tribes, everything from Wounded Knee to other issues that have affected us culturally that have caused kind of a historical shame that has transmitted across generations, even to succeeding generations, that it has been shown to be associated with increased rates of depression, drug use and drug addiction. So that's the additional issue faced by Native Americans and perhaps more sensitive in those populations that live in reservation areas.

MARTIN: From the work that you've seen and the work that you've done yourself, what do you think are the best ways to treat this problem with a particular focus on Indian country and Native American communities?

SHAW: I think the two most important pieces are, first of all, this is a biological disease at its core, whatever the reason is. And we're still finding out why experimental and recreational use in youth progresses more rapidly to opiate addiction in native populations. We're still trying to find out the best practices for preventing or slowing that down. But the biological basis is a disorder in the reward pathway in the brain known as the mezal limbic system. An important part of that therapy has to be medication-assisted treatment.

Now, the psychosocial treatment of the disease, which has to do with social living skills and having to address historical generational intergenerational trauma, that will be specific for native populations. We've always known that culture is prevention when it comes to drug use or drug abuse at an early age, but culture also is treatment. And so implementing treatment specific and culturally relevant treatment items in the treatment curriculum are very important.

MARTIN: Is there anything giving you hope right now? I mean, what is giving you hope right now? What's getting you up in the morning to keep working at this?

SHAW: As bad as it is that people are dying, it's finally got people's attention that this is an illness. And it'll translate into proper illness funding for other substance use disorders. Because in Oklahoma, it's still methamphetamine and alcohol. Who knows? Maybe before this battle has had some results, opioid use disorder and overdose deaths may increase in Oklahoma. But it's affecting Indian country, so I've used my expertise for any community, even if it's not particularly as high in the Osage nation right now.

Listen to the conversation or read the full transcript at

Pregnancy and Childbirth Mortality Rates on the Rise for African American Women

Posted: November 14, 2017

Every year, around 700 women in the United States die as a result of pregnancy or delivery complications. As many as 60,000 expectant mothers suffer problems that come close to costing them their lives.

America is one of the most developed nations in the world. Average life expectancy has been generally increasing over at least the last five decades, and deaths from illnesses that were once widely fatal, including polio, smallpox, tuberculosis and AIDS, are sharply falling. Yet when it comes to the natural process of childbearing, women in the U.S. die in much higher numbers than those in most developed nations, where maternal deaths are generally declining.

A woman in the U.S., where the maternal death rate more than doubled between 1987 and 2013, is more likely to die from pregnancy-related causes than in any country but Mexico among the 31 industrialized countries of the Organization for Economic Cooperation and Development that reported data.

There are various theories why — persistent poverty, large numbers of women without adequate health insurance, risk factors related to stress and discrimination. All come together here in Texas, with a twist that has become one of America’s most confounding public health problems: African American women are dying of pregnancy- and childbirth-related causes here at stunningly high rates.

The maternal death rate in Texas after 2010 reached “levels not seen in other U.S. states,” according to a report compiled for the American College of Obstetricians and Gynecologists, based on figures from the U.S. Centers for Disease Control and Prevention.  Black women in Texas are dying at the highest rates of all. A 2016 joint report by the Texas Department of State Health Services’ Maternal Mortality and Morbidity Task Force found that black mothers accounted for 11.4% of Texas births in 2011 and 2012, but 28.8% of pregnancy-related deaths.

“This is a crisis,” said Marsha Jones, executive director of the Afiya Center, a Dallas-based nonprofit that has taken on the issue. In May, the center published its first report: “We Can’t Watch Black Women Die.”

“There isn’t a single thing that explains it,” said Lisa Hollier, an obstetrician-gynecologist who heads the state-appointed Maternal Mortality and Morbidity Task Force. “There are so many different factors.”  The task force compared the health of a group of women who died during pregnancy, childbirth or in the immediate aftermath to those who survived in 2011 and 2012.

Cardiac events, drug overdoses and disorders associated with hypertension were the leading causes of those maternal deaths, the task force found.  Nationally, problems such as obesity, diabetes, caesarean births and delayed prenatal care are among the risk factors commonly seen, Hollier said. Such factors are particularly prevalent among black women.  “So we have a population of women that is less healthy when they are entering pregnancy,” Hollier said.

Texas has the largest number of uninsured people in the U.S., and there have been substantial cuts to women’s health programs that offer family planning and other routine services to low-income women, including screening for diabetes, hypertension and cervical cancer, which if left untreated could play a role in maternal deaths. Many of the dozens of clinics shuttered in recent years due to slashed state funding also offered prenatal care.

Manda Hall, associate commissioner for community health improvement at the agency, said several initiatives are underway to address the maternal mortality crisis. They include a program that encourages women planning to become pregnant to make wholesome lifestyle choices and another targeting historically black academic institutions that offers training focused on preconception health, the importance of fathers, health disparities and reproductive life planning.

Researchers say such programs might have an effect, but given that low-income white women fare better than black women, the causes may run deeper.

“Just being a black woman in America comes with its own level of stress,” said Jones, the Afiya Center executive director.  Some studies have shown that chronic stress triggered by racism and discrimination can lead to health problems such as diabetes and high blood pressure, and these in turn can lead to preterm births, low birth weights and life-threatening complications.


Preschoolers Learn Hands-On Farming to Prevent Childhood Obesity in Hispanic and Low-Income Families

Posted: November 13, 2017

As childhood obesity soars among low-income communities with limited access to fresh produce, some educators in Colorado are combating the problem by joining the farm-to-preschool movement. Now these preschoolers are learning their ABCs while picking veggies from the school garden and preparing healthy meals. Special correspondent Cat Wise reports.

Children in this Pueblo, Colorado, preschool are learning the ABCs of locally grown produce.  Vegetables take center stage in everything from the vocabulary they learn to the art they create and the plays they perform.

Brittany Martens is the nutrition educator for a new preschool program funded by the U.S. Department of Agriculture called CHOP, an acronym for Cooking up Healthy Options with Plants.  It’s an effort by the Colorado Health Department to combat childhood obesity with hands-on farming. And it’s part of a growing farm-to-preschool movement in early education centers.

Brittany Martens says "We want to take these things from the garden and make it a norm on their plate, so it’s not like an alien. It’s no longer the hated squash. It’s now something that they have grown, they have picked, they have harvested, and they’re going to be more willing to try it."

One in five Colorado children ages 2 to 4 are obese. The problem is particularly pronounced in low-income and heavily Hispanic communities, like the neighborhood that surrounds Pueblo’s East Side Child Care Center.

"Over 80 percent of the children that come here are from low-income family households, between 70 percent and 80 percent with a Hispanic heritage," shares Maria Subia, the center's director.

Health officials hope early exposure to vegetables will lead children away from high-calorie processed food linked to obesity.

According to the Centers for Disease Control, 40 percent of obese children remain obese into adolescence, and 75 percent of adolescents go on to become obese adults, facing increased risk for heart disease and diabetes. Nicole Cawrse, who manages the Women, Infants, and Children program, known as WIC, in Pueblo says "The chance of becoming an obese adult substantially increases once you hit the age of 8."

But for families that live near Pueblo’s East Side Child Care Center, buying fresh and nutritious food isn’t always easy, especially if you don’t own a car. David Hovar, from the nonprofit NeighborWorks Southern Colorado, is working to connect Pueblo’s East Side residents with fresh produce, after their only grocery store was shuttered more than a year ago.

For parents and educators, the new gardens are also an opportunity for learning that goes beyond nutrition.  Fawn Montoya says planting has taught her daughter, Cecilia, new math concepts at an early age. On this day, Montoya taught children how to grind corn with a stone metate, a process she hopes will connect children to history, as well as their own Mexican heritage.

Listen to the full news story at

Asian-American Groups Start Mental Health Program for DACA Recipients

Posted: November 09, 2017

A group of Asian-American and Pacific Islander-serving organizations announced the creation of a mental health program for recipients of Deferred Action for Childhood Arrivals (DACA) and their families Thursday, a month after the White House announced that it was ending the program.

Ten mental health service providers from the Asian Pacific Policy & Planning Council (A3PCON) — a Los Angeles-based consortium of Asian-American and Pacific Islander (AAPI) groups — said they will provide free counseling, case management, and other mental health services through the DACA Mental Health Project.

The groups said they are providing the services in 12 languages: Bangla, Cantonese, Hindi, Japanese, Khmer, Korean, Mandarin, Tagalog, Thai, Urdu, Vietnamese, and English.

Connie Chung Joe, co-chair of A3PCON, said it was important for the groups to say they would continue to provide services during a time of uncertainty that has seen some clients shy away from seeking help.

The scheduled termination of DACA, which shields young undocumented immigrants from deportation if they meet certain requirements, and anti-immigrant rhetoric have made much of the groups’ clientele wary of receiving services while increasing stress, Joe explained.  She added that some clients might be hesitant about enrolling in government-funded programs because of the fear attached to sharing information.

Shikha Bhatnagar — executive director of the South Asian Network, one of the collaborating organizations — has also noticed clients dropping out of services, especially when it comes to the renewal of health insurance.

“They are too afraid to come in,” Bhatnagar said. “They feel their information might be in jeopardy, and they might be deported.”

Manjusha Kulkarni, A3PCON’s executive director, said that DACA has enabled thousands of young people to “come out of the shadows” and be integrated into society since its creation in 2012, though there has been a stigma in the AAPI community regarding coming forward and applying for protections.

Asians made up 10 percent of the population potentially eligible for DACA, according to a September 2014 report from the nonprofit Migration Policy InstituteBut in a 2016 analysis, the institute found that application rates for youth born in Asia were “generally very low.”

According to 2016 federal immigration statistics, four of the 24 top countries of origin for DACA recipients are in Asia — South Korea, the Philippines, India, and Pakistan.

Joe said A3PCON’s DACA Mental Health Project is also designed to provide more flexible services and help those who might not have a diagnosed medical health condition but want to speak to a professional due to stress and anxiety.


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