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After Puerto Rico’s Earthquakes, Renal Patients Feel Mental Health Effects

Direct Relief is providing funding to the Renal Patients' Emotional Assistance program, which offers mental health support to patients and providers in the wake of Puerto Rico's disasters.


Puerto Rico

Damage in the wake of the 2020 Puerto Rico earthquakes. (Photo by Marcial Muñoz for Direct Relief)

When a magnitude 6.4 earthquake shook the southern and western regions of Puerto Rico in January of 2020, it didn’t just knock out power and communications. It also compromised medical care.

Hospitals and clinics closed. So did dialysis centers. For Puerto Rico’s kidney patients, who already experienced physical and psychological issues related to their medical conditions, the impact was catastrophic.


Alexia Suárez, a clinical psychologist who was tasked with providing mental health services to dialysis patients after the earthquake, recalled a patient suffering from renal insufficiency who lived in a car with his brothers.

It’s just one scenario among many that complicate access to dialysis and other necessary treatments. Many providers had trouble tracking down patients who had been displaced to shelters and camps. Other patients had to be relocated to other treatment centers.

And Suárez saw a greater need for mental health services for both healthcare providers and patients as health care services were interrupted and aftershocks continued.

For many providers serving patients in stressful conditions, it was the first time they spoke to mental health professionals since the hurricane. They can be equally compromised and vulnerable as their patients.

In general, Suárez said, mental health services are instrumental during emergency response and recovery efforts. That’s especially true for patients with ongoing chronic conditions who already experience related physical and mental health issues.

After emergencies, Puerto Ricans typically flock to help one another, as they did after Hurricane María and the earthquakes. But for all the generous gestures Suárez is accustomed to seeing, she said that professional mental health services were not always as available as they are now.

In part, she said, the increased availability resulted from Hurricane María, which had resounding mental health consequences across the island.

Weathering new storms

The Consejo Renal de Puerto Rico is a nonprofit organization working to reduce chronic kidney disease on the island through education, protection, and prevention.

But after observing Hurricane María’s psychological impacts, they knew a piece of the puzzle was missing. They implemented the Renal Patients’ Emotional Assistance program, designed to improve renal patients’ quality of life, as well as that of their families, caretakers, and health care providers.

Through a $50 million grant from AbbVie to rebuild and strengthen Puerto Rico’s healthcare system, Direct Relief has further awarded a $100,000 grant to Consejo Renal to offer free mental health services to address emotional distress, depression, post-traumatic stress disorder, and other mental health conditions.

It’s part of an ongoing effort to provide support to Puerto Rico’s renal patients.

To date, more than 900 hours of free psychological services have been provided through the program.

A greater need

Renal patients are prone to suffer from clinical depression and anxiety due to their condition, severely affecting their physical health. Suicide rates among this population are higher than those associated with other life-threatening health conditions and the general population.

Suárez explained that this is often due to multiple, compounded factors such as physical and psychosocial conditions, impacts on social support and financial well-being, isolation; and machine and medication dependency.

Rosa Estarellas, a psychologist with the organization, explained that the Renal Patients’ Emotional Assistance program is part of a greater effort to empower patients by giving them hope. Their health is already compromised, and any catastrophe is a danger to their physical well-being. Building the mental resiliency to weather new storms is an important tool.

“The biggest challenge is to take the patient into normalizing his or her condition and to have a good quality of life even with the condition,” Estarellas said.

After the quakes

Because these patients depend on dialysis treatment to survive, a sense of helplessness and dependence is common, Suárez said.

These feelings are exacerbated when natural disasters strike.

After the earthquakes, many houses and structures suffered severe damages. Suárez noted that about half of the patients and health care providers she worked with were displaced and forced to live in shelters, outdoor camps, and cars.

One patient suffering from renal deficiency depended on his wife, who had a heart condition of her own, to care for him. She was able to get him to safety during the earthquake, but both were concerned about their safety in light of future disasters.

Stories similar to this one are not uncommon, Suárez said. She noted that patients frequently shared experiences showing signs of trauma, conflicted loyalties, and survivor guilt.

These concerns continued, as did the aftershocks of the quake – some of them reaching magnitude 5.0, a significant event in itself. Psychologists fretted about whether they should be directing the patients to medication to control their anxiety or implement an evacuation protocol. They wanted to help patients achieve a state of peace – but also to remain alert.

And it wasn’t just the patients who were feeling the effects. Services needed to be available for nurses, doctors, social workers, and others as well.

Suárez said providers and their patients “are both survivors.”

If you are experiencing thoughts of suicide, please call the National Suicide Prevention Lifeline in the United States at 1-800-273-8255 (TALK).

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