Dr. Virginia Rubaine had plans to travel on Sept. 7, 2017. But on Sept. 6, Hurricane Irma swept through the Virgin Islands, devastating homes, businesses and livelihoods, and dashing any hopes of a vacation.
To this day, Dr. Rubaine, director of community mental health at the BVI Health Services Authority, feels like she’s still stuck on that day, in denial that she didn’t get to leave.
“Not only did I not get my vacation, but then I spent the better part of four months just working,” she said. “So I never really had the opportunity to process what happened.”
Ever since Irma, Dr. Rubaine has struggled to read print. She understands the words, but finds herself unable to focus, reading the same page over and over again. Her short-term memory is shot.
“It’s very worrisome, because reading is such a huge part of my identity,” she said. “Like who am I without it?”
Now her O and Essence magazines pile up in stacks. When she gets home she turns on the television, but instead of watching it stares into space thinking of all the things she needs to do to repair her home. For her book club, she listens to audiobooks.
“I keep thinking, ‘Okay, it’s gonna come back at some point.’ But I think the reason it hasn’t come back is we’re still in a state of new normal,” she said. “And I think that’s the biggest thing for people. This is the biggest delayed reaction I’ve ever seen because two years later people are trying so hard to get back to the old normal that they haven’t adjusted to the new normal.”
In the wake of Irma, immediate attention went to rebuilding homes, clearing debris, seeking emergency medical attention, and restoring telecommunications.
Very little attention went to mental health, Dr. Rubaine said. And two years later, she added, many VI residents have not even begun to emotionally process what happened to them as many still struggle with damaged homes, poor phone service and financial difficulties as a result of the storm.
Psychiatrist Dr. June Samuel, the director of medical services at Peebles Hospital, agreed.
“People are always going to try to have their basic needs met first,” she said. “And then they, at some point, long, long after, if ever, they will then stop to think about how they’re feeling. But it doesn’t come naturally.”
Since much of the territory is still in disrepair, it brings daily reminders of what was for many residents the most traumatic event of their lives.
“I think people are still in survivor mode,” Dr. Rubaine said. “They’re going about their daily lives and they’re living, but they haven’t correlated that the trauma from the storms is why they can’t sleep now, and why they have headaches, and why they have difficulty focusing.”
She recalled as an example that two days after the storm she craved normalcy so much that she bought feta cheese to put in her refrigerator that wasn’t turned on.
“People just haven’t had the time to really conceptualise what happened, much less respond to it. It sounds weird two years later, but I think people are literally still in shock,” she said. “We’re going through the motions because we have to.”
Deann Neptune, who feared for her life as Irma ripped apart her Virgin Gorda apartment, said she still feels the effects.
“I had trauma,” said the 43-year-old mother. “I wasn’t sleeping for months because it was so much to bear.”
As time passed she felt better, she said, but harrowing memories linger.
“I am getting there now, but there are days of reflection, there are days of Irma moments, and then I would get depressed again,” she said. “Thankfully, through the spirit of God, I try to move on from that because Irma is gone now.”
Dr. Samuel said the storm aggravated many residents’ pre-existing mental health conditions like anxiety and depression. She’s also seen an increase in related problems like insomnia and substance abuse.
Jost Van Dyke resident Wendy Hendricks saw her home destroyed by the 2017 hurricanes and was living in a tent until that too was demolished by Hurricane Dorian last week. She said in July that she was taking anxiety medication to help her sleep.
“You think that I would be able to fall asleep in 100-degree still air infested by mosquitoes and sand fleas?” she said. “How does one actually sleep in an environment such as that?”
She said her struggles with insomnia started immediately following the storm.
“For a long time you just don’t sleep,” she said. “You don’t want to go to sleep because basically you just think you might not wake up.”
The most common diagnosis Dr. Samuel sees is anxiety, and while she said it’s difficult to link it directly to Irma, the compounded losses of homes, businesses, loved ones and financial security exacerbates stress.
Laurel Freeman, head of Family, Children and Protective Services in the Social Development Department, said she sees depression in VI residents who are still displaced or unemployed as a result of the storm. While the levels now are not as high as they were immediately following Irma, she said those who are still living in shelters struggle with feelings of shame and insecurity.
“That level of self-confidence is still not where it was prior to the storm,” she explained.
Stigma in the VI
Dr. Samuel said she hasn’t seen many patients with post-traumatic stress disorder or conditions that can be directly linked to the storm, but she acknowledges that this could be because stigma prevents people from seeking psychiatric help in the first place.
She suspects many residents would not label their condition as a mental health concern, and would likely go to a general practitioner before seeking out a psychiatrist.
“The stigma is there, and it does affect how persons seek care,” she said.
Dr. Rubaine said this stigma comes largely from cultural values that discourage showing weakness.
“They believe in the stiff upper lip,” Dr. Rubaine said. “So things like feelings are kept private and we don’t discuss those things in public and we certainly don’t demonstrate them.”
Ms. Freeman spoke similarly, and said many people in the VI are reluctant to admit that they are struggling.
“It’s not culturally accepted to go and sit and talk your business to somebody: You’re supposed to deal with it in a specific way,” she said.
For this reason, many don’t recognise the symptoms of depression and don’t seek the help that they need.
“If we don’t recognise the symptoms, then we keep going deeper and deeper instead of trying to reach out to someone who could help us to navigate exactly what we’re going through and what’s happening,” she said.
Maureen Fraser, a BVI Red Cross volunteer, said she’s observed many people who she believes show symptoms of PTSD but have not been diagnosed. Some, she said, isolate themselves, growing less verbal as they retreat into a “cocoon.” Others lash out angrily.
She said many residents fear being labeled as “crazy” if they seek help for mental health problems.
“People are ashamed that they went to see a psychologist or psychiatrist,” she said. “And there’s nothing wrong with it. But people don’t look at it that way.”
In the ongoing hurricane season, Dr. Samuel said she has noticed an upswing in people with anxiety.
Helen Frett, director of the BVI Red Cross, said thunder, lightning and high winds can trigger flashbacks in survivors of the storms.
“Some persons, when they talk about their experiences they’re still very tearful. And you can see that they’re concerned about what’s going to happen this hurricane season,” she said.
She sees particularly high levels of stress in those who are still displaced or sharing rooms with relatives.
Last year’s hurricane season was even worse, she said, because people didn’t know what to expect in the months after Irma.
“Some persons don’t even want to speak about what happened because it just brings back a lot of memories,” she said.
Dr. Rubaine said she sees many patients who have dealt with the emotional trauma of the storms by ignoring it until a devastating event like the death of a relative or the dissolution of a marriage triggers an “outpouring” of grief.
“They come in because they’re struggling with the grief. And then you get the other stuff like, ‘Irma was so hard. I was displaced. I didn’t know where my next meal was coming from,’” she said. “And that’s how that stuff gets addressed.”
For that reason, she said it’s crucial that residents learn coping mechanisms early on.
“I tell this to people all the time: You have to pay. You pay now or you can pay later,” she said. “But you have to pay.”
Dr. Rubaine said some of the most vulnerable populations in the VI community following the storms are the elderly and children and adolescents.
The fact that high school students had been attending classes in a shift system in a cramped building and under tents presented a daily reminder that life had not returned to normal, she added.
One former teacher said she found it difficult teaching under wet tents as she struggled emotionally following Irma.
“It’s all confusing. It’s all a lot,” she said as she recalled the time after the storm. “I’m not a person that really talks about my emotions. Words tumble over each other.”
Before the hurricane she suffered from claustrophobia, sensitivity to noise, and reactions to mould. But after Irma, her symptoms worsened.
“In certain levels of stress there are certain inputs you can’t shrug off so easily,” she said.
She also found herself compulsively washing things and struggling with her memory.
She eventually retired as a teacher, and now volunteers at the Red Cross, which she calls an “oasis” where some of her obsessive-compulsive tendencies are useful in finance and organisation.
Meanwhile, Ms. Freeman said that mental health issues in children often manifest in behavioral issues at school.
One of the SDD’s clients, she said, was 5 years old during the hurricane and is still in therapy to deal with related emotional issues.
Another child, she recalled, stopped speaking completely as a result of trauma from the storm. The family eventually relocated to the United States to seek help.
The elderly, she said, are vulnerable at the best of times, and the storms disrupted many activities targeted at them.
“I’m worried about those two demographics,” Dr. Rubaine said. “Because they literally can’t take anything else.”
Ms. Freeman recalls one elderly woman who went into a depressive state after the hurricane and stopped talking, eating, bathing and going out. Even though the woman had family around her, they didn’t think to seek out mental health assistance for her.
She saw similar situations repeated many times, and it’s why she thinks more community outreach focused on the mental health of the elderly population is necessary.
“Instead of persons coming to us, we go to them — and I say ‘we’ along with us and all the other mental health organisations — and educate persons about what to look for,” she said. “And just have avenues where persons can access the service, and not necessarily always have to come to the service, but the service goes to them.”
The storms also have presented particular difficulties for first responders. As the people tasked with providing care to the victims of the hurricane, they themselves were also victims and often found themselves neglecting their own care.
“It was duties first, me last,” said Dr. Rubaine.
She added that she didn’t get a chance to talk about her own experience until five months after Irma, when a friend asked her how she was doing after a crisis intervention training.
“I sat there and I just poured my heart out to her. And afterwards she got up and she hugged me and I said, ‘I really needed that,’” she said. “’Cause I was so busy responding to everybody else. For me, Irma and Maria are just yesterday and I’m still waiting to get some psychological first aid, because I gave everybody else psychological first aid.”
Many first responders also struggle with feelings of guilt for not tending to their own families and responsibilities.
Dr. Rubaine said she felt guilty that her home was unattended and standing open to the elements for seven months before she could find time to address it.
“It made me feel less competent and capable. Because when I wasn’t able to do both, I wasn’t able to attend to the needs of others and attend to my needs,” she said, adding, “You still have those irrational ‘I can do it all’ thoughts.”
Red Cross volunteer trainer Edna Williams said hospital employees had to work long hours of overtime, often leaving behind their own families in order to care for others. Many of them, she said, struggled with guilt and depression.
“For some people, it’s ‘Why me? You know, why has it impacted [me]? Why did I put myself in this situation?’” she said. “‘I’m not able to take care of my own.’ Or ‘What are they doing for me while I’m doing for someone else?’”
Particularly in the VI’s “human resource poor community,” Dr. Rubaine said many mental health professionals and care providers “wear multiple hats,” increasing the sense of responsibility and making it more difficult to take the time off needed to recover.
Ms. Freeman said that many employees at the Social Development Department found themselves at the frontline doing assessments and filling out paperwork.
“Within our own professional circles, because persons’ job titles weren’t defined, so everybody was filling in where they could,” she said.
She added that going forward, there should be more resources and planning devoted to caring for the mental health of first responders.
“Within the professional circles there was a need for structured mental health avenues that did not necessarily happen, in my opinion, within the timeframe they were supposed to,” she said.
In one SDD meeting about 18 months after Irma, she recalled, employees were still so emotional that they were unable to discuss their experience.
Jacqueline Donovan, director of the Safe Haven Transitional Centre, said the ongoing hurricane season often brings anxiety to care providers as well.
“Even as managers, we feel anxious when hurricanes come. We’re like, ‘Oh, my God: I have my own to take care of and then I have my job to take care of.’ So even as managers we get a little panicked,” she said. “And that’s why it’s important that we make sure that we take care of ourselves properly — mentally, physically — so that we can be ready to meet whatever disaster comes.”
Ms. Fraser, the Red Cross volunteer, worked as a first responder after Irma and recalls rescuing a woman who fell from a two-storey building. She later learned that the woman was paralysed, and several months later she died from her injuries.
She also remembers people walking around with a sense of hopelessness, carrying suitcases and crying over the few possessions they had left.
In the months following the hurricane she threw herself into her work at the Red Cross, and when she felt overwhelmed she would go into a nearby two-car garage, a spot she nicknamed “Siberia.”
“I would say to the girls, ‘I am going into Siberia’” she said. “And I would just distance myself. If I had to cry, I would cry there. I would let it out.”
Other volunteers started asking if they could join her in “Siberia” until eventually almost all of them would come down at one point or another.
“It was that ‘me time’ for them to get it together,” she said. “To rejuvenate ourselves to go out the next day.”
Two years later, she still has flashbacks to that time. When she’s in her house, she’s reminded of when the storm blew up her kitchen sink, stove and refrigerator, sending food into the cistern.
She knows that a hurricane or another disaster could happen at any time, and she would have to do it all over again.
“Having been on the disaster team, you can’t put it in the background,” she said.
Mental health professionals worry about the impact that another catastrophic event could have on the psychological wellbeing of the territory.
Ms. Frett said the Red Cross currently offers a community psychosocial support programme and has 12 volunteers who have been trained in the module.
The organisation also sent three employees to a July training in Jamaica so that they can teach volunteers how to offer psychological first aid in response to disasters.
This month, they are aiming to train at least 24 volunteers over a three-day period.
Given that scientists predict heightened intensity of storms due to climate change, Dr. Rubaine worries what a succession of natural disasters could do to a place like the VI.
“Whatever Band-Aid is holding us together — that’s it. It’s gone. That is it,” said Dr. Rubaine. “So I am praying against that. Because there’s only so much people can take.”
She estimates it takes ten years to fully recover from an event like Irma.
“People are trying to grasp this strange new world that we’re living in,” she said. “So honestly, I don’t think people have had the time to sit down and say, ‘Oh, my God, that was really awful.’”
Nicklous Kanhai contributed to this report.