Date Published: July 28, 2020

After the most destructive earthquake in a century struck Puerto Rico on January 7, 2020, Hansel Arroyo, MD, Director of Psychiatry and Behavioral Medicine at Mount Sinai’s Center for Transgender Medicine and Surgery, and Lyse Aybar, LCSW, Clinical Program Manager at Mount Sinai Beth Israel, joined a team of mental health workers headed for the island. With the ground still trembling, they went door to door, listening to survivors' stories and providing mental health assistance. In this interview, recorded before the COVID-19 pandemic, Dr. Arroyo and Ms. Aybar share strategies they used to boost survivors' resilience and reflected on how communities respond to natural disasters.

Podcast Transcript

Host: 00:00
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about overcoming adversity. I'm Jon Earle.

Lyse Aybar: 00:11
I met this man, 81 years old. And as we're talking, he's like, "You see that door?" He pointed towards the back door. He goes, "That door is open, and it stays open ever since December 28th." And he told me, "I sleep with my sneakers on." And I'm like, "What do you mean you sleep with just sneakers on?" And then he tells me, "My wife is bed-bound. And if I had to put on my sneakers and I have to save her, I'm not gonna have time."

Host: 00:38
The interview you're about to hear was recorded in late February. A few days later, the first coronavirus case was confirmed in New York City, and everything changed. This interview is about resilience in the wake of a natural disaster. It centers on Puerto Rico, where a series of earthquakes around the new year left thousands homeless. With the ground still trembling Mount Sinai's Hansel Arroyo and Lyse Aybar arrived on the Island. They walked through affected areas, going door to door and asking people how they were doing. Like really doing. Dr. Arroyo is a psychiatrist and Lyse manages a psychiatric emergency room. Together they treated mental injuries and supported survivors' resilience. In our conversation, they share what they saw and what they learned. Their insights remain timely for Puerto Rico, which has endured more than 9,000 tremors this year, but also for communities across the country that are struggling to unite against COVID-19 and racial injustice, and even to imagine a brighter future together. So here is Dr. Hansel Arroyo and Lyse Aybar.

So first of all, thank you guys both so much for being on Road to Resilience. I'm so glad to have you here and to talk about this trip. Where did this trip come about? You get a phone call, you get an email. How do you get included on a trip of people going to Puerto Rico to provide mental health services?

Dr. Hansel Arroyo: 01:57
I heard through Dr. Sabina Lim, who reached out via email that we're looking for bilingual mental health providers. And, you know, they know that I have family living in Puerto Rico. So I just got, like, "Are you interested?" And I read through it and I immediately, I was like, "One hundred percent."

Host: 02:16
You said you have family there. What did you know about the situation?

Dr. Hansel Arroyo: 02:19
I mean I had been pretty close to what's been going on. So both my mom and my dad have informed me of every single time that there was an earthquake. And I'd already heard how even my mom was anxious, having trouble sleeping and sleeping in the living room. It's something that you can't really prepare for. It's not like a hurricane, when the hurricane hits the Island or, as it's happened, where you know it's coming, you know the expected date. So essentially you just live in a constant fear.

Host: 02:52
It's like the perfect instrument for anxiety.

Dr. Hansel Arroyo: 02:55

Host: 02:56
It's something that could upend your life at any moment. And you have no idea when it's going to strike.

Lyse Aybar: 03:01

Host: 03:01
And as I understand it correctly, it was your first time in a disaster area.

Lyse Aybar: 03:05

Host: 03:06
Were you—what were your feelings about that? Were you nervous? Did you feel like you were well-prepared? What did you do to prepare?

Lyse Aybar: 03:11
So, unfortunately I was here for 9/11, and I worked downtown at BI [now Mount Sinai Beth Israel]. So we were one of the hospitals with proximity to the site. So mentally I was prepared. I actually was expecting the worst because I had gone through disasters here, living in New York City, and I was born and raised in New York. And you kind of like build that thick skin to deal with certain situations.

Host: 03:35
What are some of the things you learned from the experiences of both Superstorm Sandy and 9/11 in terms of responding to these sorts of events?

Lyse Aybar: 03:42
So you have to come together, you have to unite, you have to lean on those that are stronger than you. You have to go into survival mode. I remember when Superstorm Sandy, which was, like, you had to get to work because you were the only hospital standing. You know, we call on our colleagues, like, "How are you going to get in? What supplies are you bringing so I can bring supplies?" So I think definitely communication and knowing what are the basic needs to survive.

Host: 04:13
Let's go to Puerto Rico. Tell me about your first day.

Dr. Hansel Arroyo: 04:15
I woke up like around 6 a.m. I was a little bit nervous, not sure what to expect. Got on this bus and drove down to Ponce. And that's when you start seeing the destruction. But the most impacting thing for me was how empty the spaces were. You would go into these communities and it would be like ghost towns. Cities that I had gone through many times as a kid that were vibrant and filled with people, and now they were just kind of empty and a lot of people had moved out. And so that was my first impression.

Host: 04:48
Lyse, describe the scenery for me. You arrive, you show up in one of these towns. What do you see? What do you feel?

Lyse Aybar: 04:53
So the first place we went to was an area where the rocks have fallen from the mountains and had affected people's homes, cars, and the area was closed off. So when we get there, I see this massive rock on someone's property, which fell on the car. And I was like, "Is that person alive?" That's the first thing I asked. "Is that person alive?" And they say, "Yes, he had not gone to work yet." So that, to me, was like, how do you even go to sleep? I would be afraid, too, to go to sleep. And that first day I arrived there, we're canvassing and we're talking to people, there was a 5.0 earthquake. And we felt it.

Host: 05:38
You felt it. What did it feel like?

Lyse Aybar: 05:40
It's like standing on top, over the MTA times 10, basically. I mean you feel the train going by, it's like times 10. But um, I processed it afterwards because at the moment you have to stay in control—.

Host: 05:56
So you just acted like, "Oh, this happens all the time. In New York we have earthquakes"

Lyse Aybar: 06:00
Yeah, exactly. I can deal with this.

Host: 06:02
So you get to these towns. You're experiencing earthquakes. You're seeing ghost towns. You're seeing people in distress. What do you, what are you doing? Are you going door to door? Like, how are you encountering people? How are they responding to you? What's that look like?

Dr. Hansel Arroyo: 06:15
We would essentially go door to door and knock and say, "Good morning, good afternoon! We're volunteers. We would like to see if we could talk for a little bit and kind of get a sense of how you've been doing after the earthquakes." And people were very welcoming.

Lyse Aybar: 06:33
Everyone I encountered was embracing. Everybody wanted to speak. There was not one person that said, "I don't want to talk to you," or "I don't have time." They were always engaging. They were like, "Come in!" I remember speaking to a lady who said, "Yes, I've gotten water. I have food. I have my medication, but no one has come here to ask me how am I doing? How am I coping?"

Host: 06:57
Take us to one encounter or one person whose story really moved you?

Lyse Aybar: 07:02
Well, I have a lot! Like I said before I think I have stories for days. I met this man, 81 years old. And as we're talking, he's like, "You see that door?" He pointed towards the back door. He goes, "That door is open, and it stays open ever since December 28th." And he told me, "I sleep with my sneakers on." That broke my heart. And I'm like, "What do you mean you sleep with just sneakers on?" And he said, "Well, what if I have to run? If I have to put my sneakers on, it's going to delay me. And then he tells me, "My wife is bed-bound. And if I have to put on my sneakers and I have to save her, I'm not gonna have time." So that really touched my heart. I even get goosebumps just talking about it.

Host: 07:07
What did you say to him? You're there to provide mental health services? What do you, what do you say to someone like that?

Lyse Aybar: 07:58
First of all, I built on his strength. And I built on the fact that he's been in the service before. So he has a plan. And just acknowledge the fact that he's strong and how proud his wife must be of him and his children, because he has children in the States. And that he needs to take care of himself, too. Because I also told him, "You gotta take off your sneakers at some point. You have to relax a little bit." And make sure that he ate well. We went over his plan, his medication. And what if his plan doesn't work? What will he do next? Make sure his cell phone is always charged, like little basic survival skills we went over. But I think more—he helped me if anything, you know, become stronger!

Host: 08:50
That's interesting, you've now given two examples of when other people helped you to be stronger. The first with the tremors, and now the second one was with this guy.

Lyse Aybar: 08:57
Yes. Because we learn from each other. When you're going through natural disasters, you don't have the whole checklist. You kind of build on each other to make it through the time, the struggles. And that's one thing I learned from there. We had to pull it together. We all have strengths and we all have weaknesses. So what I lack, he's stronger—.

Host: 09:20
You're talking about the group of service providers?

Lyse Aybar: 09:23
Yes, and even emotionally to help us walk through the community. We [unclear] for each other at the moment to debrief, "Oh, my God. Did you just hear that? Like, this is what's going on." So we kind of [unclear] off each other to make it through.

Host: 09:38
Hansel, do you want to add to that?

Dr. Hansel Arroyo: 09:40
I feel like I also learned a lot from just being in this experience and meeting with people. I'll say that at times I felt very helpless because in mental health there's no easy fix. There's no, like, "Take this antibiotics for seven days. I'll see you in a month. And you're good." Mental health services often are cumulative. You see people on a regular basis, you can provide them medication and that's the symptoms do get better. But this was a very different scenario where we were mostly providing supportive psychotherapy and actively listening and providing feedback and accentuating their strengths, like you were saying. That was a key component of like, "Oh, you mentioned you've gone through this in the past and you are here," you know, kind of repeating that to the individual so that that can get solidified in their mind. But I have to admit that sometimes I also got—sort of like had my breath taken out of me from hearing these stories. There was this one woman that I think maybe you and I saw together, Lyse. She was this elderly woman living in this very small house. And we started talking and she tells us this very tragic story of how her husband had recently died in the last few months, unrelated to the earthquake. And one of her sons had committed suicide during the period of where the earthquake had started. And she was pretty much left alone living in this house. And I noticed that the seal in the house was yellow. And I asked her, "Oh, do you feel safe in this house? I see that FEMA has marked your house as yellow—"

Host: 11:26
Which means?

Dr. Hansel Arroyo: 11:27
Which means that it's not very safe to be living in. And then she looks at me and says, "Oh, that yellow sticker was from Hurricane Maria. That's not even from this time around." And I realized, I looked—.

Host: 11:45
Which was three years ago.

Dr. Hansel Arroyo: 11:46
Which was three years ago. And somehow she had managed to keep an outlook of, you know, that things somehow would get better. I still don't know where she was tapping in to have that.

Host: 11:59
I wonder if it was faith. I wonder if it was something else, just her constitution.

Dr. Hansel Arroyo: 12:04
Faith was big. I think most households had a faith-based background.

Host: 12:11
And what does that look like in practice?

Dr. Hansel Arroyo: 12:13
It gives people meaning. It gives people meaning. It gives people an explanation. You know, we know that faith is a protective factor against things like suicide and having some sort of connection to a religious community is super helpful and develops resilience and protects people from having suicidal thoughts. And so I guess part of the theory is that it gives people meaning. "This happened for a reason," right? As opposed to, "This terrible disaster happened in a vacuum and there is no way out of it and it just did." If you give it meaning, then you have meaning for yourself and for your life.

Lyse Aybar: 12:53
As a mental health provider, you learn to build on their faith. You ask them, "What does that mean to you?" And they will tell you, "Well, we didn't expect this magnitude, but if God put us here, he'll help us through it." When you're doing your intervention, you build on that strength. You always look for what's their strength, what's their biggest strength and you build on it and you make them future-oriented.

Host: 13:15
What do you mean by future-oriented? Say more.

Lyse Aybar: 13:17
Future oriented in that the homes will be rebuilt. Schools will open again, which there was no school in session while we were there. The only schools that were open were the private schools and there were very, very few. That they will be able to get back to the employments. The neighbors will be back, even though they left. They will be able to get back to that pre-crisis mode that they were in.

Dr. Hansel Arroyo: 13:42
It's like the opposite of, like, when people have panic attacks. When you have a panic attack or an anxiety attack, you are so overwhelmed by the feeling that you're experiencing—the increased heart rate, the shortness of breath, the kind of feeling vibrating, the feeling of an impending doom, and the inability to step outside of that moment and remember, or think, "Oh, there's moments where I don't feel this way." So that is like future orientation when you realize, "Yeah, right now is bad, but this is not how every moment of my life is." So tapping into that. And especially with such short sessions or encounters, whatever you want to call it, that we had, that was like a lot of our goal, tapping into people's strengths and building that up.

Host: 14:28
How would you take somebody who maybe didn't have that future-oriented outlook and bring them along to see a future for themself?

Lyse Aybar: 14:37
That is overall challenging, regardless of which setting that we're in. So we would give them a scenario. Like, for example, this lady, I told her, "Let's say you have another earthquake. What would you do? We're experiencing one right now. What are we gonna do? You're gonna help me get outta here. So how are we gonna do this?" So giving them scenarios, role play, teach back, help them identify things that they will see if a crisis occurs.

Dr. Hansel Arroyo: 15:08
You figure out what people value. Everybody values something. We talked a little bit about how a religious background can be something of much value and can provide meaning, but people value family, people value seeing family members grow and age and seeing life progress, and so you can tap into things like that to develop hopefulness for the future.

Host: 15:33
I'm interested in resilience kind of on a community level. I've been reading a lot—I know there's a lot of sociological work about the ways that communities bounce back from disaster. And there's an irony in it in the fact that many times in the wake of a natural disaster, people are brought together in common purpose. And they often look back on those moments as being full of joy and full of meaning. And I'm wondering whether you experienced that in Puerto Rico, you saw neighbors helping neighbors, you saw meaning and resilience kind of building up from the ground floor, as it were.

Lyse Aybar: 16:12
We did see a lot of that. The community definitely came together. So one thing I observed about being there is that in the community, like within the three-block radius, you have the grandmother lives there, the aunt, the cousin. Everybody's kind of family. And those are not are family, even though they're not blood-related. I saw many people whose homes were not destroyed, and everyone else's home was destroyed. And they brought them in. They're not at the base camp. They're not in a tent sleeping outside of their home. There was a neighbor who brought in her neighbor who has a history of dementia. Brought her in, and she's been staying with her. Ensuring that when the earthquake happened, everyone hit the streets and started calling the neighbors names. "Maria, where are you? Jose, where are you?" Making sure that everyone was alive. And I think overall the community is very, very united.

Dr. Hansel Arroyo: 17:09
Yeah, very much so. So there were the government base camps where people can go, and you can set up your own tent. But not everybody liked being at the government base camps because there were some restrictions of, you know, like playing loud music, being able to drink, having to go to bed at a certain hour. So a lot of people stayed in their own community and congregated around the main park or a basketball court and set up their tents there. And that was sort of like these makeshift camps. They weren't being encouraged to do this by the government. They were just happening organically. And people felt safer because they were together with a group of people that they knew from their own community. They also feel safer because they were closer to their homes or whatever was left of their homes. I think it's human nature. We're social beings. It's human nature to want to seek each other and try to help each other in a certain way. I think it's easy to put your differences aside in the moment of need.

Host: 18:17
Yeah, exactly. And this is one of the things I find so interesting. It's like there are two conceptions of how we are, what is human nature? There's one that assumes that the veneer of civilization is very thin, the slightest crack—every man for himself, pandemonium breaks loose. When in fact it sounds like in many of these instances, what happens is that resilience and connections start generating almost immediately, and they cross all the sorts of fissures that we normally see in our society, whether it's class or race or what have you. I think that's so inspiring.

Dr. Hansel Arroyo: 18:53
There was this study that was done in some of the survivors of the Pulse shooting in Florida, where the goal was to test, or to create a narrative of what was resilience in this context. And one of the main things that survivors reported was community building. Developing a community helped. And when this happened, this shooting happened, people came together, and that was like a huge protective factor for them. And it's a key component of developing resilience, developing community.

Lyse Aybar: 19:27
Yeah and also I think helping them tap into their own awareness of how to survive. Because they went through this natural disaster, but this is not their first. So we tapped into, as well, previous experiences. They had the hurricanes, but we also tapped into their own family, you know, inner-circle disasters.

Host: 19:49
In other words, in your story you can find examples of resilience. Think about that and that will help you through this.

Lyse Aybar: 19:55
Exactly, yes.

Host: 19:57
So going back to what we were talking about a moment ago with community resilience in the wake of disasters, whether it's Pulse or whether it's a natural disaster. One of the reasons I was so eager to bring that up is because I think with climate change, we can expect these sorts of things to happen—well, not earthquakes, but other forms of natural disasters—more frequently. So it's important to talk about it and talk about the sorts of things that happen and the ways to prepare. And I was wondering if you had any thoughts along those lines, based on your experience in Puerto Rico, what sorts of things could a listener be thinking about prior to an event like this?

Lyse Aybar: 20:37
Well, with hurricanes, not so much earthquakes, I feel that there's a start point and there's an end point. So if people would start thinking that we're gonna get through this, like it'll at this time and it's expected to end at this time, and we can prepare emotionally, physically, we can prepare for natural disasters, and build on your community to make themselves stronger.

Dr. Hansel Arroyo: 21:03
One of the ways to develop resilience is to help people find groups of individuals in which they can identify with. If you're attached to a community, whether religious, racial, based on gender, sexual orientation, whatever it is, that actually helps you be more resilient and step back from stressful situations. So I would wonder if there's a way to promote that before disasters happen. I mean, you're talking about it almost in a prophylactic way, right—how do we help people?

Host: 21:36
Well, it sounds like simply investing in communities for yourself, building those connections to groups of people with whom you feel a deep affinity as a general life practice. We talk a lot about social isolation nowadays and—.

Dr. Hansel Arroyo: 21:50
Or tribal mentality.

Host: 21:51
Or tribal mentality, but it seems like that is a healthy way to prepare—not only to enrich your life now, but to prepare for something like this happening. So do you have any plans to do another deployment?

Lyse Aybar: 22:05
I do. I already said that if there was another one, I would go. There is a need. I mean, there is such a dire need that I feel I can't sit back and not do more. I was introduced to this world out there, and I can't just leave it out there without knowing how they're doing. It's just part of who I am. And I think that, like I said, if, if I can help, why not? Even if it's one person we impact.

Dr. Hansel Arroyo: 22:35
I agree. I would do it in a heartbeat. And, you know, part of the plan was—this first phase was a little bit of developing an assessment of what was the major need in the island. We ended up seeing 1,200 people, the entire team, during that week period. And so now we're collecting data and trying to determine what are the major needs or the major symptoms, diagnoses. And then the second stage is just to kind of analyze the data. And the third stage was to create a form of ongoing therapy, whether it's through telepsych or whether it's sending another team, we're not sure what that's gonna look like, but yeah, 100 percent I would be involved in it. Once you tap into it, like you were saying, once you see it, you can't unsee it. And for me it's kind of personal. My family is still there and they experience this on a regular basis. So, yeah, I would go in a heartbeat.

Host: 23:41
Great. Well, thank you both so much for your work and for being on the podcast. It's been a pleasure talking with you.

Lyse Aybar: 23:45
Thank you.

Dr. Hansel Arroyo: 23:45
Thank you, thank you.

Lyse Aybar: 23:46
Dr. Hansel Arroyo is the Director of Psychiatry and Behavioral Medicine at the Institute for Advanced Medicine and the Center for Transgender Medicine and Surgery here at Mount Sinai. Lyse Aybar is Clinical Manager in the Psychiatric Emergency Room at Mount Sinai Beth Israel. Road to Resilience is a production of Mount Sinai Health System in New York City. It's made by Katie Ullman, Nicci Hudson, and me, Jon Earle. Lucia Lee is our executive producer. If you enjoyed this episode, please rate and review us on Apple Podcasts. I know I say this every time, but it's true—it helps other people find the show, and so we really appreciate it if you could do that. Thanks. We'll be back soon with more episodes. And until then, thanks for listening, and we'll see you next time.