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Food shortages, damaged homes, fear of death, loved ones leaving. The cumulative stresses of Hurricane Maria contributed to thousands of schoolchildren developing symptoms of post-traumatic stress disorder, or PTSD, in Puerto Rico, according to a study published Friday.
The study in JAMA Network Open found that 7.2% of the students reported “clinically significant” symptoms of PTSD. More girls tended to show signs of PTSD than boys.
Researchers surveyed 96,108 public school students five to nine months after the 2017 hurricane. The cohort included youth in third through 12th grades across different regions of the island.
The Puerto Rico Department of Education — which partnered with the Medical University of South Carolina for this study — is using the data to target areas with the greatest need for mental health services, the study said.
Maria, which struck the island as a Category 4 hurricane in September 2017, killed an estimated 2,975 people within the American commonwealth. Residents struggled to access clean water and some remained without electricity nearly a year after the storm.
It had dramatic effects on the students. Nearly 46% said their home was damaged. More than 32% experienced shortages of food and water. And roughly 58% reported they had a friend or family member leave the island. The effects did not vary based on where the students lived or their families’ income.
Rosaura Orengo-Aguayo, a clinical psychologist at the Medical University of South Carolina and the study’s lead author, said the findings show the breadth and indiscriminate nature of the devastation.
“That just speaks to how big Maria was, how destructive Maria was island-wide,” she said. “And it didn’t matter what your income was or your location was on the island — you were affected.”
Similar problems have been reported among children in other parts of the Caribbean also affected by hurricanes in 2017.
Congress is at a stalemate in passing an aid bill that would send more resources to Puerto Rico and other areas affected by natural disasters. President Donald Trump has expressed his reluctance to provide more money to the island.
The trauma caused by a natural disaster can manifest itself in a variety of ways, said Frank Zenere, district coordinator of the crisis management program at Miami-Dade County Public Schools, who was not associated with the study. Family units can break down through divorce or domestic violence, he said. Young children can revert to thumb-sucking or wetting the bed. Teens sometimes try to exert control by acting out or turning to drugs to self-medicate.
To be sure, Zenere said, most people who survive a natural disaster do not develop long-term mental health conditions.
“They’re distressed by it. It has impact on their life — yes,” said Zenere, who helped coordinate mental health efforts in Puerto Rico in Maria’s aftermath. “But the great majority are not going to develop psychiatric illness.”
Zenere said the differences by gender found among students reporting symptoms of PTSD align with existing literature — boys are more likely to act out, while girls are most likely to show depression and anxiety.
The study’s authors said the loss and disruption caused by Maria contributed about 20% toward the youth’s symptoms of PTSD. While the researchers did not measure what other circumstances played a role, Orengo-Aguayo said, other “protective factors” — like eventually securing basic needs and community support — influence resiliency.
Notably, Orengo-Aguayo said, the level of PTSD symptoms reported in the study is lower than what was expected. Some studies show up to a third of children will develop chronic symptoms after surviving a natural disaster, the authors wrote.
Familial ties or the fact that the study was conducted several months after the storm could have played a role in the children’s resilience, she said. Or the children might still be attuned to trying to survive.
“What we might be seeing is that children at that stage were still focused on getting access to basic needs,” she said.
Regan Stewart, a clinical psychologist at the Medical University of South Carolina and a study co-author, said the team has secured two grants from the federal Substance Abuse and Mental Health Services Administration to continue work on the island for at least three more years. It plans to use telehealth to expand access to mental health services and train school staff and mental health professionals on trauma-focused interventions.
However, public schools in Puerto Rico are burdened by economic constraints. The island — already facing a budget crisis — closed 300 schools over the past two years due to a lack of enrollment exacerbated by Hurricane Maria.
Zenere said school staff members are among those who need to be cared for first, “because they’re going to be the glue that keeps it together for that classroom of 20 children or so.”
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“It is dangerous,” said the head of a Puerto Rican nonprofit that provides food to the homeless. “People don’t have enough money to buy food already.”
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Hamilton creator Lin-Manuel Miranda returned to the stage as Alexander Hamilton on Friday in a benefit performance in San Juan, Puerto Rico, as the island struggles to recover from Hurricanes Irma and Maria, almost a year and a half after they struck. Rough Cut (no reporter narration).
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The show’s creator hopes its 17-day run in San Juan will call attention to the struggling island’s needs as well as its riches.
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“I have never felt anything like that,” Miranda said of the crowd.
When youâre wandering around Old San Juan, youâll feel worlds away from the United States.
Quaint cobblestone streets. Murmurs of Spanish. Centuries-old fortresses.
But the capital of Puerto Rico is just a few hours by plane â and because the island is a U.S. territory, you wonât need a passport to get there.
You can also use your cell phone and spend U.S. dollars, and since almost everyone speaks flawless English, you wonât need to worry if you donât speak Spanish (though most people will happily let you practice).
I recently spent 10 days in this tropical paradise. It makes a perfect weekend getaway for Americans seeking exotic sights, sounds and tastes without having to travel far from home.
What to Expect
As you probably know, Puerto Rico was devastated by Hurricane Maria in September 2017. The storm caused $ 90 billion in damage, according to the National Oceanic and Atmospheric Administration. Many residents went without power for almost a year.
Given all the negative news coverage, I wasnât sure what to expect. What would it look like? Would there be hot water and electricity? Would restaurants and hotels be open?
When I hopped off the plane, I was surprised to see that San Juan looks, well, normal. Restaurants, hotels and attractions are open, and the city has been welcoming cruise ships for months.
Iâm not saying the work in Puerto Rico is done. It is $ 71 billion in debt, and the island faces myriad challenges. While I hope youâll take some time to learn about the territory before visiting, thatâs not what this article is about.
So, instead of diving into Puerto Ricoâs politics and history, Iâll just assure you: The average tourist can have a perfectly lovely visit. Â
And you should, because one of the best ways to support the island is to spend money there. Puerto Ricans are some of the friendliest people Iâve encountered in my travels; they will likely welcome you with a smile.
When to Go
The temperature in San Juan is around 75 to 85 degrees year-round.
High tourist season lasts from mid-December to mid-April and comes with bigger crowds and prices. Springâs shoulder season (mid-April to June) has fewer crowds.
Itâs hurricane season from June to November, though that shouldnât necessarily deter you from visiting. The weather can still be great, and you can find discounted rates on hotels, according to U.S. News & World Report.
What to Do
You wonât find yourself hurting for activities while visiting San Juan. Hereâs a sampling of offerings in this historic seaside town.
Old San Juan
For most visitors, simply wandering the charming streets of Old San Juan could provide days of entertainment.
With 16th- and 17th-century architecture, swaying palm trees, blue cobblestones and stray cats sleeping on stoops, youâll feel far removed from big-box stores and strip malls.
Stop into stores, sit in one of the many plazas, grab a cup of world-class coffee from Cuatros Sombras and watch the world go by.
Museums and Attractions
History lovers, rejoice! San Juanâs museums are incredibly affordable.
Entrance to the San Juan National Historic Site, which includes the 16th-century El Morro Fort and Fort San CristÃ³bal, is $ 7. La Casa Blanca, the oldest continuously occupied house in the western hemisphere, costs just $ 3 to enter. Â
Ready to spice up your day of history? Take a $ 15 historical tour of the Bacardi rum distillery.
When it comes to beaches, you usually have to get out of the city to find beautiful ones. But thatâs not the case here.
Neighborhoods like Condado, Ocean Park and Isla Verde all have pristine beaches and are just minutes from Old San Juan. Many visitors choose to book waterfront hotels here.
But even if you donât stay by the beach, set aside at least a half day to enjoy the sun, surf and white sand while pretending youâre in a Puerto Rican postcard.
To get out of the city, the most budget-friendly option is to rent a car. (When I looked, it was only $ 17 per day.)
You can then cruise 30 miles to El Yunque, the only tropical rainforest in the U.S. Most of its trails closed after Maria, but theyâve been steadily reopening. Even so, you can always take in its lush surroundings and waterfalls.
On your way back, hit up PiÃ±ones, a beachside town famous for its laid-back food kiosks.
Where to Eat and Drink
Although you donât hear about it as much as other foodie destinations (yet!), Puerto Ricoâs culinary scene has got it going on.
Its most famous dish is âmofongoâ: garlicky fried plantains, sometimes shaped into a bowl and filled with meat and broth. You can find it anywhere from hole-in-the-wall establishments to fine-dining restaurants. Â
As far as budget options go, here were a few of my favorite spots:
Lote 23: This industrial lot is filled with over a dozen food kiosks â itâs an absolute must visit. Be sure to try manchego croquettes at Croqueteria (two for $ 4) and homemade cashew milk lattes at Cafe Regina ($ 7). El Jangiriâs poke bowls ($ 8-$ 12) are also excellent.
La Bombonera: One of the oldest restaurants in San Juan, this bakery has been open since 1902. Its most famous offering is the âmallorcaâ, a flaky pastry filled with cheese and topped with powdered sugar ($ 3.95). Yum.
CafÃ© ManolÃn: Stop by this unpretentious local joint to sample chicken mofongo ($ 10.95) and âempanada de lomilloâ, or breaded beef steak ($ 11.95).
SeÃ±or Paleta: In San Juanâs tropical climate, youâll probably get a hankering for something cold. This gourmet popsicle shop has a range of inventive flavors; my favorite was Nutella-filled strawberry ($ 4).
Barrachina: This restaurant claims to have invented the piÃ±a colada. Although another bar in the area claims it, too, all you really need to know is the piÃ±a coladas here ($ 8) are delicioso. Sit at the bar in the courtyard, and youâre guaranteed to have a good time.
La Placita de Santurce: For a fun night out, grab a beer ($ 2) and wander around this lively bar area, where the streets fill with locals and tourists alike. Itâs perfect for people-watching â and if you stay late enough, youâll undoubtedly see some spontaneous salsa dancing.
Where to Stay
When deciding where to stay in San Juan, youâll face a tough decision: old town or the beach. While Old San Juan offers plenty of charm, staying at the beach is, well, staying at the beach.
The good news is that most options are fairly close together, and by choosing one, youâll probably only be a $ 5 to $ 7 car ride from the other.
You can also choose an Airbnb, but be mindful that it isnât always best for a cityâs residents.
Large, resort-style hotels abound in Condado, a touristy beach area a few miles east of Old San Juan. Iâd recommend staying a little further afield, though; youâll get more for your money, and wonât, be sleeping at a Holiday Inn in Puerto Rico.
Here are two wonderful options:
This trendy hostel is located just a few blocks from the beach. It has a fabulous rooftop â complete with hammocks and lounge chairs â that overlooks the ocean. It also has a shared kitchen, allowing you to cook meals to save money.
Even though Iâm past the point of sleeping in dorms, I often still book private rooms at hostels. Theyâre a great way to enjoy the low rates and sociability of a hostel without listening to other people snore.
Here are its nightly rates:
- Dorm bed: $ 32 and up
- Rooftop tent: $ 45 and up
- Private room: $ 64 and up
- Deluxe private room: $ 88 and up
This boutique vegetarian bed-and-breakfast feels like itâs out of an Instagram catalog. (I know thatâs not a thing, but if it were, this hotel would play a starring role.)
Each room is uniquely decorated with vintage finds, and the grounds, filled with plants and hammocks, ooze tranquility. Rates depend on which room you book but start at $ 89. You can opt for fresh vegetarian breakfasts ($ 11) and also make use of a shared kitchen. Â
How to Get to San Juan
Many airlines, including Southwest, Spirit and JetBlue, offer daily departures to San Juan. (Note that with Spirit, youâll have to pay extra for all luggage, including carry-ons.)
When looking at flights about a month out from my trip, here are some round-trip rates I found:
- From Chicago OâHare: $ 279 (Spirit)
- From Newark: $ 307 (JetBlue, direct)
- From Baltimore: $ 331 (JetBlue, direct)
- From Atlanta: $ 182 (Spirit)
Once you get there, renting a car isnât necessary if youâre just staying for the weekend.
Ubers and Lyfts are plentiful and cheap â with the exception of arriving at the airport, when youâll have to take an official taxi to your hotel. Within the city, walking and biking are great options; some hotels even offer free bike rentals.
Although you wonât get to see everything in Puerto Rico in a weekend, you can always save things for your next trip. Because, once you go â there will always be a next trip.
Susan Shain is a freelance writer and digital nomad. She covers travel, food and personal finance (basically, how to save money so you can travel more and eat more). Visit her blog at susanshain.com, or say hi on Twitter @susan_shain.
This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.
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For a pleasure-packed long weekend in San Juan, the resilient capital, heed these tips on where to sleep, eat, swim, sightsee and drink addictive watermelon mojitos.
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The island has shaped the “Hamilton” creator’s identity. Now he’s bringing the musical to San Juan, and things are getting complicated.
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TMZ published photos of the “Money” rapper, 26, and the Migos member, 27, riding a jet ski during a pre-holiday vacation. Eyewitnesses told the website that the estranged couple seemed cozy as they enjoyed a sunny day with friends.
Cardi, who is scheduled to perform in San Juan at the Electric Holiday festival on Friday night, was all smiles as she wrapped her arms around Offset, who drove the jet ski through the water.
The former stripper revealed on December 4 that she called it quits with the “Bad and Boujee” rapper just 14 months after they secretly married in the bedroom of their Atlanta home.
“We got a lot of love for each other, but things just haven’t been working out between us for a long time,” she said in a since-deleted Instagram video. “It’s nobody’s fault. I guess we grew out of love.”
Offset surprised Cardi on stage during her Rolling Loud Festival performance on December 15 with a floral arrangement that spelled out, “Take Me Back Cardi.” He was criticized on social media for the grand gesture, but his estranged wife was quick to defend him during an Instagram Live session.
“Violating my baby father isn’t going to make me feel any better, because at the end of the day, that’s still family,” she said, referencing the pair’s 5-month-old daughter, Kulture.
More recently, a source told Us, “Cardi and Offset will spend Christmas together … for their daughter.”
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Boston’s championship made Cora the first Puerto Rican manager to win the World Series.
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