A social worker, Lisel Vargas, has come to visit Don Gregorio at his storm-damaged home on the steep hillsides of Humacao, a city on Puerto Rico's eastern coast near where Hurricane Maria first made landfall.

Gregorio, a 62-year-old former carpenter who lives alone, looks haggard. He stopped taking his medication for depression more than a week ago, and he says he hasn't slept in four days. He feels anxious and nervous, he says, rubbing his bald head and fidgeting with the silver watch on his wrist. His voice monotone and barely audible, he tells Vargas that he has recently had thoughts of suicide.

Indeed, the overall suicide rate in Puerto Rico increased 29 percent in 2017 over the previous year, with a significant jump after Hurricane Maria, according to the Puerto Rico Department of Public Health. And that anguish is continuing.



Gregorio's descent from determined storm victim to this moment of despair is a path traveled by many in Puerto Rico, who lost much more than material possessions. Psychologists and social workers, like Vargas, say elderly people are especially vulnerable when their daily routines are disrupted for long periods of time. Those who were once active, she says, now stay home alone.

"Before, they used to watch television, they would watch their novellas [or] hear the radio," says Vargas. That predictability of TV shows, church groups and frequent visits with friends imbues life with meaning and order. The storm changed that.

"Because they feel depressed," Vargas says, "they don't have that desire to keep that routine — of sharing in the community."

In the weeks following the storm, Gregorio says, he cried all day, every day. After that, he got to work, clearing the broken branches and helping his neighbors.

But as the months wore on and his church remained closed, his regular church groups couldn't meet and many of the people he saw every day moved to the mainland. He went six months without electricity and missed the nightly routine of watching the local news. Now, he feels listless and forlorn.

"Now, I can't do anything," he says. "Like about two months that I haven't been able to do anything. I'm not motivated."

So he just sits alongside the driveway of his home, much of the day. He wanted to go live with his sister in Florida, but he says she can't take him in. He reads his Bible and prepares canned food for dinner and goes to bed early.

"We have elderly people who live alone, with no power, no water and very little food," says Adrian Gonzalez, chief operating office at Castaner General Hospital in Castaner, a small town in the island's central mountains. The loss of routine has created widespread anxiety among the elderly, he says. "We have two in-house psychologists and right now their [schedules are] packed."

Dr. Angel Munoz, a clinical psychologist in Ponce, says people who care for the elderly need to be trained to identify the warning signs of suicide.

"Many of these elderly people either live alone or are being taken care of by neighbors," says Dr. Munoz. "They are not even relatives."

In Humacao, the church has tried to bring back its slate of activities, but Don Gregorio says he often doesn't feel like going. Many of the people he once spent time with left Puerto Rico after the storm.

Standing on the hillside behind his house and surveying banana and breadfruit trees that show new signs of life, Gregorio doesn't sound hopeful.

"I would like to leave, too," he says. "I pray that God can take me out of this house — because I've lived in the same place for 62 years."

He recently called his sister in Jacksonville, Fla., and asked if he could move in with her.

"She said, 'No, you can't live with me'," he says, and tears up.

Sarah Varney is a senior national correspondent at Kaiser Health News, a nonprofit health newsroom that is an editorially independent part of the Kaiser Family Foundation.



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MARY LOUISE KELLY, HOST:

We're going to get a view now of what the slow recovery in Puerto Rico has meant for some of that island's older residents. The devastation of Hurricane Maria upended millions of lives. And for elderly people, it can be much more difficult to find the kind of structure in their daily lives that they had relied on before the storm. Sarah Varney reports that many are struggling with depression.

SARAH VARNEY, BYLINE: A social worker, Lisel Vargas, has come to visit Don Gregorio at his home on a steep hillside in Humacao. It's a city on Puerto Rico's eastern coast where Hurricane Maria first made landfall. Inside the darkened living room, bottles of donated water are stacked against a wall. Stucco and paint drip from the storm-damaged ceiling like stalactites.

Gregorio, a 62-year-old former carpenter who lives alone, looks haggard. He stopped taking his medication for depression more than a week ago. And he says, he hasn't slept in four days. Gregorio sits on a wooden chair outside his front door while Vargas take stock of his medication. His voice is barely audible. He feels anxious and nervous, he says, fidgeting with his watch. In the weeks following the storm, he says he cried all day every day.

DON GREGORIO: (Speaking in Spanish).

VARNEY: "The road was blocked," he says, "it was full of trees." Then he got to work clearing the broken branches and helping his neighbors. But as the months wore on and his church, the organizing force of his day, remained closed, his regular church groups couldn't meet. And many of the people he saw every day moved to the States. He went six months without electricity and missed the nightly routine of watching the local news. Now he feels listless and forlorn.

GREGORIO: (Speaking Spanish).

VARNEY: "Now I can't do anything," he says, "because I'm not motivated." So he sits much of the day here along the driveway, reads his Bible and prepares canned food for dinner and then settles into bed early at 8 o'clock for a long sleepless night.

GREGORIO: (Speaking Spanish).

VARNEY: "My body feels so tired," he says, "and last night my head felt hollow." He tells Vargas that he's recently had thoughts of suicide. Gregorio's descent from heartbroken but determined storm victim to this moment of despair is a path traveled by many older people here in Puerto Rico. Psychologists and social workers like Vargas say elderly people are especially vulnerable when their daily routines are disrupted for long periods of time. Those who were once active, she says, now stay home.

LISEL VARGAS: (Speaking Spanish).

VARNEY: "Before they used to watch television, watch their novellas, hear the radio," says Vargas. That predictability of TV shows and church groups or seeing friends regularly imbues life with meaning and order.

VARGAS: (Speaking Spanish).

VARNEY: "Because they feel depressed," she says, "they don't have that desire to keep that routine of sharing in the community like they did before the storm." It's the feeling that life will never be the same again. The effect can be devastating. The suicide rate in Puerto Rico increased 29 percent in the months following Hurricane Maria. But for people aged 65 to 69, the suicide rate more than doubled.

Even though the church here in Humacao has tried to bring back its slate of activities, Gregorio says he often doesn't feel like going anymore. He stands on the hillside and surveys his banana and breadfruit trees that are regrowing. He tells me that he liked to leave the island. He called his sister in Jacksonville, Fla., and asked if he could move in with her.

GREGORIO: (Speaking Spanish).

VARNEY: He tears up. "She told me no," he says, "no, you can't live with me." I'm Sarah Varney in Humacao, Puerto Rico.

KELLY: And Sarah Varney is with our partner Kaiser Health News.

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