Humacao, Puerto Rico A social worker, Lisel Vargas, recently visited Don Gregorio at his storm-damaged home in the steep hillsides of Humacao, a city on Puerto Rico's eastern coast near where Category 4 Hurricane Maria first made landfall last September.
Gregorio, a 62-year-old former carpenter who lives alone, looked haggard. He had stopped taking his medication for depression more than a week earlier, he said, and hadn't slept in four days. He was feeling anxious and nervous, he said, rubbing his bald head and fidgeting with the silver watch on his wrist. His voice monotone and barely audible, he told Vargas he had had thoughts of suicide.
Indeed, the suicide rate in Puerto Rico increased significantly in the months immediately following Hurricane Maria, particularly among older adults, the Puerto Rico Department of Public Health's statistics show, and that anguish continues.
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. Those who were once active, she said, now stay home alone.
"Before, they used to watch television, they would watch their novellas, hear the radio," said Vargas. That predictability of TV shows and church groups or seeing friends regularly imbues life with meaning and order. "Because they feel depressed, they don't have that desire to keep that routine of sharing in the community," she said.
In the weeks following the storm, Gregorio said, he cried all day, every day.
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 United States. He went six months without electricity and missed the nightly routine of watching the local news. Now, he said, he feels listless and forlorn.
"I can't do anything. Like about two months that I haven't been able to do anything," he said. "I'm not motivated."
So he sits, much of the day, along the driveway. 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," said Adrian Gonzalez, chief operating officer at Castañer General Hospital in Castañer, a small town in the island's central mountains. The loss of routine has created widespread anxiety among the elderly, he said. "We have two in-house psychologists and right now their [schedules are] packed."
Dr. Angel Munoz, a clinical psychologist in Ponce, said people who care for older adults 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," said Munoz. "They are not even relatives."
Back in Humacao, the church has tried to bring back its slate of activities, but Don Gregorio said 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 his banana and breadfruit trees that are regrowing, Gregorio said, "I would like to leave too. 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 said, tearing up.