Aimee Voth Siebert deployed to Puerto Rico
Disaster behavioral health response helps recovery
Damaged homes in Naranjito, Puerto Rico
by Jan Stapleman, Office of Communications
At 5 p.m. the evening of Sept. 29, Aimee Voth Siebert found out she was being sent to help with the response to Hurricane Maria in Puerto Rico. Thirty hours later, she was on a flight to San Juan, more than 2,700 miles away.
“This was hands-down the fastest, most whirlwind emergency response I’ve ever been part of,” she said.
Voth Siebert, a behavioral health specialist with the Office of Emergency Preparedness and Response, wasn’t sure she’d be approved for the team because of her rudimentary skills in Spanish. But her past experience in disaster behavioral response, coupled with her ability to deploy quickly, seemed to overcome any concerns about her less-than-perfect Spanish.
She’s no stranger to this work. During the 2015 Ebola outbreak in West Africa, she deployed to Sierra Leone. But then she was responding to a disease outbreak; this time it was a hurricane.
“Every disaster response is different,” she explained. “When you’ve experienced one, you’ve experienced one.”
In Puerto Rico, Voth Siebert led a team of 11 behavioral health responders from various Colorado agencies. They were responding to a request for assistance under the Emergency Management Assistance Compact, a nationwide mutual aid agreement. It was the first time any of them had worked together.
Although the team arrived with an accurate understanding of the island’s devastation ― intellectually ― no one was prepared for its emotional impact. With no power for lights, nights brought an eerie darkness over the large city of San Juan, home to almost 400,000 people. With communication channels knocked out, gathering information became a person-to-person enterprise. Learning about conditions in other areas of the island meant traveling to them.
Voth Siebert’s biggest take-away from the experience is that emergency planning for people must be as robust as emergency planning for infrastructure. With systems wiped out, she explained, people become the systems: to gather information, drive supplies to areas where they’re needed, count supplies and verify their delivery, provide security, and so on.
“But here’s the problem,” she added. “After a disaster, people are messy. There’s a simultaneous need for people and impact on people. So the disaster behavioral health goal is to reduce stress to increase functioning.”
Voth Siebert’s training tells her, after a disaster, people need five things:
  •  To feel safe.
  •  To achieve calm.
  •  To get connected to others.
  •  To do something productive.
  •  To feel hope.
Working with the local mental health agency, Voth Siebert and her team traveled from shelter to shelter all over the eastern side of the island. They provided psychological first aid to residents and workers, created quiet rooms where people could go for respite, and engaged children in activities and play.
Voth Siebert said it was inspiring to watch residents form their own systems. People came out of their houses and began interacting with their neighbors, sharing information, skills and ideas. In doing so, they were embracing an important recovery skill: reframing the disaster from a focus on what they lost to a focus on what they could do to help. Children demonstrated their resilience during play with games and coloring books. One little girl whose house lost its roof said, “At least we can see the stars now.” 
Voth Siebert’s favorite memories of her three-week deployment were of watching her team members in deep conversations with the folks who were living and working in shelters, and witnessing the positive results. One team member, for example, generated calm by engaging staff and residents in deep-breathing circles.
“This changed the desperate energy around us into positive ideas,” Voth Siebert said. “We started with the body to help the brain.”
The team also helped other responders who were there to perform cleanup tasks. Informal conversations often evolved into psychological first aid. In a report prepared for the Puerto Rico mental health agency, the team recommended routinely embedding disaster mental health workers or crisis counselors in other responder groups.
When she returned, Voth Siebert focused on taking care of herself. She meditated and got plenty of sleep, water and exercise. She reconnected with friends.  She limited her exposure to media reports of the devastation, which she called “undercovered and hyperpolarized.” Her husband, Michael, provided support, hugs and a listening ear when she needed to release pent-up frustrations. This isn’t easy work. Responders often feel they’re not doing enough, especially when the devastation prevents them from getting help to remote areas.
Overall, though, Voth Siebert is proud of her team’s accomplishments. “We planted seeds, in small moments with people, and through the ideas we left behind.” she said. The work the team began will be continued by 300 crisis counselors Puerto Rico requested through a grant. She’s confident the tiny U.S. territory will recover, because of the resilience she witnessed in its residents. But it will take a while.
“Please find ways to remind yourself of Puerto Rico now, in six months, in a year, and in five to 10 years,” she said. “Because this will be a long recovery process.”