By Gaby Hilkowitz Rurka

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Gaby Hilkowitz Rurka

There is a lot of emotional and psychological trauma currently in Puerto Rico. A lot of it dates back to Hurricane Maria which took place in 2017 when large parts of the island were devastated by the storm. On my recent mission as part of United Hatzalah’s Psychotrauma and Crisis Response Unit’s delegation, I saw just how much those old emotional injuries are still unhealed. these emotional injuries were exasperated by Hurricane Fiona, which, while being less intense than Maria, was still devastating and left large portions of the population without electricity or water for lengthy periods of time. In some places on the island, power still has not been restored. 


I left Israel a week ago with fellow unit members and we very quickly became a unified team. Our unit provides psychological first aid for people suffering from mental or emotional stress after or during traumatic events. From the people I have met here, I have learned a lot and I believe it was the correct decision for me, even though it meant leaving my own children and those I work with, back in Israel. 

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Gaby, Luis, Kamila Forkosh-Lavan, and Tamar Schlesinger working with a group of children

One of the interactions that struck me most as part of the delegation was when I met an eight-year-old boy named Jack (false name). I was together with another social worker named Avishai Levkovitz as well as a local volunteer, Luis Vasquez, who came along to translate for us and provide some medical coverage if needed. We approached one of the houses in the municipality of Anasco, where we were working that day, and met Jack. My first assumption was that Jack was on the spectrum because of his lack of eye contact and oddly shy behavior. I kept trying to make eye contact with Jack but he would not look back at me. I couldn’t quite distinguish the cause of why he was not connecting with me, but oddly enough, when Avishai came, Jack immediately connected with him. I saw Avishai could calm Jack down and started therapy exercises with him. Meanwhile, I took aside Jack’s mother to learn a little bit more about Jack and explain to her what exercises Avishai was doing with her son, and how they could help Jack express his feelings and deal with his emotional trauma.


After five minutes of doing the exercise, Jack was a whole different boy. He started talking to those around him and interacting with both Avishai and others. He began to feel safe once again, which according to his mother, he hadn’t felt since the storm hit last Sunday. After 20 minutes with Avishai, Jack began to smile and act like a bubbly happy child. His mother was overjoyed and said that she hadn’t seen him smile since before the storm. As Jack’s mother watched her son change back to the boy he was prior to the storm, she became very emotional, so Avishai went to talk to her for a few minutes. By doing so, he missed something I’ll never forget, Jack jumped up with the biggest smile on his face, ran towards his aunties, and began to hug each and every one of them. It melted my heart to see the joy that this child was able to experience so quickly after being shut down for so long.  Jack had been sitting to the side of the room by himself and interacting with no one when we came. Now, after a short period of time, during the session with Avishai, he changed from a boy who was uncomfortable, stressed, and agitated, to a child who once again felt safe and able to express himself. He was once again happy, calm, and connected to those around him. I learned an important lesson as well. I learned that I shouldn’t judge anyone just from having a negative interaction where we don’t connect. It seemed Jack needed a male person to connect to, and Avishai was the right person in the right place at the right time. 

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Avishai and Jack

Another story that moved me to tears was when I came to a home with a grandmother and two young children. Again I was paired up with Avishai and Luis. When we began speaking with the grandmother we saw that she was so overwhelmed that she didn’t even let the children speak. Avishai and I decided to do separate sessions, Avishai spoke to the grandmother and I spoke to the children. I started the therapy exercises with the children, but then the children’s mother arrived and asked me if there was another therapist who could talk to her. I called over another team member, Tamar Schlezinger, and asked her to speak with the mother. When Tamar arrived the mother objected to leaving her children alone in a therapy session. I decided to consult with Tamar and we decided on doing a session with the mom and kids together. The session’s flow was amazing and the styles of interventions we needed to use were very dynamic. We taught both the mother and the children that they need to depend on one another and support one another. We worked with them on having each one open up about their feelings to the others and we provided them with techniques that they could use on their own after we were gone to help keep them all communicating and not bottling up their feelings or worries. We learned with them as they experienced this new type of communication, we learned how best to help them through their traumas. We learned as the patients learned. 

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Gaby and Luis talking with local residents in Anasco

I’ll share just one other story because I feel that it really explains the level of trauma that we were faced with as a result of the hurricane. While in Loiza, another municipality that we were sent to in order to assist, I had a 20-minute session with a number of children. I asked them how they felt when the storm hit, and whether they did anything at the time. One of the children said in the group that he tried to push up the water so that it wouldn’t damage his home. Another child said he played with his younger brother in order to distract him so that he wouldn’t be scared. I encouraged the children to share these stories so that they could learn for themselves, that they were not completely helpless even in the face of a hurricane and devastating flood waters all around them. I encouraged them to see that they did little things to exert control and help others. 


Then told me of their fears. Most of the children expressed that they are afraid at night and also anytime it rains or when the wind blows. These are very understandable fears after having lived through not one, but two devastating hurricanes. I thanked them for sharing their fears with me and I worked with them to give them tools that even they, at a young age, could use to alleviate the fear. I handed out straws and started practicing breathing exercises with them. I did it in a simple and silly fashion which they loved. This exercise helps calm the body and mind and I told them that whenever they feel afraid they should practice their breathing techniques and talk to their parents about what they feel to help them calm down. Another exercise we worked on was one for body relaxation. It was lovely to see the kids helping and stabilizing themselves and each other. Toward the end of the session, I recognized just how much of an impact I had made when some of them opened up to me and came to sit on my lap. I received hugs from a few, while others were still shy. I noticed one of the kids throughout the session did not look at me and sat very far away. But as the session went on, he kept moving closer and closer to me, as I earned his trust through the exercises. In the end, he sat very close to me and began participating with all the others. 

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Gaby and Luis working with the children on the straw breathing exercise

It was really beautiful to see the change that we were making with all the people we interacted with. The entire team worked well together and with the people of Puerto Rico and I think we did a lot of good. On a personal note, I feel exhausted and uplifted altogether, and as our mission comes to a close, I feel that I am more than ready for the next one, even though I hope that there won’t be a need for another mission like this anytime soon. 


Gaby Hilkowitz Rurka is a social worker who works with children and youth at risk. She has been volunteering in the Psychotrauma and Crisis Response Unit with United Hazalah for the past five years.

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