A month and a half after hurricane Maria, the VA Caribbean Healthcare system is delivering care in unconventional ways. And it's helping veterans whose PTSD was triggered by the storm.
Every morning now, staff from the main VA hospital in San Juan hit the road.
The Department of Veterans Affairs knows that many of its patients had their lives so thoroughly disrupted by Hurricane Maria that they haven't been able to come in for treatment. So it's checking its records to see which ones haven't been in recently, and it's sending nurses and medical social workers like Eduardo Vicinty-Santini out to see them.
On a recent day, he checked on retired Army Master Sergeant Luciano Sevilla-Rivera, who lives alone except for his tiny dog Papito in a small retirement community in the mountains an hour southeast of San Juan.
"Do you have any other relatives that look after you?" Vincinty-Santini asked the 72-year-old Vietnam veteran.
Like many VA patients, Sevilla-Rivera responded that he's pretty much on his own. He recently lost his mother, who was his only relative in Puerto Rico.
He said his isolation, as well as the trauma of going through the Category 4 hurricane, triggered Post-Traumatic Stress Disorder.
"I just went crazy," Sevilla-Rivera said. "I didn't feel good or anything like that, so I stay in my bed because I'm here by myself."
Sevilla-Rivera says his car doesn't run, and he can't remember how to get to the VA hospital anymore. For patients like him who can't get in on their own, the outreach teams offer rides back and forth. They also are delivering medications to veterans' homes -- especially insulin, which diabetes patients are unable to safely store for more than a few days because most of Puerto Rico still lacks electricity to run refrigerators.
"If we have that kind of a veteran who needs that kind of thing, we provide the cooler with the ice," Vincinty-Santini said.
In storm's aftermath, images of Vietnam, Iraq
While some VA staffers make those home visits, others are trying to keep the island's VA clinics running. Some are in temporary facilities because of storm damage.
The VA clinic in the southern city of Ponce, one of the largest in the system, is housed in a tent village. The storm damaged the clinic building's cooling system, and mold began growing inside almost immediately.
In addition to the five tents, the temporary clinic also has a mobile pharmacy and a truck in which veterans can get counseling and help with FEMA applications.
There's also a bus that houses a behavioral health clinic, where psychiatrist Carlos De Jesus said he's seen several veterans whose PTSD symptoms have worsened because of the storm.
For some, their symptoms were triggered by the sound of helicopters, which frequently fly over Puerto Rico as part of the relief efforts. One veteran said the military-style tents being used for the clinic had startled him, because they reminded him of the command centers used by small units in war zones.
Other triggers include the trees that were stripped bare of leaves by the 150-mile-an-hour winds.
"Many Vietnam veterans see the lack of leaves in the trees as flashbacks about Agent Orange when they were in Vietnam," De Jesus said.
More recent veterans may experience PTSD after seeing the brown landscape where it used to be green.
"It reminds them of the sands and the desert in Iraq," said De Jesus.
Some feel like they have to do all they can to control their symptoms because so much is at stake right now. De Jesus told the story of one veteran who recently complained of feeling overwhelmed.
"My community, they know I'm a veteran," De Jesus recalled him saying. "I've become the leader, and I can't complain about what I'm feeling because I don't want them to feel that we are falling apart."
"Well, he was falling apart," De Jesus said.
De Jesus said he helped the veteran work through his emotions and vent a little. For now, he said that was enough to help the veteran hold himself together, so that he can do what a lot of people across Puerto Rico are having to do: devote all their energy to rebuilding.