Studying Perinatal Well-being with Dr. Karen Martínez-González, MD (offered in English, with Spanish at end of interview)

Join us this month to learn about the critical findings on the effects of natural disasters and the COVID-19 pandemic on perinatal women in Puerto Rico. Dr. Martinez-Gonzalez also provides policy recommendations for ensuring perinatal people have the social support needed during large-scale events. She also shares exciting information about research opportunities for clinicians interested in working with Latinos in Puerto Rico and the US. You’ll enjoy her Spanish call to research engagement at minute 36:40 of the bilingual interview.

For more information about training opportunities, please contact Dr. Martinez-Gonzalez at Karen.martinez4@upr.edu.

Dr. Karen G. Martinez-Gonzalez, MD, MSc, is a child and adolescent psychiatrist in San Juan, Puerto Rico.  She is an Associate Professor at the University of Puerto Rico, where she directs the Center for the Study and Treatment of Fear and Anxiety and is the Chair of the Department of Psychiatry. She also completed a post-doctoral master’s in clinical and translational research in 2006 and is now the program's Principal Investigator (R25MD007607) and Director.  She was also one of the Principal Investigators (R21MD013652) of a grant studying the epigenetic and microbial profile of prenatal stress related to Hurricane María in collaboration with the School of Dental Medicine.  She is one of the Principal Investigators of the Puerto Rico Racial & Ethnic Minority Acceleration Consortium for Health Equity (PR-REACH) FDA award U01FD007977.  She is an active member of several professional organizations, such as the American Academy of Child and Adolescent Psychiatry (AACAP) Trauma and Disaster Committee, past president of the Puerto Rico Chapter, and past president of the Association for Clinical and Translational Science (ACTS).  Her current research work is on stress-related disorders and how to promote wellness among highly traumatized or stressed populations.  She is a founding member of the University of Puerto Rico Center for Perinatal Mental Health.

Transcript

Studying Perinatal Well-being with Dr. Karent Martinez-Gonzalez

Dr. Lara-Cinisomo [00:00:04] Welcome to Studying Perinatal Well-being, the podcast of the Marcé of North America. This bilingual monthly podcast will allow new and experienced researchers, practitioners, students, and community members to hear about the latest research and community actions on perinatal well-being. I'm Dr. Sandraluz Lara-Cinisomo, your host. Dr. Karen Martinez Gonzalez is an associate professor at the University of Puerto Rico, where she directs the Center for the Study and Treatment of Fear and Anxiety and is the chair of the Department of Psychiatry. Dr. Martinez completed a postdoctoral master’s in clinical and Translational Research in 2006, and is now the program's principal investigator and director. Dr. Martinez was one of the principal investigators of a grant studying the epigenetic and microbial profile of prenatal stress related to Hurricane Maria in collaboration with the School of Dental Medicine. She is currently one of the principal investigators of the Puerto Rico Racial and Ethnic Minority Acceleration Consortium for Health Equity, also known as PR-REACH. She's an active member of several professional organizations, such as the American Academy of Child and Adolescent Psychiatry, Trauma and Disaster Committee, and past president of the Puerto Rico Chapter and the Association for Clinical and Translational Science. Her current research focuses on stress-related disorders and promoting wellness among highly traumatized or stressed populations. She is also a founding member of the University of Puerto Rico Center for Prenatal Mental Health. Dr. Karen Martinez Gonzalez is an associate professor at the University of Puerto Rico, where she directs the Center for the Study and Treatment of Fear and Anxiety and is the chair of the Department of Psychiatry. She completed a postdoctoral Master's in Clinical and Translational Research in 2006 and is now the program's principal investigator and director. Dr. Martinez was one of the principal investigators of a grant studying the epigenetic and microbiome profile of prenatal stress related to Hurricane Maria in collaboration with the School of Dental Medicine. She is currently one of the principal investigators of the Puerto Rico Racial and Ethnic Minority Acceleration Consortium for Health Equity, also known as PR-REACH. She's an active member of several professional organizations, such as the American Academy of Child and Adolescent Psychiatry, Trauma and Disaster Committee, and past president of the Puerto Rico Chapter and the Association for Clinical and Translational Science. She is a founding member of the University of Puerto Rico Center for Perinatal Mental Health. Her current research focuses on stress-related disorders and promoting wellness among highly traumatized or stressed populations. Welcome, Dr. Martinez Gonzalez. 

Dr. Martinez-Gonzalez [00:02:49] Thank you for the invitation and for this opportunity to talk about this topic that is very important for me. 

Dr. Lara-Cinisomo [00:02:57] Great. Yeah. I enjoyed hearing your keynote address at the MONA Bi-Annual Conference in 2023. I was moved by the fantastic work you're doing in Puerto Rico, and I look forward to learning more about the work that you're doing and sharing it with our listeners. Let's begin by learning a little bit about you. How did you become interested in perinatal mental health? 

Dr. Martinez-Gonzalez [00:03:16] Yes. So, I am a child and adolescent psychiatrist, and even when I decided to start psychiatry residency, I was very clear that I was going to go into child and adolescent psychiatry. So adult psychiatry hasn't really been, at least in terms of the work I do clinically, it's, it's not what I do. I work with families all the time. And after Hurricane Maria, which was a very devastating hurricane that we had in Puerto Rico in 2017, there was an opportunity from the NIH to submit small grants to study what had happened after the hurricane in terms of health, and I worked with a group of collaborators that I had, and we were all interested in looking at what had happened with women who were pregnant during the hurricane. We were, the three of us are female, the three of us have children, and the three of us were just in awe about what could have, you know, how had this hurricane been different if we were pregnant at that moment of the hurricane? So our, our research interests really grew about our concern about women and women who were pregnant or people who were pregnant at that time. And then when we started doing the project, and I started listening to the stories about the difficulty in getting treatment for mental health disorders about how prevalent depression and anxiety is in this group, I started to make connections with other people who had already been working in perinatal mental health in Puerto Rico, and when I started to see just how difficult it was to even get these people into treatment, it was obvious that I, I just had to start looking into it. And what can we do better? Because as a child psychiatrist, I know that if the family is not doing okay in the pregnancy and in infancy, then I am going to get them as children. So it was obvious that I needed to go even further back in development and start addressing this. And so that's how I ended up doing everything that I've done. So it really started with research, and then it has moved to more like clinical and advocacy aspects. 

Dr. Lara-Cinisomo [00:05:54] Wow, what inspiration to have such an opportunity to say, I want to learn about a specific topic and then have it be part of the work that you're doing now and being impacted by the people that you spoke with and that you interviewed for the research that you described. Hurricane Maria, as you said, happened in 2017, a large, category-four hurricane that had a large impact on the island and the lives of those who care about Puerto Rico and the people who reside there. What did your research show or what does your research tell us about the effects that large scale environmental disasters have on perinatal well-being? 

Dr. Martinez-Gonzalez [00:06:35] With that study, I was just so shocked about what we found in these women that we were interviewing after the hurricane; the level of depressive symptoms, the level of post-traumatic stress disorder was just so high in this group. Even compared to, because we were doing other mental health surveillance studies after the hurricane, it affected everybody. So it affected the whole island. So it was like the question was, why are we seeing higher prevalence of depression and post-traumatic stress disorder in this group that were pregnant during that time, compared to, even compared to other families that already had small children? So what was it about pregnancy and, and that period that during a natural disaster in a way makes you more sensitive to perinatal mental health disorders. And it was interesting because if I, if you look at the data before, if you look at the data from Katrina or from other natural disasters, it's like inconsistent, like there are even some papers that have stated that being pregnant during a natural disaster could be protective, because you're going to have more people who are going to try to make sure that everything is okay. And then we, that's definitely not what we were seeing here in Puerto Rico. We were seeing that their mental health was severely impacted. I think another really interesting aspect that we have now that we are now analyzing the data I've been able to find, is that we were dealing with the aftermath of Hurricane Maria and that it took a very long time for us to really rebuild and try to continue to bring back that sense of normalcy. At the end of 2019, we started getting very intensive earthquakes that even though, you know, we have earthquakes from time to time, they were never, never at this level. So, end of 2019, we start getting earthquakes. And then February 2020, pandemic is declared. And here in Puerto Rico, the government took very severe, you know, measures for the pandemic. So, we were doing our study right in the middle of the earthquakes and the pandemic. And now that we're looking back at the data, we see that we have like two cohorts within the cohort. We have one cohort who had only experienced the hurricane. And then we have another cohort who had experienced the hurricane, the earthquakes and the pandemic. And what's very interesting, or about the difference between the two cohorts is that in the first cohort, where they only were exposed to the Hurricane Maria, everyone stated that their worst traumatic event was the hurricane. But then that cohort that we, recruited while the earthquake and the pandemic was happening, then they they started saying a lot of different things were the most traumatic experience in their lives. So you can see how complex studying trauma and exposure to natural disasters is, because humans, we are complex in the way that we evaluate what is traumatic to us. So this is an area that just needs so much more research and more study. Obviously, it was the level of mental health disorders was an impact to me. But there are also a lot of other factors that have been protective of mental health that are equally important because that will help us prevent, for other people, to have negative effects from natural disasters. 

Dr. Lara-Cinisomo [00:10:38] Can you talk about some of those protective factors, either within the context of Hurricane Maria, if there were any that you identified? And then again, during the COVID-19 pandemic? 

Dr. Martinez-Gonzalez [00:10:47] Yes. So, I think the most impactful protective factor that we identified was really then working with, because after having a cohort of women who are pregnant during okay, Maria, we develop another cohort of women who were pregnant during the pandemic. We were expecting, well, if we saw that, you know, that, that the hurricane was so negative on mental health, then the pandemic must be doing the same. We did not find that. We found that the mental health impact of the hurricane had been much worse than of the pandemic. And an interesting thing that we found here that I think it's very different from other parts of the world, including the mainland United States, is that our cohort here did not feel lonely. They, when we asked about loneliness, they felt that they stated that they even though in Puerto Rico, the measures, in terms of people staying in their house, working in their house, not connecting, not being able to go out, they were very severe. What, what this, these women were telling us was that even though they were physically apart, they had found ways to continue to be connected to their families, especially during the pregnancy. And that seems to be protective, like having that connection, making sure that you're still connected to your community. And I have to say, I don't necessarily have the data to prove this, but I think that the, having suffered the hurricane and having had to come together as a community to rebuild the island, created some community bonds that then were protective during the pandemic. 

Dr. Lara-Cinisomo [00:12:35] Yeah, those are excellent observations. I know that in speaking to colleagues in Puerto Rico that's experienced the hurricane, they talked about not being able to connect with family. They had no phone access. They, some had maybe, a, you know, 1 or 2 opportunities to connect with family. So they were isolated physically and in terms of technology, access to their loved ones, whereas in the pandemic they still had that technology. Do you think that that made a difference in terms of the impact of those two events on the mental health of pregnant people that you are studying? 

Dr. Martinez-Gonzalez [00:13:12] Oh, yes, definitely. And it wasn't only that we were not able to connect after the hurricane because we had, we lost communication, we also lost electricity, so there was no internet. There was like nothing else that you can do. But we also felt abandoned after the hurricane. There was this sense that you're here on an island. There's nowhere you can go, and nobody is going to come and help us out, because that's how it felt, at least doing those first few weeks and months after the hurricane. The pandemic was a very different response in the sense that we were connected. We were able to connect. But there was also the government was, in a way, taking care of everyone because, you know, we had to take care of everyone to prevent contamination. So it was very different in both aspects, in the aspect of disconnection, isolation, but also in the aspect of feeling like this is it. There's nothing else for me. Nobody's coming, you know, to help us. And the difference that helplessness, has on, mental health. So it's social connection, but also the sense of having a community that comes together and helps me go through this very difficult situation. 

Dr. Lara-Cinisomo [00:14:38] So you were experiencing multiple forms of trauma in Puerto Rico. There was the natural disaster, the trauma of not having basic needs that you can address, but then also feeling that isolation on a large scale, really feeling abandoned by, a, systems that are supposed to create safety nets and resources for the people of Puerto Rico. 

Dr. Martinez-Gonzalez [00:14:59] Yeah, it's still interesting because like I said, when we're talking to these new cohorts that we have, so they don't talk about the hurricane as much. But if you ask them directly, it's like a flood. People just start talking about the hurricane and and they can tell you, I remember exactly where I was. I remember exactly what happened. You know, they can tell you exactly how many days they were at their home without electricity. It's just interesting how we learned to adapt in order to continue living. But then when is it too much for someone? When is it that point where they just won't be able to adapt anymore? And we need to ask as a community, as a scientific community. We really need to think about that. You know, are we putting people in positions where it's just going to be impossible to adapt because it's just too many stressors, one after the other? And if you don't provide some type of community companionship, social support, then it will take even less of stressors for people to get to that point where they won't be able to adapt. 

Dr. Lara-Cinisomo [00:16:22] Yeah, we talk about cumulative stressors, right? And I wondered about the cohort who experienced the hurricane during their pregnancy. Did any of those individuals also experience the pandemic while in pregnancy? You know, did you follow those individuals? I'm wondering about these multiple, you know, types of stressors. Did you, have you looked at that? 

Dr. Martinez-Gonzalez [00:16:45] Yeah. So we do have, we are following up these families. Both cohorts, we're following up these families and getting as much information as we can from them. And I think those cohorts have the possibility of us looking into those questions. What happens when you have these multiple stressors? And unfortunately, I also have to say that these cohorts, because, are cohorts of families that are living in Puerto Rico, it's not only all of these natural, disasters and events, it's also the economic instability of the island, the political instability of the island, the level of poverty that we encounter here on the island. So when we look and we give, we als-, in both of the cohorts, we used the life event checklist to identify exposures to, to different traumatic events. And it's always so painful to just see the level of stressors that the population here has experienced. So because it is because we're in the Caribbean, we're exposed to hurricanes. We know that. And then, you know, the pandemic is something that happened worldwide. But when you also look at the levels of childhood events, the levels of adverse events that these cohorts have gone through, it really is, how do you, as a researcher, how do you measure and control for all of those variables? But we need to know that. We need to know, because unfortunately, a lot of our communities are put in these places, where they experience trauma, stressors one after the other. So it's like painful for me as a clinician, because I know how I'm going to see these patients when they come in the clinic. I know how difficult it's going to be for me to help them. But as a researcher, it's also so important that I'm able to, to take these stories and get them out into the scientific community. And, and that I, for example, a lot of people ask us, “oh, but how are you going to control that the depression or the PTSD is really due to the hurricane? Like it could be..” And I'm like, yes, that's true. This could be someone who already had depression, you know, other episodes of depression or who already had traumatic exposure. That is true. But people are not animals in the way that you can study controlling for all of these variables. So as a, as a scientific community, we need to stop saying, oh, we need to control for these variables, or we need to have these research designs that, are very methodologically very robust and sound, because then we're not really studying the people who are the ones that we are seeing in the clinic, and we don't know how to help them. 

Dr. Lara-Cinisomo [00:20:01] Yeah, they have complex experiences. And it makes me think of Bronfenbrenner's socio ecological model. We have multiple levels, and there could be opportunities to study those adverse events at those levels, at the individual interpersonal community. And now, you know, contextual like for example, at the on the island, but also looking at the life course, we know that that model includes a chronosystem, right? So it's an opportunity to start looking at all of these experiences within the life course, because it can increase a person's risk for adverse mental health outcomes if they experience these stressors. Then we can also look at protective factors, for example, those that you identified and then maybe resources that we can provide. So one of the questions I actually have is what are, what can healthcare professionals, including mental health providers, do to help perinatal people prepare for coping with large scale events, whether they're natural disasters or health related, like the pandemic? 

Dr. Martinez-Gonzalez [00:21:05] Yes, at least from what we studied here in Puerto Rico and what we have been able to identify, and this is something that the literature has shown before, is it's nothing new, but social connection is key and social connection is it's the one protective factor that we keep seeing come up in terms of our mental health. So one of the things that we are recommending right now, we are right about to start a new hurricane season here in Puerto Rico. So what we are recommending in terms of for families and people who are pregnant is that if a natural disaster happens, you have to find a way to have that social support be near to you. So it's either make sure that you all, you know, go through the hurricane in the same physical place so that you have those supports near you, or, you know, what am I going to do if I, you know, physically cannot move after a natural disasters, and I need to contact these social supports? In the social support system that also includes I'm not only talking about like family members or people who are going to take care of me. I'm also talking about the social systems of support. So one major aspect that we saw that was very stressful for the hurricane cohort was that they could not get in touch with their health care providers after the hurricane because there was no telephone. There was people, like sometimes offices were flooded and people had to move their practices to another place, and there was no way of telling patients. So we have been working with health care providers on how do you create a system that your patients can contact you? What, what, what is it going to be, what, how are they going to know if you're not able to be at this office, how are they going to know where to contact you? So we are trying to, especially for families and people who are pregnant, you know, like, okay, so you're seeing this is your doctor and they have a private office. What would be the hospital that they want you to go if they, if you can't go to the office or what would be, you know, the numbers you can call what you know, what is the different like what is an email that they could use. Like how are the different levels that you're going to use so they can contact you? Because that was one of the worst things that they, a lot of the people in our cohort, they had to, their birth plan was completely shattered to pieces because they might not even had to like their same doctor for the birth they might had contact with like a doula or a midwife, lost contact there too. So it's we really do need to think about how is it that as health care providers, we are going to make sure that our patients know that even in natural disasters they can get access to us? 

Dr. Lara-Cinisomo [00:24:17] Well, those are great tips and strategies that people can implement now to help them if and when there's a large-scale crisis that then they have to cope with. Is Puerto Rico doing this on a large scale like public campaigns, or is this more of an effort among mental health and health providers? 

Dr. Martinez-Gonzalez [00:24:36] Well, you know, we are trying to do it in a large scale. So after all of this research and finding out that this was a population where there was this mile, marked disparity in access to health care. We also started doing work in terms of advocacy. So one of the first things that we did was that we created legislation for the first Wednesday, May. So this week to be the, to celebrate the Perinatal Mental Health Awareness Day. So we have that in place. And so we have different activities that we're working with. And then what we have started to do is trying to get all the stakeholders together that are needed to create a plan to address perinatal mental health. So we're working very closely with obstetrics and gynecology. We're working closely, I’m at the School of Medicine, so we're working closely with the training programs, but we're also working closely with different professional organizations on the island so that we can talk about these plans on what to do during the natural disaster, how to prevent the effect on mental health. But we're also trying to identify stakeholders within the government. So within the Department of Health, which are the areas that are working on maternal mental health, and then we're trying to get everyone to sit at the same table, which it's always difficult. But I found when I started working on this topic and started to, to especially talk to midwives doulas and OB/Gs, I saw that there were so many, as a psychiatrist, I'm like, there's so many conflicts here and I'm not letting these people come together. But I found that everyone knew that mental health was something that we needed to get together and address. So we found that we've been able to get everyone to sit on the table if we talk about mental health, which I think is great. So we already have had a few roundtables on like, what are we going to do? How are we going to address mental health in this population? And, you know, this is going to take time. I know it's a change in the way that a lot of people practice, and that's okay. But we are trying to move this to be not only this is what we found in research in like the university and we published it, and that’s it. We're really trying to move our research findings into public health changes and changes in public policy, but I do, I also am a realist and know that will take a longer time. But, you know, we're taking little steps and getting at that. 

Dr. Lara-Cinisomo [00:27:28] Yeah. So you're doing things to make a difference now and to make a difference down the line. For example, you are helping train future professionals who are going to be in the field. And this important work around research and how research communicates and translates findings into policy and public health practice is critical. If you don't mind, I'd like to discuss the Hispanic Clinical and Translational Research Education and Career Development Program at the University of Puerto Rico Medical Sciences campus. Can you tell us about the objective of that NIH funded program? 

Dr. Martinez-Gonzalez [00:28:01] This is a program that has been at the University of Puerto Rico for the last 22 years. So we've continuously had funding from NIH to support the development of clinical and translational researchers in Hispanic health and health disparities. So during these 22 years, we have been able to train 120, clinicians. So we look for people who have not necessarily done research before, they’re clinicians, but who see research as a way to help their patients or to address public policy. So we look for those clinicians, we train them through postdoctoral master's in clinical and translational research. And we give them support in terms of salary, support for them to have time to develop these projects. So the projects have to be within Hispanic populations. It doesn't have to be Puerto Ricans, but a lot of them are here on the island. So if they work with Puerto Rican, populations and then it has to be an area of health disparity. So it does include mental health, but it also includes areas such as cancers such as diabetes, asthma, HIV/AIDS, sexually transmitted diseases, any areas where there are concerns in terms of health disparities within Hispanics or health disparities within Puerto Ricans. So it is a program that we can train people who are here on the island, or they can be on the mainland United States. It's not they don't need to be specifically affiliated to the University of Puerto Rico. And the purpose of the program is to increase researchers in, who are working with Latino communities and who are doing research that matters to Latino communities. 

Dr. Lara-Cinisomo [00:29:59] Well, that's really exciting. We have a diverse group of listeners, English and Spanish speakers, and people who are very interested in addressing the health disparities among the Latino Hispanic community. So I'm sure they're going to be excited to hear about the program. How do people get, learn more about the different opportunities that the program can offer? 

Dr. Martinez-Gonzalez [00:30:23] They can go through the University of Puerto Rico and then look on our website. We have a website just for the program, or, I think the easiest way is to reach out and contact me, because then I could really tell them about, you know, if it's a good fit or if the program could support them or not. My email is Karen.Martinez4@upr.edu. 

Dr. Lara-Cinisomo [00:30:46] Great. And we'll include those in the show notes that people can access that information easily. Thank you so much. You're also principal investigator of the Puerto Rico Racial and Ethnic Minority Acceleration Consortium for Health Equity, also known as PR-REACH. This is an FDA funded program and includes mentoring. Can you tell us a little bit more about that? 

Dr. Martinez-Gonzalez [00:31:06] Yes. So we are very excited about being included in what's going, what's now going to be called the REACH Consortium. So the FDA, their Office of Health Equity, they're very interested in seeing how the FDA could reach more communities. They do understand, especially with the COVID-19 pandemic and vaccination, that there are a lot of mistrust issues related to the FDA and what the FDA does and just, health recommendations in general. The health communication and the myths related to health is a big barrier that as health professionals, we need to address somehow. So this, consortium, the purpose of it is to have different groups that represent areas that have been marginalized or put in vulnerable positions throughout history. So we are representing Puerto Rico, Latinos within Puerto Rico and but also people who are from U.S territories or who are not actually in a state but are related to the United States. But there are also other consortiums that are related to black health, to LGBTQ health, to American Native health, rural health. So these are different consortiums throughout the United States. And the plan is for us to listen to our communities and bring back that voice from our communities to the FDA on what is their opinion of the FDA, what is their opinion on clinical trials? Why, and why have we historically have such, low participation of diverse communities in clinical trials? So we're developing different programs here within Puerto Rico. The first problem that we're going to address is Opioid Use Disorder. So we are working on evaluating the current treatment of Opioid Use Disorder here in Puerto Rico. How we could improve that treatment and especially what is needed in terms of new therapeutics to address what we are seeing in Opioid Use Disorder. But then each of the consortiums is working on different health problems, and then we get together as a group, every six months and then talk about our different communities and what's going on in our different communities. So we're very excited about this, it doesn't seem like something that would come out of the FDA. When you think about the FDA, it's like regulation and not necessarily like listening to communities. So we're very excited that we're, we're going to have this opportunity and to talk about Puerto Rico and talk about Latinos, which is what I do every time I go anywhere. 

Dr. Lara-Cinisomo [00:34:10] Yeah. That’s fantastic. 

Dr. Martinez-Gonzalez [00:34:10]  Exactly. Mmhm.

Dr. Lara-Cinisomo [00:34:13] That's great. And so are you engaging English and Spanish speakers in this work? From the community? 

Dr. Martinez-Gonzalez [00:34:18] Yes. And I think that's one of the great resources that we have here in Puerto Rico is that most people here are fully bilingual. So I always bring up especially to these systems that provide funding or these systems that in a way organize how we are going to do research. I always tell them, you know, you have to make use of Puerto Ricans because we're in that bridge of being able to engage with the United States because we do it as a territory. But then we are very Latino in everything else: our culture, our backgrounds, our values are very Latinos. So I think, being here in Puerto Rico gives us that perspective where we're like far enough away from the mainland, but very much involved with the mainland. That gives us a very particular perspective on what's going on over there. 

Dr. Lara-Cinisomo [00:35:17] Yeah. That's really interesting to highlight the unique position that Puerto Rico is in and its people are in and to provide insight on very different complex issues that, you know, you as a community can discuss in a very critical and important way. So I'm glad that English and Spanish speakers are part of these conversations you're having around clinical trials, making sure that there is information, but also, information for the community, but that the community has a voice in those discussions and can inform FDA decisions around funding, but also, the use of data and how to potentially inform the community in a way that is culturally acceptable and culturally competent. That's wonderful. I also would like to discuss the fact that you're helping prepare researchers and clinicians as we talk to, both in English and Spanish, and they include English and Spanish speakers. This podcast is offered in English and in Spanish. And we know the need for Spanish speaking clinicians and researchers. So how can we, those of us listening and those of us interested, how can we promote the profession of perinatal mental health among Spanish speaking students and community members? And feel free to respond in Spanish. Aquí hablamos las dos idiomas. 

Dr. Martinez-Gonzalez [00:36:40] Excelente, entiendo que si hay una necesidad alta de poder trabajar con lo que es la salud mental perinatal, en general, como, cual, la experiencia que tuvimos aquí en Puerto Rico, cuando decidimos observar y vimos lo que estaba ocurriendo, ahí, yo misma, me puse a pensar y yo dije, ¿pero por qué nosotros, en nuestro hospital, nunca recibimos a nadie que tenga psicosis después del parto? ¿O sea, qué es lo que está ocurriendo? Esta es una emergencia psiquiátrica, ¿por qué no llegan? Y nos dimos cuenta que es que en las comunidades Latina, muchas veces, esos casos es la misma familia la que lo tratan, no llegan al sistema de salud mental. Sé que hay unas particularidades dentro de nuestra comunidad Latina, hay unas particularidades con sentir que cuando tú estás hablando de esto, que es tan difícil para las familias que están, este, trabajando con estas condiciones de salud mental perinatal, buscar ayuda, pedir que puede recibir alguien que hable tu mismo idioma, que entienda de la cultural de que tu vienes, que entienda que es lo que significa el embarazo, el tener un hijo, para esta comunidad. Así que los profesionales, que me estén escuchando, que hablen español, pues les puedo decir que esta es un área donde les aseguro que van a tener mucho trabajo, así que les pediría que busquen la manera de especializarse, entrenarse un poco más en el área o hasta certificarse, sabemos que poco a poco están saliendo más certificados, más oportunidades formales de entrenamiento en esta área y definitivamente si es alguien que, que le interesa buscar oportunidades en Puerto Rico o en Puerto Rico me pueden escribir y yo les hablo, verdad de las oportunidades que tenemos acá.  

Dr. Lara-Cinisomo [00:38:40] ] Excelente, si, entonces también tenemos Postpartum Support International que también tiene una alianza para hablar hispana, podemos conectarlos con esa información también. Que bien, excelente. Well I'm going to switch back to English. I am going to in the show notes indicate where we have a Spanish conversation for all those who speak only Spanish and are interested in hearing this exciting message you sent to everyone about engaging in work around, the needs of Spanish speakers. So, how can we promote perinatal mental health among Spanish speakers in the next 5 to 10 years?  

Dr. Martinez-Gonzalez [00:39:17] You know, one of the first thing is that we need more Spanish content. So even here in Puerto Rico, everyone is fully bilingual. We, you know, English and Spanish are both our official languages. And when people come into therapy, they speak in Spanish. Like when people are, have a very strong emotion, they will speak in Spanish because that's like the language in our roots, and our emotions are very primal. So we go to that language which feels like home, feels like family. So all our questionnaires need to be in Spanish, our therapy materials, they need to be in Spanish. Everything that we use should be in Spanish. And then as much as possible, the communication within the clinical encounter should be Spanish as much as possible. For example, our students here, they're working on creating a medical Spanish course to provide to medical students who are on the mainland. So sometimes you don't even have to be fully in Spanish, at least if you have, like the main concept in Spanish. And the patient sees that you're trying to speak in Spanish only that could be so helpful in breaking that barrier for that person to feel, okay, I can trust this physician, or I can trust this clinician that I have in front of me. And I'm going to talk about what's happening to me. So that's what I would say. Like, you know, we need to do better in, in making things that we have Spanish content available for our patients. 

Dr. Lara-Cinisomo [00:40:55] What a great message. And that's part of the reason why the Marcé of North America is hosting this bilingual podcast. We have English and Spanish speaking podcasts to make sure it's accessible, but also to promote the language across the profession. Whether you're a clinician, a researcher, a faculty member, a student or community member. So thank you so much for that message, so passionate, and I hear you. I'm sure others will hear you too. Well, this has been such an illuminating conversation, both in English y en Español. Before we end, is there anything you'd like to add? 

Dr. Martinez-Gonzalez [00:41:30] I would just like to add, for anyone who is listening, who might be thinking about different areas where they want to focus, I know right now there's so much need in mental health in general, especially those who might be interested in children and adolescents. If we don't go to the root, which is the development of the central nervous system during the pregnancy, it's very difficult for us, to do the work we do once someone is already a child or adolescent or even an adult. So I think as a community, we need to be more aware of it. We really do want to do prevention and health promotion within mental health. We need to go back to pregnancy and families, and looking at that stage and seeing how we can promote mental health there. 

Dr. Lara-Cinisomo [00:42:28] Wonderful. Well, thank you so much. I so appreciate your time. 

Dr. Martinez-Gonzalez [00:42:31] Thank you for the invitation. 

Dr. Lara-Cinisomo [00:42:34] Thank you for joining Studying Perinatal Well-being. Please see our show notes on the MONA Podcast website for more information about today's guest. We always look for great perinatal well-being students, community members, researchers and practitioners to interview. So please email your suggestions to monapodcast@marcenortham.com  that's monapodcast@marcenortham.com. Until next time, practice compassion for yourself and others.