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'It's all PTSD': Uvalde's only children's clinic inundated as school begins

“Parents told us that yes, their kid survived, but they’re not 100% themselves."

This story discusses suicide. If you or someone you know may be at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or go to SpeakingOfSuicide.com/resources.

As Uvalde students return to school three months after a shooter killed 19 children and two teachers inside Robb Elementary, the town's pediatric clinic is besieged again — this time, by an influx of patients experiencing post-traumatic stress disorder (PTSD).

“Normal clinic days before the shooting was 15, maybe 20 patients a day,” pediatric nurse Jose Jaramillo told TODAY Parents. “During the summer, we were seeing 35 to 45 a day — basically it’s all PTSD.”

Throughout the summer, the staff started to notice a pattern of symptoms in children who lived through the shooting.

“Of course anxiety, but also paranoia to the point of delusion,” Dr. Roy Guerrero explained. “They would see something out of the corner of their eye — be it a person or a dog — and think ‘Oh, he’s coming for me.’”

Some children stopped eating, while Guerrero says others would overeat to cope. Many children who were once gaining independence regressed and now cling to their parents. Some children retreated into isolation, while others started to act out in anger. Children who even appeared “back to normal,” Jaramillo said, would from time to time retreat into themselves.

Related: Uvalde’s only pediatrician shares the horror of treating school shooting victims

“Parents would tell us their child would be playing outside or playing a video game — being a kid again — and a minute after they’re just looking at the floor or looking up at the sky,” he explained. “The parents would ask their child if they’re OK and they’d say, ‘Yes, I am just going to take a nap.’ They’re 10 or 11 — they no longer take naps. They were triggered and isolating.”

“Parents told us that yes, their kid survived, but they’re not 100% themselves,” Jaramillo added. “They don’t act like their kid anymore. They’re not the same child the parent dropped off at school that day.”

'Never forget'

The staff at Encina Pediatrics & Primary Care will never forget the afternoon of May 24. Guerrero, a board-certified pediatrician, rushed to Uvalde Memorial Hospital to treat the wounded and identify some of the deceased. Jaramillo, a registered pediatric nurse and nursing supervisor, relayed information to parents of wounded children, letting them know Guerrero was taking care of their kids.

Esmeralda Zamora, a staff member, left work and ran to Robb Elementary in search of her 11-year-old daughter. She brought her back to work — her child shaking so badly that Zamora feared she had been shot.

Her daughter was unharmed, save for a few scratches on her arm from crawling out a busted window. The child was in shock.

Dr. Roy Guerrero and Jose Jaramillo working inside the Encina Pediatrics & Primary Care clinic on the first day of school in Uvalde, Texas.
Dr. Roy Guerrero and Jose Jaramillo working inside the Encina Pediatrics & Primary Care clinic on the first day of school in Uvalde, Texas.Courtesy Danielle Campoamor

Now that the school year in Uvalde has started, Guerrero and his staff fear that the number of patients experiencing PTSD-like symptoms will only increase.

This whole school year is going to be a trigger.

Dr. Roy Guerrero

"This whole school year is going to be a trigger," Guerrero told TODAY. "For everybody — parents and family members included. I think a lot of people are living in fear every single day."

Many of the clinic's younger patients who lost siblings simply do not understand that their sister or brother is not coming back home.

"We have baby brothers that came in and they're 3, 4 years old and they'll ask for their sisters or their brother, but mom tries to let them know that big sister or big brother is now an angel and with God," Jaramillo said. "But mom shares that they get back home and the child continues to ask where their sister or brother is. They just don't understand. When they're that age, it's hard to help them understand what happened."

Signs in front of the front desk at Encina Pediatrics & Primary Care clinic in Uvalde, Texas.
Signs in front of the front desk at Encina Pediatrics & Primary Care clinic in Uvalde, Texas.Courtesy Danielle Campoamor

Jaramillo and the clinic staff are tasked with helping children navigate their grief on a daily basis. One patient in particular comes to Jaramillo's mind — a young girl who attended Robb and who lost her cousin and best friend in the shooting.

Related: ‘You messed up’: Uvalde parents make emotional comments before school police chief is fired

"Mom said her PTSD is just getting worse," he explained. "She's crying all the time. She doesn't want to go back to school. She doesn't want to do anything. She just wants to be in her room."

Those fences are going to be there forever. It’s going to be a reminder in your face, every single day, that this happened on May 24, 2022.

Dr. Roy Guerrero

The child has been a patient of Jaramillo's for seven years, so she feels comfortable sharing her feelings with him. He says she knows that her friend is not coming back, and wants to "find that peace within herself, knowing that her cousin died the way she did and that she is not suffering anymore." The child goes to therapy three to four times a week, Jaramillo said. "It's been pretty rough on her."

A wall inside Encina Pediatrics & Primary Care clinic in Uvalde, Texas.
A wall inside Encina Pediatrics & Primary Care clinic in Uvalde, Texas.Courtesy Danielle Campoamor

'We're never going to go back to normal'

The Uvalde School District is still in the process of implementing new safety measures — including door locks, unscalable fencing and additional law enforcement — at schools across the district in order to make students and staff feel safer as they return to a "semblance of normalcy."

But the high fencing and police presence, Guerrero said, is a reminder that there will never be a "normal" in Uvalde again.

"Our worlds have changed forever," he said. "Those fences are going to be there forever. It's going to be a reminder in your face, every single day, that this happened on May 24, 2022."

Related: This teacher subdued a student shooter. Uvalde has him reliving the experience

Guerrero said many people in the community no longer trust law enforcement and the school board; the police response to the Uvalde school massacre has been widely criticized. The police chief has since been fired, and a report released last month by a Texas House committee faulted both law enforcement and the school district.

"I can't put the people's trust back into the people who failed them. I wish I could, but that's one thing I don't have any control over as a doctor," he said. "I can get them therapists. I can get them to psychologists. I can do what I have to do for that, but how can I make someone trust somebody? I can't."

The staff at Encina Pediatrics & Primary Care clinic.
The staff at Encina Pediatrics & Primary Care clinic. Courtesy Danielle Campoamor

The visual reminders of the shooting — be it the memorials, murals and high fences — and the investigation into the "systemic failures" by both law enforcement and the school district and impact students, Guerrero said, and entire families.

He said he's worried about the "six month period" — researchers have noted that there can be a spike in PTSD and suicides among parents, law enforcement and family members six months after a mass shooting.

"We're slowly creeping toward that six-month period after the shooting ... he deep depression, suicidal ideation and self-harm," Guerrero explained. "We're slowly edging to that wall now — it's coming soon — and I don't think we're ready."

We’re afraid that three, four months from now people are going to say we’re good. We’re not good.

Jose Jaramillo

For now, Jaramillo says the staff has enough resources to treat the mental health needs of their patients. Volunteers have been offering free services, including mental health professionals from San Antonio University.

The clinic also offers a screening line which Jaramillo leads; parents can call if they're noticing their child is in distress. Often, parents are directed to bring their child into the clinic for a full assessment and, if necessary, additional treatment at a nearby hospital.

Prior to the shooting, Uvalde residents had limited access to mental health support. Texas ranks last in the country for mental health support, according to the nonprofit group Mental Health America.

"What we're scared of, is that people are going to eventually forget about it," he added. "OK, first day of school started — we have all these reporters outside the schools ... but then that's it. It's done.

"We're going to need a lot of therapy," he added. "It's going to last years. If those resources leave we only have two therapists to handle all of Uvalde. That's not enough. We’re afraid that three, four months from now people are going to say we’re good. We’re not good."

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