As Damarys Cantero awakens her 6-year-old daughter in their damp, sweltering home, ocean waves crash up against the pile of rubble that was once their front porch.

The single mother opens a bag of buns in the kitchen to find that, yet again, rats had nibbled their way through. The rodents have been creeping in for months after Hurricane Maria ripped out Cantero’s front door and windows.

A few miles away, Melinda Colón, 52, wipes away tears as she looks down at the remnants of her existence still scattered across the yard: a mattress, a broken door, a piece of zinc roof. In the mountains on the other side of town, Luz Vázquez Román bathes with buckets of water from a creek, producing a rash that is ravaging her skin. Down in the city center, the only 24-hour emergency psychiatric clinic is seeing a nonstop stream of patients, some contemplating suicide.

Life in Naguabo, a fishing town in the shadow of Puerto Rico’s tropical rain forest, was completely disrupted a year ago. It was here, in the eastern corner of the U.S. territory, that Hurricane Maria introduced itself to the island, hammering away with terrifying winds and soaking rains before tearing a long path of destruction. Like everywhere else, the power went out. More than 4,000 Naguabo homes were damaged, 700 of them destroyed. Dozens of roads, bridges and buildings faltered. Gravestones crumbled in the floods.

A year ago.

Though obvious markers of devastation are fewer islandwide — power has largely been restored, and potable water flows somewhat reliably — Maria’s aftermath cripples nearly every aspect of life here, from Naguabo’s peak to the sands at the edge of the sea. It is one of the numerous places in Puerto Rico where recovery has barely begun and routines are far from recognizable.

Cantero and her three sons are still sleeping on the same mattresses that were caked with mud from the rising waters. The moldy ceilings of her seaside home have led to breathing problems. She hasn’t been able to work cleaning houses because all of her clients moved away after the storm.

“All around me, I live with Maria here,” Cantero said. “We have to get used to what she left us.”

Hurricane Maria battered the oceanfront section of a highway on the border of Naguabo. Telephone poles cracked like match sticks, and the road was impassable for some time. Although it is now open, debris lingers, including the shell of a car on an August morning. Sarah L. Voisin/The Washington Post

Damarys Cantero sprays perfume on her daughter, Sharmelehia, who is dressed in her school uniform and getting ready to leave. The bedroom’s air conditioning unit was ruined during the storm. A fan in the corner is missing a cover, its blades exposed. Sarah L. Voisin/The Washington Post

At the Mendoza Benitez Dairy Farm in Naguabo, Ramiro Cruz Tejada opens a gate for cows to enter the barn on an early August morning. Twelve cows died during the hurricane, and the business has suffered severely in its aftermath. Sarah L. Voisin/The Washington Post

If the people of Puerto Rico faced devastation in September 2017, they have been facing disruption ever since. A Washington Post-Kaiser Family Foundation survey across the island finds that 25 percent of Puerto Ricans say their daily lives are still disrupted a year after Maria. Some 39 percent of residents here say their lives are largely back to normal, while 36 percent say their lives are almost back to normal.

Residents in the eastern region, like those in Naguabo, went without power far longer than those in other parts of the island. Three-quarters say grid power was not restored until January or later, more than three months after Maria hit, compared with half or less in other regions of the island. In the eastern region, one-fifth of residents went more than half a year without electricity.

Many didn’t have safe water to drink. Others struggled to get health care. Many lost their jobs or had other economic setbacks, especially in places like this town, which relies heavily on the fishing industry and farming, both upended because of the storm.

For most Puerto Ricans, Maria’s winds fully exposed the island’s vulnerability, making the future full of haze, akin to the Caribbean sky this time of year, when the winds of the Sahara blow sand across the Atlantic. It’s hurricane season again, said longtime Naguabo resident Ramon Cantero, and the people aren’t ready — the government isn’t ready.

“The next one will wipe Puerto Rico off the map,” the 70-year-old said.

The survey found that the majority of Puerto Rican residents agreed with Cantero. The island’s power grid, people and government are not ready.

Los enchumbaos:

The drenched ones

The bulk of Naguabo’s residents went eight months or more without electricity in their homes. The power comes and goes now, and it is sometimes out for hours at a time. Some families still don’t have running water. More than 150 homes remain destroyed or barely livable. Many others have been abandoned, as thousands of residents have fled the island.

The cost of rebuilding damaged structures and relying on generators for months has left families and businesses stripped financially. Jobs are more scarce, and the economic hardships of the region are evolving into crises. The local Sam’s Club warehouse closed its doors after the hurricane, laying off scores of workers.

The infrastructure in Naguabo was crumbling before the storm, and Maria weakened it: Several highways lost giant chunks of roadway, and bridges were washed out and often closed for construction, cutting off residents in nearby barrios. It rains so much in Naguabo that the town is known as “El Pueblo de los Enchumbaos” — “The Town of the Drenched Ones” — because of all the creeks, rivers and streams that consistently inundate the neighborhoods.

Naguabeños have learned to cope and compartmentalize, officials said, and they have been adjusting to a new, lower standard of living. But the town’s emergency manager said it comes at a cost. The things that are more difficult to see have become the most difficult to overcome.

“We are just patching things up,” said Kirkland Hernandez, who tries to help solve countless tiny emergencies every day, especially for the dozens of families who haven’t received any help or don’t have money to take care of things themselves.

When it rains too hard for comfort, he said, children start to panic: “The stress is mounting.”

Rafael Salcedo walks into his ocean-view home in Naguabo early one August morning before heading out in his old pickup with a giant white cooler of fish in the back. For more than 35 years, he’s driven the area’s country roads and let people know he’s coming with songs and chants from a loudspeaker. But his profits have plummeted since Maria. Sarah L. Voisin/The Washington Post

Salcedo sells fish to Evelyn Perez and Carlos Davila. Sarah L. Voisin/The Washington Post

The fierce winds of Maria tore up a concrete pier in Naguabo. Almost a year later, it is still not repaired. A few professional fishermen continue to launch from here, but of the more than 22 boats that belonged to Naguabo’s fishing industry, three remain. Sarah L. Voisin/The Washington Post

El Malecón:

The boardwalk

Rafael Salcedo starts most of his days on the beachfront pier where he was raised among Naguabo’s fishermen lining the shore and the factories churning out seafood-stuffed empanadas, the scent of their baked shells filling the air.

There, the 63-year-old loads up his clients’ favorites from Chuito’s Fish market into the giant white cooler in the cab of his rickety pickup: Caribbean red snapper, grouper and, the most prized of all, conch. He drives up the country roads and winding hillsides, songs and chants streaming from a loudspeaker as he beckons the barrios to come out and buy his fish.

“Pescado fresco, aprrrrroveche!” Salcedo yells. If people can’t hear him rolling his Rs, the unmistakable screeching of his Ford alerts them to the imminent arrival of “Cantalicio,” or the singing fish vendor. “Fresh fish! Clean fish! Come and get it!”

Before Maria, Salcedo, who has been singing and selling fish for more than 35 years, made as much as $500 a day.

But the eastern coastal communities, where the tempest came ashore, were devastated. Naguabo was without power, and the local fishermen struggled because they couldn’t store their catch. Fuel for generators decimated savings accounts. Many of Salcedo’s most loyal customers migrated to the mainland United States.

He spent more than six months without making a dime off fish, surviving on Social Security and scavenged scrap metal. Then the lights turned on in late March.

“When the power returned, it was like my heart started beating again,” he said. But Salcedo rarely clears $115 a day now. “You have to be patient and charming to get people to open their wallets. It’s hard, but it’s not impossible.”

Of the more than 22 boats that belonged to Naguabo’s artisanal fishing industry, three remain. Fish sales declined more than 90 percent in the three months after the storm, and fishermen’s salaries followed suit, according to Carlos Velasquez, president of the local commercial fishing association, Villa Pesquera. Recovery has been sluggish, with 2018 sales and earnings cut in half so far.

“I have been a fisherman all my life, but Maria changed everything, even the ocean. The fish were gone,” said Velasquez, who worked with a conservation nonprofit to help fishermen supplement their salaries by paying them to collect illegal traps. “Most of our people left to the mainland. Those that remain are trying to innovate because we can’t go on like this.”

The food Naguabo’s anglers, divers and trappers catch supports the more than half-dozen seafood restaurants in town. Holy Week draws thousands of local and foreign tourists to Naguabo’s famed boardwalk, but sales were anemic this year as supplies diminished and prices soared for fish, mollusks and crustaceans shipped from other shores in and outside Puerto Rico, said Stephanie Torres of Vinny’s seafood restaurant.

Many are just starting to break even.

The near collapse of Naguabo’s fishing industry was mirrored in the ranches that sprawl across the nearby valleys and rolling hills. For a week after the storm, trucks couldn’t get through to the Mendoza Benitez Dairy farm, forcing owner Carmelo Colon to dump out 1,500 quarts of milk. He lost 12 cows in the hurricane.

For eight months after the storm, Colon’s farm was without electricity, so he spent $20,000 on generators and fuel to operate the farm.

“That experience, I wouldn’t wish it on anyone,” he said.

Milk sales have decreased substantially, forcing the farm to lower production and cut down on employee hours. Before the storm, he rotated about 125 cows through milk production at a time, but now he milks only 75. Colon estimates that monthly sales of milk have dropped nearly 45 percent, and prices have fallen from 81 cents per quart to about 66 cents. He predicts he soon will have to lay off at least one employee.

Part of a decrepit highway near him collapsed at the end of July, strained by Maria on top of years of delayed construction work. The large truck delivering food for Colon’s cows was unable to reach his ranch. The rancher and his employees were forced to spend the better part of three days driving back and forth to a nearby ranch to pick up 100-pound bags of food for his herd.

The lost income at the dairy farm has meant Colon has no money to help rebuild his parents’ house, which sits just up the hill. His mother, Margarita Mendoza, 82, and her husband, who suffers from severe Alzheimer’s disease, are now living in Colon’s house on the ranch.

Displaced by the storm, Mendoza has lost weight and has become depressed. She was unable to sleep for weeks, pacing around her son’s home every night praying, “Lord help me get back to my house.” She’s begun seeing a psychologist and taking sleeping pills.

“You get used to your own house, after living in it for more than 40 years,” Mendoza said. “You survive, because what else can you do?”

This bridge in Naguabo is still filled with debris from when the waters rose during Maria. What’s left of a home in Naguabo is covered with a tarp while it’s being rebuilt.

El Pueblo:

City center

It has been about two months since Naguabo’s only emergency medical facility opened a 24-hour psychiatric wing. Doctors have seen 100 patients so far.

“We’re not talking about people who are having a bad day,” said Harry Negron, director of the Naguabo Medical Mall. “These are people in crisis and on the verge of killing themselves or are hearing voices. They are an imminent danger to others or themselves.”

Mental health emergencies have spiked by more than 60 percent in Naguabo. A cluster of suicides in April and May — most of them affecting adolescents — prompted physicians such as Negron to partner with specialized service providers to get a handle on what many say could be the leading edge of a mental health catastrophe.

Residents blame the hurricane for every misfortune, physical or mental, that has afflicted them in the past year. Few conversations in the seaside town don’t start with “after Maria.”

After Maria, the car doesn’t work the same. After Maria, the house doesn’t feel like home. After Maria, the job was lost. After Maria, there is no money. After Maria, it’s all gone.

The stress and anxiety sometimes manifest themselves in chest or body pain, but the origin is often deeper, said psychiatrist Jaime G. Torres.

“This was traditionally an underserved region with limited access to medical care,” Torres said. “But we are seeing that the ambiguity, the hopelessness, the change in routine, the fight for economic security, is having a detrimental impact on patients and families.”

The deepening need for treatment has been aggravated by the flight of specialists and physicians to the mainland United States, where better salaries and job opportunities await. Negron said he has trouble finding doctors willing to travel from metro San Juan to cover shifts at his tiny hospital and is frustrated by insurers who pay less per patient in this economically depressed area.

“It was a nightmare then,” said Negron, whose facility suffered severe water and wind damage and held eight bodies in the morgue for days waiting on instructions from the government’s Institute of Forensic Sciences. “The shortage of doctors will make it worse.”

Damarys Cantero sits in a chair that washed onto the shore after being swept from a restaurant across the bay. She and her daughter, Sharmelehia, still have no kitchen table or couch. Sarah L. Voisin/The Washington Post

Cantero does her hair in the bedroom mirror. Generations of her family live in the neighborhood known as “La Ola” — the wave. Sarah L. Voisin/The Washington Post

One of Cantero’s sons, Joshua Morges, moves a road sign on the front porch of their home. For months, the sign was used to cover a window that Maria blew out. FEMA and a government program called Tu Hogar Renace helped Cantero purchase doors, windows and cabinets. Sarah L. Voisin/The Washington Post

La Ola:

The seashore

Damarys Cantero’s 6-year-old daughter, Sharmelehia, used to ride her bicycle on the porch in front of her home built on sand, a step from the ocean.

But Maria sent the sea crashing into their small house, ripping the cement porch to pieces and filling the inside of the home with a mountain of mud and debris. With no place to ride her bike, Sharmelehia spends much of her afternoons wandering through the wreckage: concrete blocks, rubber tires, soda bottles, Pringles cans and other trash washed up by the sea. Down the shore, colorful fishing boats seem frozen in time, piled and pushed up against the portico of an abandoned one-story house, its concrete columns crumbling and its paint bleached by sun and sea.

Generations of Cantero’s family, most of them fishermen, live here, in a barrio known as “La Ola” — the wave.

Just before sundown, Sharmelehia and her cousin jump around a pile of sand next to a relative’s house that is under construction. She picks up a piece of white plastic tarp and, wrapping it around her head like a veil, pretends to be a bride. The girls dance as reggaeton blasts from the radio of a parked car, which Sharmelehia’s 16-year-old brother is washing to make some extra cash.

“Sharmi, ya, vamonos,” her mother calls out to her, telling her it’s time to go home. Many blocks like this one in Naguabo still lack streetlights. Neighborhoods become pitch black, like “the mouth of a wolf,” Cantero says.

As Sharmelehia runs to catch up with Cantero, a single light illuminates the path toward their home, which is tucked down a stairway at the bottom of the hill. The walls of their small concrete house are stained with mud, the ceilings covered with mold.

Sharmelehia pretends that a piece of plastic, which once covered a pile of construction sand, is a bridal veil while playing in front of her cousin’s house.

FEMA and a government program called Tu Hogar Renace helped Cantero purchase new doors, windows and cabinets. Her family still has no kitchen table or couch. A few plastic chairs, four of which washed up onto the shore after being swept away from a restaurant around the bend of the bay, make up their kitchen furniture.

In the cramped bedroom, plastic bags filled with bread, macaroni and cheese, chips and other food hang above both beds, in an attempt to keep the food away from rats. But ever since the storm, it seems impossible to keep the critters out of Cantero’s house — the spiders, roaches and centipedes. One day, she found a snake in the bathroom. One night, a scorpion stung her in her bed, just a few feet from her daughter.

The bedroom is stifling, its air conditioning unit ruined during the storm. A lone fan in the corner is missing a cover, its blades exposed.

“I’m itchy,” Sharmelehia says as she gets ready for bed. She winces as her mom coats her legs with rubbing alcohol, dabbing anti-itch ointment on her many mosquito bites.

Just before bed, Sharmelehia asks for a nighttime snack — cornflakes. The little girl sits on the kitchen floor to eat. Her mother stands under the kitchen’s single lightbulb. The waves lap along the edge of the house.

About this story

Design and development by Andrew Braford. Photo editing by Karly Domb Sadof. Copy editing by Brian Malasics.