A new study from the Harvard T.H. Chan School of Public Health estimates the death toll during and after Hurricane Maria may be closer to 4,600 or more. The study, published this week in the New England Journal of Medicine, suggests access to medical care and basic needs may have been contributing factors.

It happens quickly, often in a single generation. Yours is the big church on the town square, the church that your family has attended for generations. Once, this church was the spiritual heart of the community. This is where people supported one another in times of crisis, remembered their roots and celebrated their joys. Once there were jobs in the town, but today young people leave to study and work in the big city. Now, on a good Sunday, 25 or 30 people gather for worship; your church struggles to survive.