Infected Wounds, Housebound Seniors: Racing to Contain Hurricane Helene’s Deadly Impact, Health Center Staff Put Their Own Hardships Aside

Shantelle Simpson's house had been swept away by Hurricane Helene over the weekend. She and her family were sleeping in her Asheville office, in the North Carolina health center where Simpson is president and CEO.

None of this, apparently, was going to stop Simpson from leading Appalachian Mountain Community Health Centers in an exhaustive response effort. Or from working to procure not just medicines and supplies for her clinicians, but food boxes for employees in danger of going without. She'd secured therapy for providers returning from the devastation they'd seen in the road, and emergency funding to pay staff salaries after Helene strained budgets and cost nonprofit health providers revenue.

But when Simpson spoke with Direct Relief on Friday morning, she was determined and even cheerful - although she admitted she needed to find some time to look for housing. She'd spent some in-person time with her team that morning, "getting to see their faces" instead of communicating through messaging. The health center had arranged a partnership with local pharmacies, so that medications for new and existing patients would be covered in coming weeks. Although her staff had started out the week with one open clinic and a mobile van, they'd been able to add working sites and expand their hours day by day.

"If we don't stand up, people go without," she said. "It's situations like this that show the true strength of federally qualified health centers."

"Wherever there is need"

The scale of Hurricane Helene's impact is only beginning to emerge, but the region's community health centers were preparing long before the storm hit. They've gathered the medications and supplies experience has taught them will be needed, such as through Direct Relief's Hurricane Preparedness Program. Vulnerable patients have been connected with medication and services. Clinics and mobile medical units have been prepped for response efforts.

Health center leaders describe staff members showing up for work immediately after Helene had passed - even though staff are overwhelmingly locals themselves, and flooded houses, missing or sick relatives, and food shortages were affecting them as well.

Providers at Cherokee Health Systems, a community health center in eastern Tennessee, had spent the last few days moving from place to place to offer mobile clinic services, following guidance they'd received from local officials. In one unincorporated community, they found 200 older people who'd been unable to evacuate and who'd been essentially "locked in" by impassable roads, said Cherokee CEO Dr. Parinda Khatri.

"They are going wherever there is need," she said.

For many of their patients, water was the most urgent issue. Cherokee Health is headquartered in Cocke County, which was in the middle of a widespread water outage when Dr. Khatri spoke to Direct Relief. Staff had parked one of their mobile medical units in front of a brick-and-mortar building so that providers could see patients using the unit's internal water system, until government responders could provide a water tank.

Providers reported encountering exhausted responders on the road - one aid worker, serving out beans and cornbread, needed immediate medical attention. A Cherokee Health employee took over the food distribution until she'd recovered. Staff passed out bottles of water and non-perishable food as they went.

Dr. Khatri described staff members working to track down coworkers who'd been out of contact, and community health workers teaming up with behavioral health providers to check in with "every single patient" the health center serves. An IT worker rode with the mobile clinic so he could set up a public Wi-Fi connection for community members anxious to check in with friends and family.

At first, the most urgent need had been for first aid, Dr. Khatri said. People were showing up with injuries - one patient had been stabbed - and she was anticipating a significant need for tetanus and hepatitis vaccines in the days ahead. But in addition, she noted, "we're starting to see people running out of their meds," and doctors were expecting a growing need for insulin and other essential medications - even as local pharmacies were flooded out.

Direct Relief was preparing a shipment of emergency medical backpacks and hygiene kits for Cherokee Health. Sanitation was a serious and widespread issue, Dr. Khatri explained, and the emergency medical backpacks would be used in hard-to-reach communities where people were likely to need first aid and medicines. Cherokee's providers are "in the community and they see what the needs are," she said.

"Coming in with this desperation"

When Appalachian Mountain's mobile van pulled up in an impacted community, Simpson said, people gravitated towards it. Clinicians saw high numbers of patients with open wounds - one provider got down on hands and knees with a bucket of water to clean out a particularly severe injury - and missing medications, and staff members passed out water, diapers, and Direct Relief hygiene kits as they went.

Simpson had received multiple requests for mobile services from local officials, who were concerned about vulnerable patients in impacted neighborhoods. On Friday, providers were on their way to a low-income senior care facility where they'd knock on doors and provide in-home medical care.

Staff were excited about a new shipment of Direct Relief emergency medical backpacks as well, she said. The medicines and supplies that the bags contain were essential for field work, but also: "They love those. They think they're very cute."

Even in brick-and-mortar clinics, "people are coming in with this desperation," Simpson said. Some were existing patients, some had never been there before. "They don't know what medicine they're on, and they don't have access to their bottles."

Chronic disease and mental health medications were urgent requests, and Simpson was proud that, in the face of insulin shortages, her health center's charitable pharmacies were working and able to supply deficiencies. Patients undergoing medication-assisted treatment for substance use disorders - an important focus at Appalachian Mountain - were showing up terrified that the disaster's upheaval would cause severe withdrawal symptoms.

Amid the urgency, Simpson watched with admiration and concern as staff members put their own needs to the side. One provider insisted on working, even though a number of her family members were still missing, and the odds that they were still alive were poor. Another handed over her own food to a displaced patient who'd gone hungry, and sat with them until they could get transportation to a shelter.

Simpson swung into gear again, organizing food boxes for the 15 employees who reported being without it, arranging for a therapist to volunteer her time with staff members, and requesting a $25,000 emergency grant from Direct Relief to pay salaries. Displaced employees - 28 people in total - were invited to stay in an office.

"We're real, we're here"

This tendency to prioritize patient needs above personal hardship is common in health centers, where caring for vulnerable patients is central to the mission, said Taina Lopez, director of emergency management at the National Association of Community Health Centers.

Lopez described one health center CEO who'd been hesitant to accept an offered air mattress after being displaced by Hurricane Helene - she was worried about taking a resource from someone whose need might be more urgent. Health center leaders were running emergency response operations while simultaneously trying to locate staff members who hadn't checked in. They were worried about paying staff, arranging transportation, and organizing the child care that would enable providers to undertake lifesaving care.

While communications were slowly improving with satellite connections, NACHC stressed that rescue operations were still underway, and a large-scale understanding of impact and need would emerge slowly over time.

In the meantime, providers were drawing on insights and wisdom gleaned from other disasters. Health center leaders in Florida, which has frequently dealt with the impacts of flooding, were offering advice to North Carolina partners about procuring medical supplies, effectively directing a public outpouring of interest and support, and maximizing response efforts.

"These natural disasters are not going anywhere," and neither is the need for resilient health systems that can respond to catastrophe, Lopez said.

Damaged clinics and providers with flooded-out homes are the flip side of an important truth: Being part of an impacted community - knowing where need exists and what's most important, feeling committed to responding - is a tremendous strength.

Simpson, at Appalachian Mountain, put it this way: "We're real, we're here, and we're doing the work."

Support for community health centers is key to Direct Relief's Hurricane Helene response. Long before tropical storm season, Direct Relief works with health center partners in vulnerable areas to stage caches of emergency medicines and supplies, and funds the purchase and outfitting of mobile medical units like Cherokee Health System's, which provide lifesaving care in the aftermath of disasters.

Direct Relief is providing $25,000 emergency grants to 10 health centers responding to Hurricane Helene, including Appalachian Mountain Community Health Centers. In response to requests, Direct Relief has shipped emergency medications, water purification tablets, first aid supplies, emergency medical packs, hygiene kits, tetanus and hepatitis vaccines, and other essential resources to local organizations responding to Helene.

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