The patient didn’t speak Spanish, only her Indigenous Nahuatl language. She had not realized that the procedure would mean that she was “going out flat,” or with her breasts completely removed, said Gitler, a breast reconstruction surgeon and founder of the ALMA Foundation.

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The ALMA Foundation is a group of plastic surgeons who specialize in breast reconstruction and perform reconstructive surgeries at no cost to breast cancer survivors.

Gitler spoke with the patient through a translator and told her about the option of having reconstructive surgery. Soon thereafter, the patient became a candidate and received a reconstruction from Gitler’s team of volunteer surgeons. 

In 2020, Mexico saw more than 29,000 new cases of breast cancer and almost 8,000 related deaths, making it the most common cancer among Mexican women, according to the WHO. Treating the disease with a multidisciplinary medical team that includes an oncologist, mental health provider, and plastic surgeon is an important priority.

For many women, reconstructive surgery is an essential part of their recovery. But it’s generally not covered by public insurance, and many individuals can’t afford the procedure.

Direct Relief has provided ongoing support to two organizations in Mexico that work with breast cancer survivors: Fundación Alma, and Fundación Voluntarias Contra el Cáncer, which helps women with high economic vulnerability navigate breast cancer treatment and connect them to services.

Both organizations offer services free of charge, including helping a total of more than 800 women thus far access reconstructive surgery at Mexican hospitals.

Now, the company Johnson & Johnson Mexico has added its support, making it possible for Fundación Alma and Fundación Voluntarias Contra el Cáncer to help more women.

“It is extremely important to support women to feel comfortable with themselves, providing information that helps them develop the confidence to self-examine, as well as to know and explore comprehensive breast cancer treatment options, including breast reconstruction,” a Johnson & Johnson press release said.

Of course, reconstructive breast surgery isn’t for everyone.

“[Reconstruction] is entirely the patient’s decision,” said Esther Cisneros, the President of Fundación Voluntarias contra el Cáncer A.C., an organization that helps women navigate breast cancer treatment and connect them with free reconstructive surgeries. “What the foundation seeks is that the patient always has the option regardless of what they decide.”

But when presented with the option, an overwhelming majority of women in Mexico —more than two-thirds—said they’d prefer to have breast reconstruction after their mastectomy. “There are many studies that if you inform patients about the procedure, you…increase the uptake of the surgery by 30%,” said Paulina Bajonero, a researcher and general surgeon in Monterrey, Mexico.  

Many women report feeling less confident after surviving breast cancer and according to Bajonero’s research, just want “to look the same as they did before.”

Gitler, who is also a breast cancer survivor, said seeing her body after her double mastectomy was “one of the most shocking moments” of her life. Now, when she counsels patients at the ALMA Foundation, she understands why having breasts can be an important part of a woman’s identity. “The phrase I hear every day is that they ‘feel incomplete,’” she said. 

Additionally, some women face fallout in their romantic relationships after having breast cancer surgery. “Sadly in Mexico there is still this thought [among] men that…women are worthy because of their breasts,” said Gitler. Sixty percent of patients at the ALMA Foundation report being left by their partners after their diagnosis. 

For many women, receiving reconstructive surgery is an important part of resuming their social and professional lives. But it’s not just about reducing or erasing the negative consequences of breast cancer surgery. Instead, it’s often about moving on.

“Reconstruction makes it so [women] can close a window,” said Cisneros, allowing them to put their experience with cancer behind them. 

Direct Relief has provided more than $260,000 in medical aid to Fundación Alma and Fundación Voluntarias Contra el Cáncer. Johnson & Johnson Mexico provided breast implants for patients receiving reconstructive surgery through these two organizations.

The post In Mexico, Reconstructive Surgeries Help Women Move on from Breast Cancer appeared first on Direct Relief.

Muchas mujeres no pueden pagar la reconstrucción, pero informan que se sienten “incompletas” después de una mastectomía. Dos organizaciones que trabajan con sobrevivientes de cáncer de mama tienen como objetivo cambiar eso.

La paciente acababa de someterse a una doble mastectomía por cáncer de mama cuando la Dra. Rina Gitler la conoció en Guerrero, México. Y estaba llorando.

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La paciente no hablaba español, solo su lengua indígena náhuatl. No se había dado cuenta de que el procedimiento significaría que “saldría plana” o que le extirparían los senos por completo, dijo Gitler, cirujano de reconstrucción mamaria y fundador de la Fundación ALMA.

La Fundación ALMA es un grupo de cirujanos plásticos que se especializan en la reconstrucción mamaria y realizan cirugías reconstructivas sin costo alguno para las sobrevivientes de cáncer de mama.

Gitler habló con la paciente a través de un traductor y le habló sobre la opción de someterse a una cirugía reconstructiva. Poco después, la paciente se convirtió en candidata y recibió una reconstrucción del equipo de cirujanos voluntarios de Gitler.

En 2020, México registró más de 29,000 casos nuevos de cáncer de mama y casi 8,000 muertes relacionadas, lo que lo convierte en el cáncer más común entre las mujeres mexicanas, según la Organización Mundial de la Salud. El tratamiento de la enfermedad con un equipo médico multidisciplinario que incluya un oncólogo, un proveedor de salud mental y un cirujano plástico es una prioridad.

Para muchas mujeres, la cirugía reconstructiva es una parte esencial de su recuperación. Pero generalmente no está cubierto por el seguro público y muchas personas no pueden pagar el procedimiento.

Direct Relief ha brindado apoyo continuo a dos organizaciones en México que trabajan con sobrevivientes de cáncer de mama: Fundación Alma y Fundación Voluntarias Contra el Cáncer, que ayudan a mujeres con alta vulnerabilidad económica a navegar el tratamiento del cáncer de mama y conectarlas con los servicios.

Ambas organizaciones ofrecen servicios gratuitos y al día de hoy han ayudado a más de 800 mujeres para acceder a cirugía reconstructivas hospitales en México.

Johnson & Johnson México ha sumado su apoyo, haciendo posible que Fundación Alma y Fundación Voluntarias Contra el Cáncer ayuden a más mujeres.

“Es extremadamente importante apoyar a las mujeres para que se sientan cómodas consigo mismas, brindándoles información que las ayude a desarrollar la confianza para autoexaminarse, así como para conocer y explorar opciones integrales de tratamiento del cáncer de mama, incluida la reconstrucción mamaria”, dijo un comunicado de prensa de Johnson & Johnson.

Por supuesto, la cirugía reconstructiva mamaria no es para todas.

“[La reconstrucción] es enteramente decisión de la paciente”, dijo Esther Cisneros, presidenta de Fundación Voluntarias contra el Cáncer A.C., una organización que ayuda a las mujeres a transitar el tratamiento del cáncer de mama y conectarlas con cirugías reconstructivas gratuitas. “Lo que busca la fundación es que el paciente siempre tenga la opción independientemente de lo que decida”.

Pero cuando se les presentó la opción, una abrumadora mayoría de mujeres en México, más de dos tercios, dijeron que preferirían hacerse una reconstrucción mamaria después de la mastectomía. “Hay muchos estudios que indican que si informas a los pacientes sobre el procedimiento, aumentas la aceptación de la cirugía en un 30 %”, dijo Paulina Bajonero, investigadora y cirujana general en Monterrey, México.

Muchas mujeres informan que se sienten menos seguras después de sobrevivir al cáncer de mama y, según su investigación, solo quieren “lucir igual que antes”.

Gitler, quien también es sobreviviente de cáncer de mama, dice que ver su cuerpo después de su doble mastectomía fue “uno de los momentos más impactantes” de su vida. Ahora, cuando asesora a pacientes a través de la Fundación ALMA, comprende por qué tener senos puede ser una parte importante de la identidad de una mujer. “La frase que escucho todos los días es que ‘se sienten incompletas’”, dijo.

Además, algunas mujeres enfrentan consecuencias en sus relaciones personales después de someterse a una cirugía de cáncer de mama. “Lamentablemente en México todavía existe este pensamiento [entre] los hombres de que… las mujeres valen por sus senos”, dijo Gitler. Sesenta por ciento de las pacientes de Fundación ALMA reportan ser abandonadas por sus parejas después de su diagnóstico.

Para muchas mujeres, someterse a una cirugía reconstructiva es una parte importante de la reanudación de su vida social y profesional. Pero no se trata solo de reducir o borrar las consecuencias negativas de la cirugía del cáncer de mama. En cambio, a menudo se trata de seguir adelante.

“La reconstrucción hace que [las mujeres] puedan cerrar ese capítulo”, dice Cisneros, permitiéndoles dejar atrás su experiencia con el cáncer.

Direct Relief ha entregado más de $260,000 pesos en ayuda médica a Fundación Alma y Fundación Voluntarias Contra el Cáncer. Johnson & Johnson México proporcionó implantes mamarios que beneficiarán a pacientes que se sometieron a cirugía reconstructiva a través de estas dos organizaciones.

The post En México, Las Cirugías Reconstructivas Ayudan a Las Mujeres a Reinsertarse en la Vida Después de Haber Padecido el Cáncer de Mama appeared first on Direct Relief.

“We would have to either put [patients] on hold and see if someone is available to speak to them, or tell them to call back somehow,” said Nancy Tardy, the director of the call center.

Because the call center serves as the main entry point of care for the Richmond, Virginia health center, these patients were at risk of not getting medical attention. They might not call back, or even hang up out of frustration.

A solution came in the form of an education session: the Medical Spanish session offered by the nonprofit group The MAVEN project. Through funding from Direct Relief, they provide educational services to physicians caring for underserved patients. This particular session was designed to help non-Spanish-speaking providers communicate clearly and effectively with Latino patients.

Providers learned key phrases and medical terms in Spanish, and culturally appropriate ways to provide care.

“They learned the basics on how to greet the patient, how to take the message and how to book the appointment,” said Tardy of her staff members who attended the session.

The Language

According to Tamara Ríos, who presented the Medical Spanish session, being bilingual in a patient’s language is not a requirement for providing culturally competent care. Instead, her education sessions focus on the basics.

“We certainly would never state that you will be fluent after taking any of our classes because that’s not realistic, but we do present concepts in a way that you can apply immediately in the medical setting, so it’s a correct, but simple Spanish,” she said. 

For example, Ríos teaches providers to use “key power verbs” which can be used to quickly give patients advice or recommendations. “So an example would be ‘necesita,’ [which means] ‘you need to,’ and then you can add on the infinitive,” she explained.

For Tardy’s staff, knowing this level of Spanish has made the difference between patients hanging up and patients getting care. “This class was like a blessing,” said Tardy. 

Common ground

But providing culturally competent care is not just about language. Providers must also understand differences in communication styles, along with important cultural beliefs and practices. 

“There are different views of what causes disease and different views of what you can do when you are sick,” explained Dr. Gregory Juckett, a former professor at the West Virginia University School of Medicine and researcher specializing in culturally competent care for Latino populations. 

Some beliefs held by Latin American communities counter those held by standard Western physicians, Juckett said. For example, it is common for illnesses to be considered either hot or cold conditions.

Juckett gave the example of high blood pressure, which some think of as a hot condition that should be treated with a cooling remedy, such as lemon tea.  

At times, this view of disease can impede on the successful treatment of a patient, Juckett explained: “Basically you’re dealing with two different worldviews and sometimes these worldviews conflict with each other.” 

He has had mothers refuse vitamins for their children who have fever or illness “because vitamins are considered a hot therapy and therefore it wouldn’t make sense to use vitamins, something hot, to treat something that’s hot.”  

However, most of the time these traditional treatments can be used in tandem with Western medications or lifestyle changes, said Juckett. With some patients who have moderately high blood pressure, he will pair a culturally appropriate therapy with diet and exercise for a three-month period and monitor the patient’s condition.

If the patient improves, so much the better. If not, he negotiates: “We try to accomplish a compromise where we hopefully take some of both worlds and use them together.” 

This approach is common among many of the providers interviewed for this story, including Dr. Marianny De Aza from Health Brigade in Richmond, Virginia. De Aza is a Native Spanish speaker from the Dominican Republic and manager of the Health Brigade’s medical clinic. 

“The whole agency is bilingual because of the need of the bilingual staff to help with the Spanish-speaking patients,” who account for 80% of the clinic population, she said.

De Aza said she often encounters cultural beliefs that conflict with the treatment she has prescribed. “I have a lot of patients telling me ‘I’m not diabetic’…or ‘I don’t want to take Metformin,’” she said, referring to a treatment for diabetes. One of her patients used cold chocolate to manage her high blood pressure, rather than the medication she was prescribed. 

“I do not tell them [their therapies are] not going to help them. I just explain to them that there has been a lot of studies that have proven that if we help you with this type of medication, in the long term, the quality of life is going to be better,” said De Aza. 

As a Latina raised in the Dominican Republic, De Aza understands her patients’ perspective. “A lot of us have been raised by our abuelita giving us remedies and they cure us, they work,” she said.

This kind of understanding is key to developing trust with patients and helping them attain better health. In her sessions, Ríos encourages providers to ask questions that acknowledge traditional healers and therapies.

When asking about their health history, for example, providers can ask patients, ‘‘’Have you seen any other provider, yerbero, doctor, santero, curandero?’” she explained. “That way it signals to us, ‘Okay, everyone is on the same team.’” 

“Personalismo”

In addition, Ríos educates providers on differences in communication styles and expectations. It all begins with the introduction.

She explained that, while it’s typical in the U.S. for providers to skip over pleasantries and get right to the medicine, this can feel abrupt for patients accustomed to receiving care in Latin America. Instead, Ríos encourages providers to ask patients their names, ensure they are pronouncing them correctly, and always ask about their family. 

“Family is very much involved in the decision-making process of anything…particularly with the health of the patient,” said Ríos. This warm welcome adds a personal touch to the visit, or “a little version of ‘personalismo,’” that can ultimately determine the care a patient will accept and receive. 

At Health Brigade in Virginia, De Aza is working with her non-Spanish-speaking staff to help them better understand their patients. She’s been using the slides from the MAVEN Medical Project session to teach basic terms and phrases, such as “me duele” (“it hurts”) or “cabeza” (“head”), and add the personal touch Ríos describes.  

“Of course, they’re not going to be Spanish speaking or fluent, but at least they can connect with a patient,” said De Aza. With just a minimal level of Spanish, providers can understand what’s bothering the patient, what kind of care they need, and how to provide that care in a way that respects their culture and desire for treatment. 

The post For Many Latino Patients, Health Care is Much More than Medicine. It’s Language and Culture, Too.   appeared first on Direct Relief.

“You see Black women who are more affluent, more educated, maybe in partnership. Maybe she has all the resources,” she said. “These Black women are still having the same devastating birth outcomes.” 

Black and Indigenous women in the United States are two to three times more likely to die from a pregnancy-related cause than white women, even when controlling for socioeconomic factors, such as income and education. 

The reason, according to Jordan, is racism: “I think why there’s so much Black maternal mortality and morbidity in our country because of generational trauma around race.” 

As a Black midwife, Jordan says maternal health care that prioritizes the social and emotional health of patients could improve birth outcomes for women of color in the United States: “My belief is that this model of midwifery care…can help to heal that generational trauma if people are getting loved on during their pregnancy and birth.” 

Understanding the benefits of midwifery and the importance of racially concordant care, Direct Relief has partnered with the National Association of Certified Professional Midwives to provide $50,000 in funding to support Black and Indigenous midwifery students in the United States. The funds will be used to assist with the cost of tuition, licensing, exam fees, and mentorship. 

Addressing the Legacy of Racism 

According to a seminal study published in the American Journal of Public Health, experiencing racism over a lifetime produces sustained levels of cortisol that cause body systems to break down more quickly. The phenomenon, known as the “weathering effect,” has been posited as one of the causes of racial health inequities in the United States, including disproportionately high rates of chronic disease among people of color.  

“Black women tend to enter pregnancy with pre-existing conditions,” said Jamarah Amani, a certified professional midwife and co-founder of the National Black Midwives Alliance. “If those are not being addressed prior to the pregnancy, then in pregnancy, they will skyrocket because of the stress that pregnancy puts on the body.” 

The hypothesis that inequities in maternal mortality are not simply a matter of cultural or socioeconomic factors is further supported by research showing that African- and Caribbean-born women living in the United States have the same birth outcomes as white women, despite sharing the same ethnic backgrounds as Black Americans. 

“It’s not a genetic marker. It’s not a socioeconomic issue. This is really about exposure to racism over the course of someone’s life. So it’s racism, not race, that is at the root of these disparities,” said Amani. 

While an extensive body of research disentangles the relationship between racism and poor health outcomes, for Amani, a Black woman, racism and its effects are “embedded.” 

“You can’t measure it. You don’t know necessarily when or how or what the trigger is going to be or how it’s going to affect you. You may not be able to ever articulate what that thing was that spiked your blood pressure or what that thing was that made you depressed…That is…the visceral kind of way that oppression and racism embed themselves into our bodies,” she said. 

The Midwifery Model 

Midwives serve as the primary point of contact for many women throughout their pregnancy and postpartum experience. They perform routine prenatal check-ups, attend the birth, and provide postpartum care. Many midwives serve as women’s primary health care providers beyond their birthing years. This differs from conventional models in which women have a primary obstetrician but are seen by different nurse practitioners for most routine visits, according to Jordan. 

Midwifery-led care has been shown to improve health outcomes among birthing women worldwide, leading to lower rates of cesarean sections, preterm births, and anemia. The World Health Organization has identified midwifery as playing a “vital” role in lowering global maternal and newborn mortality. 

At Amani’s midwifery practice in Florida, for example, addressing common diet deficiencies such as anemia usually involves a comprehensive care strategy. “Instead of just being like, take this pill for iron, we sit down and make a plan.” She reviews patients’ diets and helps them determine ways to get more iron-rich foods in their diets, and provides recipe ideas that are nutrient-rich and inexpensive. If it’s a transportation issue, she helps patients navigate the public bus or organize rides with family members to and from the grocery store. She’s even ordered Ubers for those who “just don’t have any resources or support.” 

Improving maternal health outcomes “really does require more time, attention, knowledge and care, and those are hallmarks of how midwives do what we do,” she said. 

A legacy of medical mistreatment 

While midwifery-led care has been shown to improve outcomes for women globally, it could be particularly beneficial for women of color in the United States. According to a study published in the National Library of Medicine, Black and indigenous Americans report lower levels of trust in the healthcare system due to decades of mistreatment and abuse by healthcare providers.  

Jordan says this has led to an increase in demand for her midwifery services, which are provided outside of a hospital setting: “What I’m seeing in my personal practice is that more people of color, more people from marginalized communities are looking into alternative birth options.”  

This was particularly apparent after the murder of George Floyd in 2020, she said, which led to a wave of social justice protests and increased public awareness of the Black maternal health crisis. 

Cost: “A Huge Barrier” 

Despite midwifery being an attractive alternative for Black and Indigenous mothers, they often have the hardest time accessing it. “The biggest barrier to accessing midwifery is just the cost,” said Amani.  

Black and Latino Americans are two times more likely to be poor than their white and Asian counterparts, according to an analysis of 2019 U.S. Census data. For Indigenous Americans, poverty rates are up to three times higher. 

And, in most states, midwifery care isn’t covered by Medicaid—the public insurance for low-income Americans. “That’s a huge barrier for low -income folks who want to access this type of midwifery care,” said Jordan. 

As a result, women of color are less likely to be cared for by a midwife during their pregnancy. According to an analysis of CDC data, white women in the United States are two and 3.5 times more likely to have a midwife than Latina and Black women, respectively.  

These economic barriers motivated Jordan to establish a birth center that accepts government insurance. Her birth center is part of a federally qualified health center, making it eligible for government reimbursement.  

Jordan was 20 years old and eight months pregnant when she opted to hire a midwife. She made payments to afford the services.  

“It was challenging for me to access it,” said Jordan. “Why would I create a practice where people couldn’t afford my services?”  

Today, her birth center in California’s Bay Area provides midwifery care at little to no cost to low-income women who are uninsured or underinsured.

However, laws differ by state, and most don’t allow midwives to bill Medicaid. As a result, midwives are less likely to care for women of color, and the profession itself is lacking in diversity: Nearly 90% of certified nurse-midwives are white. 

For mothers of color, this is a problem. “We know that concordant care really matters. That if I’m being cared for by somebody who understands me culturally, looks like me…that improves how I understand the care that I’m receiving, how I experience it, and it improves physiological outcomes,” said Dr. Keisha Goode, a midwife, vice president of the National Association of Certified Midwives, and professor of sociology at SUNY Old Westbury. 

A large body of research shows mothers who share the same race as their provider report higher levels of trust and comfortability with their doctor and give birth to healthier babies. One recent study found mortality rates among Black newborns were cut in half when care was provided by a Black physician.  

“Black midwives and Indigenous midwives have literally birthed the nation.” 

While today a majority of midwives and the patients they serve are white, the practice has deep roots in Black culture. ¨Well, up until the 1950s, there were Black midwives who were providing the majority of care,” explained Goode. Before the rise of obstetrics, midwifery was the dominant model of care, and all women typically gave birth at home.  

“Black midwives and Indigenous midwives have literally birthed the nation. And in our understanding of American history, midwifery has not been paid proper due,” said Goode. Before the Civil War, the majority of births in the Southern United States were attended by enslaved African women and their descendants. 

The change in the demographic makeup of midwifery is often traced back to the Shepherd Towners Act of 1921. The act was implemented to reduce infant and maternal mortality in the United States and created a system of training and licensure for midwives who had learned their practice through long-term apprenticeship for centuries.  

While the midwifery training courses introduced new techniques on sanitation that helped save lives, they also created barriers to entering the midwifery workforce. To obtain a license, midwives often had to pay a fee and travel distances to attend regular courses—which rural, low-income midwives couldn’t afford. “You can’t say everybody has to be licensed without also providing equitable avenues for people to be licensed, so sometimes laws and policies get used as a way of exclusion,” said Goode. As a result, “those midwifery practices or midwives themselves either passed on or were unable to practice.” 

Between 1910 and 1930, the number of births attended by a midwife dropped from 50% to 15%, according to a CDC report, while hospital births increased in tandem. Today, only about 10% of births in the United States today are attended by a midwife. 

“The cornerstone of direct entry midwifery is that it’s personalized. It’s about building relationships and working in partnership with your client, and so that’s much easier to do if your midwife shares a similar lived experience,” said Jordan. 

While midwifery-led care alone is unlikely to solve the maternal health crisis, said Goode, care that reflects the patient is fundamental: “It is not that having a Black midwife caring for a Black person eliminates racism. That is not at all what I’m saying. But that kind of care, being cared and loved by somebody who looks like you, knows you, understands you culturally, is so incredibly important.” 

The post Improving Birth Outcomes Among Women of Color Begins with Care that Reflects Them  appeared first on Direct Relief.

“He was getting emergency room-level care, but the thing that was eating away at him nobody was acknowledging,” said Jennifer Smith, formerly a doctor at a border hospital but now practicing at Chiricahua Community Health Center, Inc., in Arizona.

People coming from Central and South America frequently pass through some of the most dangerous migration routes in the world. Violence, robberies, kidnappings, and sexual abuse are pervasive threats. Many people sustain physical injuries and experience illness on the journey. 

“There is an idea that coming to the United States is somehow better than what they are coming from. And maybe it is, but I’m not a hundred percent sold on that,” said Rose Lira-Ostrea, the director of Behavioral Health at Su Clinica in Harlingen, Texas. “What they have to endure in the process of getting here is…inhumane,” she said. 

Su Clinica, a federally qualified health center, is located 17 miles from the U.S.-Mexico border. Many of the patients they serve are recent migrants from Central and South America who have experienced trauma during their journeys. Basic primary care appointments, such as children’s vaccinations, often turn into mental health interventions. 

Su Clinica is one of 25 federally qualified health centers in the state of Texas that has received training in trauma-informed care through the Texas Association of Community Health Centers (TACHC) and with funding from Direct Relief.

Caring for trauma

The program was conceived in 2018 in response to the influx of unaccompanied minors crossing the U.S.-Mexico border.

“When we saw that the children needed support, the families needed support, the staff needed support, we took a step back and thought, you know, these kids are probably going to end up in our health centers – which they did,” said Dr. Roxana Cruz, the director of Medical and Clinical Affairs at the Texas Association of Community Health Centers.

Since 2019, TACHC has trained over 400 health care providers throughout the state of Texas in trauma-informed care practices. 

The core assumption of trauma-informed care is that any patient may have been exposed to trauma at some point in their life, whether in childhood or as an adult, explained Cruz. The objective is to create a safe environment for the patient to receive care, one in which they feel comfortable returning.

“It’s a framework where we help our staff understand and be able to respond to that impact of trauma. We are thinking about physical, psychological, and cultural safety for everybody,” said Aimee Rachel, a licensed master social worker and the trauma-informed care coordinator at TACHC. “That is the most important thing.” 

In some cases, experiences of trauma can make patients uncomfortable in a medical setting and cause them to delay health care. “Maybe the patient has missed five appointments because the last time she had a Pap smear they were not considerate with her and it reminds her of the abuse that she went through when she was a child,” explained Priscilla Bernal, the Director of Social Services at Su Clinica.

Providers at Su Clinica are careful to explain procedures in the patient’s language and ask patients’ permission before proceeding – a hallmark of trauma-informed care. 

Thousands of stories

At Su Clinica, behavioral health and social services are often provided during medical appointments. At their women’s clinic, for example, patients come for gynecological care but often reveal to their medical providers that they are also experiencing domestic violence at home.

Many of these women are particularly vulnerable to abuse due to their legal status. “They’re being threatened by the spouses saying, ‘If you call the police on me, I will deport you to Mexico. So be very careful with what you do,’” explained Bernal. 

In this case, the medical provider can bring Bernal into the appointment to provide supportive social service resources. This can include paying for the patient to stay in a motel room for a few nights, directing them to women’s shelters, and providing them with contact information for organizations that provide advice and emergency support. The health center has designed a discreet pamphlet with these phone numbers hidden among other contacts since many women face reprisal for reporting abuse. “We have to get very savvy to give them that resource,” Bernal said. 

In addition to rape and sexual assault, women and children are at higher risk of being victims of human trafficking, for both sex and labor. In 2019, Texas reported the second-highest number of cases of human trafficking in the nation, according to the National Human Trafficking Hotline.

Bernal recalled one of her patients who was intercepted by a sex trafficker while migrating to the U.S. to be with her children. The patient reported being kept in a barn with others for months on end: “They would give them one gallon of water per day…one group with one gallon of water.” The woman eventually escaped.

This is one of “thousands” of stories both Bernal and Lira-Ostrea have heard through their work on the border. For some, these experiences of trauma become unbearable. Lira-Ostrea has had patients tell her: “’I have been through hell and back…I would rather die than keep going through this.’” 

A Right, Not a Luxury

While many of those who have recently migrated to the U.S. are some of the most in need of health care, including mental health services, they are often the last to seek it out. 

“There’s a lot of fear of maybe being visible to authorities or being seen as causing a problem,” explained Natasha Howard, an Associate Professor of Global Health and Conflict at the London School of Hygiene. “They might just say, ‘Oh, okay. I’m not well, but I don’t even want to try, because then I have to write my name down.’” 

For many, fear of deportation is a major barrier, said Howard: “People don’t want to do anything that might jeopardize their situation.” 

Other times, securing food, shelter, and work take precedent over getting health care, especially in places where health care is costly. “Often health is – while it should be a right and according to human rights law, it is a right – it’s often sort of treated more as a luxury,” said Howard. 

This is especially true for mental health care. 

“I see a lot of my patients, they’re working very hard, they’re maybe feeding two different families they’re looking towards the future and sometimes they feel stopping and addressing their mental health to too much of a degree is too indulgent,” said Smith. 

Speaking for themselves

At Su Clinica, helping patients heal from these traumas begins by “recognizing that the situation that a patient, a person, a human finds themselves in, does not define them,” said Lira-Ostrea. 

Rather, the provider’s role is to let the patient speak for themselves: “We all at some level can recognize someone else’s needs if we allow ourselves to come from an area of recognition, allowing the person to speak, allowing them to feel safe.” 

The post Treating Trauma at the U.S.-Mexico Border appeared first on Direct Relief.

People in the U.S. have lagged behind their counterparts in other large, high-income countries in getting boosted. That’s true despite clear evidence that protection from the vaccine wanes after several months—and that a booster dose provides added protection. While 65.9% of Americans are vaccinated against Covid-19, just 45.4% have received a booster shot. During the omicron surge, the United States surpassed other high-income nations in total deaths due to Covid-19. 

Misinformation was a significant reason many Americans didn’t get the initial Covid vaccine. But people passing up boosters have different reasons, according to Rashanna Lynch, the Chief Medical Officer at Ryan Health in New York City: “I think the hesitancy is not because of fear of the vaccine that we saw with the series, because if you’re due for a booster…you’ve already been vaccinated, you are not anti-Covid vaccine.” 

“You promised me two…Why are all these things changing?” 

It’s not necessarily a lack of information preventing people from getting boosted, according to Lynch, but perhaps, too much of it. 

“I think the Covid vaccine has been given the most publicity of any vaccine we’ve had in this country, so every single detail is put out every day and it’s a lot of information that’s constantly changing…It’s a lot of stuff for non-medical people to grasp and understand,” she said. While Ryan Health was “inundated with people wanting vaccines” at the beginning of the rollout, there’s been less demand for booster shots. “People are just confused about all the information that continues to change.” 

At AltaMed in Los Angeles, which serves low-income and uninsured individuals, many of whom are Spanish-speaking, Dr. Illan Shapiro says his patients are experiencing the same confusion. “’You promised me two and right now you’re adding another one and I’m hearing that I need a fourth one. Why is this happening? Why are all these things changing?’” he said he hears regularly from patients. Shapiro tells them that the booster is necessary “to actually remind your body, ‘Hey, wake up you need to produce more’” antibodies. 

Though the public health guidance is changing in response to changes in the virus, “we are all tired,” said Shapiro, “and every time they change a rule or add another rule, it’s actually very hard to accommodate.”  

Particularly for his patients. “Our community works day-to-day. They have two or three jobs. They do everything in public transportation…Every time we add another visit to a doctor or another visit to get a vaccine, they need to ask permission [from] their work, they need to make sure that they’re taking care of their kids, they need to make sure they have transportation.”  

AltaMed has been holding pop-up vaccine clinics at churches, schools, and other community spaces, in addition to providing the shots to patients at their routine visits. “We need to make sure we are creating opportunities…for our patients to be comfortable with us. To meet them where they are,” Shapiro said. 

For patients who want to make an appointment, AltaMed has patient navigators who speak Spanish and can help patients sign up online at their local pharmacy or help them book a visit at one of their clinics. Because of the increased vaccine supply, the clinic has more flexibility in when and how many patients they can administer the shot to in one day. Unlike at the beginning of the vaccine rollout, patients no longer face prolonged wait times for an appointment. 

“If you’re not there, there’s no paycheck” 

Despite the wide availability of vaccines, some patients still can’t manage to take time off work or spare a sick day, should they have side effects.  

Though some workplaces offer paid sick leave—California passed a bill mandating certain employers provide 40 hours of supplemental sick leave for Covid-19-related illness and vaccine appointments—many of Shapiro’s patients work jobs where “if you’re not there, there’s no paycheck.” They are farmworkers, servers, cooks, day laborers—jobs with few employee protections. Shapiro generally tells his patients that losing one day of work is tough, but it’s better than losing five to 10 days to a bout of Covid-19. 

According to Katie Irwin at Healing Hands Ministries in Dallas, Texas, work hasn’t necessarily prevented her patients from getting boosted. However, unlike with the first series, it hasn’t been a motivating force: “My sense is that there are a lot of people that got the vaccine because it was required. They wanted to keep their job and it wasn’t enough of a conflict for them to say, ‘It’s so important to me not to get it, that I’m going to quit my job.’”  

But now, since most workplaces don’t require their employees to get boosted, there’s less motivation to go in for another jab. “I just don’t think there was a compelling reason” for people to get boosted, said Irwin. “They just didn’t think it was that big of a deal.” 

“’I get it. There’re no microchips…I just want to wait.’” 

At AltaMed, Shapiro says his patients have expressed a similar lack of urgency. They tell him, “’I understand what you’re saying. I get it. There’re no microchips. It’s OK. We need it, but I just want to wait.’” But Shapiro is concerned, because immunity doesn’t kick in until two weeks after the shot, which means that every day patients wait, they’re leaving more time for the virus to spread. 

The reason people want to wait often comes back to mistrust, a theme that’s haunted public health officials since the beginning of the pandemic. “There’s a lot of just fear,” Shapiro said. That fear is concerning: “Covid is real and the fewer vaccinated people we have, the more people get sick.” 

This lack of trust could be a problem when and if additional vaccines are required to protect against Covid-19, which like all viruses, continues to mutate.  

To reduce hesitancy, Shapiro is working to inform his patients so they know when and why they need additional doses. “If the virus changes and the vaccines don’t work, yes, we need another one. If our body stops creating antibodies, yes, we need to have another one. If we are starting to see more cases, we need another one. If we are starting to see more complications or a higher mortality rate, yes, we need another one.” 

Though there are likely to be a “wave of questions” the next time a Covid vaccine is recommended, “I think it will be way easier next season,” said Shapiro. 

“It will probably be comparable with influenza…it will be part of the system.” 

Since the start of the pandemic, Direct Relief has shipped more than $3 billion in medical aid to 111 countries, including the U.S., and issued more than $130 million in funding to support the world’s health systems.

The post Americans Have Been Slow to Get Boosted. What Could It Mean for Future Covid-19 Vaccines? appeared first on Direct Relief.

That’s according to a recent whitepaper published in the Journal of Supply Chain Management, Logistics, and Procurement.

The paper was co-authored by Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis, and Cindy Elliott, Head of Commercial Industry Solutions at Esri, and the publication outlines how strategies used by humanitarian aid organizations to route lifesaving medical aid to communities in need can also be employed by businesses to work around logistical hurdles, like severe weather, supply chain disruptions, and changing demand within a global marketplace.

The strategy employed by Direct Relief, which has helped the organizations consistently respond to multiple emergent crises at once, is known as adaptive logistics. The approach involves predicting interruptions due to weather or conflict, identifying alternate routes and resources, and adjusting to changes in need among the communities affected.

Adaptability has become particularly important at Direct Relief as humanitarian crises become more severe and less predictable due to climate change and the Covid-19 pandemic, while daily disruptions to the global supply chain only compound the challenge of routing medical aid in a timely and efficient manner.

When responding to a disaster, the organization begins by assessing the needs of those affected on the ground. Direct Relief’s global network of more than 2,500 organizations serves as a source of real-time information that communicates who needs help, where they are, and what resources are needed most. These local contacts not only help Direct Relief deliver aid in a targeted way but also offer logistical support in the last-mile transportation of aid and resources.

For example, when responding to the 2020 Beirut explosion in Lebanon, which disrupted businesses and critical infrastructure, including a key port of entry, Direct Relief leveraged a network of in-country expatriates that helped the organization get clearance from the State Department for a 60-ton airlift of medical aid. Supplies were quickly routed to local hospitals with which Direct Relief had relationships through its previous work in the country.

In addition to its local networks, Direct Relief uses geospatial technology to gather real-time data on how a disaster is impacting a community, such as information about how and where people are evacuating, what kinds of medical resources are lacking, and who is most vulnerable due to socioeconomic status, age, and access to information.

During the 2018 Camp Fire response in Butte County, California, for example, Direct Relief was able to use geospatial data to predict potential evacuee zones and route medical aid accordingly.

While the aim may differ, businesses can adopt similar strategies to preempt consumer demand, predict disruptions in supply chains, and find alternate routes to effectively deliver products to consumers within a complex and ever-changing global marketplace.

The post Adaptability Key For Both Successful Humanitarian Response, Global Business Operations appeared first on Direct Relief.

Last week, 20 countries spanning four continents recorded record-breaking numbers of Covid-19 cases, according to The Financial Times. Australia, Denmark, and the UK experienced a surge of more than double previous peaks, and the proportion of positive tests is climbing in several countries. Australia’s infections are more than five times their previous peak, and hospitalizations surpassed record numbers, according to SCMP. South Africa, however, which was one of the first countries to detect Omicron, is believed to be past its peak.

While some experts believe Omicron to be “milder” than previous strains, it can still cause devastation in countries with minimal immunity, as reported by The Financial Times.

Only 8.5% of people in low-income countries have received at least one dose of a Covid-19 vaccine, according to Our World in Data, compared to 58.5% of the world population. Globally, 49.92% of the population has been fully vaccinated or received at least two doses of a Covid-19 vaccine.

Global News

Israel has begun offering anyone over age 60 a fourth shot of the coronavirus vaccine, expanding eligibility, as reported by the Washington Post. The country logged more than 6,500 positive cases Monday, the highest daily rate in months, according to Health Ministry figures. Some students have been forced back to remote learning if they have been exposed as more than 100 cities implement their strongest protocols. Israeli epidemiologists said this week that they expect the omicron variant to hospitalize about three out of every 1,000 infected people.

Meanwhile, the country has seen a spike in flu cases, with close to 2,000 people hospitalized in recent weeks, according to the Times of Israel. The country confirmed its first case of an individual infected with both the seasonal flu and COVID-19 at the same time, authorities said on Thursday. The identified case of “flurona,” as some have dubbed it, was relatively mild.

Initial results of a fourth dose study in Israel have shown a significant increase in antibodies, as reported by The New York Times. The fourth shot has produced a fivefold increase in antibodies in recipients’ blood.

In France, researchers have discovered a new variant called “IHU” that contains more mutations than Omicron, according to WION news. Twelve patients have tested positive for the variant amid a surge in cases. The country saw four consecutive days of record-breaking new cases above 200,000 and expects those figures to possibly double in the coming days.

Doctors across Mumbai are warning that already overwhelmed hospitals could run out of staff in a few weeks amid surging case numbers, according to The Telegraph. At St. George’s Hospital, one of the largest in Mumbai, 25% of resident doctors have contracted the virus. By last Sunday, new cases in India had tripled and doubled overnight in Kolkata.

In Asia, Japan is preparing for a possible Omicron surge by delivering Pfizer’s oral treatment nationwide so patients can recover at home rather than in hospital, according to SCMP. In The Philippines, coronavirus restrictions will be expanded this week as cases surge. The provinces of Bulacan, Cavite, and Rizal have been placed under the third-highest alert due to a sharp increase in cases.

A remote indigenous community in northern Ontario has requested Canadian military personnel to help with a COVID-19 outbreak that has infected at least 50% of its residents, according to Al Jazeera. The Bearskin Lake First Nation declared a state of emergency on December 29 and is in need of health workers, medical resources, food, water, and chopped wood.

Aruba’s cases are skyrocketing at more than 500 cases per 100,000 population, prompting the country to deny entry to any cruise ships with Covid outbreaks, according to CNN.

U.S. News

The United States added more than 1 million people to its Covid-19 case count on Monday, setting a world record for most of the new cases in a single day, according to Bloomberg. The surge has put pressure on the country’s health care system as hospitalizations increase. Last week, one in four hospitals with intensive care units reported at least 95% of their ICU beds were full, according to The New York Times.

Children are making up an increasing share of Covid-19 hospitalizations across the U.S., according to U.S. News and World Report. Connecticut, Georgia, Illinois, Kentucky, Massachusetts, Maine, Missouri, Ohio, Pennsylvania, and Washington D.C have recorded record numbers of children hospitalized due to Covid. In the past week, children hospitalized have increased by 97% nationwide.

Puerto Rico has had a 4,600% increase in new cases in recent weeks, despite having one of the country’s most successful vaccination campaigns, according to The New York Times. A third of all recorded coronavirus cases since the start of the pandemic have been reported in the past month alone. In December, the number of hospitalized patients doubled, twice. While the average age of newly infected people is 33, there is concern that with the holidays, older people are likely to become infected as well. Puerto Rico has a disproportionately high percentage of older adults, many of whom live with diabetes, obesity, or other health conditions. There is also concern that the island’s fragile health system will be severely understaffed in trying to deal with this latest wave.

The Minnesota Department of Health has noted that flu cases are growing faster than before, according to MPR News. Eighteen percent of flu cases came back positive last week, compared to 12% the week before. Fewer patients are being hospitalized for the flu than last year. However, it is not clear how Covid is affecting the availability of hospital staff to treat flu patients.

Cases in Florida have risen 948% in the past two weeks, and hospitalizations have increased by 40%, according to The Guardian. Lines for testing facilities have been reported to be hours long.

In Washington D.C., the seven-day positivity rate has increased from 1% in November to 13% this past week, as reported by The Guardian.

The Centers for Disease Control and Prevention have recommended that Americans who received two doses of the Pfizer vaccine seek a booster shot five months after the second shot and not six according to earlier guidance. The CDC also recommends that immunocompromised children between the ages of 5 and 11 receive an additional primary vaccine shot 28 days after the second shot, matching guidance for people 12 years and older. The FDA has cleared 12-to15-year-olds to receive a booster.

Direct Relief’s Response

Since the pandemic’s start, Direct Relief has delivered more than 51,000 medical aid shipments, including more than 200 million pieces of personal protective equipment, oxygen concentrators, ventilators, Covid-19 therapies for hospitalized patients and more requested resources to 56 U.S. states and territories and 112 countries. The organization has also supported health organizations during the pandemic with more than $100 million in grant funding and facilitated the logistics and transport of more than 10 million Covid-19 vaccines.

Click the map above to explore the dashboard and Direct Relief’s response.

The post Covid Infections, Hospitalizations Spike Worldwide as Omicron Spreads appeared first on Direct Relief.

Transportation, housing, and food insecurity all play a role in whether a person can adhere to a strict medication regimen, eat a healthy diet, and keep their stress levels in check—important steps in controlling a chronic disease like diabetes. “If they can’t get to their doctor or they can’t get their medication, it’s definitely going to affect whether they can manage their diabetes,” said Northcutt, who works with more than 1,600 patients at HealthNet—a network of community-based health centers that serve low-income and uninsured individuals in Indianapolis, Indiana.

Most conversations Northcutt has with patients happen over the phone. During these calls, she works to identify which barriers a patient may be experiencing and connect them with the health center’s multi-disciplinary team of providers. Direct Relief, together with BD, has provided a $150,000 grant to HealthNet to expand their care team to include a dietician, pharmacist, social worker, behavioral health specialist, and Northcutt’s position as a diabetes care coordinator. The funding is part of the BD Helping Build Healthy Communities initiative and providers at HealthNet work together to address the multiple, and often interrelated barriers interfering with patients’ ability to manage their diabetes. They can teach patients how to cook a healthy meal on a budget, for example, or provide them with transportation to and from their doctor’s appointments.

Many of HealthNet’s patients struggle to afford the basics, like food, rent, and clothing. For those with diabetes, the treatment of which typically involves costly medication, high-quality groceries, and a considerable amount of time spent monitoring blood sugar levels—something patients who work 12-hour shifts can’t always do, according to Northcutt—this can mean forgoing treatment altogether. “When you’re choosing between food and medication, you’re going to choose food every time,” she said.

HealthNet’s team of providers works to make sure patients don’t have to make these kinds of choices. The health center’s social worker can connect patients with groceries, rental assistance, and even help them apply for jobs. The pharmacist is able to provide patients with discounted medications. And the dietician can teach people how to make healthy meals with inexpensive ingredients.

But it’s not just about addressing the financial barriers preventing patients from controlling their diabetes. Many also struggle with anxiety and depression, which adds “an extra layer” to their diagnosis, said Northcutt. According to several studies, mental health issues, often accompanied by histories of trauma, can attribute to low self-efficacy and make it hard for people to feel in control of their health. “Some of our patients think they’re kind of stuck. It’s not something they can reverse.”

One of Northcutt’s patients whose diabetes went undiagnosed for years now has nerve damage in his arms and legs and poor vision. When she first spoke with him, he was struggling with anxiety and depression and wasn’t interested in treating his diabetes. “His mindset was that if I can’t be like I was, and in his eyes, better, then what’s the point? I’m going to continue to smoke and eat unhealthily and do what I want to do because that’s what I want to do.” However, his diabetes, if left unmanaged, could progress even further, causing him to go blind and even lose limbs. Despite outlining these risks, Northcutt couldn’t convince him the effort was worth it. “He didn’t see the benefit of making changes to prolong his life versus just continuing to do what he was doing because the end result would be the same.”

Northcutt talked with his primary care provider and the health center’s social worker who, together, helped nudge the patient towards treatment. Eventually, he accepted a referral to behavioral health. Sometimes, said Northcutt, “it takes multiple people saying the same thing and really letting our patients know this isn’t just a check box. We really do care.”

The post Managing Diabetes is Complicated. This Health Center is Making It Personal. appeared first on Direct Relief.

Communities confronting this issue are called pharmacy deserts. While the term is relatively new, the issue is not.  

“In 2009 and 2010, we didn’t even know there was a term ‘pharmacy desert,’ but we knew about the lack of medical access,” said Lori Giang, the CEO of NC MedAssist—a charitable pharmacy in North Carolina that sends prescription medications at no cost, both to clinics with in-house pharmacies and to uninsured patients throughout the state.  

NC MedAssist started sending prescriptions directly to patients after realizing many had issues getting to their clinic. “We had patients call and say, look, can you send it directly to my house? Because I don’t always have transportation to my clinic to go and pick it up.” 

Although many people’s notion of health care revolves around treatment by a physician, pharmacists play an important role in America’s health care system, too, seeing most patients more frequently and sometimes for longer appointments than do primary care physicians and providing important services, like medication counseling and chronic disease education.  

However, 1.6 million Americans live more than 20 miles from their nearest pharmacy. Giang estimates two-thirds of her patients fall into that category and many—with incomes less than 200% of the federal poverty level—don’t have cars. “Where states don’t have rural transportation, there’s going to be unmet pharmacy needs,” she said. 

But pharmacy deserts are not just an issue in rural areas. People living in urban communities are also affected. The common factor? Poverty.  

“By definition, pharmacy deserts are neighborhoods that are low income,” said Dr. Dima Qato, the researcher who coined the term “pharmacy desert” in 2014 and an associate professor at the University of Southern California’s School of Pharmacy. That’s because “neighborhoods that aren’t low income may not experience these transportation barriers when they need to get to a pharmacy, so the costs associated with traveling may not be as important.”  

In a low-income suburb, for example, someone who doesn’t have a car may not be able to get to a pharmacy just a half-mile away. The distance may not be walkable if it’s intersected by a freeway or in an industrial area. If the person is elderly or has health problems, they may not be able to walk. Other times, crime makes it unsafe to go places by foot. “Geography matters more for low-income people,” said Qato. As a result, they have a harder time accessing medications if there isn’t a pharmacy nearby. 

Additionally, low-income communities are also more vulnerable to losing the pharmacies they do have. In recent years, an increasing number of pharmacies have closed their doors, as higher operating costs and changes to health plans have narrowed profit margins. According to Qato, the closures haven’t affected every community equally: “We found that pharmacies that close, when they close, are more likely to close in low-income, predominantly minority neighborhoods, both rural and urban.”  

The reason, she says, comes down to Medicare and Medicaid policy. “What we see, especially with Medicare and Medicaid, is a lot of these [pharmacies] are getting paid less for prescriptions they fill for Medicaid and Medicare beneficiaries.” As a result, pharmacies serving publicly insured communities make less money and, therefore, Qato said, “don’t have an incentive to stay open.”  

They also don’t get as much business. Because of the way Medicare and Medicaid policy are designed, it’s often more expensive for people who are publicly insured to use the pharmacies in their communities. Most insurance plans, including Medicare and Medicaid, have in-network pharmacies. If someone uses a pharmacy that’s not in their plan’s network, they may have to pay full price for their prescriptions. “What we know is that pharmacies that are more likely to be excluded from those networks are pharmacies that are serving Medicare and Medicaid minority populations in low-income neighborhoods,” explained Qato.  

As a result, people who are publicly insured often have to pay more to fill prescriptions at their local pharmacy and, instead, opt to go to a different pharmacy or forgo their medications altogether. That means pharmacies in low-income communities are “not only paid less per prescription, they have fewer people going in filling their prescriptions,” making them more likely to close, Qato said. 

For some people, the costs of going to a pharmacy that’s farther away, but cheaper, is worth the savings. In Mobile, Alabama, patients at Ozanam Charitable Pharmacy—a non-profit pharmacy that provides medications for free to those who are low-income and uninsured—go to great lengths to afford their medications. “If you have medication that runs $1,200 a month, you’re going to find a way to get it for free,” said Shearie Archer, the pharmacy’s CEO.  

Ozanam serves those in Alabama—a state that chose not to expand Medicaid—who make 200% or below the federal poverty level. Some patients, who live 90 miles or more away, pay family members to pick up their medications. Those who are homeless—about 25% of Ozanam’s patients—come by foot or bike. Others receive help from social service agencies who assign caseworkers to pick up and deliver patients’ prescriptions. 

While these measures can be burdensome, the alternatives for patients are grim. Diabetes medication, for example, can cost hundreds of dollars a month if someone doesn’t have insurance or a pharmacy nearby that takes their plan. “That’s just really cost-prohibitive,” said Archer. For her patients, the choice often comes down to: “Should I pay my mortgage or should I just go without my diabetic medication?” 

For some, mail-order pharmacies offer a solution. These pharmacies allow patients to order their prescriptions online and get them delivered directly to their homes, no transportation required. When NC MedAssist was looking at ways to increase medication access in North Carolina, their original idea was to build non-profit pharmacies in rural communities. But it would be expensive. “Once you get into the bricks-and-mortar of setting up a pharmacy that costs a significant amount of money, and then you have to staff each of those locations with the pharmacist and that costs money,” said Giang.  

Instead, through their mail-order program, NC MedAssist has been able to reach people throughout North Carolina while reducing costs for both themselves and their patients. 

And, though they don’t see patients in person, they still manage to provide personalized care. The pharmacy monitors how often patients pick up their prescriptions, showing them who may need help adhering to their medication regimen. When one of their patients didn’t order a refill for a hypertensive medication, for example, Giang’s staff noticed. They called to see why the patient hadn’t ordered his next month’s supply and “come to find out he didn’t understand the label,” explained Giang. “He spoke mostly Spanish and he didn’t know what that medication was for, so he didn’t ask for it to be refilled.”  

The pharmacists now print his labels in Spanish, helping the patient to not only take his medication regularly but also have more control over his health. For pharmacies like NC MedAssist, Giang says, “compliance programs are important.” 

But according to Qato, these mail-order pharmacies are not a substitute for the brick-and-mortar pharmacies many communities go without: “Pharmacies aren’t just dispensing prescription drugs, even though dispensing prescription drugs is an important role they play.” Pharmacies offer vaccinations, check blood pressure, and test for Covid-19 and other diseases—all things that can’t be offered virtually.  

“They’re providing all these services for prevention and emergency situations that are critical to the communities they serve, but they can’t provide them if they’re not there,” she said. 

Direct Relief has provided NC MedAssist with $93.6 million in prescription medications, chronic disease care supplies, substance use treatment medications, personal protective equipment, and other pharmaceutical supplies since partnering with the organization in 2014. Direct Relief has provided Ozanam Charitable Pharmacy, which partnered with Direct Relief in 2008, with $1.6 million in pharmaceutical medications, disaster relief supplies, and other medical aid.

The post Pharmacy Closures More Likely to Affect Low-Income, Minority Neighborhoods. Here’s Why. appeared first on Direct Relief.

On Monday, the Philippine National Police confirmed 375 people were killed in the storm, while 500 were injured and 56 remain missing. 

Super Typhoon Rai, known locally as Odette, made landfall on Thursday in Siargao, part of the Mindanao island group. The storm reached winds of up to 168 mph, making it comparable to a Category 5 hurricane. In total, the typhoon touched down nine times as it swept west across the country, toppling homes and power lines, uprooting trees, and unleashing a deluge of rain over the communities in its path. Nearly half a million people were displaced, according to Al-Jazeera.  

Homes, hospitals, schools, and community buildings were ripped to shreds, said the chairman of the Philippine Red Cross, while flooding and landslides have made some communities inaccessible. 

Power and service were partially restored on Monday after the storm initiated widespread blackouts, according to the country’s biggest telecommunications and digital services provider. The outages have hampered relief operations, though the government and other relief organizations, including Direct Relief, are mobilizing to deliver goods, medical resources, and set up shelters. 

The majority of the deaths reported so far have been in Bohol, an island province in the central Vasayas region and popular tourist destination. The islands of Cebu, Negros, and Palawan were also severely affected.

Super Typhoon Rai strengthened from a Category 1 storm to a Category 5 the day before making landfall, undergoing what’s called rapid intensification—or an increase in winds of at least 30 mph over a 24 hour period. The process has become characteristic of typhoons and hurricanes in a warming climate, according to the Washington Post. 

Rai impacted some of the same regions devastated by Super Typhoon Haiyan in 2013, which killed roughly 6,500 people and ranks as one of the country’s deadliest storms on record. 

Direct Relief Response 

Direct Relief’s emergency response team is in communication with the ASEAN Coordinating Centre for Humanitarian Assistance on disaster management, or AHA Centre, as well as with long-term local partners IPI Foundation in Cebu, PH-WADAH in Palawan, and HFI in Salcedo, Eastern Samar.  

Direct Relief is coordinating with the National Disaster Risk Reduction and Management Council and the Philippines Department of Health to send emergency supplies and provide financial support for emergency relief operations.

The AHA Centre has also offered the remaining Direct Relief-funded emergency supplies from their disaster response depot in Manila to support the national effort. 

Direct Relief will continue to assess needs and respond accordingly. 

Ledrolen Manriquez and Gordon Willcock contributed to this report.

The post Death Toll Rises Days after Super Typhoon Rai Slams Philippines appeared first on Direct Relief.

While researchers say more data is needed, preliminary studies suggest the variant is more contagious than other mutations and better at evading immune defenses from previous infections and vaccines. However, the CDC says booster shots of the Pfizer and Moderna vaccines provide substantial protection against Omicron, as reported by The New York Times.

This comes as vaccinations rates remain strikingly uneven worldwide. According to Our World in Data, more than 46% of the world population has been fully vaccinated with two doses, though just 7.2% of people in low-income countries have received at least one dose. 8.51 billion doses have been administered globally.

Global News

The WHO says Omicron is now the most dominant variant in South Africa, where it was first detected, and has caused a surge in new cases, as reported by CNBC. Neighboring countries also report case spikes, with rates increasing 1,361% in Zimbabwe, 1,207% in Mozambique, and 681% in Namibia.

While one billion doses of vaccines are expected to arrive across Africa in the coming months, other barriers, such as underfunded health systems and vaccine hesitancy, have prevented the region from achieving high vaccination rates, according to The Guardian. In Nigeria, for example, the health system lacks basic supplies such as cotton swabs, and unreliable power supply requires pharmaceutical refrigerators to run on expensive fuel generators. Many others can’t afford to lose wages to take time off to get vaccinated.

In the U.K., where 70% of the population has been vaccinated, infections from the Omicron variant are doubling every few days, according to NPR. Early data shows that one person infected with the variant will spread it to two to four other people—making the variant twice as contagious as Delta. Experts believe Omicron is likely to become the dominant variant in Scotland, Denmark and other European countries, according to The Washington Post.

The Omicron variant has now been detected in Romania, where experts fear the potential for a fifth Covid-19 wave amid low vaccination rates, according to Al Jazeera. The country’s hospitals are still under pressure from the recent fourth wave in October and November, which resulted in the world’s highest death rate from Covid-19. Romania has the EU’s second-worst vaccination rate at 39% and the most poorly ranked health system.

Los Angeles Times reports South Korea is experiencing the worst coronavirus wave since the pandemic began averaging nearly 6,000 new cases a day after the government relaxed public health measures last month, allowing people to gather in larger groups, extend indoor-dining hours, and fully re-open schools. Severe cases and deaths have soared among those aged 60 and up.

In Indonesia, the recent eruption of Mount Semeru has health experts concerned that exposure to volcanic ash and sheltering in communal halls will increase COVID-19 infections, as reported by Al Jazeera.

Papua New Guinea, where less than 5% of the adult population is vaccinated, is experiencing a surge in Delta cases, creating concerns among epidemiologists that a new variant could emerge, according to The Guardian. The country, which has poor access to sanitation and clean water, is also dealing with an increase in malaria, tuberculosis, and poor maternal and infant outcomes.

In Latin America, hunger rates are at a 15-year high while the pandemic has severely reduced people’s incomes, according to ABC News. In Peru, for example, a country with the world’s worst death rate per capita due to Covid-19, the rate of poverty increased by 10% in 2020, affecting one-third of the population. This comes as hunger in Latin America and the Caribbean has increased by 2% since 2019, affecting nearly 60 million people, according to a recent report by the United Nations.

Sao Paulo, Brazil, the largest city in the Western Hemisphere, announced that 100% of its adult population—12.3 million people—has been fully vaccinated against the coronavirus, as reported by the Washington Post. The Omicron variant poses a threat as community spread continues in the city, though at a much lower rate than before.

U.S. News

A staggering 1 in 100 older Americans has died from the virus compared to 1 in 1400 younger Americans. The most recent 100,000 deaths have occurred in the past 11 weeks, suggesting that the pace of deaths from Covid-19 is accelerating.

The Omicron variant has been detected in 34 states and Washington, D.C., according to The New York Times. Meanwhile, the Delta variant is still overwhelming parts of the country, especially the Northeast and Midwest, as reported by PBS Newshour. Last week, Washington State reported a 10% rise in Covid cases with Omicron mutations over a two-day period, according to The New York Times.

Boston.com reports that Maine and New Hampshire governors will call in dozens of National Guard troops to provide non-clinical support at local hospitals as both states register record-high numbers of hospitalizations due to the Delta variant. While most of these hospitalizations are among the unvaccinated, Vermont, where 75% of people have taken the jab, has also reported a record number of new cases and hospitalizations, suggesting a higher threshold is needed for herd immunity, PBS Newshour reports.

NPR reports hospitals in Colorado are full of unvaccinated Covid patients and on the verge of collapse, seeding anger among patients who need care for other reasons and are unable to access hospital services.

The North Coast Journal reports that hundreds of thousands of immigrants from Mexico and Guatemala who speak Indigenous (non-Spanish) languages have struggled to access information needed to stay healthy during the pandemic. In California, many are immigrant farmworkers who live in poverty with less access to health care. This, combined with language barriers, has contributed to the spread of misinformation and vaccine hesitancy. The wide range of Indigenous languages—in California, people speak 23 different Indigenous languages from Mexico and 24 from Guatemala—make it difficult for health care workers to communicate important information.

Younger Latinos in California are dying of Covid-19 at much higher rates than their white and Asian counterparts, according to the LA Times. Latinos ages 20 to 54 have died from COVID-19 at a rate more than eight times higher than white people in the same age group, according to a study by USC’s Department of Preventive Medicine. Collectively, Latinos in California have lost about 70,000 years of potential life to COVID-19.

Researchers believe younger Latinos have been more vulnerable to Covid-19 for several socio-economic reasons and health factors: Latinos are more likely to live in overcrowded and multigenerational homes, have poor access to healthcare, work in essential industries, and have higher rates of diabetes, hypertension and obesity — conditions associated with severe cases of COVID-19. Latinos have the lowest vaccination rate of any demographic statewide, with younger Latinos particularly lagging, due to misinformation on social media and inflexible work schedules that leave little time for an appointment.

Pfizer has confirmed that its Covid pill, Paxlovid, helps prevent severe disease, including against the Omicron variant, as reported by The New York Times. The drug has shown that it can reduce hospitalization risk by 89% if taken three days before symptoms present. If authorized by the FDA, Americans could access the pill within weeks.

Meanwhile, a survey of over 1,700 Americans by the RAND Corporation found that two-thirds of respondents agreed the United States should send extra vaccines to other countries and that not doing so puts the country at risk.

Direct Relief’s Response

Since the pandemic’s start last year, Direct Relief has delivered more than 48,000 medical aid shipments, including more than 10 million Covid-19 vaccine doses and more than 200 million pieces of personal protective equipment to 56 U.S. states and territories 112 countries.

The post Omicron Variant Spreads Globally as Vaccination Rates Remain Uneven appeared first on Direct Relief.

“She was really worried [about whether] the baby she was pregnant with was going to live or not,” said Emile Bobozi, the program director of Integrate Health—a non-profit organization that trains community health workers at local clinics throughout Togo. Community health workers connect people with the local health care system and provide basic health services. They are typically members of the communities they serve.

While access to maternity care in sub-Saharan Africa has improved, women are still confronting malnutrition and a lack of access to prenatal and emergency care.

When the mother was taken to a clinic, the ultrasound showed she was pregnant with twins, making the pregnancy high-risk. Providers at the clinic ensured she was able to give birth at a local hospital where she had a Caesarean and safely delivered two healthy babies. Without prenatal care, Bobozi warns, “the outcome may have been really different.”

In Togo, 45% of women do not receive adequate prenatal care—defined by UNICEF as four or more visits with a provider during pregnancy—echoing similarly low rates across the continent. According to UNICEF, less than half of women in sub-Saharan Africa are seen four or more times by a provider during their pregnancy—one of the lowest rates in the world.

For women, this lack of care can have dire consequences. “In these communities where you don’t have access to prenatal care, that leads to a really high rate of mortality,” said Bobozi.

Women in sub-Saharan Africa are fifty times more likely to die from childbirth than women in high-income countries, according to a 2019 UNICEF report, and their babies are ten times more likely to die in their first month of life. The region has the highest maternal mortality rate in the world.

“I actually think prenatal care is the most important part of making sure that the women deliver safely,” said Myron Glick, an OB-GYN and founder of the Adama Martha Memorial Community Health Center in Sierra Leone and the Wellness Clinic in the Democratic Republic of Congo.

A key component of prenatal care is ultrasounds. These scans reveal critical information about a pregnancy, like whether the baby is growing at a normal rate, how the baby is positioned in the womb, and whether the mother is having twins. If the baby is not headfirst by the third trimester, for example, that means the baby may need to be turned before or during delivery. Without this information, women—particularly those who plan to stay home and birth—may not have access to the medical care they need.

Prenatal visits are also a chance to screen women for diseases, like gestational diabetes or preeclampsia—both major contributors to maternal deaths worldwide. Providers can administer medication, if needed, and give women vaccines or antibiotics to prevent them from contracting other illnesses.

“We treat every woman for malaria to ensure they don’t have malaria during pregnancy,” said Glick, in addition to giving them a TDAP shot to protect against tetanus, diphtheria and respiratory infections. “We do all of these things to help the women to be as healthy as possible for the delivery.” Without these interventions, childbirth can be a much riskier undertaking.

The reason? “Women just don’t have access to care that’s quality or even care at all, so if things don’t go well during the labor or during pregnancy, they’re in trouble,” said Glick.

For many women who live in rural villages, medical care is just too far away. In Togo, for example, Bobozi says natural obstacles, like flooded rivers and dense forests, prevent many women from accessing timely maternal health care: “You have really dense forests and you don’t necessarily have roads that cross them and that makes it really difficult to go to the health centers.”

While this can prevent women from getting prenatal care, it also complicates their delivery. Bobozi says more women birth at home during the rainy season, when the rivers are difficult to cross, making it extremely challenging to get emergency care in time.

In Sierra Leone, Glick says some mothers choose to forgo medical care because of a lack of transportation–or a lack of comfortable options: “If you’re in labor you don’t really want to ride on the back of a truck or the back of a motorcycle, so women labor in the village.” To avoid this trek, some women live around the clinic for a month or two before their due date. While this can be disruptive to their lives and family, “they are there, ready when they go into labor.”

But distance isn’t the only obstacle to a healthy pregnancy. In sub-Saharan Africa, malnutrition is a chronic health issue, making it difficult for expectant mothers to get all of the nutrients their body needs during pregnancy. If a woman is anemic because she’s not getting enough iron in her diet, for example, she is at higher risk of hemorrhaging during her delivery, the cause of nearly one-third of global maternal deaths, according to UNICEF.

In addition, malnourished women are more likely to be deficient in folic acid—an essential B vitamin that helps create genetic material and prevent birth defects. One study found folic acid supplementation among African mothers reduced the incidence of neural tube defects—a malformation in the developing spine of a fetus—by 60%. This particular defect accounts for 400,000 infant deaths worldwide each year and is the most common birth defect in Africa. “[Nutrition] is very important…as a building block for a healthy pregnancy and a healthy birth,” said Glick.

While pregnancy is something Glick’s patients celebrate—raising a family is important to them—“it’s not easy,” he says. Without resources, and disconnected from medical care, women face a host of obstacles that put both their health and the health of their baby in jeopardy. “They’re focused on just getting through it,” he says. “When you’re pregnant in a rural place like Sierra Leone, it’s a risk to your life…It takes on a different meaning.”

Since 2008, Direct Relief has supported medical efforts, including maternal and child healthcare, in Togo, Sierra Leone and the Democratic Republic of Congo with more than $120 million worth of medical support. This includes prenatal vitamins, midwife kits, surgical supplies for fistula repair and other birth injuries, and essential medical support for women and babies.

The post The Risks to Pregnant Women in Sub-Saharan Africa: “They’re Focused on Just Getting Through It.” appeared first on Direct Relief.

That was a key finding of research conducted by Direct Relief’s University of Michigan Gerald R. Ford School of Public Policy intern, Celia Sawyerr, who interviewed providers from four federally qualified health centers in Houston, Texas, Washington, D.C., and The Bronx, New York.

African migrants face high rates of chronic disease and mental health issues—similar to other minority populations in the United States—but the obstacles preventing them from accessing medical care vary.

According to providers, food insecurity and a lack of transportation, in addition to histories of trauma, low levels of health literacy, and distrust of western medicine, prevent many from being able to achieve better health outcomes. Overcoming these barriers, according to Sawyerr’s research, requires a culturally sensitive approach.

“If you want to be able to impact health outcomes, you have to first be able to connect with the culture, understand the various cultures, and then design your delivery systems around those cultures,” said Dr. Douglas York, the CEO of Union Community Health Center in New York.

At the Bee Busy Wellness Center in Houston, Texas, patients’ inability to purchase healthy food has made it difficult to get their chronic conditions, like diabetes, under control. While some can’t afford to buy healthy food, others don’t have grocery stores in their neighborhoods or within walking distance. Providers also said stress, often related to migratory experiences, hinders patients’ ability to manage their conditions and exacerbates diseases like hypertension.

In addition to chronic disease management, mental health support is a common need among African patients–many of whom have witnessed violence in their home country and isolation in the states. This often manifests as depression and anxiety.

While stigma around mental health care prevents many from reaching out for help, providers said that normalizing this kind of care increases patient engagement. For example, the Bee Busy Wellness Center saw an uptick in the use of mental health services when therapy was offered through telemedicine, rather than a traditional office setting. “African immigrants utilize the services where they feel most comfortable,” said Norman Mitchell, the CEO of Bee Busy Wellness Center. Telemedicine has also helped expand access to chronic disease care during the pandemic when stay-at-home orders made it difficult for patients to manage their conditions independently.

To address these barriers, Sawyerr offers a range of solutions including installing community fridges in public spaces, van shuttles to grocery stores, and signing people up for federally-subsidized internet to lower the costs of telemedicine. While structural changes are needed, Sawyerr says, they will only go so far.

“To effectively meet the health needs of Sub-Saharan African migrants in the United States, it is imperative that they feel comfortable seeking out care,” she wrote. This requires health care providers to understand the cultural circumstances of their patients and meet them where they’re at. “Health centers that tailor their services to the specific needs of this population will be the most successful in connecting with and improving the well-being of their African patients.”

The post Improving the Health of African Migrants in the United States: A Story Map appeared first on Direct Relief.

Her husband’s stepson, a shopkeeper at a local market in Wellington, had been killed. “The son, his wife, and daughter all vanished in the fire,” said Timbo, a nurse and Honorary Consul for Sierra Leone. “I was devastated,” she said. 

The explosion happened shortly after a fuel tanker was hit by a speeding truck at a busy intersection in eastern Freetown on November 5. When the tanker began leaking oil, hundreds of people flocked to the site of the accident hoping to collect fuel to sell. Dozens were killed instantly when the oil ignited and caused a massive explosion, turning bodies to ash, according to local reports. 

Several hundred more were injured. Many experience third-degree burns, shrapnel wounds, and disfigurement. The fire, which raged for several hours, also precipitated respiratory ailments. “During an explosion like this… there’s a lot of rescue efforts going on,” said Chris Alleway, Direct Relief’s Manager of Emergency Response. “You’re running into smoke, you’re putting yourself at risk in a very toxic environment. Whatever you’re inhaling is not going to be good for you.” Many people in the impact zone did not have vehicles and were unable to escape the smoke. 

To help address these acute—and long-term—health care needs, Direct Relief is dispatching more than $980,000 worth of wound care supplies, respiratory medications, and infection control, including antibiotics, to Connaught Hospital in Freetown where a large number of people have gone for treatment. After the explosion, Timbo – who serves as a vital connection between Direct Relief and Sierra Leone’s Ministry of Health – reached out to Direct Relief’s emergency response team for support. In response, the team has prepared 10 shipments, weighing 6,600 lbs., to be sent to the country’s MOH for distribution. Since 2009, Direct Relief has sent more than $74 million in medical aid to Sierra Leone in response to numerous health crises, including the 2014-2016 Ebola epidemic.

Several weeks after the explosion, infection control is a top priority for health care providers. “You’re extremely susceptible when you have open wounds, especially third-degree burns,” said Alleway. “If there is a shortage of supplies and you can’t re-dress the wounds,” for example, “you’re susceptible to infection.” In crowded communities, infections can spread easily. “If you don’t have antibiotics…[infection] is going to transfer from one person to another,” said Timbo. 

The explosion has had disastrous effects on families already in extreme poverty. Many of those killed were the primary breadwinners for their families, and, without this income, people have been unable to afford food and basic supplies like medicine. Others, injured in the blast, can’t work and are missing out on precious wages. Timbo says she is worried about what will happen to people after they are discharged from the hospital: “How are you going to eat? Tell me.” 

Sierra Leone has endured several tragedies in the past decade alone, including the Ebola epidemic which killed 4,000 people and flooding in 2017 that killed several hundred. “I am devastated,” said Timbo of the explosion, “but I’m getting used to it because this is not the first time… People are just numb.”

The post Direct Relief Responds in Wake of Deadly Sierra Leone Explosion appeared first on Direct Relief.

According to Our Word in Data, 49.6% of the world population has received at least one dose of a COVID-19 vaccine, and 38.85% is fully vaccinated. 7 billion doses have been administered worldwide thus far.

However, only a small percentage of these doses have gone to low-income countries where just 3.7% of people have received at least one dose.

Worldwide, Covid-19 has been responsible for over 5 million deaths with the majority concentrated in the United States, Brazil, India, Mexico, Russia and Peru.

This week, Bulgaria recorded its highest daily death toll from Covid-19 prompting the health minister to refer to the situation as “a national disaster,” according to ABC News. Romania is seeing an unprecedented surge of coronavirus infections with only 37% of its adult population vaccinated compared to the EU’s average of 75%. In Ukraine, where only 16% of adults are fully vaccinated, EuroNews has reported a surge of infections and hospitalizations. Russia has put a new week-long lockdown in place after new cases hit record highs in the country.

Helsinki Times reports that in the Baltics, where countries are facing record levels of hospitalizations and deaths, Latvia’s Minister of Health has warned that the burden on their health system could force the country to rely on other countries for aid, health care staff, and ICU capacity. Estonia has implemented new restrictions amid a record number of hospitalizations, with the speaker of parliament warning the country is on the “brink of disaster.”

The coronavirus is racing through displacement camps in Idlib Province, Syria—an impoverished, rebel-controlled area in the north-western part of the country—as reported by the Washington Post. Despite the availability of vaccines, conspiracy theories are thwarting vaccination efforts and medical supplies, including oxygen, ventilators, and testing kits are critically low.

In the United States, new coronavirus cases have fallen to less than 75,000 per day, according to the Washington Post, though some states are grappling with surges due to the Delta-variant. Colorado’s governor Jared Polis signed an executive order allowing hospitals to turn patients away when they are nearing full capacity, according to CBS News. Hospital capacity across the state dropped to less than 10% and the positivity rate is currently 8%. NBC News reports the recent wave of the Delta variant targeted overwhelmingly younger, Southern, rural, and white Americans, most of whom were unvaccinated. This is a shift from the demographic impacted early on in the pandemic who were mostly elderly or had underlying conditions and were concentrated in large cities on the West Coast and in the Northeast.

A new, potentially faster spreading “sub-lineage” of the Delta variant, known as AY.4.2, has been identified in labs across at least eight states including California, Florida, Maryland, Massachusetts, Nevada, North Carolina, Rhode Island, and Washington State, as well as the District of Columbia, according to CBS News. The variant is not believed to cause more severe disease. AY.4.2 now accounts for over 11% of Delta variant cases in the U.K.

Several Asian and Pacific Nations are among the most vaccinated countries in the world and are beginning to ease Covid restrictions, according to CNN. South Korea, Japan, Thailand, and Australia are easing domestic and in some cases international restrictions. China continues to implement its zero-tolerance policy

PAHO says that by the end of the year most of Latin America and the Caribbean will have vaccinated 40% of their respective populations, though vaccination remains a challenge in some countries. In Jamaica, St. Lucia, St. Vincent and the Grenadines, Haiti, Guatemala, and Nicaragua vaccination rates have yet to reach 20%. The organization is working to accelerate vaccine deliveries through several channels, including COVAX and donated doses. In the Caribbean—where about 44% of people are vaccinated–Al Jazeera reports smaller islands including Saint Kitts and Nevis, Barbados, Anguilla, and Saint Vincent and the Grenadines are reporting their highest numbers of new infections and deaths since the start of the pandemic.

In the United States, children ages 5-11 can begin getting vaccinated against Covid-19 after the CDC this week gave final approval for use of the Pfizer and BioNTech vaccine among this age group. The country is reopening land borders to vaccinated visitors next week and while many pandemic-related travel restrictions will be lifted, a return to normal largely depends on vaccinating 60 million eligible Americans who have yet to take the vaccine, according to the Washington Post.

NBC News reports the Novavax Covid-19 vaccine has received its first emergency use authorization in Indonesia. The vaccine does not need to be stored at extremely cold temperatures and has proven to be about 90% effective against symptomatic disease. Novavax has applied for emergency use authorization in the U.K, E.U., Canada, Australia, India, and the Philippines.

Meanwhile, In South Africa, a new clinical trial is underway for an oral vaccine developed by Oramed Pharmaceuticals that does not require cold-chain storage, according to SCMP. The vaccine would help overcome distribution barriers in parts of Africa that do not have cold-chain capacity or staff available to inject the current Covid-19 vaccines. Similar trials have been planned in Israel and the U.S.

BioNTech has announced it will be building manufacturing facilities for its Covid-19 vaccine in Rwanda and Senegal, according to The Conversation. This marks the first time mRNA technology will be manufactured in Africa and is expected to increase vaccine coverage across the continent.

Direct Relief’s Response

Since the start of the pandemic last year, Direct Relief has delivered more than 48,000 medical aid shipments containing 6,800 tons of PPE and other medical resources to partners in 56 U.S. states and territories and 111 countries.

CLICK TO EXPLORE DIRECT RELIEF’S RESPONSE

The post Uneven Covid-19 Vaccination Rates Lead to Surges in Some Countries appeared first on Direct Relief.

According to one analysis by the Stanford Environmental Change and Outcomes Lab, one month of elevated smoke exposure led to 3,000 excess deaths between August and September of 2020. The estimate, based on Medicare data, only captures individuals in California 65 years and older, making the actual number likely much higher.

At the same time, wildfire smoke is affecting the unborn. The Stanford lab estimates wildfire smoke is associated with nearly 7,000 preterm births per year in California, with a 3.4% increase in risk for every week a mother is exposed (one week is the average number of smoky days per year in California). While the study did not record any maternal-child deaths, premature babies are at higher risk of developmental delays, learning disabilities, and social problems later in life. “Not every child catches up, so some of the preterm births ended up having really long-lasting health impacts just because they weren’t able to fully develop during the pregnancy,” said Sam Heft-Neal, a co-author of the study and member of the lab.

In addition, caring for a premature baby can be expensive. “We’re much, much better at keeping preterm babies alive than we used to be, but it’s a really costly process and so any parents that have preterm births have to deal with really high bills for all the care that’s required.”

What’s less clear is whether wildfires directly cause disease. Several factors, such as housing situation, socioeconomic status, and access to health care, all play a role in determining a person’s health. And researchers say it’s hard to take all these elements into account when they draw conclusions. For that reason, it’s difficult to attribute a person’s health outcomes to any one factor, including wildfire smoke. “People who are exposed to 10 years of exposure are systematically different from the people who are not,” explained Heft-Neal.

But researchers do know who’s most likely to be affected – and it’s not necessarily intuitive. “There’s pretty clear evidence low-income and non-white households are more likely to be exposed to pollution overall,” said Heft-Neal, “but when you look at wildfire smoke, you actually see a quite different pattern.” Unlike other types of pollution, wildfires are more likely to affect white households simply because “a lot of the rural populations in Northern part of the state are primarily white and that’s where most of the fires are.”

While those with means can afford to move away from polluting power plants or highways, wildfires often erupt in California’s most affluent regions. During the 2020 wildfire season, for example, the Bay Area had some of the worst air quality in the world. “At times [wildfire smoke] covers the entire state and wealthy neighborhoods in San Francisco and Marin can get hit really hard…whereas they rarely get hit with other types of pollution.”

That being said, low-income people living in these smoke-affected areas have a much harder time insulating themselves than their wealthy neighbors. “Income definitely impacts the ways that communities are facing this issue,” said Pedro Toledo, the CEO of Petaluma Health Centers, which serves low-income and uninsured individuals in Sonoma County. Many of Toledo’s patients are farmworkers who work outside during some of the smokiest days of the year. “Harvest starts in September and October here in Sonoma County and that’s wildfire season so you have to be out in fields.” Toledo has seen a jump in respiratory illnesses among these patients: Prescriptions for inhalers are “through the roof at this point, much more than we’ve ever prescribed.”

But even for those who don’t work outside, reducing exposure is highly dependent on socioeconomic status. Many of Toledo’s patients “don’t have the discretionary income to purchase air filters,” which can significantly improve indoor air quality. Others live in homes without air conditioning, which means they are more likely to keep their windows open, letting in polluted air. These kinds of behaviors have a significant impact on how much smoke someone is exposed to, regardless of the air quality outside. According to one study published in NCBI, personal interventions, like closing the windows and using an air filter, have been found to reduce a person’s smoke exposure by up to 80%. “Even for a given level of outdoor exposure, you can have very, very different levels of indoor exposure,” explained Heft-Neal. “Forcing people to individually deal with pollution, I think, is potentially a really unfair policy because it may be just placing more of the burden on the disadvantaged households.”

At the same time, health care providers are conflicted about how to help patients cope with the smoky air. Toledo says his health center has been prescribing inhalers to patients that have never had asthma before just in case a wildfire triggers an attack. The idea is to prevent them from having to go to the ER, he says. But with wildfires, that may not be a long-term solution: “Medicating isn’t the answer, the answer is having cleaner air.”

Since August 2021, Direct Relief has sent 505 shipments of medical aid valued at more than $2.25 million to 193 health facilities treating patients in fire-affected areas across the United States.

The post Wildfires Are Causing More Bad Air Days. Is the Pollution Putting Californians at Higher Risk for Disease? appeared first on Direct Relief.

“I actually pushed for them not to come in,” said Dr. Amy Kolter, a pediatrician at Zufall Health Center in New Jersey, who was torn between delaying immunizations and potentially exposing children to Covid. “I remember going into a room and it was a physical for an older child and I was shocked thinking, ‘Why are they here? Why is a healthy, older child being exposed?’”  

While she advocated for newborns to get their vaccines, she felt the potential risks of vaccinating preteens outweighed the benefits, until the pandemic wore on. “We all thought that the pandemic was going to be over after three to six months. Nobody thought it was going to last two years.”  

Now, data from the CDC shows that while childhood vaccination rates have returned to pre-pandemic levels, the increase hasn’t been enough to make up for the dramatic dip. Between March and May of 2020, for example, administration of the Tdap vaccine, which protects against tetanus and whooping cough, decreased by 63% among 9 to 12-year-olds compared to the same period two years priors. And during the summer, when most stay-at-home orders had been lifted, these rates didn’t swing back up. From June through September 2020, Tdap vaccine rates for pre-teens remained 21% lower than the two previous years, according to the CDC analysis. 

The need to catch children up on their vaccines inspired Kotler to start Peds in the Park, a series of clinics where children can get vaccines and other health care services in places that are more accessible than a doctor’s office, like schools, parks, and community spaces. “The model is to be able to promote childhood health and improve health outcomes,” said Krishna Patel, the director of community-based clinical services at Zufall Health Center and a key organizer of the Peds in the Park program. 

At these clinics, the health center offers HPV, TDap, Hepatitis, flu, and Covid vaccines in addition to dental care, nutritional counseling, and chronic disease management. “A lot of [parents] aren’t able to get time off from work or it’s hard to make that trip out to get to the doctor for their kids, so if they can get a host of services, it really helps them.” Since holding their first clinic last December, providers like Kotler have seen over 500 patients. “We can be available and present all the time at a site, but sometimes they just need somebody to come out to them and say, you know, ‘We’re here to help you,’” said Patel.   

In addition to providing vaccines, these clinics have helped providers flag health issues that have gone unaddressed during the pandemic. “A lot of [patients] have had weight gain,” says Kotler. Many of her pediatric patients took classes online and had fewer opportunities to play outside, making it more difficult to exercise–an experience reflected in national trends. According to a CDC study, childhood obesity in the U.S. has accelerated, increasing from 19% before the pandemic to 22% during the pandemic. The study shows kids who were a healthy weight gained two more pounds a year on average and those who were severely overweight gained an average of 14.6 lbs per year compared to 8.8 lbs pre-pandemic. 

For Kotler, seeing patients regularly is key to preventing these kinds of health issues from snowballing into other conditions. If a patient has gained weight, she orders labs that can detect diseases like diabetes and metabolic syndrome. Other times, these regular check-ins are a chance to monitor chronic conditions that have gone unmanaged. Kotler says many patients haven’t followed up with their specialists. “I’ll ask them, ‘Why haven’t you gone?’ And they’ll say ‘Because of the pandemic.’”  

While Kotler says reversing health issues, like diabetes, can be difficult, the Peds in the Park program creates an opportunity to prevent new ones from emerging. “Infectious diseases, they can always come back. We want to make sure that our kids are fully protected, staying safe and healthy,” said Patel. 

Direct Relief, in collaboration with the Pfizer Foundation, provided Zufall Health Center a $250,000 grant to implement the Peds in the Park program and expand access to childhood immunizations throughout their community.

The post During the Pandemic More Kids Have Missed Routine Vaccinations. Providing Care in the Community Could Offer a Solution. appeared first on Direct Relief.

It “kind of forced me to say, ‘You know what, medications aren’t number one. The person as a person is number one’,”said Valdes, who works as a clinical pharmacist at Zufall Health Center in Dover, New Jersey.

Now, when she meets with a patient, she begins with a series of questions, seemingly unrelated to diabetes: “Where do you work? Where do you live? Do you have appliances in your home?” These questions help Valdes get a better understanding of what kind of medication regimen will be best for the patient, given their circumstances. If they don’t have a fridge at home, for example, temperature-sensitive insulin is not going to be an effective treatment, despite being the “gold standard” in diabetes care. “You can’t always just go by the book. You have to go by where [the patient is] at, what they’re willing to do, what is in their capacity to do.”

Valdes spends up to an hour with patients – far longer than the typical 15-minute provider visit – identifying barriers to getting patients’ diabetes under control.

Most of the time, it’s money. “I would say poverty or socioeconomics is probably the number one risk factor for diabetes,” she said.

Some patients simply can’t afford their diabetes medication. Other times, socioeconomic troubles make it difficult for patients to live a healthy lifestyle, particularly when it comes to diet. “If you make minimum wage or less, think about the quality of food you can buy,” said Valdes. Many of her patients are financially strapped, often forced to choose between paying utilities and buying groceries. “A loaf of wonder bread, like cheap white bread, is a dollar. To get whole grain bread is $4. So if you only have $10, are you going to buy the white bread or the wheat bread?”

The Right Approach

The health center provides patients with bags of food, grocery store gift cards, and information on how to access the local food pantry. This combined with education on nutrition, which Valdes provides as a certified diabetes educator, has helped patients achieve dramatic results – one patient reduced their A1C score, a measure of blood sugar over a three-month period – by three hundred percent.

Still, other patients just don’t have the time to take their medication. Valdes has patients who work 12-hour shifts and can’t get a break to inject their insulin. For these patients, she prescribes a once-daily oral medication that’s easier for them to take on the job. “The drug they’re actually willing to swallow and take, that’s the drug that’s going to work,” even if that means taking a drug that’s technically less effective. “We can have another medication that is double the efficacy…but if they’re never going to take that, [then] having the drug that’s only half as good that they’re going to take a hundred percent of the time, that’s the medication for them.”

Valdes also works with patients to overcome “preconceived notions” about diabetes medication. “In my population, insulin is the number one feared thing,” said Valdes. “They said, ‘Oh, my grandma started insulin and then a month later she lost her leg’ or, ‘I Googled insulin or I Googled Metformin and it says it breaks your liver.’” Though these side effects have not been proven, all drugs have effects, says Valdes and “a lot of times the risk of uncontrolled diabetes is way worse.”

But some patients need more than just a tailored medication regimen. For many, psychological struggles are the main barrier to achieving good health.

“If you don’t have good mental health and you’re not in the right space, you’ll never be able to implement all the dietary things, taking your medication on time. It requires like a lot of organization and a lot of self-care,” said Valdes.

That’s where the health center’s social workers come in. “A lot of our patients have been through things that are traumatic that can increase their risk for chronic conditions,” said Sarah Aleman, a licensed clinical social worker and the director of behavioral health at Zufall Health Center. Some of her patients have experienced domestic violence, childhood abuse, or witnessed gang violence.

Research shows these types of experiences hinder a person’s ability to manage stress, making it more difficult to turn off the fight or flight response. When stress hormones are constantly surging through the body, chronic disease becomes more likely. “The hormones that are going through your body when you’re stressed can increase your sugar levels,” and over time can put someone at higher risk for diabetes, explained Aleman.

In addition, several studies have documented the link between trauma and feelings of helplessness. When someone is exposed to harm they have no way of escaping, they have a harder time removing themselves from unhealthy situations later on in life. As researcher and psychiatrist Dr. Bessel van der Kolk puts it, people become “unable to take action to stave off the inevitable.” For those with a chronic disease, this can manifest as putting off treatment or forgoing care altogether. “When people have experienced trauma, the self-image and self-esteem, the depression, can make it much harder for them to reach out for help,” explained Aleman.

Trauma-Informed Care

Maria Menzel, a licensed clinical social worker at Zufall Health Center, notes another impact of trauma: “self-sabotage.” She has seen patients refuse to take their medication or even stop taking it after seeing improvements. Historically, this has led providers to blame or scold patients, but as Valdes found, this kind of approach has yielded poor results. Now, providers like those at Zufall Health Center, are practicing trauma-informed care.

“Trauma-informed care means assuming people have been through something and shifting from what’s wrong with this person to what’s happened to them,” said Aleman. “When we can think [about] what’s happened to them, we can get them connected to resources in a nonjudgmental way.”

For Valdes, this kind of approach represents a shift in health care. “I think as a field, medicine is learning that it’s not always the data and it’s not always the clinical trials and labs,” she said. “It’s about the person.”

Direct Relief, together with BD, has provided Zufall Health Center with a $150,000 grant to expand home monitoring diabetes care for at-risk patients by providing them with equipment and supplies, including blood glucose kits and blood pressure cuffs. The funding, part of the Helping Build Healthy Communities initiative, is also being used to deploy a dedicated care team that will tailor clinical interventions to meet the individual needs of patients and provide them with education and online assistance in multiple languages.

The post Managing Diabetes Takes More Than Medication. This Health Center is taking a Patient-Centered Approach. appeared first on Direct Relief.

Fortunately, nurse-midwife Rosena Baptiste was nearby at Maison de Naissance, a birthing center based in Les Cayes. When the pair arrived, Baptiste and her team were able to clear the baby’s lungs and stabilize both the new baby and mother, despite the fact that the center itself had been badly damaged in the quake, and the surrounding area was devastated.

The massive earthquake is the latest tragedy to befall Haiti — a country still reeling from the assassination of its president in July, widespread instability, and the effects of the Covid-19 pandemic. The quake struck the country on August 14, killing at least 2,200 people and injuring more than 12,000. Thousands of homes and buildings were toppled, trapping people beneath piles of rubble and leaving many homeless.  

Since then, Baptiste says staff have been afraid to come to work. Many still experience trauma related to Haiti’s cataclysmic 2010 earthquake, which killed about 220,000 people and caused widespread devastation, and were afraid that another shock could cause the clinic to collapse. Dozens of staff members and several patients who lost their homes have been living in tents provided by the center. 

Maison de Naissance is working to repair damages incurred during the quake, including several downed power lines, ruptured water pipes, and a cracked foundation, preventing the clinic from being fully operational. Despite these impacts, most services have continued, says Baptiste. 

But other health facilities have not fared as well. According to UNICEF, many surgical and maternity wards are no longer equipped for safe deliveries. Meanwhile, roads blocked by debris and man-made impediments have made it difficult for patients to get to health facilities. 

This comes as chronic barriers to maternal and child health services prevent many women in Haiti from receiving adequate care, even during non-disaster times. Many live in rural areas where health care options are limited. Due to a lack of transportation, getting timely medical attention is not always possible. “There’s very little health care available to people,” said Jim Grant, the Executive Director of Maison de Naissance. 

Others can’t afford the costs. In Haiti, public hospitals charge a fee. If patients can’t pay up front, they are often turned away. This includes women who are in labor, according to Grant, who estimates the average delivery costs between $25-50 USD. For Haitians— many of whom live on less than $2 a day — these costs can be prohibitive. “That 25 or 50 dollars is a lot and can be a reason some women don’t go to a hospital,” said Grant. “It’s a big deal.” 

Most women who can’t access hospital care give birth at home, where unsanitary conditions and a lack of clean water are a common cause of infection and even death. In addition, women who give birth at home are less likely to have a skilled medical professional attend their delivery. If there are complications, they may not receive the medical interventions they need. 

For these reasons, Haiti has one of the highest maternal mortality rates in the Western Hemisphere. An estimated 480 women die for every 100,000 live births, according to the World Bank, compared to the United States’ rate of about 20 women per 100,000 live births. 

Maison de Naissance is helping to fill this gap in care by providing comprehensive maternal child health services to women in rural Haiti. Since 2004, the clinic has delivered over 7,000 babies to healthy mothers, improving the local maternal mortality rate, and has increased access to pre- and post-natal care, all at no cost to patients. In addition, the clinic provides family planning services, HIV and AIDS treatment, and childhood vaccinations. 

Still, the Covid-19 pandemic has complicated access. Many women fear contracting the virus and have been hesitant to seek out care. Meanwhile, some health facilities have been forced to close, according to the United Nations Population Fund. The organization reports one facility suspended services for 27 days after one patient and two providers tested positive for Covid-19. Vaccines are becoming available, but Baptiste reports many patients are resistant to getting vaccinated, or even hearing about the vaccine, and would prefer to deliver in their homes, despite an increased likelihood of complications.

Direct Relief’s Response 

To ensure the continued operation of Maison de Naissance and the services they provide, Direct Relief is granting the birthing center $95,000 to repair structural damages incurred during the earthquake. The funding will be used to repair the clinic’s foundation, septic system, power lines, satellite receiver, water system, laboratory, and administrative building — all required for Maison de Naissance to be fully operational.

Since the earthquake struck Haiti in mid-August, Direct Relief has provided over $8.6 million in medical aid to health facilities and medical foundations operating within the country, including the Pan American Health Organization. The aid has included over $7.3 million in pharmaceutical medications and more than 5 million defined daily doses of medicine. Direct Relief has provided recipients with more than 16,000 bottles of antibiotics, 560,000 water purification tablets, 41,400 prenatal tablets, and 45 tents to be used as makeshift shelters. 

Direct Relief is in communication with health facilities and organizations on the ground in Haiti and will continue to respond to requests for medical aid. 

The post Haiti Earthquake Disrupts Access to Maternal Health Care appeared first on Direct Relief.

More than 450,000 customers in the Houston area were without power at the peak of the storm’s impacts, as well as several thousand in Louisiana, where 95,000 people still lack electricity due to Hurricane Ida. On Wednesday, roughly 84,000 customers in Houston and surrounding areas were without power, according to PowerOutage.US.

The slow-moving system is expected to linger over Louisiana late into the week, producing rain bands that affect much of the central Gulf Coast. Nicholas has already brought heavy rains to Mississippi, the Florida Panhandle, Alabama, and many of the same areas affected by Ida last month. The region is forecast to receive up to six inches of rain with isolated totals of 10 inches in some areas, according to the National Hurricane Center. The center also warns of life-threatening flash flooding, especially in urban areas. The storm is expected to dissipate by Friday.

Direct Relief’s Response

Direct Relief’s emergency response team is monitoring Tropical Depression Nicholas as shipments bound for communities affected by Hurricane Ida continue to depart the warehouse.

The organization has prepositioned several caches of emergency medical supplies at health facilities across the Gulf Coast, including those within the path of Tropical Depression Nicholas.

Meanwhile, more than $460,000 in medical supplies and equipment have been shipped to health facilities treating patients in areas affected by Hurricane Ida as many prepare to be impacted by Nicholas this week. Shipments have included wound care supplies, nutritional support, chronic disease medication, infection control supplies, and personal care products for evacuees. As power outages persist, Direct Relief continues to deploy solar-powered batteries and refrigerators to health facilities, enabling providers to maintain temperature-sensitive medications, run electrical medical equipment, and keep electronic medical records online while the electrical grid is down.

As hurricane season draws on, Direct Relief will continue to field requests for medical aid and respond accordingly.

The post Tropical Depression Nicholas Moves Over Louisiana after Leaving Thousands in Texas Without Power appeared first on Direct Relief.

“Health is not just the absence of sickness,” said Joseph, who works at one of the only clinics within the Kalinago Territory.

Health disparities, like higher rates of chronic disease, substance use disorders, and depression, are persistent challenges, and over the years, Joseph has seen this firsthand. “We are having diabetes and hypertension at an earlier age,” in addition to cancers, she said.

For many Kalinago, addressing these issues is also more difficult. The Kalinago Territory — a 3,700-acre reservation on the eastern side of the island — is largely secluded from the rest of society. The nearest hospital is an hour and a half away.

Disaster has only compounded these challenges.

When Hurricane Maria hit the island in 2017, the Kalinago Territory was one of Dominica’s most severely affected communities. The Kalinago — whose livelihoods depend on farming and fishing — lost 80% of their crops and roughly two-thirds of homes were destroyed or damaged.

Despite the impacts of Hurricane Maria, the Kalinago didn’t receive much assistance in their recovery, according to Dan Hovey, Direct Relief’s Senior Emergency Response Manager. “In view of the support Direct Relief received for Hurricane Maria, it was important for us to address the under-resourced healthcare system in the Kalinago Territory by equipping the local health workers with the tools they need to provide care for their community.”

A “Clear Need”

In 2019, Hovey made a trip to Dominica to see how Direct Relief could help. There, he met with community leaders in the Kalinago Territory, including District Nurse Winnie Joseph.

“She knew every single person in the entire territory, their story, their health records, their children,” Hovey recalled.

While the territory wasn’t lacking in skilled health care personnel, there was a marked lack of health facilities.

When Hovey visited, the community only had two clinics, and the main health care facility, “was just completely empty,” he said. There were no exam tables, no diagnostic equipment, and few basic supplies, like bandages or gauze.

For anything urgent, people had to travel more than an hour to the nearest hospital. For the Kalinago — many of whom lack transportation — this was not always possible. There was a “clear need,” said Hovey.

Direct Relief’s Response

To ensure providers like Nurse Joseph have what they need to provide care, Direct Relief, in partnership with Medical Professionals on a Mission, outfitted the territory’s primary clinic with over $36,000 worth of critical equipment including exam tables, a birthing bed, EKG machine, oxygen tanks, a medical refrigerator, and surgical supplies.

The Salybia clinic, as it’s called, now serves the Kalinago Territory as an urgent care, a birthing center, and a primary care facility where patients can be seen for everything from chronic disease management to substance use treatment. Providers have cared for more than 700 residents since the center was equipped this summer.

In addition, a new birthing bed and maternal-child health care supplies have created a place for mothers to receive comprehensive pre and post-natal care. Since June, twenty-four babies have been safely delivered by Nurse Joseph at the center.

The clinic also offers educational resources. Weekly classes are held on diabetes management, infection control, and breastfeeding for new mothers.

Direct Relief staff, including Hovey, continue to be in communication with Kalinago community leaders and are prepared to assess additional needs for medical aid or support.

The post In Dominica, Indigenous Kalinago Had Few Options for Care. Now, a Transformed Clinic is a Health Care Hub. appeared first on Direct Relief.

“We didn’t want any [patients] to have to go through medication withdrawal,” she said.

Likaj is the Clinic Practice Manager at Odyssey House – the largest substance use treatment facility in New Orleans. The facility consists of two primary care health centers and several recovery homes. Many patients at Odyssey House are receiving medication assisted treatment (MAT) for an opioid use disorder. The treatment involves taking regulated opioids to wean patients off more dangerous ones, such as heroin. But because these medications prevent cravings and withdrawal, missing a dose can have dangerous side effects, relapse being one of them. “It’s a lot of pressure,” said Likaj.

After Ida, Likaj and her staff immediately started calling patients to ensure they had their prescriptions. “We worked as much as we could to…do telehealth appointments with them,” she said. Without power, mobile phones were the only way to reach people.

While people are often instructed to stock up on their medications before a disaster, that isn’t possible for those receiving medication assisted treatment. Opioid treatment medications, such as Suboxone, are controlled substances and ordering early refills is not allowed. That means patients must obtain a new prescription every time their medication runs out, even during a disaster.

Since Ida, Likaj and her staff have been coordinating with displaced patients to fill prescriptions at pharmacies close to where they’re sheltering. But for patients who went out of state, getting them their medication has been more complicated. Regulations around filling out-of-state prescriptions vary by state. Even during an emergency, it can be hard to transfer a prescription for a controlled substance. Unlike chronic disease medications, prescriptions for controlled substances can’t be phoned in by a prescriber. They must be sent through an electronic medical system, which may not be up and running after a disaster.

To help patients navigate this regulatory landscape and get their medications on time, Likaj has been making a lot of calls. “We’ve just been working with the clients, like, ‘Where are you? What’s the nearest pharmacy next to you? Let’s call them and see if they can fill your script of Suboxone. Or, if not, let’s find somewhere else that we can fill your script in.’”

The work has been all consuming. Staff members have been working up to 14 hours a day while dealing with their own personal upheavals, according to Likaj. Most were without power in the days following Ida, some sleeping in sweltering conditions while under water boil notices. Others lost their homes or incurred serious property damage.

Still, staff have been onsite throughout the disaster. During the worst of the storm, Likaj described providers “mopping [water] out as it came in” as it threatened to flood one of the health centers. Recovery home providers have worked night shifts and made long treks to pick up food for residents while deliveries were halted. Others have found ways to get to work, even while evacuated.

The work is beyond the scope of a typical provider, but Likaj says it’s critical: “We recognize that during a disaster our services are needed much more.”

“Our doors need to stay open,” she said.

In response to Hurricane Ida, Direct Relief has shipped Odyssey House several doses of the overdose-reversal drug, Naloxone. In addition, Direct Relief is preparing a shipment of two solar-powered batteries to ensure Odyssey House has backup power in the case of another disaster-related outage. These batteries can be used to power medical equipment, maintain temperature-sensitive medications and vaccines, and keep electronic medical systems online.

The post In the Aftermath of Hurricane Ida, Providers Step Up for Patients in Recovery from Substance Use Disorders appeared first on Direct Relief.

“We often just start with a bagged lunch and a bottle of water…and we’ll see what happens from there,” said Stephan Koruba, the Senior Nurse Practitioner at The Night Ministry, a street medicine clinic based in Chicago, Illinois. “What happens from there” might include helping someone secure housing or a legal I.D., or offering them wound care and treatment for substance use disorder – all out of a van.

When providing care to people experiencing homelessness, Koruba and his team of medical providers and social workers focus on establishing relationships first. “We try to offer a non-judgmental human connection,” he said. For many, distrust of medical providers can be a barrier to treatment. “Other humans are often the biggest threat to people out on the streets,” said Koruba.

The vehicle allows providers to “look in all the nooks and crannies” for those living in tent encampments, under bridges, and on street corners. In addition, the team operates a bus they use to provide nightly care to homeless individuals across six Chicago communities.

For those with an opioid dependency, Koruba is able to provide medication-assisted treatment. A typical treatment involves prescribing Suboxone, an opioid-based medication that prevents overdose and withdrawal, and behavioral health support.

While Koruba can write the prescription, getting patients the medication can be difficult.

Many don’t have insurance and can’t afford to buy Suboxone at a pharmacy, according to Koruba. Others don’t have a vehicle or money for public transportation, making it difficult to get to a pharmacy. To bridge the gap, The Night Ministry works with a local community health center to provide patients with free transportation to and from their appointment. At the health center, they can get treatment for their substance use disorder at no cost to them.

But treating a substance use disorder requires more than one visit to a doctor’s office. Patients must follow a strict medication regimen, which involves multiple trips to a pharmacy and consistent follow-up appointments. For those living on the streets, this kind of high-contact care is not always possible. “We do make plans to meet people at a certain time, at a certain place, and sometimes they’re there and sometimes they’re not,” explained Koruba.

Because the success of substance use treatment depends on having some degree of stability, those experiencing homelessness face an uphill battle. If an opioid medication isn’t taken consistently, people can fall back to using stronger, more addictive drugs.

This can lead to overdose, especially after a period of detox, and ultimately land a person in the emergency room. From there, a dangerous cycle begins: “We have seen lots of folks get very expensive, great care for a week or two at the hospital but be discharged out onto the street and then they miss all their follow-ups and they get sicker and they end up back in the ER a few weeks later,” said Koruba.

According to Koruba, “breaking that cycle” begins with changing emergency room culture: “The institutional inertia is to disregard drug addicts when they come into the ER for visits,” he said. Often, providers assume they are “just searching for more drugs.”

But considering an individual’s personal circumstances can have profound effects on their long-term outcomes. For example, Koruba said, most ERs don’t ask about a patient’s housing. “It’s not part of the internal culture,” he explained. Instead, they treat patients for the acute issue they were admitted for, such as an overdose. But because housing status can have “a big impact on [a patient’s] medical care and their ability to follow up,” it’s a critical piece of information. For some, it can be the difference between recovery and the need for additional emergency care.

To encourage better coordination among providers, The Night Ministry has been taking ER doctors on outreach trips to provide medical care on the streets. Doctors “can see the realities that our folks face” and “change the resources available to them in the hospital,” said Koruba.

While this kind of coordination isn’t happening on a mass scale, there’s been improvement. Recently, an ER doctor recognized a patient they had treated while volunteering with The Night Ministry, who had been admitted for an overdose. The doctor notified Koruba and he was able to “help them initially on their follow-up regime,” preventing the need for emergency care down the line.

While “the ball gets dropped a lot” said Koruba, “we’re trying to change the culture little by little.”

Through the Fund for Health Equity, Direct Relief has awarded The Night Ministry $250,000 to support their mobile outreach program, including funding to provide medical care and social services to those sleeping on city trains, in tent encampments, and on streets across Chicago.

The post For Those Experiencing Homelessness, Treatment for an Opioid Misuse Disorder is Harder to Get. appeared first on Direct Relief.

A combination of existing relationships with disaster response agencies, safety-net health clinics, and government agencies, as well as data analysis and pre-positioned supplies, have enabled Direct Relief to respond efficiently and precisely to requests after each incident.

Wildfires

THE SITUATION

• The Caldor Fire in El Dorado County has grown to more than 191,000 acres, becoming the second-largest fire currently burning in California.
• The blaze started August 14, 2021, and is 16% contained, down from 19% over the weekend.
• All 22,000 South Lake Tahoe residents have been ordered to evacuate.
• At least 472 homes and 11 commercial buildings have burned.
• Five personnel and civilian injuries have been confirmed.
• The Dixie Fire, the second-largest fire in California history, has burned more than 800,000 acres in the Sierra Nevada mountain range.
• That fire started July 13, 2021, is 48% contained.
• According to the National Interagency Fire Center, there are 83 wildfires burning in 10 states across the U.S., the majority concentrated in Idaho, Montana, California, and Oregon.
• Wildfires continue to burn in countries across Southern Europe, including in Greece, Italy, and Turkey, where several fires earlier this month caused major destruction to historic cities, ancient forests, and villages

WILDFIRE RESPONSE

• Direct Relief is coordinating with CalOES, the California Primary Care Association, and local Emergency Management and Public Health Departments to assess the health needs of communities affected by the Caldor and Dixie fires, as well as several others burning across the state.
• Direct Relief has committed an initial $1 million to help support safety-net clinics and responders in fire-affected communities across the U.S. Shipments of medical aid have also departed for health providers, and health concerns include respiratory impacts from poor air quality and smoke.
• An offer of assistance has been extended to health facilities in several Southern European countries currently experiencing or recovering from wildfires
• Direct Relief’s emergency-response activities also include synthesizing a broad range of public and private data sources to map and analyze wildfire risk, social vulnerability, and population movement in fire-affected areas

Hurricane Ida

THE SITUATION

• Hurricane Ida made landfall in Louisiana on Sunday as a Category 4 storm, dumping up to 16 inches of rain in some parts of the state and causing major damage to homes and buildings.
• More than 1 million people remain without power, which creates a dire situation for those reliant on oxygen or medical devices that require electricity.
• With peak sustained winds of 150 mph, Ida is tied for the fifth-strongest storm to hit the U.S. mainland.

HURRICANE IDA RESPONSE

• Direct Relief has committed $1 million in funding for the response and made its inventory of medical aid, including antibiotics, chronic disease medication, and over-the-counter products, available to 214 federally qualified health centers and free clinics across Louisiana, Mississippi, and other states in Ida’s path.
• Emergency shipments are being prepared or are en route for providers treating patients in the New Orleans area, including Baptist Community Health Services, the Low Barrier Shelter, Odyssey House Louisiana, and City of New Orleans Shelter as well as Open Health Care Clinic in Baton Rouge, MLK Health Center and Pharmacy in Shreveport, and Rapides Primary Health Care Center in Alexandria.
• Shipments include prescription medicines, wound care supplies, infection control medication, tetanus vaccines, insulins, personal protective equipment, hygiene items for evacuees, and solar-powered fridges.

Haiti Earthquake

THE SITUATION

• Recovery efforts continue after a devastating 7.2-magnitude earthquake struck Haiti’s southern peninsula on August 14, 2021.
• An estimated 2,200 people were killed and 12,000 remain missing or injured.
• The quake toppled cement buildings, reduced homes to rubble, and damaged vital infrastructure, including hospitals and roads.

HAITI EARTHQUAKE RESPONSE

• 79 tons of critical medical supplies, packed in Direct Relief’s California warehouse and shipped via a dedicated FedEx charter flight, have been received in Port-au-Prince where they are being distributed to affected areas.
• Supplies on the flight included antibiotics, wound care items, PPE, diagnostic supplies, medical-grade freezers, IV fluids, medical relief packs, and essential medications.
• Seven pallets of PPE, medical relief backpacks, and emergency shelters have been received by St. Boniface Hospital in Fond-des-Blancs from Direct Relief’s Puerto Rico distribution hub. Direct Relief has also provided St. Boniface with $250,000 in emergency operational cash support.
• Direct Relief has approved $795,000 in grant funding to support health personnel responding to the Haiti earthquake.
• When the earthquake struck, Direct Relief had three ocean freight containers of PPE and other medical supplies already en route to Haiti-based organizations Partners in Health, St. Boniface Hospital, and St. Damien Hospital.
• In total, more than 192 pallets worth of medical aid from Direct Relief totaling $12.8M has arrived recently in Haiti, is en route, or is ready for deployment.

The post Emergency Update: Caldor Fire, Hurricane Ida, and Haiti Earthquake appeared first on Direct Relief.

The storm dumped more than 16 inches of rain in some parts of the state and peak winds reached 150mph, tying Ida as the fifth-strongest storm ever to make landfall in the U.S. mainland. Ida touched down in New Orleans on the 16th anniversary of Hurricane Katrina and one year after Hurricane Laura – also a Category 4 storm –  battered the state last August.

More than 2,000 evacuees were staying in shelters Monday morning, according to the Governor’s office, but with power lines down, hundreds of those who stayed behind remain out of reach. The Louisiana National Guard has activated dozens of rescue vehicles, including 73 boats and 34 helicopters, to recover those trapped in flooded homes and buildings, according to the Associated Press. Hundreds more are being deployed by local and state agencies.

Widespread power outages are affecting residents across Louisiana and Mississippi with roughly 1.1 million customers still without electricity, according to PowerOutages.US. More than 2,000 miles of transmission lines remain out of service, including all eight that deliver power to New Orleans, as reported by the New York Times.

Ida, now a Tropical Storm, is expected to dump rain and bring flash flooding to areas along its northeast track, including Mississippi, Tennessee, and the Ohio River Valleys. The storm will likely reach the New England coast by Friday where it will continue out to sea.

Hurricanes and Health Impacts

Hurricanes and similar storms can bring with them a host of health concerns for those affected. Covid-19 complicates evacuation efforts in congregant shelters, and health systems already strained by the pandemic may experience another surge of patients needing care from the storm’s impacts. High burdens of chronic disease, like diabetes and heart disease, can also complicate evacuation efforts. If a person managing a chronic disease is suddenly cut off from reliable prescription medications or medical care, they may require emergency care. Power and water outages can also impede local health providers, and a storm’s after-effects also present health concerns, ranging from water-borne illness to the risk of tetanus from clean-up and recovery efforts.

Direct Relief’s Response

Direct Relief has made its inventory of medical aid, including antibiotics, chronic disease medication, and over-the-counter products, available to 214 federally qualified health centers and free clinics across Louisiana, Mississippi, and other states in Ida’s path. Emergency shipments are being prepared or are en roure for providers treating patients in the New Orleans area, including Baptist Community Health Services and the Low Barrier Shelter as well as Open Health Care Clinic in Baton Rouge, MLK Health Center and Pharmacy in Shreveport, and Rapides Primary Health Care Center in Alexandria. Shipments include wound care supplies, infection control medication, tetanus vaccines, personal protective equipment, and hygiene items for evacuees.

To more effectively target medical aid, Direct Relief’s Research and Analysis team is analyzing social vulnerability in Hurricane Ida’s impact zone. Of the 5.3 million residents in the area of highest impact nearly 1 million are living below the poverty level, over 780,000 are age 65 and older, and 2 million are members of minority groups. In the same area, there are more than 350,000 mobile homes and nearly 150,000 households that do not have a vehicle. Direct Relief is working with health centers in areas struck by Hurricane Ida to set up real-time location tracking for mobile medical units used by community health providers to bring critical care to those who lack transportation.

Direct Relief staff will continue to track Hurricane Ida’s impacts and respond to requests for emergency medical aid as assessments are made.

The post Rescue Efforts Underway in Louisiana after Hurricane Ida Leaves One Million Without Power appeared first on Direct Relief.

On Wednesday, shifting winds were expected to push the fire south towards Plumas County. “[The wind] is going to push on some of these perimeters that we haven’t had a big wind test on yet,” said Fire Captain Bryan Newman during a Cal Fire briefing Wednesday morning.

The fire is projected to continue burning toward the town of Janesville and down the Highway 395 corridor while retracting its eastern attack on Susanville, the largest town currently under threat.

Mandatory evacuation orders are in place across Plumas, Tehama, and Lassen Counties. In Butte County, evacuation warnings have been issued for the northernmost communities.

Much of the fire-affected area remains under a red flag warning for high winds and relatively low humidity. A cold front overnight cleared smoke-filled skies for the first time in several weeks, giving fire crews a brief reprieve. “We got lucky yesterday,” said a Cal Fire spokesperson. “There’s no way to sugarcoat that,” he said. Smoke is expected to move back through once winds shift southwest on Friday.

The fire has been burning for more than a month, with containment hovering around 30% for several days. “It’s a pretty good size monster,” said Cal Fire Operations Section Chief Mark Brunton. “We’re not going to get this thing overnight,” he said, talking to fire crews Wednesday morning. “It’s a marathon, not a sprint.”

The Dixie Fire is only one of the fires burning in California at the moment. The Caldor Fire has grown rapidly and threatens thousands of homes in El Dorado County.

Direct Relief Response

Since the Dixie Fire broke out in mid-July, Direct Relief has sent over 21 shipments of medical aid, valued at $88,000 and totaling 458 lbs, to fire-affected health centers and clinics in Northern California. The shipments have contained respirator masks, wound care supplies, inhalers, and nutritional supplements, in addition to 14,900 defined daily doses of medicine, including mental health medications for depression and anxiety and pain medications.

As a California-based disaster relief and medical aid organization, Direct Relief has responded to wildfires in California, and throughout the U.S., for decades.

Direct Relief is a long-time partner of the State of California through its Office of Emergency Services (CalOES) and the State of California Emergency Management Agency (CalEMA). Direct Relief also serves as a key member of California’s Business and Utilities Operations Center (BUOC), which was established to mobilize private resources for the public benefit during emergencies and ensure resources are deployed in coordination with public officials managing the response.

Direct Relief’s 155,000-square-foot medical distribution center, equipment, trained staff, and various other capacities are registered with the State of California as a strategic emergency resource and available for public health or emergency response purposes. Direct Relief has specifically offered the California Governor’s Office of Emergency Services (CalOES) any needed resources, including Wildfire Health Kits, its general inventory of medicine and medical supplies, and backup power resources.

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In California, the Dixie Fire is now the second-largest in state history at just over 515,000 acres, according to Cal Fire. The blaze is burning east of Chico in four counties, including Butte, which was devastated by the Camp Fire in 2018. The fire has destroyed more than 1,000 buildings and last week leveled the town of Greenville. On Friday, the fire was 30% contained.

Several smaller fires are burning across California, producing poor air quality and prompting evacuation orders. The Monument Fire in Shasta County has burned more than 74,000 acres since igniting last month and was 5% contained as of Friday, according to data collected by the San Francisco Chronicle. In Siskiyou County, the River Complex Fire is just 10% contained having burned more than 36,000 acres and prompting evacuations in several surrounding areas.

In Montana, the Richard Spring Fire has grown to 170,000 acres since igniting last weekend near the Northern Cheyenne Nation. Dry hot weather and gusty winds are expected to exacerbate flames over the weekend, according to Inciweb. Hundreds of residents have been evacuated as crews work to increase containment from 0%. Currently, more than 25 large fires are burning across Montana–more than any other state in the country, according to Axios.

Dozens of fires are burning across Oregon and Washington as a heat dome descends on the Pacific Northwest this weekend. The Bootleg Fire in Oregon–the state’s largest–was nearly 100% contained on Friday after scorching more than 400,000 acres, according to Inciweb. In Washington, crews are battling 16 active fires that have collectively burned more than 260,000 acres across the state, according to the National Interagency Fire Center.

Direct Relief’s Response

Since mid-July, Direct Relief has provided more than $140,000 in medical aid to Northern California health facilities treating patients in fire-affected areas. Shipments have included N-95 masks, wound care supplies, respiratory medications, nutritional aid, and prescription medications for anxiety and depression.

Direct Relief has made its inventory of medical aid available to 30 health centers and clinics across Northern California in addition to three public health departments. Supplies offered include respiratory masks, tetanus vaccines, insulin, inhalers, and oxygen concentrators.

In response to wildfires burning in Montana, Direct Relief is preparing emergency shipments bound for the Northern Cheyenne Reservation in addition to the towns of Ashland, Lame Deer, and Colstrip. The shipments include twelve packs of emergency medical supplies each containing personal protective equipment, wound care supplies, diagnostic equipment, and over-the-counter infection control medications. Direct Relief is also deploying shipments containing KN95 masks, eye drops, and solar power systems as fire-related outages affect the region.

As wildfire season draws on, Direct Relief will continue to assess the needs of health facilities in fire-affected zones and respond accordingly.

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Forest fires near Athens, Greece, have forced thousands to evacuate, some by sea, as the country experiences its worst heatwave in over 30 years, according to the Associated Press. As of Wednesday, at least 77 people had been hospitalized due to the fires, according to state officials.

In Turkey, dozens of fires have been raging along the southern and western coasts, forcing mass evacuations and killing at least eight people, according to Al Jazeera. The fires have reduced villages to rubble and burned through large tracts of land, tearing through forests and destroying homes.

In Italy, hundreds of people have been evacuated as fires burn throughout the south. At least five people were wounded last weekend when fires broke out near Pescara, Italy, as reported by The Guardian. In Sicily, crews are battling several active blazes that have prompted evacuations by sea.

North Macedonia has declared a state of emergency in response to wildfires that have burned through much of the country’s eastern forests.

In the U.S., wildfires have tormented large swaths of the West throughout the summer as drought conditions and record-shattering heat persist.

More than 100 fires are actively burning across the country, with major blazes concentrated in Montana, Idaho, Oregon, and California, according to the National Interagency Fire Center.

In California, the Dixie Fire has burned more than 430,000 acres, making it the third-largest wildfire in state history, according to Cal Fire. This week, the fire decimated the town of Greenville, located about 160 miles northeast of Sacramento, destroying more than one hundred homes and structures. Thousands have been forced to evacuate as the fire surges northward at just 35% containment. Smoky skies could be seen across much of Northern California on Friday.

Direct Relief’s Response

Since July, Direct Relief has shipped over $300,000 in medical supplies to health centers and clinics across seven fire-affected states in the U.S., including California, Oregon, and Washington. The supplies included PPE such as gowns and gloves, medical items such as eye drops and allergy medications, as well as hydrocortisone, antibiotics, and insulin.

On Friday, Direct Relief committed $1 million in medical and financial support to fire response, and the organization is in communication with the California Governor’s Office of Emergency Services as the state funnels resources to crews battling the Dixie Fire. Direct Relief stands by ready to assist responders with wound care supplies, N-95 masks, and backup power resources.

Internationally, Direct Relief is assessing needs across Southern Europe and is prepared to deploy supplies to fire-affected countries including Turkey, Greece, and Macedonia.

To combat the effects of climate change, Direct Relief has invested in solar power and backup battery solutions for health centers and clinics affected by climate-related disasters. The organization has helped fund solar/battery back-up systems planned for 25 California health centers and clinics in fire-prone areas and is preparing a “fleet” of solar-powered trailers, stocked with backup power, refrigeration units, and pop-up solar tents. Renewable energy projects have also been funded in Puerto Rico, Hawaii, the Bahamas, and Dominica.

The post Fires Rage Across Southern Europe, Western United States Amid Extreme Heat and Drought appeared first on Direct Relief.

Most pharmacies charge for prescription drugs and, unlike hospital emergency rooms, “if you don’t have the money, you get turned away,” said Rusty Curington, the Director of Pharmacy at St. Vincent de Paul Charitable Pharmacy (SVDP) in Cincinnati, Ohio. For some patients, “It’s the choice between I’m going to pay my rent…or I’m going to take my drugs,” he said.

Curington works at one of a few hundred charitable pharmacies across the U.S. These pharmacies, which are members of the National Association of Free and Charitable Clinics, provide medication for free to patients who are low-income or uninsured. “I have people who drive an hour to pick up their meds because it’s cheaper than paying for the pharmacy that’s within five minutes,” he said.

In Charlotte, North Carolina, Dustin Allen has filled prescriptions for uninsured patients who have gone months without taking their medications. “People have cried out of just a sense of relief,” said Allen, the Pharmacy Manager at NC MedAssist, a free and charitable pharmacy that services all of North Carolina.

For some, especially those with a chronic condition, going without a medication can have both short and long-term consequences. “If it’s somebody that has high blood pressure, for example, and they’re not taking their medications because they can’t afford it, they may not notice anything specifically right out of the gate, but years down the line…they could have some severe side effects,” said Allen. Long-term side effects can include heart damage and kidney failure. Other times, conditions devolve rapidly. Those with Type 1 diabetes can go into a coma within a few days of not taking insulin.

Patients that can’t afford their medications often use “the emergency room consistently to manage their illness,” said Shearie Archer, the Executive Director of Ozanam Charitable Pharmacy in Mobile, Alabama. By helping patients afford their medication, free and charitable pharmacies are preventing the need for emergent care. “We are a true medication safety net,” said Archer.

But free and charitable pharmacies do more than dispense medication. Many invest in programs that “take it a step further,” Archer said. At NC MedAssist, pharmacists track how often a patient takes their medication versus how often they are getting it filled. If someone has a three-month supply of medication, but doesn’t come in for a refill, they can “make a phone call and get in front of them” to see what issues they may be experiencing, said Allen. Sometimes it can be a lack of transportation, unstable housing, or food insecurity—all of which make it difficult for someone to prioritize their health.

At Ozanam, pharmacists are helping patients improve their conditions through medication therapy management programs. Pharmacists set up hour-long appointments with patients to answer questions and provide important information. “They’re talking to the patient about the way they eat, they’re talking to the patient about taking their blood pressure daily,” said Archer. The pharmacy also provides patients with free blood pressure cuffs, blood glucose monitors, and test strips.

In this way, pharmacies are an important point of care for many patients. While those with a chronic disease may see their doctor every 6 months, patients typically refill their prescriptions on a monthly basis. “That’s a good point for me to be able to check in with them,” said Curington. For someone with diabetes, he can ask about their “numbers” or “talk about diet and exercise and all the things that help diabetes improve.”

For Curington, these visits are a “touch point” for both himself and the patient. “Every time you’re picking up drugs, [it’s] kind of a clinical visit,” he said.

The post Medication Can Be An Expensive Barrier to Care. At Charitable Pharmacies, It’s Free. appeared first on Direct Relief.

TabetaiCooking’s Twitch channel: https://twitch.tv/tabetaicooking
Direct Relief Cooking Sessions, August 2-7: https://www.directrelief.org/sessions

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In the days following the collapse, Oxnard Fire Chief Alexander Hamilton was deployed to the scene to provide mental health support to first responders working to find victims.

With funding from Direct Relief that the Miami Heat raised, Hamilton and a team of clinicians, first responders, and peer support officials organized group and one-on-one support sessions for search and rescue workers.

In this episode of the podcast, we speak with Hamilton about the search and rescue effort and its effect on those involved.

Transcript

AMARICA RAFANELLI: Can you describe what it was like when you first touched down and arrived on the scene there in Florida?

ALEXANDER HAMILTON: We arrived on a Monday. If you recall, they had that section of the building that was still standing, so they had just demolished that section of the building Sunday night. Because of the instability of that part of the building, there were a bunch of bedrooms that they couldn’t search, so as soon as they had collapsed that other section, they immediately were able to search in an area they had previously not had access to. There was actually a ton of activity going on when we first arrived.

Crews worked for an hour on and an hour off, so the first crew I interacted with had just come off the pile after recovering a family of four, so some pretty tough situations for the search and rescue teams.

RAFANELLI: Can you describe the services that you were providing? Were they group sessions, were these one-on-one counseling sessions?

HAMILTON: The situation was really unique for me in my experience because the vast majority of the time, when I’m providing mental health support to first responders, it’s after an incident has terminated. It’s after the fact that we go in there, and we help folks start processing their experiences. In this case, though, they were still very much in the middle of the incident. Certainly, there was a lot of work that could be done to bring closure to the families. It was a bit of an unusual response for us because they really can’t start processing their experiences because they’ve got to go back and keep working.

It was as much as anything, ensuring they knew that there was support. There were times where were people that would come off that were feeling overwhelmed and so we would go and have a little one-on-one session, but more often than not, it was groups of five or six and, and sort of relatively brief conversations, some of which you’d get into some of their experience, but a lot of times it was a chance for them to check out. They wanted to know how we load hose on our fire engine to California, for example, versus the way they do it. So we had these small talk conversations. Some of it, too, was understanding some of their needs. Florida is incredibly hot. It’s incredibly humid. So having good quality wool socks was something that they needed. So it was sort of these little compact things that we were able to pick up on and do something about. Neck gators, wound tactical socks.

It was day 12 or 13, I think, after the collapse when we got there, so these crews hadn’t been near their families in that time. So one of their requests was better wireless coverage so they can FaceTime with family members and just sort of have that check-in.

So there were little things that we were able to provide while also being there to give them support if they needed that support.

RAFANELLI: I can only imagine how physically and emotionally demanding this response was, trying to find victims of the collapse. Did any of the responders share their thoughts on that experience or how it affected them?

HAMILTON: Yeah, there were little pieces of stories that would come out. Obviously, decomposition is happening quite rapidly in those conditions, so the state of the bodies, if they hadn’t been impacted by the collapse itself, were relatively intact.

I think that was one of the hardest things. You could smell it when you were out there. It was really strong. So that was pretty impactful for a lot of them. You know, doing their very best to obviously bring closure to these families and also respecting these victims as they’re recovering.

One guy said it best to me, one of the crew members that recovered that family of four said, ‘I prefer to save people,’ you know, not do this. He’s like, I know we need to do this, but I don’t like it. That was sort of the sentiment. They knew it needed to be done but that it was really difficult circumstances.

RAFANELLI: So you’ve said that in the initial phases of this response, most of their needs were wanting to speak with their family, some practical needs, like wool socks. Do you anticipate that the recovery for these first responders is going to be more long-term?

HAMILTON: Without a doubt. When we first got there was a lot of behavioral health support at the site, particularly during the day: clinicians, chaplains, people with therapy, dogs, and that kind of thing. Not a lot of them had cultural competency in dealing with search and rescue teams or dealing with, with firefighters. So, within a day or two of us being, at the site and on the ground–we were all wearing these yellow lanyards to identify ourselves very clearly–people started gravitating towards those yellow lanyards.

We quickly developed that trust to some level. So yeah, I absolutely anticipate that there’s going to be some long-term issues for all of those respondents to work through.

That was one of the things that we were starting to work on is a plan for when everyone’s going home and how they were going to manage that behavioral health component.

RAFANELLI: So, as a fire chief, you’ve been involved in addressing the mental health needs of first responders for a while now. What got you into the work, and why did you identify mental health as a need among your colleagues?

That question comes up a lot. With my colleagues, everyone has a different story, whether it was an issue that they face personally or some adversity that people were able to work through. Ultimately for me, it was a call–that’ll actually be 10 years ago this Thanksgiving–that I went on, and it was a little boy that had catastrophic injuries after being hit by a car, similar age to my own child at the time.

It was really difficult seeing and we were there for a long time. Ultimately my response initially to that was, was pretty myopic. I just sort of took care of myself. I was an engineer, so I was a driver on the engine, but about eight months after that, the firefighter that was with me on that call, he came to me, and he says, ‘I’m just not coping with life.’

That was kind of my moment. I dealt with my issues, and I’d gotten some help. I could still tell you everything about that call to this day. But at the same time, when he came to me and said, he’s not coping with life, we didn’t have anything in place. We had a big distrust of our employee assistance program, which is common, unfortunately. All we had was to call the number on the back of the health care card for mental health support. And if you’ve ever tried to do that, it’s not a good way to get mental health support because the insurance company will give you a list of like 12,000 providers in your area, the vast majority of whom are not taking new clients and then there’s people that just don’t call you back. It’s a really clunky way to get behavioral health support. So, that was the point where I realized that we needed to do things a lot differently and a lot better.

That sort of took me down this road into peer support. And then, obviously, suicide was just starting to become an issue in the fire service. Unfortunately, it’s grown exponentially since we got involved. So, we started doing suicide intervention classes, suicide awareness classes.

Now, we’re just starting on teaching a resiliency class to try and sort of build those coping skills early so that hopefully we don’t end up in a bad place.

RAFANELLI: In your opinion, has climate change and the increasing frequency and severity of natural disasters, like wildfires, increased the need for mental health support among first responders?

HAMILTON: Yeah, climate change is one part of it, but our profession has changed pretty dramatically as well in the last 10 or 15 years. We’re doing a better job with behavioral health services, but the job has become infinitely more demanding. Our members are exposed to a lot more violent incidents. They are exposed to longer hours and these more grueling campaign fires that go on for weeks at a time. So it is absolutely having an impact.

Through COVID–last season was a particularly bad fire season–I think agencies all across California and likely across the rest of the country were short-staffed because we either had to pair back on training new firefighters or for a host of different reasons. So, there have been people working incredibly long hours. Last September, when the fires were at their worst, some of my firefighters did 25 days at the fire station in a month, and that’s a 24-hour shift. Because of COVID, they couldn’t have their families coming to visit stations. We had to be really careful about that, keeping our workforce healthy. So, really demanding and our firefighters, they will do it. They’ll occasionally complain, but for the most part, they understand this is the job, and this is the mission. But also, it needs to be acknowledged that it’s an incredibly heavy burden that they have to take on and that we need to be able to try and support them.

This transcript has been edited for clarity and length.

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“Anytime there’s talk of any severe thunder or rain, of course, people get nervous,” said Cory McCray, the Chief Operating Officer at Matagorda Episcopal Health Outreach Program (MEHOP). The health center serves under and uninsured individuals in Bay City, Texas—a rural town two hours south of Galveston.

“We’re having a couple of storms come through now and you can definitely see how that is affecting our patient volume in terms of people not coming to their appointments,” he said. People are scared of being stranded without their belongings because of flooding, or worse, a mandatory evacuation. That’s especially true for those who rely on public transportation or don’t have a vehicle of their own.

During Hurricane Harvey in 2017, a lack of transportation was a major issue for those trying to evacuate. “I would say close to 20% of the population stayed here during Harvey because they couldn’t get out,” said McCray. While emergency officials arranged for buses to pick up evacuees, “that’s if you can get to the Civic Center,” McCray explained.

Financial Stress

For those with limited resources, evacuating is not the only difficulty of hurricane season. Recovering can be costly. Many “don’t have this disposable income to where they can just pick up where they left off and start rebuilding their lives,” said Dr. Adlia Ebeid, the Director of Pharmacy Services at San Jose Clinic in Houston. The financial stress of repairing damaged homes and property “causes a mini mental health crisis,” she said.

Mental Health

In general, providers note heightened levels of anxiety, stress, and PTSD during hurricane season. “Mental health is something that we don’t talk about enough, but I definitely think there’s a huge impact, especially for our patients,” said Ebeid. While some patients experience stress, others relive memories of loss and trauma. The clinic provides behavioral health services, including counseling and psychiatry, at no cost to patients. Before and after a storm hits, these services are especially important, according to Ebeid.

Unmanaged Chronic Disease

After addressing patients’ mental health concerns, “we start to look at other diseases…like diabetes, hypertension, high cholesterol,” said Ebeid. During the upheaval of a storm, people are more likely to skip their medication, potentially causing more serious health issues. If left “unmanaged for a certain period of time,” conditions, like hypertension and diabetes, can lead to heart attacks, strokes, and other health emergencies.

But keeping those conditions stable in the midst of a disaster is difficult. For many, managing their chronic condition is the last thing on their mind when evacuating. “When you’re in disaster response and you’re grabbing your kids and clothes and pets and essentials, medications don’t always come” to mind, said Ebeid. To ensure patients have their medications in the aftermath of a storm, providers at San Jose Clinic help patients make go-bags with their prescriptions and instructions on use. In addition, staff do remote check-ins with patients that have been evacuated. In past seasons, staff would take home a list of patients and “grassroots start calling.” But now, the clinic plans to use telehealth to reach patients, which they’ve ramped up during the pandemic. The check-ins allow providers to “accommodate [patients] in a variety of different ways,” by, for example, shifting a patient’s prescription to a pharmacy closer to where they’re sheltering.

More Intense Storm Seasons

As storms become more frequent and more intense, providers are bolstering the resources they make available to patients. “Climate change definitely affects what we do,” said McCray, who cites an increase in behavioral health services. “I think for a lot of people it’s the whole process” of preparing and “the anxiety that takes over,” he said. “If you have to do it more than once, it really becomes a problem.”

This year, the National Oceanic and Atmospheric Agency predicts an above average number of storms, even after redefining “average.” Now, “normal” refers to 14, rather than 12, named storms per season.

“Looking at this year…it could be worse than Harvey,” said McCray. “I’m not gonna stamp that, but at the same time the Earth is changing.”

In preparation for hurricane season, Direct Relief has pre-positioned caches of emergency medical supplies at health centers and clinics across the United States Southeast, including Matagorda Episcopal Health Outreach Program and San Jose Clinic on the Texas Gulf Coast.

The post Texans Brace for ‘Above Average’ Hurricane Season appeared first on Direct Relief.

For the first episode, Jitsu, a gaming content creator who focuses on Monster Hunter and horror games, and Annie Vu, Direct Relief’s Manager of Program Operations speak with Amarica Rafanelli about live streaming antics, digital fundraising, unusual donation incentives (such as getting a tattoo for charity), and Annie’s donation-funded work, which includes responding to emergencies and managing requests for medical aid.

The post Connect Podcast – Episode 1: How Far Will Gamers Go to Support Charity? Jitsu May Have Found the Limit appeared first on Direct Relief.

In the U.S. Southwest, crews are battling nearly 100 active blazes with record-high temperatures and low humidity feeding major fires in Arizona, New Mexico, Montana, and California, according to data compiled by the LA Times.

This comes as a record-shattering heat wave smothers the Pacific Northwest, sending temperatures well into the triple digits. The heat is linked to hundreds of deaths across Oregon, Washington, and British Columbia, as reported by the New York Times.

California Fires

In California, fires have burned more than 31,000 acres since the start of the season, with 18 blazes actively burning across the state, according to Cal Fire. The largest is the Lava Fire in Northern California’s Siskiyou County, which has burned nearly 20,000 acres and forced more than 3,500 residents to evacuate. On Thursday, the blaze was 19% contained.

The fire is burning in a rural area where health care resources are limited.

“From the area where the fire is, the closest primary center is about 50 miles to the north and 65 miles south,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis. For residents, that leaves few options for health care, particularly if those health centers shut down. “It’s just a problem of low density,” said Schroeder. And should the power be shut-off to prevent wildfire expansion, the situation becomes more complex.

Without electricity, people lose access to life-sustaining electronic medical equipment and air conditioning amid the stifling heat. “If people lose power…you get this stack of problems,” said Schroeder. Wildfires can also bring about health concerns related to smoke and particulate inhalation,  health needs resulting from displacement and evacuations, and interruption of access to health providers and life-sustaining prescription medications needed to keep people out of local emergency rooms.

While the Lava Fire has consumed fire crews for days, it’s unlikely to be the last major fire in California this season. 95% of the state is under severe drought conditions, and one-third is experiencing exceptional drought conditions, according to the National Oceanic Atmospheric Agency. These conditions dry out forests and shrubbery, making them ideal tinder for fires. “The underlying fuel conditions are really at all-time dangerous levels,” said Schroeder.

This comes on the heels of California’s worst wildfire season to date, when, last year, more than 4.2 million acres burned across the state. While a significant amount of brush and forests were used up as ignition, there’s still plenty of fuel left to burn. Schroeder warns: “It’s true that the places that were burned last year are unlikely to burn again but there is still a very large portion of California that did not burn last year.”

Preparing

For emergency responders, preparing for a more extreme wildfire season can be a moving target.

It’s difficult to predict exactly when and where these fires will erupt, since areas that have recently burned are not likely to burn again. “We shouldn’t being putting preparedness resources in places that burned last year because that’s probably not going to be the places at highest risk,” said Schroeder. “You don’t want to fight the last war.”

Direct Relief’s Response

To target supplies where they’re needed most, Direct Relief’s Research and Analysis team has developed a dashboard mapping which communities are most vulnerable to the impacts of wildfires. This information is used by the organization’s Emergency Response Team to pre-position kits of emergency medical supplies at health facilities serving California’s highest-risk communities.

In addition, the organization is collaborating with the Harvard T.H. Chan School of Public Health through CrisisReady to create a health system resilience mapper projecting the impact of fires and power outages on populations in California. The tool looks at the vulnerability of the health system to power outages and wildfires and provides real-time population movement during evacuations.

Direct Relief is also funding a data project spearheaded by Macro-eyes and the California Primary Care Association to model power resilience throughout the state of California. The tool will be used to determine which health centers are equipped with back-up power—a critical resource when providing care during a public safety power shut-off. The information will be used to steer resources, such as solar batteries and generators, towards health facilities most vulnerable during power shut-off events.

As climate change fuels more extreme wildfire seasons, Direct Relief will continue to invest in data-driven solutions to increase the resiliency of health systems and equip health facilities with the supplies they need to care for patients during and after wildfires.

The post Wildfire Season Picks Up As Extreme Heat Smothers Western U.S. appeared first on Direct Relief.

“We want to make sure in our response and in our planning that we are being as inclusive as we can be of all members in our community,” said Leighton Jones, Direct Relief’s Director of Emergency Response. Jones presented at a recent webinar organized by the Federal Emergency Management Agency (FEMA) in celebration of Pride Month this June.

The agency asked Jones to present on research he conducted during his time at the Harvard T.H. Chan School of Public Health, where he served as the Senior Manager of the Emergency Preparedness Research, Evaluation & Practice Program.

While disaster responders are trained to care for vulnerable populations, including the elderly, women, and children, those in the LGBTQ+ community are often overlooked, even as they make up a significant portion of the population. In the U.S. more than 11 million people officially identify as LGBTQ+, though the number is widely regarded as an undercount. While it’s often believed these individuals are concentrated in certain cities or states, the numbers tell a different story. “There are LGBTQ people in every community across America,” said Jones. This means “every community needs to consider [LGBTQ+ people] in their disaster planning.”

This is particularly true when sheltering individuals after a disaster. Many of those who identify as LGBTQ+ are misgendered during the registration process, potentially making them a target of violence and discrimination. While some staff members make incorrect assumptions based on the way someone looks, others are relying on incorrect identification cards. Many people who are transgender or non-binary don’t have IDs with their preferred name and gender written on them, according to Jones.

But, he says, the solution is simple: Don’t ask if it’s not absolutely necessary. “Do you really even need to know the gender of the person you are helping after a disaster?” said Jones. When dressing wounds or providing victims with food and water, the answer is no. Other times, gender is important to providing culturally sensitive health care. In that case, Jones recommends non-binary registration cards that give individuals options other than male and female. Regardless, Jones advocates for “normalizing gender introductions,” so that disaster responders ask everyone their preferred pronouns, not just those they assume to be transgender.

Ensuring inclusivity is especially important in shelter bathrooms, where transgender individuals are particularly vulnerable to violence and discrimination. “We need to recognize that part of our duty of care is to make sure trans people are safe when they are entering our sphere of influence,” Jones said. At most shelters, there are only male and female restrooms, putting transgender people in difficult, and often uncomfortable situations. Creating gender-neutral bathrooms or assigning people shower times can help alleviate this stress. “This assists other shelter members, too, like single mothers with young boys,” explained Jones.

Because disaster responders collect personal, and often sensitive, information, it’s important they respect people’s privacy, according to Jones’ experience. In many circumstances, a person’s gender identity isn’t considered confidential, particularly for those who identify as male or female. But for those in the LGBTQ+ community, privacy is especially important. “Just because somebody is out doesn’t mean they’re out to everybody,” explained Jones. It makes “confidentiality much more important.”

And, in some cases, individuals don’t want to be open about their gender identity for fear of violence and discrimination. Even when a person is out to their friends and family, they may not feel comfortable sharing that with strangers. “You just don’t come out once,” explained Jones. People “come out on a daily basis” to new friends, neighbors, and other people they meet. In shelters, where many people don’t know those around them, it’s common for people to “re-closet” themselves.

For Jones, ending this kind of discrimination, and the need for people to hide their identities, begins with changing the culture of disaster response. “I think in reality, in disaster response, the assumption is heteronormativity,” he said. “Checking that we are being as inclusive as possible…is really essential.”

The post Considering the LGBTQ+ Community in Disaster Response appeared first on Direct Relief.

A national family planning program makes birth control available to women over-the-counter, regardless of whether they have health insurance. But while measures like these have reduced the country’s birth rates over the course of several decades, experts say that the picture is more fraught. Stigma, gender relationships, and ethnicity may all play a role in a woman’s experience of receiving birth control.

“It’s viewed badly to use contraception,” explained Mariana Alarcón-Cassius, the Program Director of Reproductive Health at CASA, a center for sexual and reproductive health care in San Miguel de Allende, Mexico. Alarcón-Cassius leads a contraception-access program that makes condoms available for free at commonly frequented businesses, such as convenience stores and barbershops.

For unmarried women, contraception is particularly taboo, Alarcón-Cassius said: “A girl that has sex before marriage is made out to be a bad woman.”

For that reason, many young women experience judgment or resistance when trying to access birth control, particularly methods that aren’t sold over the counter, like the IUD. One 2018 study found that providers may hesitate to provide education or contraception to teenagers and women in their early 20s.

“The role of the provider and how they treat the client has an outsized role on whether that woman is going to be able to access contraception,” said Dr. Jean Marie Place, a professor at Ball State University in Muncie, Indiana, and the study’s lead author.

The study recruited women to act as “simulated clients” at health care facilities in Mexico City. The women were instructed to ask providers about their options for long-term contraceptives — methods that aren’t available over the counter and that usually require insertion by a provider.

“In some cases, providers didn’t want to provide information, but they weren’t direct about saying so,” she said. They would come up with excuses, such as telling the women, who ranged in age from 15-24, they were too young to be using contraception or they needed a parent present. “Many women…said to me, ‘I’ll never go back to that clinic, they were so disrespectful’ or ‘I felt so judged’ or ‘I felt so rushed that I’ll never go back to that clinic,’” said Place.

The source of this stigma – and the degree to which it affects birth control access – is up for debate.

Some experts point to religion. “It’s a heavily religious country with a predominantly Catholic faith, and so the faith may have played into some of those providers’ perspectives of not wanting to provide contraception,” said Place.

Others are skeptical of religion’s role: “I would say quite honestly, that in some ways, contraceptive access and stigma, religious stigma, is stronger [in the United States] than in Mexico,” said Dr. Deborah Billings, a reproductive and sexual health care researcher who has worked and studied extensively in Mexico.

For Billings, the bigger issue is reproductive coercion. While conducting research at a textile factory on the border, Billings found many of the women had partners who didn’t allow them to use birth control, “because, it’s like, ‘You’re mine. You will have my children. I have control over you.’”

Women described having to sneak contraception past their partner. “Trying to negotiate with a partner to say… ‘We can’t have sex right now because I’m going to get pregnant,’ was in most cases not going to fly,” said Billings. Instead, women opted for birth control injections, which last for up to three months and are virtually undetectable.

At CASA, patients have noted similar experiences. “I have seen women choose methods based on the comfort of the partner,” said Laura Herrera, a midwife at the center. “Some men believe that methods such as the IUD will cause sexual intercourse to be uncomfortable, that it will decrease women’s libido.” Others worry it’ll lead to infidelity.

These beliefs are often attributed to a hyper-masculine culture. “En Mexico, la cultura es muy machisma,” said Alarcón -Cassius. For women, this often means less autonomy over their bodies.

“Basically, what the hell are men or anyone doing telling anyone that identifies as a woman what they should do or not do with their body?,” said Nadine Goodman, a sexual and reproductive health activist who has worked in Mexico for decades “Gender inequality” is the main issue, Goodman said.

While intimate relationships can lead to reproductive coercion, health care providers are guilty of it, too, Billings said. While working at a hospital in Mexico, she often saw providers insert IUDs, without a woman’s permission, after giving birth. “There are definitely problems with consent,” she said.

Laura Herrera, the midwife from CASA, has had patients recount this same experience. “The biggest problem is that the changes or implications caused by the use of these contraceptive methods, especially hormonal ones, are not explained to women,” she said. “Women don’t receive adequate counseling.”

For indigenous women, the problems are worse. Providers are more likely to make decisions about their use of birth control post-delivery, according to Billings, who said it was especially common for providers to withhold information about their options or insert IUDs without their consent. “It’s not just a gender thing,” she said. There’s an “ethnicity dimension.”

When it comes to seeking out birth control, indigenous women are also more likely to be dismissed by providers, according to Place: “The providers were a little bit more harsh in rejecting the young women’s requests or in saying things like, ‘You know, you shouldn’t be having sex,’ and being forthright and…not using those nicety excuses.”

Economic status and location – rural patients are less likely to have their choice of birth control, Herrera said – also play a role in the complex question of how a woman will experience reproductive health care.

But these issues are not unique to Mexico. In many countries, women’s access to reproductive health care is complicated by social and economic factors. “I think worldwide it’s just a continuum,” said Goodman.

For Billings, access to contraception isn’t just about location or age. It’s about power. “The less power you have in society overall, the harder it is for you to access contraceptives,” she said.

Over the course of CASA’s eleven-year partnership with Direct Relief, the centers have received numerous shipments of medical aid to support their family planning programs and midwifery clinic, including hormonal birth control, condoms, and supplies to equip midwives for safe labor and delivery. Since July 2020, Direct Relief has provided CASA with more than $84,000 in grant funding to support its initiative to make birth control and sexual health education more readily available in the community.

The post In Mexico, Birth Control is Available Without a Prescription. Still, Women Have Trouble Getting It. appeared first on Direct Relief.

“You might have these abstinence-based programs that aren’t really cool with harm reduction… but because of the overdose epidemic and so many people dying, they’re finally getting on board,” said Burrows, who runs Challenges, Inc., a harm reduction group that distributes naloxone and clean supplies to drug users in South Carolina. The organization is the only syringe exchange program in the state.

Burrows started the group after his own battle with drugs. “I used to shoot heroin and cocaine,” he said, “so I’m a person in long-term recovery from substance use.”

In addition to Challenges, Inc., Burrows founded a substance use treatment clinic. The center offers patients medication-assisted treatment or MAT, which involves prescribing patients regulated opioids, such as Suboxone and methadone, to wean them off stronger, more addictive opioids. While the medications are chemically similar to heroin, they don’t produce the same euphoric effect.

Though MAT has been proven to be safe and effective in the treatment of opioid use disorders, many sober living communities don’t allow it.

Some homes express practical concerns about the medication, like how to regulate members’ doses to prevent misuse and diversion. Supporters of MAT are often quick to offer solutions, such as pill lock boxes and one-dose dispensers.

Still, Burrows said, other concerns are based on perception. One of the sober living homes he works with didn’t want to accept individuals on MAT because “he thought you would be able to tell which guys were on Suboxone and which guys weren’t.”

But even in homes that do accept those on MAT, the treatment is highly stigmatized.

One of Burrows’ patients lives in an Oxford House, whose rules are set by members and tend to be more permissive of MAT. Regardless, the patient’s treatment has become the subject of scrutiny. He “was just telling me how much crap he has to deal with on a daily basis from the guys that live there that are constantly telling him he’s not clean,” said Burrows.

The patient is being prescribed Suboxone for an opioid misuse disorder.

Despite generally narrow views about substance use treatment, sober living homes do have “great, great benefits,” said Burows, who lived in one during his own recovery. “If you don’t have a stable, safe place to live, then yeah, it can be really effective,” he said. “It gets you out of the environment you’re in and it gets you around new people that are hopefully also living a sober lifestyle.” In addition, sober living homes usually assist members in finding steady employment.

The sober living home model is based on the founding principles of Alcoholics Anonymous (AA), a community-based fellowship established in the 1930s to help those struggling with addiction. The organization follows a 12-step program which touts abstinence from all substances, which for some, includes opioid-based medications.

“A lot of people still hold to that philosophy because they feel that’s the way,” said Gregory Plakias, the chief marketing officer at Discovery Institute, a New Jersey-based detox and rehabilitation center. At the time of its founding, AA was the only support group of its kind.

But today, options for treatment are numerous and clinical methods, such as cognitive-behavioral therapy and motivational interviewing, have been shown to be highly effective. The 12-step program, once the poster child for addiction treatment, is no longer the leading model.

In fact, in recent decades the AA approach has been sharply criticized by scholars and medical professionals who say the program lacks scientific backing. “It’s not medicine, it’s not evidence-based,” said Plakias.

Nonetheless, people have found success using the model. In a comprehensive review of 27 clinical trials published in the Oxford Academic, AA was shown to produce rates of alcohol abstinence and alcohol use comparable to first-line clinical interventions and outperform them over follow-up, meaning people in AA were more likely to avoid alcohol and drugs over time than those using other treatments.

Regardless, the goal of all treatment programs is to promote recovery. While some programs define this as abstinence, others embrace a broader definition. According to Dr. John Gallagher, a licensed clinical social worker and associate professor in the School of Social Work at Morgan State University, “Recovery is not just about someone abstaining from drugs and alcohol.” Instead, he says, “recovery is about someone improving their quality of life.”

To achieve this, Gallagher uses medication-assisted treatment, which helps patients reduce symptoms of addiction, including cravings, tolerance, and withdrawal. When these symptoms are minimized, patients are able to lead more productive, functional lives—a key sign of recovery.

And because MAT helps patients sustain an improved quality of life, the medication is often used long-term. Some people are on Suboxone or methadone their entire lives. Despite the stigma, these opioid-based medications are like any other medication used for disease management, according to Gallagher. “We don’t tell people who have diabetes, ‘Well, you’re not in real recovery from diabetes ‘cause you’ve been taking insulin for three years,’” said Gallagher.

Despite the positive outcomes, MAT remains shrouded in controversy, primarily because it involves prescribing an opioid to cure an opioid addiction. “When…critics say you’re substituting one drug for another, our response is ‘Damn right we are,’” said Gallagher. “We’re substituting addiction–10 bags of heroin a day–for recovery.”

Plakias, who has been working in the field of addiction medicine for more than a decade, used to hold these views. “Fourteen years ago, I was probably more…geared towards abstinence-based [recovery] and feeling that for someone to be in recovery, you’re going to be all in or you’re not,” he explained.

But after seeing patients go in and out of treatment—from abstinence to overdosing—his perspective on how to achieve recovery has changed. “Today I see [MAT] a lot differently,” he said. “Today I see it as saving lives.”

Since 2017, Direct Relief has provided more than 1 million doses of overdose-reversing naloxone, free-of-charge, to health facilities, harm reduction groups, and recovery organizations. Challenges, Inc. and the Discovery Institute, both featured in this story, have received donated naloxone from Direct Relief. The medication will be distributed to sober living communities and individuals in rehabilitation to prevent lethal overdoses during recovery.

The post As Overdoses Spike, the Lines Around Abstinence-Based Opioid Treatment Are Starting to Blur appeared first on Direct Relief.

“We need to think about more creative ways to respond, [but] the first step…is to use data to get the picture clear,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis.

This week, Schroeder joined a panel of researchers, public health officials, and health care providers to discuss wildfire resilience at a webinar hosted by CrisisReady – a collaborative project between Direct Relief and researchers at Harvard School of Public Health, Harvard Medical School, Stanford University, and a network of researchers in epidemiology, public health and disasters throughout the world.

Using data, “we can get much more specific about the nature of the problem: who’s affected, the frequency of the problem, [and] the ripple effect of health problems,” said Schroeder.

The project aims to provide data on the scope of fire-related health impacts, which could be used by health facilities to better respond during future wildfires. For Dr. Joan Casey, an assistant professor of Environmental Health Sciences at Columbia University and a speaker on Friday’s panel, that’s a major research focus.

Casey examined the rates of respiratory disease-related hospital visits during the 2018 Carr Fire in Shasta County, California. She found a significant rise in people seeking medical care during the times with PM2.5 (a term for tiny particles 2.5 micrometers across or smaller) was higher.

“In weeks that had greater than 5.5 micrograms per cubic meter, we saw a 14.6% increase in respiratory-related ED visits,” she said. “The next two weeks we saw no increase, so it really seemed confined to when those PM2.5 were elevated.”

In addition, Casey’s work has shown that these health impacts disproportionately affect individuals who are medically vulnerable. In studying the effects of the 2019 Getty Fire in Los Angeles County, she found an additional 0.5 visits per day among those with dementia in the months following the fire.

These insights will prove valuable as health officials seek to mitigate the effects of wildfires. “We know the older adult population is going to increase, so to protect them we need to keep thinking about social and environmental determinants of health,” said Casey.

Those who are medically vulnerable are also disproportionately affected by public-safety power shut-offs, which have become a characteristic feature of the California wildfire season. “There were nearly 1,100 eight-hour events in 2019,” said panelist Dr. Mathew Kiang, a professor of Epidemiology and Public Health at Stanford University. “So these are fairly common and they can impact quite a few people,” he explained.

For some, particularly for those that rely on electronic medical equipment, power shut-offs can be deadly. Without backup power, these individuals have no way to keep their devices running. Through his research, Kiang was able to find “the intersection between where these power outages are happening and where medically vulnerable are located.” According to Kiang’s research, the highest-risk counties include San Bernardino, Riverside, and Orange–all in Southern California.

While medically vulnerable people are at higher risk during power shut-offs, Schroeder points out that these events don’t “follow the conventional lines of social vulnerability.” In other words, both high and low-income communities have experienced an equal share of shut-off events. But for those who can afford to invest in backup power systems, the impacts may be less severe. “One issue is if the grid is unstable. The second is who can buy their way out of that problem,” said Schroeder.

Community health centers, which serve low-income and under-insured patients, are among those most at risk of losing power. “As of 2021, we still have very few health centers in California that have what you would call a truly resilient power system and that’s unequally distributed based on location, the relative wealth of the community, and a number of other factors,” he said.

These concerns are only compounded by the Covid-19 pandemic. It’s still necessary to avoid traditional shelter settings in favor of hotel rooms or other “non-congregate” accommodations. But with tourism picking up, “hotel rooms are going to be harder to come by,” explained Schroeder.

And as the Covid-19 vaccine rollout continues, public safety power shut-offs pose a new threat. The challenge is how to “maintain the vaccines to make sure there’s no cold chain interruption during wildfires,” said panelist Michael Witte, the Chief Medical Officer of the California Primary Care Association and a family medicine physician. If a health facility’s refrigerator shuts down, their vaccine supply could spoil.

These heightened risks are prompting providers like Witte to re-examine how they provide care during wildfire season. “One of the things we need to look at as health care providers is how do we get out of the four walls and help people,” said Witte, who serves a predominantly rural patient population in Northern California. “The model for how we take care of people needs to change dramatically,” he said.

A full-length recording of Friday’s webinar can be found on the CrisisReady webpage.

The post To Prepare for California’s 2021 Wildfire Season, Health Officials Begin with Data appeared first on Direct Relief.

“Nepal is on [a] steeper trajectory in terms of basically all metrics in the Covid outbreak on a per capita basis,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis.

The country is reporting nearly 9,200 cases per day, which translates into a seven-day rolling average of about 296 cases per million, according to the Johns Hopkins Covid-19 Dashboard by the Center for Systems Science and Engineering. In comparison, India is reporting 231 daily cases per million, though the country’s daily case totals have consistently hovered at or above 300,000.

The case burden has taxed Nepal’s already fragile health care system, leading to critical oxygen and medical supplies shortages. According to an announcement by Nepal’s Ministry of Health and Population last week, hospitals in about one-third of the country’s 77 districts are at or near capacity.

Since April, the outbreak in Nepal has followed a steep upwards trajectory, with cases officially peaking at 9,317 per day on May 12. Cases and deaths have since declined, albeit marginally. “There’s some indication that the worst of the indicators are flattening out,” said Schroeder, who pointed to the reproduction rate, or the number of people infected by one Covid-positive individual. At the end of April, that number was 2.1, meaning for every one person infected with Covid-19, two more would contract the virus. Now, the country’s reproduction rate is closer to 1.25.

Still, Schroeder cautioned against drawing concrete conclusions: “Officially speaking [the outbreak] has peaked, and it is declining, but that’s probably not the case.”

Due to a lack of testing, cases are almost certainly missing from official tallies. And because of gaps in health care services, many of those cases are likely hiding in rural areas.

“Although the hardest hit area is the Kathmandu Valley…as you go out from the major city, you’ll now see these waves of Covid hitting areas…that are lower density but have very poor health infrastructure,” said Schroeder.

The post On a Per-Person Basis, Nepal’s Covid Surge Exceeds India’s appeared first on Direct Relief.

“In the U. S., our typical way that we provide care is we put on our white coats…and we have all our initials after our name, and we’d like to be called doctor,” said Endrizal. “Local people here have a hard time with that.”

Endrizal heads up the community outreach department at Wahiawa Center for Community Health in Wahiawa, Hawaii—an isolated community near Oahu’s North Shore. The town used to be an agricultural mecca. Sugar and pineapple plantations drew thousands of workers from across Asia and the Pacific throughout the early 20th century. Workers received housing, education, and health care through their employers.

But then, in the mid- 1900s, these companies moved overseas to cheaper labor markets, leaving little infrastructure in their place.

Today, a significant portion of Wahiawa’s population lacks access to basic goods including medical care, adequate housing, and electricity. “This community is kind of stuck in time,” said Pua Akana, the health center’s director of pharmacy.

Due to low rates of insurance, the hospital’s emergency department is often used as a clinic for primary care needs. Endrizal says this is particularly common among those experiencing homelessness: “They go there because they’re hungry, they go there because they’re having pain and they need opioids, or maybe they need to use the bathroom.”

When this happens, the hospital calls Endrizal. “The nurse manager and I talk a lot. She’ll call me, ‘Oh, so-and-so’s back in the ER’ and I’ll tell her, ‘Okay, send them down to us.’”

To help reach these patients, BD, together with Direct Relief, provided a $150,000 grant to help Wahiawa Health incorporate community health workers into their medication management program. This investment is part of the broader BD Helping Build Healthy Communities initiative. With this funding, community health workers will help patients overcome barriers preventing them from adhering to their medication regimens, including housing and food insecurity, a lack of electricity, or a language barrier.

In order to establish trust with these patients, many of whom are wary of the medical establishment, the health center practices what’s called “cultural safety.” The approach focuses on ensuring patients feel respected and heard, which can be difficult given the variety of cultural backgrounds. Many patients are first generation Pacific Islander and often speak languages that providers don’t know.

At Wahiawa Health, a diverse staff helps bridge this gap. “When patients see someone that looks like them and talks like them and has the same mannerisms and whatnot, they’re much more likely to communicate and share what their concerns might be,” said Endrizal.

But cultural safety not only applies to interactions within the health center. It’s an integral part of their outreach. Staff frequently provide care at the local homeless encampment, but they’re sensitive in their approach. “There’s a protocol…and the protocol would be for me to be invited,” said Endrizal.

This invitation usually comes from the leader of the encampment, known as the Governor. “For me to understand that protocol and follow that protocol, that’s cultural safety,” she said. This approach has helped the health center reach communities cut off from the health care system, expanding access to care.

In addition to establishing trust with their patients, the health center works to understand what their lives are like.

“Is there electricity? Is there food insecurity? [Are] there financial constraints where patients are not able to adhere to their medication?” said Dr. Akana.

These factors, known as social determinants of health, make it difficult for patients to prioritize their health, often resulting in worse health outcomes.

Most patients at Wahiawa Health have a chronic condition; the most common are diabetes and hypertension. Managing these diseases requires adhering to a strict medication regimen, such as daily injections of insulin, a temperature-sensitive medication used to manage high blood sugar in those with diabetes.

“It’s so classic for someone to maybe scold the patient, ‘Why aren’t you taking your insulin? You keep forgetting or, or what’s going on?’ when we haven’t asked if they have a refrigerator,” said Endrizal.

These barriers, such as not having electricity or being unable to afford a certain medication, can cause patients to modify their treatment plan or skip it altogether. “A lot of patients here will take their medication every other day or every couple of days to stretch it out,” said Dr. Akana.

This can lead to overprescribing. Providers might not know a patient is skipping doses and may prescribe an additional medication if they see their condition is not improving. “That is very, very common, where we think that [the] medication wasn’t enough or isn’t working for a patient so we add on,” said Dr. Akana. “In actuality it could be something basic: a language barrier–they didn’t understand, it could be finances.”

Fear or distrust of medical professionals only compounds the issue, according to Dr. Akana. “They could be afraid to tell me…’Hey, I just, I couldn’t afford it. I never picked it up,’”

But building trust with patients is not only about improving their own their health. The effects have the potential to be generational. “In my family, dying from complications of diabetes was just accepted,” she said. “We just thought that’s the way it is.”

As a medical professional, Dr. Akana has broken that cycle. Now, she wants the same for her patients. “I think that would be a change long-term,” she said.

For more information about Wahiawa Health, a federally qualified community health center that treats patients, regardless of ability to pay, visit their page here. More information on BD’s Helping Build Healthy Communities program can be found here.

The post On the Island of Oahu, Providers Win Patients’ Trust. Then Treat Their Chronic Disease. appeared first on Direct Relief.

But minimizing the impact of India’s second wave is still possible. To do so, the country will need to shift its approach to care, according to Dr. Satchit Balsari, a practicing emergency medicine physician and Assistant Professor at Harvard T.H. Chan’s School of Public Health and Harvard Medical School. Dr. Balsari and his colleagues are drafting evidence-based recommendations for providers treating India’s critically ill. Throughout the pandemic, Dr. Balsari has written extensively on the state of care in India and contextually relevant public health interventions.

This week, Direct Relief sat down with Dr. Balsari to discuss India’s current gaps in care and what, if anything, can be done to improve the severity of the crisis over the coming months.

Direct Relief: Why is India experiencing an explosion of cases at this point in the pandemic?

Balsari:  Well, I think it is a combination of viral strains, low levels of vaccination, close to no masking for a long period of time–through early 2021 in most communities–and no physical distancing in most communities as well, including large political and religious mass gatherings, as well as, social gatherings–parties, weddings–since late winter.

Direct Relief: What are the current gaps in clinical care?

Balsari: The lack of adherence to well-established, standardized, evidence-based protocols. Medical practitioners across India are incorrectly managing and treating patients using a whole bunch of medications that have long been debunked, including antibiotics, anti-parasitic medications and inappropriately using treatments like Remdesivir or Tocilizumab, which will have an effect, if any, only when the rest of the care is optimized. In the current situation, when there is not adequate oxygen to care for patients with oxygen needs, subjecting patients to a battery of unnecessary lab tests and diagnostic imaging that has no bearing on what care can actually be provided for the patients is just gross malpractice. Families are draining their finances on trying to purchase these drugs on the black market and they’re not going to make a difference in their relatives’ lives when all other care is not optimized.

Direct Relief: Current modeling shows cases peaking at nearly 1 million by mid-May and daily deaths reaching 4,500 by the end of the month. What can India’s health system do now to reduce the number of virus-related deaths in the coming months?

Balsari: Patients with mild symptoms can monitor and self-care at home, but it is important that monitoring is initiated. So in the villages in India any attempts at isolating at home should be tightly plugged in with monitoring by community health workers who can identify patients at risk for requiring more oxygen. The only dent we may be able to make on mortality in India is by taking those patients that have moderate symptoms and giving them appropriate care so that they do not need specialized or critical care because India does not have the capacity to provide that. That is the only place where we can make an intervention. And interventions there are thankfully simple. They’re oxygenation, pronation, and steroids. And if we can protocolize this and provide support at the community level to do at-risk identification, early identification at home, transferring them to facilities that can provide oxygen, steroids and pronation we may be able to change mortality.

There are challenges. Without electricity, you cannot run oxygen concentrators. Oxygen cylinders are expensive to buy and transport and won’t provide enough oxygen at the flow rate that you need for it to be effective for COVID-19 patients. So, as people are thinking about field hospitals for India, you have to think about very context, specific issues like, backup generators when there’s no power so that you can actually run these oxygen concentrators and C-PAP machines that provide oxygen.

Direct Relief: With 1.4 billion people, India is an incredibly dense country. Local-level differences can change the contexts in which health care providers are working. What is the role of community-oriented care in responding to this current crisis?

Balsari: It’s extremely important. India has rich societal networks, a rich presence of community-based organizations, a vibrant civil society, and by and large people always caring for themselves and their communities in the absence of a robust healthcare system. So if there is any hope that we can decrease mortality, it will be through augmenting the support that communities need to care for patients with a mild amount of symptoms.

Direct Relief: Despite India being one of the world’s major producers of vaccines, only 2% of its population has been fully vaccinated. What if any role will vaccination play in subduing the current crisis?

Balsari: Vaccination will take a long time to achieve herd immunity, so one can only hope that the government does all that can to reduce financial, social and political barriers to vaccination.

This transcript has been edited and condensed.

In response to India’s second wave, Direct Relief is preparing a series of shipments bound for health facilities across the country including an 11 pallet shipment of personal protective equipment, 1 million KN-95 masks and over 3,600 oxygen concentrators–all bound for Mumbai. Six pallets of medical aid have been prepared for Calcutta and 4 pallets for Pune.

The post What Can Be Done to Subdue India’s Covid Crisis: A Q&A with Harvard Medical School’s Dr. Satchit Balsari appeared first on Direct Relief.

Many lack transportation to get to and from a vaccination site. Others live nomadically, making it difficult to commit to a second vaccine appointment.

But according to homelessness activist Tasia Thompson, misinformation is the primary issue: “Our main barrier is the fact that we have lots of social media, lots of internet sites, giving information, which may not be correct.”

Thompson works for Groundswell, a UK-based grassroots organization that connects those experiencing homelessness with health care services. Like many of their employees, she was homeless for years before getting involved. “That’s the hardest thing is trying to get across to people that yes, we may be coming from the health side and worked with the doctors, but we understand their fears and we’ve all been there,” said Thompson.

On this episode of the podcast, we speak with Thompson and others about their own experiences with homelessness and the obstacles preventing those who are homeless from accessing the Covid-19 vaccine.

Direct Relief has supported Groundswell with a $125,000 grant to support their vaccination efforts in homeless communities across the UK. The group helps individuals register to receive the vaccine, accompanies them to their appointments, and delivers information. In addition, the organization is training an outreach team to administer the Covid-19 vaccine to individuals living in homeless shelters and encampments. All staff members involved in Groundswell outreach efforts have had previous experience with homelessness.

Transcript:

People who are homeless urgently need the Covid-19 vaccine, but getting it to them is hard.

THOMPSON: So at the moment, we are doing loads of COVID vaccinations outreach, which has been a very prime thing right now where the government wants to make sure that everyone is getting at least their first vaccination.

Tasia Thompson is a project worker at Groundswell—a UK based organization that connects those experiencing homelessness with health care services.

THOMPSON: So we’re going to lots of hostels, temporary accommodation, also going to people on the streets to ask them if they want to be vaccinated. So we’re very, very busy at the moment. Lots going on.

Thompson got involved with the organization after years of homelessness.

THOMPSON: About five, six years ago, I had myself a nice mental breakdown due to stresses of work, stresses of life. Never, ever thought that I would ever be in that situation. I was one of them people who was always like that will never be me, that won’t happen. I have enough support. It can’t happen. You could have the greatest support and still have a moment where things don’t connect correctly for you. So, I became homeless.

RAFANELLI: What would you say is the biggest barrier to vaccination?

THOMPSON: The biggest barrier is, I believe, is the fear from social media. We have lots of different sites that are telling people all different news. I’m sorry, you want me to stop? Cause that lovely police car. You can tell we’re in London. OK, I’ll start again.

Essentially, misinformation. Thompson says its rampant.

THOMPSON: So our main barrier is the fact that we have lots of social media, lots of internet sites, giving information, which may not be correct. So people have read all different horror stories. People have been told that they’re going to have a chip put in them or that they’re doing this because it’s a big scheme to do something. And that’s the hardest thing is trying to get across to people that yes, we may be coming from the health side and worked with the doctors, but we understand their fears and we’ve all been there and we’ve done our research and here is what we’ve got to show you to be able to say don’t panic so much. Cause that’s the hardest thing. Social media has caused a massive stir with this jab.

Dena Pursell is also no fan of vaccines, but even she has made an exception for Covid-19.

PURSELL: I mean, I’m an anti-vaccinator. And I had the vaccine.

Pursell is a homeless healthcare navigator at Groundswell. Like Thompson, she was homeless for years before getting involved at the organization.

PURSELL: I thought how can I go and encourage people if I haven’t had it myself? Because I was very anxious. It’s a new vaccine. We don’t know much about it. But then I talked to a local doctor who we call GP service over here and listening to him it actually made me want to have the vaccination, because he explained to me what the vaccination does. He explained to me what the virus does, you know, and the implications if you don’t have it are quite severe. So that encouraged me and now I’ve took it. It’s making me much more confident in trying to encourage others.

In addition to misinformation, she says general fear and anxiety are an obstacle to vaccine uptake.

PURSELL: I mean, a lot of them have got good intentions. They do want to have the vaccine, but a lot of them are unable to get to that point. Being homeless in itself is such a big obstacle. Not only have they got homeless and to be quite honest, a lot of people who are homeless, their health is their last concern. Their health doesn’t come first to be quite honest. And it’s their health that suffers a lot when they are homeless, mental health, physical health. So a lot of people who’ve got fear and anxiety, so they’ve got addictions, a lot of people self-medicate, you know, I don’t want to think about that, you know, and. Obviously now, you know, people have to think a bit, they’ve not only got themselves to think about, and we’re trying to encourage people, you know, we’ll all be all the people, your friends and your peers and your families, and, you know, you need to keep everybody safe, you know, not just yourself.

Throughout the pandemic this line of reasoning has been used to encourage adherence with public health measures. Wear a mask to protect not only yourself, but those around you. Get vaccinated to slow the spread in your community.

Public health officials have called upon individuals to put the interests of society before their own. But for those experiencing homelessness–many of whom feel alienated by society–this may not be the most effective approach.

TASIA: I feel a lot with people that are homeless, they feel a little bit like no one probably really cared before so why would you now need me to come along and do something? It feels like there’s a bit of a hidden agenda behind it. Especially for some people they don’t have a doctor because they don’t want to be attached to the system. And so it feels a little bit like, to some people, that they’re being made to be part of this system and that there’s very much a big scam behind all of it, so they feel like they’re being asked by the system, which they feel hasn’t given them anything or hasn’t helped them.They’re being asked by the system to re return some favor. That’s never been. You know, given to them?

THOMPSON: Yeah, It’s like, ‘Oh, here you go. We haven’t done anything for you, but now we’re going to just give you this vaccine and we want all your details please.’ And it’s like, ‘You didn’t help me last week when I needed to go and see someone because I had an abcess on my arm or my mental health, you left me then.’ But because now this is global, we have to look as if we’re doing the correct thing. And it is, people do feel very much like that. They’re just like, ‘No, not having it. I’m not, I’m not going to do that.’

To better understand the roots of this skepticism, I spoke with homelessness expert Dr. Elizabeth Bowen

BOWEN: I am Elizabeth Bowen and I’m an associate professor at the University of Buffalo School of Social Work.

She says many individuals’ past experiences give them reason to distrust authority.

BOWEN: So it’s really a given that trauma goes along with homelessness, many people that are homeless have experienced various types of trauma prior to becoming homeless, as well as trauma while being homeless. And that can be in the form of violence that occurs to people physically mentally, emotionally and psychologically, sexually while being homeless and while living on the street or in other unstable housing situations. And sometimes that trauma is from other people. Sometimes that trauma may come specifically from authority figures, from police and from other people that are in various positions of authority. So, because this is such a new issue of vaccinations and COVID vaccinations it is not that well researched at this point, but I would think that these issues of trauma and specifically with people in authority are going to come up often as a barrier, that people that are homeless may not trust people who are saying they get a vaccine and they have good reasons not to trust people in authority.

That was the case for Pursell. She became homeless when she was 16 and from there was either living on the streets or in prison. She began using drugs to cope.

PURSELL: I felt alienated by everybody, but then that was partly, probably be my fault, you know? They did try and support me, but it’s very difficult to explain when you’re homeless, you’ve lost all hope, you’re at the end of the road, you probably self-medicate because you don’t want to think about all the crap that’s going on, all the rubbish that’s going on around you. The only thing you’re thinking about is to get away from that horrible place, that horrible space. So if you’re self-medicating, you know, you don’t want anyone to come and try and help you, you really don’t. So that was probably one of my downfalls not accepting all the support that I probably could have had, and lack of trust as well.

It’s hard to trust people, especially when you’re homeless and maybe you’ve been let down by one person in your life or in services, it’s very hard to build that trusting relationship again. It’s really difficult.

Now, Pursell has been drug-free for 19 years. She’s been volunteering at homeless charities for over 20.

This transcript has been edited for clarity.

The post In Homeless Communities, Gaining Trust is Key for Vaccination Efforts appeared first on Direct Relief.

“If you live in fear or you live in the shadows, you don’t really know how to get help,” said Rachel Rios, executive director of La Familia Counseling Center in Sacramento, California. The center provides counseling and support to low-income families in the Sacramento area, with a special focus on Latin American communities.

“If you don’t have access to a digital device, if you don’t know the language, you don’t really know that there might be help available to you,” Rios explained.

For this population, affordable mental health care is hard to find. While Medi-Cal, the government insurance for California, covers services for children regardless of immigration status, undocumented adults are not eligible. While some health clinics offer therapy to uninsured patients, the healthcare landscape can be difficult to navigate, particularly if English isn’t your first language.

Recently, LAFCC was approved for a grant allowing them to fund one-on-one counseling sessions for parents, in addition to children and family sessions. Because LAFCC is plugged into the community, they are well-positioned to connect people with mental health care who might otherwise go without. “We’re known within the community and we’re known within the school districts,” said Rios. 

Providers at LAFCC have found that, for many patients, being undocumented is a major stressor. “Parents have this incredible amount of fear around immigration status,” said Rios. “A lot of that is then manifested in their behavior.”

Rios described several scenarios in which one of two parents was deported, leaving the other caretaker and their children behind in the U.S. Understandably, the situation provokes major anxiety and depression. “We’ve had moms that just can’t get out of bed,” she said. In this situation, children often try to take care of themselves without the support of family or government services. “The kids didn’t want tell anyone because they’re afraid that Mom would get deported,” explained Rios.

In addition, many of these parents have endured trauma earlier in their lives, including during their migration to the United States. The counseling sessions have allowed some to talk about their experiences for the first time. “We can go deeper into…the abuses that the parents experienced but were never allowed to talk about because it wasn’t something that was even discussed.”

For many of these children, the family dynamic comes with its own challenges. There is “a lot of guilt from kids because they know how much their parents are sacrificing for them,” said Rios. Some feel pressured by expectations, leading to stress and anxiety. They want to “appreciate what their parents are sacrificing for and try to do something better for the family,” but experience “guilt when they can’t,” she explained.

Stigma is another concern for patients. “A lot of my work surrounds…normalizing what mental health is,” said LAFCC’s mental health coordinator Adriana Martinez, who does weekly check-ins to assess a family’s well-being and connect them with outside resources, including long-term counseling and legal help. “I call them wellness checks,” she says, explaining that the phrase “mental health” can cause hesitancy among patients.

While most referrals to LAFCC’s counseling program are made by schools or health care providers, more than half have come from parents themselves during the pandemic. These are called ‘self-referrals.’ “We thought that was success on all kinds of levels,” said Rios. “One, we’ve broken down this barrier about stigma, and two, parents [know] where to reach us.”

The success of these programs is largely due to providers’ own background and familiarity with their patients’ culture. Martinez, the mental health coordinator, moved from Oaxaca, Mexico when she was 7 years old. Her family is indigenous Mixtec. “My grandma still speaks Mixteco,” she said.

It’s for these same reasons LAFCC, which is primarily a children’s mental health provider, emphasizes family counseling. “In Latino culture, it’s really all about the family, and so you really can’t do one thing without the other,” explained Rios.

If parents need long-term counseling, LAFCC facilitates the connection with an outside provider. “By doing this warm handoff, what we’re also demonstrating to these other providers is that they need to have cultural competence.”

Rios recalled referring a non-English speaking patient to another counseling center. We “were like, ‘How are you going to translate? This person speaks predominantly Spanish,'” said Rios. The answer? The center used Google Translate for five months until finally hiring a bilingual therapist.

Direct Relief provided La Familia Counseling Center with a $50,000 grant to support their Covid-19 vaccination efforts. The organization, in partnership with the Sacramento Native Health Center, is hosting weekly vaccine clinics to protect medically underserved communities against Covid-19 and have worked with Sacramento County to translate Covid-19 vaccine information into Spanish.

The post Immigration Status is a Gatekeeper to Mental Health Support. This Clinic is Changing That. appeared first on Direct Relief.

The link is believed to be bi-directional, meaning both contribute to one another. Research by the U.S. Centers for Disease Control and Prevention shows nearly one-third of patients diagnosed with diabetes also experience depression, while those with depression are at higher risk of developing a chronic condition, according to the National Institute of Mental Health.

The relationship is often attributed to behavioral factors, such as diet and exercise. But scientists say physiological changes due to depression and chronic disease could also play a role. “For a long time… it was thought that whatever happens in the body stays in the body,” said Dr. Alan Kim Johnson, a professor of health psychology at the University of Iowa. But now, researchers have shown “profound communication between the brain and the body,” said Johnson.

As theories on what causes these comorbid conditions develop, so has treatment. “In our culture, we really split people apart,” said Dr. Tim Derstine, a consulting psychiatrist at Centre Volunteers in Medicine. Derstine is involved in the clinic’s effort to integrate mental health services and chronic disease care. “We try to look at it from 360-degrees,” said Derstine.

On this episode of the podcast, we explore the relationship between mental health and chronic disease and speak with providers who are integrating therapies to more effectively treat their patients.

Centre Volunteers in Medicine (CVIM) is one of eight health facilities to receive funding through the Teva Enhancing Access2Care Program — a joint initiative sponsored by Direct Relief and Teva Pharmaceuticals. Since launching in 2017, the program has provided more than $450,000 to health centers and clinics taking innovative approaches to care. At CVIM, funding has been used to integrate behavioral health checks into primary care appointments, expanding access to mental health services for patients who are low-income or uninsured. The clinic is currently in the process of analyzing data on the effects of treatment integration.

Transcript:

While mental health and chronic disease are closely connected, scientists are still figuring out precisely how. But one thing is clear:

LANDERS-NOLAN: “The more trauma a person experiences, the higher likelihood they will acquire or experience significant chronic health conditions.”

Geoffrey Landers-Nolan is a licensed professional counselor at Centre Volunteers in Medicine in central Pennsylvania. He specializes in interpersonal trauma, including domestic and sexual violence.

RAFANELLI: “So in, in your patients that have experienced trauma and are going through depression, anxiety do you see high rates of chronic disease?

LANDERS-NOLAN: For sure. Yeah. And with trauma, especially. The link between traumatic experiences and chronic disease should be extremely well-known.”

Landers-Nolan is part of CVIM’s effort to incorporate mental health services and chronic disease care.

LANDERS-NOLAN: “The physiological and physical impacts from experiencing depression and experiencing lots of other impacts post-trauma can lead to serious health consequences down the line. They end up kind of multiplying each other.”

The correlation between the two is often chalked up to behavior. When someone is depressed or anxious, they may stop exercising or eating less healthy. Conversely, if someone has a chronic condition, they may experience negative thoughts or worries that can lead to anxiety or depression.

But what if there’s more than behavior at work? Can chronic disease induce depression? Can depression cause disease?

I put the question to Dr. Alan Kim Johnson, a professor of health psychology at the University of Iowa.

He says inflammation is the common denominator. When the body is stressed, inflammatory chemicals are sent to both the body and brain.

JOHNSON: So our interest was to develop an animal model that would see if we saw signs of depression in the animal if we manipulated the heart. In other words, we can experimentally induce heart failure or heart disease and study the animal in terms of their behavioral changes that would be indicative of depression. We studied rats, so that’s not to say rats show all the kinds of signs and symptoms that are necessary to meet the criteria for major depression.

But one of the things that is able to be quantified in animal research is something called the hedonic state. In other words, how the animal responds to pleasurable situations like a sweet solution or rewarding brain stimulation. You put an electrode in particular areas and they’ll respond for positive reward. And we have to assume that poor little guy didn’t know much about his immortality being compromised. So what we found was that indeed with heart failure, the animals go anhedonic. In other words, that means a failure to experience pleasure to something normal.

And when we asked the question, well, if we induce psychological depression in animals do we see signs of heart disease, cardiovascular disease? And we can do that. There are a lot of models. There’s an experimental model, where very minor kind of little annoyances are presented to the animal.

For example, you put an animal in an environment for a few hours and flash a strobe light. Or you present, randomly what’s called white noise, or deprive an animal for a short period of time of water and then give back an empty drinking tube.

These are things we think that are probably comparable to being stuck in traffic in the morning, your morning commute, that sort of thing. So nothing is severe at all. I mean, nothing that would create tissue damage. And so, it takes about four weeks for the animals to become significantly anhedonic.

In other words, we test them once a week for their intake of sugar and we see that decline over time as compared to control animals. And then when we look to see if this has any effect on their cardiac function, we find that the animals are more susceptible to cardiac arrhythmias. That would be a sign of heart malfunction. And so it works both ways.

RAFANELLI: Why were the rats more susceptible to cardiac malfunction? What was the mechanism?

JOHNSON: Well, at this point, we never pursued that further, but the likelihood is that one of the things that occurs because of stress–major stress, minor stress–is activation of our sympathetic nervous system. If you had psych one, you probably heard about the fight flight response, right? So you know the cardiac sympathetic nervous system controls our heart rate. And sympathetic activation increases the rate that the heart beats and increases the activity to blood vessels whose diameter is important for controlling blood pressure.

While chronic disease and mental health are interconnected, they’re often treated separately. Primary care physicians prescribe chronic disease medication while psychiatrists prescribe anti-depressants. But if the two are linked, integrating treatment could be an effective route.

To better understand the debate, I spoke with Timothy Derstine, a psychiatrist at Centre Volunteers in Medicine.

DERSTINE: I’m an adult and addiction psychiatrist, and I’m a consulting psychiatrist to CVIM, Centre Volunteers in Medicine.

Many of his patients also have a chronic condition. Diabetes and hypertension are common.

RAFANELLI: So have you seen evidence of your patients improving their mental health and then improving their chronic condition?

DERSTINE: Yeah, it really goes both ways. So part of what I do with my patients is take a comprehensive medical history just as your primary care doctor would do. And often things come up like high blood pressure or elevated blood sugar that are not being currently managed. And so I’m often making referrals for people to see a primary care physician because they haven’t had a physical in a long time or they haven’t had blood work done for a long time or, coming into my office is the first blood pressure check they’ve had for a very long time.

So I’m helping people find primary care clinicians quite often. Just like primary care folks see patients who are not responding well for a variety of reasons because of a trigger–alcohol and mental health issues–the flip side is also true.

I see people who may have an abnormal thyroid function or other kinds of hormonal dysfunction. So, referring them for assessment is it’s very common.

RAFANELLI: What does a chronic condition like hypertension or diabetes do to the brain?

DERSTINE: That’s certainly part of our basic medical training. Just in the past, three weeks I’ve had multiple patients who have been seeing me for months or years for a variety of different things and have had difficulty with their cognition. And in these cases that I’m thinking about, it was either high blood pressure or diabetes that hadn’t been adequately controlled and caused vessel disease. In the brain, we need good blood flow and when there’s small vessel disease, for example, from inadequately treated high blood pressure or mini-strokes or things like that, that directly affects cognition.

And so the other thing I’m often doing is referring for neuro psych testing because psychiatric illness can present sometimes with difficulty with attention, concentration and focus, and so people may think, ‘Oh, it’s ADHD’ or ‘I’m depressed’ or ‘I’m anxious’ and sometimes they have a dysfunction in their brain because either the brain isn’t getting enough oxygen for whatever reason, or there’s some other medical problem going on.

Derstine says if treatment were integrated, many of these conditions could be prevented.

DERSTINE: So one of the things that I often say is people are one person and in our culture we really split people apart. There’s the drug and alcohol side, there’s a mental health side, there’s cardiology and, primary care.

In Pennsylvania, the way we deal with privacy around drug and alcohol results in us being split apart. So at one clinic that I work at I can’t have access to the drug and alcohol records because of privacy issues. And so I’m trying to treat a patient from a medical and a psychiatric standpoint, and I don’t have access to the drug and alcohol side of the picture when on some cases I’m doing kind of both sides of the coin.

We’re one person, whether we have the psychiatric side, so to speak, or the drug and alcohol side or the medical side. I think we really need to be working on integration and communication across those different domains because often one hand doesn’t know what the other hand is doing and the person who’s in the middle ends up suffering for lack of coordination and communication around them.

This transcript has been edited for clarity.

The post Chronic Disease and Mental Health are Linked. But How? appeared first on Direct Relief.

Over the next three weeks, the country is expected to add up 1.3 million new cases, according to modeling by Direct Relief and Facebook AI Research. “[The model] follows what appears to be a set of increasingly concerning stories about case trends across the United States,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis.

Chicago, Illinois is predicted to see the nation’s highest increase in cases, with Los Angeles County following close behind. Cook County, where Chicago is located, could add nearly 30,000 new cases before the end of April, according to the model’s forecast.

In Michigan, cases are expected to increase more rapidly than any other state, with areas in and around Detroit showing the most troubling trends. Overall, the state is on track to add nearly 70,000 cases over the next three weeks.

Officially, the CDC predicts cases to remain stable over the next month, though the forecast shows potential for variance. The model is an average based on dozens of potential scenarios. While one model shows cases increasing by nearly 1 million over the next month, another shows an increase of less than 200,000. Hospital admissions are expected to creep up this month, according to CDC models, while deaths will plateau after multiple months of decline.

Currently, more than 4 million Americans are being vaccinated against Covid-19 each day. Roughly 108 million Americans have received at least their first dose, including 63 million who have been fully vaccinated, according to data released by the CDC.

The Global Picture

Internationally, cases are rising sharply in several regions, including the Americas, Africa, and Asia.

In Kenya, new restrictions have been announced as a third wave of coronavirus cases impacts the country, overcrowding hospitals, filling intensive care units to capacity, and straining resources, according to France24.

Across Latin America, the P.1 coronavirus variant is challenging health care systems, including in Brazil where the variant was first discovered. In Paraguay, 50% of new cases around the border with Brazil are attributable to the variant as are 40% of new cases in Chile. Peru and Uruguay are both facing the potential failure of their health systems, according to the Washington Post. The variant has gained significant ground in Colombia, Argentina, and other countries in South America as well.

In India, a record 100,000 new cases were reported in a single day, according to reporting by NPR. A double-mutant variant was identified in the country last month, as well as in California.

Data in Action

Since January 2020, Direct Relief has provided millions in medical aid to health care facilities responding to the Covid-19 pandemic, including 5,906 shipments to more than 1,400 partner organizations in the United States and abroad. In total, the organization has sent assistance to 52 states and more than 60 countries.

In order to strategically allocate these medical supplies, staff rely on insights from the organization’s Research and Analysis team, who closely monitor the world’s most vulnerable regions. Through intensive data analysis, the team is able to show which areas are at greatest risk of being overwhelmed should there be a surge in coronavirus cases. These insights help inform programmatic decisions on where aid is needed most.

As cases climb, Direct Relief will continue to use data-driven modeling to inform the deployment of aid.

The post As Vaccinations Against Covid-19 Pick Up, Models Show Cases Climbing appeared first on Direct Relief.

This weekend, Direct Relief staff hand-delivered multiple caches of emergency medical supplies to San Diego, where medical services and shelter are being provided to unaccompanied minors that have crossed the border.

According to the Los Angeles Times, the San Diego Convention Center has capacity for 1,450 girls who will receive daily meals and clean clothes, as well as frequent coronavirus testing.

The federal government called on healthcare providers in the area to establish a safe place to stay for hundreds of underage female migrants who would otherwise be housed in makeshift emergency shelters or Border Patrol facilities, which the Biden administration has deemed unfit for children.

Saturday’s delivery included supplies to treat trauma-related injuries, over-the-counter medications, and hundreds of individual kits containing soap, shampoo, menstrual products and other hygiene products.

In addition to providing emergency aid, Direct Relief also supports community health centers straddling the southwestern border, including San Ysidro Health, La Maestra Community Health Center, and Jewish Family Services, many of whom care for migrant patient populations. Direct Relief has equipped providers with personal protective gear and supported patient-care with chronic disease medications, nutritional supplements, and personal care items.

Direct Relief also supports providers working to treat patients south of the border, including UC San Diego’s International Health Collective–a student-run organization that holds monthly medical clinics in Tijuana. Since 2015, the group has been crossing the border to provide care to hundreds of patients using Direct Relief supplies, including personal protective equipment, chronic disease medications for high cholesterol and hypertension, and prescription drugs to treat severe infections.

Direct Relief staff is in communication with several groups responding at the border and will continue to monitor needs as the situation develops.

The post Direct Relief Bolsters Healthcare on U.S.-Mexico Border appeared first on Direct Relief.

“In traditional medicine, if your pulse [oximeter reading] drops below 80 and consistently stays below 80, that is an indication for intubation and putting the patients in the ICU,” she explained.

But nearly a year later, Dr. Shihabuddin, the Chief Medical Officer of RWJBarnabas Health in New Jersey, said the lessons of traditional medicine may no longer hold: “What we learned with COVID is intubation may not be the answer.”

As providers learn more about the disease and its treatment, they have become more discerning with how they deliver oxygen treatment.

New Protocols

“The decision to intubate and put [patients] on a machine is multifactorial. It’s not one thing. it’s not simply because your oxygen is low,” said Shihabuddin.

Now, if patients have low levels of oxygen saturation, Shihabuddin recommends they be monitored in the hospital’s ICU and delivered high-flow oxygen through their nose instead. The treatment is less invasive than intubation and doesn’t require patients to be sedated.

In California, a Los Angeles-based hospital has also revised its treatment protocols in light of new evidence.

“Very early in the pandemic we were intubating everyone — putting them on ventilators — because we thought that was the right thing to do,” said Dr. Larry Stock, Vice Chair of the hospital’s emergency department. “We learned that, even if they had a big oxygen need, they’d actually do better if we held off on doing that.”

Instead, the hospital began giving patients high-flow oxygen funneled through a network of pipes in the walls and delivered directly into patients’ rooms. Normally patients on high-flow oxygen receive up to 15 liters of oxygen a minute. But for those in critical condition, Dr. Stock and his colleagues were turning up the flow. “We were giving people oxygen at levels of 40 to 80 liters per minute. And sometimes even double that—up to 200 liters per minute of oxygen in some cases.”

Earlier this year, the need for this kind of treatment led to mass oxygen shortages across Southern California, shocking even the most seasoned physicians. “I don’t think anyone anticipated we were going to run out of oxygen,” said Stock.

The shortages led to rationing, which in some cases meant turning down the flow of oxygen patients were receiving. “Instead of setting the goal and trying to reach a pulse ox saturation of 95% or above, our goal became 90% or above, or sometimes lower than that,” said Stock. While it wasn’t ideal, it was enough to keep people breathing. “If we tried to provide optimal care for everyone, there wouldn’t be enough for some people,” he said. As shortages have subsided in some areas and flared up in others, oxygen remains a critical component of Covid-19 treatment.

Recovering at Home

It’s not just about inpatient care, either. During surges, when hospitals fill to capacity, oxygen acquires a new role: freeing up much-needed hospital beds.

Small, portable oxygen concentrators can be sent home with patients who are stable but still require oxygen support, allowing a more critical patient to take their spot.

Last spring, RWJ Barnabas Health began sending patients home with an oxygen concentrator, a pulse oximeter, and a virtual nurse to monitor their condition through telemedicine. The program helped offload hospital beds during their worst surge to date.

Dr. Shihabuddin says the portable concentrators have been particularly useful for certain patient populations.

“There’s a cohort of patients who are uninsured, and in the state of New Jersey, we have a lot of undocumented patients,” she explained. “Those concentrators, which we have, really saved the lives of those patients.”

Many of these patients are afraid to be checked into a hospital because of their immigration status. Others are weary of surprise medical bills.

“A lot of these patients did not want to be hospitalized,” said Dr. Shihabuddin.

While the CARES Act has provided funding to cover the cost of Covid-treatment for uninsured individuals, some patients are unaware of the new provisions. Others are doubtful.

“No matter how much you tell them, ‘No, you’re not going to get a bill. Everything will be the fine. The government is going to pay for it,’ they don’t really believe us because that’s not the historic experience,” said Shihabuddin.

At AltaMed Health Services in Los Angeles, a similar program is helping low-income patients, including uninsured individuals, get home sooner.

The health center is working with their local hospital to transition patients out of the intensive care unit into their homes, where supplemental oxygen and close monitoring are used in the final stretch of treatment. But the program is more involved than handing patients an oxygen concentrator.

“It’s not just the oxygen. It’s, ‘Who’s going to bring them medication? How are they going to drive to the clinic for a follow-up?’” explained Dr. Ilan Shapiro, the Medical Director of Health Education and Wellness at AltaMed.

For those without a caretaker at home, the health center is sending in a provider to routinely check their pulse oximeter and, if they have a chronic condition, make sure their medications are stocked.

The Long Term

While most patients will only need oxygen for a short period of time, others may require more long-term support.

That’s because Covid-19 can cause inflammation of the lungs and heart. If severe enough, this inflammation can lead to scarring.

“Once you get a scar, just like anywhere in the body, it doesn’t actually go away. You kind of work with the remaining tissue that’s healthy,” explained Dr. Larry Stock, the emergency medicine physician based in Los Angeles. This scarring can cause patients to develop chronic conditions, such as pulmonary fibrosis, that require long-term oxygen therapy.

For some of Dr. Shapiro’s patients, that presents more than just a health crisis. Without insurance, funding long-term oxygen care may be a financial impossibility. Out-of-pocket expenses can total thousands of dollars per year.

“That’s where things start melting down,” said Shapiro. “Covid doesn’t distinguish if you have insurance or not.”

Since the start of the Covid-19 pandemic, Direct Relief has delivered 3,942 oxygen concentrators to health facilities in the United States and abroad, including dozens to support patients receiving at-home oxygen treatment from RWJ Barnabas Health and Alta Med Health Services.

The post Fewer Intubations, More At-Home Care: Covid-19 Is Changing Doctors’ Approach to Oxygen Therapy appeared first on Direct Relief.

“One of our villages has four year-round residents. Another village has one,” said Bernina Venua, the Incident Commander of Bristol Bay Area Health Corporation’s Covid-19 response. The health center is the only medical facility serving all 28 villages in Alaska’s Bristol Bay region, an area covering more than 45,000 square miles with a population of roughly 7,500.

“We have to make sure when we go to the villages there is a multiple of 10 or…close to a multiple of 10 to make sure there is no waste,” explained Venua. BBAHC is using the Moderna vaccine. Each vial contains 10 doses and, once a vial is open, it must be used within 6 hours.

In many of Alaska’s roadless communities, where the outside world is only accessible by plane or ferry, finding extra arms if there are remaining doses is particularly difficult.

The solution? “Chartering a plane,” said Venua. When necessary, the health centers carts residents back and forth between their homes and the nearest vaccination site on small passenger planes. “This is how we can provide that service for those residents and at the same time, minimizing any wasted vaccine.”

In one of the villages BBAHC serves, three residents were traveling when the health center’s medical team went to administer vaccines. They were at high risk and wanted the vaccine. “Instead of wasting seven doses, we flew them in,” said Venua.

The health center is also making special accommodations for patients who are homebound. While some have conditions that limit their mobility, others rely on less insulated modes of transportation, which can make travel difficult during the winter. “Getting an elder to sit on a four-wheeler in minus 10 degrees, or even at 10 degrees, to go to the clinic” is not going to happen, explained Venua. Instead, providers administer the shot in the comfort of the patient’s home.

This kind of approach has made Alaska the most fully vaccinated state in the country. As of Monday, about one-quarter of the population has received a first dose and nearly 16%  have received a second.

The push to vaccinate the community comes as the region prepares for an influx of visitors during the spring and summer fishing season, when the population typically doubles in size. “We really want people to be more protected,” said Venua.

Without thorough vaccination, tourism could undo months of effort on the part of residents to keep Covid outside their borders. “People in our region have taken Covid fairly serious from the beginning,” said Venua.

That seriousness is partly due to the impact of the 1918-19 Spanish Flu, which decimated Alaska’s tribal communities, wiping out entire villages. Many children were orphaned during that time by parents sickened by the virus. Some were without care for months before being found by rescue officials. Eventually, an orphanage was set up in Dillingham, Bristol Bay, which now serves as the site of the regional hospital BBAHC operates.

“The people that we have here are children raised by people who were in the orphanages,” explained Venua. Many patients grew up hearing stories about the devastation their communities, and families, experienced during the previous pandemic. “That fear, I think, helped people move towards protection.”

Another reason residents are taking pandemic precautions more seriously could be because, in Alaska, the stakes are higher to get to care in time.

“Anyone who has severe Covid…we have to medevac them out of the region,” said Venua. Critical patients must be flown to the nearest ICU, which is located in Anchorage. During the height of the pandemic,  weather also introduces an uncertain variable:

“If you get really, really sick and there is a blizzard, we are going to do our best to fly, but we are weather dependent.”

The most critical patients must be flown to the nearest available ICU bed. During the peak of the pandemic in November and December, hospitals in Anchorage—the closest major city—reached capacity. That meant providers like Venua had to scour the state for open beds and, should they find one, hope the weather cooperated. 

These limitations have shaped both provider and patient expectations around Covid care. “BBAHC has been pretty honest about our capacity to deal with a surge, which we can’t,” said Venua. “People know that.”

Direct Relief has provided Bristol Bay Area Health Corporation with a $200,000 grant to support their vaccination efforts, including funds to help reach patients in the region’s most remote communities.

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