Dr. Hodes asked the nuns about the boys and was told they were without caregivers. Even though he was an experienced doctor who had been in-country for about a decade, seeing the boys’ condition impacted him.

He reached out to several U.S. surgeons for help and received one “no” after another – and that’s when he managed to get a response at all. At an impasse, he decided to go in another direction with his inquiries.

“I asked the Almighty, ‘What do you want me to do?’ I didn’t get an answer and that was it,” Dr. Hodes recalled. “But three days later, I got a message in my brain and it was ‘I’m offering you a chance to help these boys… don’t say no.’”

The only way to get the boys, ages six and 12 at the time, the lifesaving surgeries they needed, was to adopt them and add them to his U.S. insurance policy. So he did.

Today, Dr. Hodes, 71, is the Ethiopia Medical Director for the American Jewish Joint Distribution Committee, or JDC, and founder of the JDC’s spine program, which he started in 2006 and has saved thousands of lives. He is also the father of five children, all of whom he adopted in an attempt to get them the health care they needed.

It’s a life he could have never imagined when he was in medical school and that has continuously defied expectations, mostly his own. Dr. Hodes said he did not expect to live his adult life in Ethiopia, did not expect to adopt five children, and did not expect to play a critical role in transforming spinal cord care in the region – much less become the subject of an HBO documentary and other documentaries, articles, and a book.

All Dr. Hodes knew during medical school was that he was drawn to global health. The problem, he shared during a call from his home in Addis Ababa, Ethiopia, is that even now, no clear career path exists for those with such an interest.

Like so much of Dr. Hodes’s life, the path forward would emerge from a mix of happenstance, reflection, and simply taking action.  

During medical school, he had stints caring for people in Southeast Asia and Bangladesh before going to Sudan right after finishing his final year to care for refugees there. In 1985, following a three-year residency at Johns Hopkins Bayview Medical Center and becoming board-certified in internal medicine, he received a Fulbright Scholarship to teach internal medicine in Ethiopia.

He spent two and a half years there, but even after that experience, Hodes still didn’t see himself as a long-termer.

“There was no way I thought I’d be living the rest of my life here,” he said.

After returning to the U.S., Hodes found himself being drawn toward his Judaism, which spurred him to move to Israel. One morning in 1990, while reading an Israeli newspaper, he learned that many Ethiopian Jews, who were trying to escape Ethiopia and emigrate to Israel due to political instability and persecution, had become stuck in Addis. Many were in dire need of medical care, which they did not have access to, having moved, en masse, from more rural areas.

“I called the American Jewish Joint Distribution Committee and said, ‘I’m an American doctor, I’ve lived in Ethiopia, I speak Amharic — can I help?’” he recalls. Thirty-five years later, he’s still on the job. 

From Emergencies to a Calling

In May 1991, Hodes and JDC played a crucial role in Operation Solomon, the historic airlift that brought over 14,000 Ethiopian Jews to Israel in just 36 hours. But the work didn’t end with the operation. He stayed behind to care for those left behind, and in doing so, he found his life’s mission. 

Hodes’s focus shifted from emergencies to chronic care. As he was directing the JDC medical program for potential immigrants, he began volunteering at Mother Teresa Mission, a self-described “home for sick and dying destitutes,” in his free time.

At Mother Teresa’s, Hodes encountered a stream of young people suffering from all manner of illnesses and hardship, experiencing what he described as “the largest collection of worst spine deformities in the world.” Hodes and JDC set up a spine and heart care program at Mother Teresa’s to address the need. Among the children needing care were his now-sons.  

For the doctor, it was a clear choice. “I was trying to save their lives and  I realized that the only way I could get them free surgery was if they had health insurance and the only way they could get health insurance is if I adopted them,” he said matter-of-factly.

That act of compassion marked the beginning of several adoptions to connect children to care.

Over the years, Dr. Hodes has adopted five Ethiopian children, all of whom are thriving including a son who is now a pharmacist in the U.S. and one who is a successful businessman in Ethiopia.

“He gave me a new opportunity, a new purpose, a new life,” said Mesfin Hodes, one of Dr. Hode’s children, during a TED talk in Mexico. Semegnew, one of the first children adopted, referred to his father as “the saver of the world” in an application he submitted for his father to be recognized as a “CNN Hero,” which was accepted.

Among the other children whose lives have been saved by Dr. Hodes is one named Mesfin Yosef, from Sidamo, who came to St. Mother Theresa’s to die. Yosef felt he was a burden to his family due to his illness. Hodes determined that the illness was heart failure caused by a heart valve problem, which Dr. Hodes treated. Several more procedures followed leaving the boy in good health. Today, he works as a perfusionist at the Mayo Clinic, and calls Dr. Hodes “his angel.” Yosef recently returned to Ethiopia with his colleague, a heart surgeon, and they operated on 15 patients.

During a stay in Gondar, Dr. Hodes happened to walk past a man and a small orphan girl with a severe back issue.  The man was her uncle, and Dr. Hodes was able to arrange travel to Addis for her, where he cared for her in his household, which sometimes swells to as many as 25 people, some of whom live in another local house. The girl received care in Ghana and grew up in his home. Today she is enrolled in a master’s computer science program in Oklahoma. This, and several other of his cases have turned into award-winning documentaries.

Dr. Hodes’s life so far is peppered with these types of events, miracles, or coincidences, in all shapes and sizes. There was the time he asked a woman at an airport to hold his Tefillin, phylacteries worn by Jewish men during morning prayers, while he went to the lavatory. They began to talk and he was able to diagnose her irregular heartbeat with his Apple Watch, even writing a kind of doctor’s note to the airline excusing her from flying. Or the stranger in a Minneapolis synagogue who happened to be a skull-base surgeon — the exact specialist needed to save a patient’s life. Dr. Hodes was only there because he overslept and wanted to pray with his Teffilin in a community setting.

“Stuff like this happens to me all the time,” Dr. Hodes said, his voice tinged with wonder.

A Framework for Care into the Future

In addition to chance, Dr. Hodes has also played an instrumental role in solidifying care options for the region’s hardest cases. In 2006, JDC and Hodes partnered with Dr. Oheneba Boachie-Adjei, one of the world’s leading spine surgeons, to launch a spine program based at Mother Teresa’s Mission. Today, it’s the largest of its kind in Ethiopia, treating hundreds of patients annually with conditions ranging from scoliosis to tuberculosis-related deformities.  The program has trained over 1,000 providers.

“These are cases you’d never see in the U.S.,” Dr. Hodes said. “The natural history of untreated spinal disease, that’s what I see every day.”  The program’s success has also catalyzed interest and support from the government, which had been lacking.

Ethiopia’s government recently allocated space in a leading Addis hospital, St. Paul’s, for the new National Spine Center. JDC will renovate and equip the Center while providing ongoing training to local doctors and health professionals, aiming to enhance their capacity to treat a greater number of patients locally. Direct Relief staff met with Dr. Hodes in Ethiopia earlier this year about medical needs and potential support.

The program relies on a global network of surgeons, with patients sent to Ghana, India, or treated locally depending on the severity of their condition. “Some cases require six months of traction before surgery,” Dr. Hodes explained.

Part of Dr. Hodes’s effectiveness in both medicine and parenting, beyond a deep empathy and desire to help, can be traced to his deep knowledge of, and respect for, local cultures and ethnic groups. He casually rattles off several subgroups of a local ethnic group during the conversation, and said he often prefers to conduct visits in Amharic versus English, since he’s able to communicate more effectively with his patients.

Even as his program has grown in its capacity to care for Ethiopia’s most difficult cases, and as he continues into his eighth decade, Dr. Hodes shows no signs of slowing down. His son Semegnew noted that his dad often eats in his car to save time and scrimps on sleep so that he can see more patients.

“Retirement isn’t in my vocabulary,” Dr. Hodes said. “My friends are retiring, but I have a mission.” 

The post Adopting Hope: The Doctor Who Became Family to Children in Ethiopia appeared first on Direct Relief.

In early 2025, the clinic will open the nation’s first surgery center operated by a free clinic, a groundbreaking initiative to provide life-changing procedures, including hernia repairs, cataract removals, colonoscopies, and more, to those who cannot afford them. Already, over 3,000 patients are on the waiting list.

For Ed Gerber, executive director of the Lestonnac Free Clinic, and a former patient, the implications are profound, having once had to balance imaging costs with eating dinner, he recalled. Gerber dreams of the surgery center becoming a national model, a goal that seemed out of reach until a $3.5 million donation from philanthropist Bill Thompson.

The creation of the surgery center, a 4,000-square-foot facility with two state-of-the-art operating rooms, five pre- and post-operative beds, and sterilization units, represents both a solution to a pervasive nationwide problem and a model for the future.

For nearly a decade, Lestonnac Free Clinic, founded by Sister Marie Therese in 1979, saw about 17,000 patients across 30,000 visits last year, and has been striving to offer surgical procedures to its uninsured patients. In one instance, the clinic borrowed operating rooms at a hospital for a single “surgery day,” completing a dozen cases— hernia repairs, carpal tunnel releases— with undeniable success. Yet no hospital agreed to repeat the program.

Eventually, through partnerships with organizations like the American Association of Physicians of Indian Origin, or AAPIO, Lestonnac secured occasional access to a Beverly Hills surgical center, performing surgeries twice monthly. It was during this period that early-stage cancers were detected in several colonoscopy patients— cases that could have turned fatal without intervention.

“That was eye-opening,” said Gerber. “We saved those lives, but the frustration was realizing how unsustainable it all was. We realized couldn’t rely on hospitals long-term. We had to build this ourselves.”

The Lestonnac surgery center is, in part, a response to the systemic challenges of U.S. healthcare. While hospitals are legally required to stabilize emergency cases, they are not obligated to treat conditions like hernias or cataracts, which can profoundly impact quality of life. “Emergency rooms stabilize and release patients. After that, you fall into a rabbit hole trying to find care,” said Gerber.

At Lestonnac, care is free, provided through a network of volunteer doctors, surgeons, and anesthesiologists. Free clinics do not receive any state or federal government reimbursements for care they provide. Addressing common perceptions about free clinics, Gerber said the volunteers are doctors with deep experience.

“They’re doctors you wish you could get. They’re well-seasoned surgeons who want to make a difference,” he said, adding that instead of doing medical missions internationally, they’re able to provide services locally.

 Courtney Harrison, the clinic’s Director of Surgical Services, envisions a ripple effect from the free surgery center. “The evolution of this is going to be fantastic. If a surgeon is willing to volunteer, I know we’ll find the patients,” she said.

Already, the clinic coordinates with 16 federally qualified health centers and other clinics, which refer uninsured and underinsured patients. “A $2,000 co-pay might as well be no insurance at all,” Gerber said, referring to private insurance plans that have high deductibles, which are out-of-pocket costs that a patient must pay before insurance begins to cover costs.

The types of procedures planned are considered routine, yet are potentially transformative: cataract surgeries that restore sight, hernia repairs that allow patients to work again, colonoscopies that prevent advanced cancer, and minor orthopedic procedures like ankle stabilizations.

“These are surgeries that don’t take much time, some are 15 minutes, but they change lives,” Harrison explained. “One hernia patient couldn’t work for two years. After the surgery, he was back on his feet.”

Bringing the surgery center to life has required a delicate balance of donations and partnerships. Kaiser Permanente has donated critical supplies, while hospitals have offered pathology services free of charge. Specialized equipment, such as colonoscopy scopes and anesthesia machines, are among the project’s major expenses, along with construction costs.

“Collaboration is what’s making this a reality,” Gerber said. The free clinic also benefits from owning the building in which the surgery clinic will be housed. “If you’re renting, you’re back to relying on someone else,” Gerber said.

Once operational, the center will prioritize patients based on severity and urgency according to Mary Baker, director of quality. Cases will be sent to volunteer surgeons, who select those they are most comfortable performing. Already, some patients are willing to drive from as far as Arizona.

The Lestonnac team hopes the center serves as a national model for other free clinics, showcasing how communities can bypass a complex, costly healthcare system to provide vital care for those who do not have another option due to cost.

“This is what free clinics are about,” Gerber said.

“Saving lives is first and foremost for all of us. But quality of life matters too. If we can do one cataract, we’ve made a difference, it’s huge for patients,” he said about the procedure, which can restore sight.

The post With Thousands on the Waiting List, California Free Clinic Aims to Provide Surgery Services appeared first on Direct Relief.

NEW YORK — As famously portrayed on scripted TV shows, medical residencies are a critical stage of training where newly minted doctors gain hands-on experience in their chosen specialty. Faced with such a weighty decision, some rookie doctors might struggle to choose which specialty and hospital to select. But Dr. Joronia Chery knew exactly what she wanted — and it wasn’t in a hospital.

“I came here because this is where I see myself making the most difference. It feels like treating my grandmother or my mother,” said Dr. Chery, a first-year resident at the Institute for Family Health’s Harlem location. Her voice brims with conviction, a result of years of witnessing, as a child, the healthcare gaps in her Brooklyn community, where she had to travel 30 minutes by bus to the closest community health center. Chery’s words echo a shared mission among the residents and faculty of this federally qualified health center, or FQHC, residency program, to address the inequities in American healthcare, one patient at a time.

While the overwhelming majority of doctors complete their residencies in a hospital setting, for over a decade, the U.S. Health Resources and Services Administration’s Teaching Health Center Graduate Medical Education program has trained physicians at FQHCs. To date, 2,027 new primary care physicians and dentists have entered the workforce after completing an FQHC-based residency, more than 80% of whom are family or internal medicine doctors. Reflecting their mission to treat everybody who comes through the door, regardless of means, FQHC residencies place a focus on delivering comprehensive, culturally competent care in underserved communities. Its mission, rooted in the Affordable Care Act, aims to meet the pressing need for primary care doctors while reshaping how and where they are trained.

Dr. Robert “Red” Schiller, who is president of academic affairs at IFH and vice chair of the Engelberg Department of Family Medicine and Community Health at the Icahn School of Medicine at Mount Sinai Hospital, leads the Institute for Family Health’s residency programs. IFH has over a dozen locations across New York City and the Hudson Valley and sees over 100,000 patients across about 450,000 visits annually. Noting the initiative’s bipartisan support, he said, the goal is “to get the workforce needed to work in community health centers and take care of people who are marginalized by racism and poverty. It is to create training capacity in these sites so that they learn the skills that are necessary to make a difference.”

Teaching health centers like this one stand in contrast to traditional hospital residencies. They immerse trainees in outpatient, community-based settings, prioritizing preventive, collaborative, and comprehensive care. Residents develop skills ranging from managing chronic diseases like diabetes and hypertension to navigating the intricate social determinants of health, such as housing and food insecurity. FQHC-based residencies also embody one of the many ways safety net clinics in the U.S. serve a wide variety of needs in their respective communities in addition to offering primary healthcare visits for all.

Schiller said traditional training programs prioritize work within a resident’s rotation. If there is a complex outpatient case, that patient would “get basically seen by anybody else and it’s a fragmented system,” At his FQHC, it’s the opposite. “We would figure out how to cover that patient with the same team,” he said.

“At the end of the day, FQHCs are the ones that actually take care of the community,” Chery said. “The cancer centers are nice, but how can you prevent cancers if you’re not doing the underground work of helping stop smoking and helping people get colon cancer screenings on time… It felt like to get to the root of the problems that we’re shuttling money to, we needed to go down to the basics, and this is where that happens,” she said.

Dr. Esha Mehta, a third-year resident, described the program’s impact on her practice. “We do so much within these walls. Patients come here for everything — procedures, mental health support, even prenatal care… This really feels like a true medical home for patients,” she said. “I love that about this space, because I never experienced it in medical school.”

Mehta said that in assessing which residency program she wanted to attend, her choice came down to emergency medicine and the FQHC program. Noting the overlap, in terms of acting as a safety net and treating patients who aren’t otherwise able to access care, she said FQHCs are able to do follow-up visits for additional health care issues, which does not exist in an emergency room setting. “We’re able to really work with them and connect these patients to care,” she said.

Situated in Harlem and serving patients from across New York City, the residency reflects the diversity of its community. Many residents, like Chery, intentionally choose the program because they see themselves in their patients. Fluent in French and Haitian Creole, she has bridged language gaps that might otherwise complicate care. “When a patient hears someone speaking their language, their shoulders relax. They know they’re in the right place,” she said.

The program’s reach extends beyond the exam room. Residents participate in community walks to understand local resources and challenges, from grocery store prices to housing conditions. They also lead initiatives like the CenteringPregnancy program, which brings together expectant mothers for shared support and education.

Dr. Sarah Duncan, a faculty member who completed her residency at IFH emphasized how personal connections enhance trust. “Patients know we’re here for the long haul. They come to see the same doctor year after year. That continuity makes all the difference,” she said. Added Schiller, “Continuity is a cornerstone of primary care, specifically in family medicine.”

Despite its success, the program continues to face an uncertain future. Federal funding for Teaching Health Centers is minimal, totaling less than 1% of the multi-billion dollar budget allocated to hospital-based residencies. Additionally, FQHC residency programs are funded by annual congressional appropriations and grant awards, compared to the stable, long-term Medicare-funded programs for traditional hospital-based programs.

The FQHC-based program trained 1,096 residents in 81 locations from 2023 to this year. These young doctors cared for over 792,000 patients in more than 1.2 million visits.

Schiller voiced his concerns bluntly. “If funding were cut, it would be devastating. These centers provide care for communities that hospitals often overlook. Without them, we’d see more preventable illnesses and deaths.”

The stakes are high. By 2035, the U.S. is projected to face a shortage of between 35,000 to 68,000 primary care physicians according to HRSA’s Bureau of Health Workforce. Teaching Health Centers have been uniquely effective in addressing this gap, with the majority of graduates continuing to serve in underserved areas. Losing funding, faculty say, could not only jeopardize patient care but also dismantle a successful pipeline for the next generation of doctors.

Still, the residents in the program see wins each day.

Mehta shared a recent patient story that underscored her commitment to community health. “A young woman came in for a routine visit but opened up about her fears around HIV. I spent time educating her about prevention, and she decided to start PrEP (medication that can prevent HIV infection). It was a small win, but it felt huge. It’s moments like that that remind me why I chose this path.”

Direct Relief supports health centers across the United States, including the Institute for Family Health, with medical and financial aid.

The post A New Generation of Doctors Looks to Health Centers for Residency appeared first on Direct Relief.

STORIES OF MIGRATION

This series of photo essays by photojournalist Oscar B. Castillo was taken across the Americas, documenting the physical and emotional landscapes of migration and highlighting key waypoints on the journey from the Venezuela-Colombia border to New York City. Each location offers a unique window into the challenges migrants face, particularly concerning healthcare access, and the resilience required to reach their destination.

AN INTERACTIVE JOURNEY

Millions of people have made the journey from South and Central America to the United States. Here is what that perilous journey looks like, and why it doesn’t end when they arrive at the U.S. border.

Click on the map to view their journeys

THE PATH NORTH

In Arauca, Colombia, the photo essays depict the journey’s beginning, where migrants often face limited access to healthcare amidst the backdrop of economic hardships and social disparities.

Mexico City plays a vital role as a transit hub, where healthcare disparities become especially evident as migrants move through its complex urban landscape, often unsure of when they will receive permission to enter the U.S.

Moving northward to the U.S.-Mexico border, El Paso and Juarez represent critical junctures in the migration route, emphasizing the precarious health conditions migrants endure. In Juarez, the essay portrays the intersection of healthcare and humanitarian crises, where migrants face heightened vulnerabilities exacerbated by limited healthcare infrastructure and safety concerns. In El Paso, the essay captures the first days of migrants’ experience in the United States as they seek medical care and a measure of stability amidst systemic barriers.

Finally, in New York City, the photo essays reflect the culmination of the migration journey for many. Here, migrants encounter a diverse array of healthcare services yet continue to grapple with a strained safety net system and adverse socioeconomic conditions. The essays from New York City underscore the resilience and contributions of migrant populations while highlighting ongoing efforts to promote accessible healthcare policies and practices.

READ MORE

Healing At The Colombian Border

Over 5,400 Venezuelans are currently living in the town of Arauquita, which also sees Venezuelans cross the border temporarily, just to receive medical care.

Migrants Work to Survive in North America’s Largest City

Living in Wait: Migrants Work to Survive in North America’s Largest City

Everything For The American Dream

The hope of better living conditions, and to let the imagination fly towards the American Dream.

A Mom’s Epic Journey To Save Her Daughter

Jungle, Thieves, and Worse: A Mom’s Epic Journey to Save Her

Searching for a New Life After the Long Journey North

Recently-arrived families who traveled from southern Colombia to Texas before arriving in New York acclimate to life in the city with the help of a local community health center.

SELECTED PHOTOS

SELECTED CLINICS DIRECT RELIEF SUPPORTS

Direct Relief supports thousands of clinics across the Americas and around the world. The following clinics are a few of those located along the migration routes highlighted in these photo essays:

• Banco de Medicamentos – Colombia
• Refugee Health Alliance – Mexico
• The Welcome Center of El Paso – Texas, United States
• Ryan Health – New York, United States

ABOUT THE PHOTOGRAPHER

Oscar B. Castillo is a Venezuelan documentary photographer, multimedia artist, and educator focusing on stories about sociopolitical fractures, race and identity, the cycle of violence and the construction of criminal networks, and initiatives for pacification and inclusion mostly for the youth from underprivileged communities.

The post Stories of Migration appeared first on Direct Relief.

One of the hardest hit locations was Spanish Lakes Country Club Village, a community for those 55 years and older, which suffered at least four casualties and catastrophic damage to multiple homes. Spanish Lakes was one of seven neighborhoods in the area that a county spokesperson said, “suffered significant damage.”

First responders and county officials said search and rescue operations are ongoing at Spanish Lakes. Determining the final toll of casualties has been delayed since many residents live part-time in other locations.

Direct Relief CEO Thomas Tighe and staff members were on location at the community on Friday for a needs assessment and to deliver requested supplies, including dozens of hygiene kits and protective equipment to support search and rescue efforts.

“It’s so sad,” said Tighe. “It speaks to the vagaries of prediction, even with advances in modeling. Milton’s strength was a story for days ahead of time, but it’s a reminder that mother nature gets her vote,” he said.

Oceana Community Health, which is operating two mobile clinics at the Spanish Lakes community, began responding to the storm even before it hit. Tighe recalled Oceana Executive Director Dr. Youssef Motii driving over a dozen miles to personally deliver a vial of insulin to a diabetic patient in need who was concerned about power outages – the medicine must be kept cold – and a lack of availability after the storm. Motii said as many as 40% of residents may be on insulin.

Motii also volunteered to help search homes after the storm in the Spanish Lakes community. These actions serve as an example of how safety net clinics serve multiple roles before and after storms, in addition to their daily services.

“Guys like Dr. Youssef play a really important role in gap-filling, especially in the wake of Medicaid cutbacks in Florida. They’re not really seen as first responders but they are first responders and can play an outsized role since people in their communities trust them. He was calling his patient personally and sending emails to see if they were OK,” Tighe said.  

Speaking with Direct Relief, Motii reported that a major concern going forward is related to community members’ mental health, both as a result of the traumatic event and the challenges of rebuilding at an advanced age.

Reflecting on his site visits throughout the state this week, Tighe said that his concerns lay with those who are most vulnerable and most likely to be overlooked, whether it’s in terms of power lines being repaired, infrastructure being repaired, or state resources being deployed in general.

“In planning for disaster responses, it’s not a bad idea to look out for the people who are most vulnerable in general,” he said. “Elderly folks, people on fixed incomes, where are they supposed to go? It will be most difficult for those people, poor people, babies, and toddlers, to be resilient and bounce back from the storm.”

Direct Relief is continuing to be in close contact with partner health organizations throughout the state of Florida, as well as state-level agencies and safety net clinic organizations, and will continue to respond to requests for aid throughout the Milton recovery process in the future.

Additional reporting contributed by Sofie Blomst.

The post Florida Retirement Community Devastated Before Hurricane Milton’s Landfall appeared first on Direct Relief.

Initial reports show severe flooding in Tampa and structural damage to residential and commercial buildings, including the roof of the Tampa Bay Rays’ stadium, Tropicana Field. Scenes from the Tampa area show boats washed ashore, cars tossed upside down, and furniture afloat in the flood waters. About 3.2 million customers are without power in the affected region, according to Poweroutage.us.

Despite the damage, according to a statement from Florida Governor Ron DeSantis, the storm’s impact was not “the worst-case scenario.” The Miami Herald reported less impact from Milton compared to Helene in some neighborhoods and noted that stacked, destroyed furniture in parts of St. Petersburg, that were feared to become deadly projectiles, largely remained in place.  

Still, state and federal officials have urged residents to be careful and remain vigilant during the clean-up process as downed power lines, debris, and unsafe roads can present serious hazards.

Emergency Response Continues

Direct Relief’s CEO Thomas Tighe and other staff arrived in Florida ahead of the storm to coordinate and deliver requested aid to safety net clinics and first responders. One of the clinics, Wildflower Healthcare, serves about 60 patients per day at no cost to the patients in St. Augustine, Florida.

The clinic, like many safety net clinics in the U.S., runs several outreach programs in their community, including initiatives focused on providing support to unhoused populations, the elderly, and a mobile clinic for those who face barriers to accessing care at the clinic’s location.

Executive Director Michelle Colee said a main concern ahead of the storm was losing power, which happens frequently during the increasingly common severe weather events in the area. Wildflower Healthcare received a field medic pack before the storm and several personal care kits with hygiene items for displaced people.

Yesterday, Direct Relief staff delivered field medic packs and personal care kits to an emergency evacuation center in St. John’s County. Mandatory evacuation orders affected about 22,000 people in the county, which includes St Augustine. County first responders received backpacks to support the local emergency operations center. Additional field medic packs and personal care kits were requested by the county sheriff and will be delivered today.

Direct Relief’s hurricane program prepositions Hurricane Prep Packs in at-risk areas throughout the U.S. and Caribbean providing safety-net clinics with the ability to care for hundreds of their patients in the days after a storm should their medicine and supplies be damaged or if supply chains are impacted. The organization has learned that several health clinics have opened their packs and are using medications and supplies to backfill their inventory.

In response to Hurricanes Helene and Milton, Direct Relief has made available $78M in medicines and medical supplies, and $350,000 in financial assistance to community health centers, free clinics, and other healthcare providers. The organization will continue to respond as more needs become known.

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First responders have reported that flooding, mudslides, and other infrastructure-related problems have made it difficult to reach many villages, especially in mountainous areas. In El Espinalillo, an isolated village in the rugged terrain near southern Guerrero’s coast, a bridge that connected the southern part of the town with the northern part was destroyed. The village also lost access to services including drinkable water, electricity, and communications, according to Dr. Giorgio Franyuti, Executive Director of Medical Impact.

The organization sends healthcare providers on medical missions into remote areas, including after disasters. In addition to challenges related to which villages need help due to the electricity and communications services outages, Franyuti said that getting to them has also been delayed due to weather and conditions on the ground.

“After several days of being disconnected from the world, people started to suffer from hunger and diseases from lack of drinkable water, sanitation, lack of food security… this grew into desperation. Some villagers left by swimming to alert authorities they were trapped there. That’s how I found out,” Franyuti said.

In response to Hurricane John, Direct Relief Mexico has supported Medical Impact with field medic packs, which are designed to meet a variety of medical needs outside of clinic walls A group of medical responders with the organization was able to travel to the impacted area via helicopter to support people with triage needs. Overall, Direct Relief Mexico sent 100 backpacks to the Mexican Secretariat of National Defense Search and Rescue team this year, and supported the health system in the region after Otis made landfall.

“No pilots were daring to make the flight until last Monday. It was a two-hour trip with heavy turbulence. The team was scared but they will not surrender, they were born for this, as heroes and champions climbing out of the aircraft with hundreds of vaccines, medical supplies, medicines, and other supplies to support impacted communities,” Franyuti said about the volunteers on his team.

Responders reported many people with open wounds, which they treated. In the days and weeks ahead, however, the threat will shift to diseases.

 Vaccines are important, Franyuti said, to combat the pathogen that causes tetanus, which can be easily acquired due to metal debris in floodwaters. He also noted the risk of increased incidences of diarrheal diseases, infectious diseases of the skin, and parasites that are common after events like Hurricane John.

As with the aftermath of Hurricane Otis, Franyuti also expects a spike in dengue fever.

Hurricane Otis, a Category 5 storm, hit the same region last year. It caused at least 50 deaths and billions in damages. Most of the region, including the city of Acapulco, had not recovered from that storm before John, a larger and wetter storm, made landfall.

“This was not like Otis. Otis was razor blades to houses, to infrastructure. This was no razor blade, this was drowning the communities. The threat was different,” Franyuti said.

Describing the scenes his team is seeing after John, Franyuti said, “Close your eyes and try to imagine, it’s like a knife cut through the jungle and between the mud and mountains of dirt you find small rivers crossing in between cracks that were not there 10 days ago.”

Additional field medic packs were sent to Guerrero’s Centro Regional de Urgencias Medicas (CRUM), Banco de Alimentos, and BREIM. Direct Relief Mexico continues to assess the situation and is working with local nonprofit partners as well as the federal and state governments to facilitate additional responses related to medicine, medical supplies, and resilient power solutions.

The post With Roads Washed Away by Hurricane John, First Responders Reach Stranded Patients by Air appeared first on Direct Relief.

CHARLESTON, S.C. — Pastor Jay Tucker and Associate Pastor Cathy Tucker thought they had seen the worst of Hurricane Debby after it came through on August 5 and 6. Even after it went out to sea and came back towards the Carolinas on Thursday, August 8, the community of Richmond Hill, outside of Savannah, Ga., thought they were still in the clear.

But the following day, Friday, flood waters started to rise, inundating the area around their church, Richmond Hill United Methodist, and the surrounding neighborhood. By Saturday night, the city announced power cutoffs. Early Monday morning, a nursing home across a field from the church had to be evacuated in the middle of the night.

The following day, many adjacent streets looked like small rivers – even as others were totally dry – and some fields still looked like ponds.

“A congregant told me it was the only time he ever prayed for a recession,” Jay Tucker said to Direct Relief, recounting the joke as he looked out over a flooded playground after stepping outside from an impromptu, grassroots aid distribution operation his congregation had established in the church to aid displaced and impacted community members with supplies like hygiene products, towels, soap, garbage bags, and more.

In Charleston, the storm also came with surprises. Located in South Carolina’s Lowcountry, and indeed several parts of Charleston are below sea level, the leadership team at Fetter Health Care Network, the area’s only federally qualified health center, evacuated medicines and mobile units to their inland Summerville location for safekeeping.

But as the storm bore down, a video feed showed a large dumpster at the supposed safe location floating around the flooded parking lot and loading dock like an unmoored dinghy.

Hurricane Debby was a deadly storm, responsible for at least 10 deaths and, according to a report from Karen Clark & Company, a catastrophe risk modeling and consulting firm, about $1.4 billion in damage. It dumped about 15 inches of rain on Charleston and neighboring Berkeley County, according to NOAA. While the storm was not as impactful as many predicted, it did impact clinics in unexpected areas and for longer. The storm also highlighted the importance these organizations play for thousands of people in the areas they serve.

Safety net clinics, comprised mostly of federally qualified health centers, or FQHCs, and free clinics, fulfill an important but often overlooked role after natural disasters throughout the United States. Most deaths from hurricanes typically occur weeks and months after the storm makes landfall due to ailments including untreated chronic conditions, injuries, and infectious diseases.

Safety net clinics can provide continuity of care due to their accessible economic models and, oftentimes, mobile clinics and the ability to help coordinate resources for their patients. Underpinning the clinics’ disaster response, like their everyday responses, is the trust they engender in their communities – in part due to their obligation to treat people regardless of ability to pay – and the sense of mission embodied by staff members.

“There was a time in my life when going to a hotel or evacuating to another city would have been stressful and impossible. So I know it’s important to make that process as stress-free as possible. That’s what we’re here for,” said Dr. Aretha Powers, CEO of Fetter Health Care Network, referring to providing their patients with medication, continuity of care, and accessing resources, such as public shelters, available to them.

“We are blessed to be in a position where we can give back,” said Fetter’s Outreach Program Manager Ryan Hatchett. “I don’t want anyone in our community to feel no one cares about them, or that they are forgotten about… we’re going to go above and beyond to make sure you’re alright,” he said.

The process to fulfill that commitment ahead of Hurricane Debby began a few days before the storm hit for safety clinics in the area, including Fetter, Barrier Islands Free Medical Clinic on Johns Island in Charleston County, and J.C. Lewis Health Care Center in Savannah, Ga.

Leadership at each took immediate steps to initiate a multifaceted communication strategy towards their patients and staff members. Appointments during anticipated closures were rescheduled. Staff and volunteers also checked medication stocks to prepare for possible resupply delays.

“I like to make sure that I have ample amounts of certain medications in case there’s a situation where we have to use and the mobile unit and it may not have this or that on it like it should,” said Dr. Victor Allen, director of pharmacy at J.C. Lewis Health Care Center.

Across all three clinics, plans were also made to ensure medications, especially vaccines, insulin and other therapies that must be kept cold, would be kept in locations with generators or other forms of resilient power.

As they continued preparations on the day prior to Debby’s first landfall, reality set in from an unexpected source. Staff at Fetter said they knew the situation could get serious when they heard the Weather Channel’s Jim Cantore was in town.

“That weatherman, I saw he’s here, so a hurricane really is coming,” Powers recalled, referring to the celebrity meteorologist.

The following morning, on storm game day, Powers led her staff through a plan for the day to ensure that patients throughout the city and on the neighboring barrier islands would have as much time to access care and get medication refills as possible.

“The city may shut down at 3 p.m., but we can’t do that. We have to give our patients an opportunity to get off with the shutdowns and then pick up their meds, Powers said. Her staff also took vaccines off the islands in case of power outages and also coordinated with migrants to help them with supplies and to find off-island shelters.

Once the storm hit, Powers said she knew pretty quickly it would be serious, which would soon be confirmed by the inland clinic’s flooded lot. If that was the condition there, the city of Charleston would be far worse. And it was.

The clinic location in Charleston suffered roof and sewage-related damage. It was closed for two and a half days, which would have been longer if not for the cooperation of the city government, according to Powers.

With that clinic reopened, the team thought they were in the clear. However, the morning after, several staff members, who all live in the same Summerville-area neighborhood, woke up to flooded streets thanks to the storm’s reappearance and resultant flooding.

“We underestimated that storm on this side of town, that won’t happen again,” Powers said.

The experience caused the team at Fetter to reflect on what could be improved when the next storm hits.

“Could we have done more? Did we go above and beyond for our community?” said Hatchett, discussing the conversations that are taking place at Fetter as they work to find a more resilient way to store medicines. Other ongoing impacts from the storm included having to reschedule appointments across the 10 sites that had to be closed during the week of the storm.

Powers said he hopes to be able to continue deploying telehealth visits, but noted that funding had only been approved through the end of the year.

Storm Days and Every Day

The responsibility to assess best practices extends beyond hurricane response at Fetter, as well as other health care center systems, because of the patients who rely on them.

“Health centers are the nucleus of our country in terms of serving individuals who ordinarily would not have insurance to pay for their health services. Medicaid in Georgia has not been expanded, and so you have a lot of individuals that aren’t on insurance, can’t afford to get insurance, or are not eligible for insurance. And so the community health centers are here for those individuals, as well as the insured individuals,” said Dr. Rena Douse, CEO of J.C. Lewis Health Care Center and a native of Savannah.

“If we were not here, I think our homeless rates would go up. I think that our crime would probably go up because I think individuals would basically try to make ends meet, to try to get items they need to survive,” she said. “I think they would go into survival mode. We see the sickest of the sickest a lot of times.”

Powers said that even with safety net clinics being available, patients still sometimes feel reluctant to seek care.

“Our patients are sometimes in desperate need because a lot of times people don’t want to come ask for help. So they wait till the last minute but it’s that same as I would be,” she said.

At the Barrier Islands Free Medical Clinic on Johns Island, an added challenge is communicating to eligible people that they can receive free care. Like Georgia, South Carolina has not expanded Medicaid, leaving many low-income individuals without health insurance coverage.

“People are going from ER to ER and that’s not a medical home,” said Melissa Frank, Executive Director of the Barrier Islands Free Medical Clinic.

Dr. David S. Peterseim, the clinic’s medical director and a former thoracic surgeon, said patients receive directed, holistic care including preventative care, as opposed to one-off ER visits that often focus on addressing acute issues.

Summing up the underlying motivation at his clinic and across the FQHC and free clinic system across the U.S., J.C. Lewis’s Allen said, “everybody’s here to help somebody.”

As the most heavily impacted parts of the region continue to recover, a range of local community groups, health-focused and beyond, figure to play a role in the recovery which extends beyond property damage and visible physical illnesses.

“One of the things we’re anticipating is just mental health. I mean, people were coming and collapsing, [saying] ‘we’ve lost everything, we don’t know what we’re going to do,’” Pastor Tucker said.

Hurricane season continues until November 30.

Direct Relief supports federally qualified health centers and free clinics throughout the United States, including all three facilities mentioned in this story. During Hurricane Debby, Fetter Health Care Network and J.C. Lewis Health Care Center both opened Direct Relief-provided hurricane prep packs, which are prepositioned throughout hurricane-prone communities in advance of hurricane season and contain medical essentials commonly requested after storms. Direct Relief also supported J.C. Lewis with a backup power generator, and has supplied all three clinics with ongoing medical aid to support patient care.

The post Shelter From the Storm: South Carolina and Georgia Clinics Stand Strong for Patients appeared first on Direct Relief.

Due south of Big Bear, a turnoff towards Jenks Lake reveals a small collection of summer camps. Camp Conrad Chinnock looks right out of a movie set: archery set, mess hall, climbing wall, flagpole, even a swimming pool. Campers laugh and lurch about, making jokes and trading stories as they walk to the next activity together.

The familiar atmosphere is precisely the aim. Camp Conrad Chinnock’s purpose is to give children with type 1 diabetes (T1D) a typical summer camp experience. Due to the nature of T1D, it’s not a simple proposition.

“The burden of diabetes management is minute-to-minute, constant, 24 hours. You can’t quit. And it’s always part of your thinking in the background. But when you come to camp, you have a support network that helps to carry your load,” said Tracy Fulkerson, a former camper who is now on the medical staff at the camp and works as a pediatric intensive care unit nurse supervisor at Rady Children’s Hospital in San Diego.

“It’s freeing, just to have the things you need waiting for you wherever you go. They’re [staff] carrying your pack for just a few miles and every little bit helps in this,” she said, referring to insulin, other supplies, and supplements, like glucose tablets.

Type 1 diabetes is an autoimmune disease that’s usually diagnosed in childhood; although experts don’t fully understand how it develops, they think genetics play a strong role. With T1D, the body produces little to no insulin, a hormone that regulates blood sugar levels and helps the body convert food into energy. Without taking insulin, it can become fatal. Globally, about 8.4 million people had type 1 diabetes in 2021. There is currently no cure.

Because T1D demands constant management and bulky equipment, such as pumps and monitors, kids who live with it often feel socially isolated. Many campers and staff – most of whom are former campers – expressed annoyance with having to answer the same diabetes-related questions over and over and deflect uninformed concerns from family and friends about what they eat.

While untangling a fishing line next to Jenks Lake and supervising some budding anglers, T.J. Julius, 21, a mentor and counselor at the camp, recalled his early years with T1D. He was diagnosed at 5 years old.

“I’m the only one in my family who has it, so I felt alone,” he said. 

Coming to camp fundamentally changed his outlook.

“Up here, it’s a family. You feel better. You feel regular,” he said. “Being at camp made me want to take care of myself more… seeing the older people and seeing what they could do.”

Julius played high school football at Jurupa Hills and now works as a firefighter.

Emma Lloyd, 18, a counselor from Long Beach, said she struggled after being diagnosed as a child. “I decided my life was over at seven years old,” she said. “I felt alone. Trapped.”

That changed when she came to camp.

“It’s like Narnia here. It’s a magical place. It’s one of the only places where people with diabetes can get together and be normal…camp is my home and people here are my family,” she said, noting that she had attended since she was seven years old.

“It’s safe here… you don’t have to explain yourself.”

Both Llyod and Julius described how, beyond friendships, the camp had educated them on the latest technologies related to insulin pumps, monitors, and diabetes management techniques.

“I found out that I can eat everything; I just have to balance it. I did not know that before camp,” Lloyd said.

Colin Moore, 17, was diagnosed when he was 12 and said camp has helped him feel more comfortable with new ways to manage T1D.

“There is all this technology that I honestly didn’t really have a clue about. Being here showed me how valuable a pump is over just pins and needles. I was scared to use a pump…but I saw all these other campers using it made me realize, OK, maybe I should give it a try,” Moore said.

“I didn’t expect to get such a crazy disease like type 1 diabetes. Just a couple of months before (my diagnosis) I was living a normal life, minding my own business. It was pretty shocking, to say the least, at first. And then now, I’ve kind of got a full handle on it and it’s a lot easier than I thought,” he added.

Today, Moore is a 6’3″ right-handed pitcher on his high school varsity team. He manages his T1D in between innings, sometimes taking in a jar full of Skittles to help balance his blood sugar levels.

Asked to compare himself to a big league pitcher, he said his style is like the Pirates’ Paul Skenes, “except I don’t throw 100, I throw 84, but I can get some zip and movement on the ball and I’m working to be the best pitcher I can become.”

It would have been hard to predict that the camp would become such a life-changing venue for children with T1D when it welcomed its first campers in 1949. Back then, it was a standard YMCA camp. About a decade later, a physician named Dr. Robert F. Chinnock asked the camp about starting a program for kids with diabetes.

Rocky Wilson, the camp’s director since 1979, remembers those early years; he was offered a job washing dishes at age 15, and his father helped create the original YMCA camp.

“We want to help kids see possibilities and to think that diabetes won’t stop them from doing anything,” he said while eating lunch at a picnic table next to Jenks Lake with his wife and co-pilot at the camp, Debi. Neither has diabetes.

The hot dog lunch followed a rotating set of activities for the campers, which included canoeing, a balance game on a large fallen tree trunk, water balloon toss, and fishing. In addition to chips and water, kits with medicines and supplies also populated the tables – one for each cabin.

Wilson, a retired psychologist and teacher, said it’s important for kids to meet inspiring adults who have T1D. In addition to staffers, who are nearly all alumni, Wilson and his team have brought in fighter jet pilots, pro athletes, and former Miss America Nicole Johnson.

Each summer, the camp serves about 900 kids, none of whom are turned away for lack of ability to pay. There are always at least two doctors on site as well as a range of additional health care providers such as nurses, dietitians, pharmacists, and physician assistants.  

No camper or staff member is asked to bring their own insulin. Direct Relief’s insulin donations, which are used every day during the camp season, keep prices affordable. Without them, Wilson said, the cost of attendance would multiply several times over: “Camp could not exist without donated insulin.”

Walking back to camp from the lake with his big chocolate labrador, Wilson reminisced on times past and offered insight on why he spends his retirement as he does, as an unpaid volunteer running a summer camp.

“This is my church,” he said, before calling for his dog, who had gotten excited by something in the woods, to come back into view.

On one of the camp buildings, a posted schedule showed that the campers were due to arrive back from the lake for a rest period, followed by an afternoon activity, snack, free time, and then blood tests to check glucose levels before dinner. Another blood test was scheduled after the evening activity and snack, then, lights out.

The next day’s wake-up was scheduled for 7:15 a.m., followed by blood tests and breakfast.

The post For Kids with Diabetes, This Summer Camp Is Like Any Other. But It’s Theirs. appeared first on Direct Relief.

“It’s a tale of two Austins,” said Marci Roe, executive director of Volunteer Healthcare Clinic. Volunteer Healthcare Clinic (VHC) is a free clinic in Austin that has cared for the area’s most vulnerable residents since its founding by a church group in 1966, making it the oldest active charitable clinic in the city. About 1,000 patients receive care there each year. 

Like many free and charitable clinics, VHC relies on volunteers. Annually, about 400 people volunteer, one of whom happens to be Olympic medalist Gabby Thomas. 

Thomas, a gold medal contender in the Paris Olympic Games who is expected to compete in the 200-meter heat on Aug. 4, initially contacted the clinic via email while training for the Tokyo Olympic Games and pursuing her since-completed master’s degree program in epidemiology at the University of Texas. 

“Who I am off the track has always come first,” Thomas said in an interview with olympics.com. “Track is an added bonus. It’s something I love. I think it’s an important perspective that all athletes should have, which is that your sport is not who you are,” she said. A representative for Thomas declined Direct Relief’s interview request, citing the proximity to the Games. 

The Safety Net of the Safety Net

“In Austin, we are so affluent; we have universities and politicians and the capital, and then there’s another Austin where people struggle to support themselves with bare necessities. They’re having to make difficult choices,” Roe said. 

Since its founding, many federal and state government programs like Texas’s Children’s Health Insurance Program and the Affordable Care Act, in addition to the expansion of the Federally Qualified Health Care clinics, have sought to ease barriers to health care for people in the U.S. with low income, leading some to expect a declining need for free clinics.  

However, “there have always been people” who need free clinics, said Roe, citing the VHC’s constant stream of patients. Many hail from neighboring counties where economic realities make Austin’s cost of living prohibitive. 

“We are the safety net of the safety net clinics. We are where you go if you’re sick, you don’t have insurance and you don’t have money to pay… we’ve got the hardest working patients around but the cost of living here is very high,” she said. 

Since the pandemic, patients who sought care at the clinic have been “much sicker,” Roe said. Whereas before Covid-19, patients usually came in for one ailment, now it’s far more common for patients to have multiple issues. 

“They don’t seek out care until their lives are really challenged,” she said. “The medicines are just too expensive.” 

A Commitment to Care

Volunteer Healthcare Clinic maintains a major focus on addressing and preventing chronic diseases like diabetes and hypertension. For patients who have diabetes, local retinal specialists and optometrists offer screenings and, if needed, will offer appointments and care in an attempt to save the patients’ vision. 

Diabetic patients are also able to work with dietitians and pharmacists to receive education on diabetes and how to control the condition. 

Other VHC specialties include dermatology, mental health, pediatrics, and well-woman care. While a $10 donation is suggested, no one is turned away due to a lack of ability to pay. For patients whose needs fall outside of those offerings, VHC assists in connecting them with other clinics, including FQHCs, programs, and support networks in the area. 

For its own patients, VHC also has the goal of finding them a permanent home for care. “We are not set up to be someone’s permanent medical home indefinitely,” Roe said. 

While patients are receiving care at the clinic, they benefit from individualized care and attention, including from Thomas personally. The Olympic athlete calls patients individually to encourage them to attend their appointments, observe their blood pressure levels, and follow any other doctors’ orders. Thomas also connects with clinic patients to find out if their experiences receiving health care are positive and if they’re able to make it to their appointments. 

Thomas also got her sponsor, New Balance, to donate over 100 pairs of shoes to patients, in an effort to encourage patients to stay active and to boost morale. 

“She wants to make a difference in people’s lives. She’s so nice, fun, cool. For about a year and a half, she was helping almost on a weekly basis,” Roe said. 

As Austin continues to grapple with the repercussions of rapid growth and socioeconomic disparities, VHC remains resolute in its commitment to bridge gaps in healthcare access. 

“Our care is incredible with our doctors, nurses, students, and all of the volunteers who donate their time and medical expertise. Even if you don’t have insurance or the money for a medical visit, but you need care, we’ll still see you,” Roe said. 

Direct Relief has provided more than $350,000 in medical support to the Volunteer Healthcare Clinic in Austin since 2011.

The post Austin Free Clinic Has Hundreds of Volunteers. One is Really Fast. appeared first on Direct Relief.

In 2023, the CDC reported a total of 3,036 cases. 
 
In Latin America, the reported case counts have increased by more than 230% compared to the same time last year. More than 10.4 million cases have been reported so far this year, according to PAHO. 

This year’s increases across the Americas reflect a trend that has emerged over the past four decades. From 1.5 million total cases throughout the 1980s decade, the number surged to 17.5 million cases between the years 2010 to 2019, the World Health Organization reported. 

A Changing Landscape

Dengue is a viral illness transmitted through mosquito bites that can cause fever, body aches, fatigue, nausea, headaches, rash, minor bleeding, and vomiting. Severe cases can include shock, organ failure, uncontrolled bleeding, and death. 
 
Vulnerable populations, especially the young, elderly, and those with underlying health conditions, are more likely to experience severe or fatal cases. 
 
Experts say several factors are responsible for the recent surge in reach and case numbers: In particular, climate change, the difficulty of combating dengue-carrying mosquitos, and increased international travel each play a major role. 
 
“A key driver has been the expansion of the mosquito vector,” said Dr. David Freedman, professor emeritus of infectious diseases at the University of Alabama at Birmingham. 
 
Dengue fever is transmitted by two types of mosquitos: Aedes aegypti and Aedes albopictus. The mosquitoes have been difficult to combat and are now at record levels, according to Freedman. 
 
While malaria-carrying mosquitos tend to breed indoors and can be combated with residual insecticides, dengue-carrying mosquitos prefer the outdoors, making them harder to target. 
 
In Singapore, for example, Aedes mosquito populations have not been successfully controlled, despite seemingly ideal conditions: The setting is largely urbanized, repeated spraying for mosquitoes has been carried out, and there has been a high level of compliance with regulations such as removing standing water near houses. 
 
“It’s a little bit discouraging…People look at Singapore’s result and ask, ‘Well, does anybody have a chance at vector control?’” Freedman said. 

By contrast, the malaria-carrying Anopheles group of mosquitos has been targeted by widespread and largely successful eradication campaigns over the past decades. However, a downward trend in malaria cases that began in 2000 has been complicated by recent increases in case numbers.

The African continent recorded 94% of cases last year. In addition, Pakistan saw the largest annual increase, with more than 2.1 million additional malaria cases.  
 
The world’s changing climate is also helping to grow mosquitoes’ numbers and range. 
 
“It’s a perfect storm of increasing temperatures and changing rainfall patterns due to climate change, which creates ideal breeding conditions for mosquitoes,” said Michael von Fricken, an associate professor at the University of Florida’s Department of Environmental and Global Health. 
 
Von Fricken also identified Covid-19 as having changed immune system profiles across the population. 
 
“Think about how much time we spent during Covid sequestered and isolated. You likely have changes in immune profiles, due to human behaviors, that impact the underlying proportion of the population that is susceptible to exposure,” he said. 

A notable decrease in reported dengue cases during the height of the pandemic was most likely due to a combination of reduced travel and decreases in mosquito-borne disease surveillance, von Fricken explained. The overwhelming majority of U.S. cases are associated with travel, not locally acquired. Puerto Rico, which is experiencing an ongoing epidemic, is an exception. 

A Complicated Disease

Dengue fever has four subtypes. If a person contracts one subtype, they will generally be immune to that specific subtype. However, exposure to other subtypes can lead to more severe symptoms, including hemorrhagic fever. 
 
“We might see an uptick in a couple of years as different serotypes move through cycles,” he said. 
 
While dengue cases have increased, not all vector-borne diseases have followed a similar trend. 
 
Zika cases have declined in recent years and chikungunya cases have varied, albeit not approaching their peak numbers from 2014 to 2016. Von Fricken said this could be due to the diseases “burning through their wood,” or essentially having infected a significant proportion of the population already.  Freedman pointed out that chikungunya only has one serotype, so after people catch it, they become immune. Still, local pockets of concern exist, including chikungunya outbreaks in parts of Brazil and Paraguay. 
 
Because dengue has multiple serotypes, immunity is a much more complex picture.  
 
However, a cure for dengue fever does not exist and current vaccines are not universally approved for all populations. One vaccine is recommended only for those who have previously contracted the disease. Another commercially available option was withdrawn from FDA approval process last year but has been approved in several European, South American, and Asian nations. Several vaccines are in development. 
 
In the absence of a cure or readily available vaccine, Freedman and von Fricken said increasing awareness and education is important to curtail outbreaks. 
 
“Dengue is not endemic in the U.S., but there are areas where it is, and we’re importing it. We need to make sure clinicians are keeping an eye out for this, and not just dismissing it as a fever,” von Fricken explained. “We also need to tell people to stay inside when they have it, so they don’t spread it.” 
 
The disease is not transmissible between people, but mosquitoes can contract it from an infected person and then spread it to others. 
 
“It spreads very easily when mosquitos are present,” Freedman said. “And the geographic region seems to be spreading and populations are mobile.” 
 
In response to the growing threat, Direct Relief has developed a comprehensive dengue kit to support its partners in Puerto Rico and Latin America.

As there is no cure for dengue fever and the vaccination picture is complicated, the kit focuses on supportive care. Each kit is designed to treat mild cases of dengue in 100 people, and includes mosquito repellents, oral rehydration salts, acetaminophen to control fever and aches, and thermometers.  
 
Health providers were consulted on how to optimize the kits to best serve their patients. Dozens of the kits have been shipped across the Americas to date, including 12 to organizations in Puerto Rico. 

The post Climate Change, Travel Fuel Dengue’s Spread appeared first on Direct Relief.

Several doctors, hospital officials, and nonprofit leaders who spoke with Direct Relief say the current situation in Haiti is the most difficult within the past 15 years, due to widespread gang violence in Port-au-Prince and a range of cascading problems that have occurred as a result, including border, airport, and port closures, food insecurity, inflation, and large numbers of internally displaced people.

On March 18, a U.S. State Department spokesperson said in reference to recent events in Haiti that “it is not hyperbole to say that this is one of the most dire humanitarian situations in the world.” Earlier this week, “the majority” of pharmacies and health clinics near the currently closed State University of Haiti Hospital, also known as General Hospital, were burned down by gangs.

“We’ve never seen a situation like this,” said Dr. Marc Edson Augustin, medical director of the St. Luke’s Foundation, which runs a hospital in Port-au-Prince and clinics nationwide that care for about 60,000 patients annually.

“Nobody is allowed to function, to move around. They fear for their lives. It’s a country in collapse,” said Augustin, whose sister, a pediatrician, was kidnapped by gangs in 2022.

“We are living in chaos,” said Hadson Albert, a communications official at St. Damien Pediatric Hospital in Port-au-Prince. Albert said gangs are active in the hospital’s neighborhood and his neighborhood. St. Damien is the only hospital providing care for children with cancer and one of the few that treats high-risk pregnancies. Part of the St. Luke’s Foundation, it is funded through donations and mostly offers free services to vulnerable populations in Haiti.

“The situation is the worst we’ve ever seen during our three-decade tenure in Haiti. There’s never been a time when the entire country has been paralyzed by the situation in Port-au-Prince like it is now,” said Project Medishare’s Jenna Green. Project Medishare provides care to about 55,000 patients annually at Hospital Bernard Mevs in Port-au-Prince and about 100,000 patients annually at its clinics in the Central Plateau region, near the border with the Dominican Republic.

Augustin said that during past natural disasters, people were able to seek to move around to find hospitals and clinics that were still open. Now, most are afraid to leave home due to gang violence and the threat of being kidnapped. He said patient levels at this hospital have been dramatically reduced since the start of the year.

“What’s been going on has been building up since the assassination of our elected president in 2021. Gangs have slowly taken control and have attacked hospitals, schools, and the government,” Augustin said. In 2023, Haiti saw its murder rate double compared to the previous year, totaling more than 4,700 deaths, according to a United Nations report.

While both St. Luke’s and St. Damien remain open, both reported drastically reduced patient flows, as many residents are afraid to leave their homes. Staff members at both hospitals have had to do extended shifts of up to 24 hours, compared to standard shifts lasting between 8 to 12 hours. Some staff members choose to stay on-site for days at a time. These measures reduce the amount of travel. Healthcare workers have been targeted for robberies and kidnappings in recent weeks.

“We are doing our best to maintain the same level of care,” Albert said.

“We’re living day by day. I’m anxious to find out if we’ll be able to be resupplied. Nothing is certain,” Augustin said.

These current obstacles, combined with crises of the past and the economic opportunities present in the United States and Canada, have led to a large exodus of medical and other professionals from Haiti in the past decade, further compounding the challenges of providing healthcare.

Countryside Concerns Increase

Outside of Port-au-Prince, in the nation’s rural areas, hospitals and clinics face severe challenges related to large numbers of internally displaced people, food shortages, and reduced access to medicine and medical supplies – even for hospitals that were prepared. Patient levels are also reported to have dropped due to fears of leaving home and the increased cost of fuel.

“We built an infrastructure to be independent,” said Jessica Laguerre, who spoke to Direct Relief from Port-au-Prince. Laguerre is the chief operating officer at Hôpital Albert Schweitzer, or HAS, which is located about 100 kilometers northwest of Port-au-Prince in the Lower Artibonite Valley. The hospital has its own power grid, solar panels, oxygen plant, access to water, staff quarters, and stockpiles of medicines and supplies to last between one and three months.

“Having that removes most challenges most institutions are facing in Haiti,” she said, interrupting her response to note gunshots she heard in the distance. The staff at HAS are all Haitian, and Laguerre believes they have higher motivation since “they are serving their family and friends.”

Still, the hospital staff are subject to violence and kidnappings, with the hospital’s surrounding area ranking second behind Port-au-Prince for gang violence. Laguerre said that a staff member had been kidnapped and that gunshot wound victims had risen from a maximum of 10 cases per year to about 10 to 12 per week.

Stressing the importance of keeping hospitals as neutral zones, she recounted a situation where a well-known gang member came in to be treated after having been shot. People in the community found out and were planning to “storm into the hospital and lynch him.”

Laguerre and her team immediately called the police to remove him to another location for treatment, which they did in an armored vehicle.

While all of the issues are troubling, Laguerre pointed out that the Lower Artibonite Valley is known as the country’s food basket, making the pervasive food insecurity-related issues even more shocking.

“You’d think a farming community would always have at least the minimum amount of food… you can only imagine what the rest of the country is facing,” she said. A new food program Laguerre and her colleagues created quickly went from one location serving 200 plates per day to five locations, with two more planned for this week, serving 600 plates each.

Hunger was also cited as a leading concern by Locally Haiti, which operates a hospital in Petit-Trou-de-Nippes, which was severely damaged during the 2021 earthquake.

“This community is not self-sufficient. A lot of food and goods come from Port-au-Prince and the Dominican Republic,” said Wynn Walent, head of Locally Haiti.

“Food is much more expensive, and people are hungry. It’s true throughout the country and also true in our area,” he said.

Walent said that there has been a large increase in population, who have mostly been displaced from Port-au-Prince and have gone to live in the countryside with family members.

“Anecdotally, we’ve seen a 25% increase in the number of students enrolled in the school we support,” Walent said.

Walent said that a substantial increase in violence has not reached Petit-Trou-de-Nippes and that the work of their hospital has not been impeded, though restocking supplies is a concern with the closed border.

“We’re not trying to trivialize concerns, but help does reach people, even in the current circumstances, and can make a difference,” he said.

Project Medishare’s clinics in the Central Plateau face a similar situation in terms of gang violence to that in Petit-Trou-de-Nippes, Jenna Green said.

“We’re in the rural areas, and there’s not as much money in the rural areas for gangs, “ she said. Project Medishare has extended deployments to three weeks for their staff due to the danger of traveling between Port-au-Prince.

Project Medishare’s two clinics are open in the Central Plateau as are two maternity centers in the same area. During one day recently, only three patients showed up across all of their clinics. Overall, Green said monthly patient totals are about half of what they were last year, due to a mix of fuel costs and security concerns.

In addition to fuel costs, pharmaceutical and supplement costs have also increased dramatically. Prenatal vitamins, for example, have increased 400% in cost compared to January 2023.

Green said the closure of the Dominican Republic border is also impacting their ability to source medications and other supplies. “We are severely lacking supplies,” she said. Hospital Bernard Mevs ran out of oxygen and blood for during a period earlier this month but remains open.

Adding to the import problem, Green said that while the port at Cap-Haitien is open for sea freight, stringent Haitian regulations prevent the import of goods for many charities since many government bureaus are closed.

Like other nonprofits throughout Haiti, Green said Project Medishare prioritizes nutrition and recently adjusted their school meal program, which serves 8,000 meals per week. To keep it active, they hired mothers of the pupils to work as chefs and bought produce and other ingredients locally, at greater cost, since it was the only viable option, given the disruptions to the supply chain.

Peace and Perceptions

Augustin, referring to over a dozen hospitals that have been attacked in recent weeks, struggled to see how the situation would stabilize without outside help.

“I have to admit, it’s starting to seem hopeless. We’ve been waiting for international support to end this nonsense… I don’t see why the gang would put down their guns if not forced to do so. They outnumber the police and have more firepower,” he said.

“We need peace,” Augustin said.

Despite the problems, Laguerre, Green, and others see reason for hope looking forward. Green noted that her optimism comes from staying open and delivering care. Laguerre focuses on the potential of the majority of Haitians rather than the minority who are creating the instability.

“It’s a small percentage of people, and they are terrorizing us, but once we do the groundwork, we can move the country in a different direction,” Laguerre said.

 “There are a lot of beautiful things happening here… there’s so much energy being directed by Haitians at any opportunity given to help,” she said.

Laguerre believes that Haiti might not be as far from stability as it may seem, even given all the current violence and associated problems.

“We’re a tiny country, and it wouldn’t take much for us to get back on track. We need a little security and help, and we’ll do the rest on our own,” she said.

Direct Relief has allocated $1 million to support the operational expenses of health facilities in Haiti during this period of civil unrest.

The post “Living Day by Day,” Health Staff in Haiti Keep Hospital Doors Open as Violence Continues appeared first on Direct Relief.

Like most natural disasters, Hurricane Otis grabbed headlines in late October as a Category 5 storm that produced record-setting wind gusts of 205 miles per hour. The storm killed at least 52 people, with dozens more missing, according to the official government count. Local outlets have placed the death toll at as high as 350 people.

Now, several months later, international media has moved on even as the deadliest phase of the storm is ongoing. In the hurricane’s immediate aftermath, lack of potable water, limited or no electricity, impassable roads and damaged infrastructure, and interruptions to local food and medicine supply chains were the most pressing issues. Today, the delayed progress in rebuilding efforts has created a breeding ground for mosquitoes.

Dengue fever, also known as break-bone fever, is a viral mosquito-borne infection that can lead to painful fevers, rashes, and low platelet counts, which reduces the ability of the body to stop bleeding. While there is no cure, many cases can be treated with over-the-counter medications and rest. However, more difficult cases require anti-hemorrhaging medication, platelet transfusion, and an array of interventions in an ICU. In the most severe cases, usually due to low platelet counts, which can lead to spontaneous blood loss, patients are transferred to hospitals in Mexico City.

The mortality rate is less than 1%, though the illness can quickly fill up hospital beds. This is reflected at a new field hospital in Acapulco, where most patients are being treated for dengue fever, according to Dr. Ivan Santana, Guerrero state’s director of medical emergencies.

Months after the storm, “there still is a lot of debris and garbage, including trees, wood, sheet metal, aluminum, mud, and dust in the hurricane-effected areas (Guerrero state). It has become a breeding ground for mosquitoes,” said Dr. Santana, who noted that some roads in poorer, more rural parts of the state remain blocked.

Santana said there were about 1,500 active dengue fever cases in Guerrero as of last week, with just about all of them concentrated in areas most impacted by Hurricane Otis. He said cases were on the rise prior to the storm — Ministry of Health figures show a case count increase of almost 340% through October 2023 compared to all of 2022 — but that the numbers in Guerrero jumped significantly post-Otis. “Dengue is also present in other Mexican states, but Guerrero has the highest number, and I believe this is due to the hurricane,” he said.  

Less than two weeks after the storm, Guerrero had 1,855 confirmed cases, representing a 50% year-over-year increase in the number of cases compared to the same period the previous year. Between January 1 and February 21 this year, Guerrero had 1,497 confirmed cases, part of more than 4,700 total suspected cases, according to PAHO. These case counts are more than the total number of dengue cases in the state from January 1 to October 23, just before Otis hit last year.

Overall, since the storm, Guerrero has seen a 237% increase in cases compared to the same period the previous year, according to Ministry of Health data. Nationwide, Guerrero has about 40% of all confirmed cases, which is down from the 75% of all Mexican cases it had at the end of January. Before the storm last year, Guerrero was not among the top five states in dengue case counts.

Assessing the current healthcare priorities in Guerrero, Santana said dengue fever is at the top, even as other maladies are present, such as other mosquito-borne diseases, including chikungunya and Zika, as well as diarrheal diseases. Santana also mentioned that people with cancer and chronic diseases, such as diabetes, chronic kidney disease, and hypertension, have faced interruptions to care due to a lack of access to their medicines and treatments at facilities. Violent crime has also persisted in Guerrero, which has also curtailed the number of physicians and other first responders willing to travel to the area, according to Santana and one additional doctor who asked to remain anonymous and who decided to suspend his medical missions to Guerrero.

“Hospital infrastructure was damaged, and services were cut. Pretty much every single medical facility was affected by the hurricane so that obviously creates some issues,” Santana said. He mentioned the lack of cold chain capacity as an example of why diabetics were unable to get insulin, for example. Other medications that require being kept at low temperatures, like some vaccines, also spoiled.

Addressing what led to the recovery effort delays, Santana said the scale of the disaster was simply too large to address quickly, given available resources.

“More than 500 trucks were moving rubble right after the storm. There was lots of heavy machinery, but the magnitude of the hurricane was so massive that you couldn’t quite do it fast enough,” he said. “It was too much for any quick response to mobilize. There was too much rubble and mud, and even now there’s mud, which is a breeding ground for mosquitos.”

In the past couple of weeks, Santana said that the outbreak has been somewhat curtailed because of favorable weather conditions, specifically meager amounts of rain, as well as more fumigation. Santana believes the situation will stabilize through the spring, but that cases will likely rise again during the rainy summer months, in addition to fumigation machinery needing to be returned to the other Mexican states from which they have been loaned.

Since Hurricane Otis made landfall in Oct. 2023, Direct Relief has shipped more than 67 tons of medical aid to support health services for those impacted by the storm.

Interview translation and additional reporting by Eduardo Mendoza

The post As Hurricane Otis Recovery Continues, Residents Face Another Challenge: Dengue Fever appeared first on Direct Relief.

Today, an estimated 11.4% of people in India, equal to 101 million people, have Type 1 or Type 2 diabetes, with the latter being far more common. This percentage is similar to the U.S., where an estimated 11.6% of the population is living with diabetes. Jali’s highly-cited 1988 study in the BMJ showed the prevalence of diabetes at 5% in a south India township across all ages. For those between 55 and 64 years old, the figure was 41%.

People diagnosed with Type 1 diabetes, an autoimmune disease caused by different factors, including genetics and some viruses, make little to no insulin, a hormone that regulates blood sugar levels and helps the body convert food into energy. Without taking insulin, it can become fatal, and limited access to supplemental insulin can lead to disabilities. Globally, about 8.4 million people had Type 1 diabetes in 2021, a figure that could double by 2040, according to a Lancet study. It currently has no cure.

Type 2 diabetes generally occurs in people older than 45 years old. Excess body fat and other factors cause blood sugar to be too high due to decreased insulin production and because cells show increased resistance to insulin and take in less sugar. Other types of diabetes, including during pregnancy, exist as well.

Jali said that three major challenges facing diabetes care in India are population size, awareness, and access to healthcare. The number of patients across the subcontinent presents policymakers and doctors with several issues. India has 28 states and eight union territories, each with diverse local cultures, languages, and foods. This impedes the standardization of policies to address diabetes care since what might work in one area might not be relevant elsewhere, Jali said.

In terms of awareness, Jali said the situation has improved over the last two decades as a result of dedicated campaigns such as World Diabetes Day. But, he said, the campaigns have been less effective in some rural communities, which still lack knowledge about the disease and the importance of seeking care to help manage it.

However, even with education, people in rural areas also face some of the greatest access-related obstacles. Jali pointed out that rural access is limited due to various factors, including lack of facilities. He is optimistic that government programs, notably the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, will help address these disparities.

Across many sectors of India, from rural to urban, medicine affordability remains a challenge for many patients and their families, especially if a patient is working through multiple chronic diseases.

Insulin Finds a Way

Seeking to support children and youth who have Type 1 diabetes, Life for a Child, a nonprofit focused on increasing access to insulin worldwide, currently serves over 50,000 children and youth in 48 countries. The group, based in Australia, estimates that there are more children and youth living with Type 1 diabetes in India than in any other country. Four hundred thousand children and youth are estimated to lack sufficient access to insulin and other aspects of care, with at least 50% of these in India.

The nonprofit anticipates an increase in the number of beneficiaries to 15,000 by the end of this year, with a long-term goal of reaching 90,000 people by 2030. Globally, Life for a Child’s goal is to support around 150,000 people with Type 1 diabetes in 65 countries by 2030.

A major challenge related to insulin is that it must be shipped and stored cold, between a temperature range of 2 degrees and 8 degrees Celsius. This challenge can prevent access to insulin in places without reliable power or refrigeration facilities. Delays related to importation and logistics can further complicate shipments.

Faced with these challenges in India, Direct Relief looked to examples in other countries that could provide insights regarding the successful import and distribution of insulin to multiple locations in-country. Pakistan and Sri Lanka provided such examples. Both nations also have a substantial need for charitable insulin shipments and necessitated a decentralized distribution model since no single group, hospital, or government agency could serve as a central hub.  

Using lessons learned with Life for a Child in those two countries, last August, Direct Relief was approved by India’s Ministry of Health to send 80,000 insulin cartridges, enough to support 5,630 youths, to 15 healthcare facilities across 12 cities in India, including Dr. Jali’s facility and others in Ahmedabad, Aurangabad, Bangalore, Belgaum, Coimbatore, Kota, Nagpur, Navapur, Pune, Srinagar, Trivandrum, and Vellore. This shipment was followed in October by the delivery of 16 single and double-door pharmaceutical-grade refrigerators to ensure the safe storage of insulin as part of Direct Relief’s Global Cold Chain Initiative.

The successful game plan to ship this amount of insulin involved the combined efforts of Direct Relief, its contracted warehouse in the Netherlands, and various freight forwarders, which together have been acting as the “hub.” A single entity in India, Samatvam, applies for and receives all importation permits and tax exemption documentation. Direct Relief and its freight forwarders then work to have the shipment imported, cleared, and delivered safely to each individual dispensing facility.

In combination with these programs, Jali said insulin pens, especially in rural areas, can also present a type of solution since they do not need to be refrigerated after they are opened and are good for about one month.

Winning the Race

Assessing current trends, Jali said that while prevailing social factors, like preserved foods and more sedentary lifestyles, might be leading to an increase in the number of patients diagnosed with Type 2 diabetes, other tools can help address the disease, even as programs focused on outreach, education, and the encouragement of lifestyle changes are ongoing.

A major development, Jali said, is the vastly increased speed by which a person can check their blood sugar. He recalled receiving results in the early 1980s took about one day. Now, results are instantaneous, and some solutions, which are still quite expensive, offer a constant reading.

Jali also said that personalized treatment plans based on precision medicine are emerging. He estimated that in five years, he and his colleagues will have a genomic lab that will allow them to tailor care to individuals based on their genes.

While high-tech options are emerging, a major help in recent years when it comes to patient care is a simple text message. “By sending them messages or calling via mobile to remind and encourage them to attend appointments, they reciprocate positively and see that we care for them,” he said. Recognizing the importance of making patients feel comfortable and increasing the chances of patients engaging with the hospital, it offers yoga and other traditional programs.

Another way Jali and his team care for patients, specifically younger ones, is via a free summer camp the hospital organizes with support from Life for a Child, Direct Relief and the EU. The camp, which mostly includes children from rural areas, enables screenings, education, and strategies to help people delay the onset of Type 2 diabetes. Besides health factors, Jali noted that the financial aspect of diabetes “can put a lot of pressure on a nuclear family.” The team also goes to local schools to do diabetes screenings.

Beyond these health-based initiatives, Jali said the fight against diabetes also requires other tactics. Penpals United was a successful program he referenced, which helps connect kids living with Type 1 diabetes worldwide via video-based support groups. He also said it’s important to tell kids and parents about people who have been successful despite having diabetes, from becoming doctors to running ultra marathons and winning medals.

“We want to empower children from the beginning,” he said. “So they understand they’re not alone in society and that others with diabetes can achieve.”

Direct Relief has provided insulin, diabetes management products, and cold-chain refrigeration for temperature-sensitive therapies to support children and young people through Life for a Child in 44 countries, including India.

Additional reporting was contributed by Kelsey Grodzovsky.

The post Redefining Diabetes: Youth Initiatives Transforming India’s Health Landscape appeared first on Direct Relief.

The Maui wildfires last August, which claimed the lives of 100 people, presented a series of tragic circumstances. However, healthcare professionals with deep roots in the community, none of whom had emergency response experience, refused to be deterred and responded to the specific needs of their patients. And they did so in a way that reflects the benefits of building trust and familiarity with the local culture.

“We know Hawaiʻians. Even if it’s free, no one is going to come in and just take. That’s not our style. If we have nothing to contribute, we’re not going to take,” said Mālia Purdy, executive director of Hui No Ke Ola Pono, one of five Native Hawaiʻian healthcare systems.

Purdy, a Native Hawaiʻian, said that setting up a way to get aid to the folks who needed it most was just one part of her organization’s successful response. Immediately after the shelter at War Memorial Complex was established, staff members were there daily, despite Purdy telling them they could take time off to address the losses so many of them suffered.

“I told them (staff) to stay home. They came in anyway,” Purdy said.

All of their post-fire work was done in direct response to community needs – something they could determine due to the trust so many people had in them.

“It was our first natural disaster, so we were just trying to learn the protocol, what services were expected and if we could contribute to what was going on,” Purdy said.

Staff at Hui No Ke Ola Pono’s neighboring Mauliola pharmacy at Wailuku’s Cameron Center were working through the same questions as they were responding at War Memorial and beyond. Hui No Ke Ola Pono and Mauliola had created partnerships in the past, mostly around health education related to diabetes, hypertension, blood pressure monitoring, and smoking cessation. Hui No Ke Ola Pono also referred many of their patients to Mauliola, which has a nonprofit arm.

Like Hui No Ke Ola Pono, Mauliola Pharmacy staff had a bias for action after the fires and began sourcing and filling prescriptions on the day the War Memorial shelter opened. The two groups communicated needs as they responded to survivors and those hosting them in other parts of the island.

“We were trying to organize the chaos as much as possible,” said Tori Ching, director of operations at Mauliola Pharmacy. The pharmacy saw prescriptions jump from about 800 per day to 2,000 per day in the days after the fires.

Like Purdy and her team, Ching and her colleagues created systems on the fly to respond as quickly as possible while integrating new information and optimizing the response.

Once people were let back into Lahaina, Ching and her colleagues began going door-to-door in order to make sure residents had their medications, something she said might not have been at the top of their to-do lists after having lost their homes and, in some cases, loved ones.

The opportunity to help people in this way, Ching said, was based on trust that had been developed over the years.

“Working with patients who already have that trust, it helped us with accessibility,” she said.

“The number one thing when being in a smaller community or working with Native Hawaiʻian populations, our culture here is really based on Aloha and trust.”

Lomilomi and Ho’oponopono

Before the fires and after, Hui No Ke Ola Pono and Mauliola both strived to bridge the gap between traditional Hawaiʻian medicine, called Lāʻau lapaʻau, and Western medicine. Programming at Hui No Ke Ola Pono is built on foundational Native Hawaiʻian customs, beliefs, and practices, according to Purdy.

While Hui No Ke Ola Pono provides primary care, dentistry, behavioral healthcare, and cardiac rehabilitation, they also offer and train practitioners to offer Lomilomi and Ho’oponopono, Native Hawaiʻian healing services. Purdy described Lomilomi as “massage-like, but not nearly as relaxing, it’s more painful… you’re trying to work something out. It’s a practice to realign your body and bring your spirit back into you so you are in total alignment.”

Ho’oponopono, she said, is more “family-based conflict resolution. It’s family therapy but not family therapy.”

Offering them gives the clinic a chance to bring in patients who might not feel comfortable going to Western medicine-based clinics, Purdy said. And vice versa.

“Our native Hawaiʻian population has kind of a reputation for being untrusting of the Western medical system and so it’s important for us to provide access to other forms of healing. And on the island of Maui, we are the only health center that has linkages and ties to traditional healing practitioners.”

Mauliola Pharmacy also fulfills the role of providing a bridge between traditional and Western care. In June, the pharmacy purchased land with the intention of planting traditional crops and providing a resource for community members to reconnect with the land.

From Survival Mode to Rebirth

More than five months after the fires, Purdy and Ching said housing remains a major challenge for survivors on the island. Ching said many pharmacy patients are in “survival mode” as they are focused on finding and maintaining long-term housing.

Given this, she said it’s been hard for her and her colleagues to get patients to focus on things like monitoring their chronic conditions, even as pharmacy staff understand it’s not the priority for patients now.

“We are trying to provide services for the community that they actually need. So we want to come in with a level of awareness. We also want to get back to that place where we can make things like getting them to check their blood pressure a priority again,” Ching said.

Like many other nonprofits, Purdy said that her organization is in a long-term planning period, especially since many outside organizations are starting to offer less support. The overall goal, she said, is training and equipping people and teams that “plan to be on Maui forever.” A major focus has been mental health care and finding ways to bring in more resources.

One plan that has already been manifested is the new Lahaina Comprehensive Health Center. A partnership between Hui No Ke Ola Pono, Hawaiʻi’s Department of Health, Mālama I Ke Ola Health Center, Waiʻanae Coast Comprehensive Health Center, Hawaiʻi Island Community Health Center, and Mauliola Pharmacy, it offers all survivors a venue where they can receive treatment including primary care, wound care, dentistry, podiatry, behavioral care, and case management. As part of the initiative, volunteers and staffers go into the community to share information regarding available resources and check in on survivors.

As new health-related initiatives emerge, Purdy hopes that locals will also be a focus and play a leading role in rebuilding efforts more broadly, something she said should be less about optimizing for tourism and more on “the ways we care for the land, which holds a lot of historical significance,” she said.

Direct Relief has provided medical aid to Hui No Ke Ola Pono and Mauliola pharmacy, and financial aid to Hui No Ke Ola Pono, in response to Maui wildfires.

The post ‘Aloha and Trust.’ Native Hawaiʻian Health Care’s Response to Maui Fires appeared first on Direct Relief.

According to Santa Barbara County Fire Captain Safechuck, a major reason for the reduced death tolls over the past three years is that wildfires have stayed away from urban areas. But hoping that fires will continue to burn away from population centers is not a strategy Safechuck and his colleagues would like to rely on.

“We are constantly trying to push out information on how people in the community can stay safe,” said Safechuck, a 23-year veteran of the department. “They need to be paying attention prior to a fire happening, particularly when the conditions are right for a fast-moving fire, and have an action plan including for when kids are at school, if some family members are not ambulatory, if someone’s out of town, or other circumstances.”

Trying to instill residents in Santa Barbara with a sense of personal responsibility when it comes to wildfire safety is a key firefighting tactic of the Santa Barbara County Fire Department Fire, even as they have increased their firefighting capabilities through new technology and equipment. Still, it’s not possible for any firefighting department to immediately respond to all areas under attack during a large-scale event.

“Most people believe there is going to be a fire engine at their house during a wildfire. Eventually, that will be the case, but it takes time for us to build that system. We have to use our mutual aid system to get resources from the state. It might take days. Our crew will work as hard as they can to save the community, but it just takes time,” Safechuck said.

Safechuck also stressed the realities of being in the danger zone, further reinforcing the importance of creating an action plan ahead of a fire event.

“It’s hard for people to imagine what it is like in that (wildfire) environment. People think they’ll defend their homes with a garden hose… but it’s so hot, every breath you take is very heated, your eyes water, and you start to vomit; it’s very hard for trained professionals to operate in that environment, so compare that to someone who has not been trained, doesn’t have the right gear on, and has a limited water supply,” he said. “It’s very dangerous for them.”

Click below to listen to an audio version of this story.

Ultimately, the goals of wildfire preparations for residents are two-fold: both to create a defensible space around houses and to be able to evacuate safely if a wildfire is threatening. Both steps can play a significant role in helping local firefighters do their jobs.

“The sooner people evacuate, the roads become more freed up for firefighting vehicles. If people don’t take it (evacuation orders) seriously, they can become trapped in there, and it makes it harder for us to operate to attack the fire. If they become trapped, our priorities change. Life safety is a priority for us but it takes away from efforts of putting out the fire. If you don’t feel safe, or you’re not sure, evacuate as long as you have a route out of there,” he said.

A central aspect of the department’s public outreach strategy is the Ready, Set, Go Action Plan developed in collaboration with the U.S. Forest Service, CalFire, and several other Southern California fire departments. Ready. Set, Go is a 10-page booklet that educates residents on how to prepare for wildfires so that they have the best chance of defending their homes and saving their own lives through proactive decision-making.  

Some of the tactics include how to create a defensible space around a house, how to build a more fire-resistant house, how to prepare a house when it’s threatened by fire (for example, by closing exterior vents), an action plan guide, what to include in a to-go kit, and a checklist for what to do as a fire approaches.

Firehawks, AI, and more

In addition to a focus on public outreach, the Santa Barbara County Fire Department has been bolstered in recent years by advanced warning technology and aerial support. There are now almost a dozen remote weather stations placed around the county, including nine permanent units and two portable ones. Additionally, the county has one AI camera system, constantly scanning high-risk areas for smoke. Santa Barbara is also part of a statewide camera system that helps identify brewing wildfires.

Once a wildfire begins, the county can utilize its Firehawk helicopter, a converted U.S. Air National Guard MH-60 Pave Hawk optimized for firefighting with an external water tank, rescue hoist, improved avionics and the ability to travel about 30% faster than the department’s other aircraft, allowing it to get back to the fire area more quickly. The county’s Firehawk helicopter was previously used during two combat tours in Afghanistan. Purchased in 2019, with support from Direct Relief totaling over $1.1 million, the Firehawk has the ability to drop about 1,000 gallons of water, which is more than three times the capacity of a Huey, a smaller and older helicopter which is also part of the county’s firefighting arsenal.

Since 2022, the helicopter has dropped about 182,700 gallons of water on 37 wildfires. Last year, the Firehawk, which is often the first responder on the scene of fire and medical emergencies, accounted for almost 90% of all water dropped by Santa Barbara County Fire Department’s Air Support Unit. It has also been involved with five rescues on the Channel Islands, seven hoist rescues, and five medical evacuations.

But even with these tools, Safechuck said recent wildfire fatalities speak to the need for residents to stay vigilant and prepared.

“We are better at fighting fires than we’ve ever been in the past, and yet we’re still having fires that are taking the lives of a lot of people,” he said, noting that wildfires have recently occurred in areas that have not experienced them historically.

“As the population grows in more rural areas, everything is growing more laterally and pushing more into more urban interfaces. During fires in those areas in the past, maybe there were only a few homes, but now there are many more. It’s important that communities like those get up to speed so that they’re as prepared as possible,” he said.

The post California Wildfires Have Been Less Deadly in Recent Years. Residents Told They Can Help Keep It That Way. appeared first on Direct Relief.

According to a Penn State study from earlier this year that focused on children in Peru over a 15-year period, a link exists between experiencing a natural disaster or other similarly impactful economic or agricultural event and poorer testing outcomes across reading, vocabulary, and math, less food security, more time spent on household chores, and worse self-reported health outcomes. The study, authored by Carolyn B. Reyes and Heather Randell, found the effect cumulative, with poorer outcomes for those who had experienced multiple shocks.

Children who experienced these events later in childhood, between 12 and 15 years old, showed worse outcomes overall than those who experienced the events earlier on. The authors point to this older age cohort as being more aware of the event, being in the midst of either transitioning to secondary schooling or supporting their families by doing chores or working as potential reasons.

According to the United States Geological Survey, this data comes as natural disasters are increasing in both frequency and economic impact. In a 2021 report, the World Meteorological Organization found a fivefold increase in weather-driven natural disasters over the 50 years. However, resultant deaths have decreased by a factor of three in that same period.

Specific Vulnerabilities of Children

A 2016 survey of literature related to the impact of natural disasters on children by Carolyn Kousky of Resources for the Future, a Washington D.C.-based nonprofit research institute, shared similar findings as those reported by the Penn State team and outlined the ways in which natural disasters can harm a child’s mental and physical health as well as their educational outcomes over the long-term.

Kousky shared policy recommendations for ways to mitigate such damage, including reinforcing school buildings and homes and placing more emphasis on reuniting families as soon as possible following a disaster. She also highlighted the potential value of supporting existing safety net health care clinics and organizations instead of spinning up new initiatives in the wake of an event.

Kousky, Reyes, and Randell all acknowledged the relatively small sample sizes and specific geographic contexts of much of the existing research but still found pervasive indications that natural disasters harm children’s health in a variety of ways. Kousky identified that children, especially younger children, in contrast to the Peru study, may be more vulnerable than other age groups since they rely on caretakers who might be unable to care for them and are less protected from physical damage due their developing bodies, an example being that children are more at risk of dehydration due to the smaller amount of fluids in their bodies compared to adults.

In severe disasters, children have been found to be less likely to survive compared to adults, such as in the 2004 Indian Ocean tsunami, according to a 2011 study in Economic Journal, which was included in Kousky’s report.

Economic Impacts on Families and Children

On the economic side, the ability of families to stay financially resilient after a disaster depends upon a range of factors, but chief among them, across the studies reviewed by Kousky, Reyes, and Randall, was access to credit and, as reported by Kousky, insurance. Without these resources, families are forced to make do with their savings.

A natural disaster and the resulting financial impact can have dire consequences for children, as families may be forced to decrease their investments in education and might result in children being forced out of school in order to work, as was reported in this year’s Peru study. However, it remains challenging to get more granular causal data as opposed to the correlations being shared.

Health and Nutritional Impacts

Economic conditions can also translate directly into physical health conditions, as families may be unable to access the same amount of nutritious food as before the event. Access to medical care and medications is often impacted as well. Kousky shared that people living in FEMA housing in 2005, following the previous year’s Hurricane Katrina, faced “fragmented” or “nonexistent” access to medical care. In particular, many children were unable to obtain their asthma medication.

Survivors living in FEMA housing at that time also reported high levels of negative mental health impacts on their children. Specifically, half of all parents surveyed said at least one of their kids was experiencing an emotional issue that they did not have before the storm. In a different study, decreases in PTSD symptoms in children were found to occur two and three years after the storm, though more than a quarter of kids still had symptoms after three years.

Assessing additional ways to prepare for disasters, Kousky said that many nondisaster programs can be effective in recovery efforts, including increasing access to credit, offering subsidies for families to maintain continuity of education for their children, and increasing unemployment insurance.

In 2023, Direct Relief provided medical aid to more than 85 countries during both times of disaster and as part of ongoing support. The organization is focused on meeting the health needs of those most vulnerable to disasters, including children.

The post Understanding the Lasting Impacts of Climate-Driven Disasters on Children’s Lives appeared first on Direct Relief.

Dr. Giorgio Franyuti, the founder and head of Medical Impact, a Mexico-based medical aid nonprofit that organizes monthly missions into underserved communities domestically and responds to disasters both at home and internationally, said the scale of devastation was well beyond anything he had seen in his career, which has spanned war zones, earthquakes, and volcano eruptions.

“This Category 5 storm was enormous… We didn’t even know where to start,” he said.

Determining that Acapulco would receive the most resources from the government and aid groups, Franyuti and his staff physicians organized a mission inland to the mountainous rural communities of Guerrero state and traveled to five different municipalities.

Before reaching the last one on their mission, Ejido Viejo, the Mexican military had to clear a path since existing roads were completely destroyed. The town had been cut off for over a week.

“It was horrendous. The houses were still drowning in mud. The cars were drowning in mud. Bodies were yet to be found,” he said. “We discovered a massacre.”

He plans to return next week with his team to continue treating survivors. Franyuti said that in his experience, which reflects the latest medical literature, the time after a natural disaster is oftentimes more deadly than the disaster itself.

“The secondary disaster is bigger than the first one. The earthquake or hurricane doesn’t kill as many people as the water shortages, for example, will. The cuts in basic services will cause major death among those affected by the hurricane,” he said.

The lack of refrigeration, combined with limited access to quality food, potable water, and gas for cooking food and boiling water, represents an extremely dangerous combination of challenges facing communities in rural Guerrero, which were vulnerable even before the storm, according to Franyuti, who said lack of clean water is the top priority.

He said he is concerned about the spread of a range of infectious diseases. Franyuti said diarrhea could kill more people than the hurricane due to the lack of oral rehydration salts and drinkable water in the area. Mosquitos, which could flourish in standing water near homes, also present a problem as some will likely vectorize diseases such as chikungunya, dengue fever, and zika. He predicts that the scarce local services will be oversaturated by these infections.

As is the case following most natural disasters, Medical Impact is working to address the shortages and barriers vulnerable communities have towards accessing chronic disease medication, particularly therapies that require being kept at cool temperatures, such as insulin. In Mexico, complications from diabetes are the second-leading cause of death.

Despite the level of need, Franyuti said the level of response has not been in line with the situation on the ground.

“I think what is worrisome compared to other disasters in the past is that while the media has given this wide attention, stakeholders have not,” he said.

Medical Impact is preparing for at least four more missions to address this crisis, each lasting for one week. Franyuti said his team has been the only one responding to these areas.

Direct Relief has been responding to Acapulco, equipping organizations with requested medical aid, including Medical Impact. The organization received a $25,000 emergency operating grant to deploy doctors to Acapulco to provide medical care in the area. Field medic packs and an emergency health kit, which contains medical essentials commonly requested after disasters, were also provided for medical providers from Direct Relief.

The post Deadliest Phase of Hurricane Otis Likely Underway appeared first on Direct Relief.

While any startup and its financiers would be thrilled with these figures, for End Overdose, the stakes are much higher.

“I can’t tell you how many times I’ve had to say, ‘Your brother is dead. Your mother is dead,” said Theo Krzywicki, founder of End Overdose. “All they had to do is put naloxone in the nose and rescue breathe.”

Last year, 109,360 people died from drug overdoses, according to provisional data from the CDC. Of these deaths, 79,770 were reported to be opioid-involved.

Unlike many better-funded programs working to address the nation’s opioid epidemic, End Overdose relies on a peer-to-peer model that seeks to prevent deaths from overdoses by distributing an opioid overdose reversal drug, naloxone, and test strips that reveal the presence of fentanyl, which can be present in other drugs. Naloxone can be injected or inhaled as a nasal spray and works by connecting to opioid receptors in the body, which can block the effect of opioid drugs. The nasal spray version, branded as Narcan, is now available over the counter.

End Overdose also gives quick, on-the-spot tutorials for how to respond to a potential drug overdose and how to administer naloxone as well as to use the test strips.

In line with other harm reduction initiatives, these trainings are judgment-free and solely focused on how a person should react when a person’s life is on the line due to an opioid overdose.

“This is a simple problem, but it affects everyone at every level. Everyone has caught on to naloxone saturation, but we still have significant problems with communication. You can give it out all over the place, but if it’s not going to the right people and it’s not the right message, they won’t use it,” said Krzywicki.

For Krzywicki, who works as a firefighter and paramedic in Los Angeles, the work is not abstract.

Krzywicki took his first opioid at 13 years old after being prescribed pain medication with unlimited refills after breaking his leg. Trekking the path of the opioid crisis in the United States since the mid-1990s, Krzywicki became addicted to synthetic opioids and eventually began using heroin at his Seattle high school.

During those years, he saw many friends die from drug overdoses. But then the scourge hit even close to home.

“My fiancée overdosed,” Krzywicki said to Direct Relief. “It was just so preventable, but at that time, no one was talking about what to do when someone overdoses.”

The tragedy set Krzywicki on a different path, and he began working in drug treatment centers and later as a paramedic. “I just wanted to do something about it,” he said.

While working as a paramedic in California, Krzywicki saw how easy it was to administer naloxone to reverse an overdose and thereby save a person’s life. He wanted to distribute it as widely as possible. In 2017, he started approaching treatment centers in California. However, Krzywicki said that most treatment centers require sobriety and will kick patients out if they relapse. He said the usual path for relapsed patients is to then seek out drugs with disastrous results. Out of treatment, they would no longer have access to the naloxone. Adding to his challenge, naloxone was “extraordinarily” difficult to source.

Thinking about how to meet the most at-risk people where they are, Krzywicki pivoted to the nightlife scene. He was able to link up with various harm reduction groups, which helped him gain access to naloxone.

“When we got embedded in the nightlife, that’s when things really changed,” he said.

Tragedy would catalyze more action. In 2017, Lil Peep, a young rapper, died from an opioid overdose. His death sparked a meeting of several prominent musicians and influencers at the Echoplex in L.A. to discuss how to make nightlife safer. Krzywicki was invited to give a training on naloxone use. Invitations for trainings followed from venues in the underground L.A. music scene and then, in 2019, from the L.A. Mayor’s Office for a citywide program, which was halted due to the Covid-19 pandemic.

No Marketing Budget

From these experiences, Krzywicki had some key learnings that he felt could be used to expand his outreach among young adults further.

“We wanted attraction rather than promotion. There is nothing more obnoxious than someone working in a healthcare space harping at you to stay safe. It’s not fun,” he said.

“We wanted to use a peer-to-peer model. Nothing is better than hearing it from someone your age, who looks like you and knows your experience,” he said. End Overdose, the name of the nonprofit Krzywicki created, decided to branch out to college campuses.

Giana Uy, 23, co-founded End Overdose’s first college chapter at UCLA last year.

“I wanted to make sure my friends around me were safe,” Uy said. “I had not heard of Narcan [before getting involved with End Overdose], and I wanted to make it accessible since there was nowhere to access it on campus,” she said. “People wanted to be able to test drugs and weren’t able to do it,” she said, referring to fentanyl test strips, which reveal the presence of fentanyl in other drugs. End Overdose also provides these test strips and related training for free.

After graduating last year, Uy decided to work for End Overdose full-time, working now as its director of external affairs and programs. Despite starting last year, the group now has 31 chapters nationally. They had to turn down about 50 applications from colleges due to a lack of resources.

“It’s all grassroots. A lot of people see the work being done on other campuses and want to bring it to their campuses. We have no marketing budget. It’s just social media, friends, and people seeing it firsthand,” she said. College chapters are all set up slightly differently depending on the specifics of the campus, but each has the goal of reaching as many people as possible.

Chapters are all given onboarding training, where they learn about different overdose responses and harm reduction in general. They are also trained on how to teach others effectively. End Overdose offers three types of trainings, based on the Substance Abuse and Mental Health Services Administration’s best practices and input from a range of medical professionals and people who have experience using drugs.

Students who lead these chapters distribute naloxone and fentanyl test strips to their peers, oftentimes by setting up tables in courtyards and routes to classes.

“Our goal is to have this on major campuses in America. We definitely want to have a chapter in every state,” Uy said.

Ready for Action

At an event for military veterans last month in the L.A. area, Anthony Banuelos, End Overdose’s director of operations, greeted passersby with a big smile and energetic greetings.

“Would you like some free naloxone?” he asked, rows of nasal spray versions of it in front of him on the table, which also had stickers, fentanyl test strips, and a life-size training mannequin.

Every person he asked said yes. Many said they knew someone who had died of an overdose. Banuelos said he survived an overdose as well.

After handing out a couple of packs of the spray, along with a QR code so the group could track usage, he launched into what he described as a “wham, bam, to the point” training process for how to identify if someone is overdosing, to call 911, how to administer naloxone, and how to do rescue breathing. He also noted that Good Samaritan Laws protect people who try to help in these situations and that naloxone has no negative effect if a person is experiencing a different medical emergency.

Banuelos then demonstrated how to use the spray on the mannequin and handed it to the trainee.

“It’s real life, unfortunately,” said MGySgt. Joe Gray, USMC. Gray received the training because he said he wanted to be able to “look after his Marines” in case the need arose. Asked if he felt ready to respond after the training, he quickly said yes.

SSgt. Jaime Serrano said he stopped by the table because of Banuelos’s friendly greeting.

“It’s the first time I heard about naloxone… I’m now prepared to respond,” he said.

Donna and Jeff Watkins, along with their friend Kim Miner, said they had several friends who lost their children to fentanyl.

“It’s the first time I have access to naloxone, and now I know how to react,” Donna Watkins said.

Jeff Watkins, who works as a key grip on Hollywood sets, said he received similar training on studio sets but not on location.

“We have AEDs (automated external defibrillators) on set; we should have this too,” he said.

Asked what drives him to do this work, Banuelos said, “We want everybody to be prepared to save someone’s life.”

Though the opioid crisis is “definitely getting worse,” according to Krzywicki, he is undeterred.

“I think we can fix this. Too often, people get lost in the tragedy… But we have medicine, training and the ability to get it out there. No one else has to die. If I don’t keep going… I’d feel like I’d be abandoning something,” he said.

End Overdose has given away over 130,000 naloxone doses to date.

Since 2017, Direct Relief has provided 2.6 million doses of naloxone to health centers, free clinics, community organizations and harm reduction groups, including End Overdose.

The post ‘No One Else Has To Die’: L.A.-Area Group Fights Opioid Crisis In New Ways appeared first on Direct Relief.

Ampla Health, a federally qualified health center system in the area, lost power at its Magalia location shortly after the fire hit, forcing the clinic to close. With support from Direct Relief’s Power for Health initiative, Ampla Health now stands ready for the next natural disaster with a cutting-edge, resilient, solar-powered system that will help healthcare providers continue to care for the most vulnerable residents by powering critical medical devices and allowing them to access records, even if the grid fails.

Direct Relief is pleased to present this original short documentary, a co-production with BBC’s StoryWorks:

“Invisible Impacts of Wildfires” is part of a series called “The Climate and Us” by the BBC and the Global Climate and Health Alliance. The series goes around the world exploring how the climate crisis is a health crisis, while highlighting innovative healthcare solutions being used to help respond.

The post Direct Relief & BBC Present ‘The Climate and Us: Invisible Impacts of Wildfires’ appeared first on Direct Relief.

NEW YORK — Alejandra Jimenez, 27, her husband, and young daughter stayed in their hometown of Barquisimeto, Venezuela, for as long as they could.

Jimenez’s daughter, Nicole, 9, has cerebral palsy, with microcephaly and epilepsy, which require ongoing care, something that the city, and nation, could no longer provide, with its deteriorating economic, security, and healthcare situations, including hospitals without potable water or consistent electricity, lack of medicines to manage convulsions and unreliable transportation options. Jimenez had to find a better solution for Nicole.

“I am, and will always be, in the place where I can give good care to my daughter,” Jimenez said. “[Nicole] has her particular condition, but I know she is happy. I try everything to make her feel happy,” she said through a translator during a series of interviews with Direct Relief last month. Throughout the interviews and reporting, she was inseparable from her daughter, constantly cuddling and kissing her.

The family moved to a border town next to Colombia, which allowed medical visits there. But after some time, the crisis in Venezuela reached them there, too, and they were pushed to move into Colombia. They experienced a degree of respite there, but Jimenez wanted to give her daughter a fuller life, one that would only be possible with surgery to relieve the symptoms.

“I have to achieve that surgery. I have to achieve that dream,” Jimenez recalled repeating to herself when they had few opportunities to make that dream come true.

It was ultimately this commitment to Nicole that catalyzed the family to make an epic journey north to the United States, with an eye towards New York City, where Jimenez’s sister lives and where she believed she had the best chance to get the surgery for her daughter.

Safety net clinics adapt to care for migrants

Jimenez is one of over 541,000 people to be allowed into the U.S. under new policies enacted by the Biden administration. About 100,000 migrants arrived in New York City from spring 2022 to August 2023.

“No one could anticipate that we were going to get over 100,000 asylum seekers in a year at the beginning of this humanitarian catastrophe,” said Daniel Pichinson, executive director of Ryan Health’s Chelsea-Clinton clinic. Ryan Health is a federally qualified health center, part of a national safety net clinic system that provides care for everyone who requests it regardless of their ability to pay. “We reached out to the mayor’s office, catholic charities, and shelter providers in the area to offer our services because we suspected individuals would need health care,” Pichinson said, estimating that Ryan Health has onboarded about 3,000 migrants in the past year.

“Step by step, I can do it by myself. This is a country of opportunities, and I will find one of those opportunities people talk about.”

– Alejandra Jimenez

The crisis catalyzed changes at Ryan Health, which saw 47,950 patients last year across its clinics, community outreach centers in homeless shelters, and schools.

“We are very fortunate to have a very dedicated staff, but they’re tired, post-Covid, post-everything the past few years. Imagine if a dozen people walked into your doctor’s office; what would they do? Turn them away. We can’t. So we did some triaging and then gave them appointments to come back,” Pichinson said. Beyond administrative issues, the clinic was also forced to reexamine some of its basic assumptions regarding patient care.

“Some people thought taking blood and seeing a nurse is the whole thing. They didn’t understand they still have to get the results and see the doctor,” he said, noting that some patients at the clinic had never been in a doctor’s office before.

“No records, no vaccinations, you go from point zero. You need to do a full medical exam before integrating them into U.S. society,” said Dr. Christian Olivo, an infectious and tropical disease specialist originally from Venezuela, who has been on staff at Ryan Health since November.

Olivo pointed out that migrants in the past received a checkup and certain medicines before entering the U.S. This is also the reason that Olivo and his team had to create a new screening protocol to check for certain parasites and diseases that are common in the Darien Gap, an area of jungle in the Panama-Colombia border region known for its difficult terrain and lawlessness. Chagas, which can lead to heart failure, and leishmaniasis, which can lead to skin sores and organ failure, are two examples Olivo gave.

Adding to the challenge of understanding new patients’ medical history, Olivo has also found that many patients who believe they have been vaccinated against certain conditions, in fact, have no antibodies. The reason, he said, is the frequent power outages in some South American countries, notably Venezuela, lead to certain vaccines rising above the temperature needed to keep them effective.

Olivo noted that the most effective care is given when the provider speaks the same language as the patient and understands or at least is familiar with their culture and experiences.

“Imagine using an interpreter to ask about sexual assault. It’s not an easy question to ask through a third person, so that’s a barrier to the care of these patients. Sometimes providers don’t really understand what these patients have suffered,” he said.

A Long and dangerous journey north

Jimenez’s more than 2,000-mile journey to the U.S. began in Ipiales, which sits on Colombia’s southern border with Ecuador, and ended in Brownsville, Texas. The route she, like hundreds of thousands of other migrants, took through Panama, Costa Rica, Nicaragua, Honduras, Guatemala, and Mexico to the United States is highly fraught.

“98, 99% of patients experience extortion by police, local thugs, and organized crime along the way, especially in the Darien gap, by Guatemalan police and in Mexico, it’s with a mix of cartels and immigration police. Also, in Mexico, you have kidnapping, slavery, and sexual assault for both males and females,” Olivo said, based on what his patients have shared with him. He is also conducting a study of 500 migrants related to tuberculosis.

Other dangers are present on La Bestia, a freight train that runs from southern to northern Mexico. Extreme weather faces passengers, who must endure temperatures that can reach 90 degrees during the day and drop below freezing at night. When the train stops, bandits will jump on the train, sometimes robbing and kidnapping migrants. Olivo said sometimes they will escape, “but it’s not because of the police.”

“Knowing you can be kidnapped, killed, raped, your level of desperation has to be high enough to decide to cross this. To me, it’s super impressive,” Olivo said about people who make this journey.

Jimenez said she and her partner, the father of her youngest son, were aware of what they could face. But within a few days of making the decision, they began their journey on April 17: Alejandra, her partner, Nicole, her three-year-old son, and her 20-year-old nephew.

Upon reaching the Darien gap, she encountered a “dense maze of mountains as beautiful as they were lethal.”

“My biggest fear was to go out of that place without any of my kids alive,” she said, sharing the story of another family who had all died after falling into a ravine. She took turns with her husband carrying the small children.

Early on in the jungle, they began to run out of food. Luckily, they met a local man who, after looking at Nicole’s condition, agreed to help them cross through a shorter and less dangerous but usually more expensive route. With that godsend, Jimenez and her family emerged from the jungle, though she contracted diarrhea and a fever.

the last leg

Jimenez continued through Central America with Nicole in a baby carrier, which presented physical difficulties but was somewhat mitigated by an ever-present sense of solidarity. They traveled via a mix of walking and buses. In Mexico, Jimenez said she and her family passed through quickly and without incident.

On May 9, they arrived in Matamoros, in the Mexican state of Tamaulipas, across the Rio Bravo from Brownsville, Texas. Exhausted and facing a river that was deeper than expected, Jimenez gave Nicole to her nephew to carry across.

She remembers seeing his feet go deep into the muddy bottom as a strong flow of water pushed against him. Most people were struggling to advance. Alejandra was panicking but determined, as were all the people, screaming and rushing to the other side.

When they made it across, they turned themselves in to U.S. border authorities and were detained. Nicole was vomiting and had a fever, but no care was rendered to her, something Jimenez said could have been due to the large group size they were in. Still, it shocked her that law enforcement ignored her daughter’s condition. They were then taken to a detention center for three days before being released and taken to a shelter in McAllen, where conditions were “very bad,” according to Jimenez. They were forced to sleep on the ground with little protection from the elements.

A new city and New mantra

After a couple of days, Jimenez’s sister managed to buy plane tickets to fly them to New York City, where she lives. Upon arriving, the family was assigned to a shelter in the Bronx. While the family reunion was joyous, it soon became clear that Nicole would need emergency care to treat her ongoing high fever. Shelter workers took Nicole to a local hospital and helped with the paperwork. Since then, Nicole has been treated by a neurologist, pediatrician, and orthopedist. She and her daughter also receive ongoing care at a local Ryan Health clinic. While surgery remains an option for Nicole, Jimenez said none of the doctors she met with recommended it for now.

In early August, outside the Roosevelt Hotel in New York’s Midtown neighborhood, one of the world’s most expensive locations for real estate and just two blocks away from the famed Rockefeller Center, migrants – mostly young and middle-aged men as well as families – walked in and out of the once landmark hotel, which was guarded by a mix of private security, NYPD officers, and National Guardsmen. A U.S. Marine, unarmed, was seen helping on-site staff with logistics. Next to the former hotel, a café was selling lattes for $6.

People staying at the former hotel said they came from Venezuela, Mexico, Russia, Senegal, Colombia, Bolivia, Ecuador, and Pakistan. People shared different focuses for the day. Some were focused on getting school supplies for their kids. Others were signing up for cell phone service, Medicaid, or a job with a delivery service—good work since it was flexible, paid daily, and required little knowledge of English. Another linking factor was New York City pizza, which was by far the lunch of choice.

Near the cell phone sign-up kiosk, Eddingson Vera, a Venezuelan national who crossed the border into El Paso last December, was waiting with his moped and chatting it up with some friends. He said he spent some time in San Antonio before arriving in New York.

“The work of delivery, even if unstable in some ways, has been paying well,” Vera said. “I’m happy my kids are going to school and that my wife is in good health.” She had been pregnant and ill around the time when they crossed.

“I’m thinking about developing my own business for street food,” Vera said.

Charter buses, some with out-of-state license plates, and vans routinely pulled up to the hotel. Asked where they were going, some migrants said they were going to different shelters. Some said they chose to go to a different city. Others said they did not know where they were going. Many had just arrived and were visiting the hotel to get registered and have a place to stay assigned.

After a couple of months in New York, Jimenez is still trying to find her work path while caring for her children. Her family is around, ready to help, but they live in different parts of the city. As she visits the doctors, the migration offices, and her relatives, she has a new mantra, which she repeats to herself.

“Step by step, I can do it by myself. This is a country of opportunities, and I will find one of those opportunities people talk about.”

Photos and translations provided by Oscar Castillo.

Direct Relief has supported medical facilities in Colombia, Panama, Guatemala, and Mexico, through which many migrants travel, as well as Ryan Health in New York City.

The post Jungle, Thieves, and Worse: A Mom’s Epic Journey To Save Her Daughter appeared first on Direct Relief.

“It’s already hard to recruit people to work in rural areas, and it doesn’t instill confidence to have to ask Congress to remember us every few years,” said Leslie Wolcott, director of communications at Roanoke Chowan Community Health Center in North Carolina.

“Big picture, between cost-of-living increases, inflation, and the cost of doing business, retention is a huge issue, just being able to pay competitive wages. How do you sustain that?” said Adam Friedman, chief marketing officer at the Saban Clinic.

Federally Qualified Health Centers, which care for tens of millions of people in the U.S. annually at a fraction of the cost of hospitals, are set to lose their main source of federal grant funding after September 30 unless Congress manages to break its deadlock on the issue. This healthcare network, started during the Lyndon B. Johnson administration, has enjoyed bi-partisan support through the years, including a notable expansion during George W. Bush’s time in office, when funding for FQHCs doubled, leading to patient number increases of 60%. Currently, there are more than 14,000 FQHC sites, also called community health centers, across the U.S.

While health center leaders do not expect the funding to be withheld, ambiguity regarding the final amount of funding is already leading to negative impacts in terms of recruiting and weakening trust among community members, according to Wolcott and Friedman.

“The uncertainty about funding just adds another layer of challenge, an additional headwind,” said Joe Dunn, vice president of the public policy and research division at NACHC.

Data from NACHC showed that in 2022, Medicaid provided 43% of revenue to FQHCs, Section 330 Federal Grants provided 12%, private third-party payers provided 12%, Medicare provided 9%, and the rest was paid by a combination of other grants, federal and not, as well as directly from patients and other sources. NACHC states the average cost of an FQHC visit is $322 compared to an average emergency room visit, which is $2,600 according to data from health insurance company UnitedHealthcare.

So far this year, more than 5.5 million Americans have been disenrolled from Medicaid. This could also impact health centers, as some people might not know they can still seek care at community health centers. However, these centers will likely face challenges with reimbursements for such uninsured visits, particularly if federal grants are not expanded and approved. Medicaid is the largest revenue source for FQHCs nationally, according to the National Association of Community Health Centers, an advocacy organization for community health centers.

“The role that health centers play in the health of the whole country is critical, so when you hear these kinds of things happening [funding cliffs], it’s concerning,” Friedman said. “It’s certainly concerning when you’re in the trenches of the health care system that we have and when you’ve been providing equal access to care for over 55 years, and you know the need is strong,” he said.

Friedman noted that the federal grant uncertainty comes at a particularly inopportune time, as behavioral health visitors increased by 50% in 2022, which will rise this year, and some of the local safety net programs, including at the county-level, do not cover behavioral health, forcing Saban to seek private donors to fill in the funding gaps.

Lenna Poulatian, Saban’s director of development, said that while past funding helped pay for a pediatric behavioral health specialist – pediatric visits have tripled since 2020 – future donations are at-risk due to the ongoing Hollywood strikes and broader economic uncertainty. Saban’s supporters include major Hollywood studios and networks as well as non-entertainment foundations and private donors.

In North Carolina, Wolcott said the timing comes RCCHC just broke ground on a new dental clinic. A hospital in their area, Martin General Hospital, recently closed, which will have ripple effects when it comes to primary health care access in the area, Wolcott said.

“Rural healthcare is really precarious,” she said. “When hospitals close, it messes up the primary healthcare system, and then it falls on FQHCs,” Wolcott said.

Further adding to the strain, many critical programs offered by RCCHC are not fully reimbursed, forcing the clinic to shore them up with additional funding from additional grants. These programs include mobile clinics for farmworkers, eye exams for diabetics, and colorectal screenings.

“We are providing care with not enough resources. And with every potential finding cliff, we have to lay out our core services to see what we would have to cut. Staffers hear this, and word gets around town,” Wolcott said, adding that, although no services have been curtailed, it reduces trust among the community.

“News spreads fast in a small town,” she said.

In LA, Friedman said Saban Clinic remains resilient and plans to continue to provide all services they currently offer, even with the uncertainty.

“We want to keep doing the work that we do, and we hope they (Congress) would see the value we provide,” he said.

The post Federal Funding Deadlock Costs Safety Net Clinics appeared first on Direct Relief.

Gundersen, a nurse who grew up in Paradise, Calif., and co-founded a free, mobile medical clinic called Medspire with her sister and mother after the deadly Camp Fire in 2018, could relate to what people in Lahaina were going through and what might be facing them in the coming days, weeks, months, and years.

“For many people living in Paradise, they couldn’t even watch the news,” she said.

With her wildfire-specific medical experience, she immediately planned to fly to Maui to support the survivors. But after taking a beat, she and her family decided they might be more helpful by sending financial support to help people pay for prescriptions and sharing their insights with local providers instead.

Listen to the radio version of this story from Public News Service:

“We recognized that running to a place of disaster is not the best use of resources and often takes away resources from local people,” Gundersen said, also acknowledging the differences in the two locations, including Maui’s island location, making logistics significantly more complicated, as well as the different demographics.

She connected with local healthcare providers and shared her experiences as a nurse after the Camp Fire, which killed at least 85 people and leveled the town of Paradise, Calif., and neighboring communities. One of the providers she connected with was Dr. Trina Chakravarty, a physician who practices at Malama I Ke Ola Health Center, which has a location in Lahaina.

“We never had disaster relief experience and didn’t know about large-scale disasters,” Chakravarty said. “Elisabeth and her sister were so helpful.”

Chakravarty recalled that, similar to Gundersen’s experience related to the Camp Fire, there was an acute lack of information as the wildfires were burning and in the days after. “The hospital census wasn’t that bad overnight. We learned that either they couldn’t find survivors or had to medevac burn victims to Honolulu. There was not much foot traffic to the hospital. We didn’t know about the live wires, debris, and how bad it was over there yet,” she said.

Gundersen said this kind of ambiguity lasted for weeks in Paradise, even around basic info such as whether her mother’s house was still standing. On Maui, Chakravarty said it took almost 24 hours to understand how severe of an event the fire was. This was exacerbated by the lack of traditional news sources in the area and the decision by local officials to close the area to media. Chakravarty, who was in the late stage of the second trimester of pregnancy, was forced to gather local info via Instagram.

For the next 48 hours, Chakravarty sought updates and tried to find how she could help, given the dearth of information. Three days after the fire in Lahaina, she began treating patients at a medical tent established in the area and at the War Memorial Gymnasium shelter, triaging injuries. Through a mutual friend, she was also connected to Gundersen.

In the following days, Chakravarty quickly realized that medications to treat chronic conditions would face shortages. Albuterol inhalers quickly ran out, as did other medicines needed to treat smoke inhalation. Even as inventory was in flux, a week after Lahaina burned down, Chakravarty began writing prescriptions by hand, completing 65 on the first day.

It was also in the initial days after the fires in Lahaina, which killed at least 115 people as hundreds more remain missing, that Chakravarty connected with Direct Relief. She said she received the requested medications within 48 hours of ordering them, including insulin, which must be kept cool. Chakravarty recounted how she accepted the first delivery and stored it in her garage, the only storage place accessible to her at the time.

While these refills help shore up supplies to an extent, Chakravarty said there was still a widespread need for medications, which national retail pharmacies on the island struggled to provide as demand spiked — particularly for people without insurance. Helping to increase access created by these gaps, some medicines were delivered from various parts of the island during the first week after the fire by locals on jet skis and boats. There were also challenges related to insurance. Chakravarty recalled some representatives from the private insurance provider on the island, who were not based locally, tried to limit patients to only those with insurance during mobile medical clinics. But, local outcries and support from local staffers and medical providers helped overcome this barrier.

“We treated everyone, Chakravarty said. People in Maui knew that providers from here would care for anyone despite what anyone else said,” Chakravarty said.

Mental health Issues, trauma responses emerge post-fire

Gundersen said that at this stage of the recovery from the Camp Fire, three things began to emerge.

“At this point, there was no potable water because the pipes had all been damaged and benzene leaked into the pipes. Secondly, we learned what medical infrastructure still stood in town. We only had one clinic and one ambulance bay in a fire station. Third, we started to see pictures from people’s cell phones and the trauma of moving back into a destroyed town,” he said.

From a healthcare standpoint, mental health has become a major and ongoing concern.

“In our mobile clinics, we saw a lot of people presenting in the first months with general anxiety symptoms: high blood pressure, panic attacks, insomnia, inability to focus or return to a productive life,” Gundersen said.

“We quickly realized that for people who would present with crazy blood pressure, we couldn’t just address their blood pressure. We would ask how they’re coping with the trauma they experienced. We tried to be a space where people could also talk about what they went through. Having providers who also went through it or at least lived there helped,” she said. “There was a pervasive need for medications used to treat insomnia.”

“Many people literally fled death on foot from the fire, things you read about and see in movies. This happened to many hundreds of people who were our friends and neighbors. We budgeted more time for appointments, so no one felt rushed,” Gundersen said.

On Maui, Chakravarty said many patients have presented with insomnia and other trauma responses as well. But, gaining trust will come with challenges that predate the fire.

“On Maui, people are more hesitant to seek care to manage chronic conditions. There can be mistrust of the medical community… Hawaii’s history is such that they don’t really rely on the government since the government came in and took over their economy and country. This all got exacerbated during Covid,” she said.

Chakravarty also noted trepidation among immigrant communities to seek care due to their legal status, even though FQHCs, such as the one Chakravarty works at, treat everyone regardless of immigration status or ability to pay.

“These communities were underserved already,” Chakravarty said.

Chakravarty said the hardest part of the experience so far was the horrible uncertainty of not knowing what happened to missing patients, noting that many lived at addresses in the burn zone.

Though her Maui clinic burned down, she said patients can still count on her and her colleagues to be there for them.

“It’s never going to feel like we can go back to normal, but we will continue providing care,” she said, noting that she delivered a baby a couple weeks after the fire hit. “It continues the swinging pendulum of life,” she said.

Gundersen said that while residents of Lahaina have a difficult rebuilding process ahead of them, including years of dealing with insurance companies and government agencies, one bright spot she noticed in Paradise is an increased sense of togetherness and community.

“People interact much more, people stepped up to help. People really feel a part of something, this collective effort to help and to build something that is better. In many ways, Paradise is better,” she said.

Reflecting on the last month, Chakravarty said it forced her to begin planning for future unplanned events and drafting an estate plan, with a hope that others on the island will do so as well.

“If you had to run out your door with your kids and your dog, what’s your plan?”

Direct Relief has supported both MedSpire and Malama I Ke Ola Health Center with essential medications and emergency operating grants to support their work during the Camp Fire and the Maui Fire Response.

The post Paradise, California, Provides Window on Maui Wildfire Recovery appeared first on Direct Relief.

Initial damage assessments are underway across all three states, even as about 200,000 homes and businesses were without power Thursday, down from over 300,000 locations earlier in the day, according to power outage tracking site Poweroutage.us.

Studies have shown that the most deadly phase of a hurricane are the days, weeks, and months after the storm hits, when survivors succumb to chronic conditions that have gone unmanaged, other interruptions to regular pre-storm care, and heat-related deaths.

In areas of northern Florida that took the brunt of the storm, including Taylor, Dixie, and Lafayette Counties, Lane Lunn, CEO of North Florida Medical Centers, described the situation today and yesterday as “chaos.”

“The feeling now is that ‘thank goodness our people are safe.’ It’s just the fact that the resources are kind of slim because there’s no power. If we had more generators to at least plug in fridges and freezers, it would be so much better,” Lunn said, adding that solar-powered solutions would also be ideal.

North Florida Medical Centers are federally qualified health centers, part of a network of safety-net health centers in the U.S. that provide care to everyone who requests it. Their locations in Perry, Mayo, Cross City, and Madison are without power.

Utility companies told Lunn to expect outages lasting for up to two weeks. Still, Lunn said she expects the Perry location to be open tomorrow, powered by a generator, so that community members can seek care for injuries sustained during the storm and clean-up, and maintain care for chronic conditions.

“For the facilities’ power, I’m going to take care of that. I got the propane companies to come and fill out the tanks. I’m worried about my staff,” she said.

Unable to communicate with patients due to the power outages and general storm debris on the roads, Lunn said she is currently focused on looking out for the welfare of her staff members, many of whom evacuated before the storm.

Reflecting similar needs as the communities they care for, providers and other clinic staff members are requesting camping stoves and the small propane gas tanks to heat them, coolers, ice, and any kind of air conditioners. Today’s temperature in Perry reached almost 90 degrees, with humidity hovering around 90%.

Additional requests have included military-style camping meals (MREs), canned food, and batteries. She noted that children are in need of, “anything to distract them,” such as coloring books, since their phones are bricked due to lack of power.

Lunn said she has been querying providers to see who can work, even as she acknowledges the difficult circumstances just about all of them face.

“No showers, no warm meals… still serving your people when you’re not as comfortable as you’d like, it’s tough,” Lunn said.

The clinics were able to avoid medicine losses due to pre-storm planning, which occurred at many FQHCs threatened by Idalia.

Temperature-sensitive vaccines, stored in a battery-power refrigerator, and other medicines were moved out of clinics and into safer locations.

Across all areas impacted by the storm, Direct Relief has received more than 50 requests for medical aid, with the most common requests including insulin, tetanus vaccines, inhalers, high blood pressure medications, PPE, and Direct Relief’s emergency medical backpacks. Direct Relief is also offering a host of backup power solutions for clinics and health facilities without power. The organization will continue responding to requests for aid.

Data helps predict future medical needs

Assessing potential future care needs, Direct Relief’s Research and Analysis team, as part of its role in the CrisisReady program, identified that Suwanne County saw a 43% decrease in population on the day of the storm while Taylor County saw a 41% decrease along with a 10% increase in daily trips over 100 kilometers, suggesting the trips were evacuations.

Surrounding counties saw less drastic though significant population decreases. Mobility data was sourced via a partnership with Meta and included anonymized data from users who have opted into the program.

Data relevant to other social determinants of health for those within 50 miles of the storm’s path include over 421,000 people who are uninsured, more than 547,0000 people who have incomes below the federal poverty line, and over 777,000 people who are under 18 years old, according to the latest U.S. Census Bureau American Community Survey. Obesity and hypertension are the greatest health issues experienced by patients who receive care at FQHCs in the affected regions, according to CDC data.

A CrisisReady report from today showed many communities along the storm’s path have elderly populations well above the national average, which could result in more acute healthcare responses as the power outages continue due to, inter alia, the correlation between age and use of power-dependent medical devices as well as barriers to accessing care due to transportation-related issues.

More than three-fourths of people using electricity-dependent medical devices were older than 65, according to a 2017 Journal of Public Health Management and Practice study. Almost 670,000 people over 65 live within 50 miles of the storm’s track, more than 39,000 of whom have electricity-dependent medical devices.

The post Deadliest Phase of Hurricanes Begins in Areas Hit By Idalia appeared first on Direct Relief.

The Tampa Bay area, home to more than 3.2 million people, is under a hurricane warning as Hurricane Idalia continues its path toward Florida, and is expected to be a Category 3 storm when it makes landfall. “Catastrophic” storm surges along coastal areas are predicted to reach up to 15 feet above ground level, according to the National Weather Service, which characterized the storm as being “unprecedented for this part of the state.” Twelve counties have mandatory evacuation orders, and Tampa International Airport has been closed. Several Tampa Bay hospitals have been evacuated as well.

Already Florida’s Gulf Coast, from Naples to Tampa, is experiencing a water level of up to two feet above normal during today’s high tide. Images taken midday in Indian Rocks Beach, a community on a barrier island west of Tampa, showed flooding.

As the storm approaches, safety-net health centers in the expected impact area are making preparations to ensure that operations continue as soon as possible in the wake of the hurricane.

Serving Patients, Before and After the Storm

“Federally qualified health centers are committed to being accessible, and we’re making sure we do all we can to accommodate that,” said Dr. Ashley McPhie, chief medical officer at Tampa Family Health Centers.

McPhie said her FQHC has taken action on several fronts to ensure operations continue with as little disruption as possible after the storm. This includes ensuring patients have the medicines they need in case of power outages, structural damage, or transportation-related issues prevent them from obtaining refills.

Tampa Family Health Centers has a centralized prescription fulfillment system, which enables them to track which patients may be running low on their medicines. Incorporating these data points, the team has been moving medicines out of areas most likely to bear the worst of the storm to ensure they don’t get damaged and can be picked up by patients at another location while also delivering medicines to patients who are unable or face challenges to pick up refills in person. Florida regulations during emergencies allow for patients to get automatic refills.

TFHC has had to close its clinics in mandatory evacuation areas but has been making sure critical appointments are still kept at their open locations. McPhie said that keeping appointments is important since it helps build trust among patients that the clinic is always there for them.

“During this time, technology can be up and down, but we’re going to be available. They (patients) know exactly where to go,” she said.

McPhie said her clinic was able to implement these emergency response measures due to planning that has been refined over the almost 40 years TFHC has been operating in the Tampa area. A key component of this is their hurricane preparation meeting consisting of representatives across all clinic departments, including IT, nursing, pharmacy, and more, where responsibilities are delegated and coordinated.

Additionally, following all hurricanes that threaten their region, whether or not they directly hit Tampa, TFHC has a debriefing where leaders from each department can review how they performed and what could have been done better. TFHC provided care to 113,418 patients last year and saw 312,058 visits across its 18 locations. They reported a 202% return on investment for each dollar invested in TFHC.

For McPhie, the stakes of disaster response are personal: she received such care following Hurricane Katrina.

“I know what it’s like to be a patient needing something after a hurricane,” she said. “I evacuated and came back to nothing.” McPhie was in New Orleans for college after Katrina hit and spent time living in a FEMA trailer. The experience both informs and drives her motivation to ensure there is as little interruption to care as possible for those in the community she serves.

Storm May Impact Vulnerable People More Intensely

Andrew Schroeder, Direct Relief’s VP of Research and Analysis, said that the current trajectory of the storm has it going over an area that TFHC serves and which is home to a demographic that “has relatively high rates of users of power-dependent medical devices” as well as an area that has a “reasonably high elderly population (20-23%). The storm is also expected to hit an area with a “very low density of health infrastructure, usually no more than 2-3 facilities total per county with large travel distances likely subject to flooding disruptions.”

“Each of these counties along the coast has 15,000-30,000 residents, but could see significant problems just given the infrastructural geography,” Schroeder wrote based on his analysis of demographic data compiled by CrisisReady today.

Most deaths related to hurricanes occur after the storm and disproportionately impact vulnerable populations, such as the elderly, people with chronic conditions, and people with lower incomes.

McPhie said she remains confident as Hurricane Idalia approaches and plans to reopen all clinics by noon local time tomorrow.

We feel prepared. The team is really laser-focused… I have that apprehension the night before something happens, but we’re ready… we’re here, we’re standing up, we’re ready for the community,” she said.

Direct Relief has shipped more than $158 million to health centers, free clinics and community organizations in Florida, including Tampa Family Health Center, since 2009, and has responded to multiple hurricanes in Florida, including Hurricane Ian in Sept. 2022. The organization is ready to respond to medical needs from Hurricane Idalia as they become known.

The post Safety-Net Health Centers Stand Up to Idalia appeared first on Direct Relief.

Even as the storms have brought acute challenges to the nation, they have also exacerbated preexisting vulnerabilities, particularly concerning the power grid, according to Léa Rahajatiana, deputy director of biomedical services for Pivot, a nonprofit that helps support the government-run healthcare system in Madagascar’s Ifanadiana district. Pivot provides training to clinical staff members, sourcing and financing certain hard-to-obtain medications and funding for other critical needs, amongst other forms of support. Pivot-supported clinics have seen over 1.3 million patient visits since 2014.

Access to power remains an ongoing concern in Ifanadiana, which is located about 260 miles southeast of the capital, Antananarivo, and is home to about 200,000 people, most of whom work as farmers. Rahajatiana said power outages are most common during the rain and cyclone season, starting in November and extending into spring. These cuts can last for up to two weeks, she said.

“The hospital is not spared,” Rahajatiana said. Last year, amidst renovations that went on for two months, power outages occurred about every two days and could last up to 10 hours. Government-allocated fuel needed to run backup generators at the hospital run by Pivot is often insufficient to meet critical needs, Rahajatiana said. Per capita spending on health is among the lowest in the world.

A lack of power makes it impossible to perform just about all surgeries. The nearest hospital is 80 kilometers away. Without electricity, other impacts include patients being forced to use oxygen tanks instead of oxygen concentrators, which pull a continuous supply of oxygen from the air, and closing down the hospital laboratory’s blood bank, which also requires a constant supply of electricity.

To help maintain a steady supply of electricity, Pivot requested and recently received three portable solar generators from Direct Relief, and the units will power the hospital’s operating room, intensive care unit, maternity and neonatology ward, and blood bank. By installing these generators, the hospital will have reliable power during outages and will be able to mitigate the substantial fuel costs of powering diesel generators.

“It’ll simplify things so much,” said Amy Donahue, senior engagement officer at Pivot.

Access to electricity, especially in the wake of powerful storms, has been an increasing focus of safety net healthcare clinics worldwide as they seek to maintain operations. Notable mass blackouts have occurred in recent years across the entire island of Puerto Rico following Hurricane Maria and in several communities across Northern California following wildfires – some of which have been started by power companies. In recognition of this, Direct Relief has started to address this need when requested in Puerto Rico, California, New Orleans, North Carolina, and around the world by providing solar power generators and solar panels.

While having power at the hospital is critical for care, Donahue said it could also have tangential effects, such as helping draw more people to seek preventive care or care at earlier phases of illness since they will know the hospital at least has electricity. Donahue said some local residents perceive the hospital and clinics with trepidation, with some believing that healthcare clinics are “places where people go to die.”

Besides power, Rahajatiana and Donahue identified access to clean water and sheer geographical distance as additional issues Pivot is focused on mitigating. Seventy-five percent of the population in Ifanadiana lives at least a five-kilometer walk from the nearest health facility. There is only one paved road in the district.

In recognition of its ability to help improve health outcomes in Ifanadiana, Pivot is working with local officials to expand its services to the entire Vatovavy region, which Ifanadiana comprises one of three districts. This will increase Pivot’s patient population fivefold, from 200,000 to 1 million people, and geographic coverage will triple.

Even as those challenges endure, another storm season will arrive in a few months, and with it, power outages. Rahajatiana said solar power will enable doctors, nurses, and patients to focus on healing rather than electrical infrastructure issues.

With access to resilient power sources, clinicians will be more free to focus on their jobs – instead of having to plan for when lights go out.

“Hospital patients and services will no longer suffer from power cuts,” Rahajatiana said.

In addition to solar backup power units, Direct Relief has provided medication support to Pivot, including more than 215,000 defined daily doses of medication, since 2018.

The post Powering Critical Care in Rural Madagascar appeared first on Direct Relief.

Direct Relief has also supported Dr. Çekmece’s work with medical supplies needed at the primary care level, including personal protective equipment, field medic packs and personal care packs with hygiene items for displaced people.

The following is a Q&A with Dr. Çekmece about his experiences during and after the quakes, including what conditions are like in his community now, almost six months later.

The following interview has been edited for clarity. Translation by Dr. Hande Arpat.

Direct Relief: Can you describe what happened when the earthquakes hit? Where were you? What was your first thought when it happened? What was the first thing you did? How did you feel in those first minutes and hours?

Dr. Yusuf Çekmece: I was sleeping at my home, and the earthquake happened at night. Actually, Antakya is used to earthquakes. We’ve always had smaller-scale shakings. So, at first, I thought this one was one of these small-scale quakes, and I started waiting for it to stop, but it didn’t. Forget stopping, it became way stronger. I tried standing up but couldn’t. I lay on the floor, protecting myself near my bed. There is no way to describe the fear at these significant moments. It’s so strange to feel death just beneath you.

How were you involved in rescue operations?

Just after the quakes stopped, I realized that I was alive; I thought of my mother and my siblings. I was more afraid for my loved ones than for myself.

They were living near my apartment, and I started to run to reach them, but the corridors of my building were full of rubble, and then I had to jump over more debris to reach my mother’s apartment. She wasn’t there. Everybody was outside, shouting, screaming. The weather was extremely cold and rainy, and it was so dark at night still. I was running so fast that my mouth became dry like a desert, and I could barely breathe.

Then I saw my mother and my sister hugging each other, crying and running toward me. My mother had bare feet, so I gave my own shoes to her. It was raining so much. My mom and siblings got back to my car, and I parked in a safe place. We tried to reach our beloved ones, but the phones were not working. After a couple of hours, we could …reach everyone except my uncle.

In the morning, I ran to my uncle’s apartment. It was unbelievable. All the buildings had collapsed, and the ones that did not collapse had huge cracks. No buildings were spared, including my uncle’s. It collapsed, and he was under. For hours, we did our best to rescue him. We only had one hammer and one shovel. Finally, after huge efforts, we rescued him by ourselves.

I had to take my family out of the city, but I didn’t have much gasoline, and there was no place left to buy some. Our relatives brought us gas from the neighboring cities, and by the second day, I could evacuate my family. Until I was called back to duty after two months, I could not return to my home province, Hatay.

What were the most difficult aspects for you in the days and weeks after the earthquake?

All of a sudden, our whole life — social lives, professional lives, our memories — tumbled. Without the opportunity of healing from the psychological effects of the earthquake, we had to start rebuilding our lives, and this has been exhausting for all of us… In the first days, I had sleep problems, waking up out of a sudden and feeling like an earthquake was happening again, or while sitting, and when someone moved the couch, I was panicking suddenly. I feel better now, I can say.

From a medical standpoint, what has been the biggest challenge in giving care to patients?

It’s been more than five months, and we still have lots of challenges related to keeping healthcare services sustainable. From my point of view, the worst challenge is that doctors and other healthcare professionals are earthquake survivors as well, and their living conditions need to be improved. Also, due to the limited transportation options, access to healthcare services is not optimal for people needing healthcare services.

I understand your office was destroyed, and you’re working out of a shipping container converted into a medical office. What has that experience been like?

Yes, my primary healthcare facility collapsed. Since the second month after the quake, we have been caring for patients inside the containers which were converted as mobile health units. I can say that it’s at least better to have a place to serve people in need than having no place to serve them.

What would you like people outside of Turkey to know about how people in Antakya are doing today, several months after the earthquakes? Is there anything else you’d like to share about how the earthquakes have changed you or the way you practice medicine in any way?

Five months after the earthquake, people lost everything that they used to have before, like big apartments, expensive carpets, tens of shoes they had, couches, etc. It’s all under the rubble. We now live in containers of 28 m² (about 300 sq. ft.); restaurants, hairdressers, pharmacies, banks, are all in containers, and we might have to get used to that. Life still goes on despite everything. What makes the people hold on is the solidarity that they feel, both national and international solidarity, which keeps us alive and strong.

People can lose everything in a second: beloved ones, properties, money, but solidarity is the cure for staying alive. Whatever happens, I wish we that we will continue to hold onto each other and keep the solidarity alive globally.

Since February 2023, Direct Relief has shipped more than $82 million in medical aid in response to the earthquake’s impacts in Turkey and Syria, and provided more than $3 million to groups providing medical care in the earthquake zones.

The post ‘Death Just Beneath You’: Doctor Describes Turkey Earthquake, Ongoing Challenges appeared first on Direct Relief.

Symba Center is a free clinic that operates out of a former gym that was converted into a wellness center for the community during the Covid-19 pandemic. While providing services to the area’s most vulnerable residents was always a challenge, providing mental health was even more difficult, according to co-founder and pharmacist Shawn Smith.

The U.S. Health Resources and Services Administration has recognized that Symba Center is in a geographically-designated Health Professional Shortage Area for both primary and mental healthcare. Smith said that the shortage is even more acute as it relates to the population he and his colleagues are caring for.

“People on the street usually have tremendous needs for mental healthcare… There are a very limited number of psychiatrists and therapists here, and we wanted to offer services for people who could not get an appointment at all because they don’t have insurance,” Smith said. Symba Center found that about 40% of the homeless shelter occupants they care for suffer from major depressive disorder and general anxiety disorder.

“The major factor leading to homelessness among our population is a mental health disorder,” Smith said.

In Northern California, a similar lack of resources faced Jose Perez, a licensed marriage and family therapist, and the care team at Samaritan House, a nonprofit that runs free clinics in San Mateo and Redwood City. Perez was hired in 2020 to start a mental health department but faced acute shortages.

“We realized the need for mental health care was huge,” he said after the clinic started implementing initial screenings. “The demand was there, but we had no staff,” Perez said, adding that, in total, only 10 hour-long appointments, paid for by the clinic, were available each week. He reported a 43% increase, year-over-year, in mental health referrals to his clinics.

Last year, Symba Center and Samaritan House were two of 11 free and charitable clinics which received a $75,000 grant to expand mental health care access to some of the most vulnerable populations in the United States. Over $17 million worth of mental health-targeted Teva pharmaceuticals were also made available to over 400 free and charitable clinics.

As a result of the grants, free and charitable clinics have been able to hire additional staff, launch internship programs, offer educational resources, including group sessions, increase collaborative efforts with local organizations and providers, and implement mental health screening programs for their patients. In total, these clinics have reached, directly and indirectly, about 22,000 people.

These developments have helped address not just mental health care needs but also primary health care needs.

“If people aren’t feeling good about themselves, they are less likely to take showers, clean their house, eat healthy, take meds, and are more likely to do destructive behavior,” said Smith. “Before the grant, there were not too many places to refer to. There’s a service gap… This has allowed us to expand our services to a whole new model.”

Smith said Symba Center is now caring for twice as many patients as before regarding mental healthcare. There have been other benefits as well.

“The more services we can offer, the more we can be available to patients, the more they trust us to provide care for them,” he said. Symba Center has been able to hire a licensed marriage and family therapist who oversees graduate interns. They have also started offering trauma-informed education to shelter staff.

At Good Samaritan, which serves a largely immigrant population, Perez said a large focus has been on implementing culturally competent care given by bilingual providers. They have started a training program and hired both a full-time and a part-time clinical and a group facilitator. He said that his clinic does not usually use the term “mental health” which he said has a negative stigma in the Latino community.

“Instead, we use the word ‘consejeria’ (counseling) or ask ‘do you need someone to hear you out?’” said Perez. “We use those terms to get them in the door and then plan what mental health is and how we can help them.”

Beyond language, Perez said treating patients with culturally competent care leads to better results.

“’I look like you, I can help you, I want to help you’… We take time to build rapport, without it they’re (patients) not going to be open to treatment. Otherwise, I’m just someone telling them what to do,” he said, adding that he is also an immigrant.

Still, even with care tailored to the local community, some people do not feel comfortable broaching the subject. Recognizing this, Perez ordered informational booklets on a range of mental health topics, such as depression, grief, anxiety, stress, family violence, suicidal ideation, and alcoholism. Each one is about 15 to 20 pages long and offers techniques that readers can use to help address these conditions.

Perez said the most popular topic in Redwood City, which has a more recently-arrived immigrant client base, has been depression, followed by stress and grief. In San Mateo, which has more elderly patients, it has been those, plus self-esteem and co-dependency.

The differing, though related, focuses across Symba Center and Samaritan House reflect how free and charitable clinics respond to the specific needs of their communities. Free and Charitable Clinics and Pharmacies provide care to about 2 million people in the U.S., according to the National Association of Free and Charitable Clinics.

Ultimately, Smith said, it always comes back to the patients.

“If you can provide a level of service to someone and promote healing to make sure people can really focus on themselves, you remind them they have a purpose in life, and they have an opportunity to live a life they’ll be proud of.

“I think each person deserves an opp to have services provided to them so they can see themselves being treated well. It’s providing dignity to humanity,” Smith said.

Funding for these programs was made available through Community Routes: Access to Mental Healthcare, a partnership between Direct Relief, the National Association of Free and Charitable Clinics, and Teva Pharmaceuticals, which provides financial and medication support to clinics expanding access to mental health services.

The post “Providing Dignity to Humanity,” Free Clinics Expand Mental Health Care appeared first on Direct Relief.

Beyond sourcing data points, such as smoke coverage, the number of hospitals in an area, and where evacuees are going, it is also crucial for decision-makers to understand how these factors relate to one another – for instance, how many hospitals are in the areas where evacuees are going.

“[Officials] depend on that information to make decisions on a daily basis,” Eric Howard, a geospatial data scientist in the California Governor’s Office of Emergency Services’ Data & Geospatial Unit, told Direct Relief.

Geographic information system (GIS) maps and applications are one way to see multiple data points on a single map. Seeking to help improve emergency response decision-making at all levels of government, Direct Relief’s Research and Analysis team has been working for years to create and refine GIS products that provide the most important, potentially lifesaving information.

Last year, as part of this initiative and as part of the CrisisReady partnership with Harvard University and an interdisciplinary team of academics, Direct Relief released ReadyMapper. This wildfire-specific GIS tool helps agencies understand key information points in the impacted area.

The tool was developed in collaboration with CalOES, the California Department of Public Health, the California Conference of Local Health Officers as well as other state agencies and hospital systems.

This year, in preparation for wildfire season, and with support from Google, the tool has been updated to add and refine the integration of social vulnerability data (which looks at who is most vulnerable based on age, disability, access to a car and other factors), population mobility data (where people are going), health infrastructure, power outages, and event dynamics, such as fire perimeters. These data are mostly sourced from public data sets. The data for population movement comes from Meta, and is anonymized.

“That’s all tightly packaged together so we can work directly with counties and immediately affected areas to give a rapid analysis of how population dynamics are affecting resources allocation,” said Andrew Schroeder, VP of Research and Analysis at Direct Relief and co-director of CrisisReady.

“Everything about a wildfire has a location. So location becomes one of the best ways we can link data together to look at different factors that combine to produce what we understand as the outcome or impact of a wildfire,” Schroeder said.  

“Maps are the best way to see all of the relatively complex impact of a wildfire as a relatively understandable picture,” he said.

The GIS apps have also helped surface concerning information ahead of fires. A recent study authored by Schroeder and his CrisisReady colleagues showed that half of California’s total inpatient hospital capacity is within less than one mile of a high-risk wildfire area.

The ReadyMapper tool incorporates input from officials representing eight California counties. These officials came to Direct Relief’s headquarters in Santa Barbara last August to train with ReadyMapper and share the gaps in knowledge they tend to face during wildfires. Schroeder said a key finding was the variances in sourcing data that exist among counties. Some still do it with phone calls and keeping notes on paper.

“With a fire that goes across two to three counties, they might have different ways of doing this kind of stuff. It’s very personal and relationship based. They just kind of work it out,” Schroeder said.

Aiming to streamline the collection and analysis of key data points with the understanding that most county governments do not employ GIS specialists, ReadyMapper provides the same interface and reports to all officials to help them better understand their own areas of operation and to coordinate responses with other counties. ReadyMapper is maintained by the CrisisReady team, but is customizable at a local level.

All the smoke

For future integrations, Schroeder said smoke-related data would be a major focus. Beyond the amount of smoke in a given area, he said the team is working to include smoke direction, duration, and impact.

While wildfires are often quantified in terms of acres burned, Direct Relief has been part of an emerging movement to focus on smoke coverage as well.

Schroeder said there are many challenges involved with displaying air quality data while recognizing the importance of it.

“Air quality depends on variance in air flow, topography, how likely you are to breathe it in… It’s not a uniform problem,” he said, but noted that adding air quality index information would at least give a “proxy measure for days spent under wildfire smoke.”

According to EPA guidance shared by spokesperson Shayla R. Powell,  while most healthy adults and children will not experience long-term damage from smoke exposure, some people may be at greater risk. These include children and older adults with pre-existing heart and lung disease, pregnant women, people who work outside, and people with low income.

In addition to smoke, the ReadyMapper development team is also working with Stanford University’s Matt Chang to look at how populations have moved in the wake of every global disaster since last year.

Comparing similar locations, vulnerability dynamics as well as the type and scale of the event, the research is trying to determine whether there are commonalities that could help inform responses in future natural disasters.

ReadyMapper is also exploring ways to integrate new data sets produced by Google, such as real-time land classification using AI.

“If you had a fire in an area and had a big burn scar, we wouldn’t just see the picture, we could see the reclassification of the land away from what it was before,” Schroeder said.

“This, I think, is actually quite an important input into understanding the impact of an event… It’s looking at long-term consequences of the change that would happen in an area, such as damage to important infrastructure, like hospitals and pharmacies.”

Though ReadyMapper was created for officials and emergency responders, Schroeder said he hopes it will also be used to help address other concerns when natural disasters strike — such as giving advocacy groups for outdoor workers information that they can use to help protect their members.

The post Seeing Through the Smoke: New Map Tools Inform Wildfire Response appeared first on Direct Relief.

LOS ANGELES — Dr. Edgar Chavez was sleeping when the call came in just before 1 a.m. early Sunday morning in late February amid a series of historic rainstorms. He dressed immediately and drove towards one of his safety net health care clinics in downtown Los Angeles, which was just about finished with significant renovations.

“I opened the (conference room) door, and it was like a river. It looked like a disaster movie,” Chavez, the founder and CEO of Universal Community Health Center (UCHC), said to Direct Relief. A section of the roof from UCHC’s O’Neill Clinic collapsed, allowing a deluge of rainwater into the building. Adding to the chaos, a rafter crashed into a fire sprinkler, expelling more water into the 15,000 square foot health care clinic that had opened the previous October.

The roof and structural failures, along with the water, ejected chairs from the room into an adjacent room and flooded the space with about six inches of water within 30 minutes of the collapse.

UCHC COO Freddy Reynoso, who was first on the scene and contacted Chavez, recalled seeing water flowing out of the clinic’s doors while driving up. “Oh no,” he recalled thinking. All of the electricity was out.

Chavez, who was named one of L.A.’s top doctors by Los Angeles Magazine this year, and Reynoso grabbed brooms and started to clear water out of the clinic as they waited for the cleanup crews to arrive. They were at a local Home Depot as soon as it opened at 7 a.m. to buy sandbags, blowers, and wet and dry vacuums before returning to the locations and continuing their work.

Driving their efforts, Chavez and Reynoso said, was the goal of getting the clinic, which sees over 2,000 patient visits per month, open as soon as possible.

“It was a huge mess…. I was soaking wet the whole time, but we got it done,” Reynoso said. “For me, it was a full range of emotions. I was saddened that something that was just built was damaged so badly, but ultimately, we just focused on ‘how do we operate, how do we open?’ This clinic is within walking distance for many patients, and the other clinics nearby are saturated.”

 The O’Neill Clinic serves what Chavez described as a “working poor” community. It’s where he grew up. Many residents do not have access to private transportation, making it very difficult for them to go to alternate locations.

“The goal is for this to be a medical home for them, and this is their clinic,” Chavez said, noting that he especially did not want to cancel appointments for people who were post-operative or diabetic, among other chronic conditions. Moving their care to another location, he said, might decrease the likelihood of them being able to make it due to lack of transportation, needing to take more time off work, and other logistics-based reasons. As a Federally Qualified Health Center, UCHC’s six locations and a school-based center treat all patients regardless of ability to pay. The system sees about 5,000 patient visits per month.

The initial consensus among the cleanup crews and contractors was that the clinic would be reopened within a month or two. For Chavez, Reynoso, and the staff at UCHC, such a timeline was unacceptable given the acute needs and lack of alternate viable options for so many of their patients in the community.

It took three days, and all preexisting appointments were kept, according to Chavez.

“I’m amazed, I’m quite surprised, not for the work we did, but just for everything coming together. It really took a small village to get everybody here. Nobody said no. Everyone we asked came over,” said Reynoso.

However, the building’s damage was extensive and uninsurable due to being under construction, said Chavez. UCHC is a tenant, which further complicates matters. While some expensive equipment was saved, such as the X-ray machine, much was lost or rendered unusable, including all their on-site servers and exam tables. In a stroke of luck, about $300,000 worth of dental care gear arrived the Monday after the roof collapsed.

Chavez said his team was able to share supplies for other locations to shore up the most critical equipment as they worked to replace it.

Pouya Ansari, a dentist who started working at UCHC the week before the flooding, said he and his team improvised after the flooding to ensure they could keep seeing patients, even if that meant repurposing a podiatry exam chair.

“The team came together, and we came up with some good ideas to be able to see about 15 to 20 patients a day, which I think is really successful,” he said.

Walking through the facility’s patient-facing areas about six weeks after the flood, the only evidence of the flood was water lines on some walls and some warping on desks. The clinic otherwise looked newly renovated, a testament to the hard work of its staff and contractors, which was reflected by a perspective shared by Chavez as he walked through the halls of the clinic.

“We’re providing medical care to people who need it,” said Chavez.

Direct Relief has supported UCHC with a $100,000 grant to help repair their roof and medical supplies. The organization’s fundraiser can be found here.

The post Los Angeles Clinic Reopens Just Days After Flooding appeared first on Direct Relief.

Of the 1,146 adolescent overdose deaths in 2021, 77% involved fentanyl, a synthetic opioid that is up to 100 times stronger than morphine. A San Jose Mercury News analysis found fentanyl contributed to one in five deaths of Californians aged 15 to 24 in 2021.

At least seventeen Los Angeles United School District middle and high school students, one who was 12 years old, have reportedly overdosed on campuses during this school year. Two high school students in Oregon’s Portland Public School system died from opioid overdoses last spring.  

In response to these deaths and many others around the country, school districts are increasingly stocking naloxone, a drug that counteracts the effects of an opioid overdose, on campuses. When administered in time, it can restore normal breathing to someone who has overdosed on opioids within two to three minutes, according to the CDC. Naloxone is not addictive and has “no effect on someone who does not have opioids in their system,” according to the National Institutes of Health. 

In January, California Gov. Gavin Newsom pledged to provide funding for naloxone for every middle and high school in the state as part of K-12 education spending for the coming year.

Major manufacturers of the drug, which was patented in 1961 by Dr. Mozes J. Lewenstein and Dr. Jack Fishman, include Pfizer, Emergent BioSolutions, Teva Pharmaceuticals, Hikma, Akorn, Adamis Pharmaceuticals, and Amphastar Pharmaceuticals.

Last year, within a few weeks of announcing a charitable distribution program with donations from Emergent BioSolutions, Direct Relief received more than 100 requests from school districts across the U.S., 582 schools/districts, making up 1,164 individual school sites, have received 2,328 doses of Narcan through the program.  

Less than a month after the two Portland students died, Jamie Smith, a trained nurse and senior school health services administrator at Multnomah Education Service District, or MESD, began working to source naloxone for the eight school districts he works with and the alternative schools MESD operates. He learned about no-cost programs through his school nursing contacts.  

“If we can have [naloxone] available and save someone’s life, we want to do that,” Smith said in an interview with Direct Relief. Smith said that discussions about stocking naloxone in schools began before the Covid-19 pandemic but lost traction in the face of that public health crisis. Following the student deaths, Smith said that both the community and educators expressed broad support for increasing access to the potentially lifesaving drug in schools. Policy changes were made easier, according to Smith, by basing the naloxone initiative on the epinephrine auto-injector– more commonly known as EpiPens – programs that have existed for many years in schools to counteract the effects of severe allergic reactions.  

“Most community members were certainly in favor of having naloxone in schools. It was something that I advised our districts on, to make sure this is supported by your community and that this is something the school wants to take on as a responsibility,” Smith said, adding that, while administering naloxone is not technically education-focused, “all of our districts recognized the need and low bar of getting involved with it.” 

Smith said that, in the past, he had concerns about unlicensed personnel, such as a secretary or support staff member, being put in a position to decide whether a student is having an allergic reaction, has low blood sugar, or has overdosed.  

“I think it’s important to expand the availability in the community so we can respond, but I’m concerned with how much the schools take on without the health expertise may or may not be needed to decide if it’s an overdose situation,” Smith said, reflecting the possibility that naloxone could be used in a situation where a different intervention is needed.  

In Beaverton, a neighboring town of Portland, naloxone was brought to the city’s school district before the 2022 school year after the implementation of policy changes and training sessions that began in August 2021 

“The [Beaverton School] District supported the process to access, administer and store Naloxone in response to the public health crisis related to rising opioid overdoses and deaths in Oregon,” said Lori Perkins, a school nurse on special assignment. 

Southwest of Portland, the small town of Sherwood has also ordered naloxone for all of its schools, including elementary schools.  

“…We believe having access to Narcan at each building strengthens the ability of our staff to respond quickly to drug-related health emergencies, as well as to provide additional on-site resources for law enforcement in the event that they respond to such an incident on or near our campuses, ” according to a statement shared by Christine Andregg, executive assistant to the superintendent. Sherwood School District ordered naloxone over the summer and distributed it to schools as staff completed the required training, according to Andregg.  

In late September of last year, following overdoses on its campuses, LAUSD announced it would make naloxone available in all of its K-12 schools. Like many districts, LAUSD is also increasing education efforts, through courses offered in its parent-focused program well as student peer-to-peer initiatives in high schools. 

Though Los Angeles Unified School District declined to comment for this story, the district recently announced that it would allow students to carry Narcan, a nasal spray type of naloxone. The other FDA-approved form of naloxone is injectable. Most districts currently hold naloxone in nursing or other offices, to be used only in the event of a suspected overdose.  

The FDA announced in a notice last November that the agency’s preliminary assessment found some naloxone products may be suitable for over-the-counter approval. In a press release issued at the tie, FDA Commissioner Robert M. Califf said that the FDA “Supports… efforts to combat the opioid overdose crisis by helping expand access to naloxone.”  

In February, an advisory committee to the FDA recommended the agency approve naloxone nasal spray to be sold over the counter and without a prescription. The FDA could issue a decision as early as this month.

Since 2017, Direct Relief has distributed more than 2.3 million doses across the U.S. during the opioid crisis.

The post After Opioid Deaths, U.S. Schools Increasingly Stock Naloxone appeared first on Direct Relief.

While each disaster is unique, especially in terms of how they affect communities, general commonalities can be found.

“There is a huge spike in need for health service with all the injuries, a huge contraction of available health services as health facilities are wrecked, and inventories of medicines, devices, supplies are lost, and an information vacuum and breaking of the supply channels through which resources can be moved efficiently to address the huge gap that develops,” said Thomas Tighe, CEO of Direct Relief since 2000.

In sum, huge gaps immediately arise, and fewer resources are available to address them, a situation now playing out in Turkey and Syria, where at least 60,000 people are reported injured, and 15 hospitals in Turkey are reported destroyed, according to the World Health Organization. In northwestern Syria, at least 57 hospitals and primary health facilities were reported to be partially damaged or have suspended services due to the earthquake.

The answer would seem obvious — send more resources immediately. But it’s more complicated than that.

“Because supply channels get crimped, sending stuff that isn’t on-point just clogs up the channels,” Tighe said.

At the same time, minutes can be the difference between life and death in crisis situations.

“Waiting until the information is perfect doesn’t work because it’s a crisis and time is of the essence, and information will be fuzzy for a while,” he said, adding that sending the right supplies is also of paramount importance since mistakes can impair disaster response.

To solve this problem, Direct Relief tracks data from a range of past disaster response operations to find patterns – what medicines are requested most often for which emergency.

To anticipate what medicines and supplies will be requested, Direct Relief’s Head of Pharmacy, Alycia Clark, and her team start by considering what injuries are most common.

For earthquakes, she said, “crush injuries and wounds, combined with delayed access to care, will lead to more significant infections. Debris and particulates in the air will create new respiratory issues and exacerbate chronic ones. It will also contribute to eye irritation and injuries. Breaks in water supply and contaminated water can lead to gastrointestinal illness, which is layered on top of the existing cholera outbreaks. Many people will have cuts and abrasions and more severely injured patients will require surgeries for fractures and organ damage.”

Clark said that the response to the earthquakes in Turkey and Syria more closely resembles the war in Ukraine than a typical natural disaster response. This is due to the crush injuries from destroyed buildings and the unpredictable nature of events.

Needed medication will likely include antibiotics, IV fluids, medications to treat shock, respiratory inhalers and nebulizers, and medications for sedation and intubation for critically-ill patients and those requiring surgery, according to Clark. She and her colleagues confirm what is available in Direct Relief’s inventory and start trying to secure additional items and quantities through donations or purchases. Those include stains to diagnose corneal abrasions and ulcerations, numbing agents for pain, prescription antibiotics and steroid eye drops, psychiatric medications for mental trauma, surgical supplies, wound care, and body bags.

In some cases, this has resulted in prepacked “kits” for events with at least some degree of forewarning, such as hurricanes and wildfires. For others, such as earthquakes, drug and supply lists are maintained internally so that they can be quickly assembled when an event, like an earthquake or tornado, occurs.

As the response moves from the acute rescue phase to a more long-term operation in the coming days, Clark noted that priority will likely shift to chronic disease management medications since substantial amounts are likely to have been lost at hospitals, clinics, and pharmacies, as well as by individuals, who lost them in the ruins of their homes. The loss of power will also contribute to the decreased effectiveness of cold-chain medications, such as insulin.

“Many chronic diseases are considered “silent killers” because they actually do not cause any symptoms until they are out of control. For example, patients with hypertension may have no idea they have elevated blood pressure until they have a heart attack,” she said. it is easy to put off maintenance of these conditions because they don’t cause immediate discomfort. Doing so causes big issues,” Clark said.

Determining the appropriate quantities to send is the next step. Clark and her team follow the latest reported casualty figures and incorporate information directly from local doctors and pharmacists. They combine that data with baseline disease rates in Turkey and Syria to produce an estimated medication need.

The result is more than 70 pallets of medical aid – diabetes, asthma, and cardiovascular medications, dialysis supplies and medications for kidney disease, mental health medications and multivitamins — cleared to depart for Syria and Turkey within days of the earthquake.

Each item was reviewed and approved by the local medical professional who will ultimately receive it.

Still, despite the best preparation, both Tighe and Clark acknowledged disaster response operations always come with unexpected outcomes, which have to be accounted for in any modeling.

“We’re never fully ready,” said Clark. “But after Ukraine, we are a lot more prepared.”

“We have to make assumptions based on the best information available and move, knowing that the reality will overtake the assumptions and we’ll have to adjust accordingly, said Tighe.

The post Turkey-Syria Earthquake: Modeling Humanitarian Need in a Disaster appeared first on Direct Relief.

“We know that thousands of people are still under buildings and because more than 6,500 buildings collapsed, and lots of them were apartments between five and 15 floors,” said Gulcin Guresci, CEO of AKUT, a nonprofit volunteer rescue organization that is now focused on helping find people in damaged buildings.

Guresci referenced an example of a city with tens of thousands of people where the mayor told them half of the residents are under buildings.

“It is impossible to reach all the people before they die under the buildings,” she said.

In addition to grave concerns about traumatic injuries and suffocation, frontline responders have also noted the cold temperatures as a critical challenge.

“Hypothermia is the biggest problem for them,” Guresci said about people trapped in collapsed buildings, adding that many roads have been damaged and that snowfall has further hampered efforts to move aid overland since there is a lack of snowplows.

In Syria, the Syrian American Medical Society Foundation (SAMS) reported hundreds of fatalities in their area of operation, northwest Syria. It said four of its health facilities had sustained damage, including two that had to be evacuated and are currently out of service. Turkey’s Ministry of Health said today that 15 hospitals are significantly damaged.

“We are in urgent need of medical supplies to treat the wounded and expand our capacity for trauma response, as well as diesel fuel for ambulances and generators to keep our equipment running and our hospitals warm,” a statement to Direct Relief from the charity read.

Multiple nonprofit aid organizations in the area have confirmed that the Bab al-Hawa border crossing, the only crossing point for humanitarian aid between Turkey and northwest Syria, has been closed.

SAMS has been active in responding to the humanitarian crisis borne of the Syrian Civil War, now in year 11, which has killed hundreds of thousands of people and displaced over 13 million people. A cholera outbreak is currently underway in the region, with more than 84,600 suspected cases reported in Syria since August last year. The case fatality rate is 0.12%.

Turkey is home to more than 3.7 million refugees from the war, most of whom live in southwest Turkey, around the earthquake’s epicenter.

To help address acute needs in the aftermath of this disaster, Direct Relief is responding to requests from its network of regional healthcare partners for emergency med packs, antibiotics, cardiovascular medicines, analgesics, personal hygiene kits, oral rehydration salts, acetaminophen, and prenatal vitamins, and more.

Direct Relief is mobilizing urgent deliveries of these requested items and has also committed $200,000 in cash assistance to support on-the-ground search and rescue efforts — a $100,000 grant to AKUT and a $100,000 grant to SAMS.

Turkey-Syria Earthquake

Direct Relief’s Response

Learn More

The post Death Toll in Turkey and Syria Rises as Search and Rescue Efforts Continue appeared first on Direct Relief.

“I’ve always been pissed that we were not doing it,” Stader, who described himself as a “young, grizzled ER doc,” said to Direct Relief. “It’s normalized in many places to not provide people with the care they deserve, especially this marginalized class of people who struggle with substance use,” Stader said.

Fed up, Stader took action. In 2018, he began a campaign, starting in his hospital, to begin changing policies, with the goal of making it easier for patients who abuse opioids to obtain naloxone.

During a year in which almost 47,000 Americans would die from opioid-related overdoses, Stader ran into heavy resistance.

“I found it was very difficult to set up,” he said. The most common objections were that naloxone distribution was not reimbursed, that hospitals are not charities and that there were staff shortages for existing programs and responsibilities.

Stader was undeterred and remembers thinking, “We should just address the barriers, so this can become the standard of care.” Along with his nonprofit team, which now consists of Stader, two co-chairs, and two project managers, what would eventually be called the Colorado Naloxone Project (CNP) began lobbying state lawmakers to expand access to naloxone in hospital emergency departments.

In little more than a year of focused efforts, CNP led an effort to get legislation passed, with Colorado’s House Bill 20-1065, which requires insurance companies to reimburse hospitals for giving out naloxone to their insured patients, reduces liability to anyone who administers expired naloxone in good faith, and increases access to clean needles by allowing nonprofits to run clean needle exchange programs without local government approval. A subsequent bill, which CNP lobbied for, extends the coverage to uninsured patients via Medicaid.

“How you can heal [the opioid epidemic] is you have to start caring about one another. The Colorado Naloxone Project challenges the idea that these are throw-away people. It’s hard to care about people if you think it’s a hopeless cause. In medicine, we’ve not used the resources at our disposal for healing outcomes. Naloxone is the first step towards doing something for those patients,” he said.

To date, CNP has signed up 108 hospitals and emergency departments, accounting for almost 90% of all such facilities in Colorado, and 20 labor and delivery units, which is about half of all such units statewide. They have also partnered with schools, clubs and bars and with other community-based organizations to increase distribution points. Next year, CNP is looking to expand its distribution and patient screening initiatives to 10 states. Direct Relief has distributed 11,500 doses of naloxone since 2021 to CNP and more than 2.2 million doses nationally, sourced from Pfizer and Emergent BioSolutions since 2017.

“I can’t overstate how important it is to go to hospitals and give them naloxone, so they have no excuse,” Stader said.

Job’s Not Finished

Despite another record year of opioid-related deaths, which exceeded 80,800 people, a host of studies suggesting the benefits of increasing naloxone distribution and education, and the recommendations of several medical and government agencies, Stader says his group still encounters resistance to its initiatives. He said most of the hesitation results from hospital administrators and staff feeling overburdened due to the Covid-19 pandemic and the flu and RSV outbreaks. Many hospitals remain understaffed, and Stader said he is often told by staff that they cannot take on any additional work.

“It’s a very real and legitimate concern,” he said. “Some also question whether it’s a role hospitals want to take on since it’s steeped in stigma, even at the bedside level,” he said, referring to care for people who use drugs.

On this point, Stader said he could relate on a personal level.

“I used to not like people who used drugs,” he admitted, explaining that he was taught harmful stereotypes about people who use drugs. When he began practicing as a doctor, he recalled being spit on and abused in other ways by drug users.

“We (health care providers) have trauma from that patient population,” he said. “We’ve also traumatized that patient population. When they come in, we’ve given them treatment of someone you don’t like,” Stader said. He hopes that CNP’s initiatives will help cut through some of these feelings, on both sides, by providing a new path forward, one he has walked himself.

“We know naloxone saves lives, but it’s also about the restoration of that therapeutic relationship with patients,” Stader said.

“I tell them, ‘I’m worried about you. You’re a person who is worth saving. You can save your life or someone else’s life, and when you’re ready for treatment, I’m ready to treat you’… That naloxone is now a physical manifestation of that treatment,” he said.

Even if a healthcare provider or patient is not at a stage where they are open to such a relationship, however, Stader still hopes they can agree on a more basic point.

“If a patient might die, send them home with the antidote, so they don’t,” he said.

Since 2017, Direct Relief has provided 2.2 million doses of naloxone to health centers, free clinics, community organizations, K-12 schools, colleges and universities, first responders and harm reduction groups, free of charge.

The post This Drug Saves Lives. Why Weren’t Hospitals Giving It To Patients? appeared first on Direct Relief.

Cholera is a bacterial infection, most often contracted from contaminated water, that leads to diarrhea and dehydration. It can be fatal if left untreated. Syria’s outbreak comes amid outbreaks of the disease in Iraq and Lebanon. Cholera outbreaks are also occurring in Haiti, the Horn of Africa, and Yemen.  

There is evidence to suggest that the outbreak in Syria is slowing, with the top five most-impacted governates, which are all the north of the country, seeing declines ranging from -28% to -5% from October 23 to 29 compared to October 30 to November 5.

Though case counts are trending down, suspected cases have now been reported in all 14 governates of Syria, and there have been no fundamental changes to underlying conditions in the country related to the spread of cholera, especially access to clean water sources in refugee camps and the ongoing armed conflict, which limits population movement.

In the northwest part of the country, including the governates of Aleppo and Idlib, there have been 11,405 suspected cases and 12 cholera-associated deaths, according to OCHA. Of the confirmed and suspected cases, more than half have been children under five years old, according to data provided by the Syrian American Medical Society (SAMS), a nonprofit whose members have been responding to the humanitarian crisis in Syria, including the cholera outbreak in the northwest and eastern parts of the country.

72% of people who are suspected of having contracted the disease live in refugee camps created by the nation’s civil war, which has lasted more than a decade. More than 6.9 million people are still displaced within Syria, and the war has resulted in a total of more than 13 million refugees, including those internally displaced people, according to UNHCR.

“The basic issue in northwest Syria is access to clean water. In all things related to water, there is a very big gap in Syria. In addition, there are a lot of camps and a continuing war. We have a lot of problems with that. Another issue is awareness of the disease and how to reduce the chances of getting it, in general,” said Dr. Reem Enderun Yonso, a senior health and nutrition officer who has been overseeing the nonprofit’s response to the cholera outbreak.

“With authority, as a health body, you can face any outbreak, but in Syria, we don’t have anything at all. Every year is not like the last year. The war in Ukraine has taken money from Syria. After 10 years, people live in camps, they don’t have any hygiene. They don’t have clean water, they don’t have a house. They drink from anywhere. For children, they treat them in the house. Many times, the case gets worse, and then they go to the hospital, and it’s too late,” she said.

SAMS has been trying to address these problems with a multifaceted approach that combines treatment facilities and door-to-door, or as Yonso said about refugee camps, “tent-to-tent” community education campaigns.

Following World Health Organization and Doctors Without Borders guidelines, SAMS has helped set up a multi-tiered care system in parts of the Idlib and Aleppo governates. This includes oral rehydration points, which are often one-room tents placed near communities with suspected and confirmed cases where healthcare workers prepare and administer oral rehydration salts to patients.

If the patients do not improve, they can go to a cholera treatment center or its smaller equivalent, a cholera treatment unit. These facilities, which function as dedicated clinics for cholera patients, offer more treatment options, such as intravenous fluids and medication. Ambulances with intravenous fluids are also being used.

SAMS has also organized community health worker (CHW) teams. These teams go to areas impacted by the outbreak to gather data, such as suspected cases, and share information about the disease, including how to prevent and combat it.

To ascertain whether or not a person has contracted cholera, Yonso said CHWs ask if anyone has had diarrhea and exhibited additional symptoms of illness. Then, they will share information about treatment options, such as oral rehydration points. CHWs also educate people about general hygiene, with a focus on handwashing, and ways to treat water, such as by boiling it or adding purification tablets.

A report from SAMS identified several key challenges currently facing those trying to end the outbreak in Syria. Some of these include many patients who refuse to give samples,  hesitancy to be admitted to the hospital, and patients, especially women, who check themselves out of the hospital due to the embarrassment of using the toilet frequently. Some doctors have also been refusing treatment to children due to their belief that only a pediatrician should treat children.

Logistically, the war has made it difficult for many patients to access care centers, water being trucked in by the private sector has been hard to monitor, and there is a general shortage of medicines and medical supplies.

“We already faced Covid for two years, so all of our health system is overloaded. After three months of a Covid lull, there’s a Covid increase, more deaths, and now we’re facing cholera and Covid with limited funds and supplies,” Yonso said, adding that fears of a potential closure of the border with Turkey in the new year are an ongoing concern, particularly since obtaining supplies from Damascus is very slow and unreliable.

As another fraught winter sets in, Yonso said many people had expressed an awful kind of fatigue.

“People don’t know what to be afraid from, Covid, cholera, the regime… even if I talk about cholera, they say, ‘Okay, we die from every cause.’ They don’t take it seriously,” she said.  

Direct Relief has responded to the current cholera outbreak in the region by shipping more than $440,000 worth of medicines, oral rehydration salts, and medical supplies to SAMS, with more on the way. Cholera treatment support has also been shipped to hospitals in Lebanon and Haiti caring for patients with cholera. Direct Relief’s cholera treatment kit contains sodium lactate solution, oral rehydration salts, antibiotics, medical supplies to administer medications, and PPE, and is designed to serve approximately 280 patients.

Since 2010, Direct Relief has shipped over $190 million worth of humanitarian aid to Syria, including over 80.5 million doses of medicine.

The post ‘We Die From Every Cause.’ Cholera Hits Syria appeared first on Direct Relief.

They left with nothing, heading towards Poland after a relative invited them. After four days at the border, in the middle of winter, they finally entered Poland.

But shortly after settling in, Zoia’s daughter caught a virus, which led to a high-grade fever, gastrointestinal complications, and a severe earache. The rest of the family also got sick. Because she had to take care of the kids, Zoia could not work.

Yulia, 34, had a similar experience escaping from her home in Kherson when the war began. She traveled by train, car, and bus to the border towards the Polish border, hoping to join her sister. Her husband joined her for half the journey, but she made the rest of the journey alone since he was forced to stay in-country due to emergency regulations.

After arriving in Poland, Yulia received news that family members had been killed.

“I needed to get psychological support,” Yulia said to Direct Relief. “I had never sought mental health care before, but it was a very tough period in my life,” she said.

Her sister was working in the same office as a translator for the Health4Ukraine program, a nonprofit initiative set up by a Polish healthcare company, Pelion, which offers free telehealth visits, pharmaceuticals, and certain medical supplies to Ukrainian refugees.

Yulia decided to register. “It was very effective,” she said about the five sessions she had with a mental health care provider on the platform.

“There is really a need for this kind of help,” she said.

For Zoia, the program enabled her to obtain therapeutics for her daughter and other family members.

“We really needed help and, before, I couldn’t access any drugs. Since I signed up, we’ve had to use it consistently… I can just go to the pharmacy and use the code they gave me,” she said, noting that her daughter had to go to the hospital four times in a single month.

An Industry Responds

The Health4Ukraine Program was spun up in the days and weeks following Russia’s invasion of Ukraine.

Executives at Pelion, Poland’s largest healthcare company, began looking at their existing programs and systems to see which ones might be suitable for this newly-needed charitable use. Two programs emerged as candidates — a telehealth platform called Dimedic, which was built out during the Covid-19 pandemic, and a fintech system called epruf, which allows users to determine the co-pay and final cost of pharmaceuticals.

Pelion decided to adapt both programs to help address the healthcare needs of millions of people who were entering Poland. In total, over 7.5 million border crossings have taken place from Ukraine to Poland, out of a total number of 12.5 million crossings out of Ukraine into European countries since the war started, according to UNHCR data. The data does not include Ukrainians who went to Russia, willingly or under force.

Today, about 1 million Ukrainian refugees from Russia’s invasion are currently living in Poland, according to data provided by Meta’s Data for Good program, which was analyzed by Direct Relief. About 19% of all displaced Ukrainians are in Poland, making it the most popular choice for those who fled the war, which began on February 24.

Poland has a population of about 38 million people and spends the least amount of government funding per citizen on pharmaceuticals compared to all other European Union members, providing an average of 36% of the cost of drugs, compared to the EU average of 57%, according to OECD data from 2021.

The high number of new arrivals and Poland’s decision to both host them and provide them with a PESEL number (akin to a U.S. Social Security number) presented the nation with a challenge regarding how to provide services and medicine for a group of people representing about 20% of their existing population.

Health4Ukraine, which is supported by a $15 million grant from Direct Relief, $1 million from Pelion, as well as donations from the Polish Red Cross, the ING Dzieciom Foundation, the Deloitte Polska Foundation and private donors, was established to address the health care access gap in Poland among Ukrainian refugees.

The program started accepting registrations on April 22, just weeks after the decision to move ahead, according to Robert Socha, vice president of finance and operations at Pelion, who oversees the charitable program. 

“IT HELPS. IT REALLY HELPS”

To date, Health4Ukraine has signed up about 276,000 people, according to data provided by Pelion. The program has been used by participants in just about all but three of Poland’s 380 local districts and more than half of all the nation’s pharmacies.

Demographically, 55.3% of registrants are women over 18 years old, 37.7% are people under 18 years old, and about 7% are men over 18 years old. Despite being an online-focused system – the program’s barcodes are only given out online due to challenges and costs associated with mailing items to many people who might not have a permanent address­ – the greatest proportion of the population that has signed up are people over 65 years old.

Data from Pelion shows that $7.1 million has been spent by Health4Ukraine participants through the end of October. Of this amount, 36% was spent on non-pharmaceutical products in pharmacies, such as vitamins, medical devices, skin treatments, and supplies such as bandages. 35% was spent on over-the-counter drugs, and 29% on prescription drugs.

Among children, antibiotics were the most common purchase. For adult men and women, it was cardiovascular therapies. Socha said that the first group of registrants purchased more medical supplies and devices than the general Polish population since they, “left in such a rush that they didn’t bring these supplies with them,” he said.

However, as the year went on, data showed that the needs of program participants reflected those of the general population, suggesting that later refugees had time to pack more essentials. Most participants, Socha pointed out, are women and children since military-age men were, and are, obligated to stay in Ukraine.

Because the Health4Ukraine team did not know what participants would need to buy and did not want to keep funds locked in unused cards, they decided to make the barcodes valid for 120 days. Since the program began, about 15% of issued barcodes have gone unused by the registrant.

Each card is loaded with 500 Polish zloty (about $110 USD), of which 350 zloty is earmarked for prescription drugs and 150 zloty is earmarked for over-the-counter drugs and other medical products. A standard-sized package of Tylenol runs about 20-30 zloty in Poland. The program covers 100% of prescription co-payments and 85% of non-prescription drug costs at all Polish pharmacies.

As the barcode is linked to an individual’s identification number, the system allows for transparency and reduces fraud. Socha also noted that doctors play a role in reducing unintended usage of the program, as they are responsible for prescribing medicines.

Socha’s colleague, Project Manager Michalina Łubisz, said that one of the aspects she hopes to change, based on past findings, is that they allow participants to apply for a third 120-day period to use the barcode, given the ongoing need she and her team have seen, based on usage.

Heading into winter, Łubisz and Socha said that the weather to date has been relatively mild and that flu cases have not started to pick up more than usual, both of which have helped mitigate any greater public health crisis in the country. Socha said that he expects weather – Ukraine’s civilian infrastructure has increasingly been directly attacked by Russia – and military action to be the key drivers of any renewed emigration from Ukraine.

For those Ukrainians already in Poland, the wait continues – along with pain, in many cases, even as they work to continue their lives.

“The situation and new life here can be tragic, but I have to find myself in order to be able to go into the future,” Yulia said. “It [access to mental health care] helps. It really helps.”

In addition to $15 million in direct support for Ukrainian refugees through the Health4Ukraine program, Direct Relief has provided more than 2.1 million pounds of medical aid to Ukraine and other countries receiving refugees since Feb. 24.

The post In Poland, Tech Aids Ukrainian Refugees With Healthcare, Meds appeared first on Direct Relief.

“This was nothing about business. We didn’t think to help or not; it was so natural. It was a natural consequence of so many people needing help. After February 24, a huge flow of people came to Poland and from the first hour, we, like very many Polish people, started to help,” he said during an interview at Pelion’s headquarters in Łódź, where hallway lights were turned off due to energy-saving government mandates.

“We are a pharmaceutical company, but in fact, we are a distribution company, and we started thinking about how we could help. There were many asks from many people, but what we realized from the very beginning is that it should be professional help,” he said.

In the early days of the war, Poles were trying to help by buying products at pharmacies and shipping them to the Poland-Ukraine border, resulting in a logistics nightmare as supplies began building up in a disorganized fashion, Molenda recalled. Additionally, people tended to purchase the same few products.

“We got information from Ukrainians saying, ‘Don’t send any more paracetamol! We have enough paracetamol!” Molenda said.  

“We can send products in bulk, and keep track of what we’re sending, so after consultations with the Polish and Ukrainian governments, that’s what we did,” he said.

PGF, a Pelion subsidiary in the wholesale pharmaceutical business, took the lead in fundraising and sourcing pharmaceuticals from Polish pharmacies — the overwhelming majority of which are owned by Pelion — to ship across Poland and into Ukraine. They also sent donations of hygiene supplies, medical supplies, food, and cash.

In addition to shipments of pharmaceuticals and medical supplies, Pelion began assessing their existing services for suitability to convert them to charitable programs for refugees. They found candidates within their telehealth service, called Dimedic, which was built out during the height of the Covid-19 pandemic and offered low to no-cost medical consultations. Another candidate was a cashless pharmaceutical fintech platform called epruf. The platform was initially set up for Polish citizens, enabling patients to see their copayment and then pay it.

With an initial $10 million grant from Direct Relief, which was supplemented with an additional $1 million from Pelion and $5 million from Direct Relief, Pelion could quickly adapt epruf for Ukrainian refugees, allowing them to receive medicines and medical supplies.

Direct Relief has deployed more than 1,030 tons of medical aid and $20 million in financial assistance to Ukraine since the war broke out.

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According to an analysis by Direct Relief, based on Pelion data, the program was supporting health commodities access for about 17% of all Ukrainian refugees in Poland, which has accepted the highest number of refugees as a result of the Russian invasion.

This service has been crucial for many refugees, especially those with chronic conditions since many people did not take medicine for the long term, said Molenda, according to both experiential assessments and data from the program, which shows the types of medications that have been prescribed for patients.

The telehealth service has also been deployed to aid refugees by providing healthcare provider assessments at no cost to the patient, including mental healthcare services.

Both systems, which comprise the Health4Ukraine initiative, were operational for refugees within weeks of deciding to move forward with the programs.

The business of doing good

Beyond helping refugees who have escaped since February 24, Pelion has also supported their Ukrainian employees hired before the invasion. Some specific measures included giving them guaranteed job security and paid time off if they wanted to visit their families in Ukraine. Employees were also assisted in the process of bringing family members into Poland. PGF offered their 300 Ukrainian employees bonuses to help with family members who are still in Ukraine as well as access to mental healthcare.

Beyond helping their employees, Pelion hosted 50 refugees, mostly mothers with their children, to live on the headquarters’ grounds in a converted warehouse and office. They provided them with food, clothing, medical care, and physiological assistance. For all refugees, in addition to the Health4Ukraine initiative, Pelion set up a Ukrainian language website that shows local job openings.

Pelion also began a push to hire post-invasion refugees. At a warehouse next to their main office, which has about 24,000 products and can provide same-day fulfillment for up to 60,000 orders, 30% of staff members are now Ukrainian.

Piotr Cieślak, CEO of PGF, said that onboarding refugees proceeded without any interruption to business operations, which he credited to Ukrainian employees who had been working for PGF and Pelion.  

“There was no impact on business operations. They have been helpful [as employees],” he said. “We felt a huge solidarity,” Cieślak said.  

Asked about the onboarding process and her early days working for Pelion, factory worker Nadiia Kravchyk, who joined before the war, said, “It was easy… everyone was very supportive, and other Ukrainians helped me with the language barrier.” Kravchyk said. Signs in Ukrainian are posted throughout the factory, sometimes with handwritten edits and additions.

Molenda and  Cieślak said employees have also acted in other ways to help refugees, both with supplies and to feel more at ease, such as by playing Ukrainian music in warehouses and offices. Some employees from Olsztyn,  Cieślak said, went with home-baked cakes to local refugee centers during the early days of the war and ate with refugees. Many employees have hosted refugees in their homes.  

“They’ve started to inspire one another,” Cieślak said.

“People love to do it,” Molenda said, noting it has buoyed morale among both Polish and Ukrainian employees.

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Molenda said Pelion plans to continue responding to the crisis, focusing on refugees in Poland. Pelion’s current charitable shipments into Ukraine are now going via the Polish government. Molenda said Pelion would continue assessing and responding to any requests from the Ukrainian government for aid.

As inflation continues to rise in Poland — it hit 17% year over year in September — and the specter of a difficult winter becomes a reality, some might want to pull back from supporting the refugees. Despite such developments, Molenda said he disagreed with any sentiment of reducing support. “These people are still here, and they still need help,” he said.

The post ‘Professional Help’ Gets Meds, Care to Ukrainian Refugees in Poland appeared first on Direct Relief.

Seeing the full impact of the storm on her community and wanting to respond immediately, Singh decided to broaden her nonprofit’s scope of services and began sourcing and offering clothing, toiletries, diapers and supplies for children, as well as pet food. PMHS also started cooking hot meals for those in need.

“The past few days have been really heavy for us,” Singh said in an interview with Direct Relief, noting the devastation Ian brought to the area and its disproportional impact on the areas they serve.

“Some people have lost everything… the community was already underserved, they didn’t have much before, and many were living below the poverty guidelines. And to lose the little they had has been crippling. Their houses are probably rental homes, and landlords are evicting them, and they’ve lost jobs because of flooding,” Singh said, recounting what she has heard from her clients.

With help from various nonprofits, including Direct Relief, which provided medical and financial support for the group after the storm, along with other agencies, PMHS was able to partially restock their medications and supplies, as well as an EKG machine, and have resumed offering medical care, though still face shortages.

“People are stepping on nails, and we can’t triage them since we don’t have the supplies we need. Children are without diapers,” Singh said. “The need is bigger than what we, as a small agency, can fulfill… the government is trying to help, but it’s not enough as these people try to recover,” she said.

Currently, according to Singh, the most acute needs in her community include diapers, bleach, cleaning supplies, Tdap vaccines, and funding to pay for additional staff members to work out of their other mobile unit. PMHS currently has six staff members. Singh is hoping to hire additional nurse practitioners and medical assistants.

Last Tuesday, a PMHS mobile clinic was parked at Suncoast Community Center, a food pantry that provides additional nutritional food to low-income households. Singh’s team and volunteers had also set up tents to provide donated clothing, cleaning products, personal hygiene products, and meals to locals.

Suncoast has many mobile homes that Hurricane Ian damaged significantly. The neighborhood was without power.

Several patients arrived and said they were either out or running low on their medications. Reflecting how disasters can result in compounding challenges, one man requested antihistamines for his allergies because he had to have his windows open over the previous week.

Though faced with significant infrastructure damage and supply shortages, Singh said she and her team have been able to identify the most pressing needs and respond efficiently due to their consistent work over the previous four years – this, despite not having been able to adequately prepare for a storm of such magnitude due to budget constraints. She can also relate to some of the challenges her clients face on a personal level, having faced and overcome similar challenges as the community she now cares for, including facing barriers to care due to her prior undocumented status and as a teenage mother.

“The community knows me. I’m one of the trusted faces in the community. Based on that trust, the community is rallying behind us, but I’m a small provider with limited resources,” she said. “We’re out here trying to provide care the best we can.”

Since Hurricane Ian made landfall, Direct Relief has shipped more than 8 tons of medical aid to Florida. It is also providing financial support to health organizations responding in their communities, including Premier Mobile Health Services.

Additional reporting contributed by Marisa Mancuso Barnes.

The post Mobile Clinic Responds in New Ways After Ian appeared first on Direct Relief.

Several Federally Qualified Health Centers (FQHCs), which provide primary preventative care to everyone regardless of their ability to pay, sit in Ian’s projected path. Over 1 million patients are currently in Ian’s path. For many people, FQHCs are their only source of healthcare, except for emergency departments – which is also the case during and after natural disasters.

“In many communities, after a hurricane, the local private sector won’t be ready to open their doors. FQHCs have a mission to meet their community needs immediately. They need to be open right away if people need a place to go… for the uninsured and elderly, it’s the only place to go, except for the ER, which is the worst place to go,” said Andrew Behrman, president & CEO of the Florida Association of Community Health Centers, which counts 54 FQHCs among its members.

Behrman, who has more than 20 years of experience in his role, said the combination of high costs, long wait times, and diversion of limited resources makes a post-hurricane ER a suboptimal choice for non-emergency care.  

Ahead of the storm, Behrman said Florida FQHCs are currently focused on ensuring staff and patients are safe from harm’s way. He said most will be closed today and likely tomorrow, primarily due to patients being evacuated.

“We’ve encouraged those in the evacuation area to get the heck out of there,” Behrman said, adding that clinics have used “every tool they can,” including emails, text messages, Facebook, and personal phone calls to inform patients to evacuate. “I have lived in Florida for over 60 years, and the last thing you want to do is be in the path of Category 4 or 5 storms,” he said.

FQHCs in Florida have also been testing generators and are coordinating details to stay in contact with local and the State Emergency Operations Center as well as with Behrman’s organization – one of the most critical aspects of disaster response and recovery, Behrman said. To ensure ongoing communications, FHQCs in the hurricane’s path have been given satellite phones. Plans are also in place to deploy “MASH-style” tents so that people can still be treated even if a building has been rendered operational, along with generators and wash stations shortly after the storm passes. These purchases were made possible by a Direct Relief Covid-19 resiliency grant.

Though not set up for emergency care, FQHCs are also prepared to stabilize patients experiencing acute trauma before getting the patient to an appropriate facility, Behrman said, again noting that communication, in this case with a local acute care center, was vital.

Offering continuity of care, especially for chronic conditions, has proven crucial in the aftermath of hurricanes.

A multi-decade study published in JAMA showed a 33.4% higher death rate after major hurricanes in the United States. The increased death rates were seen in causes of death such as injuries, infectious and parasitic diseases, respiratory diseases, cardiovascular diseases, and neuropsychiatric diseases. No increases were seen in cancer-attributed deaths.

During disasters and daily life, certain groups are more vulnerable to adverse health outcomes. Age, income, and having a disability, along with other social determinants of health, are correlated with worse health outcomes, which can be magnified during natural disasters when disruptions to care are more likely to occur—making it more difficult to obtain medications and power medical devices.

 Of the 1.05 million Federally Qualified Health Center patients in the hurricane’s path, according to a Direct Relief analysis of U.S. Health Resources and Services Administration data, about 11% are under six years old, 50% live at the federal poverty level or below, 18% have hypertension, 31.5% are classified as overweight, 4% have asthma, and 8% have diabetes. More than 20% of patients speak a language other than English.

In Pinellas County, 25% of the population is older than 65 years old, which is 8.5% higher than the U.S. national average of 16.5%. Hillsborough County’s population is younger than the average, but 14% of the population lives below the poverty line, compared to the national average of 11%.

Across both counties, which are the two largest counties by population on the Gulf Coast in Hurricane Ian’s projected path, there are about18,000 people with power-dependent medical devices. The national average per county is 895 people. A 2010 study showed the average backup battery for an intensive care ventilator lasted between about  20 and 170 minutes.

Earlier this summer, in line with a program established in 2007, which began in the wake of Hurricane Katrina to help support FQHCs, Direct Relief prepositioned a dozen Hurricane Prep Packs in Florida. The packs, which contain over 210 different products, and have been refined and updated based on feedback from FQHCs and other medical providers, currently have a range of antibiotics, syringes, basic first aid supplies, and medications to treat conditions such as diabetes, hypertension, and severe allergic reactions. One of the recipients this year was the Tampa Family Health Center, one of Florida’s largest Federally Qualified Health Centers.

Behrman said that as the storm approaches and the mission shifts from evacuation to reopening, his organization and the FQHCs they support would remain focused on the stakes involved.

“At the end of the day, we may be the only option for people,” he said.

The post As Hurricane Ian Makes Landfall, Florida Health Centers Stand Ready appeared first on Direct Relief.

Through August 22 this year, far less of the lower 48 states have seen a week’s worth of heavy wildfire smoke. However, last month alone, an estimated 1.44 million people across the US experienced seven or more days of heavy-density wildfire smoke in parts of Texas, California, New Mexico, Idaho, Oregon, Oklahoma, and Alaska.

Notable cities and census-designated places (CDPs) under such conditions include Amarillo, Texas, McLean, Texas, the Klamath area in California, and Tucumcari, NM 71 cities and CDPs in Alaska have also seen at least seven heavy smoke days, including Fairbanks.

The data from 2020 and 2021 suggest that more research and outreach are needed for wildfire smoke risks for people throughout the US.

“It’s interesting to look at the Midwest in particular, not just in terms of tornadoes and flooding, but to also add air quality [from smoke] on top of that … that last piece just doesn’t seem to be on a lot of people’s radar,” said Michael Robinson, Crisis Mapping and Data Science Specialist at Direct Relief, who analyzed smoke data from the National Oceanic and Atmospheric Administration.

According to NOAA, “heavy” smoke density refers to the thickness of smoke observed in satellite imagery. Heavy smoke density is intended to approximate 21-32 micrograms per cubic meter.

Another possible contributing factor to the increase in US wildfire smoke last year might have been Mexico’s wildfires. According to Robinson, who holds a Ph.D. in geography, atmospheric circulation transports smoke from wildfires and, in 2021, the smoke from Mexico’s worst wildfire season in more than ten years would likely have contributed to the increased smoke coverage in the southwest United States.

Analysis by Direct Relief of this year’s smoke data showed that most of Mexico’s Gulf Coast and most of its southern Pacific coast had had multiple weeks of at least medium smoke. “Medium” smoke density is meant to approximate between 10-21 micrograms per cubic meter.

Wildfire smoke has been linked to “significant” increases, within a day or two of the event, in hospital emergency departments. The most vulnerable populations to wildfire smoke include children and people with respiratory and cardiovascular illnesses.

Illnesses associated with prolonged and repeated exposure to polluted air, both wildfire smoke and traffic-related pollution, include deficits in lung function, asthma, allergies, chronic obstructed pulmonary disease, and altered immunology.

Michael Robinson, Crisis Mapping and Data Science Specialist at Direct Relief, contributed to this article.

Direct Relief responds each year to wildfires throughout the Western US, including in its home state of California, providing N-95 masks, medicine, and other resources to healthcare agencies and first responders.

The post Wildfire Smoke Blanketed US Midwest Last Year appeared first on Direct Relief.

Over the same period, an estimated 28.6 million people, or nearly 9 percent of the US population, experienced one or more days of heavy smoke.

According to NOAA, medium and heavy smoke density refers to the thickness of smoke observed in satellite imagery. Medium smoke density is meant to approximate between 10-21 micrograms per cubic meter, and heavy smoke density is intended to approximate 21-32 micrograms per cubic meter.

Broad exposure to smoke from wildfires has occurred despite this year seeing the fewest acres burned since 2014.

Last month alone, an estimated 1.44 million people across the US experienced seven or more days of heavy-density wildfire smoke.

Most locations that have endured such conditions over the past month are in Alaska, with Fairbanks being the most populous, though areas in California, Montana, and Idaho have been subject to at least seven high-density smoke days.

Though often associated with western US states, several Midwest and eastern states have also experienced at least one heavy smoke day, including vast swaths of Minnesota and Iowa as well as regions of New York and Pennsylvania.

Several studies have shown a link between wildfire smoke events and “significant” increases in hospital emergency department visits, especially for respiratory and cardiovascular ailments. These increases, particularly related to asthma and respiratory diseases, as well as cardiovascular diseases, can begin within a day or two of the events and continue for several weeks or more afterward, according to Helene G. Margolis, Ph.D., a professor in the Department of Internal Medicine at UC Davis Children’s Hospital.

“Children, people with preexisting chronic diseases, and children in utero are definitely susceptible, across the life course,” Margolis said about people exposed to extended periods of either wildfire smoke or traffic-related pollution.

Some medical conditions associated with repeated exposure include respiratory diseases, deficits in lung function, asthma, allergies, chronic obstructed pulmonary disease, and altered immunology.

After prolonged exposure to traffic-related pollution, decreased lung function has also been reported in children.

“You can almost certainly expect that wildfire smoke is contributing to that,” Margolis said.

Wildfire smoke exposure can also lead to a higher risk of contracting Covid-19 and other illnesses since wildfire smoke and air pollution can “alter the efficacy of immune response,” Margolis said.

Both wildfire smoke and air pollution can trigger inflammation in a person’s airways, causing elevated inflammatory markers to occur throughout the body, she said, which can be particularly dangerous to people with metabolic syndrome.

smoke hits differently

Though smoke blankets an area, it does not affect all people in that area equally. Key differentiating factors include where a person lives, including the ability to either seal their home or leave, underlying health conditions, and financial circumstances, including the ability to buy air filters and avoid outdoor work.

“Some studies have shown that more vulnerable populations may experience a larger impact for the same event,” said Jennifer Richmond-Bryant, Ph.D., a professor at North Carolina State University’s College of Natural Resources, noting that not all vulnerable populations are the same.

As one example, focusing on non-medical factors, Richmond noted having air conditioning can “make a big impact.”

“As climate change progresses, there are not only more fires, but those with the means can close up their homes [during a wildfire smoke event]. Without air conditioning and with 90-degree heat, you’re going to have to open your windows,” Richmond-Bryant said.

While both traffic-related air pollution and wildfire smoke can carry serious risks, wildfire smoke carries unique risks owing to its compositions, which vary based on a range of factors, including where and what it is burning and how it acts in the atmosphere.

“Wildfires are occurring with substantially higher concentrations of particulate material than regular ambient air pollution,” Richmond-Bryant said.

“A lot of locations with older growth forests were around in the days of leaded gasoline. You might have wood with trace amounts of lead. Or they might have been around during a time of coal power, more than we have now, meaning mercury may have been embedded,” she said.

In addition to natural materials, Richmond-Bryant and Margolis said that human-made materials can also increase the toxicity of wildfire smoke – an increasing problem as people continue to move into formerly undeveloped, forested areas.

“A mid-20^th century house might have lead paint and become part of the air combustion mixture. You also have a lot of plastic materials,” Richmond-Bryant said.

“Those chemicals carry much higher toxicity risk,” said Margolis about plastics and other human-made materials.

A study on the 2018 Camp Fire showed that its smoke contained “dangerous” and “concerning” levels of particulate matter and toxic metal contaminants, including lead, “which spiked for about 24 hours.”

Margolis said that issues around wildfire smoke figure to increase due to climate change and other ongoing trends.

“Given climate change and the drying of the landscape, the conditions have become increasingly arid. When you factor in more things like forestry management, these events are happening earlier, they last longer, there’s more fuel, so the magnitude, length, and the duration of exposure to wildfires is greater,” Margolis said.

“It’s going to have downstream consequences,” Margolis said.

Direct Relief has been responding to wildfires for decades and most recently shipped dozens of requested emergency field medic packs to the California National Guard to support their response to the ongoing wildfires in northern California. Each pack is equipped with triage and medical essentials, including infection control supplies, trauma care, diagnostics, and PPE.

Michael Robinson, Crisis Mapping and Data Science Specialist at Direct Relief, contributed to this article.

The post Two in Three People in the US Were Exposed to Significant Wildfire Smoke Last Month appeared first on Direct Relief.

Many community health centers around the nation have reported staffing shortages, and a majority reported increasing demand from their patients for services in addition to primary care, such as mental health care and food banks, according to a recent Kaiser Family Foundation survey that was conducted at the end of last year. Community health centers also reported that patients continue to experience transportation-related issues.

June’s Consumer Price Index showed an increase of 9.1% from June 2021, according to data from the Labor Department. Medical care services and costs have increased by 4.8% and 3.2% respectively during that same time. However, this seemingly good news is mitigated by the fact that the medical care sectors have increased more than 109% since 2000, whereas all goods and services have increased by about 70% since then.

Since Jan. 1, 2022, Direct Relief has provided U.S. health facilities, including community health centers, with more than $121.6 million worth of medical aid and grants of more than $19.1 million to support health efforts.

Transportation Challenges

As an example of how long-time issues, which were exacerbated by the pandemic, have continued to confront health care centers in the current inflationary environment, health care providers at safety net clinics have reported that patients are reluctant to drive to their appointments due to the high price of gasoline.

“Gas prices have risen, and that’s a very big concern (for patients). I have a few clients who prefer to stay with telehealth because of the commute,” said Brooke Serrano, a clinical social worker at Utah Partners for Health.

Utah is facing one of the highest rates of inflation in the U.S., according to a report from the U.S. Congress Joint Economic Committee. That report showed inflation in Utah was tied for the highest in the U.S. at 14.9% in June.

Transportation concerns, along with several other ongoing challenges facing patients and staff, have been tracked by the National Association of Community Health Centers, or NACHC, the national-level advocacy, support, and research group for community health centers, over the past few months.

“We’re concerned patients will cancel (appointments) because they can’t afford to get there,” said Ben Money, senior vice president for public health priorities at NACHC, about patients throughout the country during an interview with Direct Relief in May.

“Efforts to utilize telehealth to provide services are important now. During a pandemic, we found telehealth provided good access and continuity to care,” he said.

Along with transportation issues, NACHC also noted that the overall economic environment could lead to more people seeking care at safety net clinics care at a time when the job market remains very competitive– which is leading to staffing shortages.

“There’s not a legislative bill in congress to shore up any debts health centers have,” Money said.

Federally qualified health centers are funded by a base grant from the federal government, which is about $650,000 annually. Additional grants, including from states, are available for certain add-on services and initiatives. These clinics, which all offer care on a sliding scale based on a client’s income, are able to bill Medicaid, Medicare, and commercial insurance companies.

“Health centers have to just figure it out,” he said.

Struggling to hire staff

Though providing services for more people, without additional funding, remains a concern, many clinics reported that staffing shortages are their most immediate problem.

“Our biggest challenge has been with regards to staff and wages.  We have done multiple wage increases over the last two years, but those are not keeping pace with inflation, and we are really struggling to keep up,” said Janida Emerson, CEO of Fourth Street Clinic in Salt Lake City. She said some top staff members were forced to relocate because they could no longer afford to live in Salt Lake City.

“As those staffing shortages become more pronounced we have to close provider schedules, and that means reducing access to care,” she said.

Community Health Center, Inc., or CHC, also located in Utah, is also facing higher turnover than is typical for them.

“We have also found it extremely challenging to find candidates,” said Jennifer Thomas, executive director of CHC.

Thomas said that CHC has been forced to train staff while on the floor due to staffing pressures and their reluctance to reduce the number of appointments available to their patients. She said they have not had to increase copays or charges, even as they have increased salaries for staff.  

At Utah Partners for Health, Serrano said staff members have been coming in to take turns staffing the desk on their off days.

barriers to health, Reduced

Among many of her patients, who range from three years old to 73 years old, Serrano said that inflation has hit hard.

“[Patients] come in and are crying about not having money to eat or for housing,” she said.

With such concerns about survival, she said “it’s nearly impossible” for her and her colleagues to help patients focus on taking care of themselves, especially when it comes to managing chronic conditions.

For her younger patients, Serrano said socializing has been impacted once again.

“Teens are coming in and saying they want to hang out with friends but don’t have money to do it, or get there, with gas prices,” she said.

With such massive, structural issues, Serrano said she tries to focus on what she can do to help people on an individual basis. She recounted one story about a patient with diabetes, which can be very expensive to treat. He holds a minimum-wage job and lives with his parents. A monthly shot that his doctor prescribed was quoted at $500 per month.

“I can’t really help with housing, and I can’t necessarily fix his situation, but I can offer that empathy and other support,” she said.

Serrano called the patient’s doctor and explained his situation. Utah Partners for Health is also able to sometimes call insurance companies and negotiate on behalf of their clients. After the doctor’s discussion, she could help her patient secure a more affordable alternative, billed on a sliding scale.

Asked why she does not seek a higher-paying job, Serrano said that she continues to work at her clinic because she saw the importance of its services firsthand after she completed her undergraduate program and moved to Utah without insurance.

“I was struggling, I was a patient, and I recognized this is such a need in our community. When I continued on to my master’s program, I knew I wanted to serve this community,” she said

While inflation shows few signs of abating, Serrano said her goal at work will remain the same.

“I can’t solve all your problems, but how can I help and support you?” she said.

Since the start of the Covid-19 pandemic in 2020 and through current inflationary pressures, Direct Relief has shipped $615 million worth of medical aid to safety net health organizations in the United States, including community health centers. The organization has also provided more than $115 million in grants to support health services for vulnerable patients.

The post Inflation Hits Safety Net Health Care Centers, Patients appeared first on Direct Relief.

Air raid sirens blared overhead. Chorniy, 29, drove to a nearby bomb shelter and waited as Russian shells and missiles exploded as close as one kilometer away from him, shaking the ground under his feet.  

“The air raid alarms are frightening because you don’t know if you will see your children after the alert,” Chorniy said in a translated phone interview with Direct Relief.  

“It’s very true there is always fear, especially when the bombs fall, but understanding why you do it is the reason how you can do it,” he said, referring to his aid shipment deliveries to Ukrainian cities under direct attack. 

“We do this for good, we do this for a very positive reason,” he said.  

Chorniy is one of the many Ukrainian drivers who have been transporting life-sustaining medications and medical supplies from distribution warehouses in neighboring countries and the calmer regions of Ukraine to areas that are under direct, and at times constant, fire. With them, it is unlikely that such aid would arrive at those locations, especially given the interruptions to other forms of transport and the restrictions on movement faced by residents, health care providers, and others in the war zone.   

Though not something he anticipated when he started the job about two and a half years ago, Chorniy said he did not consider fleeing or switching his line of work in the wake of the Russian invasion— despite the fear he felt.  

“In principle, just as any person, I had fear because [one of the world’s] biggest armies is attacking. The first two days, this fear was intense, but to see how our soldiers worked… this fearsome army wasn’t as frightening as it seemed,” he said.

Currently, Chorniy is making at least two delivery runs per week, each one covering about 800 to 900 kilometers (approximately 500-560 miles) per trip. Each roundtrip can take up to four days, he said, assuming there is sufficient availability of fuel, which remains in short supply.  

He said his medical deliveries have gone to volunteer receiving locations, which accept the packages, break them down, and redistribute them to small towns and areas that most need it, with a particular focus on those areas without electricity, adequate supplies of water and food, and with children and elderly populations that were either unwilling or unable to leave.  

A representative from a logistics company Chorniy works with, Geis Group, said Chorniy is one of about 30 drivers they are working with to maintain the highest tempo of deliveries possible. Radiant Logistics, a freight forwarder that contracted Geis, said they have shifted their operations to allow for more volume.  

“Any aid disaster program is normally 24/7, that’s just the life we live, that’s the expectations we set for ourselves. If it’s not 24/7, you lose a lot of time,” said Wiley Knight, director of humanitarian aid for Radiant. For humanitarian aid shipments, the EU lifted regulations that prohibit truck drivers from deliveries on Sunday, which Knight said helped “a lot.” 

Though the pace has been intense and has included a substantial amount of danger in some of the hardest-hit areas of Ukraine, Chorniy said that the images that have stuck with him are far from the battlefield. They are from the war’s early days when he volunteered to load trains with humanitarian aid and help refugees, especially women and children, get out of harm’s way. 

“It was pretty scary. We could see the look on their faces. We were fortunate to not have seen what they’ve seen,” he said. 

Noting that the support of the West has been, “instrumental and something we can’t do without,” Chorniy said he and his colleagues realize that they are fulfilling a critical role that few others would be willing to do.  

“We don’t want war, but we don’t have the ability to make this decision. We were forced to do what we did before (as drivers), but we have to adjust to new circumstances,” Chorniy said.  

“We understand that we are the only ones who can do this for our country,” he said.   

Interview co-conducted and translated by Sam Tkachuk. 

Direct Relief has sent over 800 tons of humanitarian aid and $15 million in cash grants to help address the humanitarian crisis in Ukraine, working with dozens of nonprofit partners as well industry-leading firms including Radiant Logistics and Geis Group.

The post Drivers in Ukraine Brave Bombs To Deliver Aid appeared first on Direct Relief.

While 6.2 million people remain internally displaced in Ukraine, more than 5.5 million people who left their homes during the war have now returned home, according to the WHO’s latest external situation report.

AICM Ukraine, an NGO that has been active in Ukraine since 2006, reports that 12.1 million Ukrainians are considered in need of humanitarian health care, as the country’s health care system has been severely impacted by months of active conflict. WHO has noted 323 Russian attacks on Ukrainian health care infrastructure including facilities, transport, warehouses, and patients, in addition to broken supply chains, restricted mobility, and mass displacement.

 With the diminished capacity of the national health care system, WHO has identified priority public health concerns including conflict-related trauma, maternal and newborn health, chronic disease care, mental health care, food security, potential communicable disease outbreaks,  potential nuclear and chemical hazards, human trafficking and sexual violence.

In May, WHO European Regional Director Dr. Hans Kluge said at least 3,000 people in Ukraine have died since Russia’s invasion due to a lack of access to chronic disease medication.

According to the NCD Alliance, a global nonprofit focused on non-communicable disease issues, about 9 million people in Ukraine are living with chronic diseases such as diabetes, cancer, cardiovascular diseases, chronic respiratory diseases, and mental and neurological conditions.

AICM Ukraine pointed out that another vulnerable group includes older adults. About 20% of the Ukrainian population is 60 years and older, making it one of the highest proportions of elderly people in a humanitarian crisis location globally.

“People with disabilities, children and youth, women and girls, health care workers, and internally displaced persons, which AICM Ukraine, notes, are all distinct vulnerable populations with their own humanitarian health care needs,” said Dr. Christian Carrer, a French physician who co-founded AICM and AICM Ukraine, in an email.

As noted by AICM Ukraine, many of the social determinants of health, such as access to clean water, sanitation and hygiene (WASH), food security, shelter, security, and restriction of movement, impact the health of displaced and nondisplaced populations.

Given the deteriorating state of such factors, WHO has noted the elevated risk for an outbreak of cholera, noting that residents of Mariupol have been forced to drink from puddles, as the water supply has been severely impacted. Prior to the war, there was a polio outbreak in the country, which the WHO fears could expand, along with Covid-19, measles, and diphtheria, as access to clean water, sanitation and hygiene have been decreased. The close proximity of people in bomb shelters is also of concern.  

In Poland, which has accepted over 4.3 million refugees, there have been almost four times as many chickenpox cases this year as in the corresponding time period last year. Other areas of concern identified by the WHO include low vaccination rates for polio (56%) measles, mumps, and rubella (68%) among refugee children. Only 40% of all respondents said they were vaccinated against Covid-19. WHO said major impediments to care in Poland among Ukrainian refugees are language barriers, cultural differences, and a general lack of information, while also noting that the lack of specialized services available for people with disabilities is a “major issue.”

“Having an understanding of the status of these determinants gives context to the health issues faced by those affected and can help inform intervention planning,” said Carrer.

In an effort to help optimize aid delivery for its own operations and those of other NGOs which are responding, Direct Relief is contributing to the WHO situation reports through its partnership with a crowdsourcing company called Premise. Direct Relief’s Research and Analysis team has helped them shape a series of data collection efforts about health and medical needs both within Ukraine and throughout the refugee receiving countries so as to receive novel data of relevance to the response.

Among other research and development projects, including mobility and refugee movement dynamics and analyzing a $10 million grant program for refugees in partnership with Pelion in Poland, Direct Relief collaborated with Premise to develop two surveys on health care and pharmacy needs in Ukraine, as well as another on refugee reception centers in Poland.

“We have been involved in helping to collect data on pharmacies, displacement, and attitudes towards refugees in order to understand the scope and dimensions of this unprecedented crisis as it affects the people of Ukraine, the health system, and the host communities in neighboring countries,” said Andrew Schroeder, vice president of research and analysis at Direct Relief.

Since the war began, Direct Relief has sent 800 tons of aid and over $13.6 million in grants to respond to the humanitarian crisis in Ukraine and neighboring countries.

The post As Conflict Strains Health System, Needs Continue in Ukraine appeared first on Direct Relief.

Much of this requested support, which has included medicines, medical supplies, prepared kits, oxygen concentrators, and cold chain storage facilities, has been requested, received and distributed by local nonprofits, which are playing a critical role in shoring up the public healthcare system as the nation’s resources are largely being focused on defending against the Russian military’s attacks.

While a diverse range of focuses, goals, and office locations exist among these organizations, a common thread among the most effective nonprofits – as almost always the case during disasters of any sort – has been an ability to draw on preexisting relationships and expertise.

“We have been able to build trust because we are doctors… It’s an exchange of experience,” said Dr. Christian Carrer, a French physician who co-founded AICM and AICM Ukraine, which was created in 2006. He has been in Ukraine since 2004.

Help Ukraine Romania (HUR), a Chernivtsi-based nonprofit started about a week after the invasion, has also benefited from its volunteers’ connections within their home country.

“My network has been very helpful… I’ve been amazed by my friends and partners who have been approaching me with their help,” said Oleksii Leshchenko, HUR’s partnership coordinator, who worked as a social science researcher for the Gorshenin Institute.

During his research, Leshchenko said he was able to gain a deeper understanding of both the political and social processes in his country and the demographics and attitudes of Ukrainians.

“It helps us with where and how to move forward,” he said.

In some cases, these nonprofits have indicated they are directly supplying people sheltering in place without critical medications for chronic conditions such as diabetes and cancer and with only minimal rations and electricity access for several months. Nonprofits are also working with health care institutions at all levels of the Ukrainian system to assist in sourcing medications that are in short supply, as the nation’s domestic pharmaceutical industry has seen a 40% decline in production since hostilities began.

To date, AICM Ukraine has received and distributed about 34 tons of aid from Direct Relief, including a complete field hospital created by the California Governor’s Office of Emergency Services, in addition to food, solar lamps, water treatment systems, and goods supplied by other donors. The group has accomplished this despite being forced to relocate from Kyiv to Poltava at the onset of the war due to the Russian bombardment. In addition, out of the half dozen warehouses AICM Ukraine had before the war, only one is still accessible and active.

HUR has received about 31 tons of aid from Direct Relief, including two Emergency Health Kits containing supplies requested frequently after emergencies, including chronic disease medications. Leshchenko said HUR is working with 96 out of the 195 communities affected by war in Ukraine and is similarly providing a range of requested humanitarian aid.

Both Carrer and Leshchenko were effusive in praising the drivers who have been risking their lives to deliver medicines amidst active warfare to locations where locals are in dire need.

“They had no food, heating, or medicines,” said Leshchenko, referring to people in many communities to which HUR has delivered aid, most often rural communities in the country’s eastern regions.

The humanitarian crisis is still ongoing, said Carrer, nothing that some hospitals his team works with are totally stocked out of critical medicines for their patients. Many other hospitals, he said, have dangerously low levels of medicines, especially expensive therapies like those for cancer.

“There are places where people are still living in basements and in the metro. They’re like zombies after 3 months or more, you can imagine…I see them all the time. They need many, many things and a lot of time to come back to real life. They’ve lost their homes, job, and even some of their family members, sometimes,” Carrer said.

With such high stakes, HUR and AICM Ukraine know it’s essential to ensure aid gets to where it was intended to go and can help as many people as possible. To accomplish this, the groups have chosen to work with local elected officials, including mayors and regional council members. Such officials are most attuned and accountable to the needs of their respective communities, according to Carrer and Leshchenko.

Carrer said he is also able to add a layer of accountability due to both his medical expertise and that of his Ukrainian colleagues.  

“We speak the same language,” he said about AICM Ukraine and the hospitals they support. “We know what they should need and sometimes we can anticipate their needs and will ask them.”

“I have worked in different hospitals, in Africa and different places…  I know what’s needed to treat a bullet injury, burns, amputees, we can see before if they are playing a game with us or not, “he said.

About the aid they provide, he said, “It’s not a wishing list, it’s not for Christmas, it’s for needed stock.”

Though the safeguards are required, Carrer complimented his Ukrainian colleagues and said the care they provide in-country rivals anything in France and throughout the continent and perhaps surpasses it in some respects due to the experience local doctors have had with war wounds since 2014. Carrer said that when colleagues from the U.S. and Europe offer to volunteer, he rejects them, saying that local doctors are more than up to the task and that foreigners need time to adjust to an environment where there is no such luxury.

“I will not forget it until the end of my life”

As the war grinds on, the nature of the most needed aid has not changed since late February. AICM Ukraine and HUR both reported that their partners are in dire need of medicines, food, and hygiene products.

Leshchenko noted that one change has been the reduction in communities they are helping since some have been occupied or are currently under siege by Russian forces.

Working conditions for both groups have somewhat stabilized since the early days of the invasion, though Carrer noted that air raid sirens currently go off, on average, about every two hours in Poltava. Recent diesel shortages have also made logistics more complicated and expensive, according to Carrer.

Reflecting on the past months, both men said the war had brought them closer to their colleagues, as they’ve worked through shared hardship and towards a common goal.

“We live together, it’s a sort of community,” Carrer said.

“This period changed a lot in me, said Leshchenko. “This period of making a joint work, common thing, it is unforgettable…. Working with these young people, who fled bombs in Kyiv, I’ve been very impressed… they just wish to do things, wish to make things happen,” he said, adding that HUR began operating prior to securing any kind of funding as a volunteer effort.

“I will not forget it until the end of my life, these impressions,” he said.

Following the first interview with Direct Relief, Carrer turned his focus on the next delivery, which was scheduled to go out at 6 a.m. the following day. It was an anticipated 11-hour journey each way, which took less than 4 hours, pre-war due to destroyed bridges and roads.

The delivery ended up being a success. AICM Ukraine delivered medicine, ultrasound machines, monitors, defibrillators, electrocardiogram machines, and other supplies to 21 facilities in the east and north of Ukraine — some of which, according to Carrer, had not been resupplied since the war began.

The post Local NGOs Fill Critical Gaps Amid War in Ukraine appeared first on Direct Relief.

At an online panel discussion hosted today by CrisisReady – a research partnership between Direct Relief and Harvard T.H. Chan School of Public Health – speakers from the California Governor’s Office of Emergency Services (CalOES), Harvard University, Columbia University, American Red Cross, Mariposa County’s Health and Human Services Division, and California Conference of Local Health Officers shared new findings on the public health impact of wildfires.

The panel also discussed the latest technologies integrating disparate data sources into more centralized, easier-to-read platforms.

“We’ve got several pieces of research converging all at one time,” said Andrew Schroeder, VP of research and development at Direct Relief and co-director of CrisisReady, during a pre-panel interview.

Schroeder and the panelists highlighted a new health resilience mapping tool funded by Google.org, which is still in development but can provide actionable info. It contains data on social vulnerability, population movement, infrastructure, and the given incident, which it layers onto one interactive map.

The new research also covered the exposure of acute care hospitals to wildfire risk and the medical impact of power outages.

Research and new technologies have played an increasingly central role in state-level emergency responses for years, as decision-makers have seen the benefits of data-driven decisions.

“We have more data, but data systems and tools have not kept up,” Schroeder said.

But that is starting to change. At CalOES, the Data & Geospatial Unit is tasked with serving in a coordination role during disaster events, pulling real-time data on shelters, assets, resources, power outages, and demographic data, including health.

“We’re like traffic control throughout the process,” said Eric Howard, a geospatial data scientist in the unit. “We collect info from other organizations and compile it to assist with the response,” he said.

Howard said his team uses products at various levels of government. In an example of one use case, the data they process appears on the state’s Emergency Operations Center wall.

“They depend on that information to make decisions on a daily basis,” Howard said.

According to Howard, there is often strong demand for power outage information at the county level. He added that centralizing relevant data into one place has allowed county and local decision-makers and responders to best deploy their resources in an optimized, coordinated way.

Counties in California shoulder critical responsibilities concerning public health and disaster response, including care for the displaced populations. Still, according to Schroeder, they are “highly unevenly developed” in terms of use and access to data, integration of that data into decision-making processes, use of climate data, and prediction and mobility modeling.

Though disparities exist in usage, Schroeder said the baseline has increased due to the Covid-19 pandemic.

“There was a lot of data brought online to deal with the pandemic,” Schroder said, noting hospital bed availability as an example.

Howard said CalOES is also implanting new products based on newly available data. He mentioned a new map layer with evacuation-related information from 30 counties that launched last year as one example. Such info is critical at the country level, as county officials and sheriffs decide when to evacuate and where to tell people to go.

Another group at CalOES, the Access and Function Needs Group, has been working on a new map highlighting resources available for vulnerable communities and patients. The state is also planning to launch a non-public situational awareness tool called Scout at the end of June, geared toward first responders to help them coordinate their work.

Similarly, data is being used to increase situational awareness in the nonprofit sector.

According to the Red Cross’s Denise Everhart, such info addresses a fundamental problem in emergency response situations.

“The first step in crisis management is understanding the situation, and that’s always our biggest challenge: to figure out what’s going on. Hard data is hard to get your hands on,” she said.

“The ability I see in this tool is to see areas of where people are evaluating and where they’re going,” she said, referring to the Google.org-funded GIS map.

“In Paradise, if we had that [elderly] data we probably could’ve been better prepared, and would have realized we needed more durable medical equipment,” she said.

Researchers aim to integrate additional data layers to map products based on new findings related to public health.

“Multiple studies show links with cardiovascular disease. We have also seen an increased risk of adverse birth outcomes among wildfire exposed populations,” said Joan Casey, assistant professor of environmental health sciences at Columbia University, in emailed responses to questions.

“Another key and understudied area is exposure to wildfire disasters and the amount of stress this places on human populations. I expect disaster exposure, where people’s homes burned, community members killed, or large displacement takes place, leads to many additional adverse health outcomes, above and beyond wildfire smoke exposure,” she said.

In concert with the products, Schroeder and his team at CrisisReady are also working to ensure they find their target audience.

“There has to be this concerted approach at this point of getting data into the right hands – people with local decision-making authority and who don’t have access to, or use of, data and who can actually make large gains if we can close that loop,” he said.

“That’s the purpose of this whole thing: where are those places where we’re going to make the most gains?” Schroeder said. “It’s not just mass casualty events, but thinking strategically about how we can make the healthcare system better,” he said.

On the ground, responders concur.

“The better data we get, the better we can make decisions and allocate resources,” said Everhart.

The post New Technology Aids Wildfire Response appeared first on Direct Relief.

“My family was at the breaking point financially. My mom was healing from an accident, and she was busy with my young brother. My diagnosis wasn’t happy news,” Nabakka, 23, told Direct Relief.  “I remember when they told my father he had to buy syringes and [diabetic test] strips for me, it was a total shock,” she said.  

Beyond the financial impact, Nabakka soon found out that her condition came with additional costs.

“I wanted to play netball but didn’t get that chance,” she said, having been prevented from playing by her parents and school administrators, who were scared after she passed out a couple of times due to low blood sugar. “They said no running, no netball, no serious physical activity… It was one of the things that really got me down about my condition. It led to low self-esteem,” she said, noting that social stigmas surrounding diabetes in Uganda further exacerbated her condition.

Nabakka had to persevere throughout her childhood without someone knowledgeable to whom she could turn for questions and support. But in 2016, she found out that she could be that person for other kids and also receive care through the Sonia Nabeta Foundation, or SNF.

“It was a miracle, them coming into my life,” said Nabakka, who is now an outreach manager for the organization.

Since 2016, SNF has provided a wide range of programs that care for children with Type 1 diabetes at no charge to the patients.  They currently treat about 2,000 children.  

But even as SNF has made significant advances in the complicated medical and social fight against diabetes in Uganda, SNF and their patients, whom they call “warriors,” are facing a shortage of perhaps the most basic element within a diabetes care toolkit – syringes. This has led to an increasing number of patient infections and complications leading to hospitalization.

In the northern Uganda city of Gulu, Nathan Rubangakene, 27, an SNF program manager who has Type 1 diabetes, said about 20% of the children he cares for had developed infections due to needle reuse since the onset of the syringe crisis last December.

“There is a crisis,” said Vivan Nabeta, founder and executive director of SNF, which is named for her late sister,  Sonia Stephanie Nabeta, who died from diabetes complications in 2015. Nabeta said a similar donation shortage occurred in 2018, which got so severe that she paid for syringes out of pocket and made personal appeals to senior executives at syringe manufacturers. “The goal should be a syringe per child per day,” she said.

Last month, in response to the crisis, Direct Relief sent 342,000 insulin syringes and 20,000 insulin pen needles in response to a request from Life for a Child, a nonprofit that is focused on preventing pediatric deaths from diabetes around the world. SNF, a partner of Life for a Child, will receive about a quarter-million of these syringes.

The crisis in Uganda for donated standard syringes comes amid a broader global shortage of commercially-available, auto-disable, one-time-use syringes which are commonly used to administer vaccines in middle and low-income countries. UNICEF projected the shortfall to be as high as 2.2. billion auto-disable syringes this year.

For SNF’s patients, the shortage has led to problems beyond immediate physical symptoms – made all the more frustrating since insulin is widely available.

“Some parents misunderstood and thought their children were being difficult, but they were refusing [to inject themselves with insulin] due to pain,” Rubangakene said, referencing the dulling effect that occurs with multiple uses of the same needle.

“The children have medicine, but they can’t get the medicine into their bodies,” he said. I cannot promise them everything will be well but am trying to give them hope… If we have to inject every day with the same syringes, we must adjust,” he said.

About 110 kilometers southeast of Gulu, in the town of Apac, SNF volunteer nurse Michael Mugoya described a similar situation.

“It’s a very big problem here. With the shortages, there have been new problems,” he said, referring to infections and interruptions in disease management. “Most cannot afford the syringes on the market,” he said, which also happen to be larger, and thus more painful than the needles they use for insulin.  

“A human being with a heart, when you see the person you’re taking care of, and you cannot offer the help that’s recommended, I am frustrated. But still, we do not stop at that. We always look for means of improving, to see if we can save the situation,” he said.

Addressing the whole problem

As SNF has worked to increase the supply of donated syringes in Uganda, they have continued operating their existing programs to help increase access to care and education for children with Type 1 diabetes. A major focus for SNF is their support, along with the Ugandan government, missionary hospitals, Life For a Child, and Novo Nordisk, for more than 30 Type-1 diabetes clinics in Uganda. SNF also organizes a network of motorcycle taxis (called “boda-boda” locally) that distribute medicine and supplies, educational clinics to share knowledge about the disease and best practices for self-care, scholarships, community organizing for advocacy around issues related to the disease, including to confront stigmas, and home visits to ensure proper storage of medicines, conduct checkups, and to work on addressing nutrition-related challenges.

“People have come to rely upon us, so we started focusing on social determinants of health,” Nabeta said, explaining how she believes SNF can be most effective at improving outcomes for pediatric diabetes patients in Uganda.

In addition to the acute donated syringe shortage, ongoing barriers to pediatric diabetes care include a lack of accessible transportation, food shortages, and social stigmatization – which can be so severe that it leads to parents abandoning their children.  

Nabakka said some kids who receive care at SNF clinics travel from over 25 kilometers away, sometimes on foot. Even by bus, the journey can take some kids two hours, by which time they arrive hungry and tired.

“They are at the clinic. But they are sad,” Nabakka said.

Nutrition-related concerns are also common, she said, due to the specific needs of diabetic patients. “They get worried about the food they’re supposed to eat [as diabetic patients],” she said, since they are not sure they will be able to obtain the food needed to adhere to the recommended diet.

Local perceptions about diabetes present significant challenges for kids facing the disease as well.

“Very many parents think it’s witchcraft. They are tempted beyond measures to find out from a witch doctor what is “really” the problem with their children. Or they reach for herbal remedies. Or they can take it as someone who is unlucky or burden of guilt, or you did something, and you have a burden that came through your children,” said Nabakka.

“We believe education is an important determinant of health. It also helps our warriors to gain confidence, “she said.

“The mental well-being of warriors is very important. We let them know they can achieve their dreams. To know that we’re here for them. They may worry, but they need to know there is someone out there who is there for them,” Nabakka said.

It’s personal

Beyond family members and neighbors, diabetes-related traumas can also come from medical providers. Rubangakene recalled that, when he was diagnosed, the doctor was so cold that he thought the doctor was punishing him by telling him he needed to stop eating sweets and to inject himself with insulin every day for the rest of his life. Beyond that, he was not given even basic context about this disease.

“I thought I was the only kid who had diabetes in the whole world,” he said. “I thought I was going to die within a year.”

But as time went on, he said, his stress level reduced as he gained more knowledge from reading information online. Eventually, he began to make plans for the future, which included becoming a healthcare provider to have a chance to explain to his patients their conditions more sensitively and comprehensively than what he had experienced.  

For Mugoya, SNF similarly provides an opportunity to address the ills he experienced.

“It was out of passion [that I joined SNF]. I used to see these kids come around [to the hospital with diabetes] and, before, they were dying. In most cases, there was a misdiagnosis,” he said. “If a kid is suffering somewhere, as a nurse, I have to take action,” he said.

Like so many SNF volunteers and staffers, the mission is also profoundly personal for Nabeta, whose family is from Uganda.

“My sister died from hypoglycemic shock: one minute you speak to her, and the next minute, she was gone. To make her young life meaningful, we established this foundation,” she said.

As syringe availability remains an issue, among other challenges, the guiding message to the children SNF cares for remains consistent.

“They should know that a diabetes diagnosis is not the end of everything. They should know they can still achieve everything,” said Rubangakene.

Direct Relief, through Life for a Child, has supported children and young adults with Type 1 diabetes in more than 40 countries. Since 2018, Direct Relief has sent 462,000 insulin syringes, 100 reusable insulin pens, 16,632 vials of insulin, and 23,060 pen fill cartridges of insulin to charitable and no-charge diabetes programs in Uganda.

The post Syringe Shortage Affecting Kids With Diabetes appeared first on Direct Relief.

But she was not forgotten.

“Every 5 minutes, another family member was with me on the phone, and I finally had to tell them not to call me anymore. I just had to have faith in my daughter and the doctors,” Selbi said to Direct Relief, in a translated video call interview about the surgery, which took place last February.

Her family’s path to Israel began the first week after her daughter, Inas, was born. During that time, Selbi and her husband, Poaz, noticed Inas had turned a bluish color. They took her to a local hospital. The physicians there diagnosed Inas with Down syndrome and said she had aortic valve stenosis, a type of congenital heart defect where the valve does not fully open, thereby reducing blood flow. Present in about half of babies with Down syndrome, it is a potentially fatal condition if left untreated and represents the leading cause of death for children with Down syndrome during the first two years of their lives.

Five months after the diagnosis, Inas had a stopgap procedure performed by a team of traveling Italian physicians. However, a more complicated surgery was still required to fix the inner structure of her heart and valves. The standard cost for such a procedure in Germany is about €70,000  and is even more expensive in the United States, the two countries where they were told to go by local doctors.

As internally displaced people living in a camp in Sharya, Iraq, having been targeted by ISIS as Yazidis, Selbi and her family lacked the funds to pay for the critical surgery and thought they were out of options.

“I was told it was a very complicated surgery and the possibility of success is very low, so I was very afraid of the surgery itself, if we could get it, and for the life of our daughter,” she said.

Both issues would be addressed by a program she had never heard about, based in a country about which she knew little, thanks to a chance encounter at a neighborhood market. It was there that Poaz met a local medical advisor named Murat, who told him about a program that might be able to help Inas.  

“He said there is a group of Israelis that can operate and save my child’s heart, for free,” Selbi said. “I didn’t know a lot about Israel, I only knew that doctors there are very good,” she said.

Selbi was connected with Save A Child’s Heart, or SACH, an Israeli nonprofit started by an American in 1995 that brings children from all over the world to Israel and conducts cardiac surgeries, all free of charge. Over 6,000 children from 63 countries have been treated by SACH, including countries with no formal diplomatic relations with Israel, such as Iraq and Syria. The group also runs a free weekly clinic for Palestinian children. Since the program began over 20 years ago, 2,000 Palestinian children have been treated by SACH.

Outside of Israel, SACH doctors undertake missions abroad. They have examined over 9,500 children and trained more than 140 local physicians, nurses, and other healthcare providers in countries such as Ethiopia, Tanzania, China, and Romania. In Israel, SACH treats children in a new, seven-floor facility associated with Wolfson Medical Center in Holon. The nonprofit was able to fund the building, which is also open to local Israeli children who require care.

“SHe will be a perfect child”

Upon arriving at Ben Gurion airport in Israel, which followed an arduous journey via Turkey, mom and daughter were met by SACH staffers who, Selbi recalled, gave her and Inas “big hugs.” She said the greeting gave her relief, not only upon arriving in a new country, but also given the stress she carried due to both the surgery and the anticipated long duration, between 6 to 12 months, that SACH told her she and her daughter might be in Israel for Inas’s care.

“The trip was very exhausting, so being greeted by them gave me a lot of strength. They gave me such a warm welcome and I understood I am in a good place,” she said.

SACH patients and their families stay together in a house near Tel Aviv that can accommodate 60 people. Families are able to mutually support one another emotionally through what can be very difficult days both before and after the surgery, as outcomes for the complicated surgeries can remain unknown.

Selbi said that a meaningful part of her experience took place in the kitchen of the house.

“Cooking is a big issue at the house. It had a huge kitchen and everyone has their own unique way of cooking. Of course, each kid has their own needs too. When I was there, I felt I was in the right place, I felt energetic being with the other mothers. And I had the same feeling when I met the doctors,” she said.

During the interview with Direct Relief, Selbi was seated next to the physician who oversaw care for her daughter, Dr. Sagi Assa, Senior Pediatric Cardiologist & Head of the Interventional Pediatric Cardiology Unit at Wolfson Medical Center in Holon.

“It was a big surgery, an open heart surgery,” Assa said about the procedure performed by Dr. Lior Sasson. “The inner valve of the heart needed to be reconstructed because it didn’t fully develop. We had to create, from one huge valve, two valves inside the heart. Without the surgery, she would have died due to heart failure in the coming years.”

After many hours of waiting, Sasson came out and told Selbi the good news, even though her worries were not immediately alleviated.

“She was beside Inas’s bed in the ICU and was very worried, she was very stressed,” Assa said, since Inas was still intubated and sleeping.

“After checking an echocardiogram, I told her it’s looking really good, even perfect… I told her she has to be patient and that Inas will wake up and heal and be a perfect child. What made her really relaxed was when I told her to think about Inas’s wedding, not what’s going on in the next few hours. That’s the first time she was smiling,” he said.   

Like Selbi and Inas, Assa’s journey to that ICU room was also unexpected, as he set out to become a sports medicine doctor. That changed when he was a resident after he began treating a Palestinian baby named Ayoub, who had a heart condition.

“I got attached to the family,” the former special forces soldier said, and thus embarked on a path of humanitarian aid work focused on pediatric cardiology. He said his work connects him, his colleagues, and other staffers and supporters with the Palestinians they treat.

“So many are like family now,” he said. “It’s a privilege to work on fixing children’s hearts.”

During the video call with Direct Relief, Inas popped her head into the frame periodically, at first with a curious look, and always with a smile. With ample energy, she moved between sitting in her mom’s lap, where she was hugging her, and exploring the room. At one point, she proudly held up her mom’s phone to the camera. Because of the surgery’s success, she and her mom were scheduled to fly back home to Kurdistan after only three months in Israel.  

As she reflected on her experience, Selbi said she was filled with gratitude.

“They made me the happiest mother in the world,” she said.

Direct Relief provided Save a Child’s Heart with a $100,000 Covid-19 grant to help support their work in Ethiopia and has onboarded them as a partner to receive requested pharmaceuticals.

The post This Group Fixes Children’s Hearts, For Free appeared first on Direct Relief.

To date, Direct Relief has shipped more than 300 tons of medical aid, including temperature-sensitive therapies such as insulin, cancer treatment medications, thyroid medications, antibiotics, trauma care supplies, tourniquets, and much more, to Ukraine since February 24, 2022. The organization has also provided more than $12 million in financial support.

In this series of 1-minute videos, three Direct Relief staff members share their perspectives on what it takes to respond to Ukraine as the war continues to unfold.

Alycia Clark, Director of Pharmacy and Clinical Affairs:

Chris Alleway, International Emergency Response Team Program Manager:

Thomas Tighe, President and CEO:

CREDITS: A Direct Relief Production – Director & Editor: Oliver Riley-Smith; EP: Noah Smith; Director of Photography, Ukraine: Oscar B. Castillo; Director of Photography, Santa Barbara: Will Jobe; Translations: Sam Tkachuk and Albina Popova; Very Special Thanks: Hospital of Saint Nicholas (Lviv), Charity Fund Modern Village and Town, Dr. Zoryana lvanyuk, Dr. Iaroslava Kos, Caroleana Kvaterchuk, Dan Polonka, Meredith Riley-Smith

The post [Video] Inside Direct Relief’s Ukraine Response appeared first on Direct Relief.

But as its hallways, common areas, and some rooms stood half torn down, the war began.

“We wanted to make the best [pediatric] emergency department in all of Ukraine. That was our plan, but war came and ruined our plans,” said Dr. Zoranya Ivanyuk, deputy director of the hospital.

In the span of just a couple of weeks, after Russia’s invasion and the onset of war, SNH, a large facility consisting of several wards for specialized care, became one of the only hospitals in the country able to treat pediatric patients needing cardiovascular surgeries and neurosurgeries. Patients and their parents, having been evacuated from specialized hospitals in Kyiv, as well as from other parts of the country, began arriving in need of urgent care.

“Patients from all over Ukraine used to come here before, they wanted to because of our good specialists, but now they have to come, because there is no other place to treat their problems,” said Ivanyuk.

While most of the children at the hospital are in need of treatment for chronic conditions, they and others have also faced trauma – both physical and mental – from the war. Dr. Maria Bukartyk, who has worked at SNH for two years, said she’s been seeing many children with infections and conditions related to lack of food and exposure to the elements.

“A lot of patients and their parents are traumatized and injured. A lot of them lost their friends or their homes. A lot of children won’t eat. It’s a lot of psychological harm,” she said. “It’s a hard time for our country and for me personally,” she said, though made a point of maintaining an upbeat demeanor in her consultations with the parents of her patients.  

In the hospital’s rooms, different families and their children tried to overcome, simultaneously, the difficulties of illness, the nightmare of war and a manmade disaster. Most of them arrived from scenes of intense fighting in Kyiv, Kharkiv, Kherson and Mariupol. Their odysseys and their reasons were very similar: cities and towns under heavy shelling, a lack of basic services, a closing grip on their besieged homes and, many times, little children with difficult health conditions.

Marina, who asked to only use her first name for security reasons, said she had arrived with her infant daughter, Kristina, after leaving Kyiv’s largest children’s hospital, Okhmadyt, which was struck with Russian artillery shells.

Kristina, a twin, was born prematurely. Her twin brother died during delivery. Marina said they lived in a basement for 11 days, for shelter from airstrikes.

“When night fell, it was absolute horror. I did not sleep while I was there, out of fear for my baby,” she said.

While in the shelter, Kristina contracted an infection near where a heart shunt had been placed prior to the war to repair her heart condition. The rest of their family remains in Kyiv.

“I would not have left Kyiv had they not evacuated Okhmatdyt. I would have stayed until the end in Kyiv with my child. I don’t want to go to Europe,” Marina said.

Despite the hardship, she remained undeterred. “From the first day when she was born prematurely, I resolved that my child would be whole, that I would do everything so that this child could be just like everyone else. No war can disrupt my child from growing, from developing… I will do everything for this. This is how our Ukrainian women are,” she said.

Another family at SNH, who requested their last name not be used for security reasons, shared a story of escape from Kyiv. The mother, Lesya, and daughter, Kira, said they were being shot at by Russian soldiers while trying to drive out of the city and had to jump out of their moving car, along with another child who Lesya had also helped escape, to avoid being killed. Kira was left with inoperable shrapnel in her leg and Lesya lost a finger after it was damaged in the fall and was only able to be treated a week later when she arrived in Lviv.  

“For me, she’s a hero, I can honestly tell you,” Artem, Lesya’s husband, said. He initially stayed behind while his wife and daughter left town, “She really is a superhero. She did what not every man could have done, honestly. To take someone’s child and her own, push them out of the car, jump out herself, get scraped everywhere…”

***

Prior to the war, Ivanyuk said the hospital struggled to maintain adequate stocks of medicines and single-use supplies, due to financial limitations, mostly. They also dealt with a lack of critical equipment, such as monitors, ventilators, and anesthesia machines. While humanitarian aid has enabled them to maintain adequate amounts of medicines and supplies, the need for critical equipment has become more acute – and concerns about future medicine availability linger.

“We had such problems before. Now it’s even worse because many many patients are here from other hospitals, but also refugees, who are in bad condition after living in shelters,” she said.

The hospital only has two heart monitors, and Ivanyuk said they have to be shared or triaged among as many as 10 patients. “We really need more,” she said. “We don’t know and are not sure how long this war will last. We are okay with doctors and nurses, but what is worse is we don’t have enough equipment to serve all these patients from all over Ukraine,” Ivanyuk said, noting that a large pharmaceutical factory in Kharkiv, which provided their anesthesia medications, had been destroyed.

“We have some quantity of that (anesthesia medicines) but only for a couple of weeks or a month… without anesthesia, you can’t do anything,” she said.

As the war continues with no sign of abatement and the number of patients at the hospital increases Ivanyuk said she and her staff will continue trying to care for everyone who comes through their doors.

“We’re asking for help to give all the children equal opportunities to get the best care,” she said. “We’re doing the best we can.”

Translations of patient parent and Dr. Maria Bukartyk interviews provided by Sam Tkachuk and Albina Popova.

Since the start of the war, Direct Relief has supplied more than 280 tons of medical aid to hospitals and medical facilities throughout the country via Ukraine’s Ministry of Health as well as local nonprofit groups supporting the health system.

The post Ukraine Pediatric Hospital Faces War appeared first on Direct Relief.