As evacuation orders were announced throughout Tuesday evening and Wednesday morning, tens of thousands of people left their homes for safety. Many fled on foot with possessions and pets as roads became too crowded for timely travel.

Many of them might not have gone far. Andrew Schroeder, Direct Relief’s vice president of research and analysis, is examining anonymized population movement data provided by Meta through the company’s Data for Good project. Schroeder said the population between Malibu and Santa Monica, currently threatened by the Palisades Fire, has declined by about 20%, with increased population dispersion to the east and north.

Schroeder explained that, on average, population displacement data indicate that most evacuated people stay close by, traveling an average of only 15 or 16 miles from home.

These data cannot identify specific, individual movements but can highlight general population movements.

However, the area’s densely clustered population and expansive sprawl may contribute to particular health impacts. The relatively short distances traveled by most of the population suggest that local health concerns may impact many evacuees as well as those remaining in place.

The Los Angeles Department of Water and Power has asked residents to conserve water and notified people remaining in Pacific Palisades that water must be boiled for the next 48 hours due to ash in the system. The Environmental Protection Agency has designated much of the Los Angeles area’s air quality “Unhealthy” via its AirNow map.

Public safety power shutoffs, which occur when an electricity supplier deliberately turns off the power during dangerous circumstances to reduce the likelihood of wildfires, affected more than 100,000 people on Wednesday morning. More than half a million more people risk losing electricity from further shutoffs. The loss of electricity poses a health risk for people reliant on medical devices such as oxygen machines and other medically vulnerable populations.

Direct Relief’s local partners have indicated that the fires will interrupt routine health care as nonprofit health providers are impacted or forced to evacuate. Direct Relief staff have activated the organization’s emergency response protocols and are deploying emergency medical supplies and respiratory equipment to affected residents and first responders.

The Los Angeles Fire Department has reported that evacuation orders remain in effect between the Santa Monica and Malibu areas. Extreme winds are forecasted for the area, paired with dry air, are contributing to the fire’s rapid spread. The Pacific Coast Highway from McClure Tunnel to Topanga Canyon is closed.

The first blazes broke out mid-morning on January 7 in Topanga State Park and have spread to several other locations in the Los Angeles area. Fierce winds have shifted the flames exponentially as fires ignite across the county.

The Los Angeles County Fire Chief said there are insufficient resources to combat the flames. According to the chief, the 29 departments were “not prepared for this type of widespread disaster.”

The post Few Places to Go in Densely Populated Los Angeles County as Fires Spread appeared first on Direct Relief.

The evening before, on April 19, fire had destroyed the only public hospital on the island of Roatán, Honduras, reducing its predominantly wooden structure to ash and debris.

The cause of the blaze is still unknown, but its consequences were devastating. According to the International Federation of the Red Cross, over 55,000 people relied on the public hospital for care.

The early-morning preparations at Clinica Esperanza, a local free clinic, were part of an immediate, community-wide response. Patients and hospital staff were being routed to local medical practices to receive emergency care, and staff said they couldn’t imagine having to turn anyone away.

“I cannot handle the idea that people can die because they don’t have any other option,” said Kallie Vallecillo, CEO of Clinica Esperanza, which has operated in the community for 22 years.

Before the fire, the clinic saw about 150 patients a day. In the month following the fire, that number more than quadrupled, to about 650. While things have quieted since the initial, urgent surge of need, staff are still caring for about 50 additional patients each day, as residents who once relied on the hospital look for alternative care. Two other hospitals are still open in Roatán, but they are private entities, and many local patients can’t afford the costs.

Clinica Esperanza, which relies on medical students and volunteers to operate, has extended its daily hours to meet the increased need.

Building a new hospital structure is expected to take 18 months, Vallecillo told Direct Relief. That’s devastating news for patients with chronic conditions like diabetes and hypertension, many of whom received daily medications at the hospital pharmacy. Medical staff around the island have fewer supplies for procedures and surgeries.  

“We are a nonprofit and we do have limitations, but we know that there’s so many people that love the island of Roatán and they love the people. They’ve been so supportive to our initiatives that we are just taking it day by day,” Vallecillo said.

While the last few months have required more money, time and supplies, staff at Clinica Esperanza say they are willing to do whatever they can to help anyone who needs care. It’s costly, but they continue to share medications and supplies with partners across the island, and to treat as many people as they can.

“I think it would just be inhumane,” Vallecillo said about turning patients away or saying no to partners who need supplies.

Vallecillo, whose background is in nursing administration, became the clinic’s CEO just two years ago. She’d been the leader of a Honduran nonprofit that sourced medical supplies for the community. Through her work, she’d developed a relationship with Peggy Stranges, who founded Clinica Esperanza more than two decades ago.

“Ms. Peggy has always been someone who is just a giver,” Vallecillo said. “We serve one mission and that’s to love people. And we love people to the best of our ability.”

Clinica Esperanza, whose name in English translates to the Hope Clinic, was founded on faith.

An American expat and nurse, Stranges moved to Honduras after working at Ohio State University. In her two decades in Roatán, Stranges has become known locally as the person to go to for medical help, a role she describes as “an honor and an onus.”

Arriving in Honduras, Stranges said she wanted to do “God’s work,” but wasn’t sure what that meant at the time. She did missionary work on the mainland before settling in Roatán. When people heard she’d been trained as a nurse, they encouraged neighbors and friends to visit her for assistance.

At first, she saw about 10 patients a day, most of them women and children who needed basic care. As her reputation grew, so did the requests — and the high cost of medical supplies.

“I was praying to God on the way over” to church, Stranges recalled. She remembered saying, “‘If you want me to do this, you better open the floodgates, you know, show me how am I going to do this.’”

Soon after, she was approached by a group of doctors on a medical mission, offering their extra supplies. Other health care workers began donating their time. Outside funding helped Stranges move the clinic from her kitchen table, first to a small apartment under her home, then to an old hotel down the road.

Today, Clinica Esperanza boasts two dozen staff and a host of dedicated volunteers. Plans for the coming year include an expanded birth center with four beds instead of two, and an in-school program to provide dental care to local children.

The financial strain that followed the hospital fire is taking its toll six months later. It’s unclear what funding will be available for future programs. But Vallecillo and Stranges say Clinica Esperanza is committed to doing whatever it can to help people, no matter the cost to the clinic.

“Things that are not in my control, I don’t worry about,” Stranges said. “God is going to provide and he has all along.”

Direct Relief has provided Clinica Esperanza with over $600,000 in requested medications and medical supplies this year.

The post Fire Destroyed an Island Hospital. Months Later, a Honduran Free Clinic Is Still Bridging the Gap. appeared first on Direct Relief.

In Wayne County, Michigan, hard-to-reach populations like the unhoused and immigrant families have concerns greater than the future of their own health. Finding a safe space to sleep at night, access to food, and ensuring loved ones are safe in their home countries take priority over scheduled doctor appointments for tests that cost money.

Two organizations are focused on meeting those populations with trust.

Street Outreach Teams, a free and charitable mobile clinic, serves the “rough unhoused,” or those who sleep on the street and don’t access social services. Their patients don’t have reliable transportation, phones for calls, or personal identification.

Another Michigan-based organization, C-ASSIST, is a free and charitable clinic in Garden City, Michigan, which serves a targeted population of immigrants from the Middle East, who often encounter language barriers and experience a lack of trust in institutions.

Both organizations were among 19 groups chosen for the 2023 Innovation Awards in Community Health, funded by the Pfizer Foundation with support from Direct Relief. That grant funding supports innovative approaches to infectious disease treatment, with a focus on vaccine education and delivery.

“We don’t get out of the car empty-handed”

While vaccines for common communicable and infectious diseases are free and available, volunteers and community medical professionals at the free clinics say they must prioritize building trust through basic needs and consistency with patients first.

“If they’re hungry and thirsty and don’t have a safe place to stay, they really don’t care about a flu vaccine, that’s the least of their concerns,” said Stanley Stinson of Street Outreach Teams. “So if we can meet their basic needs, then we can kind of move them up that scale to where they might think about their health a little bit more.”

Stinson is the president and a volunteer registered nurse of the free mobile clinic. Every Tuesday, a team of volunteers meets patients where they are to provide free medical care.

Some of their patients are sex workers and those who have been trafficked. Stinson said there are high rates of influenza, Covid-19, and sexually transmitted infections like syphilis and HIV. While the organization has the capacity to test and begin initial treatments for these diseases, Stinson said the group’s target population is “vaccine hesitant.” To build a rapport, Street Outreach Teams works with a consistent volunteer base, asks questions, and offers basic necessities.

“When we go out there, we don’t get out of the car empty-handed,” he said. “We go out with food, we have harm reduction supplies, we have condoms for sex workers, and we get out and we have things that benefit them, that they want, that they may or may not have access to otherwise.”

Betsy Mott, also a volunteer registered nurse with Street Outreach Teams, said by asking questions they learn what patients are comfortable with and how to better offer information. Mott said that it can be difficult to track vaccine schedules with their patients, but if a person chooses to participate, she is glad to be able to provide a preventative safety measure.

“I think that’s why the preventative thing, in terms of vaccines, is so great,” she said. “Because you can’t always guarantee what someone’s going to do once we leave them, and having something that can provide protection against anything is wonderful, because we know that there’s only so much that we can do.”

Mott said that many of the diseases are transferred through open wounds that are difficult for patients to keep clean and dressed due to their lifestyle. Mott said that blood-borne pathogens are easily spread. During the height of the coronavirus pandemic, many patients were afraid, given they were more susceptible and had fewer options than most for testing, quarantine, and treatment. She said she does the best that she can to help patients in the moment she has with them.

 “I absolutely believe that everyone deserves access to regular, safe, and equitable care…” she said. “Oftentimes people with these kinds of backgrounds don’t get treated fairly within the healthcare system and there’s lots of reasons why people might not want to go to a traditional healthcare setting.”

Prioritizing Health and Prevention

Zeina Berry worked with patients during the height of the coronavirus pandemic, too. Berry, who is chief operating officer at C-ASSIST, said that their patients were vaccine-hesitant and thought Covid was being politicized. C-ASSIST had to ground their work in educational outreach to help patients understand vaccines were available to them and safe and effective. Since the height of the Covid-19 pandemic, C-ASSIST has re-focused vaccination efforts on influenza, hepatitis, pneumonia, and human papillomavirus.

“The situation, for a lot of them, they’re coming from war zones where their preventative health concerns are the least of their concerns,” she said. “A lot of them are missing vaccinations and a lot of them don’t have trust in their government back home and they’re bringing that mistrust over here.”

During Covid-19, Berry said the clinic used costly, yet effective measures to reach the community. They ran television ads and printed all materials in multiple languages. They hired and worked with volunteers that were part of the community, and showed up to local businesses, grocery stores, and schools to talk to people.

Most patients had questions. They worried about the cost, if they’d have to take time off of work to receive care, and the potential side effects.

Berry said this is when linguistic and cultural competency wins the day.  

“I am a very strong believer, that if you want to build trust with the community, whether that’s a community of color, whether it’s a minority, you have to train somebody from within that they trust, that speaks their language, that looks like them, and that understands their culture,” she said.

The post For Hard-to-Reach Patients in Michigan, Trust is Key appeared first on Direct Relief.

It’s been nine months of long, busy days for Diana Garcia Cortes.

The San Diego-based single mom went to work as usual in the mornings, taking calls from patients at a community health center. But instead of heading home after work, she spent her evenings in classes at the Laura Rodriguez Medical Assistant Institute, working toward a career goal that would also help her serve her community.

The combined workload was wearying and she missed her family, particularly her daughter. But it all felt worthwhile in August, when Garcia Cortes became a certified medical assistant.

Listen to an audio version of this story.

“It’s really, honestly life-changing to know that within a year I’m able to have a different career, better opportunities, a different job,” she said. “It makes a big difference in my life to be able to not worry about bills as much.”

Garcia Cortes graduated from the LRMAI earlier this month, one of a cohort of 15 new medical assistants.

At the institute where she was educated, her story — new qualifications, a new career, and new possibilities — isn’t incidental. It’s part of the mission.

The LRMAI’s program, a project of the Family Health Centers of San Diego, is focused on educating medical assistants who reflect the community they serve. Sixty-five percent of participants have been health center patients, and students have the option of attending full or part-time, as suits their needs.

Direct Relief provided a $450,000 grant to develop the medical assistant education program through its Fund for Health Equity, which aims to reduce health disparities and build a more diverse healthcare workforce.

Graduates — three cohorts have completed the program thus far — say the experience is “life-changing,” offering them a pathway to further their education, begin a career path, and support their community.

FHC of San Diego has 27 locations. The health center serves about 160,000 patients, with over 95% of them living at or below 200% of the federal poverty line, according to HRSA data. Most identify as part of a racial or ethnic minority.

Pauline Lucatero, vice president of community affairs at the health center and chief academic advisor at LRMAI, said the level of enthusiastic interest from patients was unexpected but “beautiful.”

“I interview every single one of our prospective students, and they share their stories with me, and the diversity in the background, the diversity of the life experiences that they share, it’s really, really powerful,” she said.

Garcia Cortes was born in Mexico and emigrated to the United States with her parents at age nine. She went to high school in San Diego and was unsure of her future until former President Barack Obama signed an executive order, the Deferred Action for Childhood Arrivals, that temporarily prevents deportation and allows her to legally work in the United States as an adult.

She took on customer service roles. Paying to go to school, or taking the time away from her daughter, seemed out of reach.

Two and a half years ago, she began working at the health center, helping patients schedule appointments and coordinate transportation. When her supervisor mentioned the medical assistant program, the opportunity to further support patients piqued Garcia Cortes’ interest.

“Seeing how grateful the patients are…being able to go to their homes since they were not able to come to the clinic…or just seeing the difference that it made in their life: That made me want to keep learning,” said Garcia Cortes.

Completing the program wasn’t easy, but the single mom said her parents and siblings kept her motivated, reminding her of the difference it would make for Garcia Cortes and her daughter to continue her education.

Along with nine of her classmates, Garcia Cortes continues to work at FHC in her new role. If graduates choose to stay on as staff members, the health center will reimburse their tuition costs after three years. She plans to continue working and to become a licensed practical nurse through the LRMAI program in the future.

Lucatero, who began her career as a medical assistant and is also a registered nurse, said that’s how the program works. Tuition rates are kept low, offering a “huge lift” for students who want to advance their careers but can’t afford the typical cost of education programs like these.

“I’m most proud that we’re able to offer this opportunity for people who didn’t even know that it exists for them,” she said. “Just raising their awareness that, hey, you may have grown up really rough, but we’ve created a very safe environment for them to thrive in and give them a future to look forward to.”

For an August graduation ceremony, students selected two speakers from their cohort. Garcia Cortes was one. Vanessa Montano-Ortiz, who celebrated her 18th birthday just one week after completing the program, was the other.

While giving a graduation speech was “nerve-racking,” she said, it was an honor to express her classmate’s pride and joy in completing the program and in their increased capacity to help others.

“People are coming to us because they’re sick, they don’t feel well, and if they can leave even with a slight smile or a compliment that you gave them, you make them feel well taken care of, they feel a bit better,” Montano-Ortiz said.

Growing up in California and Mexico — she moved back and forth with her family until she finished high school in San Diego last year — Montano-Ortiz wanted a career that would help her community. Just a few months after her high school graduation, her stepfather recommended the medical assistant program.

Her achievements, which allow her to work with her neighbors and benefit her community, seemed impossible only a year ago, she said. One of six graduates who also completed the national certification — an optional, additional accreditation for LRMAI graduates — Montano-Ortiz, like Garcia Cortes, has a future career as a licensed practical nurse in her sights.

In just a few short weeks, she has seen the difference a medical assistant can make. She said that small gestures, like introducing herself and asking patients their names, or explaining where she’s going to touch them before a blood pressure or temperature check, make people more comfortable and relaxed.

“I’ve had patients who, quite literally, just thanked me for introducing myself, for saying, ‘Hey, my name is Vanessa and I’m going to be the medical assistant helping you today,’” she said.

The post This San Diego Health Center Offers Patients a Career Focused on Community appeared first on Direct Relief.

Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

Over the past year, patients who rely on Medicaid have been on a roller coaster of changing rules and requirements. More than 24 million people have been disenrolled from the public insurance program since March of 2023 — often without realizing it had happened — although many later regained their coverage.

Now, a new hurdle is emerging. People who currently have Medicaid have until the end of November to make the case that they should keep it. Documentation is daunting, and many underserved patients don’t know whether they’re eligible at all.

Health centers in the southeastern United States are working to overcome the challenges, helping patients understand the rules and navigate the process so that they don’t lose lifesaving coverage.

They’ve partnered with local governments for media announcements, opened enrollment services to non-health center patients, participated in community events, and made calls or shown up to patient appointments to talk about access to care.

A Shifting Landscape

The story behind the changes is a complicated one.

During the height of the Covid-19 pandemic, the US Centers for Medicare and Medicaid Services, or CMS, allowed continuous Medicaid enrollment for individuals and families. Even if someone wouldn’t be typically be eligible, they were allowed to continue receiving Medicaid coverage, no matter their socioeconomic status.

The end of that provisional coverage and the return of enforced eligibility standards, which began on April 1, 2023, is widely called “unwinding.”

Now, enrolled patients have until the end of November to submit documentation to determine future Medicaid status or find a new solution for healthcare coverage.

Some federally qualified health centers, whose patient bases typically include uninsured, underinsured and Medicaid-supported patients, expect a brunt financial hit as fewer people qualify for the government-funded program. Private practice physicians aren’t required to accept Medicaid patients and health centers receive a Medicaid reimbursement for certain services.

However, health centers say they’ll treat patients whether they are enrolled in Medicaid or not. Their biggest concern is the number of patients, especially those with chronic conditions, who won’t seek out medical care at all because they believe they no longer qualify for coverage.

A “Lag in Information”

In Florida, a state whose legislature has long fought against expanding access to Medicaid, health center staff fear that unwinding has made their patients more unsafe.

Sandra Algarin, outreach and marketing lead at Community Health Centers in Florida, said that without expanded access to Medicaid, patients are more likely to visit hospitals for emergency care, and refuse scheduled follow-ups and general preventative care with general practitioners at health centers because they (incorrectly) believe they can’t afford them.

Direct Relief has provided Community Health Centers in Florida with more than $700,000 in donated medication and medical supplies.

Algarin’s own family has struggled with lack of access to quality care the past year. Her mother, who has dementia, needed additional care. But while their household didn’t have the funds to pay out of pocket, they didn’t qualify for Medicaid support. Instead, Algarin had to bring her mother to work with her for months because hiring a caregiver wasn’t a possibility, she said.

Even in states where Medicaid has expanded, health center staff say it’s not enough.  

“There are absolutely still people who fall through the cracks,” said Ashley Shoemaker, of Louisville, Kentucky. “A lot of these people…are actually eligible, but they don’t know that they’re eligible or, now with the unwinding, they lost coverage. So, a lot of those are our most vulnerable populations.”

Shoemaker is the Director of Outreach and Enrollment at Family Health Centers, Inc. Kentucky expanded Medicaid through the Affordable Care Act with provisions that allow people to access a state health care plan. As of August 2024, about 1.5 million people in Kentucky are covered by Medicaid.

Direct Relief has provided Family Health Centers, Inc. with more than $100,000 in donated medication and medical supplies, ranging from treatments for heart disease and hemophilia to syringes and wound care items.

A certified Connector under the state health care plan, Shoemaker said the state took advantage of expanded access and introduced continuous coverage for children in 2023. However, she explained, people don’t necessarily know whether they qualify for coverage and may avoid making an appointment to see a physician due to a “lag in information.”

Sharing the Message

To keep people informed, FHC did a joint press conference with the Louisville mayor and makes routine appearances at local health fairs and community outings. The health center also offers an extended service: Whether or not someone is a patient there, they can walk in and receive a consultation on how the Medicaid rules apply to them.

Shoemaker said there are a lot of “happy tears,” when patients realize they can afford to visit the doctor: “A lot of people you know, they’re upset at first when they’ve lost their medical coverage…But when they find out that there is still affordable insurance available, it definitely eases some of those concerns.”

In states where Medicaid was expanded during the pandemic, health center employees are trying to find ways to share information with patients.

“The message that really gets through in our state is, ‘More Medicaid for more people,’” said Leslie Wolcott, director of communications at Roanoke Chowan Community Health Center in North Carolina. “What I tried to do is make sure that we are reconveying that message, more Medicaid for more people, [and] not complicating it. And then once people think, ‘Oh, more people qualify,’ then directing them to people that can help them put the application together and help get that [coverage].”

Direct Relief has provided Roanoke Chowan Community Health Center with more than $340,000 in requested medications and with grand funding exceeding $500,000 over the past five years.

North Carolina expanded Medicaid access in December of 2023, a few months after Medicaid unwinding was announced. Wolcott said staff contend with misinformation and “mixed messages” in their efforts to connect patients with health care coverage. The state even conducted market research to determine the best ways to communicate with the public about the issue, Wolcott said.

RCCHC patients can walk into the health center and work with staff on Medicaid forms. The health center uses the same QR code as the state to find Medicaid-related information and has a dedicated phone line for Medicaid questions.  Trained staff are also available at satellite sites to discuss Medicaid, including their school-based program and mobile unit.

Nesita Bishop, Business Office Coordinator at RCCHC, said their initial outreach included making calls to patients at home. She found that patients were closed off and unlikely to listen over a home phone call.

“I started (looking for) patients on our schedule that did not have any coverage and I would just go to that clinic on that day when they come in for their appointment,” said Bishop. “And while they’re waiting, I would just chat with them and get familiar with them. And then they were more willing to come in and talk to me,” she said.

Bishop said it’s difficult to determine whether their Medicaid numbers have increased or decreased as the unwinding period continues. However, she has noticed an uptick in women of childbearing age and single individuals who are looking for coverage.

Preventing “the Churn”

Wolcott said they’ve learned that it’s important to have staff available to work with patients on documents because it can also be an exhausting ordeal.

“It’s income-based and it’s a strange percentage of a person’s income,” she said. “And qualification is different depending on how many people are in their household. It’s all kinds of things so we don’t try to leave it up to the patients to figure out if they qualify or not.”

In the past, patients have experienced burnout contending with the annual application and the obscure financial rules that can disqualify them from the program. Wolcott said that the more patients they can prevent from the unwinding, the more likely patients are to continue preventative care.

“If you think about low-income people, you’re not always in the same job and you’re not always making the exact same amount of money,” she said. “So for Medicaid, when you get kicked off and then you’re back on you just stop trying because it’s such a hassle to get enrolled [with] a doctor again. And so one of the things expansion addresses is the churn, and more people can stay on without getting frequently kicked off.”

The post Medicaid Changes Roiled the Nation. Health Centers Are Smoothing the Path to Care Access. appeared first on Direct Relief.

Now, four community health centers across Florida are expanding their fleets with new mobile health units, each retrofitted to meet a different local need.

Orange Blossom Family Health Center, Evara Health Center, Central Florida Health Care Center, and the Healthcare Network of Southwest Florida were awarded the units earlier this year. The trucks were fitted out for dental care, medical support, prenatal and postpartum care, and disaster response. Representatives from each health center said that increasing their mobile capacity will allow them to reach more patients more effectively.

The Florida Association of Community Health Centers secured several box trucks through the State of Florida’s Division of Emergency Management. In the summer of 2021, the State was winding down mobile covid testing, which it had conducted using the trucks. The Association offered the vehicles to its members through a raffle.

Over twenty-five health facilities showed interest. Seven members were awarded units and over half of these received additional funding from Direct Relief to retrofit the trucks for specific medical needs.

Gregory Hall, director of operations at Central Florida Health Center, said their mobile unit will provide optometry care. The health center serves three counties, including the fast-growing Polk County. Hall says the health center needs more resources to serve their expanding population.

“It’s going to be a tremendous add in those rural parts of our service area…areas where folks are just not getting care,” Hall said.

Polk County is situated between Orlando and Tampa. According to census data, the median household income is just over $62,000. About 40% of households in the county earn less than $50,000 annually.

Florida is one of ten states that has not expanded access to Medicaid. Under the current law, residents who qualify may earn a household income that is considered low or very low; for a three-person household the annual income before taxes must be below $34,341, according to the state of Florida.

John Fletcher, chief operating officer and general counsel at Healthcare Network of Southwest Florida (HNSWF), said their mobile unit will be used for general medical support and disaster response. The health center covers an expansive rural area with limited public transportation. Fletcher said the ease of mobility will allow them to further support migrant and farmworker populations.

HNSWF has a smaller patient base than other health centers in the state, but there’s a catch: That small patient population is scattered over a vast landmass. The rural setting creates transportation challenges and limits the center’s accessibility.

“It makes a big difference for our people,” Fletcher said.

In 2017, Hurricane Irma tore through the area, causing severe damage and limiting access to health services. Fletcher said the area experienced damage again in 2022 from Hurricane Ian.

Mobile units have been an effective way for HNSWF to provide post-disaster care in the past. Health workers have used them to give tetanus shots and other vaccinations, treat cuts and scrapes, and dispense emergency medications. Fletcher said that they also consider waterborne illnesses that people don’t generally think about when they’re trying to recover their homes

Irma “basically shut down the whole community for two weeks, and for some much longer than that,” Fletcher said.

All four health centers are adding to existing mobile unit fleets. Some had larger buses that can be difficult to bring to community functions with limited space or are costly to gas up for long road trips. The smaller, 25-to-40-foot box trucks allow health workers to maneuver wherever they are needed to provide services, even for simple needs like providing air conditioning or a clean bathroom in a rural area.

Gianna Van Winkle, Director of Emergency Management Programs at FACHC, was the mastermind behind the program.

“We really encourage our health centers to tap into available resources,” Van Winkle said. “This project exemplifies what can happen when everyone works together, and everything works out well.” 

Jermaine Forrest, chief operating officer at Orange Blossom, said the new mobile unit provides the health center with six in total. In 2022, the health center responded to Hurricane Ian and used the mobile units at sister properties to serve patients who were in flooded areas or who were experiencing power outages.

The new unit will serve another, specialized function: providing optometry services to patients who might otherwise go without.

With its custom retrofitting materials, this mobile optometry clinic would have cost the health center hundreds of thousands of dollars. 

“Without grants, most organizations would probably back out and not be able to afford a machine like this,” said Forrest.

In Pinellas County, the new mobile unit will be used to increase marketing tactics, support community health measures like regular physicals for student athletes, and provide prenatal care.

Kim Schuknecht, chief operating office and compliance officer at Evara Health in Pinellas, said the health center received an additional grant to provide care for at-risk moms and soon-to-be mothers. The additional financial assistance will allow the health center to meet expectant and postpartum mothers at their homes.

“For those that have really complex issues and then post-delivery, the plan is for the first couple of visits with mom and baby and we will send the unit back out to the home and do a visit there with them as well,” Schuknecht said. 

The post Fleets of Mobile Medical Units Provide Made-to-Order Care Across Florida appeared first on Direct Relief.

Hurricanes, extreme temperatures, wildfires, tornadoes, and earthquakes each pose catastrophic threats. As these disasters worsen and occur more frequently, local responders are learning how to prepare their neighbors and safeguard community health.

Each year, Direct Relief stages caches of emergency medicine in locations across the United States that are vulnerable to hurricanes, and gathers information and wisdom from health facilities that opened these hurricane prep packs during or after the tropical storm season.

With the 2024 hurricane season underway, Direct Relief spoke to two past and current recipients of the packs, the Mobile County Health Department and Virginia B. Andes Volunteer Community Clinic to discover what they’ve learned from responding to disasters.

“Make sure you have a plan for your people, make sure you have a meet-up place, and make sure you have enough medicine to last you,” said Melissa Creighton, grants manager at the Mobile County Health Department in Alabama.

Mobile County experienced extreme winds and flooding from Hurricane Michael in 2018. Originally, the National Weather Service predicted that it would be a milder event by the time it hit the Florida panhandle. Conditions changed rapidly, and by the time it made landfall, Michael was a multi-state Category 5 tropical storm with winds over 160 miles per hour.

Over two dozen people died and many more were injured.

Since the brutal disaster, Creighton says the Health Department has made changes to better prepare for future extreme weather events. Staff members use social media and a real-time phone application to update residents on potential storms. An update might tell residents what items to keep on hand, whether an evacuation is needed, and where to go for assistance. They’ve set up a robust emergency response plan for staff to coordinate communication and expectations throughout an event. Storm watches start as early as 120 hours before projected landfall.

The department has also installed new generators at healthcare facilities and refurbished an old school building to use as an emergency medical shelter. The shelter’s reliable power source has become crucial for residents who need to shelter in a temperature-controlled environment or need to power a medical device.

Another innovation is stockpiling emergency supplies of insulin, antibiotics, and bandages for anyone who’s had to leave home without their supplies.

“We’re really a last resort for folks,” said Kelly Warren, executive director of Family Health at the Mobile County Health Department.

In Florida, Suzanne Roberts, CEO of the Virginia B. Andes Volunteer Community Clinic, said they will use a mobile medical unit for better access to rural and hard-to-reach residents during difficult weather.

Florida was heavily battered in 2022 as Hurricane Ian, a Category 4 storm, landed in the southwestern part of the state, then traveled up the coast as far as North Carolina. In Port Charlotte, where Virginia B. Andes is located, roofs were torn off houses and debris cluttered the area after the high winds and water subsided. Roberts said the storm caused $300,000 of damage to the Virginia B. Andes building, including the roof, two air conditioning units, and the ceiling. Staff at the clinic were able to use medicines from Direct Relief’s hurricane preparedness packs, as well as field medic packs, to treat patients after Hurricane Ian.

With a $100,000 emergency grant from Direct Relief, Roberts said the health center has installed new air conditioning units destroyed after Hurricane Ian to keep residents cool during the excessive heat; restored generators at their free-standing clinics; stockpiled emergency response kits in their pharmacy; and weatherized their building to prevent further roof damage. Additional funding for repairs was secured through insurance, FEMA, the National Association of Free and Charitable Clinics, and other nonprofit organizations.

“I think we’ve got it pretty buttoned up in regards to how we’ll make a difference this year versus our last hurricane,” Roberts said.

The local county commission approved a $750,000 grant to the health center to support a new mobile health unit, Roberts said. In exchange, health center staff will serve the surrounding counties, traveling to people who don’t have reliable transportation, live in rural areas, or have difficulty leaving their homes. New partnerships will help with the increased staffing these measures require.

Roberts said that since Hurricane Ian, staff have learned how important it is to communicate with staff and local partners on extreme weather response. For example, when Ian hit Charlotte County, the hospital experienced major damage, and relied on the health center and other providers to serve patients. Now, health services throughout the county will work together for the upcoming hurricane season.

These preparations are important for another reason: Recovering from a disaster can be slow and unpredictable.

Natalie Simpson, a faculty expert on emergency management at the University of Buffalo, told Direct Relief in November that federal dollars for emergency response aren’t allocated until local officials declare a state of emergency. Even then, filing documentation and waiting for reimbursement can take months or even a year.

Direct Relief contacted the Federal Emergency Management Agency in November, requesting information on the money spent to reimburse hard-hit areas from natural disasters in the last three years. The agency declined to provide specifics, as some emergency declarations are still in place. One thing was clear, however: Public need for these funds has only gone up.

“The cost and frequency of national disaster declarations has increased markedly over previous decades. Regardless of the number of disasters or their intensity, FEMA is ready to help communities before, during and after disasters,” a FEMA spokesperson wrote in an email to Direct Relief. “And FEMA is not in this fight alone. FEMA works closely with our federal, state, tribal, territorial, and local partners to reach the communities who need assistance the most.”

Most recently, CARES Act dollars were used to support emergency response needs, health centers reported.

“We were very excited about it because there was such a great need,” Roberts said.

Warren, of Alabama’s Mobile County Health Department, reiterated how difficult it is to pinpoint how much a natural disaster costs the department. Every storm is different, and variables include hazard pay for employees, the cost of gas for mobile units, any emergency supplies they need to order, and the cost to replace or repair damaged property.

“It really depends on how long the response period is,” Warren said. “How much damage has the agency suffered and how long are our services needed?”

The intense preparations that public health departments and safety net providers have undertaken may be more needed than ever this year. The National Oceanic and Atmospheric Administration predicts an active hurricane season from June 1 through the end of November.

At Mobile County Health Department, staff members are particularly worried about misinformation and complacency over a long and wearying season.

Erin Coker, an emergency response manager, said that disasters generate plenty of false information on social media. The health department hopes their mobile app will help — and will encourage residents to take the weather events seriously.

Because hurricanes and extreme heat are a constant in the Gulf Coast, people can become complacent, even when there is an evacuation order, Coker explained. Those with pets or livestock are less likely to leave. The same is true for people who don’t have reliable transportation, don’t have family in the area to shelter them, or can’t afford a hotel stay.

“Weather folks will predict the worst storm possible and people evacuate, and they come home and they don’t even have leaves on the ground,” Coker said. “So they say, ‘Next time I’m not leaving because you predicted this and that didn’t happen.’ It’s very hard to break that complacency and encourage them to truly watch the local news and not the Facebook news.”

Direct Relief has supported both Virginia B. Andes and the Mobile County Health Department with hurricane preparedness packs each year, as well as ongoing medical support.

The post Lessons Learned: Disaster Responders Prepare for an Active Hurricane Season appeared first on Direct Relief.

While the last two years provided a sharp increase in employment, report findings share that the country has not yet returned to pre-pandemic levels—especially in skilled nursing. The nation’s aging population will require more healthcare services, and while inflation has affected the economy, healthcare has historically been a safe choice for employees.

To thwart further turnover and increase job opportunities, health centers and free clinics are approaching workforce development by building career pathways and encouraging career literacy. These federally and privately funded institutions have advocated for programs that teach, train, and mentor the incoming and current healthcare workforce to support the nation’s safety net population.

In Florida, a state that has not elected to expand Medicaid, health centers serve 1.7 million patients. According to the National Association of Health Centers, the organizations created over 25,000 jobs in 2021. Steven Bennett, Director of Workforce Development Programs at the Florida Association of Community Health Centers, said the position with the highest turnover rate within Florida health centers is the entry-level position of medical assistant, followed by dental assistant.

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FACHC surveys the 54 health centers across the state every six months to learn and analyze the workforce. The latest survey, which dates to December of 2023, reported an increase in the number of unique open positions. Including medical interpreters, which are necessary given nearly 25% of health center patients do not speak English as their first language.

“I think we now sort of see what happens when the house is on fire, and we don’t have all the things in place,” Bennett said.

Community Health Center of Florida, Inc., or CHI, operates nine health center sites and 35 school-based sites for patients in Florida’s 28th congressional district. The district was created after the 2020 census results showed an uptick in the rural area’s population. Over half of the district’s census respondents identified as two or more races, and the majority of respondents identified as a minority race.

Peter Wood, Vice President for Planning and Government Affairs at CHI, said the health center has a commitment to strengthening the overall primary care sector, specifically by serving underserved communities. Patients within the communities that CHI serves are more likely to be adversely and disproportionately affected by the social determinants of health and have a higher rate of chronic conditions.

Given CHI’s commitment to the community, the health center operates a teaching program that encourages providers to take on additional educational opportunities and to use their new skills in the same location. The teaching center is the first of its kind, nationally, and includes residency programs in family medicine and psychiatry. CHI is developing the program to include a dentistry residency and an internal medicine residency program.

“A higher percentage of them would end up taking jobs and staying in those areas, as opposed to working in a hospital and then finding another job that was not serving the underserved neighborhoods or areas of the country,” said Wood.

While medical staff at any workplace must adhere to specific guidelines and educational criteria, Bennett says there are “foundational similarities, but different types of competencies,” among health center and private practice employees. They require a highly qualified workforce that is also representative of the community they serve. Health center staff are more likely to work with patients who may not have insurance, have insurance through Medicaid, do not speak English as a first language, and may not trust or have had prior experience with providers, making them less trusting of the medical process.

“It’s the whole gambit of human complexity that arrives at our front doors, and we have to staff and build a workforce that is able to not only deal with healthcare challenges but able to manage and articulate responses to those complexities as well,” Bennett said.

While recruiting a qualified workforce is important, Bennett says it’s equally important to retain current employees. The director said health centers must take a holistic approach in their efforts and consider what career pathways look like in the long term. He encourages career literacy so that potential and current employees can better understand their career options and suggests that every employee has, at minimum, a two-year plan for their career and mentoring support. He also suggests that health centers have partnerships with local organizations, faith-based centers and schools to engage more people.

Several health centers and free clinics throughout Florida have partnered with MAVEN Project, a national nonprofit that supports primary care providers, for its mentoring program. Retired physicians volunteer to mentor current providers on clinical and or leadership skills in a trusted environment.

“I was like, ‘please, sign me up’,” said Hillary Glenn, doctor of nursing practice and co-founder of Point Washington Medical Clinic in Florida.

Glenn began working with MAVEN Project pre-pandemic and requested a mentor during the height of Covid. She said there was mixed messaging throughout the state regarding the pandemic, and she wanted to confer with another medical professional. She participated in the organization’s weekly Covid update and had bi-weekly calls with her mentor to make sure that she was up-to-date on best practices and that her organization was providing the most accurate medical advice.

“It helped me a lot professionally and to guide the organization in the right direction and (to) do things that were best practice,” Glenn said.

Glenn said that it can be difficult, especially in rural and or underserved parts of the country, to find specialists who will see patients from health centers and free clinics. She said that with the Maven Project, that access is less difficult. She called the mentor program “brilliant” and “an incredible resource for the charitable sector.”

Dr. Lo-Ann Nguyen, is a volunteer mentor for MAVEN Project and finds value in the “thought partnership” it provides to current health center employees. Like Bennett, she says medical professionals must consider the full trajectory of their careers. Nguyen has worked with a physician at a health center in Florida to support their leadership capacity and their long-term career goals for the past year.

Nguyen said that the physician expressed feeling burnt out and they have worked together on how to delegate tasks and rejuvenate their enthusiasm for their work. Nguyen said it’s common for providers to experience exhaustion. She said that she reminds her mentees of their “why” so that they think about their career trajectory and are less likely to quit.

“If you have that basic value of why you went into medicine, why you spend so many years studying and training, what is it that drew you here?” she said. “And so, how do you find joy in the work?”

Both Bennett and Nguyen emphasized the need for recognition on the job. Nguyen said providers need to know that they can be leaders within the organization and that, as leaders, they should express gratitude and create a culture of positive feedback.

“Make your staff feel empowered, feel valued, and they tend to stick with you,” she said. “They will help you more, and they’ll take better care of your patients for you. So, it’s all Win-Win all around.”

One misconception about health center employment is low salary.

“Meeting market rates for compensation is essential for not only building and retaining staff but for delivering the quality care that patients deserve,” Bennett said.

According to FACHC salary reports, most health center staff earn more than the statewide average if they work the same role at a different medical practice. However, it’s not true for every role. Bennett says that’s why having career pathways is important—it prevents employees from quitting every other year for similar roles with slightly higher pay.

“The truth is, no one’s going to retire rich working at a community health center,” Bennett said. “But the good thing is, no one comes to a community health center to get rich, right? You go into your career at one of these centers because of something deep, the mission and servant of heart.”

Direct Relief has supported health workforce development and training, including through the MAVEN Project, which connects community providers with mentorship and expertise.

The post Florida Health Centers, Free Clinics Find New Ways to Train, and Retain, Health Workers appeared first on Direct Relief.

In reality, everyone receives a gift at Plan A Health: quality medical care at no charge to the patient.

Plan A provides reproductive and primary care health throughout the Mississippi Delta, a region that historically has had poor health outcomes and low economic status. Their small team operates a mobile medical unit, outfitted with two exam rooms, that truck driver Antoinette Roby drives from city to city. Since its inception in 2018, Plan A has expanded to include a pharmacy, mail-order prescriptions, options for contraceptives, pre-and-post-natal care for patients with HIV, and telehealth for family planning. They’ve also hired a nurse practitioner that patients can call or text directly to ask questions.

While many initiatives were created to combat health disparities in Mississippi and have worked to increase access to care, the state still needs to catch up in adequate health measures. Mississippi’s government is one of the last states to consider expanding Medicaid. The State’s Health Department reported an increase in infant mortality in 2021, making Mississippi the state with the highest number of infant deaths in the country.

Related Content: In Rural Mississippi, Plan A Goes the Distance for Patients

Plan A’s brick-and-mortar site is in a small town within the Delta, within an unassuming building off the main road that was a previous physician’s office. Their next goal includes an expansion into rural Georgia, where health disparities mimic the Mississippi Delta.

“It’s really been a delight to see how it’s grown, it’s pretty cool,” said Dr. Caroline Weinberg, CEO of Plan A.

Weinberg is the only non-Mississippi native on the team. The New Yorker founded Plan A and has hired people from the communities that Plan A serves. In turn, they’ve built trusting relationships across the Delta and more than doubled their patient base in the first three years of operation.

“If you put the trust in the community, (and understand) that they know what they need, and that services delivered by the community for the community are so important,” she said. “And then empower the people in the community to deliver those services.”

The people she’s hired are also well-known community members, like Desiree Norwood, who is the mayor of her hometown of Sunflower, Mississippi. Norwood said when the mobile medical unit arrives in Sunflower, people are excited because Plan A has built a reputable reputation.

“A lot of organizations come into the community, and they do evaluations and research and then what happens? They leave,” she said. “We’ve actually been able to fill a lot of gaps and alleviate some of those barriers that they’re facing.”

Norwood said a lot of trust-building has happened because the team lives in the areas that they are serving. They endure the same barriers to success and have remained in the Delta to improve the conditions. Norwood is known for taking her personal vehicle during off hours to visit patients who have asked for emergency contraceptives or general health inquiries. The small-town mayor said there is no such thing as a “9 to 5” for her.

“This isn’t working a job, it’s a passion,” Norwood said.

Every Plan A employee shared the same sentiments. Roby recounted a time when she followed up with a patient whose blood pressure was too high and asked him to seriously consider their suggestions on lifestyle changes. Months later, the patient’s wife approached Roby and thanked her for the conversation; her husband had listened, made changes, and was in better health.  

Roby said that many uninsured people have neglected to attend doctor appointments and that some don’t know what to say or ask for when they meet with medical staff.

“You have to break it down and give them a better understanding,” she said. “Provide a higher level of patient care.”

Roby grew up in the Delta and said that the openness to learning about health conditions is growing. The driver of the mobile clinic said that parents are willing to learn about options for contraceptives for young adults and options for pre-natal and post-natal care with trusted physicians.

Roby said working at Plan A means a lot to her personally. She’s seen the effects of health disparities on her neighbors and wants to see better outcomes. She said that too often the people of the Delta have been overlooked for access to quality care.

“We never want anyone to have to choose between taking care of their family and getting the health care that they deserve,” Roby said.

While Plan A is a complement to other affordable health options in the area, some things set them apart. Plan A staff say they want to ensure that patients have options for their care. The health center offers variations of contraceptives and birth control for those who want to use the assistance. According to Weinberg, many women stop using birth control because of the side effects and the costly expense of making more appointments and purchasing new options.

At Plan A, patients can request the birth control that works for them.

Having direct access to a provider is a “big deal,” said Telvin Harrington, a community health worker at Plan A. He said that the community has embraced their team not only because they truly care, but because they can relate to the circumstances. Patients don’t have to wait 60 to 90 days for an appointment, and while transportation barriers are persistent in the area, the mobile clinic has scheduled stops so that residents know which days of the week they can receive care.

“Going to someone who looks like you, is relatable, and (can) build meaningful relationships with them, that’s important,” he said. “I come from a low-income family, and not all of my family members who have been sick have been able to afford healthcare…so just being able to see someone who is most relatable to your circumstance, it feels better.”

Direct Relief, through grant support from Organon, has awarded $800,000 to four clinics, including Plan A, which aims to address the drivers of unintended pregnancy in the U.S. through community-informed, collaborative approaches.

The post Plan A Health Hits the Road for Patients in Mississippi Delta appeared first on Direct Relief.

The bitter weather is a nuisance for most but can create dangerous health and living conditions for the nation’s growing, unhoused population. Chicago experienced severe cold weather in mid-January, coupled with a wind chill, or the rate of heat loss from exposed skin, at 40 degrees below zero, according to the National Weather Service. Experts in cold-weather states and working with people who are unhoused are addressing health concerns, but say the number of people with housing needs is growing.  

The frigid temperatures increase the risk of frostbite, and wounds on extremities are more frequent for people sleeping outside and those walking long distances.

“For me, when it snows in the morning, my day is disrupted because I have to drive in the snow and my commute is a little bit longer. But for [people who are unhoused], those challenges are tenfold, sometimes 100-fold, because where they stay is outside,” said Nedda Elewa, President of Street Medicine Detroit. “They stay in the cold, they stay on the streets, even those who are fortunate enough to find themselves in a bed in a shelter, that’s not guaranteed every night.”

Street Medicine Detroit provides quality medical care for Detroit, Michigan’s unhoused population. Elewa, who is also an MD candidate at Wayne State University School of Medicine, said that Street Medicine Detroit provides wound care during the colder months: frostbite, laceration repairs, infection prevention and control, and dressing changes. Elewa says these health conditions are in addition to the many chronic diseases they try to provide care for, including hypertension, asthma, and diabetes.

“Sometimes the treatment is just getting them into a warm space, which is a challenge a lot of times,” she said.

Others patients need more intensive interventions like surgery. However, most don’t have access to consistent medical care, due to social barriers like lack of identification, reliable transportation, and cell phones.

Social issues have compounded the nation’s housing and homelessness challenges.

In New York, local government has shifted policies around homelessness, like suspending the Right to Shelter rule, which requires a bed for those in need, and implementing a 60-day rule, requiring houseless people to reapply for shelter space after 60 days. The changes followed an influx of migrants in the city, who were expected to find shelter in an open field with minimal personal space. The city was already facing mass evictions after national, Covid-related housing protections were dropped and housing affordability decreased.  

“Housing instability definitely increased significantly after all of those protections were gone,” said Nathalie Interiano, Director of Policy and Advocacy at Care for the Homeless in New York, adding that the increase in homelessness over the last year and a half has been “pretty significant.” That’s concerning to Care for the Homeless, which provides health care, advocates on behalf of, and houses New York’s unhoused population.

“Health issues are so intricately linked with the population that we specifically serve,” Interiano said. “People who are dealing with unstable housing are also dealing with a variety of other health issues.”

The nationwide point-in-time count was conducted in late January. The count identifies the number of people sleeping outdoors on a single night and is used to inform federal policymakers on the scope of homelessness across the nation. In December 2023, the Department of Housing and Urban Development forewarned that the numbers from the January 2024 count would be 12% higher than in previous years.

However, some experts say the count doesn’t share the full scope of homelessness, since it is not a controlled study and is limited to those sleeping outside rather than houseless individuals and families who constantly sleep in different locations.

In 2023, New York’s point-in-time count for households experiencing homelessness was 59,572 and individuals totaled 103,200. Over 53,000 unhoused people in New York are in families with at least one child. Even though the city has over 173,000 beds year-round for families, adults, and children, they are spread out across the city and don’t always have space at each location for an entire family or individuals who would like to stay together.

Others may not want to be in a shelter environment. “Some of (the) reasons why people enter into homelessness or housing insecurity situations are attempting to find means of safety,” said Carol Sharp, President and CEO of the Night Ministry in Chicago. “That means the difference between visualizing a safe space inside of a home versus a safe space. And having the freedom to move at will and freedom to find people (who) might have similar circumstances and finding comfort in that.”

In Chicago, the Night Ministry served 600 more individuals in 2023 than previous years. Sharp said that Chicago is experiencing similar issues around homelessness as other cities, including limited affordable housing. However, she noted that people looking for a “safe space” also include those who experience mental illness or misuse substances, people who have experienced domestic violence, people who identify as transgender and non-binary, veterans, and those living with HIV/AIDS.

In Illinois, almost 1,500 homeless people were identified as having experienced domestic violence, according to HUD. The Night Ministry makes a point of meeting people where they are, using mobile units and volunteer physicians to see patients on the streets of Chicago and at partner-affiliated buildings. Similar to organizations in Detroit and New York, they treat wounds, frostbite, Covid, and influenza, and provide care for chronic diseases during the severely cold months.

Direct Relief supports health facilities and organizations across the U.S. focused on street medicine, including Street Medicine Detroit, Care for the Homeless, and the Night Ministry.

The post Falling Temps Pose Dangerous Health Concerns for Unhoused People in the U.S. appeared first on Direct Relief.

After a March 2023 tornado leveled a health center in Mississippi, the organization was able to run operations via a resilient power microgrid system for the better part of a year and continue serving patients, many of whom had lost everything.

The state’s oldest federally qualified health center was struck by an EF4 tornado that swept through the state last year, killing over 20 people and injuring many more. Delta Health Center’s Rolling Fork location was destroyed by the high winds, and the group swiftly established a temporary clinic to make sure residents could continue receiving care.

Since then, the community has continued to recover from the storm, and Delta Health Center has worked alongside affected residents nonstop. The health center’s staff have gone door-to-door to provide access to care, participated in community partnerships to provide food and daily necessities, and maintained a presence in their original location.

Operating there with power was made possible by the Footprint Project, a nonprofit that provides clean energy to communities after climate-related disasters. Delta Health Center had renewable energy just three days after the storm through the beginning of November 2023. The health center was provided with a Tesla microgrid that supplied four kilowatts of solar power energy with up to 30 storage hours at a time. The Footprint Project also provided a portable solar generator and eight solar backpacks to support home health care.

“It was probably one of the longest microgrid deployments that we’ve done for a disaster,” said Will Heegaard, operations director at Footprint Project, who traveled to Mississippi after the storm to install the system.

Adoris Turner, deputy chief executive officer at DHC, said the solar power allowed the health center to offer services through the worst phases of Rolling Fork’s recovery.

“It was a lifesaver, and I literally mean a medical lifesaver,” said Turner. “The ability to see a patient who may be having an asthmatic crisis or people who are having any type of medical need, it went a long way to have our facility up and running.”

Rolling Fork is a small city with a geographic footprint of less than two miles within Sharkey County in Mississippi’s Delta. Prior to the storm, about 2,100 residents lived in the area, and half of the housing structures were renter-occupied. On March 26, President Biden declared a major disaster in Mississippi, providing a pathway for assistance in Carroll, Humphreys, Monroe, and Sharkey Counties, according to FEMA.

“It’s a really slow process,” said Temika Simmons, DHC’s Chief Public Affairs Officer. “There’s a lot of cameras, there’s a lot of assistance, and then after a few months, there’s just so many people who have left Rolling Fork.”

According to the Federal Emergency Management Association, 442 homes were affected by the tornado, with 130 completely destroyed. Less than half of the residences were insured.

Related Content: Someone to Talk To: Health Center Provides Support After Devastating Tornado

Many residents remain displaced, and some have found comfort in neighbors’ and family member’s homes. Health center staff say they have prioritized making daily necessities and accessible healthcare the highest priorities, given so many residents have yet to return to a sense of normalcy.

“If you lost everything — like you don’t even have a toothbrush, and you are still sleeping in grandma’s living room while driving your kids to a different city for school — what does that look and feel like?” Simmons asked. “You’re alive; you’re still living somewhere, but you’re not at home. So we’re thinking about ‘what do people need to feel like they are at home and get back to their normal routine?’”

Simmons said that households are still without running water, electricity, and internet service. She said that Mississippi is a transient community in that people often drive to other cities for work from where they live, making it more difficult to provide care simply based on location.

Before the solar microgrid arrived, Delta Health Center used two gas generators to operate a temporary clinic and a small tent in the health center’s parking lot. After the initial installation of the microgrid, Heegaard said that the health center staff were able to operate the solar energy source themselves.

“That entire clinic, when we were on site two or three days after the tornado, that thing was not habitable. The whole hangar was a doublewide mobile office…it was cracked, split apart by the force of the wind (of the) tornado. So you definitely couldn’t go inside, the whole facility was unusable,” he said.

The microgrid and the backpacks allowed health center staff to treat Rolling Fork patients in their hometown as well as wherever residents were calling home. The health center has 12 locations across Mississippi and six school-based care sites, according to its website. Rolling Fork residents were allowed to visit any DHC location free of charge during the recovery period.

Heegaard said that the health center used solar energy almost every day, except on severely cloudy days when there wasn’t enough back-up power. Solar energy decreased carbon emissions that contribute to localized air pollution and decreased costs for health centers, which would have purchased several gallons of gas per day to maintain the traditional generators. Heegaard said the solar microgrids are also quieter than gas generators, which supports a better atmosphere to provide medical care.

“It’s not ideal to have a bunch of loud, noisy, smelly generator units running while you’re trying to comfort people,” he said.

The health center is now using a temporary clinic through FEMA that has access to power, so the solar energy system is no longer needed. A new, permanent site will open soon, and staff will continue to offer the same health services to the community, whether they have insurance or not. The staff says that DHC remains committed to the Rolling Fork area, even though it’s unclear how many displaced residents will return to the town.

FEMA has approved $13 million for total individual and household dollars for individual assistance and over $34 million in public assistance. However, Turner says residents still need money for basic necessities. Air mattresses, toothbrushes, fresh produce, and clothing remain top requests in the area.

Direct Relief supported Delta Health Center with medical aid and financial support after the tornado, and also financially supported the Footprint Project’s microgrid installation for the clinic’s continued operations.

The post Resilient Power Proves a “Lifesaver” for Mississippi Health Center After Catastrophic Tornado appeared first on Direct Relief.

In Colorado, a federally qualified health center has provided access to healthcare and quality housing for decades. Now, the health center’s Fort Lyon location is celebrating a decade of successful substance use recovery, too.

The Denver-based health center, the Colorado Coalition for the Homeless, began offering healthcare services to those experiencing homelessness 40 years ago. The founders realized that housing was a critical part of maintaining overall health needs and began purchasing property so patients could have a place to call home.

Now, the Coalition owns over 2,000 affordable, supportive housing units for individuals and families and has repurposed a Veterans Hospital-turned-correctional facility for those with substance use disorders to live while in recovery.

Health, housing, and flexibility are the secrets to the program’s success. According to Fort Lyon, over 40% of their participants exited the program and moved into permanent housing. When transitional, long-term care was included, 58% of participants moved into permanent housing. Last year, 93% of participants said they were satisfied with their experience at Fort Lyon.

“It’s amazing what can be done here,” said Vincent Orzweiler, a current participant in the Fort Lyon program. The 62-year-old said he has struggled with alcohol dependency for 30 years. He’s tried other recovery programs in the past but said many are expensive and only allow participants to stay in recovery over strict timelines.

November marked 19 months at Fort Lyon for Orzweiler, who says he has taken a deep dive into his mental and behavioral health to better understand the reasons he consumes alcohol.

“Mentally, it’s about filling a void, the spiritual intersection of addiction,” he said. “There are mental problems that we all go through, and there are reasons that we became addicts.”

Before moving to Fort Lyon, Orzweiler had a new job and said that life was going well.

“I thought I could go back and maybe use a little here and there because my life was better,” he said. “But that addiction took control again, and I ended up losing almost everything again.”

Frustrated, his friends and family encouraged Orzweiler to seek out social services. He completed an application and was referred to Fort Lyon.

No Place for Isolation

There are few rules at Fort Lyon, other than joining at least one of the many recovery groups on site. Isolation is not an option, and enrolled participants are at Fort Lyon because they want to be there.

The program can accept up to 225 applicants at a time through referrals from social services across the state. The program is free to participants, at a cost of $18,800 per person per year for the state. Participants can stay at the facility for up to three years while working on their mental and behavioral health needs. The participants are predominantly male, at 80%. About 68% of participants are from counties outside of Denver, and most participants are between the ages of 45 and 54.

Fort Lyon is located in Colorado’s Bent County, a rural area with less than 6,000 residents and the program has been home to over 2,200 people in the past decade. Patients have access to the on-site health clinic, can choose from dozens of workgroups to participate in, go to school to gain certifications and become employed to begin rebuilding their lives. They are housed across three dormitories and 10 single-family homes across the campus.

That community has been key to Orzweiler’s recovery. He said that he is prioritizing his mental health and has learned that he needs a supportive network around him. When he leaves, he’ll return home and plans to find a therapist to continue working on his mental and behavioral health needs.

“I had to change a lot of behaviors, and it’s not just the using part,” he said. “It’s the things that I would say made me a better human being. A better citizen…Why did I cheat? Why did I steal? Why do I lie? It’s all part of the addiction, and those issues have to be addressed.”

Orzweiler said that he and many others felt “beaten down” by life tolls when they arrived to the facility. After months of therapy, he says he can’t overstate how important the mental health side of his recovery has been at Fort Lyon.

Patients expressing their own desire for recovery is also why Fort Lyon has been successful, said Lisa Trigilio, operations director. Trigilio has worked at Fort Lyon since its inception as a recovery facility. She said the “loose program” doesn’t have a lot of requirements, thus increasing the chance for patient success.

“For me, it’s the phenomenal amount of people that you meet,” she said about why she enjoys working at Fort Lyon. “We have so many wonderful people that come through here, and it just excites me to see when people are changing.”

Participants can choose whether their recovery is faith-based, medically assisted, involves group therapy, or a myriad of other options. They’re allowed to leave campus to explore the town, often to eat and find local employment. Fort Lyon is also not a closed facility—those seeking help for substance use disorders are welcome to join the on-site group discussions.

Trigilio said many have arrived at Fort Lyon feeling “very broken” and that they leave feeling “excited about life again.”

“You can’t find that anywhere else that I know of,” she said.

Fort Lyon’s health center is a satellite center to the Denver location. A physician is available two days a week, as well as a licensed professional counselor and a psychiatric nurse practitioner. They offer in-person and telehealth options. The medical services are free for participants through the state’s Medicaid program. All staff are trained to administer Naloxone, and if comfortable, carry it with them while at work.

“Taking a comprehensive history is important. Many of the patients I work with not only have addiction but also mental health concerns, co-occurring disorders,” Vickie Lucero, an on-site behavioral health provider, told Direct Relief in an email.

Lucero said that she asks patients about previous trauma, treatments and outcomes. Lucero teaches healthy boundaries, and talks to her patients about how to communicate and prioritize self-care. Many arrive at Fort Lyon with unaddressed medical issues, which can affect their overall treatment plan.

“Addressing addiction requires addressing the whole person,” Lucero wrote. “Trauma, pain, grief, education, employment (and more). They all impact how an individual copes with the challenges of life. At FLHC, we work to address all those things with care and compassion, taking care of the whole person.”

Direct Relief has supported the Colorado Coalition for the Homeless with medical aid and financial support, including a $100,000 emergency operating grant to continue work during the Covid-19 pandemic.

The post “It’s Amazing What Can Be Done Here.” Colorado Health Center Offers Community for Those in Recovery appeared first on Direct Relief.

People continue to grieve the losses—at least 97 people were killed—while navigating the new normal for daily life. Homes and businesses were destroyed, and displaced over 6,000 residents who continue to live at nearby resorts. With years expected for rebuilding, children have returned to school in new formats, like learning at home, in church buildings, or being bussed to new schools farther away. As all of these changes are made, residents are working together to limit the amount of re-traumatization that may happen.

Dr. Felicitas Livaudais, a pediatrician at the Kihei Clinic, said the multi-generational aspects of Hawai’ian culture are highlighted in how residents say goodbye and grieve their losses. The pediatrician said the community has prioritized healing ceremonies, visiting the burn site to say goodbye to their properties, and taking part in paddle outs for surfers who host ceremonies and lay flowers in the ocean.

In September, the federal government sent 25 public health officers to Maui to assist with behavioral and support services. Public health officers included psychologists, psychiatrists, social workers and nurse practitioners to offer education, complete assessments, and medical health referrals.

“Tragedies like the Maui wildfires have a profound human impact on communities,” said Assistant Secretary for Preparedness and Response Dawn O’Connell in a September news release. “We are committed to doing all we can to assist the people of Hawai’i, and we are working with partners on the ground to assess ongoing needs to support recovery efforts.”

The following month, local health centers and organizations worked together to offer a community health fair. Residents received flu and Covid-19 vaccines donated by Direct Relief, hygiene necessities to take home, haircuts, massages, and culturally important gifts like ukuleles. Medical professionals in the area reported over 2,000 people attended the event.

Dr. Livaudais was one of the doctors on hand at the health fair to administer vaccines to children and adults, and said that supporting people with physical and behavioral health will require culturally competent practices.

In Maui, cultural traditions and beliefs are of utmost importance, and community members are trying to incorporate those practices into healing work through culture, connection, and conditions.

One example is serving musubi, a popular Hawaiian snack made of spam in a teriyaki sauce with rice wrapped in nori, during twice-weekly “Talk Story” community meetings where people are encouraged to gather together to thwart isolation.

“The community is really trying to help each other,” Livaudais said. “It’s hard, but there’s a lot of community support.”

According to the American Psychiatric Association, most people who experience a natural disaster will eventually return to their original level of functioning. However, sadness, depression, difficulty falling asleep or concentrating, and a feeling of numbness are common issues following a tragedy.

The Hawaii Department of Health conducted a needs assessment that found the greatest needs of residents were financial recovery and finding a permanent residence, followed by access to employment. According to the Department, 41% of survey respondents reported a decline in a household member’s health following the fires, and 22% reported their mental health as poor or very poor.

In an email to Direct Relief, a Department of Health representative said that the behavioral health impact of the Maui fires is expected to be significant and long-lasting and that they expect behavioral health needs to grow as the community grieves. The Department said they are making community mental health services accessible, like telehealth grief counseling and in-person therapy.;

A lack of permanent housing has contributed to stress and anxiety. According to the American Red Cross, 6,643 residents, or 2,748 households, within the non-congregate shelter program were housed at local resorts in late November.

Dr. Cassandra Simonson, a pediatrician at Mālama I Ke Ola Health Center, said that the community has tried to respond to as many requests for help as possible—including birthday cakes for kids, clothing needs, and a job opportunity for a musician. She said that while resources are available, some people remain “frozen, and unable to pivot” because they don’t have anyone to talk to and figure out how to move forward after losing everything.

Both physicians expressed concern about the mental health of health workers and first responders and have changed processes to limit emotional distress for patients and providers. In the first two months after the fires, providers asked patients intake questions to determine whether patients had housing and if their families had survived; they have since changed those methods because the questions increased patients’ emotional distress.

Instead, the health center uses sensory-inclusive rooms and play therapy to work with families. The rooms have low lighting, a “crash place” for children to lie down, a fish tank with bubbles, and the option to listen to music or play with toys. Originally intended for autism evaluations, the room is also useful for fire victims.

“It’s just so soothing, and even the parents have said that they felt calmer in those rooms,” Simonson said.

Air quality has been a top concern for her patients’ parents as children re-enrolled in school. Many were supposed to be bussed from one side of the island to the other, passing through the burn site twice daily on the school bus. Simonson warned that driving through the burn site every day could be triggering for children who had to flee their homes.

To better support the many children who survived the fires, doctors statewide are working on a hotline for children who may be in mental distress. Volunteers will answer the phones and point parents and relatives to resources for child psychiatrists, which can be difficult to access without a specific insurance carrier.

“If we can establish safety, at least a general feeling of safety, that’s the goal,” she said.

Direct Relief supported Malama I Ke Ola Health Center and other community organizations during the Keiki Health Fair for Lahaina residents in Ka’anapali, Maui, when over 2,000 people attended to receive physicals, donated vaccinations from Direct Relief (RSV, flu, Covid-19, and TDAP), and to have lost medical records recreated. Direct Relief has supported Malama I Ke Ola Health Center with medical aid since the fires and also with emergency operating funds.

The post Prioritizing Health of Body and Mind for Maui Wildfire Survivors appeared first on Direct Relief.

This Saturday, over a dozen providers, nonprofits, associations and the Hawai’i Department of Health will gather at Whalers Village to host a community health fair. Participants will have access to Covid-19 and flu vaccines, health screenings, conversations with physicians, food and games. The event prioritizes Lahaina residents and evacuees who lost their homes to the wildfires and now reside within the resorts in the area; however, all are welcome.

“The idea was to bring the healthcare to them,” said Dr. Cassandra Simonson. She is a local pediatrician and member of the Hawai’i Academy of the American Academy of Pediatrics, who will be present at the health fair.

Simonson also provides care to Medicaid patients at Mālama I Ke Ola Health Center, which is a sponsor for the event. The pediatrician said health professionals in the area want to find ways to make residents feel special during this difficult time. They’ve even hired non-medical professionals to participate in the event to support the local economy. Live music will be featured, and culturally significant ukeleles, many of which were lost to the fires, have been donated to give away.

The Maui fires spread for days and 99 people died. Hundreds more were unaccounted for in the first few days of the natural disaster. The Lahaina community saw the most damage. Many have lost their jobs as the fires decimated the area’s tourism industry, and there is an ongoing housing shortage since many structures were destroyed.

Simonson said while not everyone lost their home, many still feel like they are “still running from the fire” because there is no sense of normalcy. The physician said the constant unknown of the situation affects the population’s mental health.

“It’s very hard on people’s mental health to not be able to prepare their own meals and especially for kiddos who don’t feel safe because you always feel like you’re still running from the fire,” she said. “If you don’t have a normal sense of your surroundings, you’re still in fight or flight mode even if you’re in a shelter or a hotel, it doesn’t feel stable, and it doesn’t feel normal.”

Donations of food and clothing have helped, but community members say they still need more. Some households have taken in other families. Some children have not returned to school. Mentally, many endured shock at the initial situation and are now under constant stress, which can increase health risks.

Jacquelyn Ingram, of Healthy Mothers Healthy Babies, said that some students are being bussed from one side of the island to the other to go to school while others are being homeschooled. Some parents are still figuring out educational options. But missing school can prevent some children from receiving immunizations and mental health supports they would traditionally have at school.

HMHB will also participate in the upcoming health fair. Ingram said the drop in educational enrollment is doubly concerning, given the educational disruption so many saw during the height of Covid.

Ingram said that health fair hosts hope that the community event will help people realize that they are not enduring this difficult situation alone and that many are working together to find solutions. HMHB has used its mobile unit to visit rural areas and care for people where they are since the fires were exhausted. She said providing daily necessities and ensuring residents are hydrated and clothed has been key.

Direct Relief is supporting the health fair with donated vaccines, including protection against Covid-19, influenza, RSV, and pneumococcal infections such as pneumonia. Supplies and equipment are also being provided, including needles and syringes, gloves, alcohol swabs, diluent, portable refrigerators, ultra-low temperatures freezers and temperature monitoring devices for vaccine storage.

The post Maui Health Fair Aims to Reach Residents Recovering from Fires appeared first on Direct Relief.

The uninsured, underinsured, and those with private health insurance all have access to quality, affordable housing and integrated medical care in one of Denver’s oldest neighborhoods.

Through a multi-sector approach, a mixed-use structure of apartments, a healthcare provider, a pharmacy, and soon-to-be fresh produce grocery store are now offered in Denver’s Elyria- Swansea neighborhood. The structure is also two blocks away from the local light rail for those who use public transportation. In the coming year, affordable housing for people aged 55 and over and a community center are expected to open across the street. The cross-sector development approach is a nuanced solution to ongoing health and housing affordability issues in Denver’s growing metropolis.

In a 99-year land lease agreement with guaranteed renewal through Denver’s Urban Land Conservancy, the Tepeyac Community Health Center opened a new 24,500 sq. ft. building on Denver’s north side. The health center is connected to Viña apartments, a 150-unit complex with affordability options built by a Georgia-based developer.

In 2017, community survey data highlighted that 38% of respondents reported poor or fair health rather than good or excellent. Social determinants, like safe, quality housing, were a barrier to good health outcomes. At the time, residents said they lacked consistent transportation, employment opportunities and grocery stores that offered fresh food nearby. The new, commercial, mixed-use space grants the residents of Globeville and Elyria-Swansea areas access to affordable, healthy living without leaving their neighborhood.

So far, the new, integrated location has made all the difference.

When Janet Coupens had to leave work to fill a prescription by her doctor, it only took five minutes. The Community Manager at Viña Apartments said she only had to walk down a corridor to Tepeyac’s new health center for her prescription. In the past, it may have taken her an hour or more to travel and wait for care at a for-profit pharmacy.

Coupens said she’s seen the difference for her neighbors at Viña, too. When a child is sick, and a single mother must leave work to take them to the doctor, the ease of having a provider next door is helpful. Given that most of Viña’s residents don’t have cars, the ease of walkability increases the likelihood that residents will visit a physician when sick.

Tepeyac existed in the Globeville neighborhood for years, less than a 10-minute drive from their new location, which opened in February. The health center offers primary medical, behavioral, and dental services for free or at a reduced cost, and recently opened a pharmacy in September. Tepeyac’s President and CEO, Jim Garcia, said that moving to a new building was “years in the making” for their growing patient base.

Tepeyac served over 4,600 patients in 2022. Over 90% of their patients identify as Hispanic or Latino; most are best served in a language other than English. Garcia said that many are undocumented immigrants and, in the past, have not had access to healthcare. According to the 2017 community survey, Hispanic respondents reported being at-risk for diabetes at almost double the rate of non-Hispanics in the Denver area.

In 2020, state government approved a new program that offered subsidized health insurance to low-income, undocumented people called the Colorado Health Insurance Affordability Enterprise, or HIAE. At the time, the state only had enough funding to supplement healthcare for 10,000 undocumented immigrants, and policymakers have been working to expand access since the Senate bill passed.

There are over 3.2 million residents in the Denver metro area, and researchers anticipate over 900,000 more residents by 2050. According to the Denver Metro Chamber of Commerce, rapid population growth throughout the metro area and record increases in rental prices and property values, have caused a housing crisis, leaving few affordable options for working people. In a white paper published by the Chamber, researchers say they expect it will take 100 years to provide enough affordable housing for the metro area.

The Elyria-Swansea neighborhood is on the northern edge of Denver, and the area of single-family homes and the once prominent downtown area was divided by I-70, according to a 2018 Neighborhood Field Guide by the Neighborhood Association. Since the neighborhood’s heyday, the area was industrialized, causing environmental health concerns and limited employment opportunities.

Neighbors in the Globeville, Elyria-Swansea Coalition Organizing for Health and Housing Justice, say they have been promised equitable development solutions in the past that were supposed to provide employment opportunities but were only given empty promises.

The health center CEO agreed and said the area was “largely overlooked” for development opportunities for decades. He said only in the last few years has a “tidal wave” of high-rise apartments, cannabis dispensaries, and breweries opened in the neighborhood, neglecting the many ongoing needs of long-term residents. The increased tax base and gentrified area also threatened their ability to stay in the area.

However, the new Tepeyac building is a change for the better. Garcia said the partners involved held community meetings and asked for feedback about the development. Tepeyac also included a member of the GES Coalition on their board to ensure that the community was involved in decision-making processes.

Denver’s Urban Land Conservancy purchased the six-acre lot in 2015, and Aaron Miripol, the group’s CEO, said they wanted to work with a nonprofit to build something that would benefit the community. It took a year to change zoning requirements for the city to approve a mixed-use space. ULC chose Georgia-based Columbia Ventures to build and manage the apartments, which include one-, two-, and three-bedroom apartments.

Miripol said many of the apartments are secured for people earning at or below 30 to 80% of the Area Median Income. The partners used local funding repurposed through community development grants to subsidize the $57 million development.

“What was really critical was that we didn’t want to rely on vouchers,” he said. “There’s a large segment of that population that is undocumented, and because they are undocumented, they don’t have access to (housing) vouchers.”

As the Urban Land Conservancy worked to address zoning laws, Tepeyac and Columbia Ventures began conversations with the community to determine the wants and needs of the residents.

Dillon Baynes, co-founder and managing partner of Columbia Ventures, said there was a lot of mistrust among the community as the state made changes to widen the interstate, the construction of which had already divided the neighborhood, and additional neighborhood changes, like building a bridge and an amphitheater, that the residents had not asked for.

“There were a number of executions, and the neighborhood felt that it was being foisted upon them that they may not have desired that change at that level, so we came in at a time when they felt exhausted,” Baynes said.

Like their partners, Miripol said that including the community in the development phase was important to understand their wants and needs. He said that other developments had influenced involuntary displacement.

“There’s a number of communities that we’re seeing displacement and gentrification, and it kind of feels like this might be the epicenter,” Miripol said.

Even the structure of the building was important to the neighborhood. While the density of the number of apartments was important to offset costs, residents didn’t want a high-rise building looming over the existing single-family homes. The partners commissioned a local artist to add details on the building’s exterior and were intentional about how entry points to access the health center, pharmacy and grocery store.

Tepeyac stood as the trusted community partner throughout the development process. Garcia said their goal was to create a safe and welcoming environment that is echoed within the new building. The CEO said it’s best if patients want to see providers at Tepeyac simply because they offer quality, culturally competent care, and not just because it’s the only option.

“Sometimes if you don’t have insurance, you just look for the last option or you’re just trying to get by,” he said.

Baynes said that the health center had to be “neighborhood facing” and that the affordable rents at Viña are sustainable to the neighborhood.

So far, the apartment complex is at almost 95% capacity. Coupens said most are occupied by families, and in the year-and-a-half that Viña has operated, most residents have renewed their lease.

“Someone was thinking outside the box and they did a great job,” Coupens said.

Direct Relief supports hundreds of federally qualified health centers in the U.S., including Tepeyac Community Health Center.

The post Healthcare and Housing. This Denver Health Center Offers Both. appeared first on Direct Relief.

According to the American Nurses Association, the nation’s nurse workforce experienced shortages prior to and were exacerbated during the height of the Covid-19 pandemic. Retirements, racism, unsafe work conditions, and a lack of policies that support quality care are among the many reasons nurses are leaving their jobs.

About 100,000 nurses left the workforce during the height of the pandemic and within four years, 900,000 registered nurses are predicted to leave the workforce, according to the National Council of State Boards of Nursing. The U.S. Bureau of Labor Statistics predicts over 193,000 average annual openings for registered nurses between 2020 to 2030. The median salary for a registered nurse in the U.S. is $81,220, but heavily depends on the person’s location, experience, and educational attainment. Even though there is great demand for nurses nationwide, some say there are too many barriers to entering the industry that also work against a diverse and inclusive nursing workforce.

Dr. Martha Dawson, the immediate past president of the National Black Nurses Association, is a nurse educator and supporter of health equity. She became interested in the techniques of medicine and the satisfaction of saving someone’s life.

Dawson remembers her father getting second-degree burns and helping him wrap bandages around his wounds when she was a little girl. She remembers her brother falling from a horse and breaking a bone, then watching it heal over time. When her mother bought her a doll, that remains in Dawson’s house today, she wrapped it in bandages and cared for the doll like it was a patient in the hospital.

“I keep (the doll) to remind me of my mother’s sacrifice, but also her belief in my dream and my journey into nursing,” Dawson told Direct Relief in July.

But throughout her adolescence, adults told Dawson that she would make a great teacher. Dawson said she thought to herself, ‘Why can’t I be both?’

There are few nurses who identify as Black, Indigenous, and People of Color, or BIPOC, in the U.S. They make up less than 20% of the profession, according to the National Council of State Boards for Nursing. Far fewer hold a doctorate degree, and it takes longer for BIPOC nurses with advanced degrees to obtain managerial and executive positions.

Like many BIPOC nurses, Dawson began her educational journey at community college before advancing to a four-year institution and eventually earning her doctorate.

Nursing programs can also be costly.

Dara Koppelman, the Executive Vice President of Health Services and Programs at Mary’s Center in Washington, said her one-year, accelerated nursing program cost nearly $100,000 after completing her bachelor’s degree.

“The program I did was very expensive, and I had to take out loans to complete it,” she told Direct Relief. “And that’s not always accessible to everyone.”

Koppelman comes from a long line of nurses. Her mother was a nurse, her grandmother was a nurse, and several other women in her family are nurses. She now has a master’s degree in health services administration.

The executive VP began her career at a hospital within labor and delivery and was influenced by midwives who encouraged her to try different avenues of nursing. Koppelman said she listened to their advice and worked for the health department before finding her place at Mary’s Center, a not-for-profit health center. However, she may not have found a workplace that she truly loved without their help. Koppelman said that much of what is taught in nursing school prepares students to work in hospitals, not community health.

Mary’s Center, which Koppelman said employed nearly 800 people in July, is a community health center that operates under a social change model. The executive VP said their health care model goes against what has “historically or traditionally” been thought of as health care because they focus on the social determinants of health. They lost a few nurses during the pandemic, and Koppelman says she saw nurses leaving for better paying jobs given the high demand of the industry.

The health center’s social change model includes support for staff. Mary’s Center offers a scholarship program of up to $10,000 per year for staff who wish to further their education. Koppelman said that completing advanced degrees and certifications can be challenging, especially for those who must work or support families while in school.

The health center also works with a public charter school in the area to increase access to the medical field. Students can attend a medical assistant training program for free, which typically costs $20,000.

Even after some nurses have completed their education, finding a job or advancing in their career can be difficult.

In a recent survey conducted by the National Commission to Address Racism in Nursing, 63% said they have witnessed or experienced an act of racism in the workplace.

“It takes us longer from the product to practice, meaning being in the hospital, being in an ambulatory setting, being in clinics for us to move from bedside nurse to a nurse manager, a nursing director, the chief of nursing officer and then a chief nurse executive,” Dawson said.

She also said that job postings aren’t always accessible, and some institutions place higher value on candidates based on the schools they attended, whether they have family within the industry, and how willing they are to assimilate into the traditional forms of medicine.

Dawson has been influential in training the next generation of nurses. Her NBNA colleagues founded a Mini Nurses Academy to introduce students to nursing wellness, health promotion and disease prevention.

Dawson’s successor, Dr. Sheldon Fields, is known as a unicorn in the industry. Less than 10% of nurses are male, and he’s one of the less than 20% BIPOC nurses. Fields said he fell in love with the nursing profession and was encouraged to pursue nursing by his aunt, who was also a nurse.

Fields received scholarships to pay for his bachelor’s, master’s and doctoral degrees, and says he witnessed institutional and structural racism at every step. He said there is a lot of ‘gatekeeping’ within the industry, that portrays to potential nurses, “you’re not worthy,” he told Direct Relief just before becoming President of NBNA.

“Nursing has never been upfront about it, you know, because a lot of people think ‘well, nurses are angelic and kind and altruistic’,” he said. “Well, nurses are also straight-up racist and rude and can be unkind.”

Fields said it’s “irritating” to see who is deemed capable of becoming a nurse through institutional barriers when nurses are needed nationwide. The NBNA President, who is also a college professor and policy expert, said that the industry has to change for nurses to be successful moving forward.

“Covid revealed the very fragile state of our public health infrastructure,” he said.

Carli Zeggers became a nurse in 2013. She had previously worked at a food pantry and enjoyed work that allowed her to help others. Zeggers completed an accelerated nursing program to become a nurse practitioner and began working in a hospital emergency room and in hospice care management.

It was strenuous work, and she made time to continue her education. Zeggers, a first-generation college graduate, also earned her graduate degree in business administration and her doctorate of philosophy and family practice in nursing. She began a new teaching position at Florida State University this fall and continues to work in an emergency room setting. Zeggers told Direct Relief earlier this year that working in a clinical setting has helped her become a better teacher for other nurses.

“There is a huge divide between bedside nursing in the hospital, community nursing, and any sort of leadership in academia, but they’re so disconnected,” she said. “That’s a huge issue I see.”

Zeggers said that the nursing profession is reactionary rather than proactive, which was exacerbated during the height of the pandemic. Too often, she saw nurses working extended hours, put in risky health situations, and neglected during salary negotiations.

“I was getting very frustrated and actually left a couple of hospitals because there was turmoil, and I was definitely overextended and unsafe so many times,” she said.

Pati Knight, director of corporate compliance at Southeast Mississippi Rural Health Initiative, said several of the nurses who worked at the health center retired during the height of Covid-19.

Also a nurse, Knight said that nurses who worked throughout the pandemic were emotionally and physically exhausted. There was also extreme worry among staff who questioned whether they made family members more susceptible to the virus. It was easier to retire than to continue working.

“So you ask other people to take on additional roles and pitch in,” she said. “And we just got it done with the dedicated staff…they took on additional hours.”

Knight says the health center has not replaced all nurses who left during the pandemic, but they are finding new ways to incentivize those who remain at work. Knight says the health center now offers more paid holidays, higher wages and bonuses.

Registered nurses at public hospitals have the highest turnover rate, but those who work within all levels of nursing at not-for-profit health centers, private institutions, and academia say they, too, have endured the brunt of the industry. Academics and association leaders are pressing for policy changes, and community leaders say they are advocating for staff members and colleagues in every way possible.

During the height of the pandemic, Angie Settle participated in clinical hours for West Virginia Health Right. As CEO of the free clinic, that’s not in her job description.

“I wanted to make sure that if I was establishing practices and expectations, I had to have hands-on experience doing it,” Settle, who has a doctorate in nursing practice, told Direct Relief.

Settle said that Covid-19 was the “worst-case scenario come true,” as the global pandemic strained all facets of the health industry. She’s worked at the health center for almost 30 years and had to hire additional nurses during the pandemic to support the new workload while trying to maintain her full-time staff. West Virginia Health Right hasn’t lost any full-time nurses since the beginning of the pandemic, but Settle told Direct Relief in July that the health center’s budget was strained, and employees were put in emotionally taxing situations.

The free clinic partnered with the county health department and set up a drive-thru system for rapid Covid testing. It became wildly popular, especially with first responders. However, it required long hours and a six-day work week for Settle’s employees, whose interactions with others put them at risk for Covid.

“We were out there putting ourselves on the line, and it was just day in and day out,” Settle said.

A mother of eight, Settle said she has learned to treat her employees like family. She praises them at work and in the community, while advocating for access to health care for all at the state legislature.

Direct Relief provided Mary’s Center, Southeast Mississippi Rural Health Initiative, and West Virginia Health Right with funding during Covid-19 to support health staff and operations during the pandemic. Direct Relief has also provided the National Black Nurses Association with funding to strengthen the pipeline of nurses entering the field through the Mini Nurses Academy, which introduces young people to the healthcare field.

The post Where Have All the Nurses Gone? appeared first on Direct Relief.

Like many others from the town, the pair participated in health screenings to determine their eligibility to join the army. Oleh was immediately accepted, which ended his brief year of retirement, and he was put on the front lines to fight.

Just over a year later, Oleh’s duty station was hit by a Russian missile, resulting in severe wounds that required amputation at the hip on both legs. Doctors in Ukraine told the Dubovyi family that Oleh would be wheelchair-bound for the rest of his life.

A group in Minnesota helped change that outcome, however. The Protez Foundation, which connects Ukrainians living with amputations to customized prosthetics and rehabilitation, gave Oleh the chance to walk again.

Yakov Gradinar, a certified prosthetist and orthotist with the foundation, was working with Oleh when Direct Relief visited the foundation in August. Protez provides prosthetics to children and soldiers who have lost limbs during the Russo-Ukrainian War, and since December 2022, has provided over 260 high-quality prostheses and over 90 prosthetics. At the time of Direct Relief’s visit, six patients and their families were participating, the thirteenth group to take part in the program.

In less than three days at Protez, Oleh was four inches off the ground. While it’s a long way from the nearly six feet that he used to stand at Natalia’s side, they say it’s one of many victories along Oleh’s journey to recovery.

Gradinar, who is also the co-founder and chief medical officer at the foundation, is a Ukrainian American already practicing prosthesis work in the Twin City area. When the war began, Gradinar quit his job and began working out of his garage with co-founder Yury Aroshidze to support their fellow countrymen.

Aroshidze began managing the program and securing funding so that they could help more people, and even used their own money to rent an office space in Oakdale for the clinic. The local Ukrainian-American community and residents who have experienced prosthesis care in the past have volunteered their time and donated items to support the program.

“If you believe in people and that God can move mountains, you can see that this project is a miracle,” Aroshidze said through an interpreter.

While Protez has recently opened a clinic in Ukraine, some patients are flown to the U.S. as a reprieve from the combat environment and are fitted for prosthetics. They spend at least three weeks, sometimes more, learning to use their bionic limbs and have access to familial-like support through the Ukrainian-American community.

INJURIES OF WAR

More than 18 months into the conflict, Ukraine’s eastern border and parts of the south remain under Russian control. Ukraine has been the target of cyberattacks, mass power outages, and missile strikes over the last few months, and food crisis at the global level is expected given limited Ukrainian exports, according to the Council on Foreign Relations. It’s unclear how many people have died or been injured since the start of the war.

In June, Ukraine’s President lowered the age of conscription to 18, requiring all Ukrainian men up to age 60, participate in the war. This will require almost all the participants in Protez’s current cohort to return to military service once they have healed.

Oleh is the oldest participant in the current Protez cohort at age 57. He’s expected to stay in the United States for at least three months while learning to walk on prosthetics, but when he returns to Ukraine, he’ll return to military service.

When the war began, Oleh persuaded his infantry to practice basic first-aid skills to protect one another—as a result, his compatriots were able to save his life. When a missile landed, they tied tourniquets around Oleh’s legs and carried him on a gurney for a mile-and-a-half to a field hospital. He was eventually sent to an intensive care unit for eight days, where his legs were amputated.

His wife, Natalia, wears a gold pendant with an engraving of Mother Mary and Jesus, and when she was allowed to visit her husband in the hospital, she began to pray for his life. A nurse of 33 years, she instantly understood the severity of his life-threatening condition.

Though Oleh was conscious, he was still in shock, and had lost a lot of blood, and the emotional and physical trauma was great. Amputees are at greater risk for sepsis, meningitis, and vascular diseases. Given the nature of the amputations, Oleh was expected to be wheelchair-bound while having trouble sitting for long periods of time.

“Every meter matters and every step matters,” Natalia said through an interpreter. “It will take a lot of time and effort to move forward.”

While Oleh’s injuries are severe, he’s not the only one recuperating at Protez. The half dozen people recovering have their own harrowing stories of battle, injury, and ultimately, survival.

Vitalii Chukhno, 47, stepped on a land mine but was able to tie his own tourniquet and radio his comrades for help. He fell unconscious on the way to the hospital, and when he awoke, his right foot and ankle had been amputated. The first thing he did was call his wife, an operating room nurse, who had experienced many sleepless nights since her husband joined the military. She and their 18-year-old daughter evacuated Ukraine to Bulgaria for three months when Russia first invaded. They’ve since returned to Ukraine, and Chukhno’s wife was happy to hear that his injuries were manageable.

Chukhno’s injury, an amputation below the knee, can be supported by a prosthetic at $6,000 that will last three to five years. Other prosthetics, which replace a full limb, can cost upwards of $15,000 per arm or $27,000 per leg. The liners and sockets that protect the skin inside of the prosthetics can cost over $1,000.

Another Protez participant, Mykala Voronchuk, a right-handed 32-year-old, was drafted in August of 2022. He was on the front lines when Russian soldiers began to shoot towards his infantry. After two hours of battle, Voronchuk ran out of bullets as a machine gun approached him. He fell into a trench but had been hit in the arm. Voronchuk said that three of his compatriots were taken into captivity while he was left to freeze to death in the winter weather. As more Ukrainian troops entered the area, a Russian soldier fell in the trench beside him. Voronchuk took the other soldier’s clothing and used it to make a tourniquet for his wounds.

That evening, a drone flew over the area. Voronchuk waved, signaling signs of life and was rescued. His right arm was amputated at the hospital.

Danyil Khodykin, 20, also lost his dominant hand. The young soldier was a passenger in a car when a missile landed next to them, causing the vehicle to flip multiple times. He was evacuated by helicopter and taken to a hospital. When Khodykin awoke, he was numb. When he saw blood on the lower part of his body, he tried to touch his leg to check the damage. That’s when he realized his right hand was no longer there.

“I thought, ‘There’s so much blood, that’s too bad because that was a new pair of pants’,” he joked through an interpreter, able to bring levity to his situation.

A DAY AT PROTEZ

Each day at the Protez Foundation begins with a motivational speech from Gradinar. In prosthetics, 30% of recovery success is based on the machinery, and 70% is attitude, he said. Throughout the day, the patients are fit and cast for prosthetics and learn rehabilitation exercises. They lift weights, kick soccer balls, punt volleyballs, and write letters and numbers. The clinic has a familial atmosphere as children play, and the group shares jokes and watches television together during breaks. At the end of the workday, the patients go to shared apartments or stay in the homes of locals who are willing to share an extra bedroom.

They’ve all earned a spot at Protez, a highly coveted program in Ukraine for amputees. Aroshidze said everyone must apply online and they filter participants based on when their injuries happened and the type of care that is needed. They select a diverse group of candidates to ensure Protez can afford the equipment in each round and so that the participants can learn and grow together.

Much of the funding that supports Protez has come from individual giving. Minnesota has a significant Ukrainian-American population. Minnesota Compass, a project led by Wilder Research, reported that more than 16,000 Ukrainian Americans live in the state and one in four were born outside of the U.S. All of the food that is used for group meals is donated each day and cooked by local families who want to see the soldiers and children recover from their injuries.

Both Gradinar and Aroshidze’s families emigrated to the United States from Ukraine. They’ve each built a supportive community in their personal lives, which pours over into Protez. Aroshidze’s business connections have created access to apartments for the participants. Former patients of Gradinar, even those who have no familial connection to Ukraine, volunteer their time, including Coach Adam, an American resident who wears a prosthesis on his left leg, and leads each cohort in afternoon workout sessions.

His high-impact and high-intensity trainings are talked about across cohorts, according to Gradinar.

“Coach Adam is one of their favorites,” Gradinar said, laughing.

These human connections and heartfelt donations are part of why program participants said they feel welcomed and at ease.

When Oleh left the ICU, Natalia started a Facebook page to document his progress for their friends and family in their hometown. The page’s popularity grew and supporters across Ukraine began sending their family information on available programs for assistance—including Protez.

She spoke with Gradinar over the phone before the trip and said that he sounded approachable and empathetic. Natalia said he has answered every question they’ve had and eased their concerns about Oleh’s recovery.

While Oleh is expected to stay in America for several months, the couple said his journey is one of many wins and victories; he’ll just have to take it one step at a time.

Direct Relief supported the Protez Foundation with $1,070,000 in financial aid so the group can expand their mission to support those injured by the war in Ukraine.

The post Rehabilitation Effort in the Twin Cities Helps Ukrainians Recoup from War appeared first on Direct Relief.

On the fourth floor of the Manchester Grand Hyatt Hotel in San Diego, people gathered to discuss pathways to more inclusive, equitable and non-racist healthcare. The taskforce’s discussion was hosted on the first day of the National Association of Community Health Center’s Annual Community Health Institute and Expo. Those in attendance included health center clinicians, executives, health center board members, primary care associations, and health center control networks.

Participants sat around a boardroom table, with many more standing against the walls of the room and some overflowing into the hallway. The theme of racial equity was supported throughout the day as NACHC members celebrated and welcomed a new CEO, Dr. Kyu Rhee, and board chair, Paloma Hernandez— the third Latina to ever take on the role. The theme continued throughout the week with keynote speeches from the taskforce co-chair Gerrelda Davis and Heather McGhee, author of The Sum of Us.

“There’s a lot of interest,” said Yuriko de la Cruz. “Then in sessions like this, there’s really just a validation that what we see and what we hear is shared by others and that we’re on the right path in terms of understanding and that we want to advance health equity.”

De la Cruz became the program manager of Social Drivers of Health at NACHC in March 2020. She participated in NACHC’s Board Taskforce for Undoing Racism conversation and hosted a bilingual session on advancing health equity immediately following. The group discussed simple changes that promoted long-term solutions, like printing information in multiple languages, providing car rides to health and well-being activities, and declaring racism a public health crisis.

The task force began its work after the murder of George Floyd in an effort to intentionally address structural racism and discrimination within health care settings.

“We can’t address everything; we can’t fix everything or change everything. But what we can do, little by little, is make those steps towards justice and liberation,” she said.

Across the nation, 31.5 million patients are seen at health centers in medically underserved areas. About 63% of those patients identify as members of a racial or ethnic minority group. Health disparities can be exacerbated by social determinants, like access to reliable transportation, home and work locations, and other conditions of a person’s environment, all of which are being considered as contributors to health more often.

Almost 6 million of those patients live in public housing, over 7 million are best served in a language other than English, and 90 percent of all health center patients live at or below the federal poverty line.

The mornings’ discussions included dialogue on the damaging effects of stress, whether acute or chronic, at the intersection of a patient’s race and their lived experience.

Leon Harris, Ph.D., is chief diversity equity and inclusion officer at The Centers in Cleveland, Ohio. He shared that cultural factors within a community can sometimes outweigh a patient’s economic position. While 90% of community health center patients are considered low-income and 19% are uninsured, there are cultural health beliefs that can influence whether a person seeks care or adheres to the treatment a provider offers.

During small group discussions, participants said that listening to their patients, understanding their lifestyles and needs, and working with community partners will be paramount in advancing health justice.

Kevin Holmes, of Community Health Centers of Arkansas, said that health centers could create better, more equitable conditions for health by connecting to communities and patients through lived experiences. Holmes said that people are more likely to show up, listen and participate in spaces where they feel seen and heard.

Wanda Mitchell, of Sun River Health in New York, discussed the importance of a shared sense of community. She said that when people living, working, and playing within a certain geographical area are willing to address barriers to equity together, better outcomes can be achieved.

There are still many obstacles and questions regarding how to build more equitable and just systems. However, de la Cruz said that CHI participants are willing and eager to have challenging discussions that lead to inspired changes.

“We want healthier, thriving communities where children, families and individuals are living the life that they want as healthy as possible,” said de la Cruz.

The post Equity, Ending Racism, and Advancing Justice Top of Mind at Community Health Center Conference appeared first on Direct Relief.

Thousands are relying on evacuation shelters across the island, and medical and social workers like Ingram are working with first responders and other volunteers to ensure residents have access to care and necessities in the aftermath of the deadliest wildfires in the U.S. over the past century.

The women of Healthy Mothers, Healthy Babies Coalition of Hawai’i (HMHB) and the nonprofit’s partners have arrived at the site of the wildfire by jet ski, boat, and car to help those in need. Direct Relief has funded the group with a $50,000 emergency operating grant and has also shipped requested medicines to the group.

Three wildfires sparked on Aug. 8, scorching Maui’s Lahaina community, and the death toll has exceeded 100 people. However, officials say that number will likely grow over the next few days.

Ingram and her colleagues set up a medical hub through the nonprofit’s solar-powered medical unit. Their team has visited several aid sites since Friday morning to support people who have evacuated their homes or need medical assistance. The program director said that power is out in several places, and volunteers have relied on text messages to communicate, given the inconsistent broadband service.

HMHB works to improve access to maternal and child health. They support residents statewide, mostly through social service programs around tobacco cessation, providing safe sleep measures through cribs, food distributions, mental health services, and hosting community doula trainings.

Over the last few days, HMHB visited several women who had recently given birth and needed supplies for one-week-old babies. Ingram told Direct Relief that residents had requested birth control, pregnancy tests, manual breast pumps, and diapers, among other items. They reinforce therapeutic communication to lessen the amount of trauma to survivors of the fires and work with an emergency room physician and a registered behavioral health nurse.

There was a lack of access to prenatal and obstetric care before the wildfires began, with Maui’s only private obstetrics practice planning to end services this Fall and focus on gynecology as a cost-saving measure. According to the local station Hawai’i News Now, residents who don’t have Kaiser insurance and who are in need of prenatal care will visit a federally qualified health center, Malama I Ke Ola Health Center, which Direct Relief is also supporting with an emergency operating grant of $50,000 and essential medicines.

While most have left the more severe areas of the fire, Ingram said there are many long-term effects that residents will face moving forward. Many have endured smoke inhalation and extreme heat; others will be forced to find alternative housing and leave their families or communities of support.

“Imagine what it’s like to go through that experience,” Ingram said. “But what I think we can do is to utilize our critical skills and strong partnerships to really try and get assistance to people right away. And I want people to know that it’s available to them whether it’s prescription medications, doing prenatal care, or post-partum care.”

Direct Relief has provided Healthy Mothers, Healthy Babies Coalition of Hawai’i a $50,000 emergency operating grant to support their operations as they respond to the wildfires in Maui. Direct Relief has also provided them with emergency medical backpacks for triage care, and fulfilled requests for essential medications. The organization also received $475,000 in funding from Direct Relief’s Fund for Health Equity.

The post After the Fires, Providing Community Care in Maui appeared first on Direct Relief.

DETROIT — Southeast Michigan may be known for cold and snowy days, but 70% of Metro Detroit residents are experiencing hotter temperatures due to environmental factors.

Climate Central, a national nonprofit, recently released data on 44 major U.S. cities that have “urban heat islands,” or areas where temperatures are amplified. The data shows census-level tracts across the country that are at least eight degrees warmer than local temperatures.

The nonprofit reported that 41 million people nationwide are within urban heat islands and are at a higher risk of suffering from heat-related illnesses. These areas are warmed by a lack of green spaces, too many tall buildings that block airflow, a heavy population density, and an abundance of surfaces that are more prone to absorb heat, like dark roofs and paved roads.

About 4.8 million people live in the seven counties of southeast Michigan. Many of the cities and towns were built along grids that now amplify heat through distinct rows of homes and buildings. Detroit made history when the historic Woodward Avenue became the first paved road in America. However, the 27-mile-long street is now lined with buildings that draw in heat and warm the metro area.

According to Climate Central, Metro Detroit is one of nine metro areas where over 1 million people are affected by the increased temperatures.

Kaitlyn Trudeau, a senior research associate at Climate Central, said the summer’s extreme temperatures and the amplified heat can create dangerous health situations. The researcher said that development in high-density areas exacerbates climate change and acts as a “multiplier” for increased temperatures. She also said that cities built on grid systems, like those in southeast Michigan, are more likely to “trap in heat” due to lack of airflow.

Trudeau said that increasing access to green spaces and using innovative building materials will prevent temperatures from rising across urban areas.

Health Impacts of Heat

People with chronic conditions, children, older adults, and people who spend prolonged periods of time outdoors are most at risk of a heat-related illness. The three main heat-related illnesses include heat cramps, heat stroke and heat exhaustion.

Just over 8,700 southeast Michigan residents live within the parameters of Community Health and Social Services, or CHASS. Though the health center is located in southwest Detroit, the health center serves residents in areas that include Taylor, Allen Park, Lincoln Park and Ecorse, all of which have urban heat islands.

About 13% of residents within the health center’s coverage area are 65 and older, and 46% of residents are considered low-income.

Dr. Felix Valbuena, CEO of Community Health and Social Services in southwest Detroit, said a mixture of heat and poor air quality is a cause for concern. The already industrial area was blanketed with smoke earlier this summer from wildfires in Canada.

“When we talk about climate issues, we’ve been dealing with the new bridge that they’re building behind (our location), and so there’s been a lot of issues with air quality, and the wildfires in Canada that are coming down,” he said. “So people are having lung issues, chronic obstructive pulmonary disease, and have been ending up in the emergency room, and we’re bringing them in for a follow-up, or they’re calling in and saying, ‘I’m having trouble breathing.’”

Of the patients seen at the center, 264 have been diagnosed with asthma, 157 have chronic lower respiratory diseases, 988 are overweight or considered obese, over 1,300 have diabetes, and over 1,900 have hypertension.

The air and heat are a concern, and Valbuena says that they warn patients to be aware of symptoms of heat-related illnesses like dizziness, fatigue, high blood pressure, and experiences of exhaustion while doing normal activity.

He also cautioned against using alcohol during extreme temperatures and said that alcohol already encourages dehydration. Valbuena shared that those who drink alcohol in the heat are more likely to experience diarrhea and vomiting. Those who take medications to manage chronic conditions should also be mindful since they may be less likely to sweat but are still overheated.

As extreme temperatures soar across the U.S., Direct Relief is focused on supporting health centers across the country, with medical support and with backup power options through its Power for Health program, which aims to install resilient power systems so health center operations can continue during outages.

The post “Urban Heat Islands” Across U.S. Put Certain Neighborhoods At Heightened Risk appeared first on Direct Relief.

In the two years since the report was published, experts working in the space of women’s and maternal health say much has changed, but barriers persist. For people who experience menstrual cycles, it’s not only sometimes annoying or painful, but it can also be a costly and isolating experience. To combat costs and keep women and girls in school and employed, entrepreneurs, health workers, and advocates are sharing solutions to support women’s health.

Menstrual products include sanitary pads, tampons, menstrual cups and discs, and lined underwear. The National Organization for Women reported that a menstruating person spends about $20 monthly on period supplies.

When Christine Brown learned about periods and the costs associated with them, she thought it was ridiculously unfair.

“I thought, well, that sucks, and that’s not fair,” said the founder and owner of Kind Cup. “That sounds so expensive that girls and women are going to have to pay for these things.”

Brown has two patents for the Kind Cup, a sustainable menstrual cup with an ergonomic shape created with a minimal carbon footprint. The founder said she began to sketch potential products when she learned that some women might use up to 22 single-use products for each menstrual cycle.

“That’s expensive,” Brown told Direct Relief.

Across the United States, advocates have lobbied for more equitable policies regarding women’s health and to decrease expenses around what’s known as the “Pink Tax,” or additional costs associated with health products targeted toward women. Several states have adjusted Pink Tax laws to decrease how much women and girls must pay for supplies. Last year, Utah’s state legislature voted to support the availability of free period products in schools. This year, California’s state legislature voted to expand the use of federal funds to include period products for needy families.

But the Kind Cup founder said there’s never a “true sense of security” regarding women and menstrual health.

“I see, as a general trend, that we’re moving forward, but then there’s stuff that comes up where you’re like, Oh, I thought we were done with that, but here we go again, you know, there’s never a dull moment,” Brown said.

At the federal level, some healthcare policies have been adapted to allow people who have periods to use employer-driven HSA and FSA funds to purchase supplies.

Brown isn’t the first to design a menstrual cup. Dozens of other products are on the market, but the Kind Cup founder said she wanted to create a product with an improved design and user experience. Brown also recognized that materials matter, and no “fancy labeling and cut corners” would suffice. Brown said that the Kind Cup needed to be a high-quality device that people could trust.  

“You shouldn’t be in pain for having tried a bunch of different products and feeling like something’s wrong with your body,” said Brown. “No, it’s clearly indicative of there being a need for something that’s a better design.”

The Kind Cup has an added social benefit. Any purchase from Brown’s site prompts the buyer to donate a Kind Cup to another person. The first 150 Kind Cups were donated to other menstruating people.

Earlier this year, almost 100 Kind Cups were donated via Direct Relief to a Florida mobile health unit, one of dozens of organizations to receive the cups free of charge.

“We have a lot of uninsured people with barriers to getting health care,” said Michelle Nall, a nurse practitioner at the University of Florida’s Mobile Outreach Clinic.

The mobile unit is a program between the College of Medicine at the University of Florida and the university’s medical system. The mobile unit’s staff provides free, comprehensive, primary care for people without health insurance – largely those affected by factors including poverty, according to Nall.

The Kind Cups will be dispersed to patients and brick-and-mortar locations associated with the university’s health system and its partners, like local food pantries and churches. The mobile unit serves about 2,000 patients in North Central Florida, and Nall said that period poverty is common among their patients.

The nurse practitioner said that the need for reproductive justice remains pertinent as government policies shift, like the Supreme Court’s overturn of Roe v. Wade in 2022 allowed states to ban abortions, which restrict a person’s choice regarding personal health decisions, and the 2023 law signed by President Joe Biden that requires employers to provide reasonable accommodations for pregnant employees through the Pregnant Workers Fairness Act.

So, Nall focuses on what she can do to provide support for menstruating people in her community—whether they plan to have children or not.

Nall said it’s key to ask questions to gain a better understanding of what a patient needs to provide the appropriate support service.

Understanding the needs of menstruating people is a worldwide advocacy issue.

Diana Nelson, global advocacy director at Days for Girls International, said that in many countries, women who don’t have access to products are more likely to miss school and or work while menstruating. DFGI is a nonprofit that distributes sustainable menstrual health products around the world and participates in education and advocacy efforts regarding menstrual health.

To ensure worldwide understanding that menstruating is a natural process, Nelson said it’s key to include people who don’t menstruate in the conversation.

“It’s natural, it’s normal, it’s nothing to be ashamed of. It’s nothing to be scared of,” Nelson said. “So many girls wake up with blood, and they have zero idea what’s happened.”

Nelson said that DFGI works with volunteers and community leaders to educate people about menstruation cycles. That includes suggestions on creating supportive environments and sharing data about the impacts on women and girls who miss school or work while menstruating. Nelson said that in some places, menstruating people do not have a private bathroom and opt to go home in the middle of the day.

“If you want to increase education, then you need girls to stay in school… research shows they are missing school either because they don’t have access to products or because you don’t have the infrastructure where they can privately change,” Nelson said. “If you want your GDP to grow, if you want to create a labor market, you recognize that women are 50% of the laborers. And if they’re missing work because of their periods, or if they’re missing work because they have to leave to go find somewhere to manage their period….they don’t come back to work, and that is impacting your growth and your job market.”

Nelson also said good advocacy means helping the broader public understand how a singular issue impacts everyone.

To address period poverty, Direct Relief has provided period products, including Kind Cups, pads, tampons, Days for Girls kits, and more across the U.S. and globally.

The post Menstrual Health Experts Say Period Poverty Continues Across the Globe appeared first on Direct Relief.

In South Carolina’s Lowcountry, barrier islands and rural inland communities sit just above sea level. It was here, along the nation’s southeastern coast, that residents in Beaufort County lacked indoor plumbing into the early 1970s. That changed when a rural, Black community found ways to funnel money to build a health center, created their own water company, and subsequently produced better health outcomes.

Throughout the 1960s, health conditions were dire. Hypertension was widespread, and Beaufort had the lowest life expectancy rate in the state. In 1965, an average of 62 out of 1,000 children in Beaufort “did not live to see their first birthday,” according to the New York Times. By 1969, there were at least 600 homes in Beaufort and Jasper counties without sanitary facilities. Almost 1,800 households had annual incomes below $1,000, and just under 5,000 households had annual incomes under $3,000.

At the time, Beaufort’s Levy, Limehouse, and Bellinger Hill neighborhoods were predominantly Black; home to descendants of slaves who had earned multi-acre plots of land after the Civil War. Instead of installing costly indoor plumbing, property owners dug shallow wells in their yards, just five feet below the surface. Families carried buckets of water into the house for cooking and bathing. There were outhouses for waste. They unknowingly drank water infested with Ascaris lumbricoides, or intestinal parasites. Black children were disproportionately affected and had recurring cases.

“Seventy-three percent of the Negro children had intestinal parasites, and nearly five percent of the white preschool children had intestinal parasites,” a University of South Carolina report shared at a U.S. Senate hearing.
Few could afford necessary medical care, and far fewer had enough to fix the water-related health issues at their source.

“To see a kid who is three years old, pass a worm that is two feet long, it was unbelievable,” said Roland Gardner, a community leader who spearheaded many of the reforms. “That woke me up.”

While the lack of potable water in Beaufort County was an immediate problem, government officials were preoccupied with national poverty rates and racial desegregation. So, local advocates vowed to find solutions and advocated for a federally qualified health center with affordable payment options. In the fall of 1970, the doors opened to Beaufort Jasper Hampton Comprehensive Health Services, Inc, often called ‘Comp Health.’ In turn, leaders of the health center supported a new water system and created jobs for residents, influencing better health outcomes for decades. By 1974, reports indicated that the infant mortality rate had decreased by two-thirds.
“It was almost like a miracle,” said Thomas Barnwell, the first executive director of Comp Health. “Because just, for example, solving the problem of intestinal parasites was described by the epidemiologist as an almost unsolvable situation.”

In 53 years, Comp Health has expanded to host 15 health programs at 10 locations across Beaufort, Jasper and now Hampton counties. Just three executives have led the health center since its inception in 1970: Thomas Barnwell, Roland Gardner, and Dr. Faith Polkey.

The creation of the water system and the health center has yielded massive dividends; Beaufort has been recognized as the healthiest county in South Carolina for the last 11 years, and its residents have the longest life expectancy in the state.

It all started with the desire to meet an unmet need.

“Water was basic. It was a need that many people had,” Barnwell said.

The Need for Change

Barnwell, now 88, is a descendant of families from Mitchelville, the first self-governed community of formerly enslaved people in South Carolina. He still owns acres of land on Hilton Head Island, which he intends to pass down to his sons.

In the mid-to-late 1960s, researchers visited Beaufort County and surrounding areas to document issues of health and hunger. Barnwell was working at the Economic Opportunity Commission and spent his free time driving his mother, a licensed nurse who cared for pregnant women, to her appointments. She worked alongside a white physician who identified the parasites. Hannah Barnwell told her son of the depressing health conditions during their rides around town and encouraged Thomas to help find a solution.

“She said, ‘let me tell you something, son, it’s more important to provide service to people than to make money,’” Barnwell recalled.

In 1969, Barnwell testified at a U.S. Senate hearing to advocate for the creation of a federally qualified health center in Beaufort. He told the committee that the health center’s priorities would be defined by the needs of the community, which was still lacking basic sanitation infrastructure.

“But, in the area of sanitation, and I speak of basic needs—out-houses—we have been unable to fund them, projects to construct them. It is not improbable that the cost of eight studies dating from 1936 confirming the presence of the Ascaris worm in our community would, alone, have built 600 privies vital to the blotting out of these parasites. Apparently, we can send a man to the moon, but we can’t build outhouses…We have been attempting since 1966 to bring potable water to areas where residents have to haul water in buckets, bottles, or cans. Most of them are too poor to afford pumps even if potable groundwater were available. To this date, not one drop of water has reached them”

– Thomas Barnwell, in his 1969 testimony before the U.S. Senate

Transcripts from that hearing detailed the severity of Beaufort’s poor health conditions, compared to the millions of federal dollars spent on international aid for water and waste disposal and the stark differences between white and Black communities in America. Several mentioned the “desperate need” for a health center, potable water, and a sewerage system.

“Clearly, these children are suffering from the chronic effects of undernutrition, parasitism, and repeated bacterial and viral infections,” said James P. Carter, a Vanderbilt University School of Medicine and Meharry Medical College professor.

After the hearing, Beaufort County received several grants, including $342,000 for a health center. Senator James Wadell appointed Barnwell as chair of the health center’s advisory board to manage federal funding. In the fall of 1970, the Comp Health building opened to serve 25,000 low-income residents of Beaufort and Jasper counties.
Barnwell hired Beaufort locals to work at the health center.

He had connections through family, his volunteer work, and previous employment at Penn Community Services and the Economic Opportunity Commission. Though he had taken courses at seven universities, he didn’t have a college degree– so he contacted those who did. He called Roland Gardner, who at the time was a graduate student at Howard University and was home in Beaufort for winter holiday.

Gardner, who later became CompHealth’s longest-tenured CEO, said Barnwell asked him to write an outline for a potential children’s behavioral health program. At the time, Black children in Beaufort were sent to special education classes under the guise of behavioral health issues, which delayed their educational development.

Barnwell shared Gardner’s report in Washington the following spring and called the grad student from the airport.

“He said he needed somebody to run the program,” Gardner told Direct Relief, laughing.

Gardner promised to return to Beaufort to temporarily work for Comp Health upon graduation. He started the behavioral health program and found that most of the children had psychological issues due to poor living conditions, not behavioral health challenges. According to Gardner, the energy that Barnwell brought to the area mobilized others to get involved.

“That’s what this was,” said Gardner. “People in a community who said, ‘Nobody is going to come help us; we have to do it ourselves.’”

Gardner became President and CEO of Comp Health in 1980 until he retired in 2022.

FUNDING POTABLE WATER IN BEAUFORT AND BEYOND

With the health center established, funding for what became the Levy Limehouse Bellinger Hill Water Company was next on the community’s list.

Federal dollars existed for rural communities, but with federal racial desegregation taking place, not all local authorities were willing to help Black residents access those dollars.

Barnwell and Thad Coleman, the first African American to sit on the Beaufort Jasper Water Sewer Authority board of directors, began to work with a national nonprofit: The National Demonstration Water Project, or NDWP. Their mission was to help low-income, rural families gain access to safe, potable water.

The organization’s board, made up of executives from health centers and housing programs across the country, met on a quarterly basis to find clean water solutions.

“It was very exciting to see that we were traveling in a route that would open doors for people around the country,” Barnwell said. “Our problem was a greater problem as we dug more into it.”

In Bonnie Lefkowitz’s book Community Health Centers: A Movement and the People Who Made it Happen, she shares that the USDA didn’t want to support “smaller, community-based systems.” Granting loans to impoverished rural communities that couldn’t meet a marginal tax requirement as a down payment was risky.

Lefkowitz says the NDWP sued the USDA’s program to receive special funding.

Retired judge and civil rights activist Olly Neal Jr. was an NDWP member who worked alongside Barnwell and Coleman. He was the founding executive director of the Lee County Cooperative Clinic in Arkansas. Neal told Direct Relief that the group had to prove that the shallow wells built across the country were “major contributors” to the health problems of children and that financial support for new cluster well systems would solve the issue.

“That was the most important thing that we did, in my opinion,” Neal said. “We got loans to low-income communities so they could be eligible (for the program).”

Ultimately, the Congressional Budget Committee approved a $200 million budget for federal loans for water systems nationwide, and Comp Health would receive $40,357. Comp Health and other NDWP members had gained momentum on what was now a national water crisis.

THE PEOPLE OF BEAUFORT

Lorraine Bond still remembers the smell of sulfur in Beaufort from the contaminated water. “If you were washing dishes and you were wearing jewelry, it would turn the jewelry, so you had to take off the jewelry in order to wash dishes,” Bond said.

Bond sits on the Board of the current regional water system in Beaufort. Her mother, Juanita White, worked on special projects for Comp Health and was an advocate for what became the Levy Limehouse Bellinger Hill water company. As a child, Bond found her mother digging along the side of the road in desperation for pipes that would lead to clean water. Neighbors who had questions about the water would call her as early as 6 a.m.

“It was weird because my mother was very feminine and a very classy dresser, and here you go see her in the ditch with mud all over,” Bond said.

Residents had a lot of questions. Most earned less than $3,000 annually and didn’t want to stop using their free, shallow well taps and pay $50 into the new water system.

“You had to convince them to take the water,” said Emory Campbell, who was involved in the efforts. “People were reluctant, skeptical… and signing a piece of paper was a serious thing for people.”

Campbell was involved in the AmeriCorps VISTA program at the time, though he’s best known for his contributions to civil rights and preserving and sharing the cultural significance of the Gullah Geechee people on Hilton Head Island. Like Gardner, he too was encouraged by Barnwell to return to Beaufort. Campbell had an advanced degree in environmental engineering and eventually left the VISTA program to work for the State’s Health and Environmental Department, which was key in the development of the water system.

Historically, African Americans were untrusting of some government systems and signing documents that might not have truly benefited them long-term, Campbell said. VISTA participants and health center volunteers knocked on doors, attended church meetings and broadcast radio announcements to build trust and educate the community about the quality of the water that came from shallow wells.

“Our healthcare movement was tied very closely to the civil rights movement,” he said, adding that it was important for residents to hear from their friends and neighbors that the well water was contaminated. Building community-level trust and understanding encouraged people to visit Comp Health for treatment.

“We didn’t know any different, people really didn’t talk about it at that time, I guess,” Pat Walls said. “We realized that there were worms and stuff, but it’s like being Black and white. If you live away from it, you don’t really realize what you’ve got until you get something different.”

Walls had pumped water from her family’s well and carried buckets inside for cooking and cleaning. She learned of the dangerous well water conditions as an adult in the VISTA program and began working with White, while knocking on her neighbors’ doors to encourage them to join the new water program instead.

They, too, realized the issue was bigger than Beaufort. White was elected to the South Carolina House of Representatives with Walls as her campaign manager. She served for 15 years as an advocate for clean water and support for rural communities.

The more the community learned, the more they were empowered and wanted to be involved. Once there were enough residents who agreed to switch to the new water system, they named the water project after the areas it served: Levy Limehouse and Bellinger Hill Water Company. The water company’s board was composed of residents who were patients or worked at Comp Health.

The health center became the impetus for community involvement. Residents wanted to participate in the changes and to have a ‘seat at the table’ to develop policies that operated their health, water, school, and government systems.

“Everything that was done by Levy was done by the people,” Bond said.

THE FUTURE IN BEAUFORT

Beaufort’s health conditions drastically improved after Comp Health opened and clean water became accessible. Employment rates increased, and the Lowcountry became a more desirable place for people to live.

By 1989, the Levy Limehouse Bellinger Hill Water Company had reached capacity. The original cluster well system was the most efficient and economical choice for the 1970s, but not sustainable given the area’s growing population. LLBH was sold to the regional entity, Beaufort Jasper Water Sewer Authority, which paid the owners of 822 properties for their shares. Walls was chair of the board then and negotiated with lawyers to ensure property owners were paid based on the years they were connected to the system.

However, since the change in ownership, not every LLBH home was connected to BJWSA’s water and sewer lines. Many homes rely on septic tanks, and some property owners have been placed on a waitlist for sewer access—but it’s unlikely, given the low-lying area’s limited groundwater access and continued development growth. The other option is to support trucking and manufacturing companies that are trying to build in the Levy community in hopes that the company will run a new sewer line across their property. But allowing major companies to build in the area could create other issues for property owners in the rural area.

Michael Bell, the immediate past chair and current board member of BJWSA, said increasing water and sewer access in Beaufort’s Levy community is ongoing work. Bell, one of two African Americans on the BJWSA board, said that he follows in the footsteps of people like Barnwell, Coleman, and White, in ensuring that safe and potable water is available to all Beaufort residents.

Dr. Polkey, the newest President and CEO of CompHealth, says she, too, follows in the footsteps of great leadership in Beaufort County.

“That’s how we started, right?” Polkey said. “It (started) from people being in the community and being willing to go out to where the people are.”

Maintaining and building new partnerships in the community remains of high importance to Comp Health leadership. Polkey’s background is in pediatric, public health and preventative medicine, and she has spent her first year leading Comp Health through strategic planning. Originally from the Charleston area, she began working at Comp Health years ago when Gardner was still at the helm. She learned the history of the health center and the important role the community plays in its own health outcomes.

Polkey said that during the height of the coronavirus pandemic, they realized a greater need for telehealth opportunities, dental and mental health supports, and methods to address the social determinants of health.
“Keeping the community part in our community health center is of the utmost importance, like understanding the mission being central, and that is to take care of the community,” she said.

Polkey said that every community deserves the best health care, which requires advocates willing to create change to bring about better health outcomes.

“I never want us to be this corporate thing that is chasing the dollar and chasing that next patient,” she said. “We’re not here for that. We’ll take care of everybody and understand how we started and why; that’s still really important.”

The post How a Black Community Brought Affordable Health Care and Clean Water to Rural South Carolina in the 1970s appeared first on Direct Relief.

Approximately 100 million people, or nearly a third of the U.S. population, have been under heavy smoke conditions over the past two days, according to data from the National Oceanic and Atmospheric Association. Cloudy skies and low air quality have been reported as a danger and looming health issue.

The National Weather Service has reported air quality alerts for the Great Lakes region and parts of the Northeast, particularly Illinois, Michigan, and New York.

The U.S. Environmental Protection Agency has cautioned that residents in some areas should avoid all outdoor physical activity due to Air Quality Index measures of 301 or higher in ozone and particle pollution. The EPA’s Fire and Smoke map allows residents to view hourly-reported air quality conditions by searching for a city, state or area.

The EPA encourages those who may be affected by smoke-related air quality conditions to wear protective gear like N95 masks, reduce strenuous activity outside, and reschedule outdoor work tasks or take frequent breaks.

WILDFIRES AND HEALTH

Compromised air quality can cause major health impacts for people living with respiratory conditions, like asthma, groups including young children and older adults, and those with cardiovascular illnesses.

Wildfire smoke has been linked to “significant” increases, within a day or two of the event, in hospital emergency departments.

Wildfires can also force mass evacuations, during which people may be cut off from essential medications to manage chronic diseases like diabetes and high blood pressure. Fire-related power outages can also cause people to spiral into medical crises when they are without the power needed for electricity-powered medical devices needed for oxygen delivery, cold storage for temperature-sensitive insulin and more.

DIRECT RELIEF’S RESPONSE

Direct Relief is communicating with primary care associations to assess medical needs and is currently preparing shipments of N95 masks for health centers.

The organization is in contact with primary care associations in New York, New Jersey, and Massachusetts, as well as the Canadian Association of Community Health Centers.

Direct Relief responds to wildfires each year during fire season, including those that impact the Western U.S. The organization maintains a stockpile of N95 masks at its California warehouse for distribution and also manages an inventory of critical medicines often requested during fires, including asthma medications and diseases for chronic diseases often requested when people are forced to evacuate.

The organization will continue responding as needed.

The post Nearly One-Third of U.S. Population Under Heavy Smoke Conditions Due to Wildfires appeared first on Direct Relief.

Cochise County, Arizona, designated medically underserved population by the Health Resources and Services Administration, is just 12 miles from the U.S.-Mexico border. The county has a shortage of primary care health services for its population, which is facing economic, cultural, and language barriers to health care.

When Dr. Darlene Melk of Chiricahua Community Health Centers, located in Cochise County, was told her neighboring hospital in Tucson was no longer participating in free consultations with local physicians, she needed another avenue of support for her staff. Rural healthcare options were limited before the pandemic, and even moreso after. Issues like physician burnout and retention were exacerbated, creating a greater need for medical support.

“Sometimes we have to be the rheumatologist, the endocrinologist, and the psychiatrist because our patients either don’t have insurance or they have transportation barriers,” said Melk, chief medical officer at CCHC.

Melk reached out to the MAVEN Project, which stands for Medical Alumni Volunteer Expert Network, a nonprofit that provides support for clinicians. The nonprofit hosts medical consultations through email and Zoom conferencing, medical education webinars, and clinical and leadership mentoring from retired volunteer physicians. MAVEN has over 300 clinic partnerships within 21 states and Puerto Rico.

Melk said every staff member at CCHS now has access to MAVEN, which she uses for mentorship and consultations.

“It’s pretty incredible to be able to tap into this resource,” she said. “It’s been a wonderful blessing, and I’m just so grateful for it, and hopefully, we’ll be able to keep it for years.”

Connecting through SHARED EXPERIENCE

While hundreds of clinic sites have access to Maven, CCHC has its own unique set of challenges.

Dennis Walto, chief of external affairs and foundation executive director, said that CCHC serves a transnational community given its proximity to the border. In addition to patients moving back and forth across the border, some employees frequently cross the border to see loved ones and friends. Walto said many CCH employees have chosen to work at the health centers because of their connection to the populations they serve and their belief that everyone deserves access to quality care.

In Cochise County, nearly 13% of the population was born outside of the United States, and about 36% of the county’s population is Hispanic, according to census data. While just 15% of CCHC patients are best served in a language other than English, cultural competency and language access are a top priority, but with limited funds, recruiting and retaining top medical professionals can be challenging.

Melk is the daughter of a political refugee from Cuba; her Maven mentor, Dr. Lo-Ann Nguyen, was a refugee from Vietnam and relied on Medicaid in the 1970s for health care. The pair have met virtually for a year and a half, mostly on organizational vision regarding conceptual problems, recruitment, retention, and how to maintain a highly functional team. Nguyen said that it was important to Melk that CCHC employees feel like they are part of a solution and they have a consistent workflow as a team. Nguyen, an internist, also worked for Kaiser Permanente until she retired in January 2020 and began volunteering for Maven. She’s one of 170 volunteers.

“I grew up in a place where medical care was very, very unavailable, and it is an opportunity for me to participate in some solution to help the population who doesn’t get full access to medical care,” she said. “It just, it just grabbed my heart.”

Maven tries to connect clinics to physicians based on mentor availability, skills and shared interests, according to Dr. Jill Einstein, Maven’s senior director of physician engagement.

“Everything that Maven does (is through) this holistic approach to prevent or alleviate burnout,” Einstein said. “So, if a provider develops more skills and increases their confidence in caring for a patient, it won’t be as overwhelming. And if they have a system, an organized system and an immediate access to getting answers, that’s going to decrease their stress.”

In 2021, CCHC reported to the Health Resources and Services Administration that 83% of their patients live at or below 200% of the federal poverty line. While Arizona adopted and implanted the expansion of Medicaid in 2014, almost 20% of CCHC patients were without health insurance in 2021. At that time, 41% were enrolled in Medicaid or CHIP.  

Nguyen became eligible for Medicaid as a student, but she didn’t always have access to care. During a case of pneumonia, she was unable to see a private practice physician who had filled their Medicaid quota for the month, and she was forced to go to the emergency room, and her condition worsened. In another instance, Nguyen had a molar toothache for a week while waiting for an appointment. She said that she pleaded on the phone for a root canal, but was offered a cheaper, more consequential extraction instead.

“I knew exactly what people have to go through with that program, and a lot of bad things happened [when I was enrolled],” Nguyen said. “So I have always felt that we needed to do more for people who do not have good health insurance.”

CCHC hired its first psychologist in 2021, and since the clinic has had access to MAVEN they have hired two more. Melk said that mental health was and continues to be a high priority during the pandemic. Now, the biggest request from physicians and nurse practitioners is consultations from endocrinologists.

According to HRSA data, 16% of CCHC’s patients are diabetic, 36% have hypertension, nearly 58% go to CCHC to control high blood pressure and 72% seek out CCHC for prevention and treatment of cardiovascular disease.

Melk said it has been helpful to have access to experienced clinicians who give reassurance and resources. She described the Maven partnership as a “beautiful concept,” given she can get a response for a consultation in as little as a few hours. She’d rather not ask a patient to travel to Tucson to see a specialist if it’s not necessary. Some patients experience transportation barriers and often have conflicting work schedules so making the appointment would be difficult.

“I think as clinicians, your ultimate goal is to alleviate suffering and make that patient’s health journey lighter somehow,” she said. “And so we’re here to help, and when you feel like your hands are tied because they either can’t go or they don’t have insurance, or whatever reason, there are too many barriers to getting there, this helps.”

Direct Relief and the MAVEN Project have worked together to connect community health centers and free and charitable clinics with medical expertise in underserved communities across the United States.

The post Connecting Rural Health Providers to Mentorship, Support appeared first on Direct Relief.

Last month, the Centers for Disease Control and Prevention reported a 40 percent increase in maternal-related deaths in 2021 from 2020. Experts say lack of access to care, fear of not receiving proper care due to systemic racism, and comorbidities have contributed to the increase in their deaths. A litany of legislative decisions could change maternal health outcomes across the United States, if approved.

Amongst the urgency for change, midwives have stood out as a supportive resource to parents who want to feel seen, heard, and cared for during the birthing process and decreasing the overall risk of death. However, there aren’t enough midwives or obstetricians in the communities that need them.

“The comorbidities are real,” said Pandora Hardtman, a certified and practicing midwife, and Chief Nursing and Midwifery Officer for Jhpiego, a global health nonprofit focused on the health of women and families and that is affiliated with the Johns Hopkins University.

Black women’s maternal mortality rate was 37.3 deaths for every 100,000 live births in 2018; 44 in 2019; 55.3 in 2020; and 69.9 in 2021. In contrast, white women’s mortality rates were 14.9 deaths for every 100,000 live births in 2018; 17.9 in 2019; 19.1 in 2020; and 26.6 in 2021. For Hispanic women, the rates were 11.8 in 2018; 12.6 in 2019; 18.2 in 2020; and 28 in 2021.

The maternal death rate for black women is 2.6 times the rate of white women, though death rates for all women significantly increased in the past year.

Hardtman said that comorbidities like diabetes, preeclampsia, hypertension and mental illnesses have contributed to maternal mortality. The midwife said that now, as more stories are shared about the lack of cultural awareness and ongoing systemic racism within larger health systems, some soon-to-be mothers are fearful of seeking the care they need.

Finding care can be difficult, especially for those who live in rural areas. Hardtman said that there aren’t enough places for incoming midwives to receive proper in-person training, and overall access to midwifery care is centered in wealthy, predominantly white neighborhoods across the United States.

The Health Resources and Services Administration reported that just 13,409 nurse midwives and certified midwives were employed in the United States in 2021. The National Center for Workforce Analysis reported that 10.3 million women lived in counties without obstetricians and that within the next eight years, there will be a shortage of over 5,000 obstetricians nationwide.

Katy Maistros, a midwife in Cleveland, Ohio, said that when the birthing unit in neighboring Medina County closed, pregnant people didn’t have a place to go within their county to birth their babies. She said there aren’t enough midwives to serve the pregnant people in the area and not enough Black and brown midwives to bridge the cultural gaps necessary to improve health outcomes.

An annual report released by the Ohio Equity Institute shared that Cuyahoga County’s infant mortality rate was 7.6 per 1,000 live births. The Black infant death rate was 14.6 compared to 3.2 per 1,000 for white infants.
“The root cause is chronic stress and racism. It’s dismissible, its implicit bias, it’s the attitude of the health system,” Maistros said. “And that’s coming from a white, 47-year-old woman.”

Maistros is the Associate Medical Director of Midwifery Services at Neighborhood Family Practice Community Health Centers, a Federally Qualified Health Center in Cleveland, Ohio. The practice has a partnership with the local hospital, five midwives on staff and a visiting obstetrician. The midwife said it has been difficult to find midwives of color who have finished their practicum and clinical requirements over the last two years, as students were shut out of in-person programs during the pandemic.

The need for more ethnically and culturally diverse staff is proven within their client demographics. Last year, Maistros said that 35 percent of their patients speak a language other than English. The practice uses philanthropic dollars to support transportation and translation services to communicate with patients who speak 11 different languages.

But more midwives won’t solve the issue if policies don’t also change, according to Maistros. The midwife said that socioeconomic factors weigh on women who don’t have access to maternal leave, who don’t have postpartum support, and are dealing with mental health challenges throughout the pregnancy process.

“Our country is abhorrent when it comes to post-partum, and family leave laws,” she said. “I had a lady, who ironically was a health aide worker, leave on Nov. 4th and asked me for a return-to-work order ten days post-partum. She’s not even done bleeding. That’s really what’s killing women. We can’t afford to have a baby.”

The federal government has long mulled further support for midwifery services which could decrease rates of Black maternal mortality. Last year, Democratic members of the Senate introduced a group of 12 bills to funnel $1.7 trillion in support for mothers and babies in predominantly Black communities.

The package, or Black Maternal Health Momnibus Act of 2021, is likely to be passed one by one over time. The first was passed in December as a provision of the Build Back Better Act. Legislators have proposed to extend 24-month postpartum eligibility to Special Supplemental Nutrition Program and Women, Infants and Children program. It would force agencies to take action to grow and diversify the maternal health workforce, increase access to maternal care, increase research and data collection, and specifically improve maternal health among racial and ethnic minority groups.

“(Momnibus) It’s a really big deal, and it is exciting,” said Erin Ryan, a midwife and global health consultant. At the state level, efforts to increase access are also changing. There are 35 states, including Ohio, that have increased Medicaid postpartum coverage to 12 months.

Ryan said the investment needs to support Black mothers and Black midwives to make a difference. “We need to be clear that it is Black women who are dying,” she said. “And that Native women are dying.”

Last summer, the U.S. Supreme Court overturned Roe v. Wade, outlawing abortions at the federal level. Just five states used the midterm election to protect a women’s right to choose within specific time constraints of conception: California, Vermont, Michigan, Kentucky, and Montana.

“It’s not helpful to have 200,000 midwives and put them in areas of wealth with good insurance,” Ryan said at the time. “Another factor that is going to come up in the next couple of years are restrictions on abortion and abortion bans (because of) pregnancies that have to be carried to term that are higher risk. It is going to affect anyone with of a lower socioeconomic threshold who can’t go where they need to go to receive the care that they need.”

Direct Relief has supported maternal health efforts, including reproductive health and pre-and post-natal care, at community health centers across the United States.

The post To Decrease Black Maternal Mortality, Midwives and Money Could Make the Difference appeared first on Direct Relief.

When homes and hospitals were destroyed, medical professionals created shelter hospitals for emergency procedures and care. Existing medical locations remained open for women to access care when needed. Midwives, who provide an additional layer of care throughout the birthing process, have been a stronghold for birthing mothers throughout the response to the disaster.

Dr. Burcu Yurtsal is the vice president of the Midwives Association of Turkey and Head of the Midwifery Department within the Health Science School at Cumhuriyet University. The Midwives Association of Turkey has been active before and after the earthquakes, serving women and babies. The group distributed 2,200 kits containing hygiene products for women and those recovering from birth across five cities last week. More kits are expected to be delivered this week.

As part of its earthquake response efforts, Direct Relief donated $100,000 to the Turkish Midwifery Association, which has 3,910 members who provide pre-and post-natal home care and childbirth services at Turkish hospitals. Pregnant women and newborns are particularly vulnerable to health risks in disaster settings. The funding will also pay for supplies to facilitate safe births and personal care supplies for pregnant women and those recovering from childbirth.

Yurtsal said that midwives and doctors are constantly working to meet the demand for health care. To decrease the risk of burnout, Yurtsal said most are scheduled to work two weeks at a time and are then required to rest.

Treating earthquake victims who may now suffer from severe health conditions can be emotionally taxing. Yurtsal said the survivors and those caring for them are at an increased risk of trauma.

She also shared that healthcare providers, particularly midwives and doctors, have experienced more stress in the wake of the earthquakes as they provide prenatal, neonatal and postpartum care for many women in Turkey.

Direct Relief is also supporting organizations in Syria providing maternal and child health services in the northwestern part of the country still recovering from the earthquakes. Those organizations include the Syrian American Medical Society, Independent Doctors Association, and Syria Relief and Development.

In Turkey, expectant mothers have direct access to care regardless of location. Yurtsal said that all maternal health services have been made available to women and that the services at the hospital are ‘completely open.’

While also nursing a new baby in her own home, Yurtsal said that it’s important for midwives to connect and communicate with their patients. The midwife said that building peer emotional support and human connection is integral to maternal care to build trust and comfort through the process.

Now, just months after the earthquakes, Yurtsal said that medical providers continue to work together to provide the best care for the women of Turkey.

“I think, at first, people were very (afraid) of so much loss,” she said. “It was really frustrating, a very bad feeling. But after that, we need to keep hope.”

The post Turkish Midwives Step Up for Mothers and Newborns, Post Earthquake appeared first on Direct Relief.

The abundance of water caused widespread flooding and displaced residents from their homes. Local news outlets reported hundreds of people were told to evacuate the area.

Watsonville and Pajaro are small, rural areas, and their communities are predominantly Hispanic. Many are migrant farm workers who maintain the area’s strawberry crop. This is the fourth time in 30 years that the area has been evacuated due to major flooding.

In 1995, there were 2,500 evacuations and millions of dollars worth reported in damaged buildings. A Presidential disaster was declared in 1998 when the levee overflowed in multiple places. And in 2005, the City of Pajaro observed evacuation orders. Some worry that the continuous flooding and evacuations cause repeated trauma to the local community.

In response to the severe flooding, community-based organizations like Salud Para la Gente and Santa Cruz Community Health Center, both federally qualified health centers, have coordinated disaster response. Both provide healthcare services regardless of a patient’s ability to pay.

SCCH, which predominantly serves the north side of the county, had few patients affected by the flooding, given the organization predominantly serves an area less impacted by the flooding. However, Dena Loijos, chief strategy and impact officer, said a significant portion of the health center’s workforce lives in the southern region.

Loijos shared that some staff received paid leave as they were forced to evacuate their homes.

“Several of these staff reside in Pajaro and were forced to evacuate,” she wrote in an email to Direct Relief. “Others live in the Santa Cruz Mountains or a pocket in Scotts Valley that was ‘cut off,’ leaving staff stranded at home, mostly without power.”

SCCH was forced to temporarily close clinics due to flooding, high winds and intermittent power. Patients who needed to see providers were moved to a telehealth system.

Salud Para La Gente sent two mobile units to flooded areas to provide care, including medication refills, supplies, substance use supports, behavioral health services, vaccines, and non-medical emergency supplies like water and diapers.

Health conditions exacerbated, like skin conditions, exacerbated by the flooding, are still common. Providers reported that evacuees had to walk through dense water, soaking their feet. In children, colds and runny noses have been common. Medical staff reported that field medic packs sent by Direct Relief had been used in the first round of storms in January, and that quick access to medications helped patients gain control of chronic conditions like diabetes.

Amy McEntree, Salud’s Chief Medical Officer, said the health center’s partner organizations have organized support, service and supply distribution for people at shelters in Pajaro.

McEntree said that many people had to flee their homes and didn’t have time to grab medication for chronic conditions, which has exacerbated their primary care needs.

Providers are also reporting higher rates of stress and anxiety after the floods as patients sought medical attention for increased heart rate, hyperventilation, weakness, and sweating. Some patients showed early signs of post-traumatic stress disorder, including nightmares, flashbacks, insomnia and anxiety.

“The stress of uncertainty with their situation created significant pressure for many families,” McEntree wrote in an email to Direct Relief.

The organization has reported an evolving list of immediate needs from financial, housing and clean-up assistance. Residents who have been affected by the flooding are likely in need of temporary places to stay, rental assistance, cleaning and repair materials for their homes, and reimbursement for lost wages for missed work and the lack of work given the flooded farms.

On April 3, President Joe Biden announced a Major Disaster Declaration for California, increasing access to federal support for residents in eight counties affected by severe flooding, mudslides and winter storms. That includes Monterey and Santa Cruz, whose nonprofit organizations feared residents would not receive federal support based on their large immigrant populations.

The Federal Emergency Management Agency opened Disaster Recovery Centers in Monterey and Santa Cruz and is accepting individual applications for assistance for basic needs like repairs to primary homes and personal property.

In response to this year’s floods, Direct Relief shipped essential medications to Salud Para La Gente and Santa Cruz Community Health Center, including insulin, vaccines, field medic packs for triage care, PPE and more.

The post Health Centers Become First Responders During California’s Pajaro and Watsonville Flood appeared first on Direct Relief.

ROLLING FORK, MISSISSIPPI — Rev. Travis Gully had just finished dinner and was cleaning up the kitchen when his goddaughter asked him about a noise outside. Gully assumed it was from a passing helicopter on its way to the hospital. The noise grew louder and he could hear one of his godsons call out to him from the living room.

“The trees are walking down the street,” the child said.

Gully’s immediate response was to yell, “Get away from the window!”

On March 24, an EF4 tornado landed in the small, rural community of Rolling Fork, Mississippi. The tornado tore through the Mississippi Delta, crushing everything in its path. Rolling Fork, which is a mile and a half wide, was instantly destroyed as winds of 180 mph whipped from house to house.

“I never want another tree close to my house again,” Gully said.

Gully was physically safe. He was able to move back into his home two weeks after the tornado. However, 13 others in Sharkey County died from the storm. Many more experienced shock and trauma. Amid the destruction and chaos, a community pillar has remained: Delta Health Center.

Since the storm, DHC employees have worked daily to support the physical and mental health needs in Rolling Fork. They’ve made calls to colleagues, like Gully, whose homes were damaged. They’ve driven vans around town to knock on doors and care for residents who were too afraid or unable to travel to the health center. They’ve donated necessities like water bottles, sanitary supplies and baby formula to families in need. Most of all, they’ve been the trusted voice and ear to the community during a tragedy.

“The most graphic one to me was the 90-year-old lady that was just sitting in a pile of rubble and refused to leave because that was all she had,” said CEO John Fairman. “And so, our folks provided some intervention to her until she (agreed to) move.”

Fairman addressed a small crowd of nonprofit supporters in mid-April at DHC’s Rolling Fork location. The structure was totaled by the storm, and a temporary clinic was created on the property. He shared that patient numbers were up from 15 per week to over 80 per week.

Rolling Fork is a predominantly Black city with just over 2,300 residents. Some fear that the storm will force residents to leave the area, and potentially Mississippi altogether. That could hurt the city’s economic conditions. The median household income in the area is $38,558, and 20% of residents live below the poverty line.

DHC received donations of a mobile unit and solar panels for power. Direct Relief supported the organization with a $10,000 grant and disaster kits with medical supplies. The health center has also applied for assistance from Federal Emergency Management Agency.

DHC’s Deputy CEO and Disaster Recovery Coordinator, Neuviska Braughur, said that so far donations have helped survivors who need bandages, antibiotics, tetanus shots, and over-the-counter medication like Benadryl and Tylenol. She rides in the van with a psychologist, family nurse practitioner, doctors, and registered nurses. They created a list of houses visited and returned to some properties to redress bandages day after day.

“The help that we provide to them (is) from our heart,” she said. “It was more than our health care touching them: it’s mentally, emotionally, being there for them to talk to. We wouldn’t have it any other way.”

Braughur said that discussions on mental health are not common in the Black community—prayer is supposed to be best, and many are unwilling to seek out therapy. Her approach is to listen first and share that more people are willing to listen at the clinic if patients want to talk more.  

“When we go out, I always pull them to the side and talk to them about where they’re at,” she said. I ask when did it happen, how do you feel now, and a lot of them say (they) were praying, or hiding, but some can tell me exactly what they did, and from there, we refer them to come to our mobile unit and get some health support.”

As for the mental and emotional health of DHC employees, the deputy CEO said they speak to one another each day. She said she encourages their team to express how they feel and what they need as they continue knocking on doors.

A History of Care

The health center has a long history of providing relief to the community when no one else would. DHC was the first rural federally qualified health center in the nation. Its main campus in Mound Bayou opened in 1965 and accepted Black patients during segregation.

“We’re trusted because we’ve been here through the worst of times, and we’ve remained through the best of times,” said Adoris Turner, DHC’s co-deputy CEO.

Turner lives outside of the area but arrived on the scene the morning after the tornado. He said many were in shock, and utter disbelief at what had happened. There were announcements at his church for missing children, a one-year-old, and a one-month-old, as people talked about fighting to hold on to their loved ones as the wind broke through their homes.

“Some saw loved ones swept into the air,” he said.

The health center granted paid leave to employees like Gully whose homes were damaged by the storm. Nona Cooper, a registration clerk at the health center, was unable to return home in mid-April. The windows to her home were shattered, a fallen tree landed on her house, and other damage made it unsafe for her to live in the residence. She told Direct Relief that her home feels like a cave.

“It was tragic, but just the fact that I’m alive… I get emotional because I think about what could have happened.”

Cooper broke down in tears as she talked about losing her neighbors, her sister and brother-in-law who had to be pulled from the rubble, and seeing the town that she grew up in wiped away within minutes.

The 64-year-old was home alone during the storm. She tried to stay on the phone with her sisters as they watched the news for updates. Then she heard the wind, which Cooper says sounded like a “train approaching with a vengeance.” She grabbed a large furniture cushion and hid in her closet while screaming as the tornado landed in Rolling Fork.

“They were telling us the cities in the path of the tornado,” she said. “Mayersville, they said, it’s about to touch down in Mayersville right now, Rolling Fork, get ready, nine minutes, get ready, and by the time he had said that three times you could hear the wind. Oh my God.”

Gully said he’s heard people talk about the sound of a tornado, but he didn’t understand until he experienced it himself.

“I thought someone was in an 18-wheeler in my backyard and was about to hit my house,” he told Direct Relief.  

Gully underestimated the extent of the damage at first. Then he heard his sister was temporarily trapped in her home. One of the two churches he pastors was destroyed, and two of his parishioners died. He drove around town after the storm to determine the damage to his church and realized that it was gone. Gully said he stood in the parking lot, in shock.

Gully, who grew up in the area, said he’s worried that resources won’t be allocated equitably across Rolling Fork to rebuild. He’s not confident that people whose homes and businesses were destroyed will remain in town and that the economy will be affected.

However, Gully continues to work with his colleagues at DHC and volunteers from out-of-town to clean up and help neighbors recover from the tornado.

“I was telling a friend that of all the times that this has happened to other communities, maybe I’ve neglected to support like I should have,” he said. “It reminded me, you never know when your day is coming, so you should always be willing to help someone else.”

Volunteers from nearby schools like Mississippi Valley State University and disaster relief organizations from all over the country are working with residents to rebuild Rolling Fork. Piles of debris lay on the sides of the road, including the remains of a water tower that the wind knocked over.

The national, united support is astonishing to them, given Mississippi’s aggressive political and racial divides.

“It’s been an amazing display of the human spirit and our humanity,” Turner said.

Cooper said that little has changed since Jim Crow laws were active and that people are still separated politically and socially. However, she believes that the storm will bring a “new beginning” to Rolling Fork.

“I’m 64, so you know I grew up during a time when it was the way that it was,” she said. “But I have seen so much togetherness where people have pulled together, and it’s like everybody just feels the need to help and be there for each other.”

The post Someone To Talk To: Health Center Provides Support After Devastating Tornado appeared first on Direct Relief.

Haiti’s Department of Epidemiology, Laboratories, and Research (DELR) reported over 2,400 confirmed cases and over 29,700 hospitalized cases on Feb. 28. The DELR has shared that 594 people have died from Cholera in Haiti and that it has spread to Dominican Republic where there are now 88 confirmed cases.

Nearly 20% of the confirmed cases are children aged one to four and 16% of cases are children aged five to nine. Some physicians suspect the newest spread of the disease is due to a lack of immunity among young children and increased risk to bacteria from unsafe living conditions due to ongoing social and political strife. Haiti health experts have reported a lack of access to affected areas and limited fuel distribution that has inhibited basic water and sanitation services. There is also a growing global cholera crisis that has increased demand for supplies like the oral vaccine.

Cholera is a bacterial disease typically spread through contaminated water or food. Symptoms include diarrhea, vomiting, dehydration, and sometimes fever. The disease was first introduced to the country in 2010 by U.N Peacekeepers responding to the catastrophic earthquake. The Center for Disease Control reported over 820,000 cases and nearly 10,000 deaths at the time.

The earlier outbreak put a heavy toll on the Haitian people, given how the disease was brought to them and how quickly thousands died from the disease. Dr. Wilfrid Cadet, Chief Medical Advisor at Health Equity International, said the messaging around the importance of hand washing, water treatments and general sanitation has been more well-received in 2023.

“As a society, we have remembered what happened,” Cadet said. “During the first outbreak, there was denial and rejection…we haven’t seen that in the new outbreak. Instead, there is more social mobilization and solidarity.”

Cadet said that cases peaked in November of 2022 and have steadily declined, although thousands are still presumed to have been affected already. The medical advisor said that the current social and economic strain on the country exacerbates unsanitary and unsustainable living conditions. In November, Health Equity International reported that the price of food in Haiti had increased to 63% due to inflation, putting almost half the country’s inhabitants at “acute food insecurity.”

Potable water and medical supplies, like oral treatments, are also needed to stop the spread, as well as more health professionals in areas where there is limited access to care.

Dr. Marie Deschamps, Deputy Director of Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), said that patients with confirmed cases of cholera in 2022 knew their water wasn’t potable but drank it anyway because “they had no choice.”

“It is unbelievable that in 2023 so many people do not have access to clean water,” she said. “This is unacceptable; this is something that they need to consider where someone can at least have access to clean water and not have to drink contaminated water.”

Deschamps, who works in Haiti, said health officials are working to decrease the stigma around the disease. The physician told Direct Relief that residents are more informed now than they were in 2011, so they try to seek treatment when they see potential signs of cholera.

The disease causes dehydration, which can be fatal if not properly treated. Fluids and nutrients are needed to overcome cholera, usually through oral or intravenous methods.

But medical professionals say treating the new wave of cholera has proven difficult. Transportation barriers across major roadways have been blocked, forcing healthcare institutions to deliver medical supplies by helicopter. Conor Shapiro, President and CEO of Health Equity International, says the helicopter deliveries have limited the number of supplies transported each day.

“Given the security challenges out of Port-au-Prince, we’ve been (transporting) medical supplies by helicopter with the UN to people in the south,” he said. “So over 2 million people in the south of Haiti are cut off completely from Port au Prince by road because of the security situation.”

In December, the State Department put Haiti under travel advisory “Level Four: Do Not Travel.” The U.S. Embassy released a statement on Feb. 5 that the travel restrictions are still in effect due to kidnapping, crime and civil unrest, citing that armed robbery, carjackings and violent crime were common. Fewer nonprofits and nongovernmental organizations are active in the country since 2011, and Haiti’s government does not have the resources or support to fight the humanitarian crisis on its own.

Shapiro said Health Equity International prioritized prevention and treatment methods during Haiti’s “horrific” cholera outbreak in 2010. The nonprofit has increased access to potable water, supported treatment centers and supplies at hospitals, and used community health workers to teach preventative methods.

“We’re in unprecedented times in terms of security in Haiti,” Shapiro said.  

Since Oct. 2022, Direct Relief has shipped more than 61 tons of medical aid to Haiti, including cholera treatment kits, to health organizations working in the country.

The post Children Affected Most During Haiti’s Recent Cholera Outbreak appeared first on Direct Relief.

Humanitarian aid organizations continue response efforts, but those on the ground say it will be a long-term effort to recovery. Data scientists and information managers have used data analysis to track mobility patterns, understand current needs, map damage to buildings and health infrastructure, and effectively share information.

Crisis Ready, a collaboration between Direct Relief and the Harvard Data Science Initiative, hosted Data in Crisis: Responding to the Earthquakes in Turkey and Syria at Harvard on March 3 with over 200 online participants and many others in person.

The nearly two-hour conversation centered on how crisis response organizations have used novel data sources and methods to support Turkey and Syria. The presenters shared their organization’s response models, how to make ethical and effective use of data, and key takeaways from the disaster so far. While open data has helped to determine where people are going and their current needs, scientists say they still expect a drastic undercount of the displaced population as first responders and families continue to look for residents.

The in-person and Zoom event included internationally known speakers: Dr. Andrew Schroeder, Vice President of Research and Analysis at Direct Relief and Co-Director of CrisisReady; Dr. Caroline Buckee, Co-Director of CrisisReady and Professor of Epidemiology at Harvard University; Dr. Abdulfatah Elshaar, Chairman of the Syrian Medical Society and Internal Medicine Physician at Sturdy Memorial Hospital; Ozge Acar, Technical Coordinator at NeedsMap Social Cooperative; Dr. Samer Attar, a medical volunteer at the Syrian American Medical Society and orthopedist at Northwestern Memorial Hospital; Nathaniel Raymond, lecturer at Yale University in the Humanitarian Research Lab; and Can Unen of OpenStreetMap (HOTOSM).

Schroeder opened the event and shared that over 217,000 structures have been destroyed or deemed unsafe, including 520,000 housing units. Across the globe, digital volunteers have mapped buildings and their degree of damage in the earthquake area. Unen from HOTOSM explained to meeting viewers how precision mapping and open information sharing with international response agencies have been beneficial to saving lives.

With millions displaced, medical supports remain the top reported need: antibiotics, access to chronic disease medications, acute trauma support for search and rescue, and support for the displaced staff of medical organizations.

Attar, who volunteered as a surgeon in Syria, said being on the ground changes one’s perspective. There were limited resources that required doctors to make critical triage decisions. He said that they treated two to three patients on the same bed or even on the floor–most of whom had body parts that had been crushed by shattered buildings.

The surgeon said it was a sobering experience and one where he felt like his contributions were “barely making a dent.” Attar said that doctors performed dozens of surgeries per day, but many more people still need critical medical care.

“There wasn’t a lot of heavy machinery, so we would find people digging through the rubble trying to find relatives, or whoever they could find, using their hands or whatever they could find to dig them out,” Attar said.

Dr. Elshaar, also from SAMS, shared that the situation in Syria is one of the worst humanitarian crises in history, given the dire circumstances of Covid-19, the Russian and Ukraine war, the spread of cholera in Syria, and now the earthquake. He shared that hospitals and clinics have been targeted over the past 12 years of civil war in the country, making access to care more difficult.

The SAMS doctor shared an assessment of immediate needs: wound care, amputations and prosthetics, and medication for diabetes, hypertension, cancer, maternal/pediatric health, cholera treatment, and mental health trauma.

Though the situation in Turkey remains dire, access to data is increasing. Mobility data from Data for Good at Meta, analyzed by organizations like CrisisReady, show that population density is shifting away from highly impacted areas in Syria and Turkey. Survivors of the earthquakes are moving to less impacted areas of the country, including large cities like Ankara and Istanbul and rural areas with less damage. However, it’s unclear what housing will be available to them long term. Many are staying in a range of temporary and ad hoc shelters.

Dr. Buckee shared that institutional challenges are often greater than data challenges for epidemiologists trying to model the spread of infectious diseases like cholera and arboviruses.

She shared that having preexisting partnerships before disaster responses is key and that following simple models during a disaster will reap success in determining which populations are at risk, where displaced people may relocate, and identifying the medium to the long-term impact of infectious and non-communicable diseases. The simpler the models, the better for quick and efficient decision-making.

Some said they use social media to track movement, but real-time information gaps persist.

Social media also plays a key role in mapping the landscape of needs at scale. Projects on digital platforms like NeedsMap are at the center of efforts to report where individuals may need food, shelter, and medical care. They can also highlight where the capacity exists to meet those needs.

While helpful, Raymond reminded the crowd that information must be treated with high degrees of care for both individual privacy and community protection. Data can make an enormous impact on disaster response, but the responsibility exists to ensure that vulnerable populations aren’t exposed to further risk.

Dr. Andrew Schroeder contributed to this story.

The post Follow the Data: CrisisReady Shares Emergency Response Models for Turkey-Syria Earthquakes appeared first on Direct Relief.

International aid and response organizations are stepping in to support the Turkish relief effort, but it’s still early in the response process. Those who have been able to escape have relocated toward less dense areas, just a few kilometers away from the damage, according to findings from CrisisReady, a research-response initiative at Harvard and Direct Relief, supported by grants from the Harvard Data Science Initiative, Google.org, Data for Good at Meta, and the World Bank GFDRR.

CrisisReady has been publishing daily reports that are shared with responding government agencies, search and rescue groups, and agencies working in the disaster’s wake.

Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis and co-director of CrisisReady, said that it’s too early to determine how much movement is expected across Turkish borders. However, movement patterns within the country signal people moving away from downtown core areas where buildings are unstable and damage is widespread. Anonymized and aggregated data from Meta shows a glimpse into the shift in population density leading up to, during, and after the earthquake. Internet outages were initially reported after the quake, but Schroeder said improvements have already been made.

A Crisis Ready report from Wednesday showed a population decline of almost 82% within Kahramanmaras, where the earthquake struck. Neighboring towns and areas just two to three miles away saw increases in population, suggesting that residents were fleeing more dense parts of the area to get away from tall and unstable buildings, “which is totally rational behavior because the downtown areas are where most of the collapsed or at-risk buildings are,” Schroeder said. “And that pattern is repeated in a bunch of cities and so you see an increase in (less dense) areas.”

Due to the ongoing conflict between Russia and Ukraine, mobility data in Syria isn’t publicly available.

According to Schroeder, Gaziantep, Turkey, has seen similar population shifts, as those who were able to escape have moved to the outer limits of the area, where fewer tall buildings are present.

However, the data also shows a small influx of people into the larger towns and cities, presumably first responders and emergency supporters who are working to rescue others from the rubble.

Schroeder shared that it’s too early to determine long-distance movement and given the infrastructure damage many may not have the option to leave the area.

As rescue attempts continue, looming issues like housing, transportation, and access to resources will become major issues in southern parts of Turkey. Roads and railways were likely damaged by the earthquakes, preventing long-distance travel. It’s unknown how many people will be able to safely return to their homes, or if residents will be forced to shelter elsewhere. The need for resources, or everyday needs, like food, clothing, and medications, is only expected to increase.

The post Mobility Data Shows Movement Away from Some Urban Areas After Deadly Earthquake appeared first on Direct Relief.

DETROIT, Mich. — Jessica Jackson’s days are filled with back-to-back appointments at the Detroit-based Community Health and Social Services Center, Inc., known as CHASS.

The certified nurse midwife works with expecting and new moms at the community-based nonprofit health center. In the evenings, Jackson hosts a small prenatal group for expectant moms to learn about the birthing process and build community with one another. It’s one of several ways the health center is increasing access to maternal care as maternal mortality rates increase nationwide.

According to the Centers for Disease Control and Prevention, the maternal mortality rate increased for Black and Hispanic women from 2018 to 2021. National data for 2022 has not yet been released. Organizations nationwide have supported efforts to decrease Black maternal mortality deaths, which have been significantly higher than white or Hispanic mothers for years. However, in 2020, the maternal mortality rate for Hispanic women significantly increased from 11.8 to 18.2 deaths per 100,000 live births, with the greatest increase for Hispanic women aged 25 to 39. In 2021, the Hispanic maternal mortality rate increased again to 27.5– more than double the pre-pandemic rate.

The CDC also reported that coronavirus contributed to the rise in maternal mortality rates in 2020 and 2021. About 25% of those maternal deaths were Covid-19 related.

CHASS served over 8,700 patients in 2021, most of whom are Latinx. Over 6,000 of those patients are best served in a language other than English, according to the health center’s data records. Most CHASS patients live at or below the poverty line and are either enrolled in Medicaid, or Medicare or don’t have insurance. CHASS provides care no matter a patient’s circumstance

Dr. Felix Valbuena, CEO of CHASS, said the health center spaced out maternal care appointments during the coronavirus because so many patients were afraid to visit in person after being told to stay home to stay safe. The health center encouraged patients to get vaccinated for coronavirus and continued to pay close attention to expectant moms with diabetes, hypertension, and depression, which historically have resulted in low-birthweight babies and increased risk of death.

At CHASS, maternal care includes pap tests, blood pressure checks and diabetes screenings throughout a woman’s childbearing years. They talk to patients about birth control options, pregnancy tests, emergency services and outpatient services related to pregnancy.

The certified nurse midwife said since 2020, many of her patients have expressed higher levels of stress from isolation, trauma, and not knowing how to advocate for themselves.

“So many times, because people are just happy to have something, there’s not a lot of questions. And in our community, we are thankful for what we have and respect towards healthcare providers is paramount. So that’s part of the problem,” Jackson said.

The reluctance to ask questions, lack of dependable travel, language barriers, and ability to meet physicians during specific times of the day have attributed to accessing care more difficult for Hispanic women, according to Jackson. Additionally, the 2020 coronavirus pandemic resulted in significantly higher rates of stress among her patients.

To address higher stress levels, CHASS employees talk to patients about the coronavirus vaccine, give away baby necessities like diapers and bottles, host prenatal group meetings in the evenings, and have included “Social pieces” in maternity packets for moms on their way to deliver babies at the hospital.

The social pieces include speaking to patients in Spanish so they feel at ease, giving them pictures of signs to help navigate the hospital, and who to call for help with transportation. The health center works with the local Henry Ford Hospital, where most of expectant mothers give birth. Residents spend one day a week working at CHASS to learn about the cultural needs of the community and to get to know the patient base so that families feel more comfortable when it’s time to have the baby at the hospital.

The certified nurse midwife saw Yocasta Emilio Medina on Tuesday for a prenatal check-up. Medina, 27 years old, is three months pregnant with her second child. Her first baby was born six years ago, and her pregnancy symptoms are different with the new baby. Medina said she feels nauseous and vomits regularly, which didn’t happen during her first pregnancy.

Medina, who prefers to speak Spanish, went to CHASS for a pregnancy test and said she’s yet to miss a doctor’s appointment since. Medina said she feels comfortable asking her provider questions about the process.

“They know that we’re happy to care for them as opposed to caring for people as a task,” Jackson said.

Another patient, Kayla Bocanegra, 19, said her baby is due on February 6. Bocanegra said she took a pregnancy test at home last year. When it returned a positive result, she began going to CHASS for regular doctor appointments.

Bocanegra, who said she is nervous about the birth of her son, has talked to her provider about whether she has had any pain throughout her pregnancy, how she feels day-to-day, and remaining in good spirits because to her, having support means being able to have a trusting relationship with her doctor.

The evening prenatal group furthers the health center’s efforts to create an inclusive community of support, especially for those who felt alone during the beginning of the coronavirus. The program is hosting its fourth cohort in a way for expectant moms to gather in a safe, small group. Over six sessions, the moms learn about nutrition, anatomy, what to expect at the hospital, labor precautions, dental needs, and what to expect post-partum, among other things.

The health center used to offer a doula service, which CEO Dr. Felix Valbuena said they are working to bring back later this year. Valbuena said the high cost of the program made it difficult to sustain in the past.

In the meantime, Jackson continues to work with Henry Ford to ensure CHASS and Henry Ford have a common understanding of “baby-friendly” practices. For example, allowing the baby to stay in the same room as the mother after birth, providing lactation services, and showing moms how to care for a newborn in a language that they understand.

The post Maternal Health Takes Priority at This Detroit Health Center appeared first on Direct Relief.

Amy Gilbreath, the federally qualified health center’s CEO, turned away from the demolished building to help him. She understood why he, and other patients, had questions about where to go to receive care.

On November 4, an EF4 tornado tore through the rural community in southeast Oklahoma, demolishing dozens of buildings in its path, including the health center. Winds up to 165 miles per hour left behind broken glass, insulation materials, and pieces of the roof cluttering the health center’s floors. Soaking wet medical supplies were strewn about and walls separating exam rooms had fallen over.

The State of Oklahoma and McCurtain County governments have requested federal assistance to recover from the extreme weather event, but the rural area’s experience is considered a mere blip compared to larger-scaled storms in large metro areas with dense populations. The city of Idabel, home to less than 7,000 people across 16 miles, was also where people lost their homes, businesses, schools and churches in the storm and will need millions of dollars to rebuild.

That includes one of the hardest-hit institutions in the community: the health center.

“I was watching the storm on the television, and I said, “Oh my gosh, it’s over the health center. The tornado is right on top of the center,” Gilbreath recalled.

Kiamichi staff were warned at 2 p.m. on November 4 of severe weather. Gilbreath considered closing early, but the threat of the storm was pushed back several hours. The CEO said the last employee left the facility just before 6 p.m. The tornado landed in Idabel almost 45 minutes later.

The Kiamichi Center served nearly 9,000 McCurtain County patients in 2021. The median household income in Idabel is less than $30,000, and 31% of residents live below the poverty line.

The center, which had 17,000 square feet of space, opened in 2018 after a 12-year fundraising campaign and employs 32 people. The tornado demolished the health center, which housed patient records, billing, almost two dozen exam rooms, a call center, and space for staff. Like many other federally qualified health centers across the nation, the location offered medical, dental and behavioral care services, including healthy living, food supplementation and community support at little to no cost to patients in the community.

In the month following the tornado, health center staff and board members said they are quickly trying to open a smaller, temporary site to continue providing care. Even though people in the community have endured an emotionally and financially traumatic event, the health center has to keep going.

“That’s the model of a federally qualified health center, an FQHC like us, (our job) is to make sure we’re the total home for all of the health care services someone needs,” said Kara Maness, Kiamichi’s human resources manager and community outreach director.

The temporary site is expected to be operational by Christmas. Some patients can be seen by the behavioral health physician, but most medical patients have either canceled their appointments or been redirected to other locations. The temporary site has 8,000 square feet and was previously a school for nursing students. The health center’s CFO said he expects to be in the building for at least two years and that it will take several months to create exam rooms from the empty classrooms to fulfill their patient’s needs.

Maness lost her workplace and her home in the tornado. A pine tree crashed through the roof of the house that Maness and her husband rented with their two children and dog. Water was ‘ankle deep’ inside the home, she said, and when she heard the news about the health center, she realized how much she had lost in a matter of minutes.

“I completely broke down on the phone,” she said. “It was just gut-wrenching.”

Maness’ family moved into her parents’ spare room after the storm. Two other employees also experienced housing hardship from the tornado. The remainder called the center’s leadership the following day to see if they still had jobs. Gilbreath said that all employees, including the providers, were moved to different locations.

Kiamichi Family Medical Center has three other locations in Battiest and Hugo, Oklahoma, each an hour from Idabel, and a third smaller office in Broken Bow, Oklahoma, 20 minutes away.

Maness was driving home from Texas with her daughter when the tornado hit. The storm touched down in Texas, retracted, then touched down again in Oklahoma. Kiamichi’s office manager called Maness’ cell phone to warn her of the tornado as she drove home.

“When you see lightning strike, they say you can count one Mississippi, two Mississippi until you hear thunder, and that’s how many miles away it is,” Maness said. “I counted one Mississippi, and the thunder struck. I have never been more afraid in my life.”

As she drove home, Maness’s husband was at the house with their two-year-old son, who was already asleep for the night. A friend called and warned them they should leave, but Maness said her husband planned to take shelter in their bathroom if needed. The friend cautioned that wouldn’t be enough and convinced them to leave the house before the tornado landed in Idabel.

“My little boy, who is two, says ‘Mama that was a bad tornado, it was so mean, it tore up our neighborhood,’” Maness said, recounting a conversation with her son. “He talks about it every day. And then he asks me if there will be a good tornado that will come and fix it and I just have to say ‘no buddy, there isn’t such thing as a good tornado’.”

The tornado swept through the town, knocking over a church and ripping off part of the roof of a school less than a mile away from the health center. Since the storm, Stace Ebert, board chair of the Kiamichi health center and superintendent of the Denison School District, has worked to get assessors to review the properties.

Ebert closed the doors of Denison Elementary School for a few days following the storm. He said that three students’ homes and the house of the school’s principal were affected by the tornado. Denison held virtual classes for three weeks while repairs were made to the building and returned to the classroom the week after Thanksgiving.

The repairs to the school were costly but quick. It will take much longer to rebuild the health center. Gilbreath said that residents have helped one another find housing and donated food and supplies to families whose homes were damaged or destroyed. Even the health center’s community partners made calls and asked if help was needed in finding a temporary site for patients. She’s seen Ebert stand in as an auctioneer at previous charity events and said the town of Idabel has always been a very supportive community.

“There’s been fried pies that will go for $500. I mean that’s just what we do here, that’s how we take care of our people, we just do it,” she said. “We live it, but to see it from this side, it’s overwhelming.” 

It’s yet to be determined whether the wreckage from the November 4 tornado has left more damage than the community can take on itself. The Federal Emergency Management Agency awards supplemental assistance for disasters that go beyond the capabilities of the State and the affected local governments.

FEMA told Direct Relief that a Joint Preliminary Damage Assessment was filed in early November for severe floods, tornados, and storms in McCurtain, Bryan, Choctaw, Le Flore and Pushmataha counties. Joint PDAs typically include input from local, state, and federal emergency agencies. FEMA said the result is ongoing as the agency is still determining the scope of the damage in Idabel and the surrounding areas.

Gov. Kevin Stitt filed with the Small Business Administration for a disaster declaration to make low-interest federal disaster loans available to businesses and residents affected by the storms in the meantime.

A major disaster declaration was also made in June for Oklahoma and included over $4 million in assistance across seven counties but didn’t include the smaller McCurtain County.

McCurtain County Emergency Management Director Cody McDaniel said the county filed for an extension in early December for FEMA assistance from the November 4 storm. The county initially had 30 days to apply for support. McDaniel said it’s unlikely they will receive federal support because of the size of the area affected and the level of the storm.

“It was major for us, but minor on the national scale,” McDaniel said. “It’s aggravating, but it’s understandable.”

Now, they are all working to regain normalcy. The phones continue to ring for appointments, and staff members are referring patients to providers at different locations. The health center recovered patient records within days of the storm, and insurance claims for building repairs are being filed. Gilbreath said they approach each issue one day at a time because, without the health center, people wouldn’t get the comprehensive health care they need.

Direct Relief issued an emergency operating grant of $50,000 to Kiamichi Health Center after the storm.

The post After “Gut-Wrenching” Loss, Health Center Regroups After Tornado appeared first on Direct Relief.

Mobile medical units are traveling across city lines to reach rural and underserved residents in need of medical care.
According to the National Association of Community Health Centers, the number of health centers using mobile health units has increased by 40% since 2019. That increase is expected to continue in 2024 when new MOBILE Health Care legislation will take effect and allow federally qualified health centers to use new grant dollars on mobile units. Health centers have used mobile units in the past to meet patients where they are for their dental, emergency services, family planning, and general medical care, with great success.

Rhonda Johnson has seen that firsthand. She runs a mobile unit that provides mammograms to patients in underserved communities in rural Nevada that otherwise might go without. “Eighty-seven percent of the towns where people love to live are in rural Nevada, but they don’t have access (to health care) that the cluster cities have. So what about everyone else?”

The Nevada Health Center has operated the Mammovan since 2000 to increase access to mammograms across Nevada. At the time, Nevada had one of the highest breast cancer rates in the country, with many women never having had a mammogram prior to being diagnosed. The Mammovan was a pioneering program among health center mobile units that has survived on philanthropic dollars.

Johnson said it costs about $1.5 million to put the van on the road and $1.2 million for operations. The travel burden is the heaviest cost, due to maintenance on the vans, and easy burnout on employees who are subject to constant travel throughout the state.

Beginning in 2024, the MOBILE Health Care Act allows health centers to use new access grant program dollars for mobile health units. Under the new legislation, the expanded access will allow dollars to be spent to provide care in rural and underserved communities. Prior to the legislative change, the grant program forbade health centers from using grant dollars on construction costs or to expand services through mobile units.

Rep. Susie Lee (D) of Nevada introduced the bill to the House in August of 2021 and Sen. Jacky Rosen (D) of Nevada introduced it to the Senate. The House bill quickly passed with overwhelming bipartisan support and was approved in a 414-to-7 vote on September 29.

“The pandemic laid bare longstanding inequities in our health care system, and I’m fighting to make health care more accessible to Nevadans, no matter where they live. Federally Qualified Health Centers provide essential care for thousands of Nevada families who need it. With the passage of this bill, we’re one step closer to ensuring that every Nevadan has access to the care they deserve,” Lee said in a press release from her office about the legislation.
Lee’s district is home to the Mammovan, which employs 10 people who work to increase access to mammograms across the state.

Under the guise of the new legislation, Nevada Health Center hopes to purchase another van so that one will travel the southern tier of the state, a second will remain in the Las Vegas area, and a third will travel the northern portion of the state. Johnson said this method will reduce the time employees will be required to stay on the road, travel costs, and overall van maintenance.

The Mammovan hasn’t traveled during the winter months due to variations in weather, but the additional money could improve travel capabilities. “That’s three months [the patients] lose out on,” Johnson said.

Though there was widespread support to expand the use of grant dollars, Congress must approve a budget for health centers to see more financial support.

“In order for it to really work, you have to have money,” said Deila Davis, deputy director of federal affairs for the National Association of Community Health Centers. “Health Centers receive a lot of federal money, and this is one more string for them to operate under.”

Davis said mobile units help health centers build trust with patients, remove transportation barriers, and increase job availability.

In Puerto Rico, mobile medical units were used to support residents affected by Hurricane Fiona in 2022. In Mississippi, mobile units have been used to provide care for women in rural areas who need maternal healthcare, and across Florida in partnership with school districts where students don’t have consistent health care or regular access to pediatric care.

In a report published by the National Library of Medicine, mobile health units were described as favorable due to their flexibility of where patients can receive care, their ability to meet the evolving health needs of a community and address the social determinants of health.

“MHCs (Mobile Health Clinics) produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups,” the authors wrote.

Florida’s PanCare Health Center has 12 mobile health units that travel to five school districts and several Head Start programs across nine counties to visit 15,000 students each year.

Robert Thompson, chief operating officer of PanCare Florida, said their mobile school health program allows students to have regular vision screenings dental exams, and annual physicals—much of which is required for students enrolled in local school systems. Of the 12 units, three are dental vans, seven are medical units, and two are used for optometry.

The mobile program employs 20 people, some seasonally and some year-round. Thompson said using grant dollars could allow them to employ more people and purchase another mobile unit. According to Thompson, the dental mobile health unit is in high demand, but all of the mobile units are driven at high costs to the health center.
“We run them so much more than what they are designed for,” he said. “We have maintenance issues often because they are campers basically and we have problems because we use them so much, but it’s needed.”

Thompson said the majority of the students seen through the mobile school health program don’t visit the health center’s brick-and-mortar locations. Parents aren’t always able to leave work in the middle of the day and not every student has reliable transportation to get to the center. Meeting the students at their schools has created consistent access to medical care.

“It does stress the importance of regular care,” he said. “It’s not just a one-time thing; for a lot of these kids, it becomes their regular dental check-up. And it’s interactive, they have videos about how to brush your teeth and floss, and they get a to-go bag with a toothbrush and floss to continue using when they’re finished.”

PanCare Florida has also used the mobile units at local events, to support veterans, and migrant workers who often don’t have health insurance or transportation to visit the health center.
“If we had funding available right now, especially dental, within six months we could probably have it full (of patients),” Thompson said. “There’s a lot more opportunity out there.”

Direct Relief has funded the purchase of dozens of mobile health units across the United States to support the efforts of health centers beyond clinic walls, including after disasters such as Hurricanes Harvey, Irma, and Maria.

The post Mobile Health Fuels Up After New Change in Law appeared first on Direct Relief.

However, Pakistani health experts say the larger issues of homelessness, famine, and climate change will haunt the country for years to come.

Pakistan is more vulnerable to the effects of climate change than other countries based on its geographical location, although it emits fewer carbon emissions than most other countries. The United Nations reported that 33 million people have been affected by this year’s floods and it may take up to six months for the water to recede. Homes, schools, markets and more have all been washed away.

Hundreds of thousands have lost their homes after a record-breaking season of rainfall left nothing but debris behind. Pakistan’s monsoon season, which runs through the summer months, saw 243% above-average rainfall in August alone, according to the Pakistani government. Over 1,100 people have died, and hundreds were injured from the severe weather. Just months before, the country experienced a drought with temperatures as high as 115 degrees in April.

The weather affects not only the rainfall and rising waters across Pakistan, but crop yields for food and living conditions.

Haamid Jaffer, from the Murshid Hospital and Health Care Center in Karachi, said that he worries about the millions who have been displaced and where they will live in the future. Murshid Hospital provides affordable healthcare services to low-income communities and has received almost $12 million in financial and medical aid support from Direct Relief.

Many families from flooded areas migrated north, leaving behind just one family member to claim any land that submerges from the wetland, according to Jaffer. He said there aren’t always formal and legally binding documents for proof of ownership.

“They may want to protect that plot of land so that nobody else from the neighborhood nearby comes and encroaches,” he said. “The fear is always there.”

Jaffer said that homelessness is a growing problem in Pakistan, which could result in psychiatric and psychological challenges later in life. Those who have had to relocate are living in a new community, may have to find new employment, and are potentially away from family and friends.

Intense flooding can increase the risk of waterborne diseases like typhoid, malaria, and dengue. While there are vaccines to combat the illnesses, many young people in Pakistan remain unvaccinated due to cultural and religious beliefs, according to the National Library of Medicine. The severe heat can also cause dehydration, bacterial infections and skin diseases.

Jaffer said that he also worries about family planning during times of crisis; pregnant women who have had to leave their homes from the floods and likely are without consistent care throughout the duration of pregnancy, and that Murshid hospital has operated with an interest in improving maternal health for over a decade. Recent shipments contained prenatal vitamins and other medical support for the hospital treating those impacted by the floods.

Since January 2022, Direct Relief has shipped more than $35 million worth of medical aid to Pakistan, which has been distributed to health facilities across the country.

The post Millions Displaced in Pakistan After 2022 Monsoon Season appeared first on Direct Relief.

According to reports, the 7.6-magnitude earthquake was about 10 miles in depth, between Colima and Michoacan, a little over 20 miles from Placita de Morelos.

“It’s kind of ironic that we sing ‘retiembre en sus centros la Tierra,’ or “may the Earth tremble at its center” in our national anthem just days before this happens,” said Jonathan Mangotich, corporate engagement manager of Direct Relief’s operations in Mexico.

Mexico experienced severe earthquakes on September 19 over multiple years: in 1985, when over 10,000 people died; in 2017, when 350 people died; and again in 2022, when one death was confirmed.

Mangotich had returned from the Pacific Coast area where he was celebrating the national holiday when the earthquake happened. What was supposed to be a happy ending to a celebratory weekend, residents were stunned by another earthquake on the same day.   

In response, Direct Relief worked with the Department of Air Services of the Secretariat of Public Security of Michoacan to respond to the natural disaster. Donated field medic packs were used for critical care patients being airlifted from rural areas to hospitals in Mexico City and Morelia for emergency care.

Direct Relief staff in Mexico works in close coordination with local government, the medical community, and nonprofit organizations, and has built trust in communities that have seen recurring traumatic disasters.

Since 2008, Direct Relief has responded to the Swine Flu outbreak, coronavirus, hurricanes, and ongoing support for healthcare providers, which includes shipments of Vaseline, thermometers, over-the-counter products for cuts and bruises, and other prescription medications.

 In 2017 the earthquake happened around 1 p.m. on September 19, a date that Eduardo Mendoza, country director of Direct Relief’s operations in Mexico, remembered vividly.

“It kind of feels like you’re standing on jello or the gelatinous mold in the lava lamp and then the buildings around you start collapsing,” Mendoza said.

In 2017, Direct Relief responded to Juchitán de Zaragoza, Oaxaca, to deliver medical supplies and medications after 350 people died from the 7.1-magnitude quake. At the time, Direct Relief began working with local government and organizations to set up temporary hospitals, gather medical staff, and day-to-day care around disaster relief.

The southwestern portion of Mexico is prone to earthquakes that lie within a subduction zone, or an area above a tectonic plate that is pushing down on another plate. It’s also a rural area that can be difficult to reach by car.

The government-run Department of Air Services has a team of 10 paramedics and four pilots that work to reach people in critical care in difficult areas like Michoacan, where about 4.7 million people live. Air Services has two helicopters and one airplane, which were used to transport five people to hospitals in Morelia and Mexico City following the September 19, 2022 earthquake.

The department deploys its air units to respond after disasters, most often for trauma injuries, as well as complications with women giving birth.

The Air Department transferred patients from rural areas that had significant damage and took them to hospitals in larger cities where there was more support for food and medication, according to Oswaldo Abarca, who works for the department. 

Closer to the scene in Maruata, the Hospital Comunitario de Maruata was forced to temporarily close and evacuate patients due to infrastructure damage, Mangotich said. The Ministry of Health installed mobile units in Michoacan and Colima where damage was reported with at least 30 units. Almost two dozen other medical facilities were reportedly affected by the disaster, and almost a dozen schools temporarily closed in response to the earthquake.

Adding to the surreal nature of the day, the government hosts an annual earthquake evacuation drill on the morning of September 19 as a safety precaution. In 2022, the safety drill was practiced in the morning, and just a couple of hours later the ground started to shake.

It was the second time the earthquake alarm rang through the streets on September 19, 2022.  

“It’s like, ‘this is how you do it in the drill,’ and then you’re like, ‘wait, this is real’,” said Mendoza.

The alarm blares if the earthquake detection is a magnitude of 6 or above and urges residents to walk outside quietly.

“’No corro, no grito, no empujo,’ it means ‘don’t run, don’t yell, don’t push’,” said Mangotich. “You hear it, but people are still confused because it’s happening twice in one day.”

That’s terrifying for many who lost loved ones during the 2017 and 1985 earthquakes. In 2017, two major earthquakes shook within a month. An 8.1-magnitude earthquake struck on September 7, followed by a 7.1-magnitude quake on September 19. This year, the area experienced another earthquake three days later, when two people died.

Mendoza said residents held memorials for loved ones lost in 2017 when the September 19, 2022 earthquake began.

“That’s traumatizing for people to experience over and over again,” he said.

The post Direct Relief Staff Recount Recurring September 19 Earthquakes in Mexico appeared first on Direct Relief.

Lee County, which experienced a direct hit from Ian, has recorded at least 35 fatalities due to the storm, officials reported Saturday. At least 600 people have been rescued in the county. More than a dozen fatalities have been recorded elsewhere in the state.

Ian has continued to work its way up the East Coast, dumping rain on mid-Atlantic states. The impacts of Ian were not as severe in South Carolina as expected, and Direct Relief is in communication with health facilities in multiple states as flash flooding warnings continue and power remains intermittent for many.

Dozens of medical shipments have departed this week in response to Hurricane Ian, including requests for temperature-sensitive therapies, like insulin and vaccines that were lost during power outages. Antibiotics, chronic disease medications, and more have arrived or are en route to dozens of health facilities across Florida and South Carolina, and medical support will continue in the coming days.

The post More than 1 Million Without Power as Death Toll Rises in Florida appeared first on Direct Relief.

The Diocese’s 10 donation centers received supplies from Direct Relief’s partner, Fundación Solidaria del Divino Nino Jesus, Inc., and agreed to share products with the most vulnerable parts of the state. The diocese redistributed care packages and medications to give directly to families and medical centers in need of supplies.

Fiona hit Puerto Rico as a Category One hurricane more than a week ago, knocking out the power across the entire territory. Throughout the week Fiona grew stronger, rising to a Category Four storm, knocking out the power and flooding the streets throughout the Caribbean.

Hurricane Fiona is the first severe hurricane to hit the Caribbean in 2022.

Puerto Rico’s electrical grid was put to the test and failed, as the storm touched down, leaving all of its residents in a blanket of darkness. Direct Relief donated backup power systems and diabetic care medications to assist residents who had no access to power or medical care during the storm.

Medical teams in the Dominican Republic were also advised to stay home as offices closed in preparation for the storm.

Padre Villavicencio de Dioceses of Higüey said that so far those immediately affected were Haitian immigrants who live in rural areas of the eastern side of the Dominican Republic. He said that many of these communities can be difficult to reach and are easily flooded.

Fundación Solidaria del Divino Niño Jesús, a Direct Relief partner, is inland within Santiago De Los Caballeros. FSDNJ closed last Monday in preparation for the storm to keep patients and employees safe. They shared that at first, it was difficult to communicate and assess the level of damage given downed power systems and blocked roads. However, within a few days, the health clinic was able to drive supplies to the Diocese donation center in Higüey to share with the harder-hit parts of the island’s northeast side.

The Diocese distributed packs of food, prescription and over-the-counter medications and products to residents whose homes were damaged by the storm.  

The post After Fiona Ripped Through the Caribbean, Local Groups Mobilized appeared first on Direct Relief.

One of the most effective reversible contraceptives is an intrauterine device, or IUD. This small, t-shaped device is either plastic or copper and can prevent pregnancy for up to 10 years, depending on the type of IUD. However, high costs and misinformation prevent many from using the method.

Lack of health centers and transportation, clinicians trained in providing the full range of contraceptive methods, and person-centered care also contribute. About 28 million U.S. residents are without health insurance, limiting their options for access to sexual and reproductive health care. Recent judicial and legislative changes have also shifted options for family planning, like dollars that support healthcare access through the Title X Family Care Plan and the reversal of Roe v. Wade.

As laws and budgets change, the importance of health clinics and health centers that provide access at low-to-no cost remains constant. The Pew Research Center reported a decrease in births during the coronavirus pandemic and that more than half of women aged 50 and under with no children said that they don’t plan to have children in the future. For those who are sexually active, medical professionals say contraceptives are a safe option to prevent pregnancy.

“If people don’t want to be pregnant then we don’t want them to be pregnant,” said Whitney James, a nurse practitioner at Knox County Health Department in Knoxville, Tennessee. James said requests for contraceptives are ongoing and that patients have questions about the different types of contraceptives and where they can access the medications or devices. The Knox County Health Department provides services for people with or without insurance. James said that there are several contraceptive options, like a vaginal ring, birth control pills, intrauterine devices or IUDs, implants, and Depo-Provera shots. Each work differently with the same goal — preventing pregnancy.

However, without insurance coverage, IUDs have a high upfront cost that could be over a thousand dollars when you include the cost of the procedure to insert it. There are five FDA-approved IUD brands in the U.S., all of which must be inserted by a medical professional. “It’s a very simple procedure, but it can be painful for some,” James said. “It feels like a bad menstrual cramp.”

The IUD lasts for several years while other contraceptives are used daily, weekly, monthly, or every few months. James said many patients forget to take the pill daily and are averse to returning for doctor visits every few months for a shot.

The nurse practitioner said staff speak with patients about the process of getting and removing an IUD because the use of the device is not commonly known. According to James, many people don’t know the benefits of the device or that they can receive family planning care from the health department. Avenues for family planning in the Knoxville area are limited. Tennessee is one of 12 states nationwide that did not expand access to Medicaid when the Affordable Care Act was introduced, and 20 of the Knox County census tracts are considered medically underserved areas. The county reported that just 8% of Knox County residents were without health insurance pre-pandemic and that 38% of residents identified medical debt as a major problem. Black and Hispanic residents had a higher uninsured rate than white residents.

The Knoxville Planned Parenthood burned to the ground in December of 2021, followed by the forced closure of the Knoxville Center for Reproductive Health on August 31 of this year. The state’s Heartbeat Law went into effect this summer which bans abortions after six weeks. The temporary and permanent closures of these businesses and the newest abortion restrictions have limited residents’ access to learn about and address family planning.
Lack of prenatal or maternal care can contribute to low-birthweight babies, infant mortality, and maternal mortality, and medical professionals across state lines say greater access to family planning care is necessary.

In Georgia, Dr. Gabriela Pena says their clinic sees patients when they are well into their pregnancy. “I’d rather they come late to care than not get care at all,” Pena said. Pena works for Your Town Health, a network of seven nonprofit community health centers serving six counties. Their bilingual network allows them to communicate with their diverse patient base, but Pena said they mostly serve underinsured or uninsured residents.

Like Tennessee, Georgia did not expand access to Medicaid and has a law in place that bans abortions after six weeks. For people who do not want to be pregnant, they need to receive care earlier in the process.
Pena said that barriers to access to maternal health care include lack of insurance, being underinsured, lack of transportation, lack of available practitioners, inability to find doctors that speak the same language, and the costs of care. They offer services on a sliding scale, so patients pay what they can afford. Given the changing laws, YourTown Health expects an influx of requests for family planning care.

In the past, older and often married people who already had children were likely to request an IUD. But Pena said she now sees younger people who are beginning to make the same request and prevent pregnancy for several years.

Through donations from Bayer U.S. and Medicines360, Direct Relief has distributed 31,160 IUDs to 494 U.S. health centers and clinics, free of charge, since 2018.

The post Demand for Contraceptives Increases as Barriers to Access Persist  appeared first on Direct Relief.

It was the South Asian country’s first default since becoming an independent country in 1948. The result? A growing political and humanitarian crisis. Academic experts say that Sri Lanka isn’t alone: Several other countries are in similar and disastrous financial straits.

In the case of Sri Lanka, “clearly this is a humanitarian problem and not just an economic one,” said John Ciorciari, Director of the International Policy Center and Weiser Diplomacy Center at the University of Michigan. Many people are going without food and essential medicines.

After weeks of grounded planes, Direct Relief has multiple shipments in progress to support the country’s medical system, including the insulin needs of people with diabetes in the country. The organization was able to ship 22 cartons of insulin and insulin delivery devices to 11 hospitals and healthcare facilities in Sri Lanka in August. The doses should support the health needs of 212 children and young adults with Type I diabetes in Sri Lanka. Just over 11% of Sri Lankan adults aged 20 to 79 have been diagnosed with Type I diabetes.

A second shipment of insulin has also arrived in the country and is expected to be delivered to 14 health facilities next week. This shipment contains enough insulin and insulin delivery devices to treat 400 children with Type 1 diabetes.

Ciorciari, also associate dean for research and policy engagement and professor of public policy at the Ford School, said that Sri Lanka relies on imports from other countries. He said the country’s default on international loans will hurt its reputation and ability to work with other countries in the future. Sri Lanka’s fiscal reputation will be damaged at a particularly problematic moment: According to Ciorciari, countries are recovering from the coronavirus pandemic and the ongoing Ukraine war, which means there are fewer resources to go around.

These events have already affected Sri Lankans. In 2018, Sri Lanka earned over $5 billion from tourism. That revenue dropped to $1 billion in 2020, according to the World Bank, as travel was suspended during the coronavirus pandemic. Now, six months into the Ukraine war, a global food shortage has hit Sri Lankans as well.

The Michigan professor said Sri Lanka’s situation deserves a robust international response, especially considering that many of the loans came with unrealistic repayment strategies when they were signed. Pressure has been building on China to restructure some of Sri Lanka’s loans and Japan recently asked Western creditors to gather to consolidate loans, according to Reuters.

Now, several other countries are likely to default on debts in the coming months. That’s dangerous for countries that rely on imports to feed, medicate, and fuel the livelihoods of their people.

Lebanon, Russia and Zambia have already defaulted on international debts this year.

Lebanon defaulted on international debts and the country’s currency lost 90 percent of its value. Over half of Lebanon households now live in poverty. The International Monetary Fund deployed hundreds of millions of dollars to support Lebanon and has proposed several policy measures to strengthen its government.

Russia’s default is largely a response to sanctions imposed by western countries after Russia’s President invaded Ukraine and the country is expected to continue to lose access to global investors. Zambia overborrowed as well and the country is restructuring its debt with China and France.

Argentina, Ecuador, Egypt, Tunisia, and Ukraine are on the verge of defaulting on bonds and loans through foreign currency.

“Nonpayment is obviously hugely costly for the country’s reputation,” Ciorciari said.

As the government scrambles to figure out debt payments, Sri Lanka’s 22 million people are bearing the brunt of the lack of funds. Imports have been blocked from entering the country, and fuel shortages have also prevented people from leaving. Medical supplies are harder to find and government-funded support for medications has decreased, leaving many without necessary medications like formerly government-sponsored insulin programs.

Neil DeVotta, professor of politics and international affairs at Wake Forest University, said that the debt default is unsurprising, given that the country has had longstanding budget deficits since becoming independent.

DeVotta, who is an expert on South Asian politics, said he sees an economic and political crisis happening at the same time, given Sri Lanka’s political elites’ misuse of funds and prioritization of lavish infrastructure, which the country can’t afford. He said millions are expected to fall into poverty due to the ongoing debt.

“The rolling economic crisis meant that people have been waiting in line for days for essentials like cooking gas, kerosene, gasoline, sugar, milk powder, and medicines,” DeVotta wrote in an online essay this summer.

DeVotta said that Sri Lanka has prioritized and overspent on social policies that support literacy and healthcare. The lack of foreign currency exchange has inspired protestors who stormed government agencies and homes in Sri Lanka. Given the country’s ongoing debt, the number of recipients within these programs is likely to be reduced and healthcare affordability is likely to diminish.

International organizations like the International Monetary Fund, the Paris Club, USAID, and the World Bank are aware of Sri Lanka’s debt crisis but do not intend to extend further investments. The World Bank said in May that it does not plan to offer new financing but is repurposing resources to help vulnerable households.

Countries like China are also being asked to consider restructuring high-interest loan repayments as they have done for Zambia. However, the country has not confirmed that changes will be made.

Given other countries are likely to default on debt in the coming months, DeVotta said that he hopes countries across the world will agree to take a “haircut” while renegotiating the terms of foreign transactions that would be better for society as a whole.

The post Experts Say Sri Lanka’s Debt Crisis is a Global Humanitarian and Political Issue appeared first on Direct Relief.

“[The heat]’s very unpleasant,” said Dr. Caroline Weinberg, founder and CEO of Plan A Health. “But inside it’s nice and cool.”

The “inside” in question is the interior of a 210-square-foot van that a team of women is driving around Mississippi’s Delta region. They offer free reproductive and primary healthcare services in the most rural parts of the state.  

Weinberg hatched the plan for a mobile clinic in 2018, after learning that Mississippi had one of the worst health outcomes in the country. The New York doctor began visiting the area and fundraising for a mobile unit just before the coronavirus pandemic, building trusting relationships through collard green-and-cornbread dinners with local health professionals. Her dinner companions introduced her to more people and gave her tips on how to talk about the work she would be doing.

Weinberg raised $25,000 in her first year. Now, the Plan A Team has expanded to employ a host of women from the Delta region who recently celebrated one year on the road.  

“The other day we were trailing each other (on the highway) and she passed me; she was gone,” Desiree Norwood said about her colleague driving the Plan A van. “I was just like ‘Wow, she is really driving’.”

Care in the community

Norwood is Plan A’s program coordinator. She first learned about the practice when the mobile unit was scheduled to visit her hometown of Sunflower, Mississippi, in 2020. Sunflower’s population of 1,068 people is 76% Black, and the median household income is $16,824. Half of the city’s population lives below the poverty line.

Without Plan A, Norwood would have to travel eight miles north or 13 miles south to receive care — a trip that people may not be able to take.

“I was just like ‘Wow, this is going to be something amazing’,” Norwood said.  

Mississippi reported 8.3 infant deaths per 1,000 births in 2020. The infant mortality rate has decreased by about 6% since 2019. The state has been encouraged to improve maternal health for almost a decade by supporting policies that expand access to care, improve women’s overall health before becoming pregnant, eliminate racial and ethnic inequities, and increase breastfeeding and safe sleep practices.

However, the state’s maternal mortality rate is still the fifth-highest in the country. The maternal mortality rate is 22.1 for every 100,000, higher than the national average of 17.47. The state also had the highest rates of excess deaths, from coronavirus and chronic diseases like heart disease, between 2020 and 2022.

Mississippi is one of 12 states in the country that declined expanded access to Medicaid, leaving 15% of residents under the age of 65 without medical coverage, according to the latest census data.

Many of the small Delta communities lack a brick-and-mortar health clinic, and residents must drive to other cities for medical care. Weinberg says about 98% of their clients are Black women who seek prenatal and postnatal care.

The mobile clinic travels to about three destinations per week with Antoinette Roby at the wheel.

Roby was a truck driver for 10 years prior to working with Plan A. She studied healthcare administration in school, which qualified her to be both the driver for the mobile clinic and a community health worker.

The secrets of success

The Plan A Team has prioritized the power of relationships. Norwood said they have a vested interest in the communities they serve.

“A lot of people come to the Delta to do research, do programs, and then they leave,” she said.

Weinberg said she had to learn to adjust and let go of her initial dreams of what the mobile clinic could be after she began to learn more about the needs and wants of the communities she planned for the van to go to. Since the staff are from the area, they’re familiar with local government and religious leaders, they know how to talk to patients, and they understand the culture of the communities they serve.

“It’s not like I can just pick up what I did in this Mississippi and drop it in, like, Georgia or Louisiana,” Weinberg said. “You have to like, take that time to know the community, because every place is different.”

 They were also warned by people in the community about how they may be perceived if they started conversations about access to birth control and passed out condoms (which are included within their services).

Roby said their success also has a lot to do with their welcoming attitudes and ability to share accurate information. Since many of the rural communities lack physical doctors’ offices, many seek information on the internet or by talking to those closest to them, rather than from trained medical staff.

“I pretty much have this outgoing personality and this smile, too,” Roby said

When the Supreme Court overturned Roe v. Wade this summer, Plan A was already working to increase access to reproductive services. Weinberg admitted she worries about the increased risk of maternal mortality. Plan A does not conduct abortions; however, patients can receive care regarding prenatal and postnatal care, and anything related to the cervix, uterus, and vagina. Patients also don’t have to identify as women to receive care.

Though they do their best, Weinberg admitted there’s a threshold to their capacity. Like any nonprofit, they continue to fundraise, but without policy changes at the state and federal levels, major risks remain for Mississippians.  

“There are limitations to what we can do,” Weinberg said. “We can’t solve every problem, and that’s very scary and irritating. It’s like you see the problem that you want to be able to solve it and you just can’t always solve it.”

So oftentimes the Plan A team relishes their big wins, like serving 10% of a community in one day — even if that means they saw fewer than 30 people. To them, driving the 100 miles to provide care for someone in need will always be worth the trouble.

“I felt like it was bigger than, you know, just me,” Norwood said. “To be a part of this organization where they’re going into communities that don’t have a lot of access.”

Direct Relief, in collaboration with Bayer, has awarded $50,000 to Plan A through the 2022 Community Health Awards, which aim to increase and strengthen the provision of family planning services to vulnerable populations in the U.S.

The post In Rural Mississippi, Plan A Goes the Distance for Patients appeared first on Direct Relief.

The ongoing conflict forced many to leave the country and seek refuge in neighboring European countries. There have been almost 570,000 border crossings from Ukraine into Slovakia since the war began. About 80,000 of those who left Ukraine are living in Slovakia under temporary protection, leaving other family members and friends in their home country.

Slovak health officials say support for Ukrainian refugees has shifted from immediate necessities like food and shelter to health, housing, and job support. As the war continues, the opportunity for Ukrainians to return home decreases and the need for stability in their new country increases. In a non-traditional method of support, the League for Mental Health created a mental health program for Ukrainians, by Ukrainians.

As refugees began to enter Slovakia, the League published announcements on social media and with local news sources about a mental health helpline for Ukrainian refugees. The League has a similar hotline for Slovak residents in need of immediate help.

As calls began to come in, League executives said they realized they needed to build trusting relationships with Ukrainian refugees to make a difference.

Andrej Vršanský, executive director of the League, said Ukrainian refugees have been hesitant to communicate with Slovak doctors as they navigate the emotional reactions of trauma: anxiety, guilt, panic, depression, and difficulty believing what has happened. So, they began to search for Ukrainian psychologists to speak with the incoming Ukrainian refugees. Some of those hired had emigrated from Ukraine during the 2014 Russo-Ukrainian War.

“If I’m a Ukrainian and I’m displaced from my country and they come to a different country, of course, I don’t trust the new environment. I don’t want to be here,” he said. “So, whom do I trust? I trust my own people.”
Viktoria Mariniuk coordinates the groups of psychologists across Slovakia’s eight regions. There are about 35 Ukrainians working within the program now and another 30 in training.

The League’s goal is to reach at least 100 and officials say they have been willing to volunteer their time even without being processed through the system. “They’re talking to people, asking about their needs and why? Because they really care,” Mariniuk said. “They’re their compatriots. And this is really a very wise choice to invite Ukrainian psychologists to help Ukrainian people, because (of) this compassion.”

Most of those who have fled Ukraine are women and children. Most men were required to stay in the country at the risk of being enlisted to fight in the war. The League has mostly worked with teens and young adults, but they expect more Ukrainian refugees at the end of the summer as the war worsens and weather conditions change.

Mariniuk said that most of the Ukrainians who call to ask for help believe that they will be able to go back to Ukraine in a few weeks. The disbelief of their new reality is troubling to League employees like Mariniuk, who say the refugees will be better off once they feel independent within their new country.

“They’re getting jobs, they’re getting their lives back on track. They’re sending their kids to school and they can care about themselves, so they need to be stable,” she said. “And what we are doing, we’re helping people to become able to care about themselves, about their basic needs. And this is very important from the psychological point of view.”

The League for Mental Health’s status as a nongovernmental organization allows it to streamline traditional hiring practices. Ukraine’s lack of membership within the European Union and different academic standards has affected labor contracts and prevented some from finding employment. However, with help from international organizations like UNHCR, Direct Relief, and MHPSS, the League can build the local capacity of services by hiring Ukrainian mental health professionals to work with Ukrainian refugees.

Supporting non-EU members with health and housing support that isn’t offered to all Slovak people is a contentious topic for some. However, Vršanský said it’s a natural human response to help those in need. He thinks of the program as mutually beneficial because he doesn’t think that Slovakia has enough mental health support on its own.

“Because we care,” he said. “We should take care of their mental health because we don’t want them to suffer. In Slovakia, we want to create an environment that will enable them to integrate and to be a full member of our society.”

Vršanský said it’s a non-traditional method, but he believes this strategy will decrease the risk of personal harm, crime, and mental instability long term. Ukrainian refugees in Slovakia are currently eligible for healthcare, food and housing support, but Vršanský said that many don’t feel in control of their own lives in the current context.

The League hopes that if refugees are able to communicate with someone who has been in a similar circumstance, support them with their mental health needs, and feel in control of their lives that they will see better health outcomes.

“They would be able to control their own lives, at least a little bit,” he said. “It’s a very different perspective.”

Direct Relief supported the League of Mental Health with a $750,000 grant to support mental health and psychosocial support for Ukrainian refugees in Slovakia.

The post Supporting Mental Health as Ukrainian Refugees Navigate Life in Slovakia appeared first on Direct Relief.

Of those respondents, 24% said they experienced health problems and 17% said they experienced serious financial issues after the extreme weather event. About 14% had to evacuate their homes. The survey results showed that these conditions were heightened for people of color.

Gilbert Michaud, assistant professor at the School of Environmental Sustainability at Loyola University of Chicago, draws a direct link between these dangerous weather patterns and climate change.

“Thermal expansion that causes sea level rise, and how that impacts flooding and erosion is one major challenge,” Michaud told Direct Relief. “Broadly, heat waves, drought, and increased severity of storms are all major challenges with temperature rises.”

Heat

Heavy sweating, headache, dizziness, cramps, and a fast pulse are signs of heat exhaustion and heat stroke.

It’s important to know the signs of heat-related illnesses as temperatures rise and weather conditions worsen, particularly as nearly a dozen major cities across the US broke heat records this week, with more than 25 million people across the Southern US under heat advisories. 

The southern U.S. is more susceptible to extreme heat.

Extreme heat, while a leading causes of weather-related deaths in the U.S., is one of many environmental changes that adversely affect health and worry environmentalists and healthcare providers.

Wildfires

Several parts of the country have experienced massive fires earlier in the year than expected.

Fires in Arizona have been burning for as long as two months on over 95,000 acres of land. More severe fires have occurred in New Mexico, which has experienced over 884,000 acres of burning land; Texas with over 447,000 acres; and Alaska at over 300,000 acres, according to the Fire, Weather and Avalanche Center.

Over the past two weeks, Direct Relief has sent more than $54,000 in medical support to counties affected by wildfires in the United States, including N95 masks, hygiene kits, insulin, antibiotics, and a solar power station.

Michael Crimmins, a professor and extension specialist in climate science at the University of Arizona, said the limited precipitation in the air throughout the winter has caused more arid conditions. The dry and windy weather has made it easy for large wildfires, like the Pipeline and Haywire tunnel fires near Flagstaff, Arizona, to spread quickly and are difficult for response teams to control.

“These fires are responding to weather patterns rather than creating them,” he said.

Wildfires in the Southwest region are common, but Crimmins said that these fires have sprouted earlier than usual and have spread faster. Their smoke is likely to be seen across the U.S. in later months, just as smoke from fires on the West Coast were seen in the American Midwest and Northeast in the past.

The greenhouse gasses emitted from these smoke clouds are harmful to groundwater, lakes, and breathable air. In turn, the harmful environmental conditions increase risk of chronic diseases like asthma, heart and lung disease, and obstructive pulmonary disease.

Many of the fires in the southwest were contained within rural areas. However, there’s still a great threat to the livelihoods of people who live nearby.

Blackouts

Across the country, experts say residents should expect rolling, or planned, blackouts from energy and utility companies who are trying to maintain power grids.

Michaud said the American West and Texas have historically been susceptible to blackouts. Now, larger regions of the Midwest, like Chicago and St. Louis, are “particularly vulnerable” to blackouts that are happening more frequently and for longer periods of time. 

“When it’s very hot, it’s natural for many to keep the air conditioning low, or even turn it down,” Michaud wrote in an email to Direct Relief. “The rise in extreme heat causes great strain to our power grid, which is aging and not always able to meet peak demand for electricity.  Moreover, air conditioning systems themselves emit greenhouse gases, which also contributes to the climate change issue.”

These planned outages pose serious health risks to seniors and people with chronic conditions who are more vulnerable to heat exhaustion. Those who require medications that need to be kept cool, like insulin, are also at risk when power is limited during extreme hot weather temperatures.

In 2021, Direct Relief launched the Power for Health initiative, with an initial commitment of $5 million to increase energy resiliency among U.S. nonprofit health organizations. The funding, which will be used to secure resilient energy sources, such as solar generation and backup battery systems, will allow health care providers to remain operational even during disaster-caused blackouts.

Even before Power for Health, Direct Relief had invested years and $10 million in solar and battery projects for the U.S. nonprofit safety net.

The post Extreme Weather Is Taking a Toll on Human Health appeared first on Direct Relief.

A white supremacist murdered ten people and wounded three others in a Tops Friendly Market on May 14. The Department of Homeland Security characterizes mass shootings as having a random selection of victims; however, the shooter in Buffalo intentionally sought out Black employees and customers at the Tops supermarket.

Ansari’s medical team has remained in the predominantly Black neighborhood to support affected residents. Black employees have told her team that the shooter made pointed comments to them a day before the shooting. As her team works on the ground, Ansari says the long-term need is to dismantle the racism and anti-Black policies that made it possible for the shooting to happen.

Ansari is the CEO and executive director of the Community Health Center of Buffalo (CHCB), a federally qualified health center. She’s kept a physician, nurse, and counselor available to those in need, but her team isn’t being paid for services. There’s also greater demand than the supply of Black counselors.

“When we’re out working in an emergency like this, we aren’t asking people to put their claims in or asking for their insurance,” Ansari said. “We aren’t worried about getting paid, we’re just going out there.”

She says that they’ve been traumatized in the process by losing their neighbors to the shooting and listening to store employees recount the occurrence.

“One of the young men, who actually brings in the carts, [the shooter] told him he was going to kill him the day before,” Ansari said. “So there’s all those other dynamics of, he didn’t just come in and blow us away. He was strategically having interactions with people in the store and the workers. So it puts a different kind of burden on us.”

Ansari also shared that many Tops employees work multiple jobs and were expected to show up to their other places of employment after the shooting.

Others have also donated their time, transportation, and groceries. The racist attack left many mentally traumatized and physically without access to a supermarket and pharmacy, as the supermarket has yet to reopen. Ansari said that non-Black counselors have been willing to offer their services, but the community and store employees are fearful and non-trusting after the horrific event. 

“We’re all still in shock,” she said. “We still are all traumatized.”

Leaders and volunteers like Dr. Ansari’s team continue to address the community’s immediate needs; however, they say it’s not sustainable. The gruesome event has highlighted what East Buffalo’s Black community has stressed for years: Racism is decreasing their life expectancy. As the Masten community begins to rebuild, local Black leaders say dismantling racist ideology and supporting the economic development of their neighborhood is the only way to increase their survival.

A history of health inequity

Ansari said that 80% of the patients who come to CHCB are seeking medical care as a response to social determinants of health. She said the survivors of the shooting have been left with extreme anxiety and that some did not sleep for days following.

The Buffalo Center for Health Equity reported that Black residents of Erie County were dying at three times the rate of their white counterparts in a 2019 report. Researchers found health inequities through social determinants of health had decreased life expectancy for Black residents by about 12 years.

These inequities have shown up as increased risk of chronic diseases, maternal health disparities, mental health issues, lack of nutritious options, over-policing in neighborhoods, and increased tobacco use.

The Center is housed at the University of Buffalo and created through the African American Health Equity Taskforce. Their goal is to eliminate the city’s racial, economic, and geographic-based health inequities. Buffalo’s storied history of segregation has greatly attributed to health inequities through redlining, or housing policies that created restrictions on where non-white residents could own property.

“I’m unapologetically in love with Black people,” Pastor George Nicholas said on why he founded the task force that led to the Center and the Health Department’s health equity department. “Looking at the condition of Black people living in the city of Buffalo and seeing the high levels of poverty, unemployment, residential segregation, and poor health outcomes that are driven by the social determinants of health and the region at that time, the city [was] not really embracing that as a priority.”

Now, the religious leader is adding hate crimes to the list.

A segregated design

About 34 percent of Buffalo’s population is Black, and most live in segregated neighborhoods. About 27% of Buffalo’s Black population lives in a neighborhood with extreme poverty, compared to 2% of Buffalo’s white population. And 37% of Buffalo’s Black population lives in a neighborhood with high poverty, compared to 12% of Buffalo’s white population, according to a 2018 study by another local equity group.

The Center has focused on five ZIP codes where Black residents are dying prematurely. Nicholas says all four are at the intersection of the 14208 ZIP code of New York that housed the Tops supermarket.

According to the University at Buffalo’s Regional Institute, just over 10,300 people reside in the 14208 ZIP code. Of those residents, 78% are Black. Almost half of 14208 residents stopped their education during high school, and one-third of the households are without a vehicle. Now that the Tops supermarket is closed, the next nearest Tops is a 40-minute ride away on public transportation. Other branded grocers are about a 25-minute ride on public transport.

Before the shooting, it was almost guaranteed that any Black person within a 5-mile radius would visit the Tops supermarket.

Attorney General Merrick B. Garland shared a U.S. Department of Justice press release in mid-June, saying the supermarket shooter would be charged with federal hate crimes, given that he intentionally chose a location that was guaranteed to have a high density of Black people present.

Thomas Beauford, president and CEO of the Buffalo Urban League, said the city’s historic design created the perfect scenario for a white supremacist to walk into the community and cause harm. Beauford said the Tops supermarket was a “critical place” in the community, as it was one of few places for residents to be social, cash checks and pay bills, and purchase food and medications.

The Buffalo Urban League has worked within and built a trusting relationship with the 14208 community for years through their jobs, family services, and community health worker programs. Beauford joined the organization during the height of the coronavirus pandemic in 2020. The Urban League secured Federal Emergency Management Agency dollars that year to create a crisis team to address the pandemic. Buffalo’s Black population was at a higher risk for coronavirus given the chronic health conditions and people-facing jobs that limit social distancing.

Now the crisis team and community health workers who typically address chronic diseases are working to address the ongoing trauma from the supermarket murders.

Creating change

Ansari and Beauford are members of Greater Buffalo’s Racial Equity Roundtable, which produced the 2018 report. Much like Nicholas’ African American Health Equity Taskforce, the roundtable is comprised of a cross-sector community leaders working to address systems change in Buffalo. Their work has focused on narrative change, addressing racism within the justice system, and creating employment opportunities.

Some residents now fear the supermarket will never reopen. Some fear they will never go back if it does. The community fought to have the supermarket open in the neighborhood years ago and again for upgrades to make the store viable in the area.

“We’re often regulated to a zero-sum game of limited resources where we can only have ‘this or that’ and that’s been the story of the East side,” he said. “But you go into other communities, and they have this, that, these and those. They have multiples, a variety, and we’re fighting to just get one.”

Beauford called the differences in Buffalo neighborhoods “legacy problems” that have stemmed from racist public policy. He says the way forward is to allow residents to have a choice in their grocers, increase competition, and build supermarkets of different brands within the area without considering the shooting as the “single point of failure.”

There is an opportunity for economic development operations to change as donations build in response to the shooting. A newer grant program, East Side Avenues, is making strategic investments and capacity-building programs for Buffalo’s East and South sides. One of the five strategically targeted investment areas includes Jefferson Avenue to create a viable commercial district.

Tops Friendly Markets and The Community Foundation of Greater Buffalo have partnered with grantmakers to secure donations for the survivors of the shooting. Some of the dollars are supposed to support Black-led organizations in the area. Millions have already been donated.

But Beauford, who previously worked within the financial industry, said he worries about what restrictions will be put in place for grant dollars and how Black residents will be affected by the proposed development changes. When he looks at how the city has transformed in recent years, Beauford sees intentional investment to revitalize the downtown, the football stadium and the waterfront area. He says that investment has not gone toward predominantly Black neighborhoods.

A critical moment

As the nation responds to the shooting and Buffalo residents grapple with a traumatic event, Beauford, Ansari, and Nicholas say leadership is more critical than ever.

“I’m very concerned with the dialogue and the conversations that are going on right now. Because they’re more in the line of, of just services programs, and not structural change,” Nicholas said.

Beauford says he’s also worried. Two weeks after the shooting in Buffalo, another murderer shot and killed children and teachers at an elementary school in Uvalde, Texas, prompting a national conversation on mass shootings, mental health services, and access to guns.

But Buffalo’s situation was different. It was a targeted, racist attack, and local leaders say how the shooting is discussed will affect the health and well-being of Black lives in the future.

“We don’t want it to all be swept up together,” Beauford said. “We have to be careful not to let the focus shift.”

Since January 2020, Direct Relief has provided local healthcare providers in Buffalo, including Community Health Center of Buffalo, with more than $300,000 in grant funding and donated medical resources.

The post Healthcare Leaders Explain How Racism and Inequities Cut Black Life Expectancy in Buffalo appeared first on Direct Relief.

Another revelation came when she learned that the predominantly Black neighborhood she grew up in was home to a major lawsuit, as environmental toxins had influenced health disparities in the region.

While still a university student, Taiwo began working at the Whitefoord Health Center in Atlanta. Her own experience, as well as a different job in the medical field where she fielded calls from people asking for food, utility, and medical assistance to no avail, pushed her into community health.

“It was just like, I can’t just sit at home and do nothing,” she said.

Today, Taiwo is a community health worker at Whitefoord, located in Atlanta’s Edgewood neighborhood. Amid the global pandemic, she’s managed to reach disenfranchised groups and grow the health center’s patient base – a challenge in a gentrifying neighborhood where residents don’t always get along. She has hosted pancake breakfasts and bingo, passed out flyers on accessing health care, and helped people call Whitefoord to get an appointment.

Edgewood is a historically Black area with a population that has shifted to a mixture of white, young professionals with advanced degrees in the last few years. In 2019, Atlanta was considered the fourth fastest gentrifying city in the nation and the Edgewood neighborhood was seeing home prices rise. In the past, the area was known for high crime rates, low educational attainment, and high poverty rates.

Atlanta’s bustling housing market made the neighborhood a target for gentrification, as developers eyed plots of land to build new townhomes and apartment buildings. The gap in household income has widened in Edgewood, and the shift in economic status has pushed out longtime residents, many of them Black and low-income, causing divisions among community members.

Whitefoord hired Taiwo in November 2021 to connect with community members and help the federally qualified health center share reliable information about the vaccine with often mistrustful residents. While many in the United States have had at least one dose of the coronavirus vaccine, early research showed that young adults, residents with low educational attainment, and members of the Black community were least likely to be vaccinated against the coronavirus.

“We started with the vaccines and then because it was a community-wide effort, a lot of calls started coming in,” said Angela Giles, a former Whitefoord employee. “We were overwhelmed with over 1,000 calls in the first 24 hours.”

For all the success of the vaccine effort, health center staff say Taiwo’s work has gone much further: She has built trusting relationships that have helped members of the community access affordable health care services. 

Making Inroads

The pandemic actually brought with it a valuable opportunity. “It’s…caused most organizations to reintroduce themselves to the community as well as to new community partners,” said Louis Simmons, chief operating officer at the health center. “Winnie has done, I think, a wonderful job connecting us to even social service organizations that had never heard of Whitefoord. It’s definitely caused us to receive patients from those other organizations.”

Since the Covid-19 pandemic began in January 2020, Direct Relief has provided US community health centers and other healthcare providers with more than $520 million in medical resources and funding, including more than $130,000 in grants and medical donations to Whitefoord Health Center.

Simmons encouraged Taiwo to begin her outreach by connecting with local churches in Edgewood. Places of worship have traditionally been regarded as trusted, safe spaces in the Black community. Nearby St. Phillip AME Church already served as a vaccination site, and Whitefoord employees hoped other churches in the area would be willing to provide similar vaccination education.

“It’s because we know, as a Black community, the church environment is one of the main social institutions [where] we congregate,” Simmons said.

Taiwo said she quickly learned that there was a lot of misinformation within the community about coronavirus and the vaccine. She realized she could be a resource by answering questions the community brought forward and connecting people across organizations rather than just trying to sell them on Whitefoord’s services.

Building Relationships

Pastor Fert Richardson from King Memorial United Methodist Church was one of many that Taiwo called. He invited his members to participate in a virtual vaccine education event that Whitefoord hosted.

Richardson joined the church in 2020, though the house of worship has been in Edgewood since the mid-1960s. He said the church’s demographics have shifted with the changes in the neighborhood as increased property values have pushed people out of the area.

“People are very concerned about that and trying to say, ‘No, that’s too much’,” he said. “But once you made that purchase you’ve kicked up everybody’s property value, which kicks up the tax.”

Recently, a developer’s plans to build a three-building apartment complex and an adjacent parking lot on what used to be two houses in Edgewood were foiled by community groups. The land the houses were located on sold for $1.6 million.

After connecting with Taiwo and O.N.E., Richardson said he began to learn about more events in the community in which his church could participate. As they learned more about food costs and the area’s significant homeless population, church members volunteered to support Whitefoord’s food distributions.

Taiwo said it was vital that they were building trusting relationships instead of “dropping in” on the neighborhood.

“I wanted to be an ally versus someone that just comes in and starts making changes that the community didn’t really ask for,” she said. “I wanted to see what the community was all about.”

Making themselves available

According to Taiwo, the Black community of Edgewood feels unheard regarding the area’s changing landscape, which has contributed to the mistrust between residents and community organizations in the past. Taiwo realized that trying to convince neighborhood residents to get the coronavirus vaccine wouldn’t work unless she learned their values, beliefs, and needs.

They had questions about Covid-19 safety precautions, the best places to go for reliable information, and the vaccine itself – particularly about how their data was being collected.

“I really took those (questions) very seriously because it comes from hundreds of years of oppression that Black people have experienced in this country,” Taiwo said. “Healthcare has not necessarily been the best for African Americans when we think about racial disparities.”

Open Heart Atlanta, a nonprofit that provides nutritious food and cooking classes to primarily low-income people of color across Georgia, is one of Whitefoord’s informal partners. Aleta McLean, the senior director of client services at Open Heart, said working with the health center has been constructive because neither organization asks the community for anything in return. They are simply making themselves available and supporting the needs of their neighbors.

In recent months the relationships have continued to grow. Taiwo said that people had called her directly to figure out how to get services and that she continues to plan community events for residents to participate. In April, she worked with local organizations to host a bingo breakfast for seniors who had questions about the coronavirus.

Whitefoord employees said they’ve learned that taking the initiative to reengage people where they are has helped them build trusting relationships with the community to seek out the health care services they need.

Giles, the former Whitefoord employee, said Taiwo’s work is organic and honest, with a grassroots approach that people trust and encourages other organizations to work with them.

“It was a great heartwarming thing to see everybody pulled together just piling resources,” Giles said.

The post In a Rapidly Gentrifying Community, Building Trust Is Key to Improving Health  appeared first on Direct Relief.

Their accessibility to patients – they’re often right there when patients pick up medications and can meet with patients more frequently and for longer than many medical doctors – has created a pathway for health care teams to develop relationships, support efficient medication management, and find gaps within patient care. They’re also the only doctor who interacts with every specialist a patient may see throughout their treatment.

In the early days of Covid-19, pharmacists found new ways to connect with patients and maintain efficient health care management through telehealth medicine and meeting patients where they are.

“We talk to patients maybe three times more than their regular providers do, and we manage their medications,” said Nader Tossoun. “By the time their provider sees them again in three to six months, there can be tremendous improvements in their health outcomes.”

Tossoun is an ambulatory care pharmacist at Northeast Valley Health Corporation in San Fernando, California. During the pandemic, the community health center used funding from Direct Relief to hire patient navigators who work with pharmacists to engage patients. As providers became busier and short-staffed during the coronavirus pandemic, Tossoun’s team was available to meet with patients regularly to continue their care.

The pharmacist said the most critical part of his job is being present for his patients.

Tossoun’s parents were pharmacists. As a child, he watched them at work and how often they interacted with members of their community. He says their ability to help others is why he wanted to follow their professional careers.

“All you have to do is walk into a pharmacy and you have a health care professional right there ready to answer all of your questions,” Tossoun said.

But Tossoun’s team is a bit different from what a patient might find at a traditional pharmacy since they are embedded within the health center. His team uses patient navigators to engage patients on a personal level by asking about their daily routines and working with patients to create a feasible management plan. They consider the social determinants of health, like whether a patient has access to food, reliable transportation and a steady income to afford their medications, to be part of each patient’s medication management plan.

In San Fernando, California, where Tossoun’s team works, there is a large Latino population, and almost 40 percent of the population was not born in the U.S. About 10 percent of the community lives under the poverty level, and the median household income is just $60,655, compared to the national median of $67,521. Many of their patients lack reliable transportation, stable housing, and access to food.

“In society…they’re the invisible people,” said Tossoun. “They’re overlooked. They’re either looked down upon or they’re ignored and not really listened to. When they come here we try to reinstall that hope and let them know that we are here for you. We are accessible to you and we have the same goal, which is your wellness, which is your longevity, which is your qualify of life.”

Tossoun and his team say that working with patients and understanding their daily needs has fared better health outcomes. Patients are more willing to listen to them and work with them on their health and wellness plans. The patients feel like they have a shared interest in the medical decisions, not just a doctor telling them what to do.

“You’re the boss at the end of the day,” he said. “I’m here to help you, but you’re the boss.”

Share Our Selves, a nonprofit health center in Orange County, California, has a similar patient-focused mantra. Everything they do is for their patients, according to Mary Ann Huntsman, chief quality and innovation officer. She said their intent is to empower the patient by listening, meeting patients in their homes, and working with patients to determine a health plan that’s affordable and manageable.

“Acknowledge and meet the patient where they are, that’s what the pharmacist can do,” Huntsman said. “They understand medication therapy management, they understand and they see every day the struggles that patients have.”

Huntsman said that not knowing your pharmacist could be to the detriment of a patient’s health. She said the pharmacist is the “best kept secret,” that she wishes wasn’t a secret at all.

Like the Northeast Valley Health Corporation, Share Our Selves works with patients who lack reliable transportation and have lower incomes. They are redefining the roles of pharmacists to engage the community so that people feel empowered to take control of their health.

When coronavirus began to spread, Share Our Selves was forced to develop ways to better connect with the community. They pushed telehealth options and hired community health workers to ask patients about lifestyle needs to understand better and develop efficient health and wellness plans. The community health workers are also bilingual and bicultural, which has lessened communication barriers with the diverse population they serve.

Share Our Selves will bring medications and monitoring devices to patients’ homes and has a food pantry for vulnerable patients who don’t have regular access to groceries.

Nancy Dao, the clinical pharmacy manager at Share Our Selves, says the pharmacy team brings a unique view to patient care. There’s more to their work than most realize, she said. Pharmacists determine which medicines are safe and effective to take, figure out what’s cost-effective for the patient, assist patients in understanding their insurance benefits, and act as a resource for providers. Often, Dao also manages the administrative tasks of running the pharmacy.

“Everyone should have a relationship with their pharmacist,” Dao said. “We want to be so helpful and we can be the missing piece of their health (care plan).”

Since Share Our Selves added telehealth and in-home options, Dao said patients are more likely to discuss their needs. For Dao, it means she can be proactive about patient care rather than reactive.

“If I know a patient gets a delivery every first Wednesday of the month, I can plan ahead and reach out to her,” Dao said. “It’s more convenient for the patient and less headache for the pharmacy.”

Direct Relief, together with BD, has provided Northeast Valley Health Corporation and Share Our Selves grants totaling $420,000 each to expand pharmacist-led care for at-risk patients. The funding is part of the BD Helping Build Healthy Communities initiative. In total, Direct Relief has provided more than $1.2 million in grants and $420,000 in medical aid to Northeast Valley Health Corporation and Share Our Selves.

The post Why a Pharmacist May Be the Best-Kept Secret on a Health Care Team appeared first on Direct Relief.

“That left an impression on me,” Coleman said about the Black nurses she met at the conference. “I felt like ‘I can do that,’ and here I am, already a nurse,” she said, laughing.

That’s a feeling the National Black Nurses Association (NBNA), which has 114 chapters in over 30 states, wants to encourage nationwide. Of the millions of nurses in the United States, less than 9% are Black.

Coleman, a professor at Samford University and pediatric nurse, is one of several NBNA members working toward diversifying the nursing profession and enriching other nurses.

A recent pilot program, in which Coleman played an important role, taught elementary school students in Alabama what nurses are and what they do. Now, with seed funding from Direct Relief and local governments, NBNA is scaling up the service to create seven more Mini Nursing Academies across the country. 

The association hopes that the academies will encourage young students of color to begin thinking about nursing as a profession. The new programs will begin in the fall of 2022 in Florida, Louisiana, Missouri, Illinois, Connecticut, Oregon, and South Carolina. Students will conduct a research project the first semester, followed by hands-on activities the following semester with nurses in the field throughout their community. Each year a new cohort of students is expected to join the program. 

“You have to role model”

NBNA is focusing on school children from grades three to six so that students are aware of nursing opportunities early. The geographic areas the association chose had schools with a significant number of students who represented a racial or ethnic minority, a high percentage of students who qualified for state-funded lunch programs, and low graduation rates.  

“It’s when they are at an impressionable stage of life,” said Loretta Lee, who helped lead the Alabama pilot program. “We’re trying to give them a sense of worth so that they understand that they can become a nurse, and alert them to the impact of health disparities.” 

Students in Alabama’s pilot program led and participated in a research project to understand the effects of a sedentary lifestyle. They learned the research process by tracking classmates’ health through weight, height, blood sugars and heart rate before and after activities. The students also learned about chronic diseases that have significantly affected Black and Latinx populations, like diabetes, hypertension, and obesity. 

Like Coleman, Lee is an accomplished nurse who said there is great value in representation. An associate professor at the University of Alabama at Birmingham and a family nurse practitioner, Lee said she first recognized the importance of representation when meeting with fellow NBNA members. 

“Students in our communities probably don’t see people who look like them very often as nurses,” Lee said. “I believe you have to role model, meaning if a Black student or Brown student sees a registered nurse, has interactions with a registered nurse throughout their youth, then they are more apt to become a registered nurse if they can get information, if they can know what that profession is about. And they’re more apt to want to emulate what they see.” 

“A small proportion of the whole”

NBNA was organized in 1971 and incorporated as a nonprofit in 1972. The association serves as the “voice for Black nurses and diverse populations by ensuring equal access to professional development, promoting educational opportunities, and improving health,” according to its website.

Martha Dawson, who is serving in her second term as NBNA President, made a vow to her colleagues to increase diversity within the field, expand the workforce, and further the support and engagement of NBNA members. The acclaimed doctor of nursing practice said she is deliberate in her work to support Black nurses to reverse the disparities that have hindered their access to educational and professional opportunities. 

Dawson said that many of NBNA’s members are also members of the American Nurses Association, but the other organization doesn’t support all of their needs. 

“Why do we need a Black Nurses Association? Because society doesn’t see me as a person first, they see me as a Black person first,” Dawson said. “So, therefore, if I’m going to be seen as a Black person, then that means they also see me as a Black nurse. There’s still racism embedded within the nursing profession and there are still some patients out there who do not want Black nurses.” 

When Dawson ran for re-election, she told her colleagues that she would focus on diversity, equity, and inclusion. To her, that means supporting education and professional outlooks for nurses, but also building trusting relationships with patients. She said that moving past cultural congruence to cultural competency is a major part of the work. To achieve that nationally, racial and ethnic diversity is required within the nursing workforce. 

“It is my philosophy that I can never be competent in someone else’s culture,” Dawson said.  “I can provide good care to a Native American but would I ever be culturally competent? No…So it’s not just about increasing the number of Black nurses; we need to increase the number of Native American, Asian, Hispanic, because again when we look at the millions of nurses, minority nurses still only account for a small proportion of the whole.” 

“To help people survive”

That small proportion of nurses has been called on in a major way throughout the coronavirus pandemic. Members of the NBNA helped create the Black Coalition Against Covid in March of 2020. Other members used local radio stations to consistently update communities on the virus and talked about the importance of getting vaccinated once doses became available.  

The nurses held webinars and town halls to talk about coronavirus. They created a system to support elderly residents during the pandemic, and worked with health departments and the faith-based community to build trusting relationships with people. NBNA nurses have also advocated for policy issues like smoke-free environments, reducing food insecurity, and supporting environmental justice – all social issues that predominantly affect Black and Brown communities.  

“Every space that we felt we needed to be in to help people survive, those were the things we were doing,” Dawson said. 

“serving the people where they need to be served”

While serving their communities during a global pandemic, the nurses continued to look for ways to support each other.  

The Portland, Oregon chapter of the NBNA was formed in early 2020, just before the coronavirus pandemic shut down much of the country. In Oregon, just under six percent of the population is Black. 

Danaya Hall, who founded the Portland chapter, said 16 nurses decided to join the organization that February due to the “toxicity” they were experiencing at work. 

“Here in Oregon, it’s such a white community,” she said. “It was really created to be a white utopia. You know, we had laws excluding Black people well into the 60s, which wasn’t that long ago. So I think people were really reckoning with the racist history here in particular.”

Hall moved to Oregon from California and said the difference was startling. Many of her Black colleagues in the area experienced trying times at work during the pandemic. On top of working extreme hours and trying to protect themselves and their families, Black nurses witnessed the Black community die from coronavirus at a disproportionately high rate. 

They founded the Portland chapter to build trusting relationships with one another and to strategically address systemic racism in Oregon’s healthcare systems. 

“Most of the Black nurses, in whatever setting they work in, they’re the only one – and that is a very vulnerable place to be,” Hall said. “When we’re talking about managing health disparities, and all these organizations run by white folks are scratching their heads to understand why African Americans are sicker, they can’t really understand that. It’s because the institution is not serving the people where they need to be served.”

As the Oregon nurses began to discuss ways to improve equity within the sector, their work collided with NBNA’s effort to scale up the Mini Nurses’ Academy. With additional funding support, the Portland chapter plans to use a mobile unit to teach young people about the nursing profession, to support representation and racial inclusion in the nursing profession moving forward. 

Direct Relief’s Fund for Health Equity supported the National Black Nurses Association with a $248,000 grant for the Mini Nursing Academy. The organization also received $100,000 from Direct Relief’s Covid-19 Response Fund for Community Health for pandemic response efforts.

The post Nurses of Color Are Underrepresented – with Serious Consequences appeared first on Direct Relief.

When Diane Tyler-Peterson goes to the federally qualified health center (known as CHASS) for routine check-ups, she’s likely to see her doctor, pharmacist, nurse, and social worker all in one visit. Her chosen support person – her husband – is usually there too. For Tyler-Peterson, it’s helpful to have a team of people working to help her manage her diabetes.

Now, more diabetic patients will have access to the same type of team-related care, due to a grant from Direct Relief’s Fund for Health Equity.

CHASS is one of 50 recipients of grants from the fund, which was created to increase access to health care and improve health outcomes for marginalized communities. The health center, which has a longstanding and trusting relationship with Detroiters, was awarded just over $100,000 to enhance diabetic patients’ access to care coordination and medication therapy management.

Dr. Felix Valbuena, chief executive officer of CHASS, said coordinated care will help patients, medical professionals, and staff manage chronic disease together. As part of the enhanced care, pharmacists will also have more inclusive conversations with patients about medications. 

“It’s a whole team of people that are working to improve the health and wellness of that individual,” he said. “A doctor, nurse, social worker, certified medical assistant, pharmacist, outreach and enrollment officer.” 

According to Valbuena, it can be difficult for patients to get everything they need from one visit to the doctor every few months. It’s helpful to have others remind patients of their appointments, help them with eating plans, determine which medications are best and most affordable, and guide them on how often to check their glucose levels. That’s where Tyler-Peterson’s husband has an essential role to play.

“If we can leverage one more person that is part of their lives to help us avoid all of those consequences, we get one step closer to our goal in the US healthcare system where we are preventing all of these crazy diseases and all of their negative consequences,” he said.

When Tyler-Peterson was diagnosed with diabetes in 1999, she was in disbelief and didn’t plan to return to the doctor.

“I didn’t want to accept that I had it,” she said. “I just didn’t want to.”

The longtime Detroit resident said her mother had diabetes as well, eventually developing symptoms that led to amputation and partial blindness.

The medical team at CHASS warned her of the medical risks she was taking by not managing her own chronic disease, and eventually, she came around.

She reluctantly returned to the doctor and began working with CHASS, even when she didn’t have health insurance. (Federally qualified health centers treat patients regardless of their ability to pay for services.) She learned to trust her medical care team and began to listen to their suggestions for healthier living.

Valbuena says patients and their support person will receive training to manage chronic disease, while receiving an added level of preventative care. That’s unusual for CHASS patients, who often can’t afford the expenses of health care – and Valbuena said it’s why the money used to increase health equity is so important.

Mirna Robles, a nurse at CHASS, said she’s seen patients become more dedicated to managing their health conditions when they are included and educated on the details.

“It decreases the patient’s anxiety about their health,” Robles said. “I think they feel very cared for when they see that everybody is working to help them out (and) to really show that we really do care about their health.”

Over the last 22 years, Tyler-Peterson has learned how to manage her own diabetes. She relies on the CHASS care team for health protocols and her husband for at-home support. And she’s committed to working hard: She changed her diet, does a physical activity three to four days a week, and manages her daily insulin needs. Tyler-Peterson says her A1C, or glucose levels, have significantly decreased and she continues to lose weight.

Tyler-Peterson plans to continue losing weight and her goal is to stop relying on insulin. That’s why she’s her doctor’s “best patient.”

“It changed my whole output and that’s why now I’m taking care of myself, because I want to live and not die early like I was supposed to,” she said. 

Olivia Lewis is a journalist based in Detroit, Michigan.

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West Virginia has one of the highest rates of Hepatitis B in the country. The liver disease can be contracted by sharing used needles. In 2015, the state rate was 14.7, compared to the national rate of 1. Additionally, acute Hepatitis C rates have tripled across the country in a five-year span.

While treatable, the rise in Hepatitis cases stems from a larger epidemic — the growing illegal consumption of illicit drugs and wrongful use of prescription opioids. As the rise in opioid overdose death rates impact Appalachia, and the entire U.S., residual health and social issues have emerged. Priorities for local health care professionals are shifting from simply preventing overdose deaths, to treating long-term effects. To do this, many are relying on philanthropic and safety-net aid.

Though President Donald Trump declared the opioid epidemic a National Health Crisis in August, health providers are facing the growing epidemic without federal dollars.

Dr. Michael Brumage is the executive director and health officer at the Kanawha-Charleston Health Department. Most of his work day is spent confronting the opioid epidemic locally by mitigating the effects of overdoses and infectious complications. He’s seen an increase in health risks like bacterial endocarditis, heart valve replacement, infection of the bone, babies going through withdrawal after being born, and social problems like child abandonment.

To address these issues, the department has instituted naloxone trainings and disbursement, needle exchanges, creating more medically assisted treatment programs and identifying residual health disparities like Hepatitis and HIV. They are also building community partnerships and garnering compassion for substance abuse as a disease.

These wraparound health services were created after a 24 percent legislative budget cut cost the health department several employees.

“That’s the beauty of it all,” Brumage said. “None of our supplies have come through tax-payer funded activities… It’s costing taxpayers nothing out of the personnel who already work in the health department.”

KCHD received 10 packs, about 100 doses, of naloxone from Direct Relief through a four-year partnership with Pfizer Pharmaceuticals. Every Wednesday at 12:30 p.m., KCHD’s Harm Reduction Clinic holds an auto-injector training for anyone interested in learning how to save a life. The clinic also travels around the community, participating in events to do more trainings and send naloxone kits home with participants.

Brumage says other philanthropic entities have provided funding for other needs, like a sterile machine to dispose of hazardous materials.

“We rely on the staff that’s already present in our clinic, but we’re augmented greatly by volunteers,” Brumage said.

Those volunteers are predominantly students from nearby schools, like West Virginia University, where Brumage will become an assistant dean in the school of public health. Many other volunteers are community members who want to see change.

Those volunteers must be trained. The health department has written a harm reduction manual outlining policies and procedures, needle-stick protocols and Health Insurance Portability and Accountability Act.

“Many have a keen interest because their lives have been touched, either by family or a friend that has been effected,” Brumage said. “Some have first-hand experience and want to do something meaningful.”

The post Opioid Epidemic Elevates Related Health Risks in West Virginia appeared first on Direct Relief.

California renewed an 1115 federal waiver to implement Medi-Cal 2020 last year. Under the waiver and a $90 million grant over the next two years, counties will act as operators of a managed care plan system, allowing more access to care for Medicaid recipients and resources for doctors to become trained for medically assisted treatment (MAT) programs. Healthcare professionals said it’s imperative to create more access, but are fearful federal changes may affect health coverage for substance abusers and Medicaid patients in the future.

California, which expanded Medicaid under the ACA to include 3,824,774 more residents, is adopting the Vermont Hub and Spoke model to combat the opioid epidemic. This model is an intertwining of existing practices to treat people from a regional level in a state that has more substance abuse treatment centers than any other state. Stakeholders, like providers, state healthcare officials, doctors and substance users say there aren’t enough. Of the licensed narcotic treatment programs in California, most are located in Los Angeles County.

The map above shows which California counties have implemented substance abuse treatment plans. (Map by Olivia Lewis for Direct Relief)

Marlies Perez, chief of substance use disorder and compliance for the California Department of Health Care Services, said the previous system was also difficult to navigate. Some treatment centers were at capacity or were too expensive for people seeking help. Potential patients who aren’t immediately served rarely return once the practice has vacancies.

“For someone ready to seek help, we need to get them quickly,” Perez said. “So, if it’s not organized they may get frustrated and say ‘Forget it, I changed my mind’.”

Santa Barbara County, where Direct Relief is based, submitted a plan and has been approved by the state. The 64-page document includes an explanation of the county’s collaborative process, current service gaps and a referral program.

“I think everybody that can get involved in this endeavor should,” said Dr. Charles Fenzi of the Santa Barbara Neighborhood Clinic. “It’s going to be important.”

Though somewhat controversial, doctors are being encouraged to register patients for MAT programs. Through a Pfizer donation, Direct Relief distributed more than 70,000 doses of the opioid overdose reversal drug, naloxone, across the country, including to MAT supporters. The Santa Barbara Neighborhood Clinics are one organization to receive the donation.

Fenzi is one of two doctors in the Santa Barbara Neighborhood Clinic organization certified to treat substance use disorder with suboxone (a mild opioid that alleviates the pain from withdrawal). There are over 1,100 substance abuse treatment centers in California, and less than 200 are licensed narcotic treatment programs.

The Goleta location of the Santa Barbara Neighborhood Clinics is one of them.

Perez said the practice of treating opioid addiction with a less severe opioid is controversial, because it’s stigmatized. Healthcare professionals who are against the practice of giving substance abusers pills to control their addiction prefer a 12-step abstinence model, which Fenzi says have proven to be most successful for alcoholism — not substance abuse. He also knows doctors who are against MAT programs.

“They feel like it’s cheating,” Fenzi said.

The doctor hopes more clinicians will take the MAT certification to offer the service, specifically psychiatrists.

“Drug abuse and opioid use syndrome is a very complicated disease, because it changes the brain and people are dying from it,” Fenzi said. “That’s part of our community, and if we are going to have a healthy community, we have to provide for all segments.”

Aegis Treatment Centers, LLC, is the largest substance use disorder organization in California with 31 clinics across the state. The organization is a proud proponent of MAT programming, although patient retention is low.

The program requires daily methadone treatment and counseling. State regulation says patients can take home up to 28 days-worth of methadone pills before having to go back to the doctor. This treatment method can last months or years. The timeline is dependent upon the patient’s intensity with abuse.

“We have to get them into medication assisted treatment,” said Matthew Adelman, an Aegis representative. “And have it be at an earlier stage in the addiction timeline.”

Aegis also accepts Medicaid patients, while many other programs do not. Over 50 percent of the company’s patients are registered for Medi-Cal.

With threats from the federal government to diminish Medicaid, healthcare experts like Naderah Pourat at University of California, Los Angeles, said states may have to tighten their budgets. She said it could be a “really big blow to a state like California.”

“The state has to decide can they take on these additional 1 million people,” Pourat said.

The UCLA expert said there was “tremendous outreach” to enroll about 1.5 million low-income individuals in California’s Medicaid program.

Clinics like Fenzi’s are required to take anyone who walks into their office. The thought of financial cuts to the Medicaid program are troublesome.

“I can expect financial hardship (for patients), should that pass,” Fenzi said. “The proposed removal of essential health benefits is very concerning to us as well.”

For now, the state still has grant money to work with, and until future funds are determined, healthcare officials said they are doing their best to reduce the opioid epidemic.

“We don’t have all the answers that’s for sure, but we have made a lot of strides forward,” Perez said. “It’s an exciting time, with a lot of great work being done for Californians that suffer from this disease.”

(Editor’s note: This story is the fourth in a series. Earlier stories can be seen below.)

Further Reading:

‘Heroin Was Home to Me’: One Woman’s Journey from Addict to ‘Champion of Recovery’

Naloxone Reversing Overdose in California’s Coastal Communities

Confronting Opioid Crisis Strains Community Health Resources

The post California Shares Responsibility with Counties for Substance Abuse Treatment appeared first on Direct Relief.