At the request of AltaMed Health Services, a community health center whose staffmembers were providing medical care to evacuees at the convention center, Direct Relief pharmacist Pacience Edwards was delivering an emergency health kit — a large-scale supply of medications and materials commonly requested during wildfires and other disasters. 
 
Police officers waved Edwards through the barricade outside the convention center, where the contents of the kit were put to instant, urgent use. A patient with severe respiratory symptoms had been waiting for a nebulizer — a machine that delivers medication directly to the lungs — and others urgently needed albuterol inhalers. One patient who seemed on the verge of a diabetic crisis needed their blood sugar tested immediately — but the glucometer the medical team already had with them wasn’t working. 
 
“We ripped open the packaging on the glucometer [from the emergency health kit] to make sure they could use it right away,” Edwards recalled.  
 
Patients whose hypertension was made worse by the stress of the fires needed medication to reduce their blood pressure. Healthcare providers working with medically vulnerable patients in close quarters were concerned about recent outbreaks of norovirus and RSV, both infectious diseases that can spread quickly in emergency shelters. Ambulances kept arriving to pick up patients in severe distress. 
 
Direct Relief’s emergency health kits, which can treat about 100 patients affected by a disaster, include equipment and prescription medications for chronic diseases like diabetes and hypertension, respiratory equipment and medications, antibiotics, protective equipment, wound care, hygiene items, and other essential medicines and supplies. 
 
“We had what they needed and they used it immediately,” said Alycia Clark, Direct Relief’s chief pharmacy officer. Clark had been at the Pasadena Convention Center for several hours already to assess needs with the medical teams who’d been working through the night. 
 
Edwards said the level of urgent need was high. She’d been expecting to see the minor wounds and routine medical issues common in emergency shelters. But instead, nurses triaged patients on cots, and ambulances kept arriving to pick up the patients in need of hospital care. 
 
“The medical team was providing a much higher level of care,” she said. And while over-the-counter medications were easier to come by, medical providers told Clark and Edwards that prescription treatments like chronic disease and respiratory medicines were urgently needed. 
 
As the constellation of wildfires across Southern California continues to displace more than 100,000 people, the area’s community health centers, free clinics, and other nonprofit healthcare organizations are coordinating to provide in-the-field care. AltaMed providers were working at the shelter even as the health center lost a facility to the flames and evacuated staff in the path of danger. 
 
“They do not have the resources they usually do,” Edwards said. The level of care she saw physicians and nurses providing in an open shelter space “was just really impressive.”  
 
In response to requests from partners across Los Angeles County, Direct Relief has provided N95 masks, hygiene kits, emergency medical packs, reentry kits, wildfire kits, and other support to healthcare organizations working on the ground. Direct Relief staff have been working in the ground in Los Angeles to distribute N95 masks at community sites like the Koreatown YMCA Center for Community Well-being and the Anderson Munger Family YMCA, deliver requested supplies to community health centers and other partners, and assess and prepare for the next stage of medical need. 
 
“We’ll continue to support as long as needed,” Clark said. 

The post Critical Medicines Bolster Urgent Care in the Halls of an Evacuation Shelter  appeared first on Direct Relief.

A patient urgently needed oxygen, but the hospital’s supply was down to one cylinder — not enough for the case and certainly not enough for the 700-bed facility to get through the night.  
 
Edward Francis Small Teaching Hospital is an essential research and referral hospital in Banjul, the Gambia’s capital city. It is the most critical healthcare institution for the national health security of the country. But until recently, sourcing, transporting, and paying for oxygen canisters for patients were a massive drain on hospital resources. The only oxygen available was industrial, not the more effective medical-grade oxygen. Canisters were carefully rationed, frustrating providers and making it harder to provide surgeries and specialized care. 
 
Dr. Mustapha Bittaye, the hospital’s chief medical officer, explained that staff members needed to wait in a queue every two weeks at an industrial oxygen plant to purchase about 350 canisters. Purchasing the oxygen — if it was even available — might cost 2 million dalasi, or about $28,000 USD, per month. Sometimes oxygen costs more than the entire revenue the hospital collected that month.

The effort and expense it took to meet one critical need is a testament to the hospital’s dedication to its most vulnerable patients, such as newborn babies and the critically ill. But the disproportionate allocation of resources hampered preventative care, teaching, research, and the expansion of medical services.

“It was very common to have many people employed…just moving the oxygen around,” Dr. Bittaye said. “It was very common for supplies to be short. You only give it to those who need it badly…you had to do rationing.”  
 
The complex oxygen piping systems employed by many hospitals allow physicians to customize oxygen concentrations to individual patients, like premature infants, who have specialized needs. They allow surgical teams to use a built-in suction system rather than an external device. Edward Francis Small Teaching Hospital, which operates in conjunction with the University of the Gambia, trains surgeons and other specialists with the goal of eliminating the need for outside medical missions, but its colonial-era facility didn’t have an oxygen piping system or a plant to produce the medical grade oxygen required. 

Now, a new medical oxygen plant has been completed at the hospital, and a pipeline system developed to distribute the operating theaters and oxygen throughout the facility. Biomedical technicians are being trained to maintain the new system over time. 
 
The new system has rapidly changed healthcare in the Gambia, said Dr. John Sampson, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine who works closely with medical partners in West Africa. Now, a new anesthesiologist, who recently graduated from medical school, makes full use of the medical oxygen system in her work at Edward Francis Small Teaching Hospital.
 
“The hospital is transforming very rapidly,” Dr. Bittaye said. Average monthly revenue has sharply increased, and more specialists are completing training. But for his providers and staff, the increased quality of care, and better outcomes for patients, are the most important considerations. 
 
“Most important is the patient,” he said. “No more rationing, that’s the biggest thing.” 
 
The medical oxygen plant and distribution system are part of the larger Africa Infrastructure Relief and Support, or AIRS, project – a Society of Critical Care Medicine collaboration with the Johns Hopkins Global Alliance of Perioperative Professionals, or JHU-GAPP, and the Institute of Global Perioperative Care. (Dr. Sampson founded the last two organizations, and is GAPP’s executive director.) Through AIRS, Direct Relief is funding reliable power and medical oxygen projects in Sierra Leone, the Gambia, and Liberia, with a $5.5 million grant. 
 
International groups have worked to supply major hospitals around the world with oxygen plants for years, but frequently these hospitals are reliant on foreign workers to fix broken systems. When support is slow to arrive, hospitals are without medical oxygen once again. To prevent this, the AIRS project also includes extensive training for local biomedical engineers, who will maintain the plant and distribution system and repair as needed.  

Because power spikes and other electrical phenomena can damage oxygen systems, Edward Francis Small Teaching Hospital’s system is specifically designed, by a Ghanaian installer who has experience with the region’s grids, and knows how to insulate the plant from shocks.  
 
“Obviously the amount of effort of well-meaning Westerners over past years has been in the millions of dollars,” Dr. Sampson said. “But no one is addressing the core infrastructure issues that prevent the health care providers who were born, who were trained, who live, who teach [in the Gambia], and who care for their people” from providing the care which they are so capable. 
 
Dr. Sampson explained that Westerners often misunderstand the nature of health care in countries like the Gambia. West African countries train and develop their own accomplished physicians, and hospitals are staffed by skilled, committed providers. For many health systems, drastically reducing the need for foreign doctors is a high priority. But to accomplish that, high-quality medical infrastructure and reliable electricity are indispensable. 

Without necessary resources like medical-grade oxygen, West African providers may feel frustrated and disempowered, Dr. Sampson said. A surgeon may be highly talented, dedicated, and trained in state-of-the-art techniques, but performing surgery without reliable electricity won’t allow them to care for patients to the best of their ability.  
 
Choosing the AIRS projects and the best locations for each required working with regional experts, health ministry authorities, and medical and cultural partners across West Africa. The Gambia’s new medical oxygen system is intended to strategically meet the needs that health systems, hospitals, and providers encounter in their communities every day.  
 
“Our program has taken a different approach to global health,” Dr. Sampson explained.  
Now, the hospital’s leaders “can actually use their money for health care instead of cylinders.” 
 
“That’s what I love about this project,” Dr. Bittaye said. “It’s the holistic nature of it,” with partners asking what a hospital needs and what its goals are, rather than offering something that may fit an outside mission but doesn’t suit a country’s own approach to health care.  
 
“It’s going to have a big impact,” he said.  

The post A New Medical Oxygen System Supports the Gambia’s Dedicated Physicians  appeared first on Direct Relief.

Over decades of work with medical partners in West Africa, Dr. John Sampson had seen the infrastructure issues many times: Talented, dedicated doctors and nurses lighting up surgeries with headlamps or cell phones after the power went out, or patients dying because oxygen wasn’t available. One 2016 training at Bo Government Hospital in Sierra Leone stands out distinctly in his mind.

Dr. Sampson, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, had been tasked with training nurse anesthetists from across Sierra Leone to use a Universal Anesthesia Machine, or UAM. Sierra Leone’s government had purchased 41 UAMs, specialized devices that manufacture an oxygen supply for surgeries using a power source, and that maintain a flow of oxygen even during power failures, for use at 22 hospitals.

Because UAMs are designed to provide oxygen from a reserve tank if the power shuts off during surgery, Dr. Sampson needed to simulate power failures so that nurse anesthetists could practice deploying the reserve oxygen supply. However, during training at Bo Government Hospital, in the country’s Southern Province, he encountered a problem: a power failure at the training site that continued for over two weeks.

“We had to simulate a power failure while having no power,” Dr. Sampson recalled.

This August, Bo Government Hospital unveiled a new solar power installation that will provide reliable electricity to all of the major clinical areas of the hospital, including its operating theater, 24 hours a day. The installation will also support a medical-grade oxygen plant, which Sierra Leone’s Ministry of Health plans to build.

Medical providers and staff, who serve a population of more than 660,000 people, have reported successfully conducting surgeries at night, fewer interruptions to medical care, reliable storage of cold-chain medications that the hospital uses in specialty treatment, and higher morale.

“It’s been a big relief,” said Dr. Osman Kakay, the hospital’s medical superintendent. Now that staff are no longer confronting late-night outages, or completing surgeries via cell phone light when there’s no funding for backup generator diesel fuel, he joked, “I’ve been having very peaceful sleep.”

For Dr. Kakay, the project addresses an essential — and often overlooked — need. Bo Government Hospital, the second-largest facility in Sierra Leone, is a teaching hospital offering a wide array of specialty services, from ophthalmology to fistula surgery. The issues that concern him most aren’t medical staffing or training — it’s the difficulty that the hospital’s providers encounter with infrastructure like oxygen and power, or accessing medical supplies.

“Electricity in the U.S. is still taken for granted,” he said.

The new solar installation is part of the larger Africa Infrastructure Relief and Support, or AIRS, project – a Society of Critical Care Medicine collaboration with the Johns Hopkins Global Alliance of Perioperative Professionals and the Institute of Global Perioperative Care. (Dr. Sampson founded the last two organizations, and is the Global Alliance of Perioperative Professionals’ executive director.) Through AIRS, Direct Relief is funding reliable power and medical oxygen projects in Sierra Leone, the Gambia, and Liberia, with a $5.5 million grant. The project will also include biomedical training for skilled workers operating these projects, to ensure they are successfully maintained over time.

Dr. Sampson worked closely with regional experts, national authorities from each health ministry, and partners across West Africa to choose the three projects. Energy and oxygen challenges aren’t just deadly, dangerous, and unjust, he said: They also hurt the providers working to deliver medical care in unreliable circumstances.

“It makes doctors and nurses who have trained for years to hone their knowledge base and skills frustrated, and wondering if they’re actually making a difference,” he said.

Americans and Europeans often underestimate the skill that healthcare providers in West Africa are capable of providing, Dr. Sampson explained. Like medical providers everywhere, doctors and nurses in Sierra Leone and other West African countries need access to medical infrastructure. Health systems need the funds to build and maintain it.

He said short-term medical missions, often led by American or European doctors, can provide valuable patient care, but leave the health systems with the same infrastructure problems that hinder consistent quality of care to begin with. Media outlets hail the missionary providers as heroes, compounding the mistaken idea that West African medical care relies on international missions.

With reliable medical infrastructure, West African doctors and nurses may see more reason to devote their skills to their home country rather than leave for a Western country, Dr. Sampson said. Local providers can offer high-quality, reliable medical care, and patients can fully experience what their public health system has to offer.

“No one is addressing the core infrastructure issues that prevent the healthcare providers who were born, who were trained, who live, who teach, and who care for their people” from doing everything they’re capable of doing, he said. When it comes to power and oxygen, “the situation in those countries is worse than in a country that may be undergoing active warfare.”

Even when international groups focus on infrastructure, Dr. Sampson observed that they may not prioritize partnership and regional expertise, which means that projects are less likely to be a good fit for a hospital’s needs. For example, employing and training technicians to maintain a solar or oxygen project — a major emphasis of the AIRS project — is often overlooked. This has led to broken-down oxygen plants in a number of global regions, and hospitals reporting difficulty in receiving skilled support to repair them.

“It’s important to work closely with people who live and have a stake in the environment where they work,” he said.

Sierra Leone’s Ministry of Health selected Bo Government Hospital as a site for the AIRS project, but Dr. Sampson was delighted by the sense that things had come full circle. “That was the first hospital that someone referred me to when I came into the country,” he said.

Watching hospital nurses put on a skit to celebrate the launch of the solar installation — showing first an unsuccessful attempt to resuscitate a newborn with no electricity, then a lifesaving revival supported by reliable energy — was a touching moment.

“This is their chronic situation every single day,” he said.

The post In Sierra Leone, A New Solar Installation Powers Expert Medical Care appeared first on Direct Relief.

A licensed clinical social worker and certified clinical supervisor and substance abuse counselor, she’d worked in the mental health field for more than two decades, and she wanted to help. Navarro Ishiki wasn’t from Lāhainā — she was born and raised in Pāʻia, also in Maui — and she didn’t know what would be needed, but she knew the most important question: “How can I support Lāhainā?”

The most immediate answer had little to do with the mental health care she was trained to provide. People who’d evacuated were separated from their families, worried about missing loved ones, and urgently needed food, water, toiletries, and other basic necessities. While Navarro Ishiki and her fellow clinicians offered mental health support to first responders in the area immediately after the fire, most of their time was spent transporting requested supplies to hubs that distributed necessities to families.

As Navarro Ishiki distributed supplies and talked to people whose roots run deep in Lāhainā, or whose families had come to Hawaiʻi from Southeast Asia in search of a better life, she heard a repeated theme: Responders had traveled to Maui from all over during the wildfires to offer support — but it often wasn’t the support people most needed.

“They were well-intentioned, but not always culturally competent,” she said. “Especially as it relates to our historical trauma, well-intentioned people can sometimes hurt people.”

People displaced from the wildfires described a therapist who’d shown up on Maui to help, then grew upset when people didn’t seek out mental health services. Another pushed newly evacuated community members to talk about what they’d seen, and whether any of the dead or missing were loved ones.

“People were not ready to talk about it,” Navarro Ishiki explained. “They lost their community, they lost their identity, their livelihood, and for many, loved ones. They were just trying to wrap their minds around that, and wondering where their next meal would come from.”

She understood. For Navarro Ishiki, integrating her clinical training with her Native Hawaiian culture and knowledge of her people is vital.

“I am who I am because of the people who came before me: my kupuna — my ancestors — my community, my mentors, my ʻohana [family], my parents,” she said. Understanding the thousands of years of culture and way of life, and the historical trauma, that inform Hawaiʻi today is essential. “Our people need our people to do this work.”

Most survivors of the Lāhainā wildfire weren’t ready to talk about their experience until months later, Navarro Ishiki said. As a responder, she found the devastation she encountered — even the smells in the air — deeply unsettling. “I couldn’t work after what I saw,” she said. “If we could do it all again, we would wait for the call” for help to arrive.

When she began to work in-depth with wildfire survivors in January of 2024, she observed that the Western conventions of therapy — office setting, one-on-one appointments, rigid boundaries between therapist and patient — weren’t a good cultural fit for many people.

Instead, Navarro Ishiki said, the support she offered often took the form of kūkākūkā, a cultural practice she defines as “talk story.” Sharing personal stories and cultural history as a community is an important practice in the long Native oral tradition.

“We do it as a group, as a family, as a community,” she explained. “They may not be looking to find a solution. It’s just not to carry the weight of what’s in their minds, their hearts.”

In the aftermath of the wildfires, Navarro Ishiki founded Piha Wellness and Healing, a nonprofit focused on providing mental health support to Hawaiian communities, and in developing peer support specialists and mental health practitioners focused on providing culturally competent care. She’d seen the need for Piha’s mission well before the fires, she said, but had decided to put founding a nonprofit on hold as her private practice grew. The devastation on Maui made it an urgent priority.

Piha Wellness and Healing, which now serves approximately 400 people per year, will be supported by a $200,000 grant from Direct Relief.

Navarro Ishiki described speaking with Dr. Byron Scott and Annie Vu, Direct Relief’s chief operating officer and associate director of U.S. emergency response, about her plans for the nonprofit as kūkākūkā. “It felt like we were talking story and building pilina,” which means connection in Hawaiian, she said. “I didn’t feel like I had to sell myself…Culturally, I could be who I am, and I was seen for that. I felt it, and it was genuine.”

Young therapists of Native descent confide to Navarro Ishiki that they’re worried about building a client list, establishing a practice, and gaining experience. She tells them they’ll have the opposite problem: “We work within a system where we will never have enough of us, even though we work hard to put ourselves out of a job.”

As in many traditional societies, connection to place and ancestry is vital to Kānaka ʻŌiwi (Native Hawaiians), Navarro Ishiki said. For example, it would be nearly impossible to overstate the cultural and historical importance of Lāhainā, once the home of the Hawaiian monarchy, to its people — or the grief caused by the wildfire’s destruction. Navarro Ishiki, whose own family has belonged to a community for seven generations, understands this connection to place innately.

“It’s not my intention to speak for Lāhainā,” she said when asked about the community impact. She’s there to support, not to represent.

She also teaches peer support specialists and therapists in training the importance of asking, not telling. “We know not to put our biases on people,” she said. The most important question is still, “This is what I have, what I do: How can I help you?”

It’s also important that the often “sterile” therapy model — impersonal office, strict rules — isn’t what Piha represents.

“If we just do our session and then we’re done, then that’s not culturally appropriate, in my opinion,” Navarro Ishiki said. Her goal is “to shift the paradigm…we are not here to work in siloes.” If a patient doesn’t want to talk about their wildfire experience, but they need a box of food or a place to find financial support, then that’s what she hopes Piha’s peer support specialists and providers will do.

For Navarro Ishiki, that’s kākou effort — when everyone does the work together.

“The meaning of piha is to be full, filled,” she explained. “Our vision is for every home to be healed and be piha in their wellness and healing…for our kupuna, those who came before us, those who stand beside us, and those who come after us.”

In response to the Maui wildfires, Direct Relief has provided more than $2 million in medical aid and more than $2.3 million in financial support to health providers and community organizations, including Piha Wellness and Healing.

The post In Hawaiʻi, A Mental Health Support System Focuses on Cultural Competence and Connection appeared first on Direct Relief.

The prolonged conflict resulted in hundreds of thousands of deaths and caused severe damage to Syria’s healthcare infrastructure. More than half of the country’s hospitals and primary care centers were destroyed or significantly damaged, while the majority of healthcare providers fled the country in search of safety. Factors such as malnutrition, winter exposure, and limited access to medical care and treatments contributed to excess deaths.

Humanitarian aid channels into Syria have long been fraught with challenges due to shifting military control, international diplomacy, and fluctuations in funding and supply chains. Nonetheless, Direct Relief has maintained close partnerships with partners working on the ground in Syria and a steady flow of funding and material medical aid into the country, even at moments when other aid was scarce. In the past six months alone, Direct Relief has provided 13 shipments of material medical aid, valued at more than $48 million, to Syrian medical partners.

In addition, 11 Direct Relief shipments to the Syrian American Medical Society, MedGlobal Syria, the Independent Doctors Association, and Syria Relief & Development are currently in process, including two shipments in Turkey awaiting last-mile transport. These shipments contain emergency medications and supplies, chronic disease medications, Midwife Kits, hygiene items, and other requested support.

Direct Relief’s established humanitarian channels remain operational, allowing aid to continue flowing. Although the organization’s emergency response team is still working to glean a larger sense of the logistics and need on the ground, partners in Syria are sending in specialized teams to assess healthcare facilities, prisons, and medical needs of the general public.

An ambulance and referral system in northwest Syria, run by Syria Relief & Development and supported by Direct Relief, has been actively responding to increasing hostilities over the past several days. The system, which includes eight ambulances and 10 patient transportation vehicles, connects patients to more than 100 healthcare facilities across Syria’s northwest. Over the past year, Direct Relief has provided more than $3 million in funding and 49 tons of medical material aid to this area of the country.

Large-scale population movement in the aftermath of the war, and new assessments of previously inaccessible areas, are likely to contribute to a changing picture of geographic distribution and health needs in the coming days and weeks. Syrian partners have communicated that high priorities include reestablishing public health facilities and providing medical first aid and emergency psychosocial support.

Because the Syrian war was so long-lasting, healthcare nonprofits working on the ground have focused additional efforts to improve specialty care and build resilient, up-to-date medical and training facilities, even against a backdrop of conflict. Direct Relief has long supported these efforts, providing material aid and funding for oncology, maternal health, and a simulation lab used for medical training, among other projects, in addition to the organization’s large-scale support for primary and emergent medical care.

Direct Relief is in close communication with partners on the ground to evaluate immediate medical needs and long-term strategy. The organization remains committed to supporting health care in Syria, and will continue to respond as needed.

Alexandra Kelleher, Holland Bool, and Dan Hovey provided reporting for this update.

The post A Stunning End to Civil War in Syria Brings Urgent Need, New Possibilities appeared first on Direct Relief.

But across the Caribbean, carefully coordinated plans were in full swing. Officials and leaders had been running scenarios and making arrangements for months. Public messages focused on proactive measures and public safety. If potable water supplies were damaged, more would be brought in by barge.

“When we heard the prediction that 2017 was likely to be one of the worst possible years on record, we immediately went into scenario-planning mode and have maintained that level of preparedness since,” said Dr. Didacus Jules, the Director General of the Organisation of Eastern Caribbean States.

Weather agencies had predicted that 2024 might bring as many as 25 named storms. Beryl, the earliest Category 5 hurricane on record, was an ominous confirmation of their fears, killing 33 people in the Caribbean alone and causing near-total devastation on islands in Grenada and Saint Vincent and the Grenadines.

The OECS is an intergovernmental organization focused on regional integration, economic development and collaboration, protection of human rights, good governance, and environmental resilience. In recent years, the organization has deepened its emphasis on planning for natural disasters, working with state governments in the Eastern Caribbean and regional specialized agencies such as the Caribbean Disaster Emergency Management Agency, or CDEMA.

In partnership with Direct Relief, which is providing $3 million in grant funding to projects in nine member states, the OECS has been able to bolster medical infrastructure and the response capacity of member states as part of this work.

This growing focus points to a disturbing truth: The people of the Caribbean are on the frontlines of climate change, facing an increasing number of monster storms, droughts, extreme heat events, and other ecological threats. Sea level rise and habitat loss further impact their safety, economies, and natural resources.

Category 5 storms — including Hurricane Matthew in 2016, Irma and Maria in 2017, and Beryl in late June and early July — have caused direct and indirect deaths, destroyed vital infrastructure and many homes, and created severe financial hardship, among other impacts.

This disproportionate threat is especially unjust because the Caribbean States are among the world’s lowest contributors to climate change. Small island states across the globe — including those in the Caribbean — contribute less than 1% of global greenhouse gas emissions.

Among other projects in partnership with OECS Member States, the OECS Commission, and Direct Relief will procure solar-powered cold-chain storage and mobile medical units in Montserrat, develop a centralized medical oxygen system for Anguilla’s Princess Alexandra Hospital; and support vector-borne disease surveillance and prevention work in Antigua and Barbuda.

Dr. Jules spoke with Direct Relief about Hurricane Beryl’s impact, the growing impacts of climate change, and building a resilient future in a warming world.

Direct Relief: Let’s start with the aftermath of Hurricane Beryl. Tell me about the impacts, and what the response and recovery process has looked like in the months since.

Dr. Jules: The impact has been nothing short of cataclysmic, especially for Carriacou and Petite Martinique [in Grenada], and the Grenadine islands, like Mayreau and Union Island. These islands were devastated, and we immediately moved into gear with the support of Direct Relief, one of our early response partners. Before every hurricane season, Direct Relief assists us by having pre-hurricane packs located at strategic points in each country across the region. When Beryl hit, we all pitched in to provide some of the emergency supplies needed.

The first order of business was to be part of the team doing an assessment on the ground of the impact of the damage. The other lengthy part of that process has been the collection and clearance of all the debris that has been generated by the hurricane.

Our heads of government have been very central to this effort. Prime Minister Gonsalves [of Saint Vincent and the Grenadines], in a recent meeting, described the painstaking process involved in that recovery. Here you have more than 5,000 people with nowhere to sleep or to stay, having to be accommodated in tents and makeshift accommodations.

If you live in the Caribbean now, you would know how hot it is on an ordinary day. Having to live in tents in a post-disaster scenario can be unbearably uncomfortable, given the levels of heat experienced on an ordinary sunny day. To have a tent as your temporary, indefinite living quarters until recovery is completed is no longer a reliable option. Additionally, in post-disaster situations, there are sanitation problems, and challenges with the provision of meals and food to the affected population.

The clean-up is a massive effort. Now, it’s not a question of simply scouring the island and picking up galvanize [steel sheeting]. There has to be sorting of different kinds of debris.

Importantly, a lot of that stuff was blown out to sea, and a significant area of mangrove and seagrass beds was destroyed. Whatever was blown from land into the sea also needs to be recovered.

Direct Relief: What have the health impacts been?

Dr. Jules: Health impact was a whole different ball game because people are homeless: no shelter, no sanitation, and no food. Thankfully, we have partners who have been able to provide daily meals. We’ve been able to get some makeshift accommodation for them, but then the heat is stifling, and the supply of water is compromised.

Sanitation is a big thing because most of the sanitation infrastructure has been destroyed. How does one deal with human waste? Many animals have been destroyed as well, requiring the disposal of dead wildlife.

To compound it, there have been mosquito infestations in several of the islands, so the threat of dengue and other vector-borne diseases has intensified.

Direct Relief: Because of climate change, the Caribbean faces a steeply increased and extremely disproportionate threat. I’d like to hear a little bit about how the awareness of that growing threat has informed your preparedness and your resiliency work.

Dr. Jules: We have tried to digest the lessons of the previous devastations that we’ve experienced, from [Hurricanes] Ivan right up to Irma and Maria, and now Beryl. We have been discussing with our partners, including Direct Relief, how we can be more strategic in preparing for those events because it’s clear that these events will happen with greater frequency and increased ferocity.

We have a partnership agreement with Direct Relief that looks at the provision of photovoltaic systems; helping critical government infrastructure transition to green energy; solar power as back-up for public health care infrastructure in particular; strengthening the cold chain so that medical supplies can be safeguarded; looking at medical oxygen generation; and the training of personnel in the utilization of that type of equipment.

In the process of building back better, we are also looking at the architecture of the buildings and what needs to be done to ensure that they’re more resilient, able to withstand storms of the category that we’re now seeing, Category 5, and maybe even beyond. The use of concrete roofing, and hurricane-proofing of the buildings will be vitally important.

Our building codes have to be revised yet again and serious standards established. For example, water storage. We’re at a stage where we may have to mandate that every house constructed has its water storage beneath the foundation so we can have adequate supplies of utilizable water. Don’t forget, besides the storms, we have an increasing frequency of other disasters like drought.

The drought during the dry season is extremely deleterious to crops, and agriculture, and also to human water needs. We’re experiencing extreme heat, from extreme heat to extreme weather conditions with flooding, followed by periods of extreme drought, and sometimes these things happen out of season. The distinction between seasons, and the preparation for seasons, is becoming increasingly muddled.

Direct Relief: What do you most want readers to know about the impacts of tropical storms on Caribbean states and communities?

Dr. Jules: I think it’s very difficult for people in large countries with huge demographics to understand the scale of human suffering these disasters bring to small states. When you hear, for example, that maybe 20-odd people died in a hurricane in Dominica, this may seem inconsequential to most people who live in a large metropolitan city of millions, and they may [not] be sympathetic to that news unless it is put in the context of scale. For the population of Dominica, what is the impact of this disaster placed in the context of size and scale?

One has to put those things in context: twenty people dying in Dominica from a hurricane [out of a national population of about 66,000]. If there was a hurricane in New York City or Tokyo and the same percentage of the population were to die, that would definitely get the attention of the world. To the rest of the world, that would be a huge disaster.

Twenty people dying is a major disaster in the Caribbean must therefore be placed in its contextual proportion in the scale of human suffering.

Direct Relief: In terms of storm resiliency and awareness, what is the next thing that needs to happen?

Dr. Jules: I think we need to do a lot more about is building public awareness. Disaster cycles are becoming shorter and shorter, and their intensity is increasingly larger and greater. Messaging to the population about what needs to be done in the event of a disaster is something that we need to take very seriously as a priority.

We need to prepare people through disaster drills. I believe our schools have an important role to play in that because it’s easy to sensitize kids to what needs to be done. Just as they do in Tokyo, sensitizing kids about earthquakes, we need to sensitize our children and our communities so that these precautions are taken.

Just as you do a fire drill, we need to begin to do hurricane drills, tsunami drills, and disaster drills in general so that awareness is heightened, and, rather than panic when something happens, people know the correct thing to do.

We need to better prepare ourselves, psychologically and in terms of readiness to disasters, as they will happen more with greater frequency.

This interview has been edited for length. Dan Hovey and Genevieve Bitter contributed to the reporting.

The post After Hurricane Beryl’s Cataclysmic Impact, a Caribbean Leader Envisions a Resilient Future appeared first on Direct Relief.

The monstrous threat of Hurricane Milton had terrified meteorologists and emergency responders. Even after the storm was downgraded to Category 3 status, it caused severe flooding and widespread damage across Florida communities.

For one of Dr. Rhonda Cameron’s patients, a middle-aged woman who’d lived in the state since age four, the storm hadn’t just been frightening in its own right. It was an intrusive reminder of a childhood trauma.

In September of 1960, the patient recalled, the deadly and destructive Hurricane Donna made landfall just weeks after her family’s move to Florida. She remembered her mother putting her under the bed, along with her brother, sister, and the family dog, to ride out the storm.

“Hurricane Milton stirred up her PTSD from Donna,” explained Dr. Cameron, director of behavioral health services at Premier Community HealthCare, a federally qualified health center serving Florida’s Pasco and Hernando Counties.

Milton, which made landfall in early October, close on the heels of the Category 5 Hurricane Helene, damaged many of the same Florida communities, primarily on or near the Gulf Coast. Mental health providers described patients who, barely scraping by financially before the storm, were now confronting cataclysmic damage from flooding or fallen trees. People without the money to evacuate, who’d ridden out dangerous hurricanes in mobile homes. And then, after Milton dissipated, an increase in nightmares, overwhelming anxiety symptoms, and other indicators of post-traumatic stress.

Floridians often emphasize that hurricanes are a part of life, baking storm-themed cakes and taking evacuation warnings in stride.

But natural disasters have indisputable mental health impacts, causing new symptoms or exacerbating already existing ones. Providers have long reported significant increases of post-traumatic stress, anxiety, overdoses, and other related concerns in the aftermath of severe storms and wildfires. Newer evidence, such as a 2022 study focused specifically on Florida residents who’d experienced multiple hurricanes, suggests that repeated exposure to natural disasters can compound mental health impacts over time.

Now community health centers that serve Helene- and Milton-impacted communities are responding to what Premier clinical social worker Larry Legg describes as a “rush of folks coming in” seeking mental health support.

Patients at Evara Health in Pinellas County, where both hurricanes caused extensive damage, were terrified, said Kelly Singleton, a clinical social worker and director of behavioral health at the community health center.

“Normally we manage our hurricanes, but these two [coming] back-to-back, they really did terrify people,” she said. “This is the most scared I have ever seen people.”

“They can have more connection”

Tampa Family Health Centers, with several locations in the Tampa area, is providing extended hours for mental health appointments — staying open until 8:00 p.m. on weekdays and offering Saturday and Sunday options, said Dr. Latamia Green, a pediatric and adult psychiatrist and the health center’s director of behavioral health. Providers offer affected patients the option of shorter, more frequent appointments “so they can have more connection,” she said.

While each patient’s needs are unique, Dr. Green explained, hurricane response often requires a stronger focus on supportive therapy, helping patients navigate a stressful aftermath and overwhelming day-to-day tasks, rather than the insight-based approach that’s more likely to characterize long-term work with a therapist.

Caring for patients affected by natural disasters is a multi-step process, Dr. Green said. In her diverse practice — which includes overseeing a clinic for patients with schizophrenia and caring for children with autism spectrum disorders, among other mental health needs — support often begins in the days before a storm makes landfall, when she helps patients manage their anxiety and make a plan for accessing care in the storm’s aftermath.

Then, Dr. Green said, providers work with patients to meet the most urgent needs, and care navigators offer support for patients dealing with the complex bureaucratic processes of applying for emergency government support, staying in temporary housing, and getting power and water restored. “The physical destruction can make the mental health piece much more challenging,” Dr. Green said.

At Evara, too, mental health providers were available into the evening and on weekends. Same-day appointments were available to patients who needed immediate care, and specialists were connecting people to community services and helping with applications and paperwork.

“If we don’t catch them…we’ll lose them”

While all of Evara’s medical providers are trained in trauma-informed care and screen patients for mental health symptoms, Singleton says high awareness is especially important in the aftermath of a hurricane. “Patients who should be seen for behavioral health are presenting to primary care,” she explained.

Singleton is concerned because storm-affected patients are often focused on medical needs or lost housing — not on their mental health.

“If we don’t catch them in that moment…when they’re sharing how stressed they are or how anxious they are, we’ll lose them,” she said. In a population that’s already “grossly underserved,” missing an opportunity to connect a patient to mental health care can worsen needs down the road.

At Premier, Legg was concerned about patients who, confronting severe flooding, damage, and power outages, had canceled appointments or weren’t keeping in touch with mental health providers. One of his patients, a young adult, had dealt with a last-minute evacuation with a parent in a wheelchair as water flooded their home, and hadn’t been able to come in.

“They’re still in that survival mode,” Legg said.

Premier staff were acutely aware that, even as power came back on throughout the region, patients — some of them reliant on powered medical devices — were still in the dark. Students had missed an entire week of school while school facilities served as community shelters.

Legg noted that, during his own childhood in rural Appalachia, the expectation that “I’ve just got to pull up my boots and go to work” was widespread, even in the aftermath of disaster. Today, he sees many patients at Premier who feel they should “just fight through” mental health symptoms, and are reluctant to seek treatment.

Florida’s rainy season, which reminds people of past storms and past flooding, often triggers those symptoms all over again, he said.

The health centers interviewed were also concerned about staff members, who generally live in local communities and experience the same impacts their patients do. While staff often put their own emergent needs aside after a disaster, Legg was worried about colleagues dealing with neck-high flooding, fallen trees, and their own mental health symptoms while still showing up for work.

“We’re trying to also keep an eye out for each other, to fight against the secondary traumatization” of caring for deeply impacted patients, he said.

“Part of the puzzle”

Dr. Green cautioned that hurricane-affected patients require mental health support long after the most emergent needs are met: “A large part of the aftermath happens months later.” And as a psychiatrist who sees both pediatric and adult patients, and who treats a wide variety of mental health disorders, she stresses the importance of individualized treatment.

“Every patient that we see is unique,” she said.

Rather than thinking in terms of disaster response versus routine care, Dr. Green helps patients prepare for the increased stress and traumatic response that a hurricane can evoke. “That’s one part of the puzzle, living here in Florida: making sure they’re aware of how to deal with trauma and how to deal with stress,” she said.

Singleton, too, works with patients who experience symptoms of trauma to help them manage the triggering effects of storms. “A lot of people don’t take the hurricanes super-seriously, because that’s kind of the norm,” she explained, but that attitude discounts the many people for whom encountering yet another storm — or even hearing about the impacts to another community — can jog painful memories or cause severe anxiety.

Evara, responding to a growing need for mental health services, has hired more providers and made behavioral health available not just to health center patients, but to the larger community. Staff are trained to provide mental health first aid.

These services aren’t hurricane-specific, Singleton said — they’re part of a larger awareness of growing mental health needs in the community. “That’s just the population that we’re managing,” she said.

At TFHC, where mental health outreach and education work are strong priorities, it seems ironic that October 10, the day Hurricane Milton swept across Florida, is World Mental Health Day.

“We had activities planned for that day,” Dr. Green said.

Staff made up for lost time after Milton, offering “hurricane make-up days” and a mental health fair. Screening for signs of depression and anxiety, always a priority during medical appointments, became part of what Dr. Green called a “heightened response.”

Even at calmer moments, TFHC providers and staff focus on making mental health care more accessible. Care navigators, embedded at major hospitals, connect patients to providers. Education and community events are designed to raise visibility and eliminate stigma.

When it comes to mental health, “we are very vocal around here,” Dr. Green said.

Direct Relief has provided more than $3 million worth of medical support to health centers responding to Hurricanes Helene and Milton, and committed an additional $2 million in cash funding to support recovery. The organization announced last week that 28 local partners, including Evara Health, Premier Community HealthCare, and Tampa Family Health Centers, would each receive a $25,000 emergency grant to meet the increased need for health services.

The post At Florida Health Centers, “A Rush of Folks” Seek Mental Health Care in Hurricane Aftermath appeared first on Direct Relief.

Even as Direct Relief reported this story, drawing on interviews with a humanitarian partner in Lebanon, rapidly escalating conflict in the Middle East caused displacement to increase exponentially, from about 100,000 people who’d left Lebanon’s southern border to an estimated 1.3 million fleeing their homes in targeted areas across the country. Humanitarian workers — including Karim El Ferkh, an Anera health program manager based in Beirut, and many of his colleagues — have left Lebanon for safety in recent weeks.

“It’s a phenomenon that’s happening that’s not going to stop,” said Alondra Aragon, who coordinates migration health programs for the UN’s International Organization for Migration in Mexico, of the rising migration rates. “We are developing these humanitarian responses to try to reduce this gap in access to basic services.”

In a 2024 report, IOM estimates that 281 million migrants — about 3.6% of the world population — currently live outside their countries of origin. The same report calculates that about 117 million people — a group that includes refugees, asylum seekers, and internally displaced people, among others — were living in displacement at the end of 2022.

These numbers are expected to rise, and for disturbing reasons. Forced displacement from war, deadly violence, and other humanitarian crises is “the highest on record in the modern era,” the report notes. Climate change and other environmental impacts may force more than 216 million people across six continents from their homes by 2050.

When providers around the world describe caring for migrant and displaced patients, whether in refugee camps, community-run shelters, or new homes, the same stories and issues are often repeated. Their patients have post-traumatic stress and other urgent mental health issues — and cultural stigma has made it shameful and difficult to seek care. Unable to access medicine or nutritious food either at home or on the move, they have serious, untreated health conditions. Many women have experienced sexual or intimate partner violence, and pregnancies are often a first point of contact with a medical provider.

At the same time, humanitarian budget cuts and shifting public focus, combined with newly emerging conflicts and growing numbers of natural disasters, make it hard for providers to secure support and keep long-term needs in the spotlight.

“We cannot just shut our door”

Dr. Iftikher Mahmood, a pediatric endocrinologist and professor, vividly remembers the urgency he felt in 2017, when more than 750,000 Rohingya, fleeing genocide in Myanmar, crossed the border into Bangladesh.

“It was obvious that a lot of them were severely traumatized” both physically and mentally, he said. Huge numbers had lost children or other relatives, survived brutal violence, and been separated from their families.

The NGO Dr. Mahmood founded, HOPE Foundation for Women and Children of Bangladesh, had provided medical care for underserved patients since 1999. In 2007, the organization opened a hospital in Cox’s Bazar, where most of the Rohingya refugees settled and remained.

“It’s a small area, already very dense,” he said, explaining that the number of refugees in Cox’s Bazar has grown over time to approximately 1.2 million. “That impacts hygiene, it impacts nutrition.”

HOPE leaders established a field hospital and primary and women’s health care clinics focused on refugees. Dr. Mahmood said linguistic and cultural similarities helped establish trust and connection. “They found us familiar,” he recalled.

Mental health care was a high priority, so Dr. Mahmood recruited psychologists, psychiatrists, and social workers. Midwives working with pregnant patients screened for other health needs and issues like intimate partner violence, which more frequently affects forcibly displaced women.

Today, HOPE provides a wide range of services for both refugees and Bangladeshi patients, including care for non-communicable diseases like diabetes and hypertension, mobile health camps and telemedicine, oral health, and maternal and delivery services.

New and deadly violence against Rohingya communities in Myanmar this year has forced thousands more to flee the country. Refugees still living in camps in Bangladesh have died or lost their homes due to landslides, fires, and other disasters.

Dr. Mahmood’s concern is that the situation will long outlast public awareness. “There’s no solution that’s going to happen anytime soon,” he said. “We cannot just shut our door and move on.”

Political upheaval and economic changes in Bangladesh complicate the picture. Support for Rohingya refugees relies on international humanitarian funding, but the pool is limited and need is widespread, Dr. Mahmood explained.

“I don’t think many people talk about the Rohingya now,” he said. “They are kind of forgotten.”

“Common places”

Political discourse often overlooks the nuances of migration and displacement, but Aragon, at IOM in Mexico, describes a complex picture. Migrants and other people on the move in Mexico come from countries in Latin America, sub-Saharan Africa, and Asia. Many hope to settle in the U.S., but Mexico is increasingly an end destination. A number of Mexicans have been internally displaced by violence.

Migration is a fact of life, Aragon said. People need access to medicine and health care services, and instability and poverty increase those needs. The challenge is “to figure out how we’re going to make all of this work.”

Working with the government and other partners, IOM Mexico facilitates vaccination campaigns and offers access to primary health services, mental health and psychosocial support, and other medical services. They also provide “common places for people to interact and understand each other,” helping to correct misconceptions and break down communication barriers.

Like Dr. Mahmood, Aragon said that post-traumatic stress, depression, and anxiety are common among displaced or newly arrived people. Many have experienced violence or natural disasters.

Although diabetes, hypertension, and other chronic diseases are common, Aragon said, many people were unable to access health care or medicine in their countries of origin. “It’s more and more obvious that we have an underdiagnosis of these diseases in origin countries,” she said. People displaced from their homes within Mexico may also struggle to manage chronic disease.

For many women, a maternal health provider is often their first encounter with the health system.

“When they are transiting, often the main focus is not to take care of their health. It’s to reach their goal,” Aragon explained.

“It escalated so fast”

Syria’s civil war drove millions of refugees over the border into Lebanon in 2012. In the dozen years since, perhaps 1.5 million have remained, their health and circumstances fluctuating with the country’s. For Karim El Ferkh, a health program manager at the NGO Anera — and formerly an epidemiologist — working closely with a refugee population has shown how much consistency matters, and how much can change in a moment.

Syrians newly arrived in Lebanon struggled to buy essential medications out of pocket, El Ferkh explained. Despite widespread trauma, mental health care was widely stigmatized — an attitude he describes as “just pull yourself together.”

As Lebanon’s health care system grew increasingly strong and sophisticated, medical care became easier to access — for a few years. But El Ferkh said the country’s economic crisis, 2020’s Beirut port explosion, the Covid-19 pandemic, and medical brain drain have all affected health and stability.

Most dramatically, Israeli strikes have escalated since October of last year as the regional conflict has spiraled. In September, when El Ferkh first spoke to Direct Relief, about 100,000 people, many of them Syrian refugees, had fled Lebanon’s southern border. Hundreds had been killed, and government officials and other responders were working to connect displaced people to medicine and health services while strategically distributing clean water to prevent outbreaks of cholera and diarrheal disease.

A few weeks later, about 2,500 people in Lebanon had died in the strikes, and displacement had multiplied exponentially. El Ferkh described 1.3 people throughout the country, including his family and colleagues in Beirut, fleeing to safety. For him, the situation was “not political”: He was focused on the danger to civilians, and horrified by the deaths of children. “It escalated so fast, so unexpectedly,” he said.

He and his wife had taken their children first to Turkey, and then to the United Arab Emirates to stay with family, sleeping apart because there wasn’t enough room in any one house. His colleagues were working virtually in crowded quarters to coordinate emergency response efforts, while children played in the background.

Anera has worked in the region since the 1970s, offering vocational training, education, infrastructure support, and other community-building measures. The organization also provides food, clean water, psychosocial support, and medications, along with other needed resources.

Health care access is an essential priority. Anera pre-positions medications in health care centers — aiming to provide a three-month supply to each patient — and supports the Lebanese government’s mobile health care units, which provide regular care to communities in the country’s south, including in conflict areas.

Their goal, El Ferkh said, is to provide long-term, consistent support that allows communities to build resilience over time.

War had changed that overnight. “For Anera, all of our [ongoing] programs have stopped and we have shifted to emergency response,” El Ferkh said. People congregating in shelters across the country needed clean water and bedding. The approach of winter — an extremely cold season in Lebanon — demanded warm clothing and sleeping blankets.

And responders were reporting treating wounds and other physical trauma, patients in urgent need of chronic disease medicines, and a new and frightening outbreak of cholera. El Ferkh was worried about the disease spreading, and about new outbreaks as people crowded together and displacement interrupted vaccination campaigns.

When his family’s 30-day visa expired, El Ferkh said, he wasn’t sure they’d be able to stay in the UAE. He and his wife were considering taking their children to Kuwait, where his parents lived. While still devoted to his work at Anera, he said the “anxiety and stress” were taking a toll on humanitarian responders.

Still, he felt more fortunate than most. So many of those displaced by the conflict were in danger.

Many, he said, including Lebanese citizens and refugees originally from Syria, had fled across the Syrian border. Despite the country’s ongoing civil war, it was still considered safer than Lebanon.

Direct Relief supports health care providers and emergency responders around the world who care for displaced patients, migrants, and other vulnerable communities.

The post Conflict, Climate Change, and Instability Drive Migration Worldwide. Health Care Organizations Adapt in Real Time. appeared first on Direct Relief.

Washed-out roads and bridges, damaged clinics, and closed post offices made it all but impossible to tell where medications could be safely sent or received, said chief operating officer Dustin Allen. Power outages were dangerous for cold-chain medications like insulin. Downed mobile networks interfered with efforts to coordinate transport, talk to partners and patients, and keep on top of an ever-shifting situation.

Community outreach manager Sandy Torres, speaking through patchy cell service in the hard-hit city of Asheville, stressed the need for more information about local needs. In Asheville, “I’m here and I’m seeing it, and I know what hospital is open or I know what free clinic is open, or they’re doing first aid by a little market over there.” But that kind of boots-on-the-ground information had been slow to emerge from rural areas, and Torres was planning to drive out to the state’s hard-hit western communities herself to assess needs and distribution challenges.

For NC MedAssist, providing medication to large numbers of vulnerable patients isn’t itself new. The Charlotte-based organization dispenses about $70 million in medical aid each year to more than 70,000 patients in all 100 counties in North Carolina — Allen described it as having “tentacles” everywhere — and works with community health centers, nonprofit clinics, and public health departments across the state.

Asked about the pharmacy’s prominent role in North Carolina, Allen explained that the goal is to fill widespread gaps in medication access. The state didn’t expand Medicaid until December of 2023, so for years, “close to 80% of our patients fell under…the federal poverty line, but they didn’t qualify for Medicaid until recently,” he said.

Even after the expansion, many patients can’t afford the $4 copay for medications. “A patient of ours may have 15 prescriptions, and that may be $60” each month, Allen said. Nonprofit partners like health centers and clinics, which operate on slim margins, often can’t afford to provide free medicines for every patient who needs them.

There was no question that Helene’s devastation was complicating the picture.

Employees were calling individual patients to arrange safe insulin shipments through 80-degree weather and trucking medications out to impacted communities. “We’re having to do case by case [shipments] and have conversations: What do they need? What can get to them?” Allen explained.

Staff had contacted helicopter teams headed to the most rural areas to ask them to bring medicine and first aid supplies along. Local hospitals were transporting prescriptions on their mobile pharmacy units. Donations were coming in — including large deliveries from Direct Relief that included urgently requested insulin, tetanus vaccines, field medic packs, emergency medicines and supplies, and epinephrine injectors. Direct Relief staff, still responding on the ground in the southeastern U.S. this week, visited NC MedAssist on October 7 to deliver medications and supplies.

The epinephrine injectors, a lifesaving treatment for anaphylactic shock, were one of the storm’s unexpected needs. “With the pure disruption of the ecosystem, there are a lot of bees and yellowjackets,” Allen said. Emergency responders and patients in affected communities were experiencing repeated attacks.

Other common requests included over-the-counter medications like pain relief and antihistamines, first aid supplies, and treatment for diarrheal infections, which Allen said were mostly connected to water outages and contamination.

Noteworthy — and concerning — were the medications people weren’t requesting as often. Staff were noticing comparatively lower demand for mental health medications, anti-seizure drugs and other neurological treatments, and medicines for hypertension and high cholesterol. The focus instead seemed to be on treating the most urgent needs.

Mental health disorders, neurological conditions, and chronic diseases like hypertension require consistent management. The lack of requests suggested patients were likely going without maintenance treatments, and Allen expected the health picture to change in coming days as a result.

“We’ve always had the mindset that the priorities will evolve over time” after a disaster, he said.

Helene’s disproportionate impacts in western North Carolina, where Torres was planning a trip, were another challenge. “There’s always been a lack of trust from people outside of the region” in rural western communities, Allen said. “Typically, you almost have to be physically present there.” An outside offer of support, even of free medication shipped to someone’s home, might not necessarily be welcome.

The need for a local presence was complicated by a far-flung population, Allen explained: “You may travel 100 miles to catch [100] people in some of those areas.”

Over time, staff at NC MedAssist have made progress in the area, offering targeted outreach to agricultural workers and other vulnerable residents. But Allen was concerned about the comparatively small number of requests the pharmacy had received from some impacted communities.

“It obviously doesn’t bode well now,” he said.

Since 2014, Direct Relief has supported NC MedAssist with more than $147 million in medicines and supplies, and provided a $50,000 grant to support the charitable pharmacy’s cold-chain capacity. Six recent shipments sent in preparation for and response to Hurricane Helene focused on meeting health needs caused by the storm

The post A North Carolina Pharmacy Confronts Destroyed Roads, Downed Lines to Fight Helene Health Threat appeared first on Direct Relief.

“There is concern that if you want to be out before Wednesday, you should be well underway now,” said Andrew Schroeder, Direct Relief’s vice president of research and analysis. Milton’s fierce winds, small eye, and rapid intensification alarmed meteorologists and emergency managers this week, dropping down to a Category 4 hurricane early Tuesday but gaining strength as the day wore on.

But while recent data were showing new evacuations underway, Schroeder was concerned that people were leaving later and less urgently than expected, given the severity of the storm.

“Delayed evacuation is one of the most significant causes of morbidity and mortality in the event of a storm,” Schroeder said.

Using anonymized and aggregated data from Meta’s Data for Good, CrisisReady, a research-response initiative at Harvard and Direct Relief, produces population dynamics data to track how numbers of people change over time in response to a disaster.

While these numbers don’t track individual movements, they offer useful insight into how evacuation and displacement work across populations over time.

Communities along Florida’s Gulf Coast, including St. Pete’s Beach and Madeira Beach in Pinellas County, had been heavily impacted by storm surge during Hurricane Helene. By late Monday, population levels in a number of coastal towns were as much as 60% lower.

“The fastest and most extensive evacuation really took place among coastal communities,” Schroeder said.

St. Petersburg in Pinellas County had been slower to see movement despite evacuation warnings, but he noted a 6% decrease in population late Monday — a good, if late, beginning.

In the Tampa Bay area, coastal communities like Holmes Beach and Bradenton Beach were showing as much as an 87% population reduction, but population centers like Bradenton, heavily impacted by Helene, and Sarasota were seeing increases up to 9%.

“It’s an interesting and somewhat concerning pattern,” Schroeder said.

The increased risk isn’t just to people who stay in the area: “There’s a chance for some real bottlenecking to happen,” according to Schroeder, as last-minute changes and emergency needs strain resources.

CrisisReady will continue to track population dynamics as the storm approaches.

Hurricane Helene

Across the southeastern U.S., displacement from Hurricane Helene remained widespread. Asheville, a North Carolina city devastated by the storm, had seen a 40% drop in population. While that number was slowly increasing, “we usually see a more rapid rate of return” to a city like Asheville, according to Schroeder. People usually come back quickly to search for missing family and friends and check for damage to their housing.

A quick rebound in population isn’t in itself meaningful. “A return to baseline does not mean a return to normal,” Schroeder said. But slower and later population increases, despite increasingly open roads in the Asheville area, were a noteworthy indicator of Helene’s severe impacts.

Helene’s impact spanned an unusually vast area — communities across a 600-mile stretch in the southeastern U.S. were badly impacted — and Schroeder was concerned about continuing rural displacements across much of those 600 miles.

While most rural communities in the region’s interior hadn’t experienced impacts on the same scale as Asheville’s or coastal Florida’s, deaths, injuries, and damage were widespread. Damaged infrastructure and displaced residents have resounding consequences in rural economies, where people tend to be older and less mobile, economies are more fragile, and fewer resources (like hospitals, health centers, and pharmacies) serve a larger area, Schroeder explained.

Widespread health impacts in rural communities are often delayed until “weeks or sometimes months after the storm,” Schroeder said. Public awareness frequently moves on after the most acute stage of a disaster, which makes long-term health crises less visible.

Power and mobile network outages have been widespread since Helene, complicating the numbers, but Schroeder said the impacts on social media data were likely smaller than, for example, phone communications. People affected by the hurricanes were likely to check in with family and look for community updates online.

And while misinformation about Helene and Milton has caused serious problems for affected communities and responders, Schroeder said the population metadata are unaffected. Regardless of the information social media users encounter, they’re providing reliable data about population dynamics through their metadata.

The post As Hurricane Milton Closes In, Population Data Show Slow Evacuations, Long-Term Helene Displacement appeared first on Direct Relief.

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

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

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

“Wherever there is need”

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

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

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

“They are going wherever there is need,” she said.

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

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

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

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

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

“Coming in with this desperation”

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

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

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

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

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

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

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

“We’re real, we’re here”

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

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

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

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

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

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

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

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

Direct Relief is providing $25,000 emergency grants to 14 health organizations responding to Hurricane Helene, including Appalachian Mountain Community Health Centers. In response to requests, Direct Relief has shipped emergency medications, water purification tablets, first aid supplies, emergency medical packs, hygiene kits, tetanus vaccines, and other essential resources to local organizations responding to Helene.

The post Infected Wounds, Housebound Seniors: Racing to Contain Hurricane Helene’s Deadly Impact, Health Center Staff Put Their Own Hardships Aside appeared first on Direct Relief.

Hurricane Helene, sweeping across the southeastern U.S., had caused health crises on all sides. Providers at Oceana Community Health, Inc., a community clinic in central Florida, had spent the last few days on the road in a mobile medical unit, setting up mobile clinics in hard-hit communities throughout the area.

Everywhere they went, people — some of them established patients at the clinic, some of them strangers — showed up in urgent need of insulin or other chronic disease medications, said Dr. Youssef Motii, Oceana’s executive director. People without electricity to power their medical devices were experiencing acute respiratory symptoms. Patients who had been recovering from existing wounds had walked through contaminated floodwaters. Water-borne infections were on the rise.

Oceana’s emergency response specialists went out to look for some of their most vulnerable patients on foot. Once they found them, Dr. Motii explained, they’d connect to a physician via satellite to assess needs and treatments.

One patient — an unhoused woman who’d survived a series of diabetic emergencies and was working diligently with Oceana’s staff to improve her blood sugar levels — wasn’t where they thought she’d be. On Wednesday morning, emergency responders came across her belongings — including storm-damaged insulin.

When Dr. Motii spoke to Direct Relief on Wednesday afternoon, the patient had been found only three hours before. She was safe, and carrying a cooler she’d purchased at a gas station and filled with ice — to keep her remaining insulin cold. Seeing their patient alive and well, and witnessing her determination to keep her diabetes under control in the face of catastrophe, was a triumph for Oceana’s staff.

Beyond “The Hub”

Across Helene’s devastating path, community health providers and emergency responders have similar stories to share.

They talk about the people they encounter who weren’t able to evacuate, or who can’t reach the community hubs where necessities like water, food, and hygiene items are being offered. They go where officials and community leaders tell them the need is most urgent — although, as Dr. Motii said, it’s often a “cat-and-mouse game” to find paths through flooded, mud-choked, or debris-strewn roads to rural churches or community centers.

No matter what the news reports say or the social media pictures show when disaster strikes, “we never go in without an invitation and a request for help,” said Jamie Swezey, a program director at the Footprint Project. The nonprofit, a close partner of Direct Relief, provides clean energy to communities in the wake of disaster, and working with locals to determine needs and response measures is pivotal.

In the wake of Helene, Swezey said, there’s been no shortage of requests.

Swezey and her team were in Asheville, North Carolina on Sunday morning, where the sheer scale of the devastation reminded her of 2005’s Hurricane Katrina. At a technical college with working electricity, people with respiratory devices and other powered medical equipment were clustered in the lobby.

Footprint Project had shown up to evaluate whether the site had enough power to support community members. But at the site, Swezey recalled, the fire department had just gotten a call from a local elder care facility. Their generator had gone out, and some of their residents were dependent on oxygen concentrators.

The team supplied batteries for the concentrators, and the facility administrators said “this probably saved four people’s lives today,” Swezey recalled.

But she was concerned about the widespread communications outages and the reliance on word of mouth. To keep in touch with the Footprint Project’s main office in New Orleans, the team was driving periodically to the top of a hill to access cell service, so they could receive requests for aid, give logistical updates, and check in on existing projects.

Checking in local health centers and clinics to offer energy support had been the planned next step, but Swezey had just received a request from another nursing home. Their water and power were out, but many of their residents had urgent medical needs. The Footprint Project team was planning to install an atmospheric water generator — a device that turns moisture in the air into, in this case, 100 gallons of potable water per day using solar power.

In general, Swezey explained, large-scale disaster responses often rely on a hub model, where resources like food, water, and medical care are available at a local distribution point. “The people who are the most vulnerable during a disaster are the people who can’t come to the hub and get the thing,” she said.

Her goal as a disaster responder was to reach those people.

“A display of bravery and character”

Oceana’s mobile health clinic, on its rounds in Florida, had been outfitted with wound care, medications, and diagnostic equipment like an EKG for triage and evaluation. Personal care products for displaced patients, and emergency medical backpacks intended for in-the-field care, were being sent from Direct Relief headquarters.

But Dr. Motii was clear that an emergency like Hurricane Helene takes a widespread toll — on staff and providers as well as patients.

A second mobile medical unit had been damaged during the hurricane — punctured by a fence post that left a gaping hole, water was seeping in, and the unit wouldn’t be safe until it had been painstakingly prepared. At one of Oceana’s clinics, high floods had submerged and ruined medical equipment and supplies. Cold-chain medicines like insulin had been destroyed by power outages.

Tending to the most urgent medical needs Helene had created also meant that routine care had been interrupted — a frequent outcome after natural disasters that can have negative impacts on health.

One nurse practitioner had reported to Dr. Motii that her house was almost completely submerged by the floodwaters and family members, struggling with their own health impacts, were displaced. He was surprised when she showed up for a mobile clinic shift anyway.

“God knows who’s going to show up for these patients” if she didn’t, was her reply.

She’s one of many staff who have been heavily impacted and come to work anyway, Dr. Motii reported.

“They have prioritized patient care for those who are drastically affected,” he said. “To see them showing up every day for us and for our patients…[is] such a display of bravery and character.”

Direct Relief has launched a large-scale response to Hurricane Helene, committing an initial $250,000 in emergency funding and sending shipments of field medic packs, tetanus vaccines, water purification tablets, and essential medications and supplies to a number of nonprofit health partners. Mobile medical units funded by Direct Relief, including Oceana’s, are providing medical care in impacted areas throughout the southeastern U.S.

An operational overview of Direct Relief’s Helene response, including the organization’s Hurricane Preparedness and Safety Net Support Programs, is available here.

The post In Hurricane Helene’s Wake, A “Cat-and-Mouse” Game to Reach Trapped Patients through Choked-Off Roads, Downed Communications appeared first on Direct Relief.

Hurricane Helene is expected to drop up to 15 inches of rain in some areas, and could cause storm surge of up to 20 feet in places. Winds may exceed 156 miles per hour. “This is not a survivable event for those in coastal or low-lying areas,” cautioned Jared Miller, the sheriff of Wakulla County, located in Florida’s Big Bend region where the storm is expected to make landfall.

Helene has not yet made landfall, but heavy rain, flooding, and strong winds were already damaging Florida communities on Thursday.

In Hurricane Helene’s Path

Population dynamics data from Meta’s Data for Good indicate that many in danger’s path are choosing to evacuate. Using anonymized data, CrisisReady, a research-response initiative at Harvard and Direct Relief, recorded areas with increase and decrease of population in the hours and days prior to Helene’s landfall. For example, St. George’s Island off the Florida coast registered a population decline of 92% on Wednesday evening. Coastal areas from Lower Grand Lagoon to Apalachicola show declines of 25 to 50%.

Although tropical storms are extremely common in Florida, Hurricane Helene poses an extraordinary danger. In addition, Helene’s path is similar to that of Hurricane Idalia, which battered the Big Bend region last year. Idalia’s impacts were widespread and severe, and some communities threatened by Helene are still in recovery.

Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis, noted that there was a significantly higher incidence of movement away from coastal towns rather than inland areas. In the small town of Steinhatchee, for example, which experienced up to 12 feet of storm surge during Idalia, population data showed a 53% decrease.

Shelters were open and receiving evacuees on Thursday, as a state of emergency was active in 61 of Florida’s 67 counties.

Evacuations cause urgent health needs as people flee without lifesaving medications and medical devices, shelter together in close quarters, and experience trauma — a mental health danger that evidence shows is compounded by repeated exposure to natural disasters.

But evacuation is not always straightforward. Population dynamics data indicate a change in the number of people occupying an area — although Schroeder notes the correlation is somewhat lower in rural areas than urban ones — but it does not track the movements of individuals, and sometimes the data offer surprises.

As an example, Schroeder pointed out that Citrus County, currently bracing for dangerous storm surge, was registering a 12% population increase. The county has the oldest population in this area of Florida — 36% of residents are over 65 years old —and the highest percentage of people who use powered medical devices.

“That’s a pretty high vulnerability,” he said. A storm like Helene can knock out power for days, causing serious risks to people who rely on electricity to power devices.

Many people in high-risk counties will not evacuate, Schroeder said, and not everyone should. Although administrative divisions like cities and counties are useful for determining emergency measures and communicating information, the danger isn’t equal everywhere, and local guidance will vary.

But not everyone who would be safest evacuating will do so — often because they’re not able to do so. While Direct Relief’s Research and Analysis team noted that 1.9 million people in Florida, Alabama, and Georgia are threatened by hurricane-force winds connected to Helene’s storm system, more than 343,000 of those people are below the federal poverty line — about 18%. A lack of financial resources — along with disabilities and mobility issues, language barriers, and other social determinants for health — make it much more difficult to evacuate, and decrease the likelihood that someone will do so.

Federally qualified health centers and other first responders often describe the most urgent need in the aftermath of a storm coming from people who had no choice but to ride out the storm at home. Health center staff have described people in dire need of food, clean water, tetanus vaccines, wound care, and replacements for medications like insulin — which need to be delivered through flooded streets.

Direct Relief-funded mobile medical units and emergency response vehicles often fill these needs, navigating streets filled with debris and lingering floodwaters to care for patients endangered by the storm and its aftermath.

Health Risks and Displacement

Whether people evacuate or shelter in place, hurricanes and other extreme weather events have severe and long-lasting impacts on health.

Chronic diseases like diabetes and hypertension can spiral out of control in the aftermath of a major disaster, as care and access to medicines are interrupted. Shelter settings cause outbreaks of Covid-19, diarrheal disease, and other infectious illnesses. Water-borne diseases, physical injury, and tetanus threaten health as people return to flooded communities, clear damage, and begin to rebuild.

Post-traumatic stress, depression, and anxiety are a long-term threat as well, affecting new people and increasing the severity of existing conditions. New research is emerging that people in storm- and wildfire-prone areas, exposed to repeated threats, evacuations, and impacts over time, are particularly likely to experience compound effects.

Direct Relief’s Response

In preparation for these events, Direct Relief equips health centers throughout tropical storm-vulnerable regions with hurricane preparedness packs, large-scale modules stocked with the medications and medical supplies most commonly needed in the aftermath of an extreme weather event. Several of these HPPs are within or near Hurricane Helene’s projected path.

Within the past two weeks, Direct Relief delivered 10 shipments of essential medicines and supplies to six partners located in the storm’s projected path as part of the organization’s ongoing safety net support program. The program supplies community health centers, free and charitable clinics, and charitable pharmacies with medical support, which is used to treat low-income and uninsured patients and ensure greater resilience.

The organization will assess needs and potential response measures stemming from Hurricane Helene in the coming days. Transportation support and medical procurement, emergency medical backpacks, hygiene kits, new hurricane preparedness packs, and emergency grants are all frequent priorities in the aftermath of a tropical storm.

The post Evacuees Flee Florida Coast as Massive Hurricane Helene Closes In appeared first on Direct Relief.

Tropical Storm Francine was sweeping towards New Orleans on Tuesday morning, but in the city’s Lower Ninth Ward, Teresa Bovia kept her health center’s doors open.

Six new patients had already needed walk-in appointments at Baptist Community Health Services, Inc., where Bovia is the chief operating officer. Most needed to refill their medications before the storm hit, but hadn’t been able to contact their regular doctors. The health center’s existing patients also needed insulin or other medications, or wanted to check their blood pressure, before sheltering in place.

“The people we serve, they don’t have the means to leave,” Bovia explained.

Even as BCHS providers met with patients and filled prescriptions, staff members were carrying out emergency preparedness measures for an extreme weather event that had, thus far, proven difficult to anticipate or prepare for. Tropical Storm Francine was expected to strengthen into a Category 2 hurricane and make landfall on the U.S. Gulf Coast on Wednesday, but expert predictions of its path had shifted repeatedly.

Bovia was hoping to keep at least one clinic open for patients, but if storm damage made that impossible, staff were prepared to set up a temporary clinic with tents and portable generators. They’d done it before, Bovia said, in the aftermath of one of Louisiana’s many hurricanes. “I wish I could tell you the name of that storm, but I can’t remember at this point,” she said.

Two of BCHS’s six locations have generators, funded through Direct Relief and Abbott’s Disaster Resiliency grants, so Bovia had already transferred vaccines and other temperature-sensitive medications to the refrigerators safeguarded by the backup power system. She estimated that the generators would preserve close to $65,000 worth of vaccines.

Doctors and nurse practitioners were checking on or refreshing their Direct Relief field medic packs; each BHCS provider keeps one of the packs in their car for emergencies. (When Direct Relief spoke to Bovia on Tuesday, 10 additional emergency medical backpacks were being prepared for shipment at the organization’s California headquarters.)

During previous storms, Bovia said, providers had used the packs to suture wounds, dispense emergency medications, and prevent infections.

A Direct Relief hurricane preparedness pack, staged at BCHS in advance of hurricane season, had been loaded into tactical jump bags for easy transportation.

Health centers in tropical storm-prone areas develop detailed preparedness and response plans to ensure that patients are prepared in advance, have a resource to turn to when an emergency strikes, and can receive immediate and continuous care in the wake of a storm. Over time, Bovia said, staff and leadership learn valuable lessons, but she stressed the importance of flexibility.

“Every storm brings a new set of circumstances, and something you thought was going to be great didn’t work” in an unforeseen situation, she said.

But experience had taught her that essential medications and heat relief would be her patients’ most urgent needs in the aftermath of Francine. “If a pharmacy doesn’t have power, they’re not going to open, so there might only be one pharmacy within 20 miles and most of our people don’t have transportation,” she explained. Public transportation was likely to stop — “they want you to stay home” — and the September heat would be treacherous without working power.

In New Orleans’s Lower Ninth Ward, where Bovia works, patients are always vulnerable. She explained that life expectancy in the community is fully 20 years lower than it is for residents of her home neighborhood 15 minutes away. “We know [the inequity] is there and it’s our responsibility to do something about it,” she said.

BCHS was founded in the aftermath of 2005’s Hurricane Katrina, when local faith leaders who’d responded to the crisis drew attention to the urgent need for community health care. “This was the area of the city that had been most ignored,” Bovia explained. Katrina had flooded the Lower Ninth Ward with six feet of floodwaters in some places.

“We’re very strategically located,” Bovia said.

Many of the health center’s patients struggle with food insecurity and other socioeconomic challenges that experts have shown contribute to worse health outcomes. If a neighbor seems dehydrated, or a friend needs medicine, community members are likely to call BCHS to ask for guidance.

Because BCHS chose locations that would be easily accessible to vulnerable patients, flooding and power loss are regular risks during hurricane season. Like their patients, health center staff have learned to adapt. “It’s storm season, we all know” what to expect, Bovia explained.

A mobile medical unit, supported by an Abbott Disaster Resiliency Grant and currently in the process of being outfitted, is BCHS’s next disaster preparedness and response project. When it’s completed, Bovia said, health center staff will be able to drive it into affected neighborhoods and offer on-the-spot care.

“This is what we do,” Bovia said.

Since 2017, Direct Relief has supported Baptist Community Health Services, Inc., with $2 million in funding, medications, and supplies.

Through the Abbott Disaster Resiliency Grant program, a multi-year initiative aimed at mitigating the impact of disasters and ensuring continuity of response, BCHS has received three grants totaling $190,000. These grants were used to purchase two generators that have helped sustain power and preserve cold-chain medicines, and, with the most recent round, to support the purchase and outfitting of a mobile medical unit that will be used for community outreach and deployed as part of disaster relief efforts.

During the Covid-19 pandemic, Direct Relief supported BCHS’s community care with a $500,000 operating grant.

The organization has also supported BCHS’s disaster resiliency and accessible health care services with hurricane preparedness packs and emergency medical backpacks; chronic disease treatments and other medications; PPE; nutrition support; and an additional range of requested medications and supplies.

The post As Francine Bears Down on New Orleans, A Health Center Braces for Impact — and Plans for Uncertainty appeared first on Direct Relief.

Nutrition education begins as soon as a patient with diabetes begins working with pharmacy staff. Learning to manage blood sugar is essential, as are setting and working toward lifestyle and nutritional goals. Staff follow a detailed protocol of monitoring, follow-up, and assessment. Through interactive demonstrations in the pharmacy’s teaching kitchen, dieticians teach healthy cooking skills. 
  
Pantry4Health began with a focus on donated fresh foods, but Curington quickly learned that produce was too risky — it went bad quickly, it was time-consuming, people weren’t familiar with the offerings. Now, the program teaches pharmacy patients to cook healthy foods using shelf-stable ingredients available in its food pantry. Dieticians and dietetics interns develop easy recipes based on the current offerings and bundle them together. Seasonings are bought in bulk, combined, and measured out for each bundle.  
  
New recipes and bundles are offered monthly. Staff constantly incorporate in feedback. For example, one patient, experiencing homelessness and with nowhere to cook, inspired a recipe for no-bake peanut butter balls with walnuts, oats, and cinnamon. Can openers are available in the pantry because many people don’t own one. 
 
“The meal I was taught today will help me so much because it is a vegetarian meal, and I am diabetic,” said one patient who received nutrition education through Pantry4Health. “I am moving soon, and this will be the first meal I am making for my family at our new home. It was delicious!” 

Sometimes inspiration is born of necessity. A beloved Hawaiian tuna rice bowl recipe began when canned tuna sat unwanted on food pantry shelves. Realizing that “we’ve gotta move this tuna,” Curington recalled, recipe developers combined it with coconut flakes and pineapple. Despair over canned salmon was resolved when a receptionist who grew up in the South taught other staff members to make a salmon croquette. Chickpeas and couscous weren’t popular — “no one knew what to do with them” — until a Mediterranean bowl recipe. 
  
The Transformative Innovation Award has also been a jumping-off point for new partnerships, including with the University of Cincinnati. St. Vincent de Paul now offers internships to dietetics students who want to focus on caring for vulnerable communities. “We didn’t have a program that would attract them” before this, Curington said. “When a nonprofit gives us funding, we brag about it a lot, it builds credibility, and it really helps bring more resources in.” 
  
Offering free medication and chronic disease management — there is no cash register at any of St. Vincent de Paul’s three pharmacy locations — means thinking strategically about long-term goals. Curington doesn’t want to build up a patient roster or even have permanent patients. “If I just keep collecting people, I won’t be able to [work with] new patients,” he said. The end goal is to “help people transition out of the safety net. No one wants to live in the net.” 

It’s a complex process that involves helping patients apply for insurance, learn to exercise and manage medical conditions — even to get them off medication if possible — and design a plan to maintain their health and well-being. 
  
That often takes six months to a year, but patients who need longer-term support to implement a plan receive it. Curington knows inflation, housing shortages, and the shifting public insurance landscape stack the deck against people who are already vulnerable. Someone who seeks out St. Vincent de Paul because they can’t pay rent and still afford medicine needs immediate support, but they also need a partner who can help them build stability over time. 
  
St. Vincent de Paul’s goal is to be that partner, Curington explained. Volunteers and interns are there because they want their neighbors to thrive.  
  
“Our love for our town, our love for our community, we’re blending that into our mission,” he said. 

The post For Patients with Diabetes, Growing Health and Self-Sufficiency One Meal at a Time appeared first on Direct Relief.

“It’s being able to provide a safe place for clients to share their stories, without judgment, without added stress,” she said. “You’re creating a safety net and [they know] that there’s someone who’s interested in walking this path with them.”
 
Moreno didn’t always plan on being a bereavement therapist. She went to college expecting to become a private investigator. But then she took a psychology class, and fell in love. She also saw a high need for mental health services in her Latino community, and was concerned about the stigma she saw community members holding toward psychology and mental health care.
 
“I thought, ‘Maybe if I look like them and talk like them, I can help them,’” she recalled. “I felt a yearning and a calling for that.”

Santa Barbara County is famous for its natural beauty and elaborate mansions, but the area is rife with inequity and income disparities, particularly in the northern part of the county, which has historically had little in the way of affordable health care.
 
That changed in 2022, when physician Ahmad Nooristani saw the extraordinary need for medical services in north Santa Barbara County, and founded Savie Clinic in the city of Lompoc, to provide free health care for uninsured patients.
 
Savie’s leaders first became aware of the urgent need for bereavement therapy in their community when a young patient died suddenly from an illness last year. As Savie’s staff worked to organize support for the boy’s family, they began to hear other stories of patients losing family members suddenly, whether from murder, suicide, car accidents, or natural causes.
 
“Hearing more of these stories made my hope to partner with Hospice increase,” said former Savie executive director Eryn Shugart, who is now a grant writer, in an email to Direct Relief.

Shugart said Moreno was a natural choice to provide the expanded services: “She is bilingual and bicultural, and 90% of our patients speak Spanish only. She is also an excellent and experienced clinician.”
 
For Moreno, it was an opportunity to bring an essential treatment to an underserved population.
“I was excited because I know that north county doesn’t get a lot of services,” she explained. “We don’t turn anyone away.”
 
But the care itself is familiar. “The subject is the same. It’s death and dying,” Moreno said. “This is what grief looks like…They’re brave enough to come in and fall apart, and then pull themselves together again.”

In Moreno’s experience, many members of Santa Barbara County’s Spanish-speaking population need mental health care, but they’re afraid of reaching out, and aware of the stigma. Part of her work is helping her patients understand and process the fear they’re feeling. “Whatever emotions you’re feeling, it’s normal,” she tells patients.
 
Ultimately, Moreno’s goal is to give the people who seek her help the tools they need to work through grief, trauma, and other emotional pain in their lives.
 
“They’re going to learn coping skills,” she said. “So when they get triggered, or they feel like the world is falling apart, they’re going to draw on their coping skills.”

The post In a Wealthy County, Uninsured Patients Struggle with Grief and Trauma. This Therapist Helps Them Heal. appeared first on Direct Relief.

Via telemedicine calls, patients were describing asthma or COPD symptoms worsened by air quality. “We have a lot of respiratory disease up on the mountain,” said Denise Highfill, Shingletown’s chief operating officer.

Behavioral health providers from the health center were calling patients — some of them still recovering from the Camp and Dixie Fires, which destroyed whole communities in this mountainous part of northern California — to check in and talk through anxiety.

Staff members helped patients access inhalers and respiratory medicines, and prepared to distribute hygiene kits to people displaced by what is thus far the fourth-largest blaze in California history.

The Park Fire, which began more than a week ago, has been helped along by high temperatures and strong winds, destroying hundreds of structures and displacing thousands of people across Butte, Tehama, and Shasta County, despite a massive containment effort.

In 2018, the Camp Fire became the deadliest wildfire in California history, killing 86 people — many of them older adults — and destroying the Butte County town of Paradise. The blaze contaminated water and air quality, left many struggling to find housing and rebuild their lives, and increased or worsened substance use disorders, mental health concerns, and chronic disease in the area. Repeated emergencies — including the Thompson Fire in Butte County earlier this year — have threatened the area.

Now, safety net providers and public agencies, informed by past experience, are working to meet the most urgent health needs — while keeping an eye on the future.

Community Response

Because Shingletown Medical Center couldn’t operate its emergency food pantry and resource center — and local groups working to address food insecurity couldn’t reach patients either — Highfill was worried about patients going without food as well.

Home visits are an essential part of Shingletown’s medical services — providers offer everything from chronic disease management to wound care for ulcers — but getting to patients with mobility problems wasn’t possible amid the fire.

Highfill explained that many of their patients were under evacuations or warnings, but some had chosen to stay, unwilling to leave their animals behind or undergo another displacement. “Our community is a very, very rural, self-sufficient community. We also have a lot of elders,” she said.

Shingletown was working with local agencies to find a safe place “to be able to actually see and touch our patients,” Highland said. She was worried about patients who weren’t getting wound care.

At Ampla Health, a health center network with 20 Northern California locations, staff were focused on making sure patients were receiving needed medical care. Rocio Valdez, director of communications at Ampla, explained that people displaced by emergencies frequently lose access to their medications — along with their insurance paperwork and identification. Getting patients reconnected to health services, and transporting them to appointments and pharmacies, were priorities during an emergency.

Direct Relief has supplied two of Ampla’s facilities with resilient, solar-powered systems via the organization’s Power for Health initiative. (Shingletown Medical Center is also a Power for Health partner.) John Fleming, Ampla’s director of planning and development, explained that public safety power shutoffs, as well as the wildfire risk, have repeatedly affected their clinics. But all their locations were currently operating at full capacity and seeing patients affected by the Park Fire, he said.

Staff were also prepared to dispense hygiene kits, provided by Direct Relief, at community events.

The Butte County Public Health Department had set up a shelter last week at a church in the city of Chico, which housed about 200 people at one point. There, nurses focused on triage. People who’d inhaled smoke needed respiratory treatments. Some had left home without wheelchairs or CPAP machines, a number had wounds, and others needed transportation to a hospital or other medical setting, said Monica Soderstrom, a community health division director.

In addition, public health workers were monitoring to prevent the spread of infectious disease — displacement during the Camp Fire had led to an outbreak of norovirus — and working to connect people with their home care agencies or primary care providers.

Behavioral health needs were also widespread, responders noted. Butte County has a dedicated behavioral health department that was providing support to affected and displaced residents.

Soderstrom explained that being prepared to respond to emergencies quickly and effectively — without sacrificing ongoing programs — was key. “We’re making sure that every staff member understands that they are a disaster service provider,” she said. Simulations and trainings for shelter settings and other emergency measures are key to their work.

“Unfortunately…we get a lot of practice,” Soderstrom said.

A Long-Term Outlook

Direct Relief has focused on increasing resilience and meeting health care needs in this area of California since the days of the Camp Fire, including providing support for a temperature-controlled warehouse for storing medicines and supplies that Butte County Public Health staff said was integral to their response work.

To help meet emergency health needs during the Park Fire, Direct Relief is providing emergency medical backpacks, hygiene kits, replenishment supplies, a wildfire kits, and requested medicines to responding organizations.

Highfill, at Shingletown Medical Center, was anxious to return to home visits and in-person care. In particular, she said, the emergency medical backpacks, which are designed to treat a variety of chronic and acute conditions, are ideal for home visits.

Shingletown was also preparing to meet increased needs for mental health services and substance use disorder treatments. The health center recently hired a new psychiatrist. But Highfill explained that it’s hard to find specialty care providers in the area, and residents rely on local behavioral health providers for a range of needs.

Fleming said that Ampla was also working to increase its behavioral health capacity, with a Chico clinic primarily focused on behavioral health services. For patients who lost property or were in harm’s way, or who are reminded of past disasters and evacuations, post-traumatic stress is a particular concern.

Butte County Public Health is preparing for the aftermath, arranging for debris removal and water system testing, dispensing safety information for residents, and working with local partners.

Community ties are strong in this area, Soderstrom and Highfill said. Health care providers have lost homes in past events, and some have been subject to evacuation orders during the Park Fire.

“We have a small enough county that, for everyone, this is our home,” Soderstrom explained.

Highfill described a nurse storing emergency medical supplies in her home and staff members showing up to implement emergency plans despite being displaced themselves.

“It’s their community, it’s the people they go to church with and see in the grocery store,” she said. “That community wouldn’t have care…if we weren’t there.”

In response to the Park Fire, Direct Relief is providing Shingletown Medical Center with emergency medical backpacks, hygiene kits, prescription medicines and supplies, and a wildfire kits. Ampla Health will use Direct Relief-supplied emergency medical backpacks and distribute hygiene kits as part of their response work. To support Butte County Public Health Department, Direct Relief provided disinfectant supplies for shelter use and replenished emergency medical pack contents.

The organization has also supported local health care resilience through its Power for Health initiative, which outfits community health care facilities with resilient solar power systems, a temperature-controlled warehouse used to store medical supplies, grant funding, and a wide range of medicines and supplies.

The post The Park Fire Creates Urgent Health Needs, And Long-Term Threats appeared first on Direct Relief.

A silent killer is on the rise, growing in severity and frequency along with floods and hurricanes— and killing more people than all other weather-related disasters combined.

Extreme heat, defined as more than two days in a row above 90 degrees, can cause health problems for anyone, but it’s especially dangerous for people who are vulnerable already: children and older adults; people with pre-existing conditions and disabilities; people who experience homelessness, work outdoors, are incarcerated, or are low-income.

“This extreme heat is felt even more sharply in our cities due to the urban heat island effect,” said Jana Eubank, CEO of the Texas Association of Community Health Workers. Urban areas experience higher temperatures than rural ones due to a combination of heat-absorbing buildings and roads with a decrease in vegetation and green spaces.

This summer, as waves of extreme heat rise across different parts of the U.S., the weather phenomenon is getting plenty of attention. The federal government has released new tools and programs aimed at combating its effects. Texas and Florida made national headlines for blocking heat-related protections for outdoor workers. On-the-ground media coverage details the impacts on communities and individuals.

But for community health centers, which focus on caring for the country’s most vulnerable, heat-related care, outreach, and education are already integral to the services they provide. It’s not a question of learning the impacts or even developing new solutions, but of carrying on and expanding the work they already do.

“At the mercy of the weather”

For staff at Camillus Health Concern, a Miami-based health center that focuses primarily on people experiencing homelessness, minimizing the impacts of heat “has always been our way,” said CEO Francis Afram-Gyening. It’s the intensity and frequency of these events that has changed.

“The necessity is more than I’ve ever seen,” Afram-Gyening said. “With this heat in Miami, if you don’t have air conditioning, you are really at the mercy of the weather.”

Many of the patients Camillus Health Concern cares for are improvising shelter from cardboard or other materials. Even those in shelters often don’t have access to air conditioning, Afram-Gyening said. Patients with diabetes need to store insulin, which must be kept at cold temperatures to be safe and effective. And health conditions from hypertension to depression can be worsened by the heat.

It’s a complicated problem that requires a multi-pronged approach. Outreach teams pass out cooling towels, electrolytes, and hydration supplies — much of it donated by Direct Relief, Afram-Gyening noted. Street medicine teams arrange transportation to cooling centers, many of which are located in central areas near one of Camillus’s facilities.

At the facilities themselves, patients can access water and hydration support. Camillus Health Concern offers insulin storage itself, and also partners with local organizations, such as housing groups, who can store insulin for patients on site.

Even the process of helping patients find housing — always complex, as there isn’t enough to go around — has changed. Staff members are more likely to ask for priority housing for a patient whose health is particularly endangered by heat.

Afram-Gyening observed that nothing in his formal education prepared him to meet the needs of a vulnerable patient population regularly exposed to extreme heat. It’s through practice, experience, and partnership that he and his staff have “developed some competencies of, ‘How do we address issues like this?’”

“Until they absolutely have to”

Dr. Marsha Thigpen, CEO at Gulf Coast Health Center in southeast Texas, described seeing patients for follow-up care after they’d been discharged from the hospital this summer. Acute symptoms of heat-related illness — swollen feet, labored breathing — had required emergency care.

“A lot of people in our community don’t seek help until they absolutely have to,” she explained.

And the extreme weather is “slowly getting worse,” Thigpen said. “Most of us are really concerned about this hurricane season…We are consciously looking every time there’s a disturbance in the Atlantic.”

Worsening the situation for Thigpen’s patient population is the presence of nearby refineries, Thigpen said. Southeast Texas has a high incidence of diseases, like cancer, that often have an environmental component, and she’s concerned about the consequences for her patients.

To protect patients from the effects of extreme heat and other weather events. Thigpen and fellow providers employ a combination of preventative care, screening, outreach, and education. Patients are screened for everything from pulmonary function to behavioral health symptoms, and staff members are taught to be on the lookout for symptoms exacerbated by heat.

Making sure patients are well stocked with medications is a high priority. “If they’ve got asthma, COPD [chronic obstructive pulmonary disease]. Diabetes, hypertension, they’re more likely to have issues with the extreme heat,” Thigpen said. And during extreme weather, “they may have difficulty getting to the pharmacy.”

Gulf Coast Health Center staff also counsel patients about preventive measures such as hydration and regular breaks — particularly essential for patients who work in construction or other outdoor industries, Thigpen said — and offer advice for dealing with the heat via local radio, fliers, and on-the-ground outreach. Patients are encouraged to exercise during cooler hours and reminded not to leave children or pets in cars.

“Dehydration is going to exacerbate any symptoms they have,” Thigpen explained.

Working with partner organizations has given Gulf Coast Health Center the opportunity to provide care and education via community health fairs. They began staffing last summer, Thigpen said, and another is planned for this August.

Whatever the care being offered, Thigpen said that flexibility and availability are key. Gulf Coast Health Center keeps extended hours and a 24-hour on-call service.

If a patient is experiencing heat-related illness or the symptoms of an existing condition are worsening, “they can walk in the same day,” she said.

Direct Relief equips community health centers throughout the country with requested medications and supplies designed to protect against the effects of extreme weather. Since June 1 of this year, the organization has provided Camillus Health Concern with more than $84,000 in medical support, including electrolytes, nutrition aids, and other medical essentials. Gulf Coast Health Center has received more than $152,000 in medical support, including electrolytes, a range of essential medications, and a Hurricane Preparedness Pack stocked with medicines and supplies commonly requested after severe storms.

The post Extreme Heat Is Increasing — and Deadly. Health Centers Protect Patients from Its Dangers. appeared first on Direct Relief.

Brazil’s fatal flooding in May of this year, caused by torrential rainfall, has killed at least 169 people and displaced more than 600,000. Experts have said that the vast scale of the disaster is due to climate change, and that massive displacements and deadly weather events like this will become increasingly common in a rapidly warming world. 
  
For Duani Teixeira, a businessman in the municipality of Xangri-lá who participated in the rescues, it was the beginning of something entirely new. Working with colleagues, he founded a new NGO, S.O.S Irmãos do Litoral, focused on helping Rio Grande do Sul recover from the disaster. 
  
“I think the gravity of the situation brought to the surface a sense of urgency and responsibility that they had to do something about it,” said Grangeiro, an acquaintance of Teixeira’s who texted him amid the flooding to ask if he needed help and played a key role at the organization. “They couldn’t return to their regular lives. They had to keep helping.” 
  
Getting people away from the most immediate danger was only the beginning. Hundreds of thousands of displaced people needed food, clothing, hygiene products, and other necessities. An outbreak of leptospirosis from contaminated water killed several individuals.  
  
The brand-new NGO pivoted fast, turning its attention to finding and distributing supplies to over 150 shelters and health care centers, and procuring food for volunteer-run kitchens. “Wherever there were two or three grandmas, there was a kitchen,” Grangeiro said. The community response was tremendous — it’s rare to meet a local who didn’t donate time or money, she recalled — but organizing and transporting food and supplies, and auditing the recipients to make sure they’d use donations efficiently, was a huge effort. 
  
As part of a larger response to the disaster, Direct Relief helped S.O.S Irmãos do Litoral meet emergency needs, providing a $50,000 grant along with nine pallets of nutritional and hydration products.  
  
“We didn’t have enough supplies and food to help those who were undernourished,” Grangeiro recalled. “It was really efficient what they sent.” 

In retrospect, Grangeiro said, it was astonishing that she and her colleagues formed a licensed NGO in four days, found donors able to help, and developed procedures for procurement, oversight, and distribution. The group accomplishes its widespread work primarily through the work of volunteers. Members are so focused on helping — and so aware of the need — that they have to be reminded to go home and rest. 
  
The floodwaters have receded and many have returned home, but the group’s work is only beginning. They’ve pivoted again, focusing on providing food and necessities to organizations working on the ground. “We became…specialized in finding serious projects that are still helping,” she said. “The challenge was to find those projects that were doing a very good job of reaching people.” 

S.O.S Irmãos do Litoral’s members are keenly aware that the danger is not over. A return to normalcy is years away for affected communities in Rio Grande do Sul. The region is still alarmingly vulnerable to climate disasters. 
  
“We’re facing future tragedies ahead,” Grangeiro said 
  
But she’s heartened by the outpouring of support she’s seen, and by a sense of togetherness and responsibility in communities across the state. “Everyone was touched, everyone did something,” she said. “What we did here changed everybody.”   

The post Amid Brazil’s Deadly Floods, Daring Water Rescues Were Only the Beginning  appeared first on Direct Relief.

Several roofs on the block had already been badly damaged — or torn off entirely — when a storm hit the city in May. They’d been partially repaired. And then, when Hurricane Beryl crashed through Houston last week, “they were torn off again,” said Smith, chief program officer at the Houston-based Spring Branch Community Health Center. “These were the same individuals who were impacted by the storm in May, and they’re still impacted.”

Spring Branch, which cares for an underserved patient population at eight local health clinics, had been hit hard by the storm too. Four of its locations lost power. Staff members were contending with the same issues — damage, power outages, brutal heat — that were affecting their patients.

But leaders and staff alike were determined to be there for their communities. “We have a pretty vulnerable population. Their needs don’t stop with a natural disaster,” Smith said.

That involved simultaneously meeting the most urgent needs — like water, food, and wound care — while preserving continuity of care. Keeping scheduled appointments meant that patients managing chronic diseases, expectant parents worrying about their pregnancies, and kids needing vaccinations wouldn’t slip through the cracks.

“The most vulnerable patients, they suffer during times like this,” Smith said.

At the same time, people who depended on the health center as a community resource needed a place to find supplies and information, to get out of the unrelenting heat, and to charge their phones.

“It’s seat of the pants when [a storm] hits, but we’ve been through several of these,” said Gerard Peperone, Spring Branch’s chief development officer. However, he said, having half the health center’s clinics out of commission added a new wrinkle.

Health care providers would have to double up in the remaining facilities. Call center staff would need to alert patients that their appointment location had changed — and arrange transportation for those who were too far away.

Despite concerns about overcrowding, Smith recalled, the doubled-up clinics moved smoothly. People took refuge in the working air conditioning, patients met with providers, and “you saw phones literally sitting and charging in every corner of the building,” he said.

Spring Branch’s staff filled in the gaps with mobile medical units, which Peperone explained had been provided by Direct Relief after Hurricane Harvey caused widespread devastation in 2017. Staff distributed food and water, supplies donated through the work of local government and community organizations.

In addition, they opened a Direct Relief Hurricane Preparedness Kit, stored at the health center in advance of hurricane season for use in emergencies, to distribute medications and medical supplies.

Spring Branch’s Family Development Center, located in a high-density Houston neighborhood with many immigrant families, was a particular concern. The power was out and providing care in the clinic wasn’t an option. But the center, Smith said, is “kind of the hub in this area” — a place with an onsite Boys & Girls Club and a WIC program offered through University of Texas Health.

“When things like this happen, people generally flock over to the center for all kinds of services,” he explained. “We always feel like we need to be present…Even if we can’t help them, their house has been destroyed, they need a place to come.”

Spring Branch staff set up a mobile clinic outside the center, so a provider could see people who came seeking health care. Smith noted that for many of them, having a provider see kids with respiratory or other illnesses was their top priority. Hot food was available, as was FEMA assistance.

At one point, Peperone remembered, rain started falling heavily while community members were picking up hot lunches. Staff and residents alike ran to move food and supplies into the clinic, so nothing would be lost.

When Smith and Peperone sat down to talk to Direct Relief, power was newly on at all locations. Air conditioners were cooling the overheated rooms so patients would have more places to take refuge. But it was clear that they weren’t stopping for a rest.

“We’re just at the beginning of hurricane season, and they’re thinking that it’s going to be a bad one,” Peperone said. “We need to look at everything we’ve done this time, where are some of the holes that need to be plugged in.”

Because hurricanes will increasingly be a way of life in Houston, which is located on the tropical storm-prone Gulf Coast, Peperone wants to make sure that everyone knows what works — and what to do — when disaster strikes.

“This was more than a dress rehearsal. It was a trial by fire,” he explained. “We now have the components in place.”

Smith agreed. “It’s not a matter of if,” he said. “It’s a matter of when.”

Direct Relief has worked with partners to meet emergency and medical needs caused by Hurricane Beryl since before the destructive storm made landfall. In Texas, the organization has dispatched requested medicines and supplies to a number of health centers, clinics, and others responding to the storm or caring for impacted patients. Shipments have included emergency health kits, each designed to provide medical care for 100 people for three to five days, emergency medical backpacks, hygiene kits, insulin, diabetes supplies, electrolytes, insect repellent, naloxone, personal protective equipment, prenatal vitamins, and other essential support.

Spring Branch Community Health Center received an emergency health kit, eight emergency medical backpacks, and 20 hygiene kits. In addition, a generator to be used for emergency needs and any future outages is being provided.

Direct Relief will continue to work closely with partners to meet health care needs in affected communities, and is committed to replenishing supplies and increasing medical resilience via its Hurricane Preparedness Program.

The post A Houston Health Center Meets Urgent Needs, Protects Long-Term Health in Beryl’s Aftermath appeared first on Direct Relief.

Alejandra Hernandez Ezquivel was in her house in the 500-person community of Santa María Chimalhuacán, in eastern Mexico, when her husband came running indoors. The landfill nearby — the one that had appeared one day out of nowhere years earlier, with no opportunity for the community to object — was on fire.

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“It was like a monster, so immense,” she said through a translator, recalling the fire that began raging on May 29, 2022. The blaze was out of control by the time firemen arrived at the rural community, located in the municipality of Chimalhuacán, about an hour away from Mexico City. Even the portable water tanks they’d brought with them couldn’t fully quench it.

Ezquivel ran from house to house, telling neighbors to close the windows and turn off their gas tanks. But the smoke was so toxic that many had to evacuate to a government-run shelter.

In the weeks that followed, Ezquivel and other community members patrolled the streets at night, working to keep opportunistic looters at bay. Once a thief ran into her house, trying to convince her she needed to evacuate immediately. She wasn’t fooled.

And she cared for patients all the while, supplementing the government-provided services by seeing people affected by the fire’s toxic fumes. Her patients with diabetes and hypertension were experiencing complications. People had gastrointestinal, respiratory, and ocular health problems related to the ongoing flames. Ezquivel herself experienced eye irritation and respiratory distress.

The flames are still burning in the landfill two years later, too deep down in a mountain of refuse to be reached or effectively extinguished, Ezquivel said. But the nurse’s dedication to her community has been recognized with a full-time primary care center, funded by the NGO Fundación Escala and staffed by a dedicated doctor, therapists…and Ezquivel herself.

Embedded from the Start

When Ezquivel and her husband first came to what is now Santa María Chimalhuacán in 2008, there were only cornfields.

Tired of renting, they had decided to build a home, and sold their truck to buy a plot of land in this uninhabited area of the Chimalhuacán municipality. Houses sprang up around them. Today, about 500 people live in the formally recognized community. Most commute to Mexico City, where they work in construction. A few make a living locally, working in agriculture or waste sorting.

Formal recognition from the government came slowly. The community gained access to electricity only five years ago, and running water two years later. Even today, there is no municipal sewage. Most people have septic tanks instead.

From the beginning, neighbors knew that Ezquivel was a nurse. The nearest clinic was more than an hour away, and she often found herself giving vaccinations and treating injuries in her home, both for community members and for neighbors from the community next door, La Escalerilla. Mexican NGOs, including Fundación Escala and Medical Impact, worked with her to implement local health campaigns and provide medical care.

But about a decade ago, workers began digging a massive hole next to Santa María Chimalhuacán, and quickly filled it with trash. Ezquivel and her neighbors couldn’t even figure out who was responsible — the two local municipalities blamed one another.

Then it caught fire.

A Primary Care Center from Scratch

Fundación Escala, working alongside Ezquivel to meet medical needs in the weeks after the flames, saw how indispensable the nurse was to her community — and that their need for health services was growing.

The NGO responded by pulling together the funds to develop a local primary care center in nearby La Escalerilla, procured medicine and equipment, and recruited Dr. Carlos Sanchez, with whom Ezquivel works closely. A local church provided the physical space.

Today, the center is called Consultorio Médico Escala. It does “a little bit of everything,” Ezquivel said. Prenatal care, chronic disease treatment, pain relief, vaccinations, therapy for mental health issues, and more are all provided. For low-income patients and those with physical disabilities, house calls are an option.

“Whatever patients need, that’s what we provide,” Ezquivel explained.

She has hopes and plans for the center. In particular, she’s hoping to be able to expand into specialty care like gynecology, so her patients will have the services they need close by.

The work isn’t always easy, but Ezquivel loves seeing patients leave with a smile after they’ve seen her or Dr. Sanchez. They’re “the reason I keep going.”

Much of Ezquivel’s dedication — from patrolling the streets of Santa María Chimalhuacán to offering wound care in her home — seems beyond the call of duty. But for her, it’s all in a day’s work.

“From the moment I decided to become a nurse, I knew my passion was to help people,” she said.

Through Fundación Escala, Direct Relief has provided more than $44,000 in medications and supplies to Consultorio Médico Escala.

The post Health Care Hero: A Landfill Fire Was Poisoning Her Patients. She Cared for Them at Home. appeared first on Direct Relief.

Alejandra Hernández Ezquivel estaba en su casa en la comunidad de Santa María Chimalhuacán donde viven 500 personas, al este de México, cuando su marido entró corriendo. El vertedero de los alrededores, el que había aparecido un día de la nada años antes, sin que la comunidad tuviera oportunidad de protestar, estaba incendiándose.

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“Era como un monstruo, enorme”, dijo a través de un traductor, recordando el incendio que comenzó el 29 de mayo de 2022. El fuego estaba fuera de control para cuando llegaron los bomberos a la comunidad rural, ubicada en el municipio de Chimalhuacán, a una hora de la Ciudad de México. Ni siquiera los tanques de agua transportables que habían traído pudieron apagarlo por completo.

Ezquivel corrió casa por casa, avisando a los vecinos para que cerraran las ventanas y desconectaran los tanques de gas. Pero el humo era tan tóxico que muchos tuvieron que evacuar a un refugio gestionado por el gobierno.

En las semanas siguientes, Ezquivel y otros miembros de la comunidad patrullaron las calles por la noche, tratando de mantener a raya a los ladrones oportunistas. En una ocasión, un ladrón entró corriendo a su casa, tratando de convencerla que necesitaba evacuar inmediatamente. Pero ella no se dejó engañar.

Y mientras tanto atendía a los pacientes, complementando los servicios prestados por el gobierno atendiendo a las personas afectadas por los humos tóxicos del incendio. Sus pacientes con diabetes e hipertensión presentaban complicaciones. Había personas con problemas gastrointestinales, respiratorios y oculares debido al incendio. La propia Ezquivel presentaba irritación ocular y problemas respiratorios.

Según Ezquivel, el fuego sigue ardiendo en el vertedero dos años después, a demasiada profundidad en una montaña de desechos como para poder alcanzarlo o extinguirlo eficazmente. Pero la dedicación de la enfermera a su comunidad ha sido reconocida con un centro de cuidados primarios a tiempo completo, financiado por la ONG Fundación Escala y atendido por un doctor y terapeutas comprometidos… y la propia Ezquivel.

Integrados desde el principio

Cuando Ezquivel y su esposo llegaron por primera vez en 2008 a lo que hoy es Santa María Chimalhuacán, sólo había campos de maíz.

Cansados de alquilar, decidieron construir una casa y vendieron su camioneta para comprar un terreno en esta zona deshabitada del municipio de Chimalhuacán. Las casas empezaron a construirse a su alrededor. En la actualidad, unas 500 personas viven en esta comunidad formalmente reconocida. La mayoría viaja a Ciudad de México, donde trabajan en la construcción. Unos pocos se ganan la vida en la localidad, trabajando en la agricultura o en la clasificación de residuos.

El reconocimiento oficial del gobierno fue llegando lentamente. La comunidad sólo obtuvo acceso a la electricidad hace cinco años y dos años después al agua corriente. Sin embargo, en la actualidad no hay alcantarillado municipal. Por el contrario, la mayoría de la gente tiene fosas sépticas.

Desde el principio los vecinos supieron que Ezquivel era enfermera. La clínica más cercana estaba a más de una hora de distancia, por lo que a menudo se encontraba vacunando y tratando heridas en su casa, atendiendo tanto a los miembros de la comunidad como a los vecinos de la comunidad de al lado, La Escalerilla. ONG mexicanas, como la Fundación Escala y Medical Impact, trabajaron junto a ella para implementar campañas de salud locales y proporcionar cuidados médicos.

Pero hace aproximadamente una década, unos trabajadores empezaron a cavar un enorme hoyo en las cercanías de Santa María Chimalhuacán, y rápidamente lo llenaron de basura. Ezquivel y sus vecinos ni siquiera pudieron averiguar quién era el responsable: los dos municipios locales se culparon entre sí.

Y entonces se incendió.

Un centro de cuidados primarios desde cero

La Fundación Escala, que trabajó junto a Ezquivel para responder a las necesidades médicas en las semanas posteriores al incendio, se dio cuenta de lo indispensable que era la enfermera para su comunidad, y de que su necesidad de servicios de salud estaba creciendo.

La ONG respondió reuniendo los fondos para desarrollar un centro local de cuidados primarios en la localidad cercana de La Escalerilla, consiguió medicamentos y equipos, y contrató al Dr. Carlos Sánchez, con quien Ezquivel trabaja muy de cerca. Una iglesia local les proporcionó el espacio físico.

En la actualidad, el centro se conoce como Consultorio Médico Escala. Allí se hace “un poco de todo”, dice Ezquivel. Se ofrece atención prenatal, tratamiento de enfermedades crónicas, alivio contra el dolor, vacunas, terapia para problemas de salud mental y mucho más. Para los pacientes de bajos recursos y aquellos con discapacidades físicas, las consultas a domicilio son una opción.

“Cualquier cosa que necesiten los pacientes, eso es lo que les ofrecemos”, explicó Ezquivel.

Ella tiene esperanzas y planes para el centro. En particular, espera poder expandirse hacia una atención especializada como la ginecología, para que sus pacientes tengan cerca los servicios que necesitan.

El trabajo no siempre es fácil, pero Ezquivel ama ver a los pacientes irse con una sonrisa después de haberla visto a ella o al Dr. Sánchez. Ellos son “la razón por la que sigo adelante”.

Buena parte de la dedicación de Ezquivel, desde patrullar las calles de Santa María Chimalhuacán hasta ofrecer cuidados a los heridos en su casa, parece ir más allá del llamado del deber. Pero para ella, todo es parte de su trabajo diario.

“Desde el momento en que decidí convertirme en enfermera, sabía que mi pasión era ayudar a la gente”, dijo.

A través de la Fundación Escala, Direct Relief ha proporcionado más de USD 44,000 en medicamentos y suministros al Consultorio Médico Escala.

The post Héroe de la Salud: Un Incendio en un Vertedero Estaba Envenenando a Sus Pacientes. Ella Los Cuidaba en Casa. appeared first on Direct Relief.

Rafia Rauf, a maternal health leader, heard these and many other stories as part of a qualitative study conducted by the White Ribbon Alliance in Pakistan. The goal was to better understand, on an individual level, how climate change affected women’s pregnancies and birth outcomes. “My pregnancy was the worst experience of my life” due to the heat, one woman told her.

Growing evidence shows clearly that climate change is materially, measurably harmful to pregnant women and babies. Whether it’s a climate-related disaster like a hurricane or flood, or a harmful shift in local environmental conditions, climate change is a destructive force: It increases the risk of intimate partner violence, leads to reproductive complications and even pregnancy loss, and can kill infants exposed to contaminated water.

Midwives have essential roles to play in protecting women and babies — while helping to ensure a more sustainable future. On May 6, during an International Confederation of Midwives webinar, experts discussed the ways in which midwives are “the workforce we need for a warming world.”

World Health Organization Director-General, Tedros Adhanom Ghebreyesus, described midwives in pre-recorded remarks as “first responders” whose work could save 4.3 million lives each year.

During disasters, midwives are often the first responders on the ground. Paulina Ospina, associate director of maternal and child health at Direct Relief, described the way midwives swung into action in August of 2023, when destructive wildfires broke out in Hawai’i. The very first request for medical supplies Direct Relief received was from a local midwifery group, Healthy Mothers, Healthy Babies Coalition of Hawai’i, who were moving from Oahu to Maui to care for people displaced or affected by the blazes. And by the time Direct Relief staff were on the ground, the group was already working with the local health department.

“Midwives…are already embedded in the community. They’re representative of the community,” Ospina said. Where health services are frequently disrupted during a disaster, she added, midwives are frequently motivated to continue caring for mothers and babies.

Even as disasters continue to worsen, midwifery offers a sustainable model of care — and a focus on climate adaptation that’s sensitive to cultural and environmental needs.

“Most often, pregnancy and birth do not require grand interventions or technologies,” said Jahan Zuberi, a midwife coordinator at Pakistan’s Indus Health Network. Midwives, who rely on skill, experience, and local and cultural knowledge, “respect the climate that is available to them.”

Moreover, Zuberi explained, excessive outside intervention can separate communities from trust in their own traditional practices and resources. “As we continue to bring midwifery back to the community, we’re going to be promoting practices that are inherently sustainable,” such as the use of effective local herbs, she said.

Maeve O’Connell, a professor of midwifery at the Fatima College of Health Sciences in the United Arab Emirates, offered an important example: breastfeeding. Infant formula is so intensive to produce, she said, that meeting World Health Organization breastfeeding goals would do more to protect the climate than replacing natural gas with renewable gas. “We actually have done the calculations,” she said, referencing a study she conducted with colleagues on this subject.

Moreover, she said, it’s often unsafe to dilute with water – as some formulas require – after a natural disaster, because water can be contaminated by the event.

O’Connell emphasizes that mothers are not to blame for the prevalence of formula feeding. Policy is. Predatory advertising abounds, and the support that many women need to allow them to breastfeed successfully often isn’t available. “It needs to be a collective advocacy,” she said. Midwives can “advocate for policies and practices that support breastfeeding as a sustainable choice for families and the environment.”

That means, in part, giving midwives more room to practice the full scope of their profession. Many midwives, for example, work in labor and delivery wards but aren’t given the opportunity to follow up with families postpartum.

In the wake of a disaster, midwives can ensure that resources are used effectively and meet community and cultural needs. For Zuberi, Pakistan’s 2022 floods are an illuminating example. “There were donations that never got used because that was not the community’s practices,” she said. The menstrual pads were wasted, and menstruating women and girls went without needed resources.

In general, O’Connell said, midwives are uniquely qualified to “harness the evidence” that connects climate change to sexual and reproductive health. The issue is making sure that their voices, and the voices of the people they serve, are heard.

Rauf put it straightforwardly: “Let women be the guide.”

The post Climate Change Hurts Mothers and Babies. Midwives Are on the Frontlines. appeared first on Direct Relief.

In California’s East Bay, Roots Community Health Center, a community clinic and partner of Direct Relief, is working to care for precisely these individuals through two, year-long tailored programs.

One, Nia Care, is intended for clients with mild to moderate mental health symptoms. The other, Afiya Care, works with people who have moderate to severe symptoms. Both programs combine the work of a behavioral health care provider with that of a care navigator – someone who can connect clients to food, housing, employment, transportation, and other resources.

“You might see the therapist in the morning and then see the navigator right afterward,” said Shanice Smith, who is the clinical services manager for behavioral health at Roots. She explained that the experience of being incarcerated is itself traumatic for many people and that the process of rebuilding a life involves navigating a complex and difficult system.

Roots is a state-licensed community clinic, which means that it provides primary and preventative health services to a largely underserved population. But Roots doesn’t stop there: From a street medicine clinic to an apprenticeship and internship program, they run a series of initiatives designed to meet the complex needs of their patient population.

“It’s beyond a clinic, and I want people to know that,” Smith said.

A new approach

Even before Nia Care and Afiya Care, Roots worked to connect people who had been incarcerated to legal and other services. So when Alameda County needed partners to help provide mental health and navigation services to patients, Roots’ CEO, Dr. Noha Aboelata, jumped at the chance.

“We were already doing that work, so it wasn’t anything new,” Smith explained.

The goal of both programs is first to meet clients’ basic needs – helping them find food, housing, and clothing, and working to stabilize any acute mental health issues. Gradually, clients gain stability and self-sufficiency. Their mental health improves, they secure employment and permanent housing, and they grow increasingly confident as they rebuild.

Today, Nia Care works with approximately 70 people each year; Afiya Care will reach about 40.

Many patients are referred to the programs through probation officers, the county, and other nonprofits. But anyone who has a history with the justice system can walk in and be assessed by a navigator, who will refer them to a behavioral health provider and begin connecting them to services.

Navigating the system

Navigators are “the biggest workforce at roots,” Smith said. “They’re on the frontlines…you might see your navigator every single day.”

For the Nia Care and Afiya Care programs, Roots focuses on navigators who have relevant lived experience.

“I know what the struggle is. I know what they’re up against, and everything in me is to let them know, ‘You can do this,’” said Kisha Williams.

Williams has been incarcerated in the past and went through both Nia Care and Roots’ Emancipators Apprenticeship program, which helps people prepare for employment. She’s now a certified community health worker. She explained that her experience helps her understand and empathize with clients’ perspectives.

“I can relate to a lot of the trauma that comes from being incarcerated,” she said. “I have a passion for [this population]. It’s rewarding after I know I’ve made a difference.”

Working with clients means helping them meet their own unique goals. “They’ll tell you what it is that they need,” whether that’s housing, treatment for a substance use disorder, help to regain custody of children or employment, Williams said. “The best way to meet a client is with empathy.”

Some of it is a “waiting game,” particularly for housing – which is in short supply in the Bay Area. Getting people trained and prepared for employment is also time-consuming.

But much of it is also about mindset – a lesson Williams said she learned from the Nia Care program. When people have a history of incarceration, she explained, they frequently feel that “’I’ve been in jail, and now my life is over.’”

The best way to overcome that is to support clients – and help them find opportunities. “When they get that job interview or get that job, their mindset changes…they get to look at things in a positive way,” Williams said. “I’m helping them to break down the barriers that they think prohibit them from being successful.”

Williams gave the example of a client who went through the Emancipators Apprenticeship program and found stable housing and a permanent job. He’s even planning to go back to school. “He’s a person now who can smile…He’s living his best life,” she said.

Developing strengths

Behavioral health services are an indispensable part of both programs, and can help clients navigate a frustrating system.

Smith gave the hypothetical example of a mother trying to regain custody of her children. Many of the women who participate in the programs “either don’t have [visitation] rights or the time that they do have is supervised,” she explains. A client struggling with anxiety, anger, or past trauma may have trouble dealing with the situation.

A therapist would help that mother “start putting names to these feelings,” Smith said, and work with her to reframe thoughts that “aren’t contributing to you getting your kids back.”

These techniques might involve everything from deep breathing to role-playing to motivational interviewing. Therapists also work with a psychiatrist and primary care providers, who make sure clients are on an appropriate medication regimen.

Social worker Monika Scott, the lead clinician for the Afiya Care program, said she always begins by “getting a really good story…just allow them that space.” Clients may have post-traumatic stress or auditory or visual hallucinations that need addressing.

But what’s most important are the client’s priorities. “I really feel that I’m there to partner with them on whatever their goals are,” Scott said, whether that’s reducing anger or improving self-esteem.

Whatever the goals, Scott said she focuses on clients’ individual strengths. “Everyone has strengths, and…some of the things they have overcome, they have taught me invaluable lessons,” she said.

Many of Scott’s clients are highly concerned about returning to their lives after a long period of incarceration. “How many people have been locked away for ridiculous charges, and spent the majority of their life in prison?” she asked. “I want to help people navigate that and get around that.”

Alison Powe, a behavioral health clinician for Nia Care, explained that awareness of the role incarceration plays is essential. “We really have to be mindful of them being locked up for so long,” she said. Even activities like going to the grocery store can feel overwhelming.

The goal of the programs is to help clients become self-sufficient within a year. However, some patients elect to continue their behavioral health services – along with their regular health care – at Roots.

“The door is always open,” Scott said.

Direct Relief has supported Roots Community Health Center, a member of the National Association of Free and Charitable Clinics, with more than $200,000 in medical material and cash support since 2015.

The post For People Who Have Been Incarcerated, A New Approach to Rebuilding appeared first on Direct Relief.

Local refugee resettlement agencies were helping the new arrivals settle into new lives in the area – a familiar process for HOPE’s staff, who care for newly arrived patients from around the world.

But one aspect of the situation was relatively new: Because many of the Afghans were parolees – a temporary status that’s not considered a permanent path to U.S. citizenship – they didn’t have access to the same kind of services that people who have formal refugee status can receive.

“What was familiar…was their confusion about the U.S. health care system. What was different, quite frankly, was the lack of paperwork,” said Karin Dunn, director of programs at HOPE. “If you’re a refugee, your whole life is documented as much as it can be.”

Children were arriving without vaccination records. Pregnant women hadn’t received prenatal care. Some people had never seen a physician in Afghanistan, and, when HOPE Clinic staff began doing medical checkups, were discovered to have undiagnosed diabetes or hypertension.

HOPE staff members were accustomed to providing care to a patient population of many different nationalities. Texas is the second-largest resettlement state in the United States, and many of those who arrive are placed in Harris County, where Houston is located.

In addition, HOPE, which was established by the Asian American Health Coalition in 2002, has a long history of providing services to patients from Syria, Myanmar, Nepal, and other Asian countries. They knew the Medicaid system and American health care in and out. The health center brought a number of skills, such as linguistic and cultural sensitivity, to the table.

But the new arrivals meant increased costs, and to meet those costs, HOPE Clinic staff turned to Direct Relief, which provided them with a $50,000 operational grant designed to help them serve newly arrived patients from Afghanistan.

Since December, HOPE has treated 733 individuals newly arrived in Afghanistan through 1,849 encounters. The services they have offered have included prenatal, dental, optical, and behavioral health care. They’ve done Covid-19 and tuberculosis vaccination and outreach. They’ve made sure that children were up to date on their vaccinations so that they could attend local schools.

And they’ve done it all with a sense of warm welcome – the hope is that patients will continue to receive their care at HOPE for as long as they’re in the area – and with linguistically and culturally appropriate care. Translators and community health workers who represent the Afghan community play a major role.

“You could see the fear in their eyes until they had a language interpreter show up, and they just relaxed, and the way you could see them relax was very physical,” recalled Lulu Toumajian, an outreach specialist at HOPE. “Patients are more forthcoming when it’s their language and their culture, and when their culture is not just accepted but celebrated.”

Dr. Fatimah Lalani, medical director and an OB-GYN with HOPE Clinic, described the affinity she felt for her Afghan patients. “I’m an Indian Muslim, so I identify with the culture,” she said. “I felt a great satisfaction in taking care of them and kind of understood the cultural aspect.”

For many patients, the complexities of the American health care system – such as dealing with prescriptions through a pharmacy – were confusing. Others struggled with transportation and making regular appointments. Still, others were uncomfortable with the pelvic exams or concerned with giving blood for prenatal testing.

In particular, Lalani said, she was concerned about the mental health of many of her patients. They “had been through pretty traumatic situations to come here, and that was obvious. Some patients did have a lot of anxiety and some depression,” she said. Some felt guilt about leaving family members behind, or frightened and lonely in their new homes.

But Lalani said the cultural stigma around mental health issues was strong for many of her patients. “It’s not easy to get them to talk about how they’re feeling,” she explained. “A lot of times they would just decline and say, ‘No, I’m fine.’”

HOPE Clinic’s work is far from finished. Dunn said their next step is to apply the lessons they’ve learned from caring for Afghan and other patients to another newly arriving group – Ukrainians fleeing months of violent war.

The post For Newly Arrived Afghans, Prenatal Care, Vaccinations, and Open Arms appeared first on Direct Relief.

Then, on May 24, a shooter entered Robb Elementary School in the town of Uvalde, killing 21 people – 19 students and 2 teachers – and injuring 17 others. Nine of the health center’s staff members lost family members in the shooting – and among them were two nurses whose children were killed.

“You never think that this is going to happen to you. We’re not safe anywhere,” said Mayela Castañon, the CEO of Community Health Development, Inc. (CHDI). “There is not a single person in our facility who was not affected…we heard the shots over here.”

The shooting has left community members shattered. “This is not something that is going to go away. This is going to be decades,” Castañon said.

And immediately after, CHDI began a response to the increased need that Castañon knew her community would experience. Staff members worked to meet urgent behavioral health and related issues, while Castañon figured out a long-term plan to improve resilience – and prevent future tragedies.

Different symptoms of a common trauma

Within a day, CHDI staff set up a crisis center that included behavioral health provider volunteers who had come to the area in response. They started by treating staff. “My main goal was to get ourselves ready. I wanted to make sure we were in a safe frame of mind to be able to offer services,” Castañon said.

Then, the crisis center opened to the public – not just to CHDI’s patients but to anyone needing care, particularly trauma-informed behavioral health services. Castañon heard initial concerns that local residents – many of them rural and Latino – would be unwilling to seek services due to stigma. The concerns were wrong.

“I am so pleased to know that our community realized that those services were available and that they needed help,” she said. “We seem to be completely booked.”

At first, “everybody was in a state of shock,” said Rebecca Zapata, a licensed professional counselor at West Texas Counseling & Guidance who oversaw providers at the crisis center. “Everybody was hurt. The first few days, people were walking around in a fog…In the next week, a lot of anger started coming out.”

Zapata noticed that many of the people who came to the crisis centers had “past trauma not related to the incident or some generational things that had gone on,” but before the shooting, they hadn’t sought treatment. “They had kind of put their behavioral health on the back burner.”

According to Castañon, many patients came to CHDI with symptoms that weren’t ostensibly related to behavioral health, such as gastrointestinal symptoms or headaches, “not realizing that the headache is [connected to] behavioral health issues.”

Planning for the future

The crisis center was designed to meet the community’s immediate needs, but Castañon doesn’t want to stop there. Long-term interventions are needed in Uvalde and the surrounding areas, and she wants to make sure her health center is prepared to respond.

Among Castañon’s plans is to establish a school-based health clinic for children and their families at a local campus. The goal is in part to meet medical needs in the community, but Castañon has an additional goal in mind: preventing future violent tragedies.

“We’re going to have a professional trained in trauma-informed care,” she said. The stomachaches and headaches children report may be “something else” that a trained provider can identify and treat.

For the shooter, Castañon pointed out, “that idea was brewing in him for weeks, months, maybe years. But we never caught it, we never did anything. But we can do something…and if we don’t do it now, when are we going to do it?”

In addition, she plans to build a multipurpose center close to a local Walmart – “everybody goes to Walmart,” she explained – that can provide medical, dental, and behavioral health care, as well as connecting patients to services like housing, employment, and government-sponsored insurance.

“We’re not going to be the answer to everything, but we can work with other entities” to improve people’s circumstances – and by extension, their health, Castañon said.

That will mean recruiting more providers to CHDI – a challenge at the best of times. The health center worked with volunteers in the aftermath of the shooting because there weren’t enough providers to treat everyone who needed interventions, Castañon said.

But while the area filled with volunteers providing behavioral health and other services in the aftermath of the shooting, Castañon said that now many have gone home.

That won’t be true of CHDI, she said: “We’ve been here for 38 years, and we’re going to continue being here.”

An immediate response

Within an hour of the shooting at a Buffalo Tops Friendly Market, Dr. Takesha Leonard was in the market’s parking lot.

“I needed to know whether any of my patients were in the shooting,” said Leonard, who has a doctorate in health policy and is a family nurse practitioner at Jericho Road Community Health Center, a Buffalo, New York-based safety-net provider and long-term Direct Relief partner.

On May 14, a shooter motivated by racism and white supremacy murdered 10 Black people at the Tops Friendly Market, choosing a food store and pharmacy on which many in the primarily Black neighborhood relied. An additional three people were injured.

After hours of waiting in the parking lot with people desperately hoping for information on family and friends, Leonard decided to order pizza so that people could eat. Jericho Road’s CEO, Dr. Myron Glick, sent her his credit card information, and she ordered “boxes and boxes of pizza.”

At the end of the day, “none of them were my patients, but I stayed there. I stayed there all night,” Leonard said. “I went to all of the vigils and all of the ceremonies.”

Immediately, Leonard – along with the rest of Jericho Road’s staff – prepared to respond, calling vulnerable patients to check in on their mental and physical health, and increasing their behavioral health services to meet a drastically growing need. Behavioral health providers offered support to fellow staff members as well as patients.

Tragedy strikes a traumatized community

One patient posted on Jericho Road’s Facebook page, asking staff members to tell Leonard that “’I am not OK,’” Leonard recalled. The patient’s daughter had been at Tops at the time of the shooting. “The next morning at 7:30 in the morning, I got up and I called that lady.”

In offering increased behavioral health services to the larger community, Jericho Road’s behavioral health providers knew that they were dealing with a population already dealing with a history of segregation, violence, and other sources of trauma.

“If you are from the east side of Buffalo, you hear gunshots,” said Amanda Budwine, a licensed clinical social worker at Jericho Road. “We are all trained as trauma therapists…and because we are trauma therapists, our approach has always been patient-centered and trauma informed. We are continuing to do what we’ve always done.”

But the shooting at Tops, Leonard said, was utterly devastating. “I’m angry, and [my family is] angry, and the community is angry,” she said. “It just ripped the soul out of us.”

A history of service

Jericho Road’s staff is used to meeting community needs, especially when conventional channels aren’t working. The community health center offers specialized services to refugees and other vulnerable groups; trains doulas to help patients deliver their babies; and has a parent-child home program in which volunteers provide toys and books, and model reading and play to support families.

“We’re very intentional about looking at some of the non-medical factors that influence a person’s health,” Glick said.

Leonard offered as an example Jericho Road’s response to the Covid-19 pandemic, in the days when testing required a doctor’s order. Many of her patients didn’t have access to the Internet or transportation. “It wasn’t that Black people didn’t want to get tested. It’s that you put so many barriers in place that they can’t access the testing,” even as Black patients were being disproportionately affected by Covid-19, she explained.

At Leonard’s suggestion, Glik secured Covid-19 tests for his patients, with no further requirement than simply showing up. “On the east side, it’s word of mouth,” Leonard said. “Within that day, we had 100 people show up, when they knew they could get tested.”

Preparing for the long term

In the wake of the Tops shooting, more than behavioral health care was needed. The supermarket wasn’t just a place to buy food – the store’s pharmacy was also where many people in the community got medications for chronic diseases and other medical issues.

“Nobody was thinking that they don’t have their medications,” Leonard said. “People are coming into my office and they’re stressed, and their blood pressure’s elevated…and then they can’t take their medication.” A number of patients with diabetes or hypertension worsened.

Jericho Road responded by delivering medications from their in-house pharmacy directly to patients.

“Our being integrated into the community is lifesaving for folks. It’s what we’re supposed to be doing,” Glick explained. The high level of trust Jericho Road has earned among community members has made it possible for the health center to do more good, more effectively.

Glick is well aware that the shooting will have long-term implications for the Buffalo community. “This is all still very acute, but I think we’re going to be seeing the ripple effects for awhile,” he said. “When something like this happens and folks have already experienced trauma in their lives, it just reignites that feeling and that can cascade into depression or anxiety, or just not taking care of yourself.”

For many of Jericho Road’s patients, a long history of racism and segregation in the city of Buffalo directly affects them today, Glick said. He explained that approximately 85% of Black residents of Buffalo live on the city’s more dangerous east side. “That reflects hundreds of years of decision-making that have caused folks to be segregated,” he said. The shooter “chose Buffalo and he chose the east side of Buffalo and he chose that Tops because that’s where he would find, in his mind, the greatest concentration of Black folks.”

But Leonard is optimistic that that things may get better. She noted that government officials are seeking out Jericho Road’s input, along with that of other important community members like local pastors, to help them more effectively provide services to Buffalo residents.

“We’re at that table,” she said.

The post Health Centers Help Their Communities Heal in Wake of Tragedies appeared first on Direct Relief.

Planned Parenthood Great Northwest, Hawaii, Alaska, Indiana, Kentucky (PPGNHAIK) has two brick-and-mortar health clinics in Kentucky – one in Louisville and one in Lexington – “but we know this isn’t sufficient,” said Steven Conrad, PPGNHAIK’s institutional giving officer. Many patients lack the transportation needed to easily travel a long distance to a clinic, don’t have time, or don’t have the child care needed to make it to an appointment.

Conrad reported that 76 of Kentucky’s 120 counties have no OB/GYNs.

For people who need birth control, getting to a local clinic may not even be a desirable option. Their parents or a friend’s parents may work there, or they may just feel concerned about whom they might encounter in the waiting room.

“Sometimes folks in rural areas only have access to one county health clinic, and they may not feel comfortable going to that clinic for birth control,” Conrad said. “We sometimes hear from patients that they forego reproductive health services due to fear of judgment.”

PPGNHAIK decided to think outside the box, with an increased focus on providing virtual appointments to Kentucky patients with a clinician through their Planned Parenthood Direct app.

In many states, the Planned Parenthood Direct app, which launched in 2017 and has more than 320,000 enrolled users, can provide birth control, emergency contraception, and UTI treatments. In Kentucky, the only service currently available is birth control, although PPGNHAIK is working to change that.

Through Direct Relief’s Community Health Awards, funded by Bayer, PPGNHAIK is working to expand awareness and access to patients seeking birth control in Kentucky, with the goal of doubling the number of Kentuckians receiving contraceptive care through the Planned Parenthood Direct app. The organization is one of three that received $50,000 to expand creative programs that remove barriers to reproductive health care in underserved communities. The Community Health Awards are currently in their second year; first-year awardees are profiled here.

“This generous grant from Direct Relief will support PPGNHAIK’s efforts to increase awareness of and access to telehealth services, which is critical to providing sexual and reproductive health care in communities facing the most barriers to care,” said Rebecca Gibron, CEO of PPGNHAIK, in a statement.

According to the Guttmacher Institute, 47% of Kentucky’s pregnancies are unintended. Conrad explained that teen birth – Kentucky has the fourth-highest rate in the country – and unintended pregnancies increase the rate of childhood poverty and can perpetuate poverty over generations.

That’s particularly problematic in Kentucky, which is among the poorest states in the U.S., with a poverty rate of 16.3%. Poverty rates for women are even higher, and the country has the fourth-highest teen birth rate in the country.

“Through the Planned Parenthood Direct app, we can…provide the same quality care that [patients] would receive at a health center visit. We want every patient – no matter where they are – to be able to stay healthy and reach their life goals,” Conrad said.

In particular, he explained, the pandemic has shown the importance of providing virtual access to contraception in rural areas.

The app isn’t intended to replace in-person exams, and clinicians still counsel patients on the importance of getting preventative care. “This can be a challenge with some patients who like the comfort of telehealth services, getting them in the clinic for preventative care and continuing to follow up with those services needed,” said nurse practitioner Deborah Dlik, who provides virtual care in Kentucky through Planned Parenthood Direct.

Still, Conrad said, it’s an effective part of the picture: “PP Direct can help countless Kentuckians take control of their reproductive lives.”

Learning from local sources

Dr. Caroline Weinberg has learned a lot from launching a mobile reproductive health clinic in rural Mississippi.

“If someone had given me $1 million the day I had the idea…it wouldn’t have been a good program that was a part of the community,” she said. “You do really need that time to get to know the community.”

Weinberg was drawn to Mississippi because of its maternal health outcomes – for example, the state has approximately 33 maternal deaths per 1,000 live births, nearly twice the national average – but quickly found that providing sexual, reproductive, and primary care in a rural setting wasn’t going to be a straightforward enterprise.

“The fact that I was not from Mississippi was a barrier, and a totally legitimate one,” she said, citing a long history of “people shoving local perspectives to the side to think that they could solve every problem.”

Through conversations – often over meals – with members of local communities, she learned some indispensable lessons: Hire local, but not too local, because no one wants to run into a reproductive health provider at the supermarket. Confidentiality is everything, because sometimes clinic workers will talk – even though doing so is in violation of federal confidentiality requirements. Trusted local programs often don’t have an Internet presence. Don’t advertise that you’re offering birth control – instead, focus on whole-person wellness and primary care – “because if you do, everyone will know your business when you walk into the clinic.”

Today, the clinic provides sexual and reproductive health care, along with primary care, to people throughout rural Mississippi, often traveling to towns with populations as small as 170 people. “If you go to a town of 170 people and you see 10 people, you’ve done a really good job at outreach,” Weinberg said. “Sometimes we travel 100 miles to see 10 people, and that’s OK.”

Education is a major component of the work her team does. Weinberg gave the example of a man who came in with syphilis and was concerned it might turn into HIV/AIDS. Encouraging patients to get Pap smears and mammograms – Weinberg said many don’t bother, because they think they won’t be able to get the follow-up care that’s needed if something is wrong – is also essential.

And her team has grown accustomed to dealing with crisis situations: “Basically never a week goes by without someone coming in…with blood pressure high enough to go to the emergency room.” One patient came in with blood pressure of 220/110. The team got her to the emergency room immediately, then followed up with her.

Without the mobile clinic, many patients may not get care at all. In some cases, “you have to choose between getting food on the table or getting your kid to a doctor or getting yourself to a provider,” Weinberg said.

The grant from Direct Relief and Bayer will help Plan A try new things, like doing education in high schools and hiring a community health worker to present at events. “Part of the problem with operating on a shoestring, which a lot of mobile clinics do…is that there’s not a lot of room to experiment and see what works,” Weinberg said. “You’re worried about every dime.”

In addition, she thinks it will increase trust in the community, because they’ll be able to fulfill more needs. “We really hate saying no to people,” Weinberg said.

Creating a comfortable environment

For safety-net clinics in Oklahoma, providing sexual and reproductive health services means making patients comfortable, whether that means culturally responsive care, trauma-informed care, or simply creating a place where vulnerable patients feel willing to discuss an often uncomfortable subject.

The organization Health Alliance for the Uninsured (HAU) is working to make patients more comfortable in central Oklahoma clinics, as part of a larger collaborative project with the group Thrive OKC, a sexual health collective aimed at youth. The goal? To provide trainings to up to 30 medical staff and volunteers from 10 clinics, with the goal of improving the family planning services they provide.

The collaborative wants to “help providers to help their patients to navigate their reproductive choices,” said Dr. Ronneal Mathews, Thrive OKC’s director of community engagement. The trainings are designed to help providers “create spaces where, when adolescents do come in to access their services, it’s an environment that’s comfortable for them.”

In particular, HAU and Thrive OKC are focused on “walking clinicians through some really practical steps that they can take to make their clinics…more accessible for a younger audience.”

The training, called the One Key Question Certification Training, is built from an evidence-based curriculum by the organization Power to Decide. Mathews said the goal is for providers to begin by asking patients if they plan to become pregnant in the next year, and help patients make family planning decisions from there.  

Asked why Oklahoma in particular needed this intervention, Mathews explained, “It’s difficult in Oklahoma at this point in time for teens to find places where they can seek reproductive health services…it’s really important for them to provide care that is confidential…nonjudgmental and non-shaming.”

The post From a Digital App to Local Connections, Finding Creative Approaches to Reproductive Health Care appeared first on Direct Relief.

So Well Born – a Polish organization of midwives, doulas, psychologists, and lactation consultants that focuses on independent midwifery practice and out-of-hospital perinatal care – swung into action.

“Imagine you have nothing and you have a laboring woman…What would you need?” said Maria Romanowska, a midwife and co-coordinator of Well Born for Ukraine, a project designed to provide pregnant women in Ukraine and their attendants with the necessary tools for a safe, successful birth.

Members of the project designed a kit women could carry with them that contained the basic materials needed for a birth – such as instruments to cut and clamp the cord and blankets to keep the baby warm. Included were instructions intended for someone without any medical training that explained, in detail, what to expect and do. Materials on lactation were also included. “We did our best to write it in layman language, and then we had it translated into Ukrainian,” Romanowska explained.

The birth kits proved useful to organizations working in Ukraine. “Since the very, very beginning of the war, there has been feedback that those packages were very useful and very helpful,” said Romanowska, recalling pictures of pregnant women carrying the kits with them as they traveled. “It is very heartwarming and sad at the same time.”

The kits – over 800 of them – were primarily driven over the border into Ukraine by an informal network of volunteers. For example, “we received info about someone who has a pickup and he’s going to Kyiv twice a week,” Romanowska explained.

In a village of approximately 1,500 people in Ukraine’s Khmelnytsky district, a woman named Natasha works as a feldsher – a health worker designation similar to a physician assistant that is no longer awarded in Ukraine, although existing feldshers still practice. She described receiving birthing kits that she passed onto a regional hospital and a nonprofit group caring for pregnant women.

“Our day-to-day activities have barely changed. At the same time, we never have any certainty that the missiles won’t reach us. So we continue on with our work this way, but we have to be ready for anything,” Natasha said.

Even for individuals who couldn’t access the birth kits, the instructions on birth and lactation – written by Romanowska and fellow birthing professionals – proved invaluable. People began contacting Well Born for Ukraine over social media, asking for the instructions.

“The hospital is 10 minutes away [for some Ukrainians] but there is fire on the streets,” Romanowska said. “This is a strange, funny war: You are facing death in a shelter, but you are online.”

Often, she wasn’t able to send the kits themselves, but she could get pregnant women, their families, or those caring for them the instructions over the Internet.

As the war has changed, so too have the kits. Once it became clear that women were no longer in imminent danger of giving birth without a skilled attendant – and instead, that the need for appropriate supplies in hospital settings was acute – Well Born for Ukraine pivoted.

They began creating kits for health care providers with medical but no perinatal experience, then specialized kits for obstetricians and midwives working in hospitals.

The kits contain medical and surgical tools, but “it is handy, it is small, so it is supposed to be used in the hospital to have a regular hospital birth safely,” Romanowska said. “If the hospital in which you’re working is suddenly bombed, you can grab the package and you can grab the patient, and you can use it anywhere.”

In addition, the organization is providing requested equipment and supplies to Ukrainian hospitals, such as pulse oximeters, sutures, and bedding materials. “We send hospitals exactly what they ask us for, not what we think they might need,” she explained.

Well Born for Ukraine’s members plan to continue their work even after the war in Ukraine is over, as the need will continue to be great.

“We feel that our main goal in our work is elasticity,” Romanowska said. “We need to adjust to the situation, and the situation is changing basically every day.”

Direct Relief provided Well Born for Ukraine with a $140,000 grant to develop and assemble birth kits and distribute them in Ukraine. The organization is committed to providing support for Ukrainian women and pregnant people as the war continues.

The post For Pregnant Women in Ukraine, A New Kind of Support appeared first on Direct Relief.

Conflict-related trauma, maternal and newborn health, chronic disease care, food security, communicable disease outbreaks, potential nuclear and chemical hazards, human trafficking, and sexual violence have all been identified in a WHO report as priority public health concerns.

According to one WHO representative, at least 3,000 people in Ukraine have died from a lack of access to chronic disease medication alone.

As courageous volunteers are brave bombs to deliver humanitarian medical aid to areas under fire, Direct Relief continues its large-scale response. Since the war broke out, Direct Relief has provided more than 800 tons of aid and over $15 million in funding to Ukraine and neighboring countries. It has also helped inform humanitarian efforts with information and analysis support.

To list a few recent examples:

• Direct Relief’s research team is helping to gather data on pharmacies, displacement, attitudes toward refugees, and more.
• A $750,000 grant from Direct Relief is providing mental health and psychosocial support for Ukrainian refugees in Slovakia.
• For people with diabetes, Direct Relief has delivered nearly 30,000 glucose meters with strips for children’s hospital emergency rooms and ophthalmology clinics across Ukraine.
• The organization has also provided a $583,000 grant to enable maternal and newborn health care for Ukrainians who have fled the country.

The ongoing needs in Ukraine and countries that have received refugees are severe, and Direct Relief will continue responding strategically to the medical conditions created by the war.

IN BRIEF

The United States

• Over the past two weeks, Direct Relief has dispatched 606 shipments to 456 healthcare providers in 46 states and territories, totaling $9.6 million in value and more than 14,000 pounds.

• During that time, $614,000 in grants has been distributed.

• Health centers and their patients are feeling the effects of inflation.

• Research featuring eight Direct Relief-funded health centers has been published in the Journal of the American College of Clinical Pharmacy. The study found that patients enrolled in a comprehensive medication management program significantly lowered their estimated risk of death.

• In response to an influx of unaccompanied minors at the border, the Texas Association of Community Health Centers has thus far provided trauma-informed care training to 25 organizations in the state.

Around the World

• Direct Relief has made 30 shipments to 35 nonprofit health facilities in 19 countries in the past two weeks, totaling $16.3 million in value and more than 114,000 pounds.

•More than $63,000 in grants was distributed over the same two weeks.

• Sri Lanka’s economic crisis has led to medication shortages. A Direct Relief shipment of antibiotics, thyroid and chronic disease medications, vitamins, and more arrived recently with public health facilities throughout the country. The organization is working with Sri Lanka’s Ministry of Health and Ministry of Foreign Affairs to determine needs and coordinate further shipments.

• A Bangladeshi organization, with Direct Relief support, provided food and mobile medical clinics in the wake of Bangladesh’s devastating flooding. More than 500 people per day received medical care, and more than 1,000 a day received food.

IN THE MEDIA

• Project Joint Guardian outfitted with critical supplies from Santa Barbara County ahead of mission in Ukraine – KEYT: “Thanks to Direct Relief, this shipment arrived in Europe ahead of the specialized unit. And, more is on the way.”

• More resources for managing emotions of participants of Boys & Girls Clubs of Puerto Rico – El Vocero de Puerto Rico: “The funds granted by Direct Relief will support the hiring of a social worker and art teacher for the Clubs in Isabela and Bayamón; and technical assistance and curriculum from the Puerto Rico Institute of Traumatology, an entity that will also train the work team, provide therapies, psychological services, and perform an evaluation at the end of the project.”

• UN OCHA Ukraine Situation Report: “Health-care concerns also remain on the rise, including maternal and newborn health, mental health and chronic disease management, especially for vulnerable groups such as people with disabilities, children and youth, women and girls, health-care workers and internally displaced people, according to analysis shared by Direct Relief.”

The post Global Update: Response in Ukraine, Bangladesh, and on the U.S.-Mexico Border appeared first on Direct Relief.

Approximately 90% of the more than 6.5 million people who have fled Ukraine in the wake of Russia’s invasion are women and children. ICM estimates that approximately nine percent of refugee women are pregnant. Refugee women are at increased risk of sexual violence, unwanted pregnancies, exposure to sexually transmitted disease, malnutrition, poor sanitation, and a lack of maternity care, according to ICM.

By conducting a needs assessment of midwives’ associations throughout the region, ICM determined that women and children fleeing the conflict in Ukraine are in particular need of maternal health care, mental health care, hygiene items such as diapers and menstrual care products, and accommodation, among other needs.

“When these events occur, ICM takes immediate action to connect with its midwives’ associations in the impacted region(s) and collect on-the-ground perspectives to understand the specific needs of its members, and the challenges facing midwives in upholding quality care for women and newborns,” explained ICM’s Chief Executive, Dr. Sally Pairman.

The Direct Relief grant is designed to address these needs, supporting midwives’ associations in Europe as they care for Ukrainian refugee women and their families; procure and distribute supplies such as food, hygiene products, and bus and train tickets to women and children; place families in accommodation; and provide other vital services.

“Women and children are disproportionately affected by humanitarian conflict, and in this particular situation, when they form the vast majority of refugees fleeing the war in Ukraine, understanding and meeting their needs is essential,” said Thomas Tighe, President and CEO of Direct Relief. “The International Confederation of Midwives, with its on-the-ground connections to the midwives’ associations providing maternal and child health care every day, is uniquely positioned to develop a thorough understanding of the situation that refugee individuals and families are facing, and to develop and support strategic approaches to meeting those needs.”

In particular, ICM has designed a rapid response grant process through which midwives’ associations can request funds to support their work caring for Ukrainian refugees. Already, a number of midwives’ associations have requested funds for translators, mental health providers, and other professionals; supplies such as hygiene and sanitary products, bedding, and clothing; and funding for transportation fees.

“Through this new partnership with Direct Relief, we will be able to move from advocacy to action by directly funding the efforts of ICM midwives’ associations to effectively respond to humanitarian emergencies,” Dr. Pairman said.

The post Meeting the Needs of Ukrainian Women and Children through a New Grant appeared first on Direct Relief.

Flooding has killed 68 people in Bangladesh, the majority of them in the country’s Sylhet region, and left approximately 4.5 million stranded, according to Reuters. Houses and livelihoods have been swept away. Waterborne illnesses, including skin infections and diarrheal disease, quickly spread.

The HOPE staff have responded to mudslides and other disasters before in the Cox’s Bazar area where their field hospital is located. They’ve been training emergency response teams since 2017. But this was their first time responding to an emergency far from home, said founder Dr. Iftikher Mahmood.

Thus far, the team has treated more than 500 people a day via a mobile medical clinic stocked with emergency medical packs and medicines from Direct Relief and has distributed hot meals and dried food to more than 1,000 a day. They continue to travel through flooded areas, providing free medical care, food, and water to people affected by the floods.

Mahmood talked with Direct Relief about his team’s response, what it’s like on the ground for those affected by flooding, and what he anticipates seeing in the weeks and months to come.

Direct Relief: What is the situation like in Sylhet now?

Mahmood: The Sylhet division has multiple districts, and several districts got flooded. The water is actually receding now, but the water level is rising in some other areas. So it’s better in terms of the flood, but it is still unpredictable.

It was a big event. A number of people lost their lives, unfortunately. At the same time, many people have been displaced, properties have been damaged, and livestock has been damaged. [People] became homeless.

But support from all over the country actually poured in: social organizations, non-governmental organizations, private individuals, also the government. A lot of people came to help.

Direct Relief: And a HOPE for Bangladesh team responded as well. Can you talk a little bit about your response?

Mahmood: We are far from that area, definitely a few hundred miles. In Bangladesh, a few hundred miles is a long way.

But because we are a humanitarian organization, and we have experience working with the refugees in Cox’s Bazar, we have teams of people who can respond quickly. Also, we have some supplies from Direct Relief, and when it happened, we quickly decided to send a team [that included two paramedics] with dry food and medicines.

And the next day, we sent four more, and the following day we sent a six-person medical team. So in total, 14 people are in Sylhet right now, and also we recruited volunteers locally. They are cooking food because we are distributing hot meals, and also dried food.

Since we had the medical team arrive, we set up a mobile medical clinic, so we went to different locations.

Direct Relief: What is your staff seeing on the ground as they respond?

Mahmood: Now, our people are serving in areas where it’s still flooded.

When the flood water receded, a lot of people are homeless so they’re still in shelters. And there are some outbreaks of intestinal infection, skin infection, respiratory infection. But we are serving them, giving them treatment: medical examinations, free medication. And also, we are giving them clean water.

The support is coming, but some places probably got good support and some places probably still need support.

Direct Relief: Tell me about your disaster response training.

Mahmood: We got training locally in Cox’s Bazar. We’ve been training for these kinds of emergencies because, in our area, there are a lot of natural disasters like cyclones, mudslides. So we get trained agencies every year through the UN agencies and through our own training.

We’ve had an emergency response team since 2017.

This is a good exercise for us, away from home. That tells us that we can actually mobilize our team to many other places whenever it’s needed. And also, we can increase [our] capacity; we can expand the team. In case we need thirty people or forty people, we have the experience of traveling to a distant place and giving service without any trouble.

It went extremely well. I was not only surprised; I was very pleased.

Direct Relief: What were the greatest needs when your team arrived, both medical and otherwise?

Mahmood: When they arrived, what they needed most was food. Now that water is receding, the greatest need is medical support. And next will be rehabilitation. Many people lost their homes. Some areas are very poor areas, so their homes are small and fragile, and the flood washed them away.

Direct Relief: You had some existing medical support from Direct Relief that you mentioned was helpful. What supplies did you have, and how did they help your team?

Mahmood: We have been getting emergency response supplies from Direct Relief since 2017. We had emergency [medic] packs; we have water purification tablets; we have small procedural equipment. We have antibiotics, antibacterial cream, many ointments. We have a range of things.

Direct Relief: How did these floods compare to other disasters you’ve responded to in the past?

Mahmood: We’ve responded to several floods locally. The difference is in our area, many times, there are mudslides, which can be acute and dangerous. It sometimes happens unnoticed. But this is a big area, so it was different. But both are dangerous. It gave us a good lesson on how to respond in different circumstances. It made our team really strong.

Direct Relief: Financial inflation has been a major problem in Bangladesh, as in the U.S. Has that affected this disaster or its response?

Mahmood: Yes, prices are higher.

There are always people who, even aside from inflation, when things like this happen, try to take advantage and raise the prices for services and goods. That’s always there. But as a humanitarian organization, we only focus at this time on people and what they need. So we pull resources together from different places and try to do a job to save lives.

And also, we got support from good people and organizations, who gave money and other supplies.

So inflation is a problem, but we did what we had to do.

Direct Relief: People are still in the immediate aftermath of this disaster. What concerns do you have for affected people going forward in the coming weeks or months?

Mahmood: We’ll be watching out for different kinds of illnesses. Especially small children, especially elderly people, I think they’ll have respiratory problems. Asthma, bronchitis, pneumonia. And people who have chronic conditions, if they have diabetes or hypertension, if they’ve lost their medication, they will have problems. Diarrheal diseases. Some will need hospitalization.

I worry about the kids, pregnant women, and elderly people. Because they will have problems that they won’t expect.

And of course, after that, they have to find a place to live. In this kind of area, there are a lot of financial issues, so now they will need help to rebuild their houses.

The government has provided a lot of support already, and there is good coordination in that administration, so I think a lot of people will get help from the government, and also NGOs and other organizations and individuals will come together and try to help these people.

A shipment containing over 4,000 pounds of medical aid, valued at $81,000, left Direct Relief’s warehouse on June 29, bound for HOPE Foundation for Women and Children of Bangladesh. The shipment contains wound care products, surgical instruments, vitamins, IV fluids, and other medical supplies. Additional support is currently being coordinated.

The post Responding Amid Bangladesh’s Devastating Floods appeared first on Direct Relief.

Diabetes is a complex condition that generally requires changes to diet and exercise as well as careful monitoring and medication. “You’re often assuming, as a medical provider, that they may be able to join a gym or be able to buy exercise equipment,” said Laura Starr, director of development and communications at CommunityHealth.

But the vast majority of the clinic’s patients are uninsured and low income, making a holistic approach to diabetes care difficult. Many work in restaurants or on construction sites.

“It became very clear very quickly that what [a provider] would recommend to any patient with diabetes might be more difficult for them to access,” Starr said. “We knew early on at CommunityHealth that, if we were going to recommend something to our patients, we wanted to be able to provide that thing if at all possible.”

Today, CommunityHealth’s offerings include services from a wide variety of doctors and specialists, such as podiatrists, nephrologists, and ophthalmologists, who deal with some of the complications of diabetes. But the clinic is also intensely focused on providing the kinds of resources that help keep patients from needing those services to begin with.

Patients can meet regularly one-on-one with a pharmacist or nurse. Glucometers and test strips are available for patients who need them. A cooking and nutrition class is designed to teach patients to care for their health in a way that’s accessible and culturally appropriate. Patients who need help accessing nutritious food are connected to a local food pantry. And pre-pandemic, the clinic offered kickboxing, pilates, yoga, and other exercise classes. “We’re only as limited as the volunteers we can find,” Starr said.

In addition, the clinic just created a micro-site in a neighborhood where many of their patients live – and that, for many of them, required two bus transfers to get to a clinic location. Patients can have their vitals checked and labs drawn, and a reliable telehealth connection is available on-site. The site shares a location with a community organization that offers food services, English-language courses, and other resources.

Supporting on-the-ground efforts

CommunityHealth was the recent recipient of a grant from Direct Relief and the Baxter International Foundation, to support their work caring for diabetes in a holistic and sustainable way. The Transformative Innovation Awards in Community Health, as this three-year program is known, invests in programs that work to expand access to diabetes care through nutrition, prevention, and treatment.

“Providing patients with resources and education to manage and prevent diabetes is an important component of our commitment to empower patients,” said Verónica Arroyave, executive director of the Baxter International Foundation. “We are inspired by how each clinic that has received funding through this program has implemented innovative solutions that address specific needs of their community members.”

The awards come as safety net providers around the country take on the challenge of finding creative but sustainable ways to meet the needs of patients with chronic diseases. Many clinics and other organizations rely on volunteers or private funding to keep their doors open.

But underserved patients rely on these organizations and programs in turn. “Patients who come to CommunityHealth are typically those who don’t have anywhere else to go,” Starr said. When providers ask patients where they’d receive treatment if the clinic weren’t open, “most either say ‘the emergency room’ or ‘I wouldn’t get care’ or ‘I don’t know.’”

An integrated approach

At Faith Community Health, a charitable clinic in Branson, Missouri, and another awardee of the Baxter International Foundation-funded program, a 12-week class teaches first healthy living habits, then cooking, in a way that takes into account their patients’ financial and environmental challenges.

For example, a patient may need to exercise but “may live in a place that doesn’t have sidewalks or it’s very hilly,” said Heather Lyons-Burney, a clinical pharmacist at Faith Community Health. Someone who needs to lose weight may not have a scale. Someone who needs to cook healthy meals may need an appliance to cook them in. 

Faith Community Health works to meet those needs for patients, providing Instant Pots, scales, access to food, and other necessities for people enrolled in the course.

“We’re all about ‘How do we change someone’s lifestyle?’” said Lyons-Burney. “You’ve got to give someone the skills and the tools to do that.”

 Lyons-Burney explained that having this program integrated into their clinic operations makes it particularly effective. “It’s a place that they are already comfortable with. They come to us as a clinic; they come to us to get their medications,” she said. “They’re coming to see familiar faces.”

For many patients, just meeting basic needs is a challenge. Dealing with the complexities of diabetes care, and the holistic approach it so often needs, might be insurmountable without Faith Community Health’s intervention.

“No one would ever think of a dietician or cooking class,” Lyons-Burney said. “Getting exposure to these things would be completely outside their budget, and they would just remain unhealthy.”

Long-term change

At Puerto Rico’s Asociación Puertorriqueña de Diabetes, patients who participate in a holistic program have been shown to have improved A1C levels – a blood sugar test that’s frequently used to monitor diabetes. Program participants meet with a health educator, nutritionist, psychologist, endocrinologist, and personal trainer to address the different ways that a diabetes diagnosis affects their lives.

For example, a psychologist can help a patient come to terms with the changes in lifestyle and feelings that come with a diabetes diagnosis, said Adia Aponte, the organization’s coordinator of communications and health education services.

The program is designed to lower A1C levels, decrease body mass index, and teach patients to incorporate healthy habits into their daily lives. Patients exercise together, learn healthy cooking together, and even have a dedicated WhatsApp chat.

In a previous group, one patient lost 10 pounds in a month, Aponte said. This new iteration of the program, funded by one of the Baxter International Foundation awards, will serve 25 patients over three months.

Aponte stressed that the goal is to teach sustainable habits that will continue long after participation is over. “The change doesn’t stop with the program,” she said.

This ability to help patients – particularly those who may not otherwise receive reliable health care – make lasting changes can’t be overstated. That’s one of the many reasons why supporting the efforts of safety net healthcare providers is so essential, said Rose Levy, a program manager at Direct Relief.

“These providers are doing amazing work,” she said. “It doesn’t take moving heaven and earth to help them do well by their patients.”

The post Managing Diabetes Takes Much More than Medication. Meet Three Organizations Thinking Beyond the Needle. appeared first on Direct Relief.

“The baby looked terrible on the monitor,” Dr. Lurvey recalled. The mother had so few red blood cells that it was impairing the ability of those cells to reach the fetus. Dr. Lurvey transfused the patient, and she and her baby improved.

But Dr. Lurvey has seen plenty of anemia among the mothers she treats, both at the hospital and at Eisner Health, a federally qualified health center that serves many low-income, primarily Latina, mothers-to-be. About 10-15% of the pregnant women Eisner Health’s providers see already have anemia when they deliver their babies.

“For many, many, many years, folks have recognized that folks in certain socioeconomic groups are more likely to show up anemic,” Dr. Lurvey said. “Between food deserts and cultural perspectives…many of [the women Eisner Health serves] don’t have an ideal diet.”

Despite the risks to mother and baby, which include premature birth, low birth weight, and a slower recovery, Dr. Lurvey said anemia during pregnancy hasn’t received much attention: “It’s not sexy, it’s not a big picture thing, and people don’t hold marches.”

The local level

Instead, anemia – and other micronutrient deficiencies, such as folate, Vitamin D, and iodine – during pregnancy are often addressed on the local level by organizations caring for medically underserved pregnant women. Dr. Lurvey wanted to implement a program to address the anemia she frequently saw among Eisner Health’s patients and find a way to do it without pulling away from the vital care that her health center provided to patients every day.

Through funding from the life sciences company Bayer, as part of The Nutrient Gap Initiative, Direct Relief identified four California health centers working to address micronutrient deficiencies in pregnant patients. Each of these received a $50,000 grant through dedicated Community Health Awards. The awards are intended to help fund or expand programs that work to improve pregnancy outcomes in medically underserved communities by educating patients or providing nutritional interventions.

Eisner Health was one of them, adding a new perinatal nutrition case manager to its Women’s Health Center, with the goal of reducing anemia among pregnant patients by half. (“Perinatal” refers to the time before and after birth.)

“I need someone to follow [the patients] for the free weeks between when they identify the anemia and when they deliver the baby,” Lurvey sad. “The problem with big systemic changes is that they’re really hard to pull off. This is a targeted intervention in a time-sensitive population.”

“Struggling to keep anything in their stomach”

At Camarena Health in Madera, Claudia Arrellano, an educator in the Comprehensive Perinatal Services Program, noticed that a number of pregnant patients weren’t taking their prenatal vitamins. “In the first trimester, mostly, we see a lot of moms who are struggling to keep anything in their stomach, and one thing they often stop is their prenatals,” she said.

The health center’s staff members were particularly concerned about patients missing out on folate, iron, and Vitamin D. But Arrellano and her colleagues empathized with patients, and wanted to teach them how to maximize their micronutrient intake.

Camarena Health staff are developing an interactive program to teach pregnant patients about these vital nutrients. Emily Valdez, a registered dietician, explained that some of the health center’s patients are unable to read, and many have low health literacy. For that reason, she and her colleagues didn’t want to simply give out information sheets about the importance of micronutrients.

“We’re not just handing people a handout….but having an interactive education while they’re there in the office with our educators,” she said. Patients can learn about different micronutrients through sound features, and tap on foods containing high levels of a nutrient like folate. “I sometimes think with our patients less is more – giving them one or two things to take away,” Valdez said.

Arrellano said that the pregnant women she works with are very receptive to learning about nutrition, in part because they feel responsible for the health of their babies. “They enjoy learning about it, that [prenatal multivitamins] aren’t the only way they can get these nutrients,” she said. “There’s a lot of vague information that they have, and I do see the ‘Aha’ moment when they see what foods are recommended for pregnancy.”

Overcoming “linguistic and cultural isolation”  

At Asian Health Services in Oakland, the focus is on providing information that’s culturally and linguistically appropriate for their primarily Asian and Pacific Islander perinatal patients. In particular, explained Dr. Emily Guh, a family medicine specialist, the federally qualified health center is emphasizing participation in its Mommies 2 Be program, which provides education, support, and a community to pregnant patients.

“A lot of our patients are facing linguistic and cultural isolation, so pregnancy can be a really challenging time,” she said.

Asian Health Services is partnering with a local chapter of WIC – the government’s supplemental nutrition program for women, infants, and children – to add a culturally appropriate nutrition component to group Mommies 2 Be meetings.

“It’s not lecture-based, but really discussion,” Guh said, explaining that a typical conversation might involve asking women in the discussion what foods they think of as nutritious or bringing in examples of familiar foods. Before a group facilitator answers a question, she may open the forum up to other participants to share their own answers, and pregnant women may discuss together how they’ll incorporate healthy foods into their diets.

“A lot of the routine counseling…can be done in the group setting,” Guh said

The health center works to enhance community by grouping pregnant women with similar due dates together, with the hope that they’ll also graduate together to a new group intended for the mothers of new infants. They also work with volunteer students from nearby U.C. Berkeley, who act as labor coaches and translators for women in delivery. Part of the students’ responsibility is to help pregnant patients develop a birth plan, so that they can think in advance about some of the major decisions they’ll have to make during the delivery process.

“Another life depends on them”

According to Ivan Flores, associate director of Prenatal Support Services at Family Health Centers of San Diego, deficiencies of iron, folic acid, and vitamin B12 are frequent among the roughly 3,500 pregnant patients his health center treats each year. Many patients eat few fruits and vegetables. And many are overweight.

In response, Family Health Centers is ensuring that patients have access to healthy food through a local WIC program, helping eligible patients navigate the complex sign-up process “to make sure they actually receive the benefits,” Flores said. He estimated that 80-90% of the pregnant women Family Health Services works with are eligible for WIC, although some decline the option because they’re concerned about their immigration status.

They’re combining the access to nutrition with high levels of monitoring and education, seeing some patients as often as weekly, working to secure needed supplies – such as glucose monitoring equipment for patients with gestational diabetes – and teaching patients to get the most out of their nutrition, such as by combining high-acid foods like orange juice with meat.

Part of their process is being realistic about patients’ needs, said, Gina Parra, manager of the health center’s prenatal support program, who oversees its nutritionists and dieticians.

“As much as we want them to eat five meals a day, or eat your fruits, or eat your vegetables…tell that to a homeless mom,” she said.

Still, she said, it can be particularly rewarding to work with pregnant women, precisely because their nutrition and health are so important to them.

“These are patients who, for the most part, listen to you because another life depends on them,” she said.

The post For Pregnant Patients, Iron and Other Nutrient Deficiencies Pose a Threat. These Groups are Fighting Back. appeared first on Direct Relief.

Propelled by fierce winds, and defying the efforts of more than 1,800 firefighters and other responders, the Calf Canyon/Hermit’s Peak Fire has grown to more than 236,000 acres in New Mexico, according to the governmental National Wildfire Coordinating Group. A spokesperson for the state’s governor said that 277 structures have been destroyed thus far.

In preparation for wildfire events, Direct Relief’s 155,000-square-foot medical distribution facility in Santa Barbara, California holds a significant inventory of medical aid frequently requested during these emergencies. That inventory includes N95 masks, inhalers, eye drops, asthma medications, and chronic disease medications, which are frequently needed by evacuees who have left their homes without them.

Direct Relief’s Response

Last week, Direct Relief delivered an emergency delivery of air purifiers, N95 masks, and personal care products requested by Tewa Women United, a Native women-led organization that has also received a Direct Relief Fund for Health Equity grant. That organization serves a community currently being affected by the network of wildfires.

In addition, the organization made initial contact with New Mexico Voluntary Organizations Active in Disaster and with the Federal Emergency Management Agency on the ground in New Mexico.

Direct Relief has a long history of responding to wildfires, particularly in the western United States and has already responded to several wildfires this fire season, including the Tunnel Fire, which burned nearly 2,000 acres in Arizona.

In an emergency such as a wildfire, groups serving affected communities typically make requests for medical aid in the days or weeks after the acute threat is lessoned, as emergency responders, health care providers, and others evaluate medical needs on the ground.

Wildfires cause an obvious and immediate threat to health, frequently causing burns, injuries, and respiratory and cardiovascular issues. But as people leave their homes and communities behind, they frequently leave behind their medications as well, such as those to manage diabetes and hypertension. If left unmanaged, chronic conditions can become life-threatening, requiring urgent care and further stretching the resources of hospitals working to respond to the emergency.

Direct Relief is ready to provide a wide range of medical support over the coming weeks and will continue to communicate with organizations working on the ground to assess and prepare to meet needs.

The post New Mexico’s Largest Raging Wildfire Has Forced Tens of Thousands from their Homes appeared first on Direct Relief.

Ukrainian-American Klepach grew up in the city of Lviv, but moved to Sacramento, California with his parents after the fall of the USSR. He’s worked first as a paramedic, than a firefighter, for more than two decades. He currently works for the Cosumnes Fire Department and has three children.

When the Ukraine war broke out, Klepach began recording Ukrainian-language videos for first responders in the war-torn country, drawing on footage of fellow firefighters to demonstrate how to force a door, extract people from a vehicle, and pull a hose line. He posted them to his Facebook page.

Then a fellow firefighter reached out to ask if Klepach wanted to put his skills to work on the ground in Ukraine.

Eric Halle established Project Joint Guardian as an international nonprofit organization made up of firefighters. When the war started, he began laying the groundwork to get a team of first responders into the country, and invited Klepach to join him. “By myself, I wasn’t able to do much, versus working on a team,” Klepach said. He accepted. Fellow firefighters began covering his shifts, so he could take the assignment.

Direct Relief supported Project Joint Guardian with a $50,000 grant to transport first responders to Ukraine and help them purchase needed equipment. The organization also supplied the firefighters with Emergency Medical Backpacks intended for triage care, and shipped equipment to the region on their behalf.

Klepach is currently an “urban camper” somewhere on the outskirts of Kyiv – he can’t say exactly where – where he spends his days searching for people in areas hit by missiles, clearing debris, and anything else that’s needed.

He and his fellow Project Joint Guardian teammates are there at the invitation of the State Emergency Service of Ukraine, and the Minister of the Interior has stopped by to express his thanks. He and his teammates have been told that the trail they’ve blazed has inspired other teams of first responders to follow in their footsteps.

But what he sees horrifies him. “They are killing innocent civilians. There is no question about it,” he said.

Klepach sat down to talk to Direct Relief about his work in Ukraine and what it’s like to return to the country he once called home.

Direct Relief: Tell me about being invited to do search and rescue in Ukraine. How did that happen?

Klepach: I’ve got to say, we had to jump through a lot of obstacles. First of all, we had to figure out a way to get into the country. We couldn’t just pick up our firefighting gear and jump on a plane and come over and say “Here we are! Put us to work!” It had to be official.

So we worked with the Ukrainian and the American embassy in order to get the right paperwork in place. And then we had to get in touch with the Ukrainian fire service. Luckily I have a Facebook page I have been sharing with firefighter experience and knowledge. So I was actually known by a few firefighters. Actually about 5,000 of them in Ukraine.

And so I’ve been reaching out to my contacts to help us out, to achieve our goal. At the end, we were given the green light by the Ukrainian fire service to come into the country and assist them with search and rescue missions.

Direct Relief: Why did you want to go?

Klepach: Well, first of all, I could not stand alone seeing that Ukrainian firefighters are working hard – you know, up to today, over 30 firefighters have been killed. And I felt that we could make a difference by going into Ukraine, assisting Ukrainian firefighters.

First of all, we provide firefighting equipment and some gear and medical supplies. Additionally, [we were hoping] it would be a huge morale boost for many firefighters, feeling that they have this feeling of a broader group, that someone from a different country, which in this case would be the United States, Germany, Australia, is coming over as a team to help them out.

I couldn’t just stand alone and say, “Oh, that’s OK, you know, they can deal with it.” It was just not going to happen for me.

Direct Relief: When did you arrive in Ukraine, and how did you get there?

Klepach: First of all, we flew into Poland, Warsaw. We were unable to fly into Ukraine because active war is going on. And then we got some of our equipment. We drove to Kyiv, and linked with the local Ukrainian rescue fire department, and started working with them. We’re still waiting for some equipment.

We’ve been working in the outskirts of the Kyiv area, where Russian forces came in and they actually had been staying for a week or two in a certain area. And we stayed in a couple more cities where the Russian military had actually killed civilians and dropped bombs and missiles on the residential buildings.  

And we helped in search and rescue, debris removal. Today, we helped firefighters to remove some debris from the fire station and did some work so that the fire station could be functional. We do all kinds of work.

Direct Relief: Let’s talk a little bit about the work that you’re doing there. What do your days look like?

Klepach: We have a plan that we’ve established for the day. For example, a few days ago, we went to this town, which had a significant damage, and we were literally searching five to nine story apartment buildings; we went up into every single apartment on this search for people or for bodies. And also we search for any important documents. We put those into a backpack that we have with us and give them to the police department.

The next day, we went to this smaller residential neighborhood and there were a couple of homes that missiles had struck. And in one of the buildings, we found the body of a resident who has been under the rubble for probably three weeks or so. We had to clear out the debris, which took about four to five hours, 15 to 16 firefighters. We cleared out the area around the body, and then the police had to come in and do an investigation. At that point our job was done, and we would move on to the next building and help clear out debris or search for bodies.

I’ll be honest, unfortunately, in some places where the missiles would hit, we weren’t able to find the body, although there were reports that people were in houses right before the strike. But with the missile strike and the high temperature, we were unable to locate anybody.

So we did as much as we could to help those families to find some kind of closure.

Direct Relief: What is it like, the area where you are now?

Klepach: I’ve never been to a war zone. But driving into some areas and seeing what has happened to those streets and buildings…It’s hard to describe. It’s kind of like a movie, but there’s still smell of burning metal, and there are horrific, horrific scenes. Those images are probably going to remain in my mind for a long time.

It’s different seeing in pictures or on the news versus being in person and seeing it. It’s a magnitude of destruction that seems like someone decided to destruct and kill everything in its path.

Direct Relief: You are Ukrainian by birth. How does it feel for you to see your original home in the midst of war?

Klepach: Honestly, that’s not how I want to see Ukraine. I was in Ukraine four years ago with my family, and this is just a totally different Ukraine. It’s very sad.

One family that we talked to, when we told them we were unable to recover their body, the only thing we found was the wristwatch that they described their father was wearing on him right before that missile strike. That’s all we could do, and then this man, he was crying, and we had to comfort him. I could not hold my emotions back. And not only myself, but members of our team.

I do feel very emotional. Sometimes I do tear up to contain emotions, seeing what Ukraine and the Ukrainian people are going through.

Direct Relief: What equipment have you and your colleagues needed, and have you been able to get it? What are the conditions like that you’re working in?

Klepach: We have our basic firefighter protective gear, we have some shovels, we have some crowbars, some basic tools. Also, we have some battery-powered tools and a generator that can charge them. Tomorrow, we’re going to have more equipment when it arrives, and it will be more tactical rescue equipment.

There is no water, there’s no light, there’s no electricity, there’s no restroom. Literally, you are an urban camper. You have to depend on yourself.

Direct Relief: Are you optimistic that you’ll continue to find survivors?

We’re optimistic that we will find people because the airstrikes don’t stop. Every night we hear the sirens go out in Kyiv, and we were told, God forbid, if any air strikes hit any areas near us, we are able to respond and help the local fire department rescue team with the search and rescue of people. So I hope that doesn’t happen, but [if it does] I hope there are still survivors out there somewhere.

The post A Ukrainian-American Firefighter Works Amid the Rubble in His Home Country appeared first on Direct Relief.

The for-profit medical system, based in Kyiv, boasted two hospitals, 17 outpatient clinics, 30% growth, 2,800 employees, a fleet of 22 ambulances, and “very big plans in terms of becoming a national provider,” said COO Vadim Shekman. “We’re socially conscious, but we were in a business to make a profit.”

Shekman, who is Ukrainian but had spent 30 years in Chicago, came back to his home country specifically to work at Dobrobut. “Life was full of potential,” he said.

Most patients paid out of pocket, with approximately 10% to 15% using some sort of private insurance.

But when the Russian invasion loomed, Shekman and his colleagues decided the time had come for a pivot. People were going to be injured and sick, and they wanted to help – never mind turning a profit.

“It just felt right,” Shekman said. “You can’t make money during a war on the misery of others.”

When Russia invaded, many of Dobrobut’s clinics in Kyiv and the surrounding areas became unsafe. Some staff members fled – although Shekman tells the story of two of his doctors, on a trip to Turkey when the war broke out, who immediately flew to Moldova and took multiple buses to get back to Kyiv so they could start treating patients. Twelve of their ambulances went to the military for their operations.

Dobrobut’s leaders decided to focus their efforts on a single hospital, where they would see members of the military for free, and ask civilians to pay for their care only if they could – no one would be turned away.

Injured and sick people reached out to them on social media or asked for help through the country’s volunteer networks, and Dobrobut sent its remaining 10 ambulances out, both in Kyiv and around the country, to rescue them, bringing them either back to their facility or to hospitals in Italy, Germany, the Netherlands, and Poland, which were all receiving patients.

War made it too dangerous for Dobrobut’s doctors to go home between shifts, so the company converted a wing of the hospital into sleeping quarters. “It ended up being a big family,” Shekman recalled. At one point, an ambulance brought in a hairdresser, who stayed for a day to groom Dobrobut’s staff members.

Medical needs have changed over time. “When Russians were at the Kyiv walls, we had a lot of injuries from bombings and things like that,” Shekman said. His staff members have terrible things: children with missing limbs and a brain injury. Patients with extensive damage to their lower bodies after the Kramatorsk station attack.

“The story I keep hearing, it’s the story of a person who can’t leave…because they have a bedridden father or mother or other relative, and then they end up being killed,” said Shekman.

Now that the Russians have been pushed away from Kyiv, Dobrobut’s medical staff are seeing people who need heart surgeries and oncology treatments, people with neurological issues or unmanaged chronic diseases, and the occasional Covid-19 case.

But money was quickly becoming a problem. “Our doctors, as heroic as they are, they still have families. We still need to feed them,” Shekman explained. “When people have that much dedication to their hospital and their patients, you want to do what you can for them.”

Dobrobut’s leaders decided to pivot again, hoping that they’d be able to find funding to pay and feed their staff members – and, with any luck, provide free care to every patient who had been injured or was sick.

Then they heard about Direct Relief. The NGO provided Dobrobut with $750,000 to pay salaries and buy food for staff members. “We are able to provide surgical and hospitalization care to our patients in Ukraine for free, thanks to the generosity of Direct Relief,” Shekman said.

The funding is particularly valuable, he explained, because it bolsters Ukraine’s existing medical infrastructure. Where a nonprofit “could have brought a field hospital with volunteer doctors, it could have squeezed out regular doctors…after the war ends, it will be easier for the system to come back to life.”

Dobrobut began its new program on April 1. When they explained to patients that there would be no fee for their care, many thought it was an April Fools’ Day joke.

But not everyone was surprised. An anonymous writer left a note for doctors at the hospital, saying that they’d expected nothing less of Dobrobut.

The medical system is still encountering challenges. Shutdowns and logistical problems have made it difficult to get medications and supplies. Direct Relief has also provided Dobrobut with more than 1,900 pounds of medical aid, including insulin and emergency medicines intended for use during a major disaster.

For Shekman, seeing people step up to provide for, treat, and transport those affected by the war makes the situation a little more tolerable. He admired the bravery of Dobrobut’s staff members, as well as the volunteer networks working throughout the country to help people who are injured and sick.

“Obviously the war is a horrible thing,” he said. “But if there’s a silver lining in the war, it’s how much care people have for other human beings.”

The post To Treat Ukraine’s Injured and Sick, This Medical System Put Profit Aside appeared first on Direct Relief.

The grant funding adds to the more than 508,000 pounds (230,425 kg) of direct medical aid provided by Direct Relief since February 24, 2022, when Russia first invaded Ukraine, to groups helping refugees, internally displaced persons, and others affected by the ongoing crisis.

The Ukraine war has created shortages of vital medications, including insulin, oncology drugs, and thyroid medicines, while increasing the need for medical aid such as PPE, wound care, antibiotics, and even an antidote to chemical weapons. Direct Relief has provided all these medications and supplies to partners working in the region.

However, the situation has also created needs that cannot be answered by shipments of medical aid. Ukrainians who have fled the country are finding themselves with no means to pay for urgently needed prescription medications. A Kyiv hospital offering free care to people injured or affected by the war is unable to pay its medical staff their salaries. A coalition of first responders, invited by the Ukrainian government to conduct search-and-rescue operations in the country, needs transportation and equipment.

The grants provided by Direct Relief will help with these costs, and much more.

Recipients of grants provided or committed include the following:

Direct Cash Assistance to Ukrainian Refugees ($10 million provided): Ukrainian refugees in Poland will receive medical care, but face high copays for prescription medications that many, fleeing without income or resources, will not have the means to pay. With a focus on mothers and their children, along with older adults, this grant will be used to pay prescription copays for Ukrainian refugees at pharmacies throughout Poland. The program is a joint initiative between Direct Relief and Pelion, Poland’s largest healthcare company.

Charity Fund Modern Village and Town ($250,000 provided): This Ukrainian NGO has established a distribution center in central Ukraine, where they have procured medicine, medical supplies, and hygiene items for people fleeing the violence. Two $100,000 grants were used to help defray operational costs, such as for trucking and generators. In addition, the organization has been tasked with emergency patient transfers out of conflict zones in eastern Ukraine, for patients with cancer, cystic fibrosis, pericarditis, and other conditions requiring urgent medical attention. An additional $50,000 was granted to help Charity Fund continue these services in the coming months. 

Ukrainian Diabetes Federation ($150,000 provided): The war in Ukraine has created severe logistical hurdles for people with diabetes, making it difficult to access insulin, glucose monitoring equipment, and even food. This in-country organization distributes medical equipment and is currently monitoring where people who need insulin are located and where they are fleeing. This grant will be used for operational costs so that they can distribute material aid, also provided by Direct Relief, and continue gathering and sharing vital information. 

Polish National Agency for Strategic Reserves ($350,000 committed): The Polish government has appointed this organization to act as a hub for humanitarian aid, including medical and other needed materials. In this role, they have been working with Direct Relief to store medical aid safely. They will use the funding to continue their humanitarian operations.  

Project Joint Guardian ($50,000 provided): This organization is a coalition of U.S. and international firefighters that support first responder and search and rescue efforts around the world. At the invitation of the State Emergency Service of Ukraine, the group will send 20 representatives out to conduct search and rescue and first responder operations, as well as training Ukrainian responders in some rescue techniques. (Direct Relief is providing logistical services to send search and rescue equipment items to Ukraine, and the 20 representatives will also use Direct Relief emergency medical backpacks.) The funding will be used to cover transportation costs and purchase needed equipment. 

Society for Critical Care Medicine ($750,000 provided): This organization is a global community of clinicians who care for critically ill or injured patients in over 100 countries. Members in Ukraine and the surrounding countries have identified critical medical aid needed for people affected by the ongoing war. The funding will be used to procure medication and supplies needed most urgently by intensivists in these countries, using well-established supply chains. 

Polish Diabetes Federation ($102,000 committed): This organization is a senior member of the International Diabetes Federation. They have identified 500 Ukrainian refugees in Poland who have diabetes, need help, and will use the funding for pharmacy and food vouchers for these patients. 

Dobrobut Hospital ($750,000 provided): Prior to the Russian invasion of Ukraine, this was a private hospital network in Kyiv with a large fleet of ambulances. Once the war began, they began acting as a nonprofit hospital, providing care on a pay-if-you-can basis and sending ambulances into the community to find victims of attacks and bring them to hospitals. The grant will allow them to provide free care to all patients, and pay salaries and supply food for medical staff over the coming months.

The post Direct Relief Awards More than $12 Million in Grants for Ukraine War Relief  appeared first on Direct Relief.

Many people were calling the NGO, Charity Fund Modern Village and Town, searching for insulin and other typical drugs – increasingly difficult to find as the war caused logistical issues throughout Ukraine, and even basic medications were made scarce in the areas under attack.

In addition to supplying hospitals and other health facilities with medical aid, the organization responds by searching for requested medications, and letting patients know where they can access them. In some cases, they’ll even acquire a medication for a specific patient.

But some people were searching for something more unusual: levothyroxine – a hormone replacement used by people whose thyroid glands have been removed or whose thyroid function is impaired. Before the war in Ukraine, it was inexpensive and highly available, said Dr. Robert McConnell, a physician at the Columbia University Irving Medical Center and expert in radiation-caused thyroid disease, which he has studied in Ukraine since the aftermath of the 1986 Chernobyl nuclear power plant disaster.

It was also widely needed. For the past 25 years, working with the National Cancer Institute and in partnership with the government of Ukraine, McConnell and his colleagues have studied a cohort of 12,000 people who were under the age of 18 when they were exposed to the effects of Chernobyl’s fallout.

Even among their cohort, approximately 300 people had thyroidectomies, about half of them due to cancer. Even decades later, “we’re finding an excess number of cancers, beyond what you would expect from screening. And the cancers have a unique genetic signature…they are radiation induced,” McConnell said.

Many of the people affected by thyroid disease rely on the medication levothyroxine.

According to McConnell, a pharmaceutical manufacturer of the medication was destroyed by artillery fire. Ukrainians “haven’t had any levothyroxine available locally since the second week of the war,” he said. “Now we have these young adults who were exposed to Chernobyl, and they’re without thyroid hormone.”

In addition, there have been reports of people wanting levothyroxine to protect them from the effects of radiation caused by a nuclear attack.

However, it works differently than something preventative like potassium iodide, said Alycia Clark, Direct Relief’s director of pharmacy and clinical affairs. “As a hormone replacement, it’s really meant for people who already have experienced impaired thyroid function,” she said.

Going without the medication is dangerous. McConnell explained that withdrawal symptoms – including low blood pressure, extreme fatigue, muscle cramps, depression, and sensitivity to cold (“and it’s winter,” he pointed out) – begin after about two weeks without treatment. After three months without it, people’s conditions can become life-threatening.

Complicating matters is the fact that the subjects McConnell and his colleagues are tracking have scattered because of the war. “It’s just a big, big question mark. We don’t know how many have gotten out,” he said. “It’s heartbreaking and sickening.”

Even before the war began, Direct Relief had a shipment containing levothyroxine packed and ready for shipment to Ukraine. “We almost always have levothyroxine in our inventory,” Clark said.

In the days immediately after the invasion, “the first requests were [for] all the wound care and trauma,” she said. But as the war has dragged on, the drugs required for routine care – including levothyroxine – are increasingly requested.

Direct Relief has shipped more than 14 million defined daily doses – totaling above 30,000 pounds – of levothyroxine to Ukraine’s Ministry of Health at their request, and to Charity Fund Modern Village and Town, for distribution to health facilities serving people affected by the conflict.

The post For People Living with Chernobyl’s Effects, A Medication Shortage Threatens appeared first on Direct Relief.

“It was scary for those who were there…and then they evacuated, and they were in camps for months,” said Muzhda Oriakhil, a community liaison and new community engagement manager at Friends of Refugees, a Clarkston-based NGO that offers support to refugees resettling in the United States. “Mentally they are really exhausted.”

Many of them were also late in their pregnancies, and some were experiencing difficulties. One mother of eight who had never before had pregnancy-related health problems began having severe headaches and contractions. Another told Oriakhil that she felt ashamed and uncomfortable staying with all her children in a single hotel room.

“The trauma, the anxiety…can impact their pregnancy and does require special treatment,” said Virginia Tester, the director of Embrace, a program under the larger umbrella of Friends of Refugees that focuses on pregnant and postpartum women.

Harrowing though it was, their journey was more expedited than most. According to Friends of Refugees, people who flee their country, fearing their safety, will spend an average of 17 years in refugee camps. The process of seeking safety in a new country is a fraught and complex one.

“In general, they may have spent years in a refugee camp, so their health and their experience may vary greatly,” said Tester of the pregnant women the Embrace program supports.

When a pregnant woman arrives in the U.S. with refugee status and no health insurance, she qualifies for Medicaid. But the processes of signing up, getting access to social services, and finding prenatal care can prove daunting for someone newly immersed in a different language and culture.

That’s where Embrace often comes in.

“The Spirit of Friendship”

In the mid-1990s, Clarkston transformed quickly from a small Southern town to one of the country’s most diverse areas, called “the Ellis Island of the South.”

Its first refugees were from Serbia, fleeing the Yugoslav Wars, explained Friends of Refugees Executive Director Kendra Jeffreys.

Retired nurse and Clarkston resident Pat Maddox saw that these new arrivals needed help – getting to doctor’s appointments, navigating paperwork – and founded Friends of Refugees.

Today, the organization focuses on supporting refugees in the United States, with particular emphasis on education, employment, and health and well-being. The Embrace program, which became part of Friends of Refugees several years ago, falls in the last category.

It’s not often that a nonprofit organization can boast proven results. But Embrace is an exception. A 2021 study found that participation in the program “was significantly associated with 48% lower odds of labor induction…and 65% higher odds of exclusive breastfeeding intentions.” The program was also associated with positive trends for reduced cesarean sections, higher full-term gestational age, and reduced low birth weight.

“We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women,” the study’s authors wrote.

Today, Embrace works primarily through word of mouth. The organization’s community liaisons, which provide information and outreach, are well known and trusted among women in their work communities. Oriakhil, for example, might find herself serving as a translator for a pregnant woman at an obstetrician appointment one day and answering questions about the Covid-19 vaccine in a group session the next.

“Friendship is so essential to our core,” Jeffreys explained. “We always say we’re not an aid agency. We come along with people in the spirit of friendship.”

“If you don’t know how to speak English, it’s going to be harder”

For the women they work with, Embrace serves a number of functions. The program helps women navigate the process of applying for Medicaid, getting food stamps or other social services, and establishing care with a provider. Community liaisons provide interpretation services for women at doctor’s appointments.

“I feel like people in my community, especially women, they need a lot of help. Usually they are stay-at-home moms, but they also have to take care of the children,” said Mu Naw Naw, a member of the Karen community of Myanmar who is Embrace’s new client services manager. “It’s not only about their everyday life. Sometimes they need help going to the doctor or teacher. If you don’t know how to speak English, it’s going to be harder.”

Naw helps pregnant women make a doctor’s appointment – and sometimes takes them. Her role also involves helping them to apply for Medicaid and WIC – the U.S. supplemental nutrition program designed to support woman, infants, and children with healthy food.

“This is the kind of work that I already wanted to do since I was young. I want to give back to my community as much as I can,” she said.

In addition, the Embrace program offers a culturally specific and sensitive class, called Healthy Moms, designed to introduce mothers to healthy eating during pregnancy, hospital and obstetric office procedures, and techniques to help during labor.

Aku Dogbe, a community liaison who is now Embrace’s health education manager, teaches a version of the class in French, primarily for women from African countries. In Togo, where she’s from, she worked as a midwife, and educating women was an important part of her work.

“This class is where they can learn about the health system and also…what they need to do to have a healthy pregnancy,” she said. “I love to do it, because this is how I help.”

Dogbe remembers one woman who had chronic high blood pressure and was extremely worried about her pregnancy. Through the class, Dogbe was able to educate her about her health and what to expect from the process, as well as share her own pregnancy journey. The woman ended up having a healthy baby and a smooth delivery.

“When the moms can take everything we teach them, and they can apply these things during pregnancy and then get a better outcome at the end, is what’s important to me,” Dogbe said.

The class format has been so successful, in fact, that other organizations providing services to refugee communities have requested access to the curriculum. Embrace is training one group in Missouri to teach a similar class.

Some women decide not to have their partner at birth, often for cultural or childcare-related reasons. For these women, Embrace offers a birth support person who also serves as an advocate in the room.

Among the Rohingya community in the area, that person is Rahina Kamal. “She’s been there for almost every birth in her community,” Tester said.

Kamal explained that partners often stay at home with the children while women attend prenatal appointments and give birth. Since many of the women in her community don’t speak English, she acts as both translator and advocate during women’s pregnancies and the labor process.

For Kamal, who experienced an abusive marriage in Myanmar and who has family still in the camps in Bangladesh, assisting at births is a way to ensure that other women have a more positive, supported experience than she did. “When the baby comes, the delivery is so exciting,” she said. “In my life, I had a…hard time. I try to help people.”

But being a resource for refugee communities often means taking on additional work, whether it’s bringing food to a new family, dropping off flowers for new arrivals, or even helping people when they’re – quite literally – lost.

Tester described one woman who got on a bus to do her grocery shopping and ended up off at the wrong stop, late at night, with her groceries. “That’s when they’ll call Muzdha [Oriakhil],” she said.

“I feel like they’re seen now”

Friends of Refugees’ Embrace program is the recipient of a $120,000 grant from Direct Relief’s Fund for Health Equity. Embrace is using the funds to promote Oriakhil, Naw, and Dogbe from community liaisons to these new, more integrated positions.

“The trust that Mudzha provides and secures, that sometimes takes years to build,” Tester explained.

The choice to place women from refugee communities in staff positions, and to amplify their voices, has been a deliberate one. “We are elevating them to a place that feels like they have more room to share their gifts, their knowledge, their experience with the world,” Tester said.

In addition, the funds will be used to provide phones and tablets to the community liaisons who care for women in refugee communities, and to train them as postpartum doulas, so that they can offer support to new mothers in the weeks after their babies are born.

Embrace’s core staff will do the training with their community liaisons, working with a trusted program, to ensure that the process is supportive and interactive.

Embrace’s staff recently completed a training with the Center for Victims of Torture, designed to help them provide trauma-informed care. The training taught them to identify signs of trauma, connect people to resources, and care for themselves while working with refugees experiencing trauma.

“Especially as we watched hundreds of new Afghans arriving last fall…that feels like an essential part of what a refugee-serving organization should do,” Tester said.

Tester, a certified nurse-midwife and family nurse practitioner, feels acutely aware that it’s not traditional health care interventions that the women she serves need most. Instead, she said, it’s a birth companion like Kamal, or a knowledgeable resource like Oriakhil, Naw, and Dogbe.

“As a health care provider, it means a lot to me that Direct Relief sees this: that our community liaisons are essential, are effective, make positive change in the community in a better way than I ever could – despite having a master’s degree,” she said. “I feel like they’re seen now.”

The post Caring for Refugee Women in the “Ellis Island of the South” appeared first on Direct Relief.

At Baptist Community Health Services (BCHS), a federally qualified health center in New Orleans, staff members are preparing to respond over the coming days and weeks to a deadly tornado that blew a path through the city on the night of March 22.

One death has been reported, and multiple people are said to have been injured in the storm. Widespread damage has been reported in multiple parishes. BCHS was lucky – the storm cut a path between two of its locations – but many patients were affected.

“It’s very rare in New Orleans for tornadoes to happen,” said Jeremy Simmons, the health center’s CEO. He’s lived in the city for eight years, and only seen two tornadoes thus far. However, he said, BCHS is well accustomed to responding to hurricanes and other tropical storms, and they have some sense of what to expect.

Staff are stocking up on bandages and tetanus vaccines. They’re directing patients whose houses have sustained damage to get assessments, have roofs tarped, and whatever else is needed to the appropriate resources. And they’re gearing up for what Simmons anticipates will be an increased need for chronic disease medications, Covid-19 testing, and mental health services.

They’re also preparing to distribute hygiene kits provided by Direct Relief. The organization is providing an initial shipment of 100 individual hygiene kits and 100 family hygiene kits, intended for those displaced or otherwise affected by the tornado.

In addition, Direct Relief is in contact with local partners to assess needs and offer assistance, and is preparing to provide additional support.

Simmons explained that many people will receive a hygiene kit distributed through a local church or other community organization. That’s also how he anticipates people will find the health center in the coming weeks, when they’re seeking a refill of a lost diabetes or hypertension medication, help from a mental health provider, or other health care services.

“In the wake of a disaster, counseling and psychiatry are so important – not today, but in the next few weeks,” Simmons said.

In addition, he’s concerned about displacement and crowding leading to an increase in Covid-19 cases. “We’re still in the middle of a pandemic on top of all of that.”

But he has reason to feel optimistic. Simmons said that, where a tropical storm can cause widespread damage and displacement, the tornado’s effects were relatively contained. “Because it’s a smaller area, the city can better absorb the impact,” he explained.

Still, the storm is enough of an unknown commodity, according to Simmons, that “I don’t know exactly what the impact’s going to look like. We’re just kind of getting started.”

Direct Relief will continue to monitor the crisis and will respond as needed. As always, the organization is concerned both with meeting short-term, immediate health care needs and with providing the resources needed for long-term recovery.

The post After a Massive Tornado, A New Orleans Health Center Prepares to Respond appeared first on Direct Relief.

The country’s health minister said that Russian forces have shelled 135 hospitals and damaged 43 ambulances, and the WHO has confirmed 49 attacks on hospitals and nine on medical transport units.

“The number is astonishing in such a short period of time,” said Leonard Rubenstein, a professor and director of the Program on Human Rights and Health in Conflict Johns Hopkins University’s Bloomberg School of Public Health.

He compared the situation in Ukraine to the more than ten years of war in Syria – in which health facilities have been heavily targeted and in which Russia is likewise significantly involved. Even compared to Syria, “where the attacks were horrific and sustained over many, many years…this concentration is astonishing.”

The war in Ukraine is likely to hurt the health of those affected for a long time to come, and it’s likely that the destruction of hospitals and other health facilities will have grave consequences, Rubenstein said.

The attacks in context

Only a small percentage of the country’s roughly 2,500 hospitals have been attacked, but health economist and former Ukrainian Deputy Minister of Health Pavlo Kovtuniuk, who is working with a team evaluating damage to Ukraine’s health facilities, said that’s not the right way to consider the matter: “We should look at where they are destroyed…there are cities where all the health infrastructure is destroyed.”

Because these attacks frequently come in areas occupied or under siege by Russian forces, “facilities are being destroyed exactly in the areas where needs are becoming most acute,” said Judy Twigg, a professor of political science at Virginia Commonwealth University and an expert on Russia’s and Ukraine’s health systems.

“With the number of hospitals hit, we know that their capacity in the short term to deal with the enormous demand on services, particularly with traumatic injuries, is going to be severely compromised,” Rubenstein said. “Most hospitals, most communities, are not used to dealing with…these traumatic injuries.”

Rubenstein also heads up the Safeguarding Health in Conflict Coalition and Is the author of “Perilous Medicine: The Struggle to Protect Health Care from the Violence of War.” He explained that conflict situations severely affect health systems and public health, in ways that aren’t necessarily intuitive.

Although the conflict in Ukraine – and Syria and Yemen before it – have drawn public attention to wartime attacks on health facilities, there isn’t enough information to know whether such attacks are on the rise.

“Nobody was tracking them like we are trying to track them now, so we don’t have a baseline,” Rubenstein said. “It had the problem of not being on the global health agenda, and it wasn’t particularly on the human rights agenda, except for a handful of organizations.

Dangerous consequences

But it’s clear that war increases the prevalence of infectious disease, both because people are in crowded conditions and because vaccine campaigns are often disrupted by the conflict. In Yemen, where the health and water infrastructure were damaged, which led to more than a million cases of cholera – “and the capacity to treat it was also diminished by attacks on hospitals,” Rubenstein said.

Because travel is dangerous, people often “take their chances without medical care, which leads to more suffering and more death.”

Women giving birth are often afraid to go to hospitals, and more likely to receive a Caesarean section if they do, Rubenstein said.

In addition, “the hospitals are stressed and the supplies diminished, so dialysis programs diminish. Trauma care often has to be prioritized to save people’s lives, so chronic disease care diminishes significantly.”

Trauma from the event leads to widespread mental health issues – and perhaps particularly for people like health care workers, a fact that Rubenstein said is not widely addressed.

Attacks on hospitals – and the harm it causes to civilians – most often goes unpunished. “There has been complete impunity,” said Rubenstein. “There’s been no accountability in Syria, there’s no amount of accountability in Yemen, so yes, they feel they can get away with it.”

And health care workers often flee the country along with other civilians during a war, further decimating the medical system where a conflict is taking place.

Health in transition

Before the conflict, Ukraine’s health system was in transition.

“Prior to 2015, Ukraine was the last of the countries that had been part of the Soviet Union to undergo any kind of reform,” Twigg said. “It was an inefficient, wasteful, corrupt dinosaur.”

But reforms beginning in 2015 addressed the issue of corruption in drug procurement and created a new national health service, in which state funding for health care went through an independent agency that published its records. Nearly every Ukrainian adult signed a contract with a primary health care doctor. The country focused its efforts on primary care, reducing reliance on what Twigg described as a bloated hospital system with the longest average lengths of hospital stay in the world.

The country maintained its share of health problems, however. Kovtuniuk described repeated recent outbreaks of polio and measles, due largely to extremely low vaccination rates. Tuberculosis, hepatitis C, and HIV/AIDS were all ongoing challenges.

In addition, rates of alcohol use and smoking were high, as was the prevalence of non-communicable diseases like diabetes and hypertension. Rates of mortality among middle-aged men were especially pronounced, according to Twigg.

The dozens of facilities shelled in the war present a significant problem for Ukraine’s health system, Twigg said. “I think what we can expect to see is a huge need for resources to be diverted, once the war is over, into reconstruction of destroyed or damaged facilities,” she said. “Even with an enormous amount of postwar investment…it’s going to take a lot of money.”

Regardless of outcome

Twigg is concerned that Ukrainians’ day-to-day health needs will be affected by the urgent requirement to rebuild health infrastructure and deal with the most pressing health issues. She’s also deeply concerned about the mental health of people affected by the conflict. And should the war continue, she feels Russian attacks on health facilities are sure to follow suit.

Should the worst-case scenario occur and Russia end up occupying most or all of Ukraine, Twigg said Ukrainians will continue to resist, most likely leading to ongoing war injuries. People who use intravenous drugs could be denied medications like methadone, which Twigg said are illegal in Russia.

Should Ukraine manage to repel the Russians, Twigg said it’s essential for humanitarian organizations to follow the country’s lead when it comes to rebuilding, and to “support according to their priorities and their needs.”

But even when the war comes to an end, Kovtuniuk said, normalcy won’t return. “They use civilians and their sufferings as part of the war,” he said. “The world will never be the same again.”

The post Attacks on Ukraine’s Hospitals Will Cause Long-Term Harm to Health appeared first on Direct Relief.

Ocheretenko, the board chair of the Ukrainian Diabetes Federation, has an adult daughter who was diagnosed with Type 1 diabetes as a child. Her daughter has an amputation, making travel extremely difficult.

But staying has had its dangers. On the north side of Kyiv, where the two live, Ocheretenko said she could hear explosions and see soldiers. And on Monday, her daughter, who has access to insulin but not regular meals, had an episode of hypoglycemia and required an ambulance.

According to Ocheretenko, the situation for people with diabetes in Ukraine is growing increasingly complex. “We have problems now, and it will be more difficult in a moment,” she said. “There is not enough food…people with insulin can’t reach people who need insulin.” Test strips, used to measure blood glucose levels and an essential component of at-home care for many people with diabetes, are also in short supply.

In addition, Ocheretenko explained, hospitals are focusing on the most urgent cases, which means that people in need of diabetes care aren’t always able to get it. “People who need some care, some help, cannot get some,” she said.

According to Ocheretenko, insulin and high-quality medical care were readily available in Ukraine before the conflict. “The main problem was education,” she said. “Now, the situation is tremendously different. We have big problems with logistics.”

Direct Relief’s response

In addition to requests for oxygen concentrators, trauma medications, and much more, Direct Relief has also received several requests for insulin and other diabetes treatments.

Direct Relief’s Director of Pharmacy and Clinical Affairs, Alycia Clark, explained that diabetes monitoring and treatment are essential during a humanitarian conflict. “Insulin requirements can change in stressful situations, so being able to monitor blood sugar during the crisis is extremely important,” she said.

Clark also explained that tight blood sugar control is needed in critically ill hospitalized patients to improve outcomes, even if they do not have diabetes at baseline, leading to even greater insulin need.  

Walking a tightrope

Humanitarian crises gravely disrupt health care, making it more difficult to get medications and receive treatments even for conditions that are relatively straightforward to manage.

But for people who have insulin-dependent diabetes, managing their condition requires a careful combination of monitoring, insulin, and diet. “These people walk a tightrope every day between high and low blood glucose,” said Dr. Graham Ogle, a pediatric endocrinologist and general manager of the NGO Life for a Child, which provides medical support, education, and other services to children with type 1 diabetes.

Ogle explained that insulin is a complex molecule that needs cold shipment and storage. Even when a patient receives it, it should be stored in the fridge – although research suggests that evaporative cooling techniques, such as employing a clay pot, may be effective. If a person with diabetes is displaced by conflict, keeping insulin cold may be near-impossible, if they’re able to access it at all.

But for many people with diabetes, especially those with type 1 of the disease, it’s an absolute necessity. “If you have type 1 diabetes, you’re insulin-dependent. Without insulin, you would die within a week or even less,” Ogle said.

In addition, “if there’s a crisis, you might be out of your normal routine, and you may not be eating as much. You may not be eating anything.”

Amid conflict, a growing need

Ethiopia has been experiencing an ongoing, violent conflict since 2020. While it began in the organization’s Tigray region, it has since spread to the neighboring regions of Amhara and Afar.

For Tenagnework Goshu, general manager of the Ethiopian Diabetes Association, the most challenging part of working during a conflict setting is the lack of information.

Although the association has been sending insulin and other supplies into the three conflict-affected regions, Goshu said they are forced to do so with relatively little knowledge of what the need is or how many people with diabetes are currently affected.

“I’m sure the need is huge, but we cannot say there is this amount,” she said. “We have to go through an assessment…or else we need to have some kind of communications.”

Complicating matters is that hospitals have been damaged and even looted in the conflict.

Goshu explained that, although her organization was able to send insulin to Tigray as recently as a month ago, “we cannot just go or send [medical aid] because the road is not open…It involves war, it involves politics, so it’s not an easy thing to deal with.”

And although Goshu said the circumstances in Ukraine are different from those in Ethiopia, she said that having as much information as possible – and working closely with humanitarian organizations that can access insulin and other medical aid – has been key to her organization’s response.

Over the long term, Ogle said, the question during and after an outbreak of conflict becomes, “how strong are the services to look after people with diabetes?”

But because much of Europe has been mobilized to respond to the crisis in Ukraine, “I think I am less worried about the ones who made it out.”

For now, Ocheretenko said, her organization is concerned with procuring insulin and other diabetes treatments. She’s concerned that people will be unable to find the type of insulin they’re accustomed to using and will have to learn how to switch to whatever is available.

She’s also concerned that over time, people will forget about Ukraine – which would have severe consequences for many people, including those with diabetes: “I think that the usual situation is when people forget about the difficulties of others.”

“Even now, I can’t believe that it’s happened,” she said. “It’s unbelievable.”

Ukraine Relief

Direct Relief is working with Ukraine’s Ministry of Health and other groups in the region to provide requested medical aid, from oxygen concentrators to critical care medicines – while preparing longer-term assistance to people displaced or affected by the war. To date, Direct Relief has deployed more than 25 tons of requested medical aid to Ukraine.

The post In Ukraine, People with Diabetes Need Insulin, Medical Attention, Even Food appeared first on Direct Relief.

• Covid-19 has caused oxygen shortages around the world. Direct Relief is providing more than $20 million in medical aid and funding to increase access to this vital resource.
• The consortium CAF-Africa, anchored by $10 million in funds from Direct Relief, has distributed more than 121 million units of PPE across the continent.
• In partnership with the International Diabetes Federation, Direct Relief has delivered $155 million in medical aid for patients with diabetes in 26 countries, including Syria, Afghanistan, and others experiencing humanitarian crises.
• As the Ukraine crisis heats up, a Direct Relief shipment containing $5.4 million in medical aid is en route to the country.

Top Stories

A Short Documentary from Direct Relief — “This Bus is an Angel Bus”

The situation: On a frigid Chicago night, a film crew with Direct Relief joined the nonprofit Night Ministry as they cared for their fellow Chicagoans living on the city’s streets.

The context: The Night Ministry was recently awarded $250K from Direct Relief’s Fund for Health Equity, with support from the AbbVie Foundation, for its mobile outreach program, which extends medical and social services to people sleeping in trains, tent encampments and streets across Chicago.

The Big Picture: The organization is among nearly 100 groups to receive funding from Direct Relief through its Fund for Health Equity. The fund was launched last year with an initial $75 million to support community health centers, free and charitable clinics, educational institutions and other community-based organizations fighting the inequities that further health disparities.

Confronting the Global Oxygen Shortage

The situation: Even before the pandemic, medical-grade oxygen shortages were common. But Covid-19 spikes have caused oxygen crises in countries around the world.

The response: Direct Relief has already invested more than $15 million in responding to Covid-19-related oxygen shortages. Now, the organization is committing an additional $5 million to develop resilient, efficient oxygen sources in low-resource settings.

The impact: “The advantage of a group like Direct Relief is lives saved,” said one expert on the global oxygen crisis.

For Community Health Workers in Sub-Saharan Africa, a Vital Resource

The situation: Community health workers provide essential health care to 400 million people across Africa, offering vaccinations, maternal and child health care, and other services. Despite their vital role, they have often been the last in line to receive PPE.

The response: The Covid-19 Action Fund for Africa (CAF-Africa), for which Direct Relief has provided funding, sourcing, and ocean logistics, was created to rapidly scale up the procurement and delivery of PPE to community health workers. A recent third round of aid distributed 40 million additional units of PPE to workers in 10 countries in sub-Saharan Africa.

The impact: “As Covid-19 cases continue and variants emerge, protection for community health workers is imperative,” said Thomas Tighe, President and CEO of Direct Relief. “Direct Relief is privileged to support the public health effort with infusions of PPE.”

As Global Diabetes Rises, Direct Relief Supports Treatment, Maintenance

The situation: Diabetes is particularly challenging to manage in low-resource settings, and it’s on the rise globally. Approximately 537 million adults are living with the chronic condition, and that number is expected to increase to 783 million by 2045.

The response: Working in partnership with the International Diabetes Federation, Direct Relief has delivered over $155 million in medical aid intended for patients living with diabetes. That aid has been shipped to 26 countries, including Afghanistan, Haiti, Syria, and the Democratic Republic of Congo.

The impact: Direct Relief is now delivering over a million vials, pens, or cartridges of insulin every single year to tens of thousands of underserved patients, along with other essential support.

Providing Support to Ukraine Amid Crisis

The situation: The world’s eyes are on Ukraine as the Eastern European country awaits the possibility of a Russian attack.

The response: Direct Relief is providing routine support to the country. Most recently, the organization sent $5.4 million in medical aid to a Ukrainian NGO that’s a long-term Direct Relief partner. This shipment included mental health and cardiovascular medications, IV fluids, and more.

The impact: The NGO serves local Ukrainian hospitals, ambulance stations, and medical centers.

In Brief

The United States

• Over the past two weeks, Direct Relief has made 871 shipments to 540 healthcare organizations in 45 states and territories, totaling $19.6 million in value and more than 30,000 lbs.
• During the same period, $425,000 in grants was distributed.
• A new $50,000 grant will support Black and Indigenous midwifery students with tuition and mentorship.
• A $2.5 million grant for infectious disease treatment and prevention has just completed its first of two years. Eleven health care providers have reached more than 100,000 patients thus far and delivered nearly 200,000 vaccines.
• In preparation for hurricane season, Direct Relief is sending approximately 70 Hurricane Preparedness Packs throughout storm-prone areas of the U.S.

Around the World

• Direct Relief has sent 41 shipments to 42 organizations in 23 countries in the past two weeks, totaling $34.2 million in value and 680,000 lbs.
• More than $788,000 was granted during the same period.
• To support North Macedonia as it increases testing at primary and secondary schools, Direct Relief is providing 124,000 rapid antigen tests.
• Direct Relief is funding the construction of a new cold storage room for the Ministry of Health of Nepal. The new cold room will provide more than a 500% increase to the Ministry’s current cold chain capacity.
• A cervical cancer screening program in Nepal is underway, with 782 women receiving screenings thus far.
• A new collaboration will support breast cancer survivors in Mexico with breast reconstruction surgery in public sector hospitals as part of their comprehensive treatment.
• Direct Relief’s work on oxygen support to countries around the globe is featured in the publication GasWorld.

The post Global Update: Medical Support for Afghanistan, Syria, Ukraine, the U.S. and More appeared first on Direct Relief.

Toting a “heavy” Direct Relief emergency medical pack, he and a patient navigator made their way from site to site in the heat, looking for people experiencing homelessness who might need medical care. When they finally stumbled across an occupied encampment, they introduced themselves to the people there, got a tour, and promised they’d be back.

“The next time when they saw us, that we had actually come back and held to our word, they allowed us to treat them for medical issues,” he recalled.

Neighborhood Health, a community health center in Nashville where Cathcart works as a physician, began its street medicine program during the pandemic. The health center, like providers around the country, had moved many of its services online because of Covid-19, and its leaders quickly noticed that many homeless patients weren’t accessing telehealth services.

Sending a team into the street to dress wounds, monitor chronic diseases, and provide mental health services was a way to make sure their most vulnerable patients were still receiving health care.

Today, the street medicine team includes doctors, nurse practitioners, registered nurses, a van driver, and a patient navigator whose role is to connect people to other services, such as housing. Along with medicine, they bring tents and sleeping bags to distribute to homeless patients.

For Cathcart, the trust he’s earned from patients living on the streets is key. Many don’t trust the medical establishment and were initially suspicious of doctors who showed up out of nowhere, offering help. “Now, that level of trust is there,” he said. “Our patients readily seek us out now. They even come to our clinic.”

One patient, whom Cathcart began treating for a skin infection during street medicine rounds, has now been housed – Cathcart attested that the man’s cat was an emotional support animal – and comes to see the physician during clinic days.

He’s gained much-needed weight, said Cathcart, and is managing a long-term spinal cord injury with the help of physical therapy. “He doesn’t have the stressors he once did,” he said. “He looks like a different person.”

Good medicine

Dr. Jim Withers isn’t the first person to practice street medicine – he credits the work of physicians like Jim O’Connell, Jack Prager, and Joe Greer as inspiration and influence – but he’s the one who coined the term.

“Street medicine” refers to medical care, aimed primarily at people experiencing homelessness, that takes place outside the walls of a clinic. “This was a field of medicine without a name, and it needed to be promoted,” Withers said.

For Withers, the need for a U.S.-based street medicine movement became clear when he was working as a physician in Pittsburgh. Emergency departments would regularly call in the middle of the night, reporting patients whose unmanaged illnesses had turned into crises. “People were ill, disconnected, traumatized,” he recalled.

As a member of the medical establishment, Withers felt like part of the problem. “I wanted to take off the white coat and just be able to liberate myself from the structure, the power dynamic,” he said. “People came in, and they were so traumatized that they didn’t trust you at all, and [even] with your best feelings and dreams toward them, you knew that you were part of the structural violence” that homeless patients regularly experience.

So on the advice of a man named Mike, Withers began dressing in ragged clothing, rubbing dirt into his hair, and going out to spend time with people experiencing homelessness. “Very quickly I realized I couldn’t just be that observer. I needed to dress that wound, I needed to get that blood pressure,” he recalled.

In 2008, Withers founded the Street Medicine Institute, an organization that today connects practitioners working around the world to treat homeless patients. “It’s innovative, it’s rewarding, it’s needed, but honestly, it’s kind of countercultural,” he said of the medicine he practices. He regularly runs into people who fear the social ramifications of practicing street medicine – or just plain don’t approve.

Although unsheltered individuals have many of the same medical issues that the general population confronts – chronic diseases, mental health concerns – Withers said that practicing street medicine means letting go of some of the conventions of the doctor-patient relationship.

For one thing, whatever you have in your backpack is all you can use, he said. For another, a patient struggling with alcohol or substance use disorder, or an unmanaged chronic disease, might be unwilling to change some behaviors. The goal is to provide them with the best care possible while understanding that their goals may be different from a physician’s.

“Street medicine is good medicine,” Withers said. “It’s the only medicine these folks are going to get” if they’re unwilling to go to a clinic or doctor’s office.

Housing and health

Sometimes, said Dr. Danielle Williams, the unreliability of street medicine poses an additional, extraordinary challenge.

Williams heads up the street medicine team at Roots Community Health Center, an Oakland, California-based health center. She regularly practices primary care and treatment for mental health issues and substance use disorders on the street. But in addition, her team, like Cathcart’s, works directly to get people into housing. Her team also routinely brings food and water to unsheltered patients.

For Williams, getting patients into housing – an essential factor in overall health – is a top priority. Since the pandemic, she’s been able to refer a patient directly to housing. “Honestly, the hardest part is finding the patient again sometimes and letting them know they were accepted,” she said. That can also be an issue when treating substance use disorders. “I can offer suboxone, but I have to be able to find that patient regularly, and I haven’t found that to happen,” she said.

She explained that keeping track of medications can be difficult for many of her patients. Many struggle with back issues or arthritis “from having such a hard life.”

“I think focusing on housing is more important,” she said.

The delicate balance between addressing immediate needs and creating a healthier future for a homeless patient is something that street medicine practitioners regularly confront, Withers said. Many have the “hidden agenda” of getting patients into housing and high-quality, regular primary care, but they understand the need to meet patients where they are rather than dictate a course of care for them.

It’s important to be aware that many homeless patients “are tired of having more people take power from them,” he explained. That’s why the work of physicians like Williams, Withers, and Cathcart, who build trust with their patients, treat them appropriately, and listen to their needs, is so essential.

“It’s like harm reduction. You’re going to make the best connections when you just respect people,” Withers said.

Street medicine

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Health Care in the Park

Beyond the confines of a clinic, Doctors Without Walls treats patients without permanent housing.

street medicine

Caring for Homeless Patients During the Covid-19 Pandemic

A San Francisco Community Health Center formed teams to provide care in the city’s Tenderloin district.

The post Understanding the Practice of Street Medicine appeared first on Direct Relief.

Finding helicopters wasn’t the problem; companies volunteered their services, said Dr. Aban Gautam, a physician and president of the aid organization Mountain Heart Nepal. And Mountain Heart Nepal’s staff provided in-flight medical support to gravely ill patients.

Instead, the problem was medical-grade oxygen.

“We were told to bring our own oxygen supply,” Gautam recalled. But medical-grade oxygen was scarce all over the country. “It was a very challenging time for us to refill just one cylinder…we had to wait in a very long queue” at a local oxygen plant.

Even medical support and in-flight oxygen weren’t enough. When a patient reached a hospital, there was no guarantee of enough oxygen to support them.

“We could not take any [more] patients because of oxygen shortages,” recalled Pramesh Koju, public health officer at Dhulikhel Hospital in Kathmandu, Nepal’s capital city.

Dhulikhel had onsite a pressure-swing absorption (PSA) oxygen plant. But it was operating far below capacity. “We cleaned all the filters, cleaned the room… but it couldn’t generate enough oxygen for demand,” said engineer Sanil Shrestha.

To care for patients in its 136 designated Covid-19 beds, Dhulikhel needed between 150 and 200 oxygen cylinders every 24 hours. Its PSA plant could only produce about 60.

Direct Relief to Boost Global Oxygen Supply Amid Covid-19-Caused Shortages with $5 Million Investment

By Talya Meyers | Direct Relief
JANUARY 20, 2022 5:08 PM

Shrestha would wait overnight at a local oxygen factory to secure enough oxygen to treat hospital patients to make up the difference.

Dan Hovey, Direct Relief’s emergency response director, hears similar stories every time a country experiences a Covid-19 surge, beginning with China.

“We learned that a spike in demand for oxygen was completely overwhelming the local supply. And we’ve seen that in every outbreak since then,” Hovey said.

global inequity

This isn’t a new problem. Even before the pandemic, a lack of oxygen was killing children with pneumonia and others who needed it, said Leith Greenslade, the coordinator of the public-private coalition Every Breath Counts – it numbers UN agencies, businesses, nonprofits, and academic institutions among its participants – and an expert on oxygen supply shortages.

“Oxygen was really rare in hospitals” in settings across sub-Saharan Africa and South America, Greenslade said.

In wealthier countries, where road systems are more reliable and commercial oxygen more available, hospitals are most likely to purchase oxygen from a medical distributor dispensing liquid or gas oxygen, explained Sarah Sceery, director of external relations at Build Health International, a nonprofit organization working to improve health care infrastructure in low-resource settings. The oxygen is delivered in large tanks and incorporated into a facility’s system in these cases.

“Oxygen is almost a no-brainer” in many wealthier countries,” Sceery said.

However, in low-resource settings, purchasing a large tank of oxygen isn’t always an option, whether because of poor-quality roads, seasonal conditions, or a lack of local suppliers, Sceery said. The global supply chain issues caused by the pandemic have only exacerbated the problem, especially in many low-income countries that rely exclusively on imported oxygen.

Instead, many hospitals rely on PSA plants, which separate oxygen from other gases onsite, said Eric Buckley, Build Health International’s director of oxygen engineering. But many such PSA plants are broken or not working at full capacity. They’re often donations from an external entity, but local staff are not provided with sufficient training to maintain the plant or troubleshoot problems.

Buckley emphasized that underfunded and overburdened hospital staff are not to blame for the situation.

“The bad guy here is not the facilities person in the hospital, who’s been given nothing more than a screwdriver and a roll of tape, and asked to maintain the PSA plant,” he said.

But there’s no question that the pandemic has severely worsened global oxygen shortages, even as it has drawn attention to the issue. And untold numbers of people have died – sometimes publicly, on the street – as a result.

“Oxygen is also needed for neonatal care, maternal care, surgical care,” Sceery said. “When [hospitals] become overrun with Covid and with Covid patients, it becomes even more disastrous.”

“We first started hearing about the vast quantities of oxygen” needed to care for severely ill Covid-19 patients, Greenslade recalled, “and we just knew it was going to be a horror story.”

Oxygen crisis

At the China Friendship Hospital in the Caribbean country of Dominica, Covid-19 cases stayed low until the summer of 2021. Then the delta variant surged, and case levels remained high, said Nicole Laville, the director of engineering services for the Dominica Hospitals Authority.

“What we found is that, since August, the demand for oxygen has gone up,” she said.

The hospital had a PSA plant, but it had been damaged by Hurricane Maria, the Category 5 storm that caused widespread damage to Dominica and Puerto Rico in 2017. “We’re kind of walking on glass with regards to this oxygen plant,” Laville said. “In an emergency situation, people need oxygen, so they had to run the plant, so it caused further damage to the plant.”

When Laville spoke to Direct Relief in late December, one particular patient was going through 10 cylinders of oxygen a day. The demand was so great that China Friendship Hospital could no longer afford to share with other hospitals in Dominica.

“A lot of those island nations have been in oxygen crisis, but they’re small and tend not to be able to get the attention of the large international agencies,” Greenslade said.

Addressing this oxygen crisis requires a multifaceted approach. Oxygen concentrators, which have received widespread media attention, have proven to play a valuable role in the fight against Covid-19, allowing patients to recuperate at home while opening up vital hospital beds for the sickest cases.

But they’re generally not suitable to treat the sickest patients. A typical concentrator might provide five liters of oxygen per minute, Greenslade said. A patient with a severe case of Covid-19 could require as much as 60 liters per minute.

A way forward

For Greenslade, oxygen is the missing link in the global response to Covid-19. “Early on in the pandemic, a wrong path was taken, and we’ve been on the wrong way ever since then.”

The problem is an over-reliance on vaccines to solve the problem. “They are amazing vaccines, but all the effort was put into bringing them to market quickly,” without taking vaccine uptake adequately into account, she said. “A lot of people would just decide, ‘We’re not going to take them and you just can’t make us.’”

In the meantime, Greenslade explained, “we didn’t focus enough on preventing deaths, on taking care of people who were getting sick.” That meant that the vital role oxygen plays in treating Covid-19 wasn’t emphasized enough.

Part of the solution is making sure that hospitals and health organizations have access to reliable sources of medical-grade oxygen. With this in mind, Direct Relief has already funded oxygen plants in several countries.

While a PSA plant is often the best solution, Hovey explained, an unreliable electrical grid and lack of access to spare parts make it the wrong solution in countries experiencing conflict, such as Syria. Instead, the funding will go toward a liquid oxygen filling station.

With funding from Direct Relief, Build Health International worked with Dhulikhel Hospital to figure out why their PSA plant wasn’t working well, diagnosed the problem, and got the plant running at full capacity.

For China Friendship Hospital, Build Health International recently traveled to the site to evaluate the plant and issued a full report within days.

“We need very nimble humanitarian agencies that can almost operate in a parallel universe” from that of governments and other official bodies, Greenslade said. With a government, she explained, an official report on a broken PSA plant might take four to six months – and more deaths.

“The advantage of a group like Direct Relief is lives saved,” she said.

Dan Hovey and Alycia Clark contributed reporting to this story.

Direct Relief has committed $5 million to the oxygen supply problem and is joining the Every Breath Counts coalition. The organization will work with the coalition and with Build Health International to build and restore PSA plants or other effective, resilient oxygen sources in countries such as Dominica, India, Madagascar, Nepal, and Syria. Direct Relief will also receive guidance on oxygen strategy and prioritization from the Society of Critical Care Medicine, which is the largest nonprofit medical organization devoted to critical care and has members in 100 countries.

The post Confronting the Global Oxygen Shortage and its Consequences appeared first on Direct Relief.

• Direct Relief’s Fund for Health Equity is awarding $9.3 million in funding to 49 on-the-ground organizations fighting health disparities.
• The organization is working with Meta to increase Covid-19 vaccine uptake among U.S. parents and children.
• In the wake of Haiti’s August earthquake, injuries have given way to malnutrition and other indirect consequences. Direct Relief awarded $600,000 in emergency grants to organizations treating those affected.
• With the National Association of Free and Charitable Clinics, and the medical technology company BD, Direct Relief provided $300,000 in grants to U.S. clinics.

Top Stories

New Round of Grants Supports Groups Fighting for Health Equity

The situation: Non-clinical factors such as a person’s physical, social, cultural, and economic environments play a significant role in their health. For marginalized groups, these factors contribute to a lack of access to care and worse health outcomes.

The response: Direct Relief created the Fund for Health Equity to address these disparities. The newest round of grants will provide $9.3 million in funding to 49 organizations in 22 U.S. states and Washington, DC. Initiatives funded include a campaign to overcome anti-Asian hostility and its effect on well-being; a center supporting Black women’s wellness, and a program designed to improve birth outcomes for refugee populations.

The impact: “These funds will allow these exemplary organizations to continue innovation as they improve health outcomes for vulnerable populations across various communities in our country,” said Byron Scott, MD, MBA, co-chair of the Fund for Health Equity and board director of Direct Relief and chair of its Medical Advisory Council.

For Free and Charitable Clinics, a New Chronic Disease Initiative

The situation: Free and charitable clinics around the country care for chronic diseases, such as diabetes and hypertension, in innovative ways that meet the need of their vulnerable and often marginalized patients.

The response: BD, the National Association of Free and Charitable Clinics (NAFC), and Direct Relief came together to build the Continuity of Care program, a multi-year initiative supporting clinics in expanding innovative models of chronic disease care. This round of grants distributed $300,000 to 12 US clinics.

The impact: “This important program helps our members provide important services…among patients in underserved communities,” said Nicole Lamoureux, NAFC President and Chief Executive Officer.

In the Aftermath of Haiti’s Earthquake, Remaining Nonprofits See Malnutrition, Mental Health Issues

The situation: Nearly six months after a magnitude 7.2 earthquake rocked southern Haiti, many NGOs have gone home and displacement camps have broken up. But the problems caused by the earthquake haven’t gone away. Groups working on the ground are treating widespread malnutrition, mental health issues, unmanaged chronic diseases, and other challenges.

The response: With the goal of providing flexible funding to allow these groups to meet essential needs, Direct Relief provided $600,000 in emergency grants to three nonprofits caring for those affected by the earthquake.

The impact: The funding will help pay for medications, fuel, training, and other tools to help people recover and the area develop greater resilience.

A New Campaign for Promote Vital Covid-19 Vaccinations

The situation: Previous analysis showed that people in states with low vaccine acceptance reacted negatively towards mandates, and public discussions were deeply polarized. In addition, prior research showed that people who are hesitant toward vaccines tend to value personal liberty.

The response: Direct Relief, in partnership with Data for Good at Meta, launched an online campaign, which reached 1.4 million people in states with below average vaccination rates, designed to build confidence in Covid-19 vaccines.

The impact: In addition to the widespread reach of the campaign, the team behind it found that messages emphasizing social norms and personal choice can be effective at increasing vaccine confidence.

In Brief

The United States

• Over the past two weeks, Direct Relief has made 651 shipments to 454 partners in 46 states and territories, totaling $6 million in value and more than 27,000 pounds.
• During the same period, $8 million in grants was distributed.
• Shipments contained more than 1 million N95 and KN95 masks and nearly 600,000 doses of medications to treat various conditions, from diabetes meds and test trips to birth control tablets and naloxone.
• Covid-19 has changed health care in the U.S. Here’s why that may be a good thing.

Around the World

• In the past two weeks, Direct Relief has made 32 shipments to 26 healthcare providers in 17 countries, totaling $18.4 million in value and more than 1.4 million pounds.
• A total of $715,000 was granted during the same period of time.

The post Global Update: Support Continues for Health Equity, U.S. Free Clinics, and Medical Efforts in Haiti appeared first on Direct Relief.

But for community health centers and free and charitable clinics around the country, that may actually be a great thing.

Rosalie Danchanko, the executive director of Pennsylvania free clinic Highlands Health, described distributing Covid-19 vaccines at grocery stores, churches, and even a local farm show. “We stand on street corners, we go into bars,” she said.

Highlands Health has also implemented telehealth and curbside services for people picking up their medication. But for Danchanko, it’s the home visits that staff members are making to remote, rural households that’s the biggest change.

“We have learned from this whole pandemic that no longer can you be a physician or a medical provider if you’re not willing to go where the people are. That’s my new mantra: We have to go where the people are,” she said.

The vaccinations and other services her team has provided to disabled or hard-to-access patients have inspired Danchanko to adopt the practice permanently. She’s planning to set up a mobile van that can drive up to community buildings or travel the rough terrain to marginalized patients’ homes – sometimes following directions like “go four miles and look for the red barn,” she said.

“Where They Are”

Dr. Shantanu Nundy, a community health center physician and the author of Care After Covid: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It, would likely be unsurprised to hear Danchanko’s story.

For Nundy, Covid-19 didn’t break the health system. It just showed the problems that were already there. “I really look at Covid as a magnifying glass rather than an anomaly,” he said.

What was wrong, he explained, was a system that didn’t really serve patients – and that left many unwilling or unable to seek care.

“In my mind, what’s broken [in health care] is this heavy reliance on fixed facilities,” he said. “We need to meet patients where they are – literally meet them where they are, whether that’s at home, at church, at the barbershop, or online,” he said.

Nundy said the current health care system is designed around acute care, rather than prevention or well-being: “We have to wait for people to raise their hand and say that they need help.”

But many nonprofit health care providers, like health centers and clinics, are rising to the task, Nundy said. He described texting with patients due to Covid-19 restrictions, and finding out something that might not have come up during a scheduled medical appointment: they couldn’t afford the medication he’d prescribed at the pharmacy. Nundy was able to prescribe more affordable options for this patients.

Where, when, and how

Dr. Wilhelmina Lewis, a physician and chief executive officer of Florida Community Health Centers, said technology has helped her staff treat patients more effectively. For example, remote monitoring devices, such as blood pressure monitors, glucose monitors, and pulse oximeters, can relay patients’ results directly to the health center’s staff, giving them more readings – and perhaps more accurate readings – than they may have gotten during a single doctor’s visit.

“It gives us more data points as we engage in medical decision-making,” she said.

Lewis’s health center, like Danchanko’s clinic, is developing a mobile team that will go to community centers, local agricultural buildings, and other places where hard-to-reach patients are likely to be found. Team members will provide health education, HIV testing, vaccines, and primary care, as well as enrolling patients in Medicare or Medicaid.

Lewis explained that reaching patients isn’t just a matter of being in the right place. It also matters when a provider is there. With that in mind, she’s looking to outfit the mobile clinic with people who are willing to work in the evenings and to expect the unexpected.

“One day they could be Covid testing, the next day they could be next to an orange field,” she said. “It would be hard enough to find people willing to do that work if there were not a workforce shortage [in health care]…You really have to find people who are very mission oriented.”

“The meeting of mind”

“We talk a lot in clinical medicine…about trying to meet the patients where they are. But I don’t think people understood what it actually meant,” said Dr. Monera Wong, a geriatrician and chief medical officer at the Massachusetts-based community center Harbor Health. “Meeting the patients where they’re at is truly meeting them where they’re at, not where we believe them to be or want them to be.”

For Wong, that’s not only a question of providing vaccination clinics or employing technology – although she said telehealth has played a vital role in helping families be involved in a loved one’s health care.

But in addition, she said, it’s about “understanding their health, poverty, job loss, bereavement.”

Wong gave the example of a health center patient who was on her way to pick up her daughter at 4:45 p.m., expecting a 5:30 p.m. telehealth visit. Instead, the doctor called her 45 minutes early because they were ahead of schedule.

“It struck the patient that [the doctor was] truly not sensitive to what their needs are,” Wong said. The patient had the choice of pulling over to take the appointment, or declining and rescheduling. Instead, providers need “to really understand, when we’re making decisions like that, what it might look like to a patient on the other side.”

Sometimes, for providers, that means understanding that a patient coping with a bereavement isn’t emotionally ready to talk about managing diabetes. As a geriatrician treating patients who’d lost loved ones during the Covid-19 pandemic, Wong has seen that firsthand.

“It’s as though my priorities for their health and their priorities were not aligned anymore. They couldn’t afford themselves what they needed to get back on track,” she said. “It’s not only the physical meeting, it’s the meeting of mind.”

Beyond the pandemic

Treating people more holistically and empathically doesn’t begin and end with patients. Lewis described setting up town halls for overwhelmed staff members that included the presence of a psychologist, so they could share what they were going through.

She plans to continue the practice. “Even though the pandemic will go away, health care will always be a stressful profession,” she said.

Providers have been especially receptive to new ways of interacting with patients during the pandemic because they have experienced the loss of their own patients, Wong said. For that reason, she’s encouraged staff members to express their own grief and to highlight the loss of individual patients in group sessions.

“When they went in to approach the next patient, that approach was less transactional,” she said. “I think the pandemic has allowed us, and we have embraced it, to really make empathy a norm for our interactions with patients.”

And Wong described extending vaccination and testing outreach to people – such as ambulance drivers and home health aides – traditionally described in the business as “vendors.” Wong felt a responsibility to those people who were involved in patients’ care, even if they weren’t affiliated with Harbor Health.

For Nundy, all of this is reason for optimism. These changes mean it’s likely that more patients will receive the care they need, and that care will be more effective.

“If you’re in someone’s home…you don’t need to do a survey to find out they have five steps going up to their house, or if they have carpet, or food. You can see it,” he said.

 Since the pandemic began, Direct Relief has provided more than $489 million in medical aid to more than 3,000 nonprofit health care providers and organizations in the United States. During the same period, the organization granted more than $96 million to U.S. nonprofit groups, including health centers and free and charitable clinics.

The post How the Pandemic Has Changed Health Care – For Good appeared first on Direct Relief.

“What we’re really confronting now are the ongoing effects of the earthquake,” said Conor Shapiro, president and CEO of the nonprofit Health Equity International, which provides health care and other vital services in Haiti.

Shapiro explained that, while the camps have disappeared and people have returned to their homes, it would be a mistake to think that life is in any way back to normal. Wounds and other earthquake trauma have been replaced by unmanaged chronic diseases and malnutrition – that last, particularly in children. The damage or destruction clinics underwent meant that many people lost their health care sources. Families whose houses were damaged are living under tarps.

“A lot of these towns have been completely leveled, and that’s housing, that’s physical infrastructure like schools and clinics and markets,” Shapiro said.

Before, many people walked miles to a nearby clinic, said Jenna Green, development director at Project Medishare for Haiti, which is also continuing to work on the ground in the wake of the Haiti earthquake. “Now, if you wanted to walk an hour to the closest health facility, it’s completely gone…People may be six hours away” from a clinic or other health care provider.

Most recently, on January 24, a smaller magnitude 5.3 earthquake struck Haiti’s southwest, killing two people and causing more damage, making people afraid to return to their homes, the Independent reported.

Facing impediments

Ongoing unrest, difficult-to-pass roads, and other issues have also stalled recovery. “We’ve had so many problems it’s hard to know where to start,” said Father Rick Frechette, founder of St. Luke Foundation for Haiti and a priest and medical doctor at St. Luke Hospital.

Late last year, Haiti was struck by a fuel shortage that made headlines. Although fuel is now widely available, Frechette said that it’s twice the price it used to be – devastating for a country where the electrical grid is unreliable and many facilities, including hospitals, rely on diesel-run generators.

Frechette described closing the hospital’s lab and some departments, cutting the lights, and turning off aid conditioners to “try to lower the pressure on the grid” during the fuel shortage.

Omicron also seems to be sweeping through a primarily unvaccinated population; Frechette said: “The labs here can’t distinguish [variants of Covid-19], but delta had finally died down, and we’re a month or two behind what’s happening in the States.” At the same time, droves of doctors and nurses are leaving the country, he explained.

The road to the south is controlled by gangs at Martissant, a huge neighborhood in the south of Port-au-Prince, Frechette and other sources said, which makes it difficult to get supplies and aid workers to the earthquake-struck southern half of the island.

That block at Martissante works both ways, keeping residents of southern Haiti from accessing help in the capital.

And sources described a weak international response to the August 2021 earthquake, further impeding long-term recovery.

“So many organizations came in and did their thing and then went home,” rather than focusing on increasing resilience in southern Haiti, Green said.

Shapiro is concerned that Covid-19 has distracted people from thinking about international needs. In addition, “Haiti has had so many disasters, from the earthquake of 2010 to Hurricane Matthew,” he said. “I worry that people didn’t pay attention to how devastating this was…because it was a disaster in Haiti again.”

Working on the ground

Health Equity International provides daily mobile clinics in remote communities in southern Haiti, where care is hard to access. When they come to a village or town, they’ll typically set up in a school or church or another public facility and work with community leaders to make sure people know their services are on offer.

“They’re crossing through rivers, dirt roads, just to be sure they’re reaching people,” Shapiro said. Asked what providers are treating most often, he explained that “this is a patient population that has no other access to care, so it could be a wide variety of things: infectious disease, chronic disease, malnutrition.”

For Dr. Inobert Pierre, Director General of Health Equity International, and the affiliated St. Boniface Hospital, lack of healthcare access has led to a disturbing decline in patients’ health. “Many of those people don’t see a doctor on a regular basis, so many of them are seen by our team in really bad shape,” he said.

That also includes an increase in mental health issues. The mobile teams have a rotating psychologist who goes from community to community to meet people.

In addition to medical care, the team provides food, multivitamins, and access to nutrition services for patients with malnutrition. They’re outfitting clinics with medical support. And patients who require more intensive treatment are referred to St. Boniface Hospital.

And despite widespread Covid-19 vaccine hesitancy in Haiti, Pierre said they’ve had good luck convincing people to get vaccinated, thanks to close ties to community leaders and the work of trusted community health workers.

Project Medishare is also providing mobile clinics, emergency food and hygiene kits, and birth kits containing clean, safe supplies to care for pregnant women.

In addition, they’re providing training modules for local health workers to help them care for patient needs. One training module is for community health workers; the other is for nurse-midwives and matrons – a Haitian birth attendant – to care for pregnant women who otherwise would lack access to a skilled birth attendant.

“The goal is to boost up this community, empowering them to continue providing this care,” Green said.

To get medical and other supplies down to the south, Project Medishare’s driver continues to make the journey through Martissant – and thus far, he’s done so safely. Asked how the organization manages such a feat, Green explained that they keep close tabs on local logistics and gang activity and never make the trip at night. “It’s a miracle” that it keeps working, she said.

To support Health Equity International, St. Luke Hospital, and Project Medishare in their vital work, Direct Relief is providing emergency grants of $200,000 to each organization.

For Frechette, the funding means having enough fuel to care for Covid-19 and other patients. “We’ve budgeted the price of gas, but it’s double,” he explained.

For Shapiro and Green, the primary benefit is the flexibility of the funding, which allows them to meet needs as they encounter them in the ways that best serve their patients. “To get this grant now…it’s a really incredible thing for us to continue to help,” Green said.

Interviewees said the resilience and work of the people affected should not be overlooked.

“People are so resilient, and all they want to do is have jobs and opportunity, and take care of their families,” Green said.

“Rural poverty is a very hard poverty, because there’s nothing to hang onto,” Frechette said. Still, “we always see heroism: people who are carrying their children in…facing thieves to get here with their children when they’re sick.”

Dan Hovey contributed reporting to this story.

The post In Haiti, Earthquake Traumas Give Way to Chronic Disease, Malnutrition…and Heroism appeared first on Direct Relief.

“Limited availability of medical-grade oxygen was a chronic challenge before the Covid pandemic, but it has been a recurring, acute crisis since it’s essential to treat people who become most ill from the virus,” said Thomas Tighe, Direct Relief President and CEO. “That’s why Direct Relief is devoting focused resources to increase availability in the highest-need areas.”

Direct Relief’s commitment adds to more than $15 million invested already by the organization to respond to recurring crises of Covid-19-related oxygen shortages by providing, among other things, more than 33,000 oxygen concentrators reaching healthcare providers in 52 countries — from the U.S. to Brazil, India, Nepal, Yemen, and more.

Investing in Sustainable Oxygen Production

Even before the pandemic, medical-grade oxygen was scarce in much of the world, in part due to cost and the need to transport oxygen cylinders hundreds of miles via cryogenic tankers, from production plants to hospitals, then back for refilling. Pandemic-induced supply chain issues have only exacerbated the problem, especially in countries relying exclusively on imports.

“We’ve seen repeatedly that Covid-19 causes a sudden spike in demand for medical oxygen that completely outpaces the local supply,” said Emergency Response Director Dan Hovey. “No surge capacity exists for oxygen.”

A sustainable alternative to imported oxygen exists in pressure swing adsorption (PSA) plants, which separate oxygen from other gases onsite at hospitals.

Direct Relief has funded permanent oxygen-generating plants at hospitals in several countries to ensure a reliable oxygen supply. The organization is also joining Every Breath Counts, a public-private coalition including UN agencies, businesses, academic institutions, and Build Health International, to build and restore PSA plants in countries such as Dominica, India, Nepal, and Madagascar.

PSA plants can meet the oxygen needs at most facilities; however, in low-resource settings, PSA plants often require repair.

For example, in Nepal last year, as the delta variant swept the country, Dhulikhel Hospital needed 150-200 oxygen cylinders every 24 hours to care for patients in its 136 Covid-19 beds. Its PSA plant was only generating 60 cylinders per day. Staff member Sanil Shrestha described waiting overnight at a local oxygen factory in the hopes of being able to bring more supplies to Dhulikhel’s patients.

With funding from Direct Relief, Build Health International diagnosed the problem and got Dhulikhel’s plant running at full capacity.

To track the estimated need for oxygen need in low & middle-income countries, Direct Relief, in collaboration with Every Breath Counts, developed a map and data dashboard. The tool also displays crowdsourced reports of oxygen plants requiring repair.

“Organizations like Direct Relief have an absolutely critical role to play in preventing oxygen shortages in low-resource settings,” said Leith Greenslade, the coordinator of Every Breath Counts and an expert on oxygen supply shortages. “We need very nimble humanitarian agencies that can almost operate in a parallel universe.”

The post Direct Relief to Boost Global Oxygen Supply Amid Covid-19-Caused Shortages with $5 Million Investment appeared first on Direct Relief.

The reason? The lights go out, and the expensive medications will be unusable if they’re not kept under carefully monitored refrigeration.

Lewis is the deputy chief of clinical operations at LifeLong Medical Care, a health center with locations primarily in California’s East Bay. “We have power outages every year here, and each time it happens, it’s a challenge,” she said. “Sometimes, it’s only an hour or less, but we certainly have had a few lately that were twelve-plus hours.”

Lindsay Farrell, the president and CEO of Open Door Family Medical Center in the Hudson Valley area of New York, described losing medications earlier this year when Hurricane Ida barreled through, knocking out power at one of her health center’s locations.

“It could have been much worse,” she said of the event. “Yes, we were flooded, and yes, we lost our vaccines, but so many of the people we take care of, they lost everything.”

For health centers across the United States, power outages bring serious challenges, whether it’s the loss of medication, lack of access to electronic medical records, a shutdown of some clinic procedures, or absent staff members – at precisely the moment when patients need increased care.

An emerging link

For researchers, the link between power outages and health outcomes is just beginning to be understood.

“The data’s not that great and it’s not that comprehensive, so my sense is that we’re severely undercounting the effects of power outages,” said Joan Casey, a professor of environmental health sciences at Columbia University’s Mailman School of Public Health.

What is known tends to center on the impacts to individuals rather than on interruptions to health systems, Casey said. In the wake of single large outages, clinicians report people showing up in unexpected numbers, most frequently with carbon monoxide poisoning related to generator use, cardiovascular issues, and uncharged medical equipment that’s dependent on power.

However, Casey explained, the link between health and access to reliable power is of increasing interest: “I would say this is an emerging area. One, our electric grid is aging, so we’re having more power outages, and two is climate change, so we’re having more storms.”

For health centers treating patients on the ground, however, the link is clear.

“The mission of the [federally qualified health center] is to be open all the time and to see everybody,” said Tom Knox, director of emergency management at the Florida-based health center PanCare. “In order to do that, we have to have electricity to be open, or use one of our mobile units,” which have their own sources of power and which the health center deploys during emergencies, such as during Hurricane Michael.

Backup power

When Hurricane Michael knocked out power at a PanCare clinic location in 2018, a backup generator should have kept the most indispensable clinic functions, like medication storage, up and running.

But large trees had fallen on the generator, damaging it too badly for it to function.

Some health centers have backup sources of power; others don’t. It’s not precisely clear how widespread backup power is among safety net providers, although a recent analysis run by Direct Relief, the California Primary Care Association, and MacroEyes found that fewer than 40% of California’s safety net health care sites had some form of backup power.

Generators aren’t always a viable solution. Farrell described an intricate, multilayered process of getting permits, finding funding, and other roadblocks. “It was one issue after another,” she said.

And having source of backup power doesn’t mean that everything functions as usual.

Dr. Charles Fenzi, the CEO of Neighborhood Health Centers in Santa Barbara, California, explained that while his health center is in the process of developing solar power systems at two of its locations, it’s also reliant on backup generators. “We periodically lose power living in Santa Barbara,” he explained. The generators will power some computers and refrigerators so that electronic medical records are accessible and medications are safe, but the ultimate goal is to have solar backup for everything.

“We live in a place where that’s absolutely possible, because most of the time we have sunlight,” he said.

Some of LifeLong’s locations do have backup generators, but the health center has also installed solar power at one location and is looking into doing so at another.

But LifeLong also has a series of protocols it employs whenever the power goes out, so that clinic locations can stay open. They use paper charts and prescription pads, keep a charged laptop and battery-operated lamps, and employ an electronic medical record system that can be accessed through a remote server.

“We can provide services as long as we have light and as long as there’s paper,” Lewis said.

The power of electricity

A power outage often means that health centers can’t carry out procedures, run a dental clinic, or conduct some exams. That may be the case even though need is always high, and will likely be exacerbated after an emergency, when patients have injuries, lose their chronic medications, or have mental health needs related to what they’ve just undergone.

Knox described having to reschedule dental appointments, flu shots, and medical appointments requiring equipment.

Having power isn’t just about powering medications or electronic medical records, Knox said. It’s also about encouraging staff – also dealing with flooding, damage, or whatever the aftermath of an emergency has brought – to come in and help with the increased medical need.

“There’s always a surge after a big event,” he said. “Do you want to meet the surge with 40% of your staff or 65% of your staff?”

Providing a place for staff members to take a shower, do laundry, eat a meal, and put the kids in front of the TV is one of the most effective things PanCare can do to make sure patients receive needed care after a hurricane, Knox said. In part for that reason, the health center’s goal is to outfit each of its 15 locations with a large backup generator.

“That’s how important electricity is,” he said.

Keeping doors open

Recognizing the indispensable link between reliable power and access to health care, Direct Relief recently announced the launch of its “Power for Health” initiative. The organization is committing an initial $5 million to ensure that the U.S. health care safety net has access to resilient power.

The commitment follows $10 million that the organization has already invested in solar and battery power systems for health centers and other nonprofit health care providers.

As disasters such as wildfires and hurricanes grow more severe, the threat of power outages will only grow, Casey said: “I can say as we continue to see more climate-related events, we will continue to see more power outages, especially if we don’t invest in our grid.”

Casey explained that solar power, in particular, presents a significant opportunity to both “reduce our carbon emissions and also improve our resiliency to disaster.”

For health centers doing everything in their power to stay open, even during an emergency, a reliable, resilient power source is a valuable piece of the puzzle.

Lewis explained that need doesn’t stop during an emergency, which means that LifeLong, like other health centers, continues to see patients as long as it’s safe to do so.

Closing the doors is “always absolute last-case scenario,” she said. “Our community relies on us so much for their health care needs, and we always do whatever we can to prevent having to close up. We will keep going through the normal schedule.”

The post The Indispensable, Overlooked Link Between Power and Health appeared first on Direct Relief.