“The Yazidis have been forgotten by the world,” said Gier Fjeld, head of international operations at the Medical Initiative Norway, speaking from his office in Iraqi Kurdistan in late 2024.

Public support programs for displaced Yazidis, refugees, and other vulnerable people in the region were canceled or discontinued beginning in 2023. People living in camps for safety have been told to return to their homes in hostile areas, where their safety will be at severe risk. Yazidi women, many of them victims of sexual violence, were widowed by the genocide, and now struggle to pay for food, water, and medicine for their families. Fjeld said many have been forced into prostitution to feed their children.

“When you remove all the services — food, water, safety, and medical care — you force the Yazidis out of the camps. They’ll create temporary settlements in abandoned buildings, without any access to safety,” he explained.

The loss of public funding has caused suspended services, closed camps, and severely limited the regional healthcare system, which is responsible for more than a million refugees and internally displaced people. The Duhok Directorate of Health, a public health authority in Iraqi Kurdistan, cares for people, including Yazidis, in camps and other temporary settlements. While medical providers are available to care for patients, even going without pay for long periods in some cases, medicine shortages are a serious issue for people with cancer and other chronic diseases.

“Getting diagnosed is not a problem. The problem is the treatment. Most people are referred to private treatment,” which they can’t afford, explained an aid worker stationed in Iraqi Kurdistan, who asked to speak anonymously to preserve their safety while working in the field, during a 2024 Direct Relief interview. They have been working in the region since 2014.

“If you have a chronic disease, and you are without medication, there’s no stability. You might receive some…medication this month, but you might not for the next two months,” Fjeld said.

Partnering closely with the Duhok DOH, Direct Relief has mobilized over $144 million in cancer drugs alone to Iraqi Kurdistan since 2020. The organization has also provided partners in the region with emergency preparedness and response items, such as field medic packs, insulin and other medications for non-communicable diseases, and other requested items – totaling more than $156 million and 1,300 tons since 2016.

“Direct Relief is the largest contributor of aid to the Directorate of Health in Duhok, securing life-saving medications for thousands of patients throughout the Kurdish region of Iraq,” wrote Dr. Lazgin Jamil, a pediatric oncologist with the DOH, in an email. “As the DOH continues to suffer from lack of medication…in addition to lack of funds to purchase medicines and medical consumables, we are grateful beyond words for the incredible support from Direct Relief.”

Fjeld explained that a patient with symptoms of cancer might be referred to a public health facility for diagnosis: “They’ll have a bed, doctors, and nurses,” but without outside support, there would be “no cancer medications.”

“Because of Direct Relief’s support the cancer medicine is there and freely available,” he said. The partnership is “saving thousands of children suffering from cancer.”

Iraqi Kurdistan is largely out of the media spotlight right now, said the on-the-ground aid worker, which means that it’s often overlooked as a potential location for donor support. However, they emphasized, the dedicated public health providers, strong logistical network, and close partnerships make it an especially effective place to establish and deliver a system of longer-term medical support.

Direct Relief’s shipments of oncology supplies and other medications have also freed up room in healthcare budgets, allowing organizations working in the region to offer more services. Fjeld explained that providing medications alone might be half the monthly cost of running a camp, but “Direct Relief is giving medicines for free.”

“It’s been a very successful program, beyond what I ever imagined,” the aid worker noted. “It’s really been amazing what we’ve been able to pull off.”

The post In Iraqi Kurdistan, Medicines Support a Displaced People appeared first on Direct Relief.

Knight, a nurse practitioner at the Diabetes Association of Jamaica, or DAJ, had given the patient’s family new supplies – a blood glucose meter and the vital medications needed to manage their child’s Type 1 diabetes – at a health fair in August. “It had been washed away” as Hurricane Melissa swept across western Jamaica, Knight told Direct Relief.

She contacted a doctor, who was able to call the child’s prescriptions into a nearby pharmacy. A volunteer picked it up and drove it to Catherine Hall, the Montego Bay community where the family lives.

Managing diabetes demands a precise care regimen and reliable access to supplies and medications – including insulin, which must be stored and transported at cold temperatures under painstaking monitoring conditions.

But in the aftermath of a disaster, whether it’s a hurricane, fire, or flood, people with diabetes are often forced to flee without these lifesaving components, or their medicines and supplies are destroyed.

For Knight and DAJ chairman Steven Chen, what was most concerning was that they weren’t hearing more patient stories like that.

“We have patients through Life for a Child [an international nonprofit that supports children with diabetes in countries around the world] in pretty much all of these communities,” Chen said of Jamaica’s hurricane-struck western districts.

Staff at the diabetes association had been reaching out to clinicians and pharmacists across the country to get a better sense of the scale of need.

“There are still a lot of communities that are still inaccessible, and a lot of helicopter drops,” Chen said. But a long history of responding to the needs of patients with diabetes had given staff some idea what to expect: “We know there will be complications later on.”

Diabetes is a serious public health concern in Jamaica. Approximately 235,000 people, about 12% of the population, have been diagnosed with the non-communicable disease.

Direct Relief has worked with the DAJ for years, providing insulin and other support for diabetes treatment. The organization’s support “is what we distribute across the length and breadth of Jamaica,” Chen explained.

On November 11, Direct Relief delivered a large-scale shipment of insulin – enough to support annual treatment for about 300 children with Type 1 diabetes – to the DAJ. The DAJ will also receive a $20,000 Direct Relief emergency grant, which Chen explained will be used to purchase blood glucose meters, lancets (for taking blood samples), blood pressure machines, and other equipment and supplies.

In addition, Direct Relief provided 16 tons of medicines and supplies worth more than $1 million, including diabetes medications and other essential medical treatments, to Jamaica’s Ministry of Health and Wellness via a chartered Boeing 757 cargo plane.

For patients in Haiti, Direct Relief provided a shipment of insulin – enough to treat 100 children with Type 1 diabetes for a year – to La Fondation Haïtienne de Diabète et de Maladies Cardiovasculaires, a Haitian diabetes organization and long-term partner.

The Diabetes Association of Jamaica travels across the country to provide insulin and other components of diabetes care to patients. They work directly with the country’s National Health Fund and with Life for a Child. DAJ staff include a doctor and nurse practitioner who can provide clinic services, and the National Health Fund “can distribute the insulin on the spot,” Chen explained.

DAJ staff provide meters, lancets, and other supplies – and, after a disaster like Hurricane Melissa, they’ll distribute soap, toothbrushes, blankets, tents, and other hygiene and shelter materials to keep their patients from developing further health issues.

Through about three outreaches each week, they’ll reach thousands of patients per year, Knight said. Last year, the DAJ reached more than 7,000 patients.

“We transport where the needs are. It’s better managed that way,” Chen explained. Currently, DAJ staff are preparing for the go-ahead to begin providing services and medicine to patients in Hanover, Black River, Saint Elizabeth, and other areas severely affected by Melissa. “We’re guided by the pharmacists in those locations” to know how much is needed and where,

DAJ staff are also concerned about nutritional needs. Western Jamaicans experienced widespread loss of food, crops, and potable water. The food that’s available to people severely affected by disaster tends to be high in carbohydrates and low in nutrients, with a high percentage of canned and processed foods. Diabetes patients need to carefully manage their blood sugar, and high-quality, nutritious food is an important component of their care.

Distributing processed or canned foods “solves the need of hunger, but, later on, the complications of that” emerge for diabetes patients, Chen said. In many affected areas, he explained, nutrition was already an ongoing issue: “A lot of the low-income communities can’t afford proper nutrition on a regular basis.”

Chen estimated that it would take three to four years to get many of Jamaica’s diabetes patients back to equilibrium.

“There’s always need in terms of diabetes patients,” he said.

In response to Hurricane Melissa, Direct Relief has provided $2 million in material medical aid and $120,000 in grant funding to affected countries.

Sofie Blomst contributed reporting to this story.

The post Damaged Food, Medications Swept Away: Hurricane Melissa Profoundly Affected Patients with Diabetes appeared first on Direct Relief.

At a community clinic in Montegrande, Haiti on Tuesday, midwives treated a new patient: a woman halfway through her pregnancy who’d fled the catastrophic damage of Hurricane Melissa for the country’s safer north.

She told midwives her house was likely destroyed. If it’s still standing, she explained, it’s been looted by now.

“She is resigned to starting her life entirely over,” said Jane Drichta, executive director of Midwives for Haiti, a nonprofit health organization whose clinicians care for women displaced by violence and disaster, living in what Drichta described as 23 different temporary camps.

Another woman whose home had been destroyed by Melissa, sheltering with a three-week-old infant, “seemed to be in shock,” Drichta said.

“Even though we didn’t get a direct hit like Jamaica” from Hurricane Melissa, Drichta said, “the lack of infrastructure and political instability” led to Haiti’s high death toll. Forty-three deaths have been reported in Haiti thus far.

Like every displaced woman Midwives for Haiti’s staff care for, the two evacuees had braved gang-controlled roads where violence is rampant, and the danger to their lives extraordinary, to seek shelter in northern Haiti. Even in the dozens of camps for Haiti’s displaced, who have fled gang violence – and now a Category 5 hurricane that caused widespread destruction in southern Haiti – there are so many gang members that Drichta won’t allow clinicians to care for patients in the camps. Instead, pregnant women in the camps are transported to a nearby community clinic by ambulance.

For thousands of Haiti’s internally displaced women, many of whom fled their homes in Mirebalais, Lascahobas, Sodo, and other areas overtaken by armed violence in recent months, circumstances are desperate. One patient with severe intellectual and physical disabilities was raped in the camps and became pregnant, but was unable to understand what that meant. Drichta reported on Tuesday morning that the woman had just undergone a scheduled C-section and was recovering at Midwives for Haiti’s high-risk maternal waiting home. Another pregnant woman, recently arrived, was doing her daughter’s hair when gangs suddenly invaded her town. She grabbed her two children and ran – barefoot – from her home.

After walking 15 miles, “she found her way to us, and is due any day,” Drichta said.

When the city of Mirebalais fell to gang control earlier in March of this year, an estimated 22,000 people became newly displaced. Drichta calls that a “conservative estimate.” Mirebalais was a devastating loss from a healthcare perspective: The city had a well-equipped hospital and a number of highly skilled providers. Now Drichta said the hospital is “shut and looted.”

While it’s impossible to tell how many have been displaced from their homes by Hurricane Melissa – there simply isn’t enough capacity in Haiti to keep close track – she notes that she’s seeing similar increases in the number of pregnant women urgently needing care. The average recent clinic has seen numbers of patients about 45% higher than usual – comparable to the numbers associated with displacement earlier this year. A Monday clinic that normally tops out at 50 pregnant women saw 120 patients in need of maternal health care.

“Our midwives didn’t get home until eight p.m., and one of my greatest rules is no one on the roads after dark” due to the danger of violence, Drichta said. Safety precautions, such as transporting pregnant women from the camps for care and restrictions of travel, are intended to keep clinicians and staff safe.

But midwives are often so concerned about patients – they know that the care they provide every day is lifesaving – that they can be careless of their own safety. “Nobody listens to me,” Drichta said, with a humorous note in her voice.

It’s far from just an abundance of caution. A senior midwife at Midwives for Haiti’s training school was kidnapped two years ago. “It was the worst three months of my life,” Drichta recalled. On a recent call with Direct Relief, she mentioned calmly that she’d passed two dead bodies on the road on her way to work that morning.

But Hurricane Melissa brings new dangers. Haitian women are fleeing the south, but Haitian women who have lived for years in the Dominican Republic have also been deported or been forced to flee the hurricane’s impacts. Many do not speak Haitian Creole. “It’s a complex disaster,” Drichta said.

Midwives are also reporting an increase in patients with heavy bleeding from placental abruption, which Drichta thinks may be due to the stress of Hurricane Melissa and the continuing violence. “We’ve had an extraordinarily stressful event and we’re seeing it more now,” she said.

Nutritional deficiencies and a lack of medical oxygen threaten many of her patients. Patients at camp clinics receive two daily meals, staff give packets of food to families, and Midwives for Haiti distributes therapeutic food for children with acute malnutrition. But Drichta said it’s common for babies to be born prematurely because of malnutrition and need acute care, which isn’t always available: “A lot of them are dying due to a lack of medical oxygen.”

Widespread flooding from Hurricane Melissa has made cholera and malaria all but inevitable, Drichta reported: “One hundred percent, we’re going to be seeing an uptick” in water- and vector-borne diseases.

An increase in sexual violence, too, is all but inevitable. Drichta feels confident she’ll see more cases like the woman who received a C-section Tuesday morning. Increases in the pregnancy complications that are already too common in Haiti – hypertension, eclampsia, and preeclampsia – are highly likely as well.

“It’s not just what happens in an emergency,” she said of Hurricane Melissa’s destruction. “It’s what happens after. These people are now high-risk pregnancies.”

Direct Relief supported Midwives for Haiti with 30 full midwife kits and 30 resupply kits – enough equipment, medicine, and supplies to support 3,000 safe births – and a $50,000 grant to secure additional medicines last year. The organization has allocated an additional shipment of midwife kits to support Midwives for Haiti’s ongoing work.

For the clinicians of Midwives for Haiti, earning these women’s trust will be the first step.

“The weather has betrayed them. The gangs have betrayed them,” Drichta said of her patients. “Luckily most of midwifery care is done with the heart and hands, and not just with medications…Our midwives are very good at this, at building these relationships.”

But she stressed that a disaster with Hurricane Melissa’s magnitude has consequences for everyone.

“With the influx of people we’re going to have even more [patients] and we’re going to need to do more camps,” Drichta explained. “My midwives will be overworked, and they will go out into the field” when they’re needed, whether it’s safe or not.

“No one is coming, so we have to do it ourselves,” she said.

The post In Haiti, Pregnant Women Flee Melissa’s Devastation through Gang-Controlled Roads appeared first on Direct Relief.

“It’s by far the most destruction we’ve seen here thus far,” said Rodriguez, a Direct Relief emergency response manager who’s currently evaluating medical needs in Jamaica. “The hospital is standing but it’s in pretty bad shape.”

Ivonne Rodriguez-Wiewall, a Direct Relief consultant who’s responded to numerous Caribbean emergencies and who traveled to Jamaica as part of the emergency team, described a shattered dialysis facility, also in Black River, that was managing to still serve patients in the tiny space that was still whole.

“It’s completely destroyed,” she said of the building. “It only has one place where the patients are, with a generator working only the equipment.”

The Pan American Health Organization, the regional WHO office and long-term Direct Relief partner, has documented a range of severe damage to hospitals, clinics, and other health infrastructure across Jamaica. In St. James, the roof of the children’s ward at Cornwall Hospital collapsed – one of five hospitals with severe damage. At least 15 facilities across the country experienced significant damage during the Category 5 storm, and 11 are remaining open without even a full day’s worth of medicines and other essential resources.

For Rodriguez-Wiewall and Rodriguez, both Puerto Ricans who have responded extensively after a number of hurricanes, including 2017’s Hurricane Maria, much of what they have seen is familiar: tattered, flooded communities, shocked faces, and many examples of everyday heroism.

“Walking through the streets of Montego Bay and Saint Elizabeth reminded me so much of what we lived through in Puerto Rico after Hurricane Maria,” Rodriguez-Wiewall said. “The destruction is immense, and many families have lost their homes, their medications, and the basic essentials they depend on.”

She described children helping their parents clear mud and debris. One older man told her he’d been unable to take his blood pressure medication for days. The local clinic was closed and the pharmacy had flooded.

However, Rodriguez-Wiewall noted, the same sense of community and concern for others is a feature of Jamaica’s response to the disaster: “Just like in Puerto Rico, there’s a powerful spirit of resilience here, people helping one another and determined to rebuild.”

Providers working in the small area of the dialysis facility still standing were caring for patients who had gone nearly a week since their last treatment. Dialysis must typically be completed three times a week for patients with serious kidney disease. But the generator was only sufficient to power the dialysis machines themselves.

“These are patients who have not received their dialysis since the hurricane passed,” Rodriguez-Wiewall reported.

Rodriguez described providers still working at Black River Hospital, with no power. “We gave them the medical backpack we had,” he said.

Direct Relief has a wide network of partnerships with Jamaica, including with the country’s Ministry of Health and Wellness. Rodriguez-Wiewall and Rodriguez were delighted to learn that Direct Relief’s medical aid was familiar in Black River – including the organization’s distinctive orange-and-black field medic packs.

“She recognized the backpacks,” Rodriguez recalled of one aid worker.

Many communities have been cut off both from aid and communications. Hurricane Melissa flooded and blocked roads, and downed power and internet, all over Jamaica.

But Rodriguez-Wiewall said public agencies had been quick and effective at clearing roads and establishing lines of communication.

“Today we crossed from Kingston [Jamaica’s capital] all the way to Black River,” a city in Jamaica’s southwest, she explained. While Kingston was relatively intact, Black River, about 12 miles away, had been devastated. “We had to go around if there was flooding or bypasses, but we were able to make it.”
Montego Bay, a city in the north of Jamaica, was similarly devastated, Rodriguez-Wiewall reported after conducting an evaluation.

Direct Relief has launched a multifaceted response to Hurricane Melissa. Prepositioned supplies have been deployed in Jamaica, Haiti, and the Dominican Republic. A large-scale cache of emergency supplies, which Direct Relief positioned in the Pan American Health Organization’s facilities in Panama, has been deployed regionally.

Rodriguez-Wiewall and Rodriguez plan to meet a new Direct Relief shipment in Kingston, scheduled to arrive this week. The shipment contains 100 additional field medic packs, designed for first responders caring for patients in emergent circumstances, and a large variety of hygiene items for displaced people. These items are intended to prevent diseases caused by lack of sanitation, such as cholera and scabies, both serious risks in the aftermath of disasters.

A far more extensive shipment, containing water purification tablets, oral rehydration solutions, diabetes medicines and supplies, IV items, insect repellent, reentry kits for people returning to damaged, homes, prenatal vitamins, and mental health medications, among other medical aid, is en route.

A $50,000 emergency grant will be awarded to the JAHJAH Foundation, a nonprofit working on the ground in impacted Jamaican communities to meet health, water, and other essential needs. Direct Relief staff visited JAHJAH Foundation staff to evaluate medical needs and see their operations at work.

Direct Relief staff are conferring with local health systems and providers to determine what medical aid and funding allocations will be most effective at preventing the serious health impacts caused by hurricanes.

Rodriguez-Wiewall cautioned that needs would be extensive and likely long-lasting. While government agencies and regional groups have launched fast, coordinated responses, the scale and severity of Hurricane Melissa meant that many people have gone too long without food, clean water, or emergency care. Jamaican partners have reported that bodies are continuing to be uncovered.

“There are a lot of people walking by with needs for food and water,” Rodriguez-Wiewall said, describing conversations she’d had in affected Jamaican communities. “They need everything. They’ve lost everything.”

The post On the Ground in Jamaica, Direct Relief Emergency Team Reports Devastation, Heroism after Melissa appeared first on Direct Relief.

But storms like Melissa aren’t deadliest in the short days when they’re active. Instead, it’s in the weeks and sometimes years afterward – when affected communities struggle with a blocked road to the nearest hospital. A contaminated water source, or a local clinic with a missing roof and ruined equipment. Or perhaps a communal refrigerator that held insulin but is now damaged and its contents unsafe.

In coordination with Jamaica’s Ministry of Health and Wellness, Direct Relief’s warehouse and logistics staff are currently packing an urgent shipment of requested medicines and supplies, valued at roughly $1 million wholesale. This shipment supplements aid Direct Relief had already positioned in the region before hurricane season began and medical aid currently on the way – and its purpose is to head off what’s commonly called “the second disaster.”

Research is increasingly proving that this second disaster – a period of months or years after a natural disaster severely damages a community – is deadly. Sixty-four Puerto Ricans were directly killed by Hurricane Maria in 2017. But a groundbreaking 2018 study conducted in the months after found a number of excess deaths above 4,000 – about 70 times the cited death toll. About one-third of those deaths were caused by a lack of access to healthcare, as blocked roads and closed clinics kept people from providers and medicine.

A study in Nature last year showed that hurricane-related deaths can be 300 times the original death toll, as people go without medicine, lose crops and livelihoods, and struggle to find housing amid severely damaged infrastructure.

The Second Disaster

1. The Environment

Tropical storms like hurricanes unleash a host of threats into affected communities.

When local water sources are contaminated, water-borne illnesses like cholera become a severe and potentially fatal risk. Digestive ailments like norovirus can spread through contaminated water and food, especially in crowded conditions like shelters. Because both uncontaminated food and drinkable water are in short supply in Jamaica right now, preventing these illnesses and preparing to treat their symptoms will be high priorities.

Pools of standing water quickly become breeding grounds for mosquitoes, especially in warm climates. In the Caribbean, mosquitoes cause vector-borne diseases like dengue, zika, and chikungunya. Because dengue has been on the rise in recent years, it’s a particular concern right now.

Communities affected by hurricanes have reported a growing need for epinephrine autoinjectors, as people working to clear damage and return to their homes encounter beehives and other potentially deadly allergens. And physical traumas such as injuries occur both during storms and as people work to clear debris and reach help.

2. Lost Medicine and Food

People with non-communicable diseases like diabetes, hypertension, respiratory ailments like COPD, cancer, and kidney disease are at increased risk during and after hurricanes. Medicines are often damaged by the disaster or people are forced to flee without them. The lifesaving treatments used to manage these conditions generally demand consistent, reliable access to care and monitoring.

In addition, contaminated food sources or lost crops can quickly lead to nutritional deficits, with pregnant women and other vulnerable people at higher risk. In Jamaica, Hurricane Melissa has destroyed both food and crops. For people with diabetes, managing the disease with little food or with whatever is available is likewise much more hazardous.

3. Mental Illness

Communities that experience hurricanes experience increased levels of post-traumatic stress, depression, anxiety, and other mental health issues that can continue for more than a decade. Long periods of uncertainty – such as when recovering families struggle to access housing or find employment – can create or prolong psychological distress.

A single hurricane can cause widespread impacts, but repeated events compound the effects. Research has demonstrated that survivors of multiple traumatic events are left with worsening mental strain and greater vulnerability to future mental health illness.

4. Damaged Infrastructure

Damaged clinics and hospitals – Jamaica has reported at least five significantly damaged hospitals – can cut off access to care for months. This affects both people needing emergent care, such as for diabetes or a mental health condition, and people who need surgery or specialty care for cancer, kidney disease, and other complex illnesses.

When Hurricane Dorian battered whole islands in the Bahamas in 2019, both primary care clinics and specialty care hospitals were affected. The Covid-19 pandemic, which began the following year, drastically complicated access to care in the Caribbean nation.

But even if clinics and hospitals are open and able to care for patients, blocked roads and landslides can make accessing that care impossible. Puerto Rico, like many other areas of the Caribbean that are vulnerable to hurricanes, has increased its mobile and rural healthcare efforts in the aftermath of Hurricane Maria.

5. Poverty, Displacement, and Struggle

Some of the most lasting consequences of hurricanes are hard to quantify – but they can be deadly. Excess deaths in the years after a hurricane aren’t always easily attributable to it. But when people lose their homes or their livelihoods; when they are displaced from their communities for long periods; when the community as a whole struggles to rebuild or restore services; when contamination and pollution continue to haunt communities, then the number of excess deaths will increase.

First Response

The medical aid being prepared for transport to Jamaica includes a wide variety of requested medicines and supplies. Some of these – including epinephrine auto-injectors, water purification tablets, oral rehydration solutions, IV supplies, antibiotics, insect repellent, personal protective equipment, field medic packs for emergency responders working on the ground, and reentry kits for people returning to damaged homes – are designed to prevent emergent conditions common after a disaster.

Many other items, including prenatal vitamins and medications and supplies to manage diabetes, will help prevent spiraling health emergencies caused by a lack of treatment. People with non-communicable diseases and pregnant women, among other medically vulnerable groups, are at particularly high risk in the aftermath of a hurricane.

The Jamaican Ministry of Health and Wellness has also requested a range of mental health medications for people affected by Hurricane Melissa, as post-traumatic stress and other mental health conditions pose significant risks to disaster-affected communities. These medications are included in the shipment.

A separate shipment of pediatric insulin and materials for children with Type 1 diabetes is also being prepared by Direct Relief for shipment to Jamaica and awaiting dispatch to the Jamaica Diabetes Association.

Recovery in countries affected by Melissa will likely take years. Direct Relief has strong, active partnerships throughout the Caribbean, and in Jamaica, Haiti, the Dominican Republic, and the Bahamas in particular. The organization has worked for years with regional and local partners to increase resilience and disaster preparedness.

Direct Relief will continue to collaborate with partners, monitor the changing situation, and respond as needed.

The post Second Disaster: After Hurricane Melissa Kills Dozens, The Caribbean Faces These Five Threats to Health appeared first on Direct Relief.

“Over the past two days, Melissa brought heavy rain, flooding and landslides” to this part of Haiti, said Linda Thélémaque, Hope for Haiti’s chief program officer, in a video update. “The soil is saturated, roads have been cut off, and many families are recovering from water damage and loss of crops.”

Hope for Haiti, which serves more than 1 million people across southern Haiti, is using the medical supplies from Direct Relief to stock outpatient and mobile clinics working to reach people cut off from care.

Six large medical caches are staged for the regional response: four in Haiti and the Dominican Republic, and two at the U.N. Humanitarian Response Depot in Panama for regional deployment. Each pack contains more than 200 items and is designed to sustain care for up to 3,000 patients for 30 days.

The caches are “filled with critical medicine and supplies that help us respond to hurricane related health needs. These include items to treat injuries, respiratory infections, skin conditions, diarrhea, and other illnesses that often follow heavy flooding,” Thélémaque explained. The supplies will allow Hope for Haiti clinicians “to respond quickly in the days and weeks ahead.”

In the Dominican Republic, Fundación Solidaria del Divino Niño Jesús received two pallets of insect repellent from Direct Relief on Oct. 21. The country’s Ministry of Health and Wellness will distribute the repellent in high-risk, flood-affected areas to help limit dengue and other mosquito-borne diseases.

Direct Relief supplies currently staged in Panama — including medications and field medic packs — will be routed to affected areas by the Pan American Health Organization (PAHO), the regional office of the World Health Organization.

An emergency response specialist at PAHO alerted Direct Relief on Thursday that the organization was preparing to ship one of the Hurricane Preparedness Packs, along with 10 field medic packs, to Jamaica to aid in response efforts.

PAHO had staged an additional HPP in Haiti last month in preparation for emergencies.

When a large-scale disaster strikes, the immediate priority is getting aid into devastated areas as quickly as possible. In the aftermath of a catastrophe like Hurricane Melissa, however, secondary threats can be deadlier than the initial storm: loss of chronic medications such as insulin, contaminated water, standing water that promotes mosquito-borne disease, damaged health facilities and blocked roads.

Direct Relief is rushing medical aid to affected communities – allocating $250,000 in initial emergency funding, shipping 100 field medic packs and 250 hygiene kits to Jamaica’s Ministry of Health and Wellness, and making its entire inventory of medicines available to hurricane-impacted areas in Jamaica and other countries.

The organization’s response built on years of regional investments intended to strengthen resilience and speed emergency response. Recent support includes $3 million for resilient infrastructure, power access and two mobile health clinics in Jamaica; another $3 million for resilient power, cold-chain, medical oxygen and mobile healthcare services across the eastern Caribbean; $1 million to bolster the Dominican Republic’s cold-chain and medical warehousing capacity; and $1 million to support emergency operating costs for nine Haitian health facilities affected by ongoing conflict.

“Direct Relief’s preparedness programs are active all year round, all working towards the goal of strengthening the response capacity of our local healthcare partners,” said Dan Hovey, Direct Relief’s vice president of emergency response

Melissa remains a threat, and affected communities are still taking stock of the damage and evaluating which health interventions are most needed. Jamaica’s Ministry of Health and Wellness has flagged mental-health impacts as a priority, said Genevieve Bitter, Direct Relief’s vice president of program operations. People — especially in the southwestern areas that bore the brunt of Melissa’s landfall — have lost homes, livelihoods and schools. Many are without running water, power or sufficient food and are unable to reach loved ones.

“People have been through a trauma,” Bitter said. Direct Relief staff are collaborating with MoHW officials to determine how best to meet mental-health and other hurricane-related needs.

But the strategic stockpiles placed throughout the region are already the first step in mitigating the “second disaster” after a major catastrophe. The loss of insulin and other lifesaving medications, standing water and unsanitary conditions, blocked roads, and the lack of access to medical care that often follow a disaster can be far deadlier than the initial event.

“We’re able to stay present, keep our doors open and mobile clinics running, and bring care where it’s needed most” because the medicines were already there, Thélémaque said.

The post Hurricane Melissa Left Devastation Behind. Medical Aid was Already Ready and Waiting. appeared first on Direct Relief.

The brigade arrived in Álamo, Veracruz on Friday, October 17, just days after heavy rainfall pummeled this area of Mexico.

There, the team – six doctors, four nurses, and a psychologist, among others – found people with nowhere to live after their houses had been flooded up to the second story. Patients with diabetes, hypertension, asthma, and HIV who’d lost their medication. Open wounds on the hands and feet of people working to clean up communities damaged by some of the heaviest rainfall Mexico has seen in years.

“The situation is not good,” said Gabriel Sánchez, the team leader and a coordinator of medical operations at Medical Impact, an organization that deploys brigades of healthcare providers to communities in Mexico and around the world. “Many families were left homeless, their belongings were lost.”

At least 76 people were killed last week when unexpected, heavy rainstorms caused flash flooding and landslides in the Mexican states of Hidalgo, Querétaro, Puebla, San Luis Potosí, and Veracruz. Hurricane Priscilla, which passed over much of this area earlier in October, brought heavy rainfall, but much less damage.

That’s part of the problem, said Dr. Giorgio Franyuti, Medical Impact’s executive director. “Usually…we are very adaptive toward activating protocols against hurricanes,” he said of Mexico’s extensive public and nonprofit emergency response systems. “We had this with Hurricane John, Otis, and Erick [in June of] this year.”

But rains that aren’t part of tropical storm systems are rarely so destructive, Dr. Franyuti said.

“The devastation is massive,” he said. “It will take a very long time for health systems to achieve a reconstruction of their infrastructure.” He said the heavily damaged areas cover more ground than the whole of Central America.

Medical Impact deploys brigades all over the world – Dr. Franyuti has provided medical care in Guatemala, Gaza, and Colombia, among other places – both in emergencies and to temporarily boost healthcare in overwhelmed or under-resourced settings. When Dr. Franyuti spoke to Direct Relief on Wednesday, he turned his phone camera on to show brigade members packing pharmaceutical supplies and field medic packs the organization had donated.

Direct Relief funded Medical Impact’s flooding response brigades with a $25,000 grant. The organization also supplied essential medicines and medical supplies, as well as 10 field medic packs earlier this year, in advance of hurricane season, to enable swift in-the-field deployments like this one. (The organization also provided medical support to Mexico’s Secretariat of National Defense, or SEDENA, and the Guerrero Ministry of Health’s Urgent Care Unit, which mobilized responders to the area.)

The grant “enables us to jump-start the response so we can start right away,” Dr. Franyuti said. Staff members were packing portable mattresses and potable water along with the medicines and supplies. “We do not know where we’re going to stay, but we have to deploy anyway. It is so time-sensitive, and so critical. We usually resolve [logistical issues like shelter] on the spot.”

Dr. Franyuti was already distressed by the high death toll caused by the flooding and landslides. But he warned it was only the beginning.

“Let me tell you about the bigger monster: the secondary disaster,” he said. “These people do not have drainage. They do not have refrigeration. They do not have drinkable water.”

The loss of medications, and of refrigeration to store medicines like insulin, was severely dangerous. Parasites and water-borne diseases would be a growing risk in coming days. Then, he said, mosquito larvae would hatch in standing water in the next couple of weeks, likely causing an increase in dengue cases. All of this threatens health facilities in affected areas, which “do not have the necessary productivity or capacity” to treat thousands of patients in acute need at once.

Of the 1,079 patients Sánchez’s team treated over the next three days, he estimated that 90% needed replacements for chronic disease and other lifesaving medications that had been lost in the floods. All needed preventative deworming treatments.

For those three days, the brigade split into two, Sánchez explained. One team remained at a stationary clinic, and the other went door to door to treat patients who were injured, older adults, or unable to leave their homes.

One of them, he recalled, was a patient in her 70s. A neighbor alerted the mobile team that the woman was alone at home because her two adult children had gone in search of supplies. When asked if she needed medical attention, she showed providers a wound on her foot – she could not travel over the debris-filled streets – and asked for diabetes medicines to replace the ones the floodwaters had swept away.’

When the team treated her, “she cried in gratitude and wanted to give us food,” Sánchez recalled in Spanish.

That kind of reaction is common, Dr. Franyuti said, and it’s often what motivates volunteer providers to undertake this work, despite the dangers and the months of deployment.

The work “is sad, but it is also very hopeful,” he said. “You get hugged every day. People come and give you sunflower seeds, they give you mangoes. It’s a cultural experience so rich and so life-changing.”

Dr. Franyuti estimated that this disaster would require at least six months of repeated deployment. Teams are rotated every week to give responders time to rest – “You do not want to have people exposed to a disaster for a long time…it does cause post-traumatic stress,” he said – and the brigades continually collect and analyze data about community-level healthcare needs to enable tailored, efficient responses.

A brigade may respond to a volcano eruption, only to find that nearby health needs are relatively few, but people dozens of miles away are experiencing severe respiratory impacts as particles are carried on the wind. A flooding event may raise concerns about contaminated water and interrupted supply chains…but a severe outbreak of dengue may end up presenting the biggest risk. Pregnant women or children may be more affected than the team expected.

That’s why data analysis is so key to Medical Impact’s brigade deployments: “There’s a gold mine behind the data,” Dr. Franyuti said. “You do not achieve anything with only one intervention; you have to continually study” the situation.

Touching base with Direct Relief while back in Mexico City late Tuesday afternoon, Sánchez had already handed an early data set over to his colleagues. While they were analyzing it, the brigade was off to Huauchinango, in Puebla, another state badly affected by flooding.

The data doesn’t just serve Medical Impact’s response. Dr. Franyuti said one of the organization’s highest priorities is ensuring that local health systems are ready to take over after a medical brigade leaves the field: “Handing the steering wheel back to the public sector” is always the goal, no matter where in the world a team is working. Providing accurate, on-the-ground data about healthcare needs, and how they’ve changed over time, ensures that a public health system can step back in as efficiently as possible.

“Every disaster is unique,” Dr. Franyuti explained.

The post After Deadly Mexico Floods, a Medical Brigade Provides Care appeared first on Direct Relief.

On August 31, a magnitude 6.0 earthquake struck eastern Afghanistan, killing more than 2,200 people, destroying whole villages, and displacing tens of thousands. A few days later, Dr. Yousafi arrived with a team of medical workers in Anderlechak, a village in the Sawkai District of hard-hit Kunar Province, and saw piles of material in front of the small local mosque. A resident explained that villagers had had to hurriedly find shrouds for approximately 85 people killed by the quake.

“I felt fear” seeing the piles of shrouds,” he explained in English. “This was a very dazzling story and memory for me.”

Dr. Yousafi is a physician with the Afghanistan Islamic Medical Association, a nonprofit group. Since September 5, AIMA workers have been providing medical care to Afghan people in earthquake-affected villages: treating injuries and infections, caring for pregnant and lactating women, and providing medicine to patients with chronic diseases.

Speaking to Direct Relief both in English and with the aid of a translator, he described scenes of urgent need and harrowing loss.

AIMA’s group of providers split up: One team quickly established a stationary clinic, which Dr. Yousafi heads, in the Osmane displacement camp in Khas Kunar District, while a mobile team travels to hard-to-reach villages in the mountainous area using an off-roading vehicle.

AIMA’s earthquake response teams were equipped by a 17-pallet emergency shipment from Direct Relief. The shipment contained about 8,300 pounds of antibiotics, prenatal vitamins, oral rehydration salts, water purification tablets, prenatal vitamins, inhalers, medications, insulin, and other supplies for chronic disease management – about $6 million in wholesale value.

The supplies were received and distributed by the Afghanistan AMOR Health Organization (AAHO), a long-term Direct Relief partner and one of the few NGOs in the country that can receive international humanitarian support. Over the past 12 months, Direct Relief has provided $460,000 in material medical aid to Afshar Hospital, which AAHO operates in Kabul.

Earthquakes happen frequently in Afghanistan. Even at relatively moderate magnitudes, they are a serious threat to the country’s rural provinces, where buildings are often informally constructed from easily available materials and highly vulnerable to collapse. Because this earthquake occurred when people were sleeping at home, the death toll was particularly high, and women and children were especially affected, witnesses have reported.

Mountainous terrain and damaged roads can cut vulnerable communities off from rescue and aid, as this quake did. And even without the added impact of natural disasters, the Afghan people experience high levels of poverty, hunger, and malnutrition. The United Nations estimates that more than 23 million individuals – over half the country’s population – urgently need humanitarian assistance.

Adding to the humanitarian need, over 2.2 million Afghans have returned to the country from Pakistan and Iran this year – often involuntarily. Thousands of returnees from Pakistan currently live in earthquake-devastated areas.

Asked about reports that many women have been unable to access medical care after the earthquake, Dr. Yousafi said it was “a true story.” To ensure that women in displacement camps and affected villages could receive primary and maternal healthcare, AIMA’s medical team included several female members: two physicians, a midwife, and a nurse.

Pregnant and lactating women in these areas had low levels of iron and other nutritional deficiencies, Dr. Yousafi reported, making prenatal vitamins and other nutritional support an urgent need.

He estimated that the two teams had treated more than 1,250 people thus far, in an October 13 conversation.

Many of the people treate by AIMA’s team have experienced horrors. One young boy, trapped under collapsed wood for about 18 hours, had a fractured leg and other injuries. After being airlifted to a hospital for treatment, he was returned to the Osmane displacement camp.

AIMA staff changed his dressings every day, Dr. Yousafi recalled: “Now he is completely healthy.”

A man treated for a fractured femur had lost his wife, four sons, and two daughters during the earthquake. Their deaths happened right in front of him, he told Dr. Yousafi.

“This story was very important for me,” the physician recalled. Many of his patients had devastating injuries and serious health issues, and many had lost numerous family members.

“They have very great difficulty living,” he said.

Arifa Dashte contributed translation services and interviewing to this story.

The post In Afghanistan’s Earthquake-Shattered Villages, A Doctor Treats Wounds and Infections, Hears Stories of Loss appeared first on Direct Relief.

There’s a scheduled helicopter flight once a week to the mainland for people who need transport, and supplies flown into the island are usually hand-carried wherever they’re needed. The families who live there feel a strong connection to place, community, and tradition, said Megan Mackiernan, a physician assistant and chief quality officer at Norton Sound Health Corporation, a tribally owned, nonprofit healthcare organization. 

“Families really value their kids having that experience of growing up on the island,” MacKiernan explained. “We take that ‘It takes a village’ thing very strongly.” 

There’s also a clinic located in the village of Diomede – one of 15 village clinics operated by the Norton Sound Health Corporation, which serves rural communities throughout the Norton Sound and Bering Strait region.

That clinic’s story has been key to the organization’s close partnership with Direct Relief, according to Mackiernan. 

In September 2022, when the Little Diomede clinic was newly built, a helicopter dropped off a large shipping container filled with equipment and supplies Norton Sound had purchased for its facility: machines for monitoring vital signs, exam tables, a pharmacy dispensing unit. When a typhoon barreled across Alaska’s western coastline, the container tumbled around the island’s coast, damaging and destroying the contents.  

Norton Sound had received a $50,000 Direct Relief emergency grant a couple of years earlier, at the height of the Covid-19 pandemic. When the clinic’s supplies were destroyed, Mackiernan recalled, a colleague suggested, “Why don’t you reach out to those Direct Relief people?” 

Direct Relief provided a second emergency grant, this time of $160,000, to cover the cost of getting replacements for the destroyed supplies shipped to the village.“We were able to have all that stuff and get that clinic functional,” Mackiernan said. 

Today, the two organizations work closely together. Direct Relief supports Norton Sound’s care with shipments of sterile water, liquid IV and oral rehydration supplies, epinephrine, naloxone, and over-the-counter medicines and supplies – over $494,000 in total material aid.  

In an area where running water, medicines, and even food are expensive – supplies are generally brought in by plane or barge – Mackiernan says the ongoing support is invaluable: “Norton Sound really loves Direct Relief.” 

Today, Norton Sound operates not only 15 village clinics but a regional critical-access hospital, located in the town of Nome (population about 3,600), and a nursing home for Alaska Native elders. About 85% of the organization’s patients are Inupiat, Central Yup’ik, and Siberian Yupik, and about two-thirds of them live below the poverty line. Mackiernan said other patients include recent immigrants – such as teachers who come from Korea or the Philippines to teach in local schools. 

“We get very experienced teachers,” she said. Many of them work in small villages and even live at the schools where they teach because of the area’s acute housing shortage.  

Norton Sound providers deliver babies, treat injuries, clean teeth, test hearing, offer physical therapy, and care for chronic diseases. And caring for the area’s patient population, which has particular medical needs, requires a nuanced understanding of traditional diets, culture, and daily life. 

The population has a high percentage of patients with CPT1A, a gene that, in its Arctic variation, affects fatty acid metabolism. While medical attempts to manage the gene often lead to obesity, Mackiernan said, “the traditional native diet is really just the best thing.” 

The organization’s patient population also has high rates of TB, cancer, and serious mental health conditions such as major depressive disorder and schizophrenia. Norton Sound provides full-time inpatient and outpatient psychiatric services to meet mental health needs. 

Five communities in the region don’t have piped running water, and a single shower is expensive at the local washeterias – a place where residents can access showers and laundry, Mackiernan explained. Norton Sound works with village communities to make washeteria facilities more accessible. Patients can receive free passes for coming to a wellness visit or screening for colon cancer. 

“Our goal is to make this a wellness center,” she said. “Cleanliness is such an important part of health, but when a shower costs $10, when are you going to have a shower?”  

Awareness and time are key to healthcare in the area. Mackiernan explained that a typical visit lasts at least an hour, and developing trust and rapport is key to working in partnership with patients, who frequently rely on subsistence hunting and gathering to feed their families and can be cautious about communicating with newcomers.  

“Life here does not operate at the same pace it does elsewhere,” Mackiernan said. “You come in and you sit down. You don’t touch the patient, you just sit down…Having that first conversation with your ears open, that’s going to be where you learn important things about the patient.” 

Louisa Albright, a physician assistant at the Unalakleet clinic, said she’s learned to look to her patients for nonverbal communication, like facial expressions, movement in the shoulders or arms, or just a growing quietness to indicate how the conversation is going. Her husband and children are Alaska Natives, she explained, and she first learned the importance of nonverbal communication in her husband’s family.  

“It’s important no matter where you are, to be aware of people’s expectations and their backgrounds, and what they’re trying to accomplish,” she said.  

Unusually for a provider, Albright does immunizations, blood draws, and home visits. She cares, on a daily basis, both for chronic conditions and for patients whose needs are so acute she often needs to contemplate an emergency transfer.  

“You have to know sick versus not sick: Do I need to transfer this patient emergently?” she explained. “We really do everything from birth to death. We take complete care of the patients.” 

Helping patients manage chronic conditions means understanding their values and cultures. If a provider knows that eggs are still out of stock at the grocery store – they’d been out for five days when Albright spoke to Direct Relief – they’ll be a better resource for patients working to manage nutrition and finances. Foraging for berries, a traditional practice, can provide essential vitamins, exercise, and mental health benefits together. Working with a tribal healer in Albright’s village has helped Albright understand her patients’ perspectives. 

“People here tend to not want to be on medication…I try to be really sensitive to that,” she said. “If people can eat a traditional diet, I always encourage that.” 

Norton Sound also works to fill gaps in food availability – for example, providing fresh produce to patients either at cost, or for free after a patient has a blood sugar or cholesterol check.  

Mackiernan said new providers, often from schools in higher-resource settings with large populations, need guidance to work well with Norton Sound’s patients. “You need to think about what life looks like for that family, you need to offer something doable,” she said. Pushing people to purchase supplements or produce that are expensive or unavailable won’t help – it will just dishearten them. 

Vast, sweeping changes in the region’s history have deeply affected patients and communities. “Some communities are less than 150 years from contact” with Western culture, Mackiernan noted. Disease outbreaks, such as the 1918 influenza pandemic or the COVID-19 pandemic, have taken a huge toll. Many still experience the devastating legacy of forced enrollment and assimilation in the United States’ residential schools for Native children. Melting permafrost destabilizes life in traditional communities and jeopardizes hunting – a serious loss in communities where a moose can provide months’ worth of food for a family. 

Norton Sound actively partners with regional tribes to enhance community health by employing local professionals such as community health aides, dental health aide therapists, and behavioral health aides. These workers, well known and trusted in local villages, encourage patients to visit the clinic and take advantage of available services. Tribal representation is invaluable in guiding the direction of healthcare in the region, ensuring that it effectively meets the needs of the community.

For Albright, living and working in a primarily Alaska Native community of about 600, her familiarity in the community where she works bolsters the care she provides.  

“I think people automatically put back their chips and pop” when they see her in the grocery store, she laughed. But knowing her patients outside the clinic helps her. If there’s an injury on the school basketball court when Albright is there with her kids, she’ll jump up to treat it – knowing community members will look after her kids while she’s working.  

“My kids go to school with these people, I see their families in the community,” she said. “People share a lot.” 

The post Healthcare at the Top of the World: Long Appointments and Deep Awareness Bolster Health in Alaskan Villages appeared first on Direct Relief.

“There was no electricity, no senior doctor, no communications,” Mahabubara Belee Sikder, a midwife at Bangladesh’s HOPE Midwifery Institute, recalled.

She monitored her patient’s vital signs and attended her until help was available. “Both mother and baby survived,” she recalled, relieved.

Sikder received her midwifery education and training at the HOPE Midwifery Institute, which was founded in 2013 and has rapidly become a competitive and much sought-after program for hopeful midwives. The institute, which trains midwives to work amid the Bangladeshi and Rohingya refugee women of Cox’s Bazar, builds on a growing national and global awareness of the importance of accessible, high-quality, and compassionate maternal health care.

Many hopeful midwives who apply to the program are inspired by their own families, said Sarmin Nesa, vice principal of the institute.

“They see their mother and the babies…not getting enough service during their deliveries,” she explained. “This is the most important thing they share with us, that they would see their mothers’ and [infant siblings’] many challenges.”

The HOPE Foundation for Women and Children of Bangladesh, of which the midwifery institute forms a part, operates a hospital in Cox’s Bazar. The group also operates a separate field hospital located within the area’s Rohingya refugee camps and a new primary and maternal care facility on Moheshkhali Island that is designed to bring healthcare access and reduce maternal mortality. The latter facility aims to serve the approximately 600,000 community members living on nearby islands where perinatal care and skilled birth attendance are difficult to access.

The organization offers mental health services and surgery to repair fistula – a debilitating, complex injury caused by prolonged labor without appropriate care – as well as burns and cleft palates. The setting is challenging, demanding that midwives care both for Bangladeshi women, many living in poverty, and for Rohingya refugees, displaced from their native Myanmar by violence and often living in makeshift shelters.

For many midwives, that challenge is appealing, Nesa said: “They want to save the mothers’ and babies’ lives.”

Refugee mothers are often unwilling to go to a facility for care or delivery, Nesa said. HOPE midwives conduct door-to-door visits, offering information and services to pregnant women. They deliver babies both at facilities and at women’s homes. They screen women for potential complications, so they can be referred to specialty care if needed.

This contact with patients informs the midwives’ approach, Nesa explained: “They are building trusting relationships,” often with patients who have no experience with maternal healthcare and don’t know what to expect.

HOPE midwives are trained to handle emergent situations, such as stabilizing hemorrhage and keeping patients with eclampsia safe until help can arrive. Nesa said a strong focus on respect, communication, and professionalism helps student midwives handle difficult situations. As an example, she described how a woman experiencing a difficult labor kicked a student midwife, who calmly counseled her patient, helping her to relax and deliver her baby safely. After the delivery, Nesa checked in with the student midwife to ask if she was injured or needed support.

“No, ma’am,” she recalled the young woman saying, “I saved their lives, and I delivered the baby.”

“The normal process”

Medglobal’s Bangladesh maternal health facility is located in the Somitipara neighborhood of Cox’s Bazar, where it serves primarily Bangladeshi women who were displaced to the area after a destructive 1991 cyclone. The clinic is consistently over capacity, and a health outpost in one of the camps sees as many as 400 patients per day.

Still, encouraging women to seek maternal health care is often a multi-step process, explained Dr. Rahana Parvin, MedGlobal’s clinical coordinator in Bangladesh.

“This community is not well educated” about health issues, she said. Many of the women approached by a midwife initially feel that, “if you got pregnant, there’s no need to do anything. This is the normal process.”

The organization has responded by getting creative: Mother’s Clubs educate girls and women of reproductive age about healthy pregnancy and maternal healthcare. Women who are willing to give birth in a health facility receive a neonatal kit filled with supplies for their babies. A hotline provides counseling to women experiencing worrying symptoms, and midwives call patients who are due for delivery daily to check in.

Dr. Parvin explained that inadequate nutrition and sanitation, as well as poor living conditions, affect many of their patients’ health. “The living style is really very poor,” she said of her patients. MedGlobal bears all costs associated with maternal healthcare – including transfer to a hospital and a staff escort for patients who have obstetric emergencies – to ensure patients receive the treatment and monitoring they need.

Shipan Akter, a MedGlobal midwife, said that saving the lives of mothers and newborns is her greatest motivation. She’s also acutely aware that the high-quality care and support that MedGlobal provides aren’t always available to women in Bangladesh.

“I work with the hope that one day, every mother in our society will have access to safe childbirth,” she said.

“A famous and popular job”

For the midwives who train and work in these communities, their profession is an opportunity to serve others and protect lives – but it’s also a valued and desirable career path for many women in Bangladesh.

Sanjida Kawsar Tania, a student midwife at HOPE, said she appreciates learning evidence-based treatments for managing emergencies like post-partum hemorrhage and eclampsia. “I get some difficult cases…when I do night shift duty,” she explained.

In addition, Tania said the institute offers a supportive environment, with senior midwives offering advice and teaching new skills to students in training.

“I feel very proud to be a student of HOPE’s midwifery program,” she said.

Akter, who has worked as a midwife with MedGlobal for four years, explained that the organization has helped her build her career as well as care for vulnerable women. “Working here has been a very important chapter of my life,” she said. “It has provided me not only with the opportunity to serve patients but also to enhance my professional skills through training and hands-on experience.”

Maternal and other health needs in Bangladesh continue to be high. Cuts to public aid, ongoing displacement, and inability to access or afford healthcare have all increased the demand for support. Years after the 2017 genocide that forced many to flee Myanmar, Rohingya refugees threatened by violence and instability have continued to arrive in Bangladesh. There, their movements are restricted to within the camps, giving them limited opportunities to earn a living or build new skills, and increasing their need for humanitarian aid.

Nesa explained that Bangladesh’s government employs midwives in communities across the country. At HOPE Midwifery Institute, student midwives receive a combination of classroom education and practical skill-building that will allow them to work in a private or government hospital. About 90% of graduates secure government jobs after completing their certification exams, and HOPE-trained midwives oversee more than 1,000 births per year in the organization’s own facilities.

“Nowadays midwifery is a very famous and popular job” in Bangladesh, she said.

Since 2009, Direct Relief has provided the HOPE Foundation for Women and Children of Bangladesh with 58 shipments of material medical aid, totaling $14.8 million in value. That support includes 94 full midwife kits and 40 resupply kits, enabling 6,700 safe births. The organization has supported MedGlobal Bangladesh with five shipments of medical aid totaling $2.3 million in value. Additional maternal healthcare support to Bangladesh is planned for later this year.

In total, Direct Relief has also provided 21 fistula repair modules to HOPE and other partners in Bangladesh, supporting about 1,200 obstetric fistula repair surgeries, and 45 perinatal kits to treat life-threatening conditions affecting women and infants, including eclampsia, premature birth, infection, and neonatal respiratory distress. More than $664,000 worth of prenatal vitamins, and $1.18 million in total grant funding for healthcare needs, including maternal health, has also been provided to partner health organizations in Bangladesh.

Holland Bool contributed reporting to this story.

The post Bangladesh Maternal Health Programs Save Lives, Educate Mothers, and Build Bright Careers appeared first on Direct Relief.

“That was the moment he decided, ‘What am I doing? This is not sustainable. This is not the life I want for myself and my family,’” recalled Dr. Young, the director of medical services at the Free Clinic of Simi Valley in southern California.

But the patient, who had a highly noticeable, profane tattoo across his forehead, was having difficulty finding employment. He’d received the tattoo while newly imprisoned, and now, several years later, it was keeping him from moving on with his life. “It was so hard to get up in the morning and look at himself and try to make a change,” Dr. Young said.

For the last year and a half, FCSV has provided a tattoo removal service, free of charge, for people who have been incarcerated or experienced human trafficking. The laser used for removal and the associated services were provided by Ventura County, which partners with the clinic to provide this service without cost.

Dr. Young explained that tattoo removal often isn’t just a question of emotionally moving on, or even finding a job: For gang members and people who have escaped from being trafficked, having an identifying tattoo can place them in much greater danger.

“It makes you a marked person,” she said. Removing these symbols “really releases [patients] from the hold they were under.”

Fred Bauermeister, the clinic’s executive director, made clear that, while most tattoo removals are considered cosmetic, not medical, FCSV’s patients are motivated by safety and the hope of financial stability.

“This is not a cosmetic thing,” he said. “These are people who are trying to make better lives.”

For FCSV’s providers, who were specifically trained to practice medicine in rural settings, learning to remove tattoos was a far cry from delivering babies, monitoring chronic diseases, or suturing wounds – which made learning the procedure exciting, Dr. Young said: “That’s something in family practice we don’t see every day,” she said. “It’s fun as doctors to be able to learn new things, and it’s fun to help people in such a positive way.”

While the training that doctors received explained that a professionally inked tattoo might take eight to 10 sessions for removal, they quickly learned that prison tattoos responded much more quickly, within two to three sessions.

Tattoo removals are painful. The laser doctors use essentially irritates the area to encourage the body’s natural defenses to kick in, working to heal the blistering and inflammation – and breaking down the ink’s chemical bonds at the same time, Dr. Young said.

That was the case for the young father with the forehead tattoo.

“Removing a tattoo from the face is not comfortable, but he was in it for a long haul,” she remembered. “Every time he came, it was a little brighter, a little bit further gone, and you could just see him brightening.”

Particular care is taken with survivors of trafficking, who receive services during separate hours and are given complete privacy from other patients while at the clinic.

But while some providers had initial concerns about providing tattoo removals for patients who had been incarcerated, Dr. Young said the experience has been wholly positive.

“We haven’t had a single problem,” she said. “They have been so polite and so kind.”

Some tattoo removal patients are extremely embarrassed or apologetic. Others are simply thrilled.

“They made different life choices earlier, and they want to make a new one, a better one,” Dr. Young said. “It’s hard to do that if you have profanity tattooed on your face.”

The laser used for tattoo removal – as well as the clinic’s medical refrigerators and dental program – is dependent on electricity in an area that experiences frequent power outages. A Direct Relief Power for Health grant of $165,000 funded a resilient solar power system on the clinic’s rooftop that became operational late last year, and an additional grant of $250,000 allowed a battery to be paired with the project – a total of $415,000.

While the Power for Health project was primarily intended to protect vaccines and other clinical operations, having a reliable source of electricity has had positive impacts across the board, Bauermeister said: “It’s a big deal around here when the power goes out.”

Before the solar power system was installed, power outages placed expensive vaccines at risk, often at the height of fire season and just before school began, and frequently shut down operations in the dental program. “Medical can get by with a flashlight,” as Bauermeister explained, but other services were repeatedly compromised.

Being able to reliably provide services during a power outage has made a significant difference to clinic staff, Dr. Young said.

“We’re [a clinic] that’s here for the community,” she explained, adding that FCSV has plans to add a vision clinic to its existing services. “These are just steps that we’re using to help our community grow.”

Like safety net providers across the country, part of FCSV’s work involves connecting patients to partner organizations that help people find stable housing, access health insurance, receive food assistance, and meet other social drivers of health – the non-medical factors that affect health over time. Dr. Young sees the tattoo removal service as similarly impactful: It’s an economical and quick way to help someone move on safely and gain greater financial stability, giving them a better chance at building and maintaining their well-being.

“This was something we could do that not only helps them react to a problem, but solve it before it’s started,” she said.

The post An Unusual Service Keeps Patients Safe, And Aids Healing, at a California Free Clinic appeared first on Direct Relief.

“They just had a baby last year…they’re stressed, it’s a lot of work for them at home,” she explained. “When you see a patient like this, you’re like, ‘Would you desire a long-term birth control? We put it in and you don’t have to think about it.’”

For Joseph, a nurse practitioner at Healthcare Network of Southwest Florida, helping these women access the right contraceptive care is a passion – and a health justice issue.

“We can reduce unintended pregnancies. Patients can get the birth control that they would like, they have more understanding, they know their options,” she said. “The goal is to promote health and wellness in women.”

Healthcare Network, a federally qualified health center in Collier County, Florida, cares for primarily rural patients who often have low health literacy, may speak Spanish or Haitian Creole as a primary language, or need culturally sensitive care.

“A lot of our patients have cultural and religious beliefs,” Joseph said. Many have heard misinformation from family, friends, or social media. Asking patients, “Why does that concern you? Why do you feel this way? What information do you need?” often helps her get to the heart of patients’ concerns and help them develop a more accurate understanding of family planning options.

Joseph is of Haitian descent, a background that helps her connect to patients who are wary of medical information. “They kind of have a sense of safety: ‘You’re Haitian, you speak Creole,’” she said.

Healthcare Network works to reach patients of reproductive age (approximately 15 to 44 years old) with accurate information about contraception and family planning – helping them prevent unwanted pregnancies and achieve the best reproductive outcomes for their lives. According to the Centers for Disease Control and Prevention, 45% of pregnancies in the U.S. are unintended, with rates highest among people with lower levels of education and income, people of color, and people between the ages of 15 and 24.

To help the health center provide culturally appropriate, non-stigmatizing, and accurate contraceptive care to more women, Direct Relief designated them one of four awardees for the 2025 Community Health Awards: Locally-Driven Approaches to Prevent Unintended Pregnancy.

These awards, funded by women’s health company Organon, provide four $200,000 awards over two years to nonprofit partners working to prevent unintended pregnancies in vulnerable patient populations. Each of the four awardees provides contraceptive services and education in an under-resourced area, through programs designed to meet the unique needs of their local communities.

“A bigger need”

Lowering barriers to contraceptive care is complicated, explained Deisy Martinez, Healthcare Network’s obstetric care coordinator. A patient population with low health literacy requires clear information in simple terms, sometimes illustrated with pictures. Transportation makes it hard for many patients to maintain continuity of care. Women in traditional family structures may depend on their husbands to make family planning decisions.

Of the approximately 10,800 women of childbearing age served by Healthcare Network last year, only about 2,500 receive contraceptive care. In the next two years, their goal is to bring that number to 3,500.

In many cases, the best way to ensure patients have accurate information about contraception and know the best decision for them is to start a conversation, Martinez explained. For example, a woman may not want to have more children, but may want to continue experiencing her menstrual cycle, worry about weight gain, or be concerned about maintaining future fertility.

“We ask a lot of questions…to understand where our patients are coming from,” said Gabrielle O’Boyle, Healthcare Network’s senior director of marketing and communications.

Earning trust means offering reliable interpreters, layperson-friendly language, and helpful visual aids, O’Boyle said. Because Healthcare Network is active in the community, O’Boyle said, offering healthcare services at schools, community health fairs, and home visits, people know “we are a safe place to get care and that we welcome patients of all backgrounds.”

For Joseph, a program specifically aimed at reducing unintended pregnancies meets “a bigger need”: Her patients “need the care, they’re not really informed like they should be. There’s a lot of language barriers, there’s a lot of culture barriers,” she said.

“They’re just not aware of what’s out there”

Healthcare Network will use the Community Health Award to support the Contraceptive Access, Resources, and Education (CARE) program, a multi-faceted approach to preventing unwanted pregnancies. Staff members will be trained in new approaches to contraceptive counseling, with a focus on providing care that is culturally sensitive and non-stigmatizing. Contraceptive counseling will help women choose and implement their preferred method of preventing pregnancy. In addition to providing contraceptive services in on-site clinics, health workers will offer contraceptive education and counseling through telehealth and Healthcare Network’s mobile unit, the Van Domelen Health Express, which travels to geographically isolated areas to offer a range of preventive, dental, and primary health services.

In addition, Healthcare Network will use the award funding to develop informative, engaging content about contraception, including videos for social media – three each year, featuring expert information and lived experiences and offered in English, Spanish, and Haitian Creole – and programming for a local radio station.

Martinez explained that an earlier series of videos — focused on maternal health issues like nutrition, gestational hypertension, and diabetes — made the new project a natural fit for them. The maternal health videos introduced women in the community to accurate information and explained how the health center could help them maintain their health during pregnancy.

Healthcare Network “treats about 90% of this community,” Martinez said. The goal is to teach patients about the range of services on offer, and to help overcome hesitation, misinformation, and stigma. “We…understand that some people have never seen a contraceptive device. Some people have never seen a condom before.”

Joseph said helping patients find the birth control method that’s right for them is rewarding. A patient who kept forgetting to take birth control pills but is thrilled with a patch or vaginal ring, or one who was worried about side effects and is now delighted with her IUD, can make her day.

Often, “they’re just not aware of what’s out there,” she said.

The post Increasing Access to Care in a Rural Florida Community appeared first on Direct Relief.

Kılıç, a professor of public health at Turkey’s Dokuz Eylul University and president of its Association of Public Health Specialists, known as HASUDER, explained that maternal and reproductive health are often overlooked in the aftermath of disaster – as are the increased risks of sexual violence, women’s hygiene issues, and sexually transmitted infections.

The 2023 earthquake killed more than 59,000 people in Turkey and Syria, displaced as many as 3 million, many of them already refugees from Syria. The quake caused damage and displacement across 11 Turkish provinces, which was most challenging for women and children. In the hard-hit province of Hatay alone, more than 200 camps, container cities, and other temporary settlements were created to house hundreds of thousands of displaced people.

The lack of women’s healthcare “was a very big and serious problem in the camps,” he said.

More than two years after the earthquake, HASUDER has found that women’s health needs continue to be unmet. Women and girls in temporary settlements report increased exposure to violence, both from family members and strangers. Unsanitary conditions and a lack of clean toilets and showers have led to increased urinary tract and vaginal infections. These displaced women and girls are more likely to be forced into marriage, to experience unintended pregnancies in unsafe conditions, and to contract sexually transmitted infections.

Closed-down primary care centers and maternal health facilities have made it harder to receive prenatal care and safely give birth, significantly increasing the risk of maternal and child mortality. (While HASUDER estimates that the earthquake-affected areas can expect to see about 20,000 births per month, the current healthcare capacity is far lower.)

The organization puts it bluntly: “Disaster has a gender.”

To meet women’s health needs in the aftermath of the 2023 earthquake, Direct Relief awarded grant funding to HASUDER and the Turkish Family Health and Planning Foundation, or TAPV: above $655,000 to HASUDER and $375,000 to TAPV. For more than two years, these organizations continued to offer mobile women’s health services, referrals, community outreach, and education in displacement camps, container settlements, and other affected communities. Today, they are focused on increasing their capacity and training for future emergency response work.

HASUDER and TAPV provided a wide range of services, from education about vaccines, birth control, and hygiene to cancer screenings and hospital referrals for high-risk pregnancies. Both organizations offered services in Turkish and Arabic, making access easier for refugee patients.

By working with local partners and authorities, surveying affected communities to determine needs and approach, and employing flexible strategies to help women access care effectively, they offer essential models for a longer-term approach to meeting health needs after a disaster.

HASUDER provided sexual and reproductive healthcare services to more than 7,200 women affected by the earthquake in Hatay Province over an 18-month period. TAPV provided healthcare services, referrals, and education to more than 8,400 women – through household visits, cancer screenings, family planning, and more – over the course of ten months.

For healthcare workers at TAPV, mobile health services and referrals to hospitals for women who were unwell or experiencing high-risk pregnancies were high priorities. Also top of mind were focus groups and in-depth conversations with women in affected communities about the services available to them.

One patient who noticed a lump in her breast during self-examination was referred to a cancer treatment center, where a high-risk mass was detected, and she was able to undergo treatment. Many women experiencing high-risk pregnancies had never sought maternal healthcare, but were willing to receive healthcare services after receiving counseling from TAPV team members.

A number of women living in container cities, interviewed about their experiences with TAPV, described learning about critical health services. Those included cancer screenings, being informed about family planning and preventing sexually transmitted infections, and understanding the importance of prenatal care and vaccines for their newborns. Women whose husbands were abusive and prevented access to contraception were able to access it by working with a reproductive health counselor.

“After the earthquake, we had actually forgotten about this information,” one woman said during an interview. “More precisely, we had forgotten ourselves as women—we had forgotten how challenging gynecological health issues can be. Through this project, we became aware of these again.”

Nurcan Müftüoğlu, TAPV’s executive director, explained that many of the issues healthcare teams worked to resolve are rooted in culture, which doesn’t prioritize women’s sexual and reproductive health. Women’s health needs, already likely to be overlooked in disaster situations, are even more likely to go unmet in situations where they were not already a high priority.

Many of the women whom TAPV reached are Syrian refugees, who Müftüoğlu explained are already underserved and hesitant to access health services. Transportation to health facilities, even for women eager to reach them, was often nonexistent, so TAPV worked to arrange transportation services for women needing cancer screening or other facility-based care. Many primary care facilities are heavily damaged or simply closed.

“These are more reasons for a crisis situation,” Müftüoğlu said.

HASUDER nurses noted that forced marriage of girls as young as 16 – and even younger among refugee populations – is a growing problem in earthquake-affected regions because the schools are closed. “The girl child is seen as a surplus in the family,” a report from nursing staff explained. Many men do not allow their wives to use contraception, or deny their wives medical treatments that they worry may damage their kidneys or cause weight gain. Misinformation is rife, and violence against women a widespread problem.

Kılıç said that the women’s health needs his mobile teams encountered were huge, ranging from a lack of underwear, sanitary pads, and clean facilities to more complex issues like maternal health and gender-based violence.

Building trust was a high priority, he said. About two years ago, when HASUDER teams began providing traveling clinics in mobile medical units, it was hard to convince many women to access health services or discuss intimate issues like contraception and hygiene.

Then, things changed.

“A few months later, we noticed that at every camp there is a leader woman,” Kılıç recalled. (Informal community leaders are a common presence in refugee settings, where people designate trusted community members to advocate for their interests, build vital relationships, and let them know who’s safe to trust.) HASUDER’s team began cultivating relationships with these community leaders, calling them before driving to a camp site to let them know what services would be available, answer questions, and cultivate a relationship.

Very quickly, Kılıç said, they began seeing hundreds of women each month.

“Every woman [leader] in every camp started to call our team,” he said. They were asking, “‘When will you come again?’”

The post After Turkey’s Cataclysmic Earthquake, Women’s Health Programs Offer a Model for Long-Term Disaster Response appeared first on Direct Relief.

Cadogan is the CEO of GoFundMe, the community-powered fundraising platform, which means efficiency and trust are key to his work. And as an Altadena, California, resident, he’s been an active member of the Sierra Madre Search and Rescue team since 2010, responding to emergencies, including the January 2025 Eaton Fire. (Direct Relief supported Sierra Madre Search and Rescue with $25,000 in grant funding, along with field medic packs and protective equipment for in-the-field response.)

“When a disaster strikes, you need help in every form you can imagine and some you can’t,” Cadogan said during a talk at Direct Relief’s Santa Barbara headquarters earlier this summer. He’s seen it firsthand now. While his family’s home wasn’t burned, neighbors and community members who weren’t as fortunate are now deep into the often years-long process of recovery.

Search and rescue, or SAR, operations are strategically developed and honed over time, and volunteers are rigorously drilled to minimize risk. At the end of the day, Cadogan said, it’s the processes that keep people safe and ensure things run smoothly.

“I think that lesson is one that carries through to a lot of parts of life,” he explained.

Cadogan recently sat down with Direct Relief to talk about his scariest SAR experience, Eaton Fire recovery, and how he stays engaged and compassionate, even when it seems needs are only growing.

Whether he’s in the field or at the helm of GoFundMe, he’s inspired by the deep-seated human desire to help others. “It’s part of us as a species,” he said, noting that people have formed communities that helped them care for one another throughout history.

Direct Relief: During your talk at Direct Relief headquarters earlier this summer, you talked about your work volunteering for Sierra Madre Search and Rescue, including being a part of the Eaton Fire response. I’d love to hear about what drew you to SAR work and what keeps you on the team even as you run a very big company.

Tim Cadogan: The motivation – and this is back in 2010 – was quite simple. I was getting older, and I thought, “I have to do other things that would be helpful in a meaningful way.” Then I asked myself, “What are my capabilities?”

I spent a lot of time in the mountains doing trail running. I knew the trails very well in our area and was able to move through them pretty quickly. I thought, “It could be really helpful with search and rescue, but there’s a lot of things I don’t know. How’s it going to work?”

I spent some time with the team, and they said they would train me on all the things I didn’t know. What they are really looking for is “the desire to help and the ability to learn.”

I spent about seven years being very active, and then I moved into an associate member role, which means I respond when I can. Because my work life got so, so busy, particularly in the last five and a half years with GoFundMe. [Cadogan joined the company in 2020.] I’m not able to respond as much as I used to. I’d love to do more, but I stay on the team because I can help. On those occasions, particularly on more complicated searches, I can be pretty helpful given my knowledge of the terrain and experience on some of the more obscure trails.

Direct Relief: What has been your most challenging moment or maybe your scariest moment on an SAR mission? And what do you think you took from that?

Tim Cadogan: The first thing I want to say is that we spend a lot of time training and preparing not to have scary moments and to reduce the risk factors as much as possible. That is just hammered into us from the first training session onward: Manage the risk with a team, and we exist and operate in a way that reduces risk for each other and, of course, the people that we’re trying to help find and help.

That said, you are operating in an environment, often, that just has inherent risks that are hard to manage.

I’ll give you an example: There’s one kind of operation called a Stranded Hiker. This is where a person is stuck on a very steep hill or a cliffside and can’t go up or down, so you need to go and get them. The person designated to do this is lowered down on a rope system, gets down to the stranded hiker, and must very carefully attach a harness of webbing to that person. That person is then attached to you, and we lower down or raise back up, depending on the situation, to a safe place.

On this particular stranded hiker operation, I’m the person going down. I attach myself to the victim. I’ve got them. They’re strapped to me. In this case, we were being lowered down to the bottom of a steep canyon. As we were going down, there was a rockfall above us. I look up and I just hear these sounds and there’s just a big pile of rocks coming straight towards us.

That was pretty frightening. My instant reaction was to pendulum and swing to the left. And that clatter of rocks zoomed past us. That was one of those moments when there was a lot of adrenaline right afterwards. You say to yourself, “Oh, my goodness.”

So, what did I learn from that? One: You need to always be super vigilant, including constantly assessing the environment, the situation, for risks. The second [lesson]: You can trust the system. The team is there to operate in a way that minimizes risk and to build, in this case, physical systems that allow us to protect ourselves. It comes down to: You trust your operating execution, you trust your team. This means you can move quickly and be sure that system is going to hold for you.

I think that lesson is one that carries through to a lot of parts of life. You build systems, whether you’re Direct Relief shipping billions of dollars of supplies, where you have a very intricate system, or it’s us operating GoFundMe during crisis relief or every day. We can build a system that is replicable and repeatable, and we can trust it and each other.

Direct Relief: At your Direct Relief talk, you said people who have experienced a disaster need help in every imaginable form, and some you wouldn’t imagine. You live in Altadena and you’re part of a community that is still very much in recovery mode. What are some of the needs you’re seeing from your friends, your neighbors, your larger communities that you didn’t anticipate, even with years of experience behind you?

Tim Cadogan: So many, frankly. Let’s take the case of people in our community who’ve lost their homes. The list of things that you need to be navigating is almost endless: making sure in the immediate aftermath that you have a place to stay, a place to send your kids to school, the food that you need, the cash that you need to get through the situation, help navigating with your insurance. You also need to be thinking about rebuilding and how you consider those decisions.

This process is very long – years long – and goes through these different stages. Take the immediate response – for instance, Direct Relief is super involved in making sure that the folks responding to the crisis had supplies, including very generously [supporting] my search and rescue team. And then there are other nonprofits we work with who are providing food, or spiritual and mental support, or even cash grants.

Then as you get deeper into the situation, you need advice and counsel and perspective in navigating this really complex interplay of ongoing issues. I knew a little bit of that beforehand, but it was different to actually see it firsthand.

We were fortunate we didn’t lose our house, but it needed to be remediated. And I didn’t understand what’s involved in remediating a house after a fire. You don’t understand because you haven’t experienced the different stages before. I learned about the fact that recovery is a multifaceted process and there are so many different kinds of help that are needed, and they are deeply appreciated when they’re provided.

Direct Relief: You mentioned the fact that when the disaster happens – when the fire is contained, for instance – it’s really just the beginning. And you do go deeper and deeper into this process.

We’ve been thinking about this a lot in terms of compassion fatigue. We hear a lot of worries from partners about this: that there are more disasters, that they’re worse, that the impact is longer and deeper and there are fewer resources to take care of everybody because there is so much need and so much competition for public attention.

As both a SAR volunteer and the head of GoFundMe, how do you stay engaged and compassionate when there is a constant need, and it is so enormous?

Tim Cadogan: I think the simplest way to think about that is to bring things down to the individual level. The reality is yes, so many people need so many different forms of help, but every single bit of help makes a difference.

I’ll give you an example: One of the things at your HQ that I really liked was seeing the different kits that you send out. I particularly remember the midwife kit, which would assist with 50 births. To me, that’s a very practical example. Yes, there are just enormous problems, but if you fund a midwife kit, those are 50 babies who will be born more safely. That’s massive, and that is making a difference.

There is no world in which we can solve all problems. But we can solve a lot, and we can help a lot. That is a state of being. None of us are ever going to live a perfect life and there are always going to be challenges. But we can make it better with specific actions that have specific results for individuals.

The more we can bring those stories to life and show people, “You really did make a difference,” then I think people can stay engaged and stay connected to the impact that they’re having.

Direct Relief: For all of us who are devoted to helping, whether we are a registered charity like Direct Relief, a community advocate or organizer, or a concerned friend or family member posting on GoFundMe: How do we talk about our cause, our issue, in a way that’s truthful, that doesn’t paper over the hard stuff, but also doesn’t cause people to disconnect or lose focus?

Tim Cadogan: With a lot of realism. I’m often impressed at just how clear-headed and practical people I’ve talked to who are dealing with a tough situation are. This is usually after the initial shock of something happening. Shortly after the shock has subsided people tend to say to themselves, “OK, I need this, this, and this, and these will help me to do these things.” It’s a very realistic, practical assessment, which connects to my prior answer: That gives the person considering helping a really clear sense of how, if they do help, it will have an impact.

You’re being direct and very authentic about what is going on and what would make a difference for you.

It’s also just the reality that any of us could be in these situations. We could have been born in a different place or time. We could have had one of these events happen to us. You never know. So just understanding the practical details of, for example, what would happen if you didn’t have access to a midwife kit, is important. Simply laying out two or three examples can help people understand. Things as simple as getting clean, sanitized equipment can make a massive difference.

Direct Relief: As GoFundMe’s CEO, you’re interacting all day with the stories of people who have experienced misfortunes and constantly seeing the scale of need. What keeps you going? What keeps you optimistic?

Tim Cadogan: Very simply, the power of help. Whatever happens, people want to help each other. One of the strands of [human nature] is that we live in groups, we are a social species. Even in early societies, we lived in villages because we needed each other to do things.

And we continue to do that. We like helping each other. It’s often when people are the absolute happiest: when they’re helping someone else. If you can find a way to make that opportunity available to someone in a way that they can see the impact they’re having, it’s super powerful.

The fact that the smallest thing does make a difference. When you’re receiving help, the fact that someone cared about you is immensely important, and the act of caring doesn’t have to be a big act. I’ll give you an example: On many of our fundraisers, when I speak to [beneficiaries], they say, “I really appreciated the donations. I saw several people gave me $5, and I know many of those people don’t have much. It means so much to me that they gave to me and that they care about me.”

It shifts out of financial support into psychological support, and it’s immensely powerful. I think all of us can relate to that. We all want to be seen and cared for.

It’s really about unlocking these patterns of behavior; this concept of helping one another. It’s innate to us, and it’s a privilege for us to work on manifesting that as much as we can, whether that be for individuals or for organizations.

The post GoFundMe CEO Tim Cadogan Weighs in on Search and Rescue Volunteering, the Eaton Fire, and the Human Urge to Help appeared first on Direct Relief.

“Of course, we do not self-deploy,” explained Shoe, an assistant division lead at TEXSAR, a volunteer search and rescue organization that responds to emergencies throughout Texas. “We just needed the go.”

At around 2 p.m., Shoe’s team received notice to deploy on the banks of the river. Silt in the river and dams at close intervals created a challenging situation the first day, she recalled, but her team stayed in the field until past midnight.

One unusual element of their assignment stood out to her.

“There was not a rescue phase. It just went right to recovery,” she said. Generally, emergency responders like TEXSAR begin by trying to save lives, searching for people who have survived a disaster but are stranded or trapped – the rescue phase. Over a longer period, when the hope of rescue is past, the focus shifts to recovery: searching for the bodies of people killed and helping to bring closure to family members.

“I couldn’t wrap my head around it,” Shoe recalled. “This deployment was very different compared to, say, a hurricane.”

The number of the missing kept rising at a shocking rate, she remembered.

Today, the death toll from the Texas Hill Country floods stands at 138 people, many of them children. More than 38,000 homes are estimated to be damaged. While the area has long been prone to flooding, and a number of Texas-based search and rescue teams deployed in response to the July flooding, the scale and death toll are vast. Providers have reported increased mental health needs – including for first responders, who are often forced to confront disturbing sights and personal danger – and severe financial hardship among their patients.

Shoe’s deployment after the July floods lasted two weeks. She recalled breaking down in tears when finding a set of toddler-sized pajamas amid flood debris. “With your whole heart and soul, all you want to do is just find something, to bring closure,” she explained. “It just kills you when you can’t do that.”

At one point, she recalled a family approached her search party, asking them to check a big pile of debris that was from their destroyed home. Officials had told the family to stay away from the damage, but they were missing three people, including their daughter and grandson. “All they could focus on were those debris piles,” Shoe remembered. Her team found the family’s papers and identification among the wreckage, but not their loved ones.

Search and rescue, or SAR, teams are generally staffed primarily by volunteers who are extensively trained and drilled in responding to disaster situations. SAR volunteers are generally motivated by a desire to serve others, which keeps them going during the wearying and often dangerous process of rescue and recovery.

“Just to be around these people dedicating their lives and their time…to people having their very worst day, it’s very empowering,” Shoe explained.

In the field, she said, a responder’s focus is narrow. “None of us really went online because it just upsets you more, and you just want to focus on what’s in front of you,” she explained. But seeing a horizontal line high above her team’s heads, on the bark of the surrounding trees, where the water had risen – an official told them the waters reached 82 feet high in places – and the bodies of fish stranded far from the water, her team couldn’t help but be shocked.

“You can’t help but try to imagine the water being that high and going by,” she said.

The support from the community touched Shoe’s all-volunteer team. People from nearby communities brought food or supplies, or offered their homes up for visiting responders. Shoe recalled one man driving up in a vintage 1970s car and furtively opening the trunk of his car to reveal granola bars, other snacks and supplies. “He was just a cool cat,” she said, chuckling.

Over a long deployment, Shoe said, emergency responders rely on their teammates. “You start wearing down, you are tired, you do start getting emotional,” she said. Fellow searchers understand: “You have your own camaraderie.”

The sheer devastation of the floods made deployment especially difficult for Shoe. Her team found a number of victims, but it was hard to leave many people without closure.

Still, Shoe said, she’s grateful for the training and experience that enabled her to do this work.

“I searched things as best as I could, and I know there was no one [left behind] where I was,” she said.

Direct Relief supported TEXSAR’s response to the flooding in central Texas with a $50,000 emergency grant for equipment and training, as well as field medic packs designed to equip first responders with the medicines and equipment needed for triage care.

The post “All You Want to Do Is Just Find Something”: Search and Rescue Volunteer Recalls Responding to Flooding in Central Texas appeared first on Direct Relief.

Aguilar coordinates mental health care at the Clínica de Atención al Trastorno por Estrés Postraumático, or ISSEMyM, in the State of Mexico. The clinic focuses on post-traumatic stress, often from gender-based violence, among the state’s government workers. When patients are referred to the clinic, they are screened for mental health disorders, and psychiatrists work in consultation with psychologists to develop a care plan that includes sourcing or covering the cost of mental health medications.

About 70% of her patients are women, Aguilar said. “Women are more affected by social factors,” such as additional, unpaid labor and intimate partner violence, she explained through a translator. Men are also less likely to seek care for mental health conditions, which are stigmatized in Mexico, as in countries around the world.

Desvenlafaxine, a medication often used to treat major depressive disorder and related mental health conditions, is a key component of care for many of the patients at ISSEMyM. But Aguilar said these types of medicines aren’t always available to patients. Certain treatments, specifically serotonin-norepinephrine reuptake inhibitors, or SNRIs, like desvenlafaxine and selective serotonin reuptake inhibitors, or SSRIs, are widely needed.

“This is common in the health services,” Aguilar told Direct Relief.

To fill these essential gaps, Direct Relief’s Mexico office is working closely with biopharmaceutical company Pfizer to supply desvenlafaxine to five mental health partners across Mexico.

While mental health has worsened worldwide since the pandemic began, Mexico has been hit particularly hard, said Jonathan Mangotich, a corporate engagement manager at Direct Relief Mexico.

Mexico’s Ministry of Health reports that 3.6 million adults are currently experiencing depression – a significant increase from pre-pandemic numbers.

Direct Relief’s program in partnership with Pfizer is designed to increase access to essential mental health care for vulnerable individuals, Mangotich said, with a particular focus on treating widespread anxiety and depression.

He estimates that the donation of desvenlafaxine has supported about 700 patients across Mexico.

“Our efforts to create greater access to mental healthcare are driven by the understanding that mental well-being is fundamental to overall health and quality of life,” a Pfizer representative told Direct Relief. “Through strategic partnerships, innovative programs, and a focus on affordability and equity, Pfizer is working to ensure that individuals, regardless of their socioeconomic status or geographic location, can access the mental health support they require.”

“When Pfizer donated this medicine, it contributed significantly,” Aguilar said. “Women were suffering in particular” without it.

She explained that menopause and other women’s health concerns can affect depression and other mental health conditions. “This pill helps them with just that,” she said.

Aguilar explained that by the time ISSEMyM screens new patients for mental health symptoms, a general practitioner or other provider has already reported concerns or identified a potential need for mental health intervention through screening. At ISSEMyM, the goal is to identify how urgent the needs are – there are three tiers, the highest of which indicates that a patient is at imminent risk of self-harm – and develop an effective treatment plan.

When medicines aren’t available, that plan can be affected, Aguilar said.

“When there is no economic support for the purpose of medication…that leads to disengagement of treatment and care,” she said.

The post Amid a Crisis of Mental Health in Mexico, a Donation Fills Gaps in Care appeared first on Direct Relief.

“There was a massive amount of people who were showing up and multiple shelters that were opening up,” recalled Mentesane, who was the executive director of MLK Health, a free clinic and pharmacy in Shreveport, Louisiana, about five hours’ drive from New Orleans. (She is currently the clinic’s grants manager.) “They had no medications and no physicians…Their pharmacies were destroyed, along with the records and data.”

Mentesane’s experience reflects a larger challenge of the Hurricane Katrina response that surprised many – although not the safety net providers working on the ground.

“Primary healthcare needs, especially among low-income and chronically ill populations who couldn’t evacuate, outweighed traditional emergency care and triage for the injured,” recalled Amy Simmons, communications director at the National Association of Community Health Centers, or NACHC. “The most pressing need among Katrina survivors wasn’t treating storm-related injuries. It was medical attention for chronic health conditions that went untreated as the public health system collapsed.”

MLK Health’s providers prescribed medicine to people displaced at Shreveport shelters, a process that often required them to examine and re-diagnose patients who’d already been diagnosed with a chronic disease.

“To be on the safe side, we didn’t just dispense 90 days’ worth of pills based on what someone told us,” Mentesane explained. That kind of patient care is time-intensive and detailed, and MLK Health at that point was a tiny free clinic with a pharmacy “the size of a walk-in closet…It was difficult, let me tell you.”

Thousands of people who’d been displaced by Hurricane Katrina stayed in the area – which was then hit by Hurricane Rita, a Category 3 storm, the following month.

Mentesane remembers it as a “chaotic” time, but one that shone a spotlight on the urgent need for healthcare in southern states – and that launched a groundswell of support for community providers like MLK Health.

“Starting from Scratch”

Hurricane Katrina made landfall on Monday, August 29, 2005. The impact was cataclysmic: 1,833 people were killed by the storm in Louisiana and Mississippi. But while the death toll was horrific on its own, that number doesn’t begin to account for Katrina’s disastrous consequences for health care access, insurance coverage, community mental health, housing, food security, or many other measures of health.

Even before the disaster, Louisiana and Mississippi were ranked the two least-healthy states in the U.S., with high rates of chronic disease, food insecurity, and other issues. Health care was an unaffordable expense for many thousands of people. The storm exacerbated many of these problems: The number of operational clinics in the New Orleans area dropped from an estimated 90 to 19. NACHC reported that 11 local health center facilities were destroyed by Katrina and 80 more significantly damaged.

In part because of the lack of available primary care, NACHC explained, many people used the overstrained local hospital system to manage their health, but a Government Accountability Office survey found that New Orleans hospital capacity in February 2006 was operating at about 20% of its pre-Katrina capacity.

In addition, thousands of physicians and other providers were forced to evacuate – one study estimated as many as 6,000 doctors had been displaced from the NOLA area – and approximately 200,000 people lost employer-sponsored health insurance after Katrina and Rita, according to NACHC.

Mental health issues such as post-traumatic stress skyrocketed, with providers in the area reporting that widespread trauma persists to this day. Health issues from toxin exposure to skin conditions to substance use disorders to gastrointestinal illnesses proliferated. Children, especially those with diseases like asthma or mental health issues, were particularly severely affected by the storm.

Dr. Keith Winfrey, now chief medical officer at the New Orleans East Louisiana Community Health Center, was working as a physician at another community health center in the city of New Orleans. (NOELA had not yet been founded.) He remembers having a staff meeting the Friday before the storm made landfall, and reviewing evacuation plans with colleagues.

“We all thought we would return to work on Monday,” he said.

Instead, Dr. Winfrey’s family, which included a toddler and an infant, fled to Alexandria, Louisiana, where Dr. Winfrey worked for three years, caring for community health center patients who had been displaced by Hurricane Katrina and were struggling to get their prescriptions, re-establish care for chronic diseases, and manage anxiety and distress related to their experiences.

“Many patients didn’t have access to their medical conditions or history, but they’d tell you they needed their medications filled,” he recalled. “You were pretty much starting from scratch in terms of trying to get a good handle on their medical conditions.”

“The Right Kind of Intervention”

Dr. Winfrey returned to New Orleans in January of 2009 as a Tulane University professor of internal medicine who also provided community health care. During appointments, he was struck by the widespread post-traumatic stress his patients were experiencing. “When they would come into their appointment, everyone would pretty much have a Katrina story,” with many patients describing witnessing bodies floating down the street or being trapped on their rooftops for days, he said. “They were there for non-communicable diseases, but the trauma was so fresh.”

“I don’t think people realize how traumatic it really is,” said James Comeaux, the executive vice president of the New Orleans-based health center Access Health Louisiana, who is also a licensed clinical social worker. “You have a whole generation of people [in New Orleans] who have PTSD.”

Access Health’s providers worked “ungodly amounts of hours” in the weeks after Katrina, Comeaux recalled. Where 35,000 patients in a year might have been a typical number, they saw 35,000 in the first month after the storm hit. Many had physical trauma or needed a tetanus or hepatitis vaccination, and many others needed their prescriptions for diabetes or hypertension filled.

But it was quickly obvious to Comeaux that mental health issues – along with a broader need for maternal health care and other integrated services – were going to drive health care needs over the long term. “Finding the need is not difficult; it’s finding the right kind of intervention,” he explained.

However, the horrors of Hurricane Katrina drew public attention to the area’s urgent health needs, and the lack of affordable health care. Tulane University, like other local players, was drawing on the groundswell of support to increase community health care in the NOLA area, expanding the presence of federally qualified health centers designed to serve low-income and underinsured or uninsured patients.

One of those health centers was NOELA, where Dr. Winfrey is now chief medical officer. The FQHC was founded by the Tulane University School of Medicine in 2008.

Hurricane Katrina “led to a sort of rebirth of how primary care was delivered in New Orleans,” Dr. Winfrey explained. The push for more available and effective care also led to the use of new kinds of electronic medical records that allowed patients’ diagnoses and treatment regimens to be widely accessible rather than locally housed.

In the aftermath of Hurricane Rita, MLK Health received enough financial support to install a generator that could power their entire pharmacy, allowing them to keep medications cold – and safely dispense them – during power losses. A few years later, they were able to upgrade their pharmacy and install an electronic medical record system that allowed them to accept and fill prescriptions from outside pharmacies. “That’s been a game-changer for displaced people,” Mentesane said. By that time, MLK Health was outgrowing its original clinic building, and purchased and renovated a new facility.

“It was a combination of not only the community need, but also community support,” she recalled.

“To Be Ready”

The combined disaster also grew MLK Health’s partnership with Direct Relief. While the organization had provided support to nonprofit healthcare providers in California, most of its work was international at that point.

For Direct Relief, too, the catastrophic impact of Hurricane Katrina was a pivotal moment.

When the storm struck the Louisiana coastline, Direct Relief had recently wrapped up a successful pilot program focused on providing medication to California community health centers and clinics, free of charge. Damon Taugher, a former director of U.S. programs at Direct Relief, called NACHC to ask if similar medical support would be helpful to health facilities serving communities impacted by Katrina.

Direct Relief had responded to international disasters for decades, but its U.S. work at that time was less extensive. The organization had never responded on a large scale to a U.S. disaster. But within six months, Direct Relief had provided more than $50 million in material medical aid and cash assistance to Gulf Coast community health centers and free clinics.

“Not only was the response among the largest in Direct Relief’s history, but it shaped the organization’s next ten years,” Taugher recalled in a 10-year retrospective essay on Hurricane Katrina’s impact. “To be ready for the next disaster, Direct Relief set out to establish relationships with a nationwide network of safety net providers.”

“Direct Relief was first introduced to the nonprofit healthcare safety net in the aftermath of Hurricane Katrina, and it quickly became clear that providers at community health centers, free and charitable clinics, and charitable pharmacies were already so deeply aware of the community needs, and so ready to serve their patients in any capacity,” said Katie Lewis, Direct Relief’s regional director, U.S. Programs. “Those partnerships were a natural fit for us.”

“Willing to Step Up”

Today, Direct Relief works with more than 2,000 community health centers, free and charitable clinics and pharmacies, and other safety net providers across the U.S., and has provided more than $2.8 billion in material medical aid and $238 million in grants to U.S. healthcare providers.

Direct Relief’s network of U.S. partnerships allows the organization to provide ongoing programmatic support to safety net providers over the long term, both in the form of grant funding and through the provision of material medical aid, such as the medicines and supplies needed to manage chronic diseases like diabetes, hypertension, and chronic obstructive pulmonary disease; vaccines; reproductive health supplies; infrastructure for cold-chain medical storage; and much more.

The organization provides more support in the U.S. than in any other country, Lewis said.

“These community health centers, clinics, and pharmacies are indispensable providers in their communities,” she explained. “They are continually being asked to do more: fill healthcare gaps, reach more people in need, respond to more frequent and severe emergencies, and help the communities they serve rebuild resilience over the long term. And despite all the challenges and limitations, they are somehow always willing to step up.”

These long-term partnerships also make it possible for Direct Relief to respond quickly and effectively during emergencies such as natural disasters, when safety net providers send out mobile medical units; dispatch doctors, nurse practitioners, and emergency responders into the field to offer emergent care; provide medical care and mental health support at shelters; and reestablish continuity of care for people who have fled immediate danger, among many other lifesaving strategies.

Direct Relief has also funded resilient power projects for safety net providers in disaster-vulnerable U.S. communities from California to Louisiana to Puerto Rico through the organization’s Power for Health program; provided financial support for mobile medical units; and distributed emergency grants to search and rescue groups and community organizations responding in the aftermath of disasters.

Over the long term, too, these safety net providers will support communities still recovering years or decades later – like New Orleans, where Hurricane Katrina is still a monumental part of the area’s history, identity, and current health landscape – from a disaster.

Research increasingly shows that communities deeply affected by tropical storms will experience vastly increased morbidity and mortality for decades to come: In some cases, the excess deaths caused by a disaster can reach 300 times the original death toll in the years following.

Community health centers, free and charitable clinics and pharmacies, and other nonprofit providers work to prevent these excess deaths by connecting people to housing, reducing food insecurity, implementing new disease prevention measures and mental health monitoring, and much more.

“People Still Don’t Realize”

Today, Mentesane said, healthcare in Louisiana is a much larger network of coordinating organizations who work together during the Gulf Coast’s frequent Atlantic storms to coordinate care.

Safety net organizations are assigned roles in local and state emergency planning – MLK Health, for example, acts as a pharmacy and distributor for people displaced by disasters, conducts preparedness drills, and has its own detailed plans in place to keep tabs on patients, provide emergency care, and reopen as quickly as possible.

MLK Health receives and stages Direct Relief’s large-scale Hurricane Preparedness Packs, which contain the medications and supplies that responding organizations most frequently request in the aftermath of a tropical storm. If the storm season is uneventful, the medical support – much of it intended for patients with chronic diseases – is used as part of the health center’s ongoing community healthcare work.

Access Health also receives a Hurricane Prep Pack from Direct Relief, which Comeaux describes as a boon. “Those supplies really do change lives,” he said, recalling a child at one of the health center’s facilities who received a nebulizer from the pack when he urgently needed one. Direct Relief also provided funding to support the purchase of two mobile medical units for Access Health.

“We have benefited from that relationship in amazing ways,” Comeaux said.

After Hurricane Katrina, “the emphasis became more on continuity of care for people with chronic diseases and disabilities,” Mentesane said. “I think that a lot of people didn’t realize – I think a lot of people still don’t realize – the amount of chronic illness in Louisiana and a lot of the southern states.”

New Orleans has changed since Dr. Winfrey’s return. Where he originally cared primarily for members of the city’s lower-income Black communities, he said people from growing Latino and Vietnamese communities in the NOLA area have become a larger percentage of his patients. Chronic diseases affect each community, but “these are unique medical conditions that can be impacted by language and culture,” he said. His patients need “someone who is culturally aware and familiar with dietary practices.”

His practice has changed along with his patients, allowing him to suggest healthy substitutes for foods like white rice and tortillas, and learn more about how his patients see issues like chronic disease prevention and cancer screening.

“Each culture has their own way of viewing the importance” of health, Dr. Winfrey said.

The post Twenty Years Ago, Hurricane Katrina Transformed American Healthcare – and Direct Relief appeared first on Direct Relief.

In the first weeks after floods tore through central Texas, killing at least 138 people and damaging thousands of homes, people kept their heads down and pushed through.

Mikki Hand, a family nurse practitioner and executive director of Frontera Healthcare, a community health center serving a number of severely impacted communities, described a provider who came into work despite losing her home to the floods. “I have more than our patients, and I didn’t lose somebody,” the provider told her.

“I can control this, but I can help people. If I go home, I have nothing left, and I’m not ready to deal with that,” Hand recalled a staff member saying.

Hand, a seasoned provider and community health leader, knew the worst need was still ahead.

Frontera staff who had lost their homes or suffered severe damage faced overwhelming financial challenges. Meanwhile, first responders—nearly all of them volunteers—were returning to their own hard-hit neighborhoods after taking on swift water rescues and emergency operations that otherwise might not have happened, Hand explained. “They’re expected to resume their everyday lives,” she said.

The health center’s patients were struggling with damaged houses and property – they had nowhere else to go. A nursing home where Frontera staff provide medical care was heavily damaged by water, Hand told Direct Relief.
Parents began requesting mental health appointments for their kids, who “learned on social media or the news that people they knew were gone,” Hand said.

Frontera and the close-knit rural communities it serves are no strangers to tragedy. The area’s rivers are prone to flooding, and the area has struggled with recent wildfires, although the death toll has never been so high – or the public spotlight so glaring. In March of 2025, the Crabapple Fire destroyed nearly 10,000 acres near Fredericksburg, where one of Frontera’s clinics is located: Krista Bopp, a licensed professional counselor at Frontera, said many of the same first responders who’d worked through the fires had gone back to the field to help with the flood response.

“These men and women in these small towns, they are working full time jobs and volunteering as first responders,” Bopp said.

Hand, a dedicated advocate for her staff and patients, knew the needs in flood-affected communities would be tremendous – and they were only beginning to emerge. She secured a $50,000 emergency grant from Direct Relief for Frontera, one of five grants the organization awarded in the aftermath of the flooding. Part of the funding was used to cover healthcare costs for flood survivors and to give emergency cash assistance to health center staff members who were experiencing severe financial hardship, enabling them to continue working. Funds also covered staff time to help patients clean out their homes, mental health support for staff members, and mental health and wraparound services to first responders and volunteers.

“The funding Direct Relief provided has empowered us to care for these patients,” Hand told the organization. Bopp and Hand both described Frontera’s patients – most of them from small towns in the central Texas counties of Mason, Menard, Kimble, McCulloch, and Gillespie – as deeply committed to their communities and concerned about their neighbors, in part because so few outside resources are available.

“There aren’t enough hands-on deck to assign roles, so people do many roles,” Bopp explained. She offered the example of her own father, a small-town mayor, schoolteacher, and volunteer first responder when she was growing up. “His example has led me to what I do: It’s a part of me to be service-oriented.”

In the aftermath of the flooding, public funding and other support have been slow to come in, Hand said: “Neighbors are helping neighbors.”

She described one patient who was hesitant to apply for aid, even though her family had lost their livestock and they were experiencing financial hardship. They hadn’t lost their house, so felt their need was less. Others had experienced property damage, but didn’t want to take funds or attention from those more heavily impacted.

Frontera’s role in these affected communities is pivotal. “We are the only primary and only behavioral health providers in some of the counties we serve,” Hand said. “These counties don’t have the biggest infrastructure and they’re not the best funded.”

Hand said more than half of Frontera’s staff experienced impacts from the flood, whether property damage or mental health symptoms. Caring for them is essential, even as Frontera “is starting to plan and mount the long-term response” in the larger community.

“We’re so intertwined in these small communities,” Hand explained.

Mental health support will be an urgent priority in the coming months, Bopp said.

“This isn’t even here yet,” she said of the coming need for mental health services. “I can see the wave off in the distance…We’ll start to see our first wave of people who say, ‘I’m not OK.’”

Bopp is already working with search and rescue volunteers and other first responders, and said more are beginning to seek counseling.

The number of children affected by tragedy has made the July flooding especially devastating. “When you have that aspect of children, people just go weak at the knees,” Bopp said. She noted that two children of a first responder had brought up the tragedy during a play-therapy activity. They hadn’t fully understood the danger, but they knew their dad had gone to help people and “all we could do was pray he was going to come back.”

Frontera is developing partnerships with local schools to help them prepare for an influx of children who need mental health care.

Because she works in a small community and is well known, Bopp said she emphasizes the legal confidentiality of therapy, and promises patients she’ll never approach them outside of a session. If they want to say hello, she’ll say it back. Telehealth is also available to first responders in neighboring counties, who often prefer a therapist they’re unlikely to see in the grocery store.

“I have to be a safe place,” Bopp said. As people get through the process of securing material needs – funding assistance, food, medications – they will be able to turn their attention to post-traumatic stress, anxiety, and other mental health issues connected to the floods. “This rolls into something so much bigger as time goes on.”

The post In Central Texas, A Health Center Cares for Flood-Devastated Communities, First Responders – and Its Staff appeared first on Direct Relief.

The clinics Keith Harvey oversees cover 8,500 square miles in northern Minnesota – and serve about 14,000 patients.

“Our clinics are very remote,” explained Harvey, CEO of Scenic Rivers Health Services, whose six locations serve the area’s rural patients, many of them miners, loggers, and agricultural workers. “If somebody gets strep throat, they go to the local clinic. If that local clinic isn’t available to them…the ultimate result is that people receive less care.”

Rural community health centers like Scenic Rivers fill essential gaps in communities across the country. Providers treat comparatively fewer patients – but the care they provide is often exceptionally complex and multifaceted, demanding high levels of commitment. Some of Scenic Rivers’s physicians, for example, staff two local hospital emergency rooms that are open 24/7, work shifts in the hospitals’ inpatient department, and care for patients at two Medicaid-funded nursing homes, in addition to their clinic practices.

People who live in the sparsely northernmost areas of Minnesota often travel to a Scenic Rivers facility when they need healthcare. “A lot of people live on the lakes. They’re not in our community but we take care of them,” Harvey said. “We are the primary caregiver to that whole region up there.”

“It’s very high touch: Our volumes are low, but our needs are high,” said Kate Surbaugh, CEO of Sawtooth Mountain Clinic, a health center in northeastern Minnesota. New staff members often develop a “deer-in-the-headlights look” when they realize how complicated patient care in the area is.

About 35% of Sawtooth’s patients are over 65 and many have complex health needs. An older adult in a rural or tribal community (Sawtooth provides health services to members of the Grand Portage Band of Lake Superior Chippewa Tribe, Surbaugh explained) may need extensive assistance to coordinate specialty care – and transportation to the nearest city where it’s available.

For example, an older patient may need to consult a cardiologist, endocrinologist, and podiatrist for interrelated health issues. Duluth, the most convenient nearby city, may be hours away – and the patient may not have a car, and be dependent on the weekly bus.

“This happens every day for us,” Surbaugh said.

Publicly funded community health centers are uniquely important in rural Minnesota because jobs are vulnerable and chronic health conditions common, said Jonathan Watson, CEO of the Minnesota Association of Community Health Centers. Taconite miners, for example, are peculiarly vulnerable to shifts in the global steel market.

“Folks need access to care when they lose their jobs and lose their insurance,” Watson said.

While populations are small, the need for healthcare providers is high – and Watson said keeping and recruiting providers is often one of the hardest challenges local health centers face.

“We have young folks growing up in these communities and they see the bright lights in the big city,” Watson explained. “That really has an impact on health centers and our ability to grow our own workforce.”

Sawtooth has developed in-house programs to train pharmacy technicians and medical assistants – nurses, who Surbaugh said are hard to attract to the area, require more extensive training.

“It’s really important for the providers to just be present,” Surbaugh said. “They have to be honored and interested” in working in areas like Grand Portage, where being familiar, reliable, and dedicated are key to earning patient trust.

Sawtooth has developed specialized arrangements for patients with mobility issues, works closely with tribal providers, and even opened up a nonprofit pharmacy in 2021 when the Covid-19 pandemic forced the area’s commercial pharmacies to close down.

“There’s no shortcut to building trust in the community,” Surbaugh explained.

Many rural health providers are homegrown, Watson said. He recalled one clinic director who “recruited a waitress in a bar” to train as a dental assistant.

“Now she’s one of the best dental assistants,” he chuckled.

Several of Scenic Rivers’s physicians have deep ties in the community – one, Harvey explained, is the son of the health center’s first CEO. “I hope and I pray they stay here forever, because they make it a great place to get health care,” he said.

However, finding enough providers to meet community needs is an ongoing challenge.

“We currently employ three different dentists, but we could employ five more and they would be busy tomorrow,” Harvey said. “There are thousands of people who can’t get dental care.”

Watson and Harvey are both deeply concerned about Medicaid cuts, which would potentially cause up to 80,000 Minnesotans – and nearly half of the state’s community health center patients – to lose health insurance coverage.

While a $50 billion Rural Health Fund was passed as part of the One Big Beautiful Bill and will be implemented by the Centers for Medicare & Medicaid Services, a KFF analysis found that Medicaid spending in rural areas was likely to decrease by $155 billion, more than three times that figure.

“That’s my greatest anxiety: how we’re going to provide the services we need to provide,” Harvey said. Scenic Rivers’s revenue will be significantly affected by the cuts, and he’s concerned that patients will be less likely to seek care they can’t pay for. “They’re going to get sicker, and they’re going to need a lot more care.”

Health conditions that aren’t cared for promptly can spiral out of control, Harvey noted, whether that’s a chronic condition like diabetes or even an injury – common in an area with high levels of manual labor, recreation, and seasonal tourism. “Let’s say you cut your hand and you need stitches,” he said. If a patient can’t afford care – or the nearest health facility is hours away – they might forego medical attention and end up with an infection.

“Now you have something much more serious, and you’re going to end up in an emergency room,” he said.

Direct Relief equips rural health centers throughout the U.S. with medications and medical supplies, resilient power projects, mobile medical units, grant funding, and other support to bolster their work in smaller communities.

The post Across a Vast Terrain, Rural Health Centers Fill Crucial Gaps appeared first on Direct Relief.

They’d wait for the emergency medical brigade from Fundación Margarita Valiente, carrying a Direct Relief-issued emergency medical backpack. For many of them, the glow stick provided in the pack became a recognizable symbol: A medical worker was nearby.

“It is something to have a little clinic on your back,” said Dr. Ronaldo Similox, the head of the emergency response and community support NGO, which serves Guatemala’s Maya population, of the field medic packs. “To attend to the trauma, the equipment inside the bag is very, very important for us.”

Dr. Similox said thousands of people had fled eruption events this year. Many others, unable or unwilling to leave their homes behind, needed care as well. Providers at Fundación Margarita Valiente, which operates two clinics in Chimaltenango and supports 20 Maya-focused clinics throughout Guatemala, treated respiratory infections, skin and eye injuries, and urgent mental health symptoms.

People of Mayan descent make up about half Guatemala’s population. They are not a monolithic entity: There are 22 distinct Maya groups, each of which has its own distinct cultural, linguistic, and historical identity. Many of those who live in Volcán de Fuego’s vicinity have no other viable choice. In the aftermath of Guatemala’s brutal, 36-year civil war, and the decades-long genocide of hundreds of thousands of Indigenous Maya people, the volcano-adjacent land was offered to surviving communities, explained Dr. Similox, who is a member of the Kaqchikel people, the second-largest Maya group in the country.

“It’s a very dangerous place,” he said. His patients “have no land, they have no money to have a safer piece of land. Poverty in the population is very high, so they don’t have a place to go.”

About 40% lack electricity, Dr. Similox said – often because their villages are located in such seismically active areas that electrical infrastructure would simply topple over.

Dr. Similox explained that his Maya heritage helps him identify with his patients and understand their needs. Many speak a Mesoamerican language with little or no Spanish, for example, and understanding their customs, beliefs, and even foods helps him provide nuanced and culturally appropriate care. He said Fundación Margarita Valiente also prioritizes hiring and training Maya women professionals.

The goal is to “strengthen their experience and empower their work,” he explained.

Fundación Margarita Valiente was founded in the aftermath of Guatemala’s devastating 1976 earthquake, which killed approximately 23,000 people and caused widespread devastation. In the earliest days, Dr. Similox recalled, providers focused on widows and orphans – providing primary and maternal health care and nutritional support for malnourished children. Today, specialty and tertiary care, as well as emergency services and safe shelters for evacuees, are also available to patients. Additional programs support educational and community development. One of the foundation’s two clinics is dedicated to mental health care.

The Guatemalan Civil War caused “many problems with health” that persist today, Dr. Similox said. Because so much genocidal violence was focused on men, many women and children were left without husbands and fathers. Today, many of his patients are farmers and weavers struggling to get by.

Volcán de Fuego makes things more complicated. For many people, evacuation means endangering the homes and lives they’ve built, Dr. Similox explained, so providing care to displaced people and those sheltering at home are both essential. The volcano’s extremely high level of activity – its last cataclysmic disruption was recent, in 2018 – is both part of the background and an ever-present danger.

When the volcano erupted in March, Direct Relief provided Fundación Margarita Valiente with 36 emergency medical backpacks, N95 masks, and a range of requested medications and supplies, such as women’s hygiene kits and water purification tablets. All told, Direct Relief has shipped more than $600,000 in material medical aid to Fundación Margarita Valiente since March or this year, and about $10.4 million in medicines, equipment, and supplies since 2009.

Dr. Jose Quinillá Santos, a physician who coordinates local emergency brigade missions, described using his Direct Relief-issued field medic packs during the Volcán de Fuego response to assess patients’ vital signs, perform diagnostics, and provide pre-hospital care to patients who needed more extensive treatment. “The supplies and instruments contained in the backpack are of vital importance,” Dr. Santos said.

Dr. Similox said even the packs themselves are increasingly recognized in his patient community. “When people see these kinds of backpacks, they say help is coming,” he said. “Somebody will help them.”

Luis David Rodriguez contributed reporting to this story.

The post The “Volcano of Fire” Threatens Maya Communities in Guatemala. Again. appeared first on Direct Relief.

Galvez, the head of the emergency response group REMAR SOS, had gone to thank the older man whose building the team was using as a distribution center and headquarters. His host was gracious. Then he drew Galvez’s attention to the view out the window: a valley stripped bare except for a single large tree.

When torrential rains swept over eastern Spain in October and November of 2024, the resulting floodwaters killed 232 people, and placed many more in immediate danger. The building’s owner had been one of them.

Standing in that valley when floodwaters suddenly burst through, he had been dragged along in the fierce current. He’d managed to seize hold of that one tree as he was swept along, and to use materials from passing debris to lash himself to its trunk.

The deluge caused catastrophic damage across a number of eastern Spanish communities, including the municipalities of Pobla de Vallbona, Alfafar, and Benetússer – where the emergency response organization Bomberos Unidos Sin Fronteras spent days searching for survivors before turning to restoring heavily damaged schools.

“It wasn’t so much the high flooding” that made responding difficult, BUSF director general Jesus Lluch Ferrer explained through a translator. “There was so much rainfall in so little time, the levels rose up pretty high, but came down pretty quickly.” Instead, he said, for most of the people who survived the initial deluge, the dangers were exposure to contaminated water and economic devastation.

In particular, he was concerned about the contamination of houses, businesses, and community buildings like schools that his team saw. “When you try to get rid of mud, you need special machinery, which local agencies didn’t have,” he explained. His team has focused on cleaning and restoring local schools contaminated by mud and floodwaters, so that they are safe for students to return.

“It’s so kids can come back and have the school they deserve and were accustomed to,” he said.

“It Happens Everywhere”

Ferrer has responded to many international disasters, including Haiti’s cataclysmic 2010 earthquake. He found it unnerving to see such high levels of devastation in a high-income country like Spain.

“It wasn’t something we expected,” he said. Many areas affected by floods were unreachable, and cut off from communications, for days. Coordination was slow in coming. Some communities went a full week without access to potable water or food supplies.

REMAR SOS is the emergency branch of the larger, Spain-based organization REMAR, and Galvez, too, has responded to many international emergencies. He currently lives in Romania, but he and his team were at a conference in Spain when the flooding began. He, too, was taken aback by the level of devastation he witnessed.

“No one was expecting anything like that in Spain,” he said through a translator. He cautioned that a country’s median income level or existing infrastructure isn’t a good indicator of its emergency preparedness: “No country is ready for a disaster like this to respond immediately. The chaos, the tardiness of the response, it happens everywhere.”

Galvez cautioned that not all response is automatically a good thing. “Everybody wants to help, but a lot of times the help is not organized and it brings more disruption,” he said. In addition, help often disappears too quickly, with emergency responders pulling out within days or weeks, leaving health threats and economic devastation – both of which continue to be serious issues in eastern Spain – insufficiently addressed.

Both BUSF and REMAR SOS have remained in Valencia communities, clearing out and restoring flood-damaged buildings with specialized equipment. BUSF has focused on local schools – REMAR SOS on community businesses and other essential buildings. Galvez explained that REMAR SOS is also providing hygiene supplies to prevent waterborne diseases and other serious health threats from the contaminated floodwaters, and boxes of food to local families, for whom economic impacts were severe.

“A lot of them lost their businesses, so they have no way of providing for their families,” he explained.
An estimated 48,000 businesses were affected by the flooding. Small businesses, including shops and restaurants, manufacturers, and service providers, were particularly hard hit, with owners and workers complaining that compensation has been slow to arrive.

Ferrer was impressed by the strong community bonds he saw among people affected by the flooding. He described seeing families fleeing the disaster in their cars stop to dig other people’s wheels out of the mud. “A lot of times, when you’re facing these disasters yourself, you’re worried about your home, your family,” he said. “The people were very willing to help and support other people.”

“A Need That’s Growing”

REMAR SOS has committed to remaining in Valencia for a full year after the disaster. “That’s where Direct Relief luckily came in,” Galvez said of the $250,000 emergency grant that Direct Relief awarded the organization to maintain sanitation and prevent waterborne diseases in impacted communities. “It was a blessing that they came out of nowhere.”

A second grant of $70,000 was awarded to BUSF, a long-term Direct Relief partner. The emergency response the organization conducted was extensive, demanding medical evacuations, specialized equipment such as generators and water extraction pumps, and first aid measures. The funding from Direct Relief will help BUSF replenish its medical stockpile and emergency equipment, so they are prepared for the next disaster.

Direct Relief has supported partners in Europe for many years: shipping long-term material medical aid to providers in North Macedonia, Romania, and Belarus; providing emergency support to communities in the Balkans amid natural disasters and to Italy during Covid-19; and supporting mobile and primary health care for refugees and asylum seekers in Greece, among other response work. The organization has also worked with healthcare partners across Ukraine and in Poland to support Ukrainians impacted by the ongoing war with Russia, from pediatric mental health to prosthetics and rehabilitation services for amputees.

Alexandra Kelleher, an emergency response senior program manager at Direct Relief, said that higher-income countries often need less systemic support, but natural disasters or outbreaks of conflict that affect the most economically vulnerable people often require a localized emergency response like the one in eastern Spain, or the support to refugees and asylum seekers sheltering in Greece. Fluctuations in the global economy, political upheaval, and changing attitudes toward international aid have all affected the humanitarian resources available.

“Climate and conflict disasters are occurring more frequently, and economies are fluctuating. So there’s a need that’s growing as support becomes more inconsistent,” she explained. Direct Relief’s ongoing presence in Europe allows it to act as a quick-moving emergency resource when disasters occur.

“We want to help,” Kelleher said.

The post Preventing Illness and Rebuilding Community in Flood-Stricken Spain appeared first on Direct Relief.

“I hear the daily stories of children who lost their lives because of lack of insulin or diabetes complications,” said Dr. Elhassan, a pediatric endocrinologist and clinic coordinator for the Sudanese Childhood Diabetes Association.

Before Sudan’s conflict between government factions broke into open war on April 15, 2023, the SCDA cared for about 11,000 children with diabetes, in 26 clinics across Sudan. The organization ran the most advanced pediatric diabetes center on the African continent in Khartoum, Sudan’s capital city. Staff had been trained to store and transport insulin under fastidious cold-chain protocols; to educate young patients and families about managing the disease; and to keep precise clinical records that ensured precious insulin was available when and where their young patients needed them.

“We had a very meticulous system,” Dr. Elhassan recalled. “The situation was completely stable.”

War upended that system essentially overnight. Militias occupied the Sudan Childhood Diabetes Centre in Khartoum in 2023. The center had cared for 3,000 young patients – and served as a storage facility for insulin used in all 26 other clinics. Because electricity has been interrupted, Dr. Elhassan knows those medicines are unusable, their safety and potency compromised.

Insulin must be kept within certain temperature ranges to be safely used. For people living with Type 1 diabetes, improperly stored insulin isn’t just ineffective. It can be life-threatening.

Displaced families are scattered across Sudan, and many have left the country. Although SCDA has worked to connect many displaced children with Type 1 diabetes to a new clinic, Dr. Elhassan said keeping track of all their patients has been impossible. “Many, we don’t know what happened to them. They are not reported in clinics, many were lost in hospitals.”

The fighting is currently concentrated in Darfur, as well as many areas in the west of Sudan. In these places, insulin and other Type 1 diabetes treatments are difficult to come by. Dr. Elhassan said many of SCDA’s patients in the area have died, often because treatment was unavailable and their families were unwilling to take the risk of fleeing.

“Many families prefer to lose one child from diabetes, rather than the whole family having to be displaced,” she said.

Damaged Facilities Among War Impacts

Across Sudan, war has killed tens of thousands of people. (The exact number is debated.) Dozens of hospitals have come under attack, and people in several areas of the country are experiencing severe hunger.

The fighting has also brought severe, often fatal, interruptions to medical care for non-communicable diseases.

This group of diseases, which includes diabetes, hypertension, cardiovascular and kidney diseases, and cancers, has been a growing threat to health for decades, and is the most common reason people seek healthcare in most parts of the world. Before the war, NCDs accounted for more than half the reasons Sudanese patients sought healthcare, said Dr. Dalya Eltayeb, the director-general of primary health care in Sudan’s Federal Ministry of Health. In Sudan, care for these diseases is provided by the federal government and is free of charge in many cases.

But the outbreak of war has altered the country’s medical landscape. In 2023, Rapid Support Forces seized control of the country’s medical supply warehouses in Khartoum, essentially erasing much of the country’s inventory of medicines and supplies. Tahani Gawish, the national drug supply chain coordinator for Sudan’s Federal Ministry of Health, estimates that $500 million of medical supplies were destroyed. Warehouses, cold storage rooms, and other essential infrastructure were damaged or looted.

Conflict and militia control of supply routes make it difficult to get medications like insulin or oncology medications to many areas of the country.

Dr. Eltayeb described losing access to three national centers for cardiac care because of the war, as well as more than 150 kidney dialysis units, a national radiotherapy center, the country’s main centers for cancer therapy, and a number of diagnostic laboratories. Many of these resources were clustered in Khartoum, a major urban center where the fighting has been particularly intense. (The Sudanese government announced about a month ago that the Rapid Support Forces had been pushed out of the area.)

“It happened suddenly,” she said of the losses.

Many healthcare providers have fled their homes for safety – making them among the 13 million displaced by the conflict, according to UNHCR. Displaced patients often can’t get near enough to a clinic to receive medical care.

Consequences For Care

Dr. Dafalla Abuidris, Director General of Sudan’s National Oncology Center, described seeing patients dying because the oncological drugs they needed were newly unavailable, or cancer care wasn’t available in their state. “Many cancer patients who cannot afford displacement will stay in the state without treatment,” he said. “There is not much radiotherapy outside Khartoum.”

A radiotherapy center in northern Sudan now has to serve most of Sudan’s patients with cancer. “You can imagine the waiting list,” Dr. Abuidris said. But that facility is about 500 miles from the middle of the country, making it inaccessible to many – and it’s privately owned, which means that patients have to pay for care that would be free of charge at a government facility.

“They hear about the treatment sessions, and they decide not to go,” Dr. Abuidris said. “This is the reason the waiting list is six months. Otherwise, it would be two years.”

Even when people are able to obtain needed medicines through illegal markets, Gawish said lack of regulation makes the practice dangerous. “People have started to smuggle medication, but they can’t guarantee the quality of that medication,” she said. “It is a disaster.”

The vast spike in physical trauma and emergent mental health needs – the immediate results of the violence – have strained Sudan’s health system, making fewer resources available to patients managing a chronic condition, Dr. Eltayeb said: “The burden of non-communicable diseases is expected to surge.”

In addition, many of the humanitarian medical donations to Sudan, while urgently needed, have focused on the direct impacts of conflict, according to Gawish.

“The first donation is always about injuries” in a conflict setting, she said.

Meeting Medical Needs

Direct Relief, in collaboration with long-term partners in Sudan, including Life for a Child, the Changing Diabetes in Children partnership, the National Medical Supplies Fund, the Sudanese Childhood Diabetes Association, and the Federal Ministry of Health, among others, is working to help meet the country’s need for non-communicable disease care and cold-chain capacity.

Since war broke out in April of 2023, Direct Relief has shipped $25.9 million in medical material aid and distributed more than $60,000 in grant funding. Much of that support has focused on non-communicable disease care: For example, in 2024 alone, Direct Relief provided enough insulin to meet the needs of over 9,600 individuals, nearly 40% of the country’s population under age 20 with Type 1 diabetes. The organization has also shipped a variety of diabetes management supplies, more than $1.7 million in cancer medications and supportive therapies, and dialysis supplies to help people living with renal failure.

To increase centralized cold storage capacity, Direct Relief also purchased two 40-foot refrigerated containers for Sudan’s National Medical Supplies Fund, primarily intended to store the large volumes of insulin provided in support of SCDA’s activities across the country. Direct Relief has also purchased and delivered 35 solar medical-grade refrigerators to the 25 still-functioning diabetes centers receiving, storing, and dispensing insulin from SCDA to children and young adults living with Type 1 diabetes. Some of these centers are in rural or hard-to-reach areas of Sudan, including East Darfur.

The organization is also assessing the need for centralized and decentralized ultra-cold storage needs across Sudan, to ensure the proper storage and handling of medications and vaccines which must remain frozen.

A Path Forward

Dr. Elhassan, the pediatric endocrinologist, said healthcare workers are beginning to resolve the difficulties of tracking patients and sourcing medicines in many areas of Sudan. They’ve relocated their main diabetes center and established or reestablished care in strategically placed facilities. They’ve developed educational materials to teach families how to keep insulin cold, even during a crisis. Tracking clinic reports has made it easier to manage the insulin supply and transport effectively. The clinics have also developed a chain of communication designed to keep tabs on displaced patients. Even in Darfur, she said, physicians and other providers are choosing to stay amid the danger, without salaries, to care for their patients as best they can.

One doctor told her, “I cannot leave those children. We will die together or live together.”

“We have been able to save many children,” Dr. Elhassan said. “I hear a lot of brave stories about the physicians, educators, dietitians working in these clinics. They make sure to do everything” for their patients.

Even as the war continues, the next priority is to restore continuity of care across Sudan, and to improve the medical supply chain, said Dr. Eltayeb, the director-general of primary health care.

“The fighting is concentrated in a few areas,” she explained.

In the four states of Sudan – there are 18 overall – where instability is greatest, 80% of the primary health centers aren’t functional, Dr. Eltayeb noted. Providing healthcare has meant adapting, such as providing care via mobile clinics, so patients can reach providers safely.

“More and more people are coming back to Khartoum. We need to ensure…there are health services for them,” she said.

Kelsey Grodzovsky, Avrie Collier, Jeffrey Samuel, and Aaron Rabinowitz contributed reporting to this story.

The post Against a Background of War, Sudan Works to Restore Clinics, Distribute Medicine, and Locate Patients appeared first on Direct Relief.

These workers, many of them women, spend eight to nine months of the year harvesting and preparing salt for purchase, migrating from village life to work long hours in the open air, in heat that often exceeds 120 degrees Fahrenheit. The work is high-risk even at the best of times, often leading to injury, mineral toxicity, and heat-related health impacts. What water is available is trucked in – not enough to cool the shelters they erect from bamboo and burlap sacks, or even their bodies.

But in 2022, the situation started to change for the worse, said Reema Nanavaty, a social worker and director of the Self-Employed Women’s Association of India, or SEWA, an organization that advocates for the security, fair employment, health, and well-being of low-income women workers and their families. Temperatures soared above 125 degrees Fahrenheit during the summer, and workers were unable to labor safely in the heat.

“Whether they drank hot water or tea, it was the same,” Nanavaty recalled. “The salt, which was ready to be harvested…they had to abandon it all and return to the villages.” That meant going without the income they’d spent the past several months working to earn.

Large swathes of India and Pakistan experienced severe heat emergencies most recently in April 2025, with temperatures of 120 degrees Fahrenheit made worse by large-scale power outages, according to CNN.

None of these are isolated events. Direct Relief’s Research and Analysis team developed a series of recent reports showing the health impacts of a profound rise in extreme heat emergencies, as well as chronically higher temperatures and higher numbers of severely hot days, across the globe.

“Extreme heat events are occurring with increasing frequency, intensity, and duration worldwide, creating an urgent and growing threat to human health,” said Rachel Green, a Direct Relief data scientist. “These events are also deadlier than any other weather-related disaster.”

The Global Heath Health Information Network describes extreme heat’s “urgent and growing threat to human health” from immediate impacts like cell toxicity and heat exhaustion to the exacerbating effect on chronic conditions like cerebrovascular disease and diabetes to the stresses placed on health systems responding to a widespread and emergent need.

Not everyone is equally vulnerable, Direct Relief researchers noted. Infants, children, and older adults, along with people who have chronic illnesses, are pregnant, or are living with a physical or mental disability, are more likely to experience adverse effects. So are people who work outdoors, such as agricultural workers, people congregating closely together, and people who are unsheltered, low-income, or exposed to higher levels of air pollution, among other factors.

However, the dangers to health may go far beyond even heat exhaustion or exacerbated cardiovascular symptoms. Researchers at the National Bureau of Economic Research, in a working paper released earlier this year, noted that overcrowded health systems may lead to excess deaths – even among patients whose illness was not related to heat – as providers struggle to meet the increased demand for care.

For many of SEWA’s members, Nanavaty said, the most severe impacts of extreme heat at this point are economic. Agricultural workers may struggle to work enough during the heat to harvest crops (which may themselves be affected by soaring temperatures). The loss of income may mean there’s not enough food; that children go without health care; or that women turn to unscrupulous moneylenders or are compelled into sex work to ensure they and their families can eat.

“Nobody looks at these impacts,” Nanavaty said. She noted that while climate scientists often focus on large-scale data – global temperature fluctuations and increased numbers of extreme heat events over time, for example – people experience impacts that are location-specific and immediately relevant to their own lives. Many of SEWA’s members, for example, may not know what’s causing the rise in temperatures.

“How does that science translate into action?” Nanavaty asked. “We cannot wait for policies and programs to come because their day-to-day survival is at stake.”

The experience of SEWA’s members is directly in line with what scientific research shows, Green explained. “In regions prone to extreme heat, economic losses from these conditions can create a deadly cycle where families can’t afford air conditioning, healthcare, or the luxury of staying indoors, forcing them into increasingly dangerous conditions that worsen both their health and financial situations.”

For that reason, Direct Relief researchers noted, health interventions that effectively mitigate climate impacts often focus on household or community-level solutions. Access to personal cooling strategies like self-dousing in water or soaking clothing often mitigate the most immediate threat. Healthcare workers can be trained to monitor for, recognize, and immediately treat heat-related symptoms.

Many commonly prescribed medications – including mental health treatments, drugs for cardiovascular conditions such as ACE inhibitors, diuretics, and antihistamines – may actually increase vulnerability to heat-related illness, according to the Arizona Department of Health Services. And while cooling centers can be an effective community intervention, reducing heat-related emergencies and other impacts, social stigma often prevents people from seeking relief, The New York Times reported.

Financial programs may also help vulnerable populations mitigate their heat exposure and reduce the risk to their health. The federally funded Low Income Home Energy Assistance Program, for example, assists many U.S. households with the costs of cooling their homes in summer. SEWA operates an extreme heat microinsurance program, which provides financial payouts to members when extreme heat persists for two days – insulating them from the extraordinary financial costs of protecting their health from dangerous heat levels.

Despite the need for local- and household-level intervention, Green said large-scale data have an increasing role to play as well.

“Heat is deceptively dangerous,” she explained. “Unlike hurricanes or floods, extreme heat strikes without obvious warning signs, making early detection and public awareness life-saving tools.” Monitoring and analyzing climate change on a global scale allows researchers to anticipate heat surges and long-term changes – and can inform preparedness and response work.

“For healthcare systems, emergency managers, policymakers, and organizations like Direct Relief, comprehensive data enables preparation for heat surges, targeted warnings, and resource deployment to affected communities,” Green said.

The post Extreme Heat Causes Deaths and Strains Health Systems, Compounding Dangers. Here’s What Can Be Done. appeared first on Direct Relief.

More than one in five medically vulnerable people who responded to survey questions reported missing medical appointments – going without care for weeks or months in 90% of those cases. In addition, more than one in five respondents said delayed medical care after the wildfire had harmed their health.

Those are just a few of the findings reported in a study newly published in the journal Disaster Medicine and Public Health Preparedness, part of Cambridge University Press. Andrew Schroeder, Direct Relief’s vice president of Research and Analysis, is one of the co-authors, along with a team of emergency medical researchers at Harvard University, and Mariposa County Health and Human Services officials. The study is one of a series of four on health and wildfires recently published or under development.

After a disaster, Schroeder explained, “one of the things people want to know is, ‘How were the most vulnerable people affected?’”

The Support and Aid for Everyone, or SAFE, program of Mariposa County’s Health and Human Services agency provided an opportunity. Participation in the program is voluntary for residents who qualify as medically vulnerable and at higher risk during an emergency. Mariposa County officials worked with CrisisReady, a disaster response initiative at Harvard University and Direct Relief, to learn more from SAFE program participants about their experiences during the Oak Fire.

“Rather than randomly sampling households, we were directed toward this group of people who had already been identified as being medically vulnerable,” Schroeder said.

Many of the findings are startling: Fifty-three percent of respondents reliant on powered medical devices weren’t enrolled in PG&E’s Medical Baseline Program, an assistance program for customers whose medical care depends on electricity.

While county officials worked quickly to issue emergency alerts, offer guidance to people in affected communities, and communicate evacuation orders and warnings, 59% of people first learned about the fire when they saw flames or smelled smoke.

Schroeder sat down with Direct Relief to talk about what the research team learned, what it means, and how new knowledge can help California navigate future wildfires.

Direct Relief: From your perspective: A) What are the most significant findings of this study and B) What surprised you as a researcher?

Andrew Schroeder: We commonsensically know that the most medically vulnerable people on a normal day are also the most medically vulnerable in disasters. But we often don’t quantify that in terms of, “How they are affected in particular ways? What proportion of people are likely to be medically vulnerable? Is it uniformly distributed, or clustered in some way? Does it relate to certain kinds of behaviors that people exhibit during disaster, or their [specific] medical conditions?”

The Mariposa County population’s exposure to disaster is kind of a top-heavy distribution overall: You have the population that’s affected by disaster. Then you have more medically vulnerable people who are somewhat more affected as a subset of that total.

But even 20% of that [medically vulnerable] group was disproportionately likely to have the most severe problems. And that population was also more likely to have more medical conditions [per person]. They were also more likely to have power-dependent medical devices that were subject to outages.

In a nutshell: Yes, the medically vulnerable, as a group, are more likely to have more problems than the general population. But even within that, there’s actually an 80-20 problem for exposure to risk that pops out of the data.

Direct Relief: Looking at the two earlier studies in this series, both of them have a broader lens, right? The first one is calculating the increasing proximity of wildfires to inpatient facilities, even as those facilities take on greater numbers of patients. And the second looks at exposure to power outages across California counties in 2019.

But this new study takes a narrower focus: It’s a specific fire, a specific fire-affected community. I’d love to hear a little bit about how this narrower, deeper lens fits into the larger research project.

Andrew Schroeder: Well, there are multiple levels of this problem. We want to know whether acute care facilities are affected by wildfires in a way that is significant or has spatial variance in the first article. We weren’t looking in time. There’s a fourth article forthcoming in this kind of group that will look at this problem over time, in terms of changing proximity to fire perimeters.

But basically, from the standpoint of public health, or medical resource planning, what can we say about the likelihood that an acute care facility is going to be close to the perimeters of wildfires over a particular area. Does that vary across the state? Does it vary based upon the type of facility?

The power outage study takes the same planning problem but looks at it from the standpoint of the functionality of the facility and the exposure of people with power dependent devices – not just in acute care facilities. We’re also looking at long-term care, and we’re also looking at community health centers.

So not only are you seeing fire perimeters encroaching more closely on areas where there is medical infrastructure. You are also seeing the operational status of those facilities placed at risk to some degree by the coincidence of power outages and wildfires.

Then [in this third study], you drill down into, “What does that literally mean for people who are affected by wildfires?” That’s where the Oak Fire study fits in. And it’s not uniform. It has this particular communication dimension to it. There’s a significant aspect of, “How do you promote health-seeking behavior? How do you ensure continuity of power for medical devices at home?”

There is a set of things that are being done to mitigate the problems, such as the PG&E Medical Baseline Program. But even there, the uptake is surprisingly low, at roughly 50%.

I wouldn’t necessarily say that you could straight-line generalize from Mariposa County to everywhere in California – everyone will have some variation in these problems – but Mariposa is not a bad place to treat as a kind of representative study of rural counties in California. It’s a piece that does give you, I think, a broad view of some of the problems that California faces around this particular type of hazard.

Direct Relief: So much of the research that has been done on disaster impacts does something similar to what you’re describing here: It has a focused lens looking at a particular disaster, or maybe a specific community that’s experienced multiple disasters. We’re slowly building a body of those studies, but a lot of them are specific to place and time.

My question is, how much of a disaster’s impact and aftermath are unique to these places and to these individual events, and how much can we extrapolate to prepare for a future event in a different place?

Andrew Schroeder: Ideally, you would do this all the time. You would regularly study the impact on the general population, and clearly on the high-vulnerability population, so there’s an effort to learn from the past. Often that is not done. So, there’s a need for more research.

But you can compare the characteristics of medical vulnerability to a lot of different places. There’s similarity at the population level. There’s similarity at the geographic level. There’s similarity at the policy level.

The exact numbers would be different, but at the agenda-setting level I think [the study] does point to a lot of similarities. I would be surprised if you were to go up to, say, Siskiyou County and get really drastically different results for a similar population.

Direct Relief: Direct Relief often hears from partners that, “We don’t have the kind of data we need to create further preparedness and response plans, and we can’t wait for it. We need to know what to do now.” And often there’s this informal network where a particular community or a particular response organization will have wisdom to share, and they’ll just call up another county or organization and say, “Hey, we think you should be ready to do X.”

In this case, let’s say a rural county or community planning for disaster came to you and said, “OK, you did this study. What should we do know?” What would you say to them?

Andrew Schroeder: One [recommendation] is to just steer people towards programs like the Medical Baseline Program. There’s a need to create connectivity between people and available programs. There’s a need to build preparedness for interruptions to care, which means having a specific mitigation plan for your medicines, your care provider.

Obviously, there’s a need to improve outreach and risk communications. There needs to be more creative thinking about how to get reliable information into the hands of people who have demonstrated issues receiving that kind of information.

Direct Relief: It is so striking that the majority of respondents learned about the fire when they saw plumes or smelled smoke. That’s just not what we hope to hear.

And many respondents said they found the evacuation process uncertain. They didn’t know if they could bring belongings, they didn’t know when they could come back, and it was stressful.

Andrew Schroeder: They also said there’s a gap between creating a preparedness plan and actually evacuating. And the experience is different in that you’re told what you need to take with you, lists of medication and key contacts. And these are not necessarily super tech savvy people, so they’re writing a lot of this down on paper.

Then when you have to put that into practice, reality is always different from your plan. One of the things that was consistently reflected back is that [study respondents] were surprised by how different the experience of evacuation was from anything that they had predicted or put into their plan.

Something is needed to close that gap.

Direct Relief: So this is a serious issue for people who did make those plans as instructed but felt that it didn’t serve them.

Andrew Schroeder: Yeah. There’s no single answer to that, but I do think you could try to solve it through some kind of exercise, or some kind of discussion group or simulation. I would imagine that’s pretty hard to do, actually, and I would imagine there aren’t great [existing] resources for it, but just raising the question would be an important start.

Direct Relief: It seems like sharing lived experience could be a good thing: people who have made plans and lived through disasters coming in to talk about what they did that helped, and what no one could have prepared them for.

Andrew Schroeder: I think that’s a great idea, and I think you should quote yourself on that one.

Direct Relief: I’m not doing that.

You know, I just said that the study was hyper-local and hyper-focused. But it also covers a breadth of information: You talk about missed medical appointments, and the health impacts those caused. You talk about preparedness, you talk about information needs, evacuation needs, how and if people evacuate at all.

What is the benefit of looking across the board at these different kinds of data together as opposed to more siloed information?

Andrew Schroeder: Well, it’s a complex experience. The causes and consequences of medical vulnerability and disasters are not one thing. One of the sources of medical harm is that, if you’re on the [Mariposa County] SAFE list, you’re more likely to need regular contact with your physician. If that is interrupted, then your probability of medical harm, by definition, goes up.

That’s why I think one of the important findings is that, if you missed one appointment, you were likely to miss contact [with a medical provider] for months. That’s a long duration of interruption to care. And interruption is only one dimension. At the household level, the loss of power that changes your ability to utilize home medical devices is a different dimension of your medical vulnerability.

You have to be able to look at this as a problem that has more than one facet to it, or you’re not going to actually capture the lived experience of people who are subject to these kinds of conditions.

And if you’re going to try to formulate policy or improved public health practice, you won’t be accounting for the factors you need to if you don’t see this as an integrated problem.

The post How Do Wildfires Harm Health? New Research Is Filling in the Knowledge Gaps. appeared first on Direct Relief.

That’s not a coincidence. “We’ve all traditionally lived north of McDowell [a Phoenix neighborhood], up to the Indian school,” explained Walter Murillo, a member of the Choctaw people and Native Health’s CEO, of the area’s Native American communities. “There are pockets of communities of American Indians within the valley…That’s why we have our centers there, and that’s why we have our services there.”

Native Health is an Urban Indian Health Program, a private, nonprofit agency that receives partial funding from the Indian Health Service. The organization provides a vast array of healthcare services, social support, and community health and wellness programs, through four healthcare facilities and a mobile medical unit, to members of approximately 300 U.S. Federally Recognized Tribes living in the Phoenix Metro area.

“We understand each other and we know each other,” Murillo said of Native Health’s essential role in local Native American life. The health center features an Elder Talking Circle and Community Talking Circle, both led by a local traditionalist; cooking classes featuring Native American recipes; a healthy-living and activity program for Native children called Wellness Warriors; a Traditional Garden, which employs traditional Southwest tribal irrigation and agricultural techniques.

Kimberly Dutcher, an advisor to Direct Relief on governmental affairs and Native American health, is Diné and serves on Native Health’s board. She explained that the health center provides an essential source of both culturally appropriate care and community engagement for the Phoenix area’s Native American population.

“A lot of the time, when we leave the reservation, there’s a loss of community, there’s a loss of social ties,” Dutcher explained. Growing up on a reservation, her own health care came from the Indian Health Service, and she said health services designed with tribal communities in mind offer an important benefit: “They understand me and my background more. I don’t have to explain.”

But while Native American health and cultural needs are an essential priority, Native Health is also a Federally Qualified Health Center and an Urban Indian Health Program whose range of programs – from health, behavioral health, and dental care to healthy cooking, a family literacy and cooking program, emergency assistance, and much more – are available to anyone.

“Every service we offer is eligible to every person who walks through our door,” Murillo explained of the dual designation. “We knew that when a person walked in the door seeking services, we couldn’t make them eligible for some services and not for others.”

“Needs and wants”

Each of Native Health’s array of programs was a direct response to community needs, explained program manager Susan Levy. For example, the Central site is a designated National Voter Registration Act site – the first at an Indian Health Service facility and the first in Arizona. Every person accessing medical, dental, or behavioral health services is asked if they would like to register to vote.

Indigenous civic engagement is an essential rights issue – Arizona was one of the last states to allow its Native citizens the right to vote, and voting access remains an issue for Native communities, said Levy. Large civic engagement events began when she noticed that young interns from Arizona State University, who volunteered in Native Health reception areas, weren’t interested in voting. Native Health staff and volunteers have worked to increase civic engagement through programs like Frybread for the Future, which registered eligible community members to vote and explained the importance of the Native vote.

That responsiveness is key to earning trust in an area where many feel wary of large systems, Murillo said: “We keep our word, we do things in the community, and we offer things that the community needs and wants.” Native Health’s staff work with patients to prevent health and dental issues; help them manage copays and deductibles; and offer health care to patients regardless of insurance status or ability to pay.

The health center’s extensive food support options – they work with local food banks and government programs, but also purchase food to distribute to people experiencing a financial emergency; supplement patients’ diets with produce and other nutritious food; and feed children while school is out over the summer – are a perfect example of meeting those needs and wants.

“People in waiting rooms told us in surveys they were hungry,” Murillo explained. Staff members asked the question they so often do when learning about a community need: “What are we going to do about that?”

Native Health is in the process of adding chiropractic treatments, and financial and legal assistance, to its roster, responding to growing local demand.

Levy is proud of the holistic way Native Health often helps patients, who may be drawn to the health center when searching for healthcare or looking for a healthy cooking class, but who end up benefiting from many of the services on offer. She recalled doing outreach at a nearby federal prison, then receiving a call from a woman who’d been newly released a few weeks later.

The woman began receiving medical, dental, behavioral health care, and support services at Native Health. Through the health center’s partnerships, she trained as a truck driver and found employment, leased an apartment, and received legal assistance. She reunited with her daughter and began helping with childcare for other family members.

“She really wanted to turn her life around,” Levy said. “Look what she did, and look what Native Health did for her.”

Not all interventions bring an uplifting story. In 2023, the public became aware of a massive fraud and trafficking scheme focused on Native American people in Arizona. Sham treatment programs for substance use disorders had recruited thousands of Native people – some of whom needed treatment for substance use disorders, some of whom didn’t have disorders and thought they were just moving to new housing, Levy explained – into “sober living” facilities for years. More than 40 Native people died in these facilities, and many others described being held against their will, often without care or even basic necessities like food and toilet paper.

Because the object of the scheme was to fraudulently collect insurance payments, the crisis launched a government investigation and crackdown that has made much-needed care less accessible to Arizona’s Native communities.

Levy recalled widespread need during and after the crisis, beginning with a phone call from a local official who asked Native Health staff to assist members of the White Mountain Apache tribe who’d been sequestered at a hotel. Staff members helped people who’d been trafficked find new treatment centers and housing; booked bus and plane tickets for those who wanted to return home; and provided healthcare and other services to those who remained in the area.

“We had so many victims in our offices every day, and we are still seeing them,” Levy said.

“Their Names, Their Stories, Their Families”

Cultural connection and nutrition are often a community member’s first link to the health center, said Britney Joe, Native Health’s community health and wellness director.

Joe began her Native Health career on the medical side but transitioned to working on Native American youth programs a few years ago, focusing on mental health awareness, suicide prevention, and cultural connectedness. “I was able to get more creative, use my cultural knowledge,” said Joe, who is Diné, of the transition.

Community volunteers may decide to get involved when they pass by the Traditional Garden, which uses a variety of Indigenous agricultural methods, such as the Three Sisters planting technique of combining squash, corn, and beans. Approximately 300 community volunteers work in the traditional garden, which covers about an acre, Murillo said.

A family that comes in for cooking and literacy classes may need a connection to a medical or mental health provider. They may also benefit from access to WIC, the federal nutrition assistance program for women, infants, and children that, at Native Health, is supported by the Inter Tribal Council of Arizona and available to all who qualify. Their WIC program currently supports about 1,400 families each month.

“We get to know their names, their stories, their families,” Joe said.

In Joe’s experience, many people like learning about essential health topics – such as maintaining good mental health, preventing suicide, and cooking healthy meals – in a larger context of Indigenous culture and practice.

A program focused on Native American painting offers a valuable opportunity to talk about art’s role in building mental health. A cooking class focused on healthy winter soups might incorporate traditional stories of winter from tribal nations. The diabetes prevention camp for children doesn’t just teach prevention techniques – it also helps get kids out of the city during the heat of an urban summer, and gives them the space to play outdoors and connect to nature.

“Just the Right Time”

Native Health is a long-term partner of Direct Relief’s, and has employed cold-chain storage equipment, vaccines, and personal protective equipment from the organization into its diabetes prevention camp and healthcare services.

Now, a new Direct Relief Power for Health award for over $950,000 will outfit Native Health’s Mesa facility with a resilient solar power and battery system that will protect and support the care they provide. The Phoenix area is highly vulnerable to extreme heat, interruptions to the power grid that can cause rolling brownouts, and destructive monsoons.

“They’re violent storms in Arizona that move through quickly, but they can do tremendous amounts of damage,” Levy explained. A storm may pass through in a matter of minutes, but the damage to local power systems can leave a patient stranded in a dental chair mid-procedure or destroy vaccines and insulins quickly in heat as high as 120 degrees Fahrenheit.

“If your grid goes down or your line goes down, [a resilient power system] is what’s going to save tens of thousands of dollars of vaccines,” Levy said.

Extreme heat, dust, and wind storms, and monsoons have become ever more serious concerns for the area’s health resilience, Murillo said: “Power for Health came along at just the right time for us.”

The post In Urban Phoenix, Native Health Supports Tribal Communities – and Anyone Else Who Needs Care appeared first on Direct Relief.

It would be the beginning of a sustainable approach to disaster resilience and accessible healthcare in rural Nepal, he explained.

Mountain Heart Nepal, the medical organization Dr. Gautam founded in 2015, was his and his colleagues’ response to a devastating magnitude 7.8 earthquake that devastated many Nepali communities, killing more than 9,000 people and destroying huge amounts of the country’s rural healthcare infrastructure.

Since then, Mountain Heart Nepal has responded to a number of emergencies, including repeated flooding and the Covid-19 pandemic, with a focus on rural health.

Many of Nepal’s medical facilities and providers are concentrated in Kathmandu, its capital city. In the remote communities where Dr. Gautam and his fellow physicians worked, mountainous terrain and a lack of local infrastructure made it difficult for patients to access even basic primary health care. A serious emergency might mean days of travel by foot or a perilous airlift out of the mountains. And a disaster like a flood or earthquake could make routes entirely unpassable, cutting people off from medical care

While the organization’s physicians provided care through health camps and temporary clinics, “it was only for a short period of time,” Dr. Gautam said. Moreover, patients often had medical needs that couldn’t be fully addressed in a health camp: “We couldn’t do more in that setting because of the limited resources.”

For Dr. Gautam and his colleagues, a permanent facility in central Nepal, accessible by surrounding communities even in the aftermath of a severe disaster, was an ideal solution.

“We had this dream of having our own hospital,” Dr. Gautam explained.

Last year, in June, that hospital opened, supported by a Direct Relief grant of more than $700,000.

The Siddhasthali Rural Community Hospital, founded by Mountain Heart Nepal in the central municipality of Makwanpur, provides emergency, outpatient, and inpatient care; radiology, laboratory, and pharmacy services; dentistry, and other healthcare to rural and marginalized communities throughout the surrounding municipalities.

A carbon-neutral model

Siddhasthali’s facilities are powered by a solar photovoltaic system that ensures an uninterrupted power supply for hospital operations. Dr. Gautam explained that hydropower, Nepal’s main energy source, is prone to interruptions during the monsoon and dry seasons, forcing many healthcare facilities to rely on diesel generators. The hospital has also established an oxygen plant, ensuring a reliable, resilient supply of high-quality medical oxygen – an under-addressed health need in Nepal, as in countries around the world.

Sophisticated cold-chain equipment enables the hospital to store temperature-sensitive vaccines and other essential medications in ideal conditions.

Resilient power and on-site medical oxygen protect and bolster high-quality healthcare, but in Dr. Gautam’s eyes, there’s another important benefit: The carbon-neutral Siddhasthali Rural Community Hospital acts as a model for state-of-the-art care and sustainability for health facilities throughout Nepal.

“Hospitals are a major source of carbon emissions,” Dr. Gautam pointed out. In climate-vulnerable Nepal, where extreme weather events like heat and flooding are a growing concern, a sustainable model matters.

Dr. Gautam said the hospital routinely receives visiting physicians and other providers who are eager to observe and learn from Siddhasthali’s model.

Both local and national

When Mountain Heart Nepal’s physicians began scouting for a hospital location, accessibility was a high priority: They wanted a central municipality that could be easily reached by patients throughout Nepal – what Dr. Gautam called “a gateway region.” The hospital needed to be easily accessible, so providers could provide emergent care if rainfall or damage blocked roads into Kathmandu.

Makwanpur fit the bill. In addition, Dr. Gautam said, the municipality is home to a high number of members of traditional communities, including the Tamang and Chepang people. The latter – a semi-nomadic group that collects root vegetables for the forest and is historically marginalized – often has little access to health care.

An early patient at the hospital, a member of a Chepang community, had fallen from a tree, severely injuring his leg. The traditional medicine he’d been given at home – hot oil poured into his wounds – had exacerbated his injury, and the leg needed amputating.

Providers from the hospital frequently visit patients in their homes to describe the hospital’s offerings and explain the importance of preventive care. “If we counsel them well, and with the help of local community leaders,” many are willing to trust the hospital with their care, Dr. Gautam said.

“This hospital is unique: We take time to address the patient,” he explained. “I think that is lacking” in much regional healthcare.

In the Siddhasthali’s first few months of operation, a boy of about twelve came in with a fractured leg. A local hospital, using an outmoded X-ray machine, had missed the fracture, and the boy was in severe pain. An orthopedic surgeon found the break on the hospital’s digital X-ray machine and referred the patient for surgery. Without a nearby facility, “he could have faced difficulty for the rest of his life,” Dr. Gautam remarked.

An older woman whose stroke was previously undiagnosed was quickly diagnosed and treated by a cardiologist at Siddhasthali, who noted that the patient would previously have had to travel to Kathmandu, where she would have waited a long time for care, and the cost would have devastated her family. Dr. Gautam explained that families frequently lose their homes to pay for specialist or more complex care.

A vision realized

Because of Siddhasthali’s rural location, Mountain Heart Nepal at first had trouble recruiting healthcare providers and staff members.

“Everyone wants to work in the city,” in part so they can have appointments at multiple Kathmandu hospitals, Dr. Gautam said.

However, the hospital’s fast-growing reputation for sophisticated medical care and equipment, and its focus on sensitive, patient-centered care, have led to a huge uptick in applications.

Physicians “come into this rural area to dedicate [themselves] full time to this hospital,” Dr Gautam said.

Even in expensive private hospitals in the city, “the doctor doesn’t have time to look at the face of the patient,” he explained. “We need hospitals that are for the people.”

A focus on strict protocols designed to increase accountability and improve patient outcomes has also brought doctors and administrators to Siddhasthali, so they can learn from the techniques and training the hospital employs.

High-quality medical equipment and medications – many of them, including a portable ultrasound, EKG machine, non-communicable disease medications, analgesics, and prenatal vitamins, provided by Direct Relief – are also indispensable, Dr. Gautam said.

“We can go to rural communities and screen with our equipment,” he explained.

Even the solar project and medical oxygen plant help keep Siddhasthali self-sufficient. Surplus solar power can be sold for credits that then pay for patient care. Medical oxygen canisters can be distributed to the larger community, and the proceeds used toward hospital costs.

New dreams

State-of-the-art, carbon-neutral, and culturally sensitive medical care has all been achieved. Next for Siddhasthali Rural Community Hospital is a vital role in a larger vision of reliable, extensive, and widespread disaster response.

In the past, “every response we did was more related to donor funding,” Dr. Gautam said. Donors’ missions, and their willingness to fund response work, significantly affected Mountain Heart Nepal’s ability to care for patients.

With Siddhasthali as a permanent facility, “we’re better prepared to respond to emergencies from our side. We don’t have to wait for any resource.”

Having realized one dream, Mountain Heart Nepal’s physicians have developed one even more ambitious: a network of facilities across Nepal providing state-of-the-art care and efficient emergency response that are tailor-made for the country’s propensity to earthquakes and flooding, and its beautiful, but hard-to-navigate, mountainous terrain.

“We want to be in all seven provinces of Nepal, from the mountains to Terai,” a lowland area in the country’s south, Dr. Gautam said. “It will help us in reaching those unreached people, just to be close to the homes of the people.”

Dan Hovey contributed reporting to this story.

Since 2017, Direct Relief has provided $2.9 million in aid to Mountain Heart Nepal. In addition, Direct Relief last year helped equip the Siddhasthali Rural Community Hospital with medical-grade refrigerators to safely store vaccines and other temperature-sensitive medications, following the founding grant of more than $700,000.

The post A New Hospital in Rural Nepal Brings Disaster Resilience, Carbon Neutrality, and State-of-the-Art Care appeared first on Direct Relief.

Since the conflict escalated into open violence in April 2023, a team of health care workers from the International Organization for Migration in South Sudan – the UN Migration agency – had been providing immediate medical assistance for refugees and South Sudanese returnees at five border crossings in South Sudan. Some issues, like skin and eye infections, physical trauma, exhaustion, and hypoglycemia, could be cared for on the spot. Others, like chronic kidney disease, required swift access to dialysis and hospital care.

“They arrived in really dire condition,” Dr. Alai said of the people fleeing into South Sudan. “All of this is related to what people have gone through.”

From the beginning, IOM South Sudan’s medical team was on the lookout for cholera – a bacterial disease that spreads via contaminated water or food and that can kill quickly through dehydration, especially when instability or lack of resources limits access to supportive care. Waves of outbreak in the country between 2014 and 2017 were closely tied to civil war and displacement in the larger region. Those fleeing the conflict were sheltering in close quarters with limited access to safe drinking water. The eye and skin conditions the team was already seeing were indications of inadequate sanitation. And cases of cholera had recently been reported in Sudan, where attacks on water infrastructure were correlated with increased cholera deaths.

“Where there’s massive population displacement, we know the risk of transmission is higher,” Dr. Alai explained. In a situation like this, “it’s just a matter of time” before cholera appears.

Cholera was found in South Sudan in late September of 2024: A four-year-old child and her mother were the first diagnosed cases, and Renk County, near the border with Sudan, quickly became the most affected of the border crossing areas. The South Sudanese government declared an outbreak in October, and the disease spread quickly, causing more than 33,000 cases by April of this year.

An essential partnership

But IOM South Sudan’s vigilance had prepared them.

Direct Relief, an IOM partner, had been collaborating closely with medical staff, and dispatched a large-scale shipment of cholera treatment supplies, such as oral rehydration solution and IV fluids; 12 emergency medical backpacks; and other essential medical supplies, including additional oral rehydration solution, that IOM staff received in mid-October.

Equipped with the cholera treatment and emergency medical packs, IOM’s Rapid Response Team deployed to help contain the outbreak, setting up four cholera treatment units and numerous oral rehydration points to provide supportive care for people with cholera symptoms.

Although vaccines do exist for cholera, and antibiotics are sometimes recommended for severe cases, supportive care – particularly rehydration to replace the fluids and electrolytes lost through diarrhea and vomiting – is widely acknowledged to be the most important aspect of treatment. The vast majority of cholera patients will recover with supportive care, but an untreated case can quickly kill someone.

Direct Relief’s caches of cholera response supplies “can manage both the severe and the mild cases, so it really came in handy,” Dr. Alai explained. “We were able to control the cases in the community.”

In addition, she said, the analgesics, antibiotics, and other first-line treatments in the “meticulously packed” emergency medical packs were essential for patients experiencing pain, exhaustion, and infection. “It was really helpful at that point.”

A flexible approach

Dealing with the cholera outbreak demanded outside-the-box thinking. Because IOM South Sudan’s staff were working at border crossing points, their patients were virtually on the move, often by boat, which meant that providing on-the-spot care alone wouldn’t be enough. Medical staff trained local boat workers to monitor sanitation on board and to administer oral rehydration solution – the most important treatment for cases of cholera – to anyone who showed symptoms of illness. When people docked at Melut, on their way to safety in the South Sudan city of Malakal, medical teams came onboard to assess people and transfer patients in need of more comprehensive care to a local hospital.

“It’s a modality we had to adopt to manage the situation,” Dr. Alai explained.

She recalled one pregnant mother, traveling with her children, who became ill while traveling by boat. IOM’s medical team transferred her to the hospital with her children, where she received five days of treatment before traveling on to Malakal.

“A flexible approach” was essential throughout, Dr. Alai said. Even when people arrived at a border crossing with cholera symptoms, and could be cared for at an IOM-run health facility, their families needed cash assistance.

A mother with six children, one of them sick with cholera, might decide “to leave one behind and save the other five” without money to feed them, she explained. “We are happy they didn’t have to make that decision.”

A New Response

Although IOM South Sudan’s original focus had been on providing care to the refugees and returnees at the border crossings, staff members soon got word that Mayom County – an area of South Sudan that’s hard to reach due to flooding patterns and that has a high number of nomadic, pastoralist communities – had been badly affected by cholera.

“It happened so fast that, within one week, 70 people had died,” Dr. Alai recalled.

IOM staff deployed another team to Mayom – also equipped with Direct Relief medicines and supplies – and mounted a comprehensive response. They established an additional cholera treatment unit and a hospital-based treatment center, but again, Dr. Alai said, an innovative response was called for. When people from nomadic communities contracted cholera, they traveled long distances – sometimes for days – to access care.

“People were dying on the road on the way to the facilities,” she explained.

Patients who were severely ill often needed to be transported over floodwaters in canoes – a harrowing journey that made supportive care more difficult.

IOM staff set up additional oral rehydration points in cholera-affected areas – places where people with cholera could receive supportive therapies for the disease. Community health workers traveled along the roads, treating people with cholera symptoms as they encountered them. Canoes were outfitted with oral rehydration solution, and community health workers traveled with sick patients to administer treatment. IOM teams rehabilitated a community water source and constructed new sanitation facilities to keep the disease from spreading.

A widespread impact

Asked which elements of IOM’s response were most effective, Dr. Alai pointed to the most unusual ones: the mobile oral rehydration work (oral rehydration points are usually stationary in affected communities) and partnering with and training boat union workers. However, she stressed, a “multifactorial approach” is needed in a complex disease outbreak like this one.

Since April 2023, more than 1.1 million people have crossed the border from Sudan into South Sudan. In addition, it’s estimated that more than 50,000 people in South Sudan, including refugees and returnees, contracted cholera during this outbreak, and over 1,000 died from the disease.

But IOM’s presence has had a significant, lifesaving impact. More than 498,000 people received medical assistance from IOM South Sudan’s staff. Five cholera treatment units and a hospital-based treatment center, along with 21 stationary oral rehydration points, have treated thousands of patients.

Cholera is not yet fully contained in South Sudan. However, in Mayom County, an average of 50 people were hospitalized with cholera each day when the outbreak was at its worst. That number has dropped to one.

Direct Relief’s Research and Analysis modeling estimated that the organization’s supplies, about $54,000 in total value, averted 9,450 cholera cases and 366 deaths.

A new Direct Relief shipment containing two additional cholera treatment kits and a large-scale emergency health kit arrived in South Sudan on May 13 for IOM’s medical staff. More shipments of cholera treatment supplies are currently en route to the region.

Aaron Rabinowitz and Mila Dorji contributed reporting to this story.

The post They Fled to South Sudan for Safety. Cholera Followed Them. appeared first on Direct Relief.

“She was able to hold the baby in,” recalled Teresa Maniego, COO at the maternity clinic, which is located in the province of Palawan, in the Philippines. “But as soon as they parked in the parking lot, the solar lights started lighting up.”

The woman didn’t make it indoors fast enough, and a midwife helped her give birth just outside the ambulance.

Maniego wasn’t surprised. In the rural province where Bahai Arugaan is located, she explained, reliable electricity is hard to come by. The clinic can be seen from far away at night, simply because it’s brightly lit up – thanks to a solar installation funded by Direct Relief’s Power for Health initiative.

A $50,000 grant from Direct Relief funds Bahai Arugaan’s solar power system, as well as the administrative, logistics, and maintenance costs associated with ensuring it continues to run well. As of August 2024, the entire birthing center became fully powered by this solar installation and no longer relies on the regional grid, which Maniego said is subject to interruptions that have the potential to affect patient care.

Bahai Arugaan ni Maria, a reproductive and maternal health facility as well as a birthing center, is part of the Buma Sehat Foundation, founded by renowned midwife Ibu Robin Lim. Lim, a human rights advocate, is also a proponent of a gentler and more holistic approach to maternal health and birthing, especially for women in rural and lower-resourced medical settings.

For pregnant women arriving from miles around, the well-lit birthing center is a beacon of comfort where they’ll receive high-quality, gentle care in a well-maintained facility.

“Some give birth as soon as they enter the gate,” Maniego said. “Some of them would reach the parking lot.”

Even for people who aren’t pregnant, like weary travelers, the clinic feels like a place of safety.

“People will stop in front of the clinic, and take a rest, because there’s just light,” Maniego said. “It’s just such an amazing thing: At Bahai Arugaan, there’s always light. People feel safe stopping here.”

The solar installation powers all lighting, ventilation, cold storage, and other needs throughout the clinic itself. It also powers the huts where new families stay together after labor, and the well-lit gardens where Bahai Arugaan’s staff grow Malabar spinach, pigeon peas, and other nutritious foods to bolster their patients’ prenatal diets.

“It’s literally a farm,” Maniego said of the property. The lights even keep looters out of the garden beds, ensuring that the food staff members grow is given to pregnant women.

Currently, about 85% of the pregnancies Bahai Arugaan’s midwives attend are those of Indigenous women from surrounding communities. But that doesn’t need to be the case, Maniego said: “Whatever part of the Philippines you’re from, it doesn’t matter. You can come here to birth.”

The ventilated clinic rooms are also more comfortable for women who might otherwise labor in heat above 100 degrees Fahrenheit.

Midwives don’t just attend births; they also care for women throughout their pregnancies and after delivery. The nutritious crops they grow are part of a larger effort to help local women eat protein every day during their pregnancies, and give them access to healthy vegetables. They’re also encouraging women to come earlier for their deliveries.

“Some of them won’t call until the baby is crowning,” Maniego said. “The challenge really is making sure we reach them on time.”

Women in labor often arrive, lying down, in motorcycle sidecars, after long journeys down from their mountain communities.

“It’s pitch black when you drive at night,” Maniego said. “Bahai Arugaan is the only place that you see.”

The post For Pregnant Women in the Philippines, a Birthing Center Lit by Solar Power is a Beacon of Comfort and Safety appeared first on Direct Relief.

“Thousands of families were displaced because of the floods,” the Ugandan midwife recalled. Experience told her there wouldn’t be nearly enough providers to monitor pregnant women, attend deliveries, monitor mothers and babies postpartum, or ensure displaced women had access to family planning services. “These climate crises make women so vulnerable.”

Kiconco traveled to the district with a group of fellow midwives, where they found empty health facilities damaged by landslides—local health workers had fled to safety. They offered prenatal and postnatal health services, and distributed maternal health kits to pregnant women who were nowhere near the nearest health facility, so they’d have the medical supplies they needed for a delivery nearby.

She particularly remembered caring for pregnant women sheltering in primary schools without even a mattress, surrounded by their other children. “Even privacy was a problem,” she said. “We improvised with what little we had.”

Neha Mankani is a Pakistan-based midwife, and humanitarian engagement and climate advisor at the International Confederation of Midwives. She explained that, when pregnant women and new mothers are displaced by disaster, their ability to access care often depends on whether there is a practicing local midwife.

“The midwife is part of the community. She knows what the needs are,” she said.

When widespread flooding killed more than 1,700 people in southern Pakistan in 2022, and left millions homeless, Mankani was working in Karachi, Pakistan’s capital city. She and a colleague traveled to one of the affected provinces, planning to distribute kits with sterile birthing equipment and help provide continuity of care.

“The need was much greater,” she recalled. Pregnant women and babies in displacement camps were ill or malnourished, or needed routine antenatal and well-baby care. Traveling around to 23 displacement sites in just three months, “we were on the ground providing these services.”

Now, the goal for both Kiconco and Mankani – and for midwives worldwide who work in communities threatened by climate change – is to make midwifery widely available during disasters, and ensure that midwives are specially trained to care for patients in crisis settings.

“A safe, easy birth becomes something else”

The International Confederation of Midwives – a global organization that works with midwives and midwifery groups to build greater access to reproductive, maternal, and child health services – has chosen “Midwives: Critical in Every Crisis” as its theme for 2025’s International Day of the Midwife on May 5.

“Midwives are trusted first responders, who if enabled can strengthen health systems to be well-prepared to face any crisis. They can provide up to 90% of sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services, even in the most complex humanitarian settings,” ICM’s website explains.

Mankani said midwives are already used to providing community care in low-resourced settings, such as rural villages, and that many already care for patient populations struggling with the growing impacts of climate change: long droughts, catastrophic flooding, crop die-off, habitat loss, unsanitary conditions that cause diarrheal disease, cholera, and scabies, and extreme heat that can be especially dangerous for pregnant women and vulnerable newborns, just to name a few.

But in a world where disasters like tropical storms, large-scale floods, and wildfires are growing ever more frequent and extreme, more needs to be done, she explained. Midwifery needs to be integrated into disaster preparedness and response measures. Midwives need training to respond to crisis situations, and payment that will allow them to stay with their communities and oversee vulnerable patients during a disaster.

Often, “a safe, easy birth becomes something else because there’s no skilled provider” during disasters, she said. The stress a pregnant woman experiences, and the unsanitary conditions that often come with displacement and extreme weather, also pose serious risks.

For Mankani, a woman she saw during the 2022 flooding vividly illustrates the need for a broader approach to maternal and child care.

At a camp for people displaced by the flooding, Mankani was providing walk-in care in a tent. A woman who was pregnant with twins came in for an examination, and Mankani immediately noted that both babies had “very elevated” heartbeats. The woman herself had a fever, and Mankani suspected malaria.

She immediately offered to send her patient to a hospital, explaining that “the babies are not safe right now.” But the pregnant woman had three other children, and knew no one else in the camp with whom she could safely leave them.

“She refused care after that, so we don’t know what happened to her,” Mankani recalled. “This is how people are having to go through this.”

“She’s the one who feels that pain”

In addition, Mankani said, midwives need to better understand the impacts of climate change, so they can educate their communities about what’s coming and how best to prepare. A farming community may need to grow new crops to address malnutrition, develop new, more resilient water systems, or know the most effective ways to cool down, especially in cultures where women cover their heads and bodies.

Kiconco explained that in Uganda, where subsistence farming is a necessary activity for most families, educating people about climate change is essential. Long droughts have damaged crops and farmlands; floods can sweep whole harvests away.

“For the past three days we’ve had floods in the city,” she observed. “It’s destroyed even my garden.”

Teaching families what to expect in coming years, and how to grow and store more resilient crops like beans and millet, will be essential. Kiconco explained that midwives have an essential role to play. “We are in touch with most of the community members,” she said.

Moreover, she said, Ugandan women are often eager to learn how best to ensure their families are fed. If a woman’s children go hungry, “she’s the one who feels that pain as a mother,” Kiconco explained. “That’s their culture.”

“They knew exactly”

Many climate-vulnerable countries train midwives to work in small community clinics, Mankani said, but may not provide sufficient training for disaster response or care outside clinic walls.

“They don’t have birthing kits, they don’t know disasters are in their scope of work, they don’t have resources,” she explained. Her plan is to change that: “They also need to have that flexibility to pivot.”

For Kiconco, responding to disasters without sufficient supplies is a source of distress. “We don’t have what we need to use to help them,” she said of her patients. “That affects us mentally. You have the knowledge, you have the skills, but you don’t have the resources to fight for this mom.”

Mankani conducts trainings with midwives in disaster-vulnerable countries, teaching them how to create a portable cache of disaster supplies and helping them develop responses to different scenarios. Frequent impacts of climate disasters, such as sexual violence and obstetric emergencies, are discussed as well.

Some things have to be adapted from place to place, she said, but many elements of the training are universal.

At a training for midwives in Kenya, Mankani showed photos of the flooding in Pakistan, and of people displaced and severely affected by the disaster, asking them, “What do you think will happen to women in these communities?”

“They knew exactly,” she recalled. “These kinds of things are happening all over the world in different shapes and forms.”

“We just want to see…”

However, Mankani emphasizes that individual or small-scale actions aren’t, and shouldn’t be, enough.

“Midwives should not be doing their response in isolation,” she said. Even the most dedicated provider cannot work without recompense, in dangerous conditions, with inadequate supplies. Systemic training, equipment and supplies, mental health support, large-scale planning and response measures, and greater awareness are all needed.

“Midwives are resilient and they’re working in all kinds of situations,” Mankani explained. “But they still need to have the resources.”

Kiconco said she sees tremendous dedication in the midwives she encounters. They’re willing to respond to disasters; they just want to do it well.

“We just want to see a healthy mother, a healthy baby, a healthy community,” she said.

Direct Relief supports midwives’ associations around the world with grants and material medical support for both community and in-the-field care.

The organization also provides emergency grants to midwifery organizations working in emergency settings, including the National Organisation of Nurses & Midwives of Malawi, Hope Foundation for Women & Children of Bangladesh, and the International Confederation of Midwives.

In the past year, the organization provided 900 full midwife kits and 500 resupply kits – enough to support 70,000 safe births – to 17 countries, including Yemen, Haiti, Uganda, Kenya, and Paraguay, all of them vulnerable to climate impacts.

The post Midwives in Climate-Vulnerable Countries Prepare for a Future of Disaster Response appeared first on Direct Relief.

“Frankly, the whole community has been traumatized,” said Spiro, the director of development at the Pasadena Educational Foundation, which works with the local school district to meet the educational, health, and related needs of students and families.

Spiro, who lost his own home in the blaze, said many families who have been fighting to meet the most immediate needs – safe housing, food, medical care – are only beginning to think about confronting the mental health or educational impacts of the Eaton Fire.

He – along with supporters of schools across Los Angeles County – expects the need for mental health services and educational support to rise significantly in the coming months.

“Things are very different here,” he explained. “You can feel the stress. Every time you look at the scorched mountains, it affects you.”

Erica Villalpando and Lara Choulakia, both licensed clinical social workers for Pasadena Unified School District, said meeting students’ mental health needs was already challenging.

“Especially post-Covid, we’ve been at capacity from the beginning of the school year,” even with several practitioners on staff, Choulakia said.

Offering mental health support services through the school has been key since the Eaton Fire, Villalpando said. Parents may need “a short psychoeducation session” to know how to support a child who keeps drawing the flames again and again. A child who wants to tell and retell the story of his family’s evacuation needs an attentive, empathic therapist.

A local approach

Across Los Angeles County, schools and school districts are working to meet the mental health and educational needs of families affected by the January wildfires.

Children and families across the county have experienced trauma and immense stress. Many have lost their homes and schools, and many are still struggling to secure housing, nutritious food, and other necessities. Students are at risk for learning loss and other serious impacts to their education, which can further harm mental and physical health.

The county’s three education foundations, working closely with school districts, are funding school grants and developing programs to respond to these urgent needs. Through their support, local school districts are able to hire crisis counselors to care for students and families over the coming months; students at schools across the county will participate in summer enrichment programs; and teachers will set up “calm corners” and purchase books and toys that teach social-emotional skills.

Direct Relief is supporting the Greater Los Angeles Education Foundation, the Pasadena Educational Foundation, and the L.A. Unified School District Education Foundation – three organizations that work closely together – with grants of $500,000 each, totaling $1.5 million in funding, for their work responding to the L.A. County fires.

“When you’re displaced, that’s all gone”

Education and health outcomes are deeply intertwined, a relationship that’s been studied closely in Los Angeles in particular. Higher levels of education are associated with lower levels of chronic disease, better mental health, and other markers of well-being. The relationship works the other way around, too: Health concerns as diverse as depression, asthma, and poor nutrition cause students to miss school and can interfere with learning.

Kerry Franco, president at the Greater L.A. Education Foundation, said that this intersection between health and education has long been a priority for organizations like hers.

“A healthy, well-adjusted child is going to give their best and really thrive academically,” she explained.

GLAEF embraces a Community Schools Model, where school sites serve as hubs for community resources, offering everything from onsite mental health care to connections to outside social services. The goal is to be “so tuned in with the students and families that there is real-time engagement and support,” Franco said.

The Covid-19 pandemic and its aftermath have taken a severe toll on students’ mental health, which was already a growing area of concern, Franco explained. Many families were already confronting food and housing insecurity, and suicidal ideation and other symptoms of urgent mental health needs were on the rise. “The long-term impact [of Covid-19] hasn’t even been written yet,” she said.

The effects of the January wildfires on an already high level of need are hard to even fathom. A sense that “‘I’ve lost my school, I’ve lost my home, I’ve lost my community’ is difficult for the savviest adult in the world,” Franco observed.

Her foundation’s priority now is, as much as possible, to prevent further impacts to students and families, and enable their long-term recovery.

The Direct Relief grant funding will be used to provide counseling services to students and staff – many of whom were also deeply affected by the fires, are experiencing their own trauma, and still struggle to secure necessities like stable housing. Micro-grants will fund teacher-led projects to equip classrooms with necessary resources and new programs.

L.A. County schools will also use the money to develop climate resilience and sustainability plans, knowing that wildfires will continue to be a threat to their communities. And finally, enrichment programs after school and over the summer will prevent learning loss and provide a sense of community.

Community plays an indispensable role for many families across greater L.A., Franco said. “When you’re displaced, that’s all gone,” she said. “We’re going to make sure that kids, wherever they are, have that support, that they feel safe in their physical environment, their family is engaged.”

“A peak comes at six months”

Before the wildfires, Spiro was proud of an instructional garden program that taught students at Pasadena Unified schools how to grow produce and “have a different relationship with the earth.” Many of the district’s students lived in food deserts with little access to fresh foods, he explained. Educators wanted kids to learn that “good food comes from the ground.”

Now, Spiro said, the program is indefinitely on hold: “They can’t eat anything that was grown in any of the soil.”

It’s just a small example of the enormous impact the wildfires have had on the district’s students, families, and staff.

Pasadena Unified has been helping families connect to services supporting the most immediate needs, such as food and housing. Direct aid has been distributed to families and staff to help them secure housing and other essentials. In addition, Spiro said, the district and education foundation are both highly aware that measures to support mental health and prevent learning loss will need to grow rapidly in the coming months.

Community representatives in Colorado, where massive fires have destroyed hundreds of thousands of acres in recent years, reached out to the Pasadena Education Foundation to offer their perspective, which Spiro summarized: “‘Your long-term need is going to be the students, the families, and your own mental health. Don’t give all the money you’re receiving just yet; hold some back to address the long-term mental health needs.’ They said a peak comes at six months.”

Mental health practitioners have reported that the number of threat assessments they conduct each week – a process that occurs when a child reports a desire to harm themselves or others – has increased. Students are expressing elevated levels of sadness, stomach pain, anxiety, and other symptoms of emotional distress.

Spiro said many staff members, like him, lost their homes, and many need trauma-informed mental health services so they can continue their own work.

The funding from Direct Relief will allow the school district’s mental health services department to hire two full-time crisis counselors to support staff, students, and families. In addition, the grant will help fund the district’s Summer Enrichment Program, which will enroll more than 1,000 children this year.

“It’s a fun, supportive learning program,” Spiro said. “We wanted to make sure everybody had the opportunity to send their kids to our program, and the cost would not be a barrier.”

While kids are participating, parents can have some time to breathe and search for housing and other needs. Spiro, currently living in a 400-square-foot vacation rental, can empathize with families crowded uncomfortably into temporary, too-small housing:

“I cannot imagine what that is like with children,” he said.

“People are calling, asking for help”

Responding to the wildfires requires a hyper-local response, said Sara Mooney, interim executive director at the LAUSD Education Foundation. While schools across the district were affected, a school that’s completely burned down has different needs from a school that’s opened its doors to displaced students.

“We really rely on the content experts of our school district,” Mooney said.

For LAUSD schools, Mooney explained, “joy and wellness” need to be as important as academics: “You can’t teach a child unless you touch their heart.”

LAUSD Education Foundation will use grant funding from Direct Relief to provide fully funded mental health support to local families. The district’s mental health team is working closely with community partners to place people experiencing mental health symptoms with a local counselor.

While the district is conducting outreach to let families know this support is on offer, Mooney said it’s often not necessary. “People are calling, asking for help,” she said.

The funding will also go to support mini-grants for teachers and schools, covering the cost of bibliotherapy, social-emotional learning tools, “calming corners” where students can retreat when they feel overwhelmed or distressed, and other support measures.

“We want to help kids handle their emotions in a healthy way,” Mooney explained.

A number of the grants will also provide support, such as an upcoming wellness retreat, to faculty and staff.

“All staff in that area were first responders,” Mooney said. “They were evacuating kids onto buses while the fire bore down.”

The post Mental Health Support, Summer Enrichment, and Mini-Grants Meet Growing Needs After L.A. Wildfires appeared first on Direct Relief.

The quakes, the strongest of which registered at a magnitude of 7.7, have killed more than 3,500 people and injured thousands more. Dr. Si Thura, the chief executive officer of Asia-based nonprofit Community Partners International, described local health centers reduced to rubble, and no medicines or supplies available in some areas, even for patients with physical trauma.

“At all levels, the facilities are gone,” he said.

So many people lost their homes that thousands have been sleeping on the street. “There are rains in the central Myanmar area…so people are now sleeping in the rain,” compounding the risk of water-borne illnesses, tetanus, and digestive diseases caused by contamination, Dr. Si Thura said. “It’s a bad situation for hygiene.”

CPI’s teams on the ground have spent the days since the earthquakes providing emergency care through a roving mobile clinic, distributing water and sanitary supplies, assessing health facilities for damage, and delivering medicines and medical supplies to health centers and hospitals that are still able to operate.

Decades spent building relationships within Myanmar’s complex and fragmented social and political contexts, and deep partnerships with local service providers embedded in the country’s hardest to reach communities, give CPI extensive reach.

“Because of the trust we’ve built over 27 years, and our partner network on the ground, we’re able to reach most of the affected areas,” explained Dr. Tom Lee, CPI’s founder and a professor of emergency medicine at UCLA.

A background of conflict

More than 70 years of conflict in Myanmar have taken a tremendous toll on its citizens’ health. HIV, tuberculosis, and malaria are all serious health concerns in the country – and CPI’s programs focused on preventing infectious disease were shut down in February, due to USAID freezes.

Airstrikes and other conflict-related violence cause physical injuries and limit access to health care. Rohingya refugees, forced to flee their homes in 2017 in response to genocidal violence, continue to need care in camps that are vulnerable to flooding and disease.

Communities in Myanmar still strongly feel Covid-19 pandemic’s economic and health impacts, Dr. Lee said.

Trust-based relationships, crucial access

All of these elements add to the devastation the earthquakes have caused, he said. While Myanmar’s urban centers, like Mandalay, generally have more health resources, they’re in no way equipped for the extraordinary medical and mental health needs.

These areas are so densely populated that Dr. Lee thinks the actual death toll and the number of injured are likely “much greater” than current estimates.

Media reports in the earthquake’s aftermath have focused on NGOs’ difficulty receiving official permission to enter Myanmar and deliver supplies in the country. “It’s hard to get permission…because there’s conflict and there’s civil war,” Dr. Lee explained. CPI’s local presence in Myanmar and deep, trust-based relationships have allowed staff members crucial access to patients and healthcare providers.

“A way to make it happen”

Until the most emergent needs from the earthquake are met, Dr. Si Thura explained, CPI will focus on getting medicines and supplies to community healthcare partners, providing medical care in areas where local partners are incapacitated, and delivering water and supplies to affected communities to reduce the impacts of damaged sanitation.

Over the long term, however, bigger goals will have to be achieved. Damaged health systems will need to be restored. Diarrheal diseases will likely spread in crowded and wet conditions. Humanitarian funding cuts, damage to health systems, and a lack of cold-chain infrastructure will make infectious diseases like tuberculosis, HIV, and malaria even more serious threats in the long term. Dr. Si Thura is even concerned the lack of containment may have international consequences: “Diseases don’t respect borders.”

Providing mental health resources will also be an urgent priority, Dr. Si Thura explained: The people of Myanmar, already living against a background of violence, now must confront the aftermath of a devastating disaster.

“Psychosocial support is really needed, because people are really desperate,” he explained. “We are going to find a way to make it happen.”

Providing the right support, as urgently as possible, is Dr. Lee’s highest priority. A Direct Relief emergency grant of $50,000 will fund CPI’s first, most urgent response phase.

“Five minutes after the earthquake hit, I got a text” from a Direct Relief emergency responder, Dr. Lee recalled. “You guys always come through.”

Dr. Lee cautioned that what’s most needed after a disaster isn’t always what people might expect: For example, he remembered, Rohingya people fleeing genocide received plenty of rice and pans to cook it in, but not nearly enough fuel to light cooking fires. CPI’s model of working with community providers relies heavily on local expertise and insight, to help them source medicines and decide on next steps.

“The local people are the smartest ones, the ones who know exactly what they need,” Dr. Lee said.

The post In Myanmar, Earthquakes Add a New, Deadly Threat to Struggling Health Systems appeared first on Direct Relief.

“Someone who has come…with no hope, and seeing them leave with hope” makes his work fulfilling, he said.

Some of his young patients have been misdiagnosed before, sometimes repeatedly. Some have been rejected by friends or family, or heard parents worry that paying for medication or schooling for a child who will never be cured isn’t worthwhile.

These are all experiences Dr. Manzi knows. The 27-year-old physician confronted each of them during his own childhood.

Today, he works for the Rwanda Diabetes Association, the organization that supported him with free insulin and monitoring supplies for his own diabetes, taught him the ins and outs of managing his blood sugar, and assured him that his own life was only beginning. It’s also the organization that helped him grow into a dedicated advocate and educator for people with diabetes and their families.

“Trust me”

In 2008, at age 11, Aime Manzi became suddenly unwell. Within a few weeks, despite his young age, he lost more than 30 pounds. He needed to use the bathroom so frequently that his brother complained about sharing a room with him, and his teachers assumed he was looking for excuses to leave the classroom. He often fell asleep in the middle of the day, during class, compounding their frustration.

A local hospital thought he might have malaria or tuberculosis – both common and highly visible infectious diseases in Rwanda. “I think they didn’t think a young person could have diabetes,” Dr. Manzi recalled.

Eventually, the doctors decided he was dehydrated, and instructed him to leave school temporarily, and try to eat and drink more.

That didn’t work, so his parents took him to a traditional healer, who said he had been poisoned and provided a medicine that made him vomit uncontrollably whenever he took it. Then, thinking his illness might be spiritual, they took him to a Catholic priest, hoping for a miracle.

“I started to believe this was a punishment from God,” Dr. Manzi said.

When the young Aime Manzi collapsed, nonresponsive, in the middle of doing a chore, an uncle carried him in his arms for three hours to a hospital in Kigali, where he was diagnosed with type 1 diabetes. Doctors explained that the disease was lifelong and would require daily injections, but Dr. Manzi’s parents were skeptical.

Aime had trouble managing his injections several days later – no one had properly explained the protocols, he said – and his parents assumed he’d probably been cured and no longer needed to buy insulin.

But, of course, that wasn’t possible.

Eventually, Aime was referred to the Rwanda Diabetes Association, a nonprofit organization where doctors showed him how to manage his blood sugar and provided him with a blood glucose meter, test strips, and insulin, all free of cost. Without the support they provided, he said, his parents would not have been able to manage the expense: “It was a lot.”

Aime’s parents were upset to learn that their son would always have diabetes. The expense and difficulty of providing separate, appropriate meals disturbed them, and they assumed he’d developed the disease by eating too much sugar.

“If you eat too much sugar, you’re going to be like Manzi,” Dr. Manzi recalled other parents telling their kids.

School in Rwanda requires tuition fees, and Aime’s parents didn’t want to pay them. Dr. Manzi summed up their perspective: “Instead of spending money on this one, we can just spend money on the other kids who are healthy.”

At a time of heightened concern about AIDS and tuberculosis, two diseases that spread through person-to-person transmission, other parents didn’t want their kids to spend time with him, assuming he might transmit his diabetes to them.

“I was left with no friends to play with,” Dr. Manzi said.

Then the Rwanda Diabetes Association invited him to an overnight camp session – an invitation that marked a turning point in his life.

The other kids at the camp “were young kids, very joyful, doing well at school,” he explained. “They were OK with insulin, they could inject themselves well. I was like, ‘How did you do it?’”

Equally importantly, staff members focused on teaching the campers that their diabetes was completely manageable, and that they could live great lives and achieve long-term dreams.

When Aime arrived home, he told his parents, “‘You don’t believe in me, you think I’m going to die, but trust me: Let me go back to school.’”

He also began volunteering with the Rwanda Diabetes Association, encouraging other kids with new diagnoses to see their diabetes as manageable and their future as bright.

“Change the Whole Narrative”

The last puzzle piece fell into place when Aime asked a science teacher what he knew about diabetes. (“I was testing him a little bit,” Dr. Manzi admits.) The teacher’s answer was full of misinformation: Diabetes could only be passed on genetically, he said, and those who had it were always “one step from death.”

A natural advocate, Aime corrected his teacher, who invited him to speak to his whole class about diabetes – a daunting prospect for a child, but “I wanted to play with my friends again,” he said.

That experience – and reconnecting with his classmates – taught him to love science, and to seek out chemistry and biology classes, where he frequently asked teachers what they knew about diabetes. “Teachers didn’t really know how diabetes worked, they had a negative image,” he recalled. “I liked to challenge them and change their mind.”

Throughout medical school, he continued to volunteer with the Rwanda Diabetes Association, leading camps and peer support groups. Being a doctor makes it possible for him to “change the whole narrative” surrounding diabetes in Rwanda.

“A Happy Man”

Today, Dr. Manzi is a general physician who works with children with diabetes at the RDA’s clinic in Kigali. (He eventually hopes to specialize in endocrinology.) He’s also a committed advocate for his patients, working with their families so they can offer effective support and see the diagnosis in an appropriate context, and educating larger communities about how diabetes actually works.

The Kigali clinic cares for about 500 young patients, he said, and the RDA serves approximately 1,300 across Rwanda.

Rwanda has made tremendous investments in its health system over the past few decades, and Dr. Manzi said children with diabetes often have the option of being treated at “fancy clinics.” But they frequently prefer the RDA, which, while reportedly less fancy, offers “a family of people with the same condition.”

Dr. Manzi loves telling his young patients that he, too, has type 1 diabetes. It’s often the first step of teaching them how much they have to look forward to, and how little the disease will limit them.

For many of them, caring for diabetes would be financially impossible without support. Their family incomes are simply too low to pay for insulin, testing strips, a blood glucose meter, and regular blood panels, as Dr. Manzi’s was during his childhood.

Through the Rwanda Diabetes Association, they get all of these at no cost. The RDA receives insulin from Direct Relief through Life for a Child, an organization that supports young people with diabetes around the world. Through a partnership with Life for a Child, Direct Relief has provided insulin and diabetes management tools to children in 44 countries. In addition, because insulin must be transported and stored under precise temperatures and conditions, Direct Relief provides cold-chain support to many local partners.

Since 2011, Direct Relief has supported the Rwanda Diabetes Association (also called the Association Rwandaise des Diabétiques) with more than $10.9 million in material medical aid, including insulin, glucose test strips, and other essential components of diabetes management.

Just recently, Dr. Manzi began treating a 14-year-old boy diagnosed with diabetes. The teenager, a bright student, reminded Dr. Manzi of himself – “I think I wasn’t as bright,” he said drily – and this boy, too, was in danger of going without an education.

He was having difficulty managing his blood sugar levels at school, where the food provided wasn’t enough to counter the level of insulin he needed to take. Fearing the painful symptoms of low blood sugar, he was even refusing to administer insulin while at school – and beginning to develop complications. His mother, distressed, had begun to wonder whether keeping him in school was worth the money.

“I’m still working to make his glycemia [a medical term for blood sugar levels] fall in the right range,” Dr. Manzi said. “If it all works out, I’ll be a happy man.”

The post After a Childhood Spent Struggling with Diabetes, a Rwandan Doctor Teaches Children to Thrive with the Diagnosis appeared first on Direct Relief.

Even before the war, Yemeni families arranged marriages for 12-year-old daughters, said Dr. Wafa Al-Shaibani, the NGO’s country director. While current numbers aren’t available, she said about 30% of marriages before the war began involved girls under 18.

“We try to educate people that she’s a child, that she will have complications” with early pregnancies, Dr. Al-Shaibani said. But it’s most often poverty, exacerbated by years of war, that motivates the decision.

“The people, they get hungry,” she explained. A family that can’t feed a daughter may feel compelled to agree to an early marriage so she and their other children can survive.

MedGlobal Yemen’s midwives care for pregnant women and girls at local clinics, many located in rural communities where health care is otherwise inaccessible. Dr. Al-Shaibani said that while education about reproductive health and the risks of child marriage are available to patients, midwives’ work is often preventing the worst from occurring.

“When a child comes to the health facilities, she has to have special care,” she explained. “At least we can help these mothers not to die.”

The War on Women’s Health

War, no matter when or where, is disastrous for the health of women and girls. And in Yemen, where an uncertain period of calm has given way to new U.S. airstrikes across the country (the most recent attacks occurred overnight and into Monday morning) and escalating hostilities, the consequences of war have been devastating. A Yemeni woman dies in childbirth every two hours, most often from preventable causes, according to the United Nations Population Fund, and 5.5 million women lack access to reproductive and maternal health services.

Dr. Al-Shaibani said that women and children currently make up 77% of those displaced in Yemen, and a growing number of households are headed by women alone and dependent on women’s income.

Breast cancer, the most common cancer among women worldwide, is a growing threat in Yemen, where cancer treatment centers have closed and those that remain are overburdened, doctors have fled the country, and funding and cancer medications are difficult to come by. Dr. Amani Hussein Saleh Shehab, an oncologist at the Pink Clinic in Yemen’s Lahj Governate, said that most women with breast cancer have an advanced case by the time they are able to be diagnosed.

To meet women’s health needs in Yemen, Direct Relief is supporting both MedGlobal Yemen and the Pink Clinic, founded by longtime partner Yemen Aid. MedGlobal Yemen received a 2024 grant of $100,000 to train midwives to operate maternal health and family planning clinics in remote areas where health care is much less accessible. The Pink Clinic was funded through a grant of $16,000, part of more than $360,000 in grants Direct Relief has provided to Yemen Aid.

MedGlobal Yemen also received 20 midwife kits, each containing enough medical instruments and consumables to facilitate 50 safe facility-based births, and other medical supplies.

In addition, through Yemen Aid, Direct Relief provided a delivery of the breast cancer medication trastuzumab, a biologic agent requiring precise cold-chain transport, monitoring, and logistics, and valued at a $1.77 million, to the Ministry of Health.

“Despite very limited refrigerated storage at the Aden airport, disruptions in regional flight schedules, and restrictions on cargo size, these critical temperature-controlled medications were delivered safely,” said program operations specialist Holland Bool.

“Her Families and Her Tribe”

Restrictions on women’s movements, a lack of health care access, and men’s control over family decision-making present ongoing threats to health outcomes for mothers and babies, Dr. Al-Shaibani said. Women may not be allowed to have a skilled birth attendant, or deliver outside the home, making infections like tetanus or complications like a ruptured cervix much more likely.

To make maternal health care and skilled delivery more accessible and routine, MedGlobal Yemen is training midwives to operate clinics in remote communities.

“There are very remote areas where there are no health facilities, no access to any health care,” Dr. Al-Shaibani explained. Families have no money to travel to faraway health clinics, and are often more trusting of their own communities.

In response, MedGlobal developed the idea of Female-Friendly Community Clinics, working with midwives who were already part of remote communities but who would primarily have worked in patients’ homes, receiving money or even food for their services. “She is one of the community, so these are her families and her tribe,” Dr. Al-Shaibani said of the midwives. “They do this work but it is not organized, so we will organize it.”

Midwives trained by MedGlobal and outfitted with Direct Relief maternity kits will operate in about 50 small local clinics, providing family planning, maternal and antenatal health services, and women’s health education. Complicated cases and young mothers can be referred to a health facility to receive additional monitoring and care.

Those who have completed the training have described using new techniques to save a mother and baby during a breech delivery; working through the night to attend critical cases; learning to use portable ultrasound devices and insert IUDs during patient care; and rejoicing in their ability to reduce complications for mothers and babies.

For women who are their family’s sole source of income, too – increasingly common during the war, Dr. Al-Shaibani said – or who have struggled to feed their children as the conflict drags on, midwifery offers a valuable career, providing financial stability while benefiting the larger community.

“She is also a woman who needs to feed her children,” Dr. Al-Shaibani explained.

Critical Care

Breast cancer is the most common cancer for women worldwide, but Yemen reports a high rate of young women with breast cancer, a high likelihood that the cancer will not be diagnosed until advanced stages. where oncological treatment centers have closed and those that remain are overburdened, and where funding and cancer medications are difficult to come by.

The Pink Clinic, in Lahj, is focused on breast cancer, and hopes to soon offer treatment for cervical cancer as well. Dr. Shehab, the oncologist, said that the decline in services has also meant less awareness – “many families don’t know about this cancer” – and most people can’t afford treatment even if a woman develops breast cancer. Shame is an additional factor, with women who show symptoms often preferring to hide them until pain or symptoms become untenable.

“Most cases that attend the Pink Clinic are in the critical or late stage,” she said.

Despite the challenges, Dr. Amani said, the clinic has had remarkable success. One woman came to the clinic seven months pregnant, but urgently needed treatment for breast cancer. She and her baby are both healthy now. A new mother who came to the clinic with a rare type of cancer was quickly treated and able to return home.

For many women with breast cancer in the surrounding area, the Pink Clinic is their best hope. There are hospitals in Aden, a major city, but it’s far to travel. Moreover, Dr. Amani explained, women in Lahj Governate are particularly vulnerable to cancer because of contamination from nearby laboratories and factories.

Loss of international support threatens the Pink Clinic’s work, and Yemen Aid staff are concerned about funding the clinic’s services, as well as other programs focused on women and children, after July.

“A New Normal”

War doesn’t just kill people directly, Dr. Al-Shaibani said. It threatens their health, and merely surviving is just too low a bar.

“A mother may survive, but she survives with a ruptured cervix” when health services are cut off by conflict, she said.

MedGlobal Yemen’s goal isn’t just to meet the most emergent needs, but to rebuild the health services that Yemeni people need to live good lives, even as the conflict goes on – what Dr. Al-Shaibani calls “a new normal.”

“We [build] qualified health services that will help them in the future,” Dr. Al-Shaibani said. “It’s not just life. It’s quality of life.”

The post Yemen’s War Has Devastated the Health of Women and Girls. Midwives and Doctors Are Building a “New Normal.” appeared first on Direct Relief.

Doctors and other providers were working amid crumbling infrastructure and outdated, broken equipment in areas that former president Bashar al-Assad’s regime had controlled. Even critical medical supplies were scarce. Medical records were missing. Salaries for medical workers were unpaid.

“There was a huge network of corruption,” Dr. Tajaldin, a country director in Turkey for the Syrian American Medical Society, a volunteer-run medical relief organization. International sanctions “didn’t affect the regime, but they did affect the infrastructure of the country. The health infrastructure is very old and very weak. It’s a disastrous situation.”

Perhaps most worrying of all was the “spotty and dangerous” skill set of medical providers in regime-controlled areas, said Dr. Amjad Rass, an internal medicine physician and chairman of the SAMS Foundation. Physicians who’d been cut off from communications and training were using protocols that had been outmoded for a decade.

A director at a Syrian children’s hospital told Dr. Rass that, during a recent visit from German physicians, a child went into cardiac arrest. The doctors on staff didn’t know how to do CPR according to protocol. “I wanted the floor to open up and swallow me,” the director recalled.

Syria’s future is still highly uncertain. New, large-scale outbreaks of politically motivated violence have killed more than 1,300 people, reigniting widespread terror. Humanitarian aid channels haven’t opened as hoped into Syria, and shutdowns in public funding have created new difficulties for nonprofits working in the war-torn country.

Increasing access to health care across Syria, especially to formerly isolated areas, must be a vital priority, SAMS volunteers said.

“Those things don’t exist in Syria”

Media reports on Syria’s health care system have primarily focused on the direct impacts of war: bombed hospitals, providers operating in darkness. But those reports focused on areas of the country that were controlled by the rebels and sometimes accessible to outsiders. Even for doctors who’d worked in the rebel-controlled northwest of Syria for years, gaining new access to regime-controlled areas was shocking.

In particular, SAMS physicians and staff described vast and widespread needs – for mental health care and psychosocial support, working dialysis equipment, cancer treatments and other specialty medications – coupled with an urgent demand to train providers in up-to-date techniques, new medical knowledge, and clinical best practices.

Doctors described such widespread fear, anger, and distrust that the situation amounted to “collective trauma,” said Dr. Iyad Alkhouri, a child psychiatrist who works with SAMS. “You…wake up one day and you don’t have any moral code or order, and society is completely collapsing,” he said.

Most urgent from a mental health perspective, he said, are the thousands of people who have been released from prisons. Many are malnourished, dealing with musculoskeletal conditions, or need treatment for tuberculosis.

“To survive an earthquake is a miracle, to survive 20 years of torture is heroism,” he said.

Dr. Alkhouri is concerned that, while Syrian psychiatrists are dedicated and well-meaning – he estimates there are about 80 of them still in Syria, where they’ve been working in appalling conditions for years to care for patients – he wants to ensure that released prisoners are treated with up-to-date approaches used with survivors of torture. Their symptoms are “a normal reaction” to living in unimaginable circumstances.

“To be told they have PTSD is so demeaning…Their main need is not medicine for nightmares. Their main need is dignity,” he said. “We have to start from zero, without insulting those professionals who worked under the regime for decades.”

Only about 10% of Syrians in need of mental health care will require a psychiatrist, Dr. Alkhouri said. The others primarily need psychologists, social workers, and other providers who focus on non-medical care, and who can provide mental health support under supervision from therapists versed in new research and techniques.

But “those things don’t exist in Syria,” he said. Instead, mental health is highly pathologized and stigmatized, seen as a medical ailment that removes people from mainstream society.

Physicians in primary care centers and emergency departments “were looking at the minimum acceptable quality of care,” Dr. Tajaldin said. Patients provided what supplies and medications they could afford, and “emergency was using whatever was available.”

“The backbone”

A simulation lab in Qah Hospital, in northwest Syria, is key to SAMS’s strategy for rebuilding Syria’s health care system.

The lab, completed in April of 2024 and supported by a Direct Relief grant of more than $708,000, precedes the regime’s fall. However, the trainings and certifications it offers – the Sim Lab has already trained more than 400 physicians and medical workers in basic and advanced cardiovascular life support, maternal and perinatal health care, and much more – have proven indispensable to doctors and other providers in newly accessible areas.

Additional, advanced trainings, such as in new surgical techniques, are also planned.

A recent SAMS training for physicians conducted in Aleppo and Latakia, two Syrian cities, taught new techniques for diagnosing and treating physical trauma, low blood oxygen, shock, kidney injury, and other emergent conditions. The training concluded with two days in the Qah Sim Lab, providing hands-on experience to help physicians prepare for a variety of life-threatening clinical scenarios.

“Over a decade of war has forced many academic and teaching facilities to close their doors, which has led to major disruptions to medical education programs throughout Syria. The 2023 earthquake in northwest Syria caused further strains on an already overburdened health care workforce,” explained Dan Hovey, vice president of emergency response at Direct Relief. “This medical simulation training facility will provide thousands of Syrian health care workers access to high-quality and hands-on medical training, improving the standard of care in healthcare facilities across the region.”

Many physicians and medical students in Syria lack the real-life skills they need, Dr. Rass said: “They get stumbled by someone with low blood pressure, but they can give you a whole lecture on what causes low blood pressure.”

The Sim Lab has the potential to save countless lives across Syria, but finding funding that isn’t directly focused on emergent care can be difficult. Dr. Rass said.

“I can go to any donor and say I need to support pediatric services,” he said. Convincing donors to support a high-tech training center, where the impact is longer-term and farther-ranging, is more complicated.

“You were the backbone,” he said of Direct Relief’s support.

“A new day”

Cohorts of medical providers and students from regime-controlled areas have traveled to the Sim Lab to learn lifesaving new techniques for intensive care, emergency work, and specialist treatment. “I’ve seen this on TV. I thought this would never get to Syria,” one medical student told Dr. Rass.

Dr. Alkhouri described working with Syria’s government ministries to incorporate mental health degrees into higher education and reintegrate former political prisoners back into their families and communities. The new Ministry of Health has established a task force to address widespread health needs, like kidney disease and cancer, Dr. Rass said – and four of its nine members are SAMS physicians.

“We are assisting the health authorities to rebuild and regulate the health system,” Dr. Tajaldin explained. Assessing health care facilities’ needs, retraining providers, and finding gaps between need and available care are high priorities.

Rebuilding Syria’s once-celebrated health care system will take time, Dr. Rass said. However, SAMS has spent years working against a background of unending war and destruction. During that time, the organization hasn’t just helped meet emergent needs: It has supported oncology, surgical services, obstetrics, and a wide range of other specialty care, bolstering Syrian health care even as conflict raged on.

“SAMS cannot operate forever,” Dr. Rass said. That’s what makes the Sim Lab – and its cutting-edge training programs – so important. “Once we build the experts, that means we build the leaders of the future.”

In partnership with the Syrian American Medical Society, Direct Relief has provided $165 million in material medical aid, and $3 million in grant funding, to health care providers in Syria and organizations providing health care to Syrian refugees, since 2014.

The post Lifesaving Medical Training Becomes Available to Once-Isolated Areas of Syria appeared first on Direct Relief.

“You look so old!” one told another.

“Oh, my God. You were ugly before, and you’re still ugly!” another told the first.

When Ken Barasch recalls a lifetime working to improve health care access and outcomes in Fiji, many of the memories warm his heart. The scuba instructor whose hand and arm, badly damaged during an accident, were successfully repaired by a prominent reconstructive surgeon. The fisherman whose severe cataracts, as well as lung problems, were preventing him from earning a living, until the Savusavu Community Foundation, Barasch’s nonprofit, arranged surgery and treatment for him. The girl from a remote island whose family brought her in, covered in boils and barely breathing, to a local clinic. After two days of treatment, “she was walking around,” Barasch recalled. “She’s gone on to a successful career.”

The three sisters, who’d gone years without seeing one another clearly, make him chuckle.

Barasch and his wife, Donna, didn’t travel to Fiji planning to start a nonprofit, or to devote their lives to bringing more medicine, health care, education, or climate resiliency projects to the island nation.

But in 1990, after several years of vacationing in Fiji, they noticed that many of the locals were missing teeth. Cloudy eyes, where the bright sun reflecting off the sparkling water and sand had caused cataracts, were common.

“Everything was not so perfect in what seemed to be this idyllic country,” Barasch remembered. “The most frequent dental appliance was a freely wielded pair of pliers.”

While Fiji’s Ministry of Health and Medical Services was dedicated to improving health outcomes in the country through what Barasch estimated were about 220 health centers and stations throughout the country, there were often shortages of medical equipment, supplies, and providers in hospitals and clinics. People in rural areas and on smaller islands, where the nearest clinic was often a boat trip away, had a harder time accessing health care.

The Barasches formed a registered nonprofit, the Savusavu Community Foundation, and began focusing on health care. At first, the foundation’s work centered on dental care and cataract surgery and prevention.

“The more we went, the more I realized there was a need for other kinds of care in Fiji,” Barasch said. Reproductive health care, eye exams and glasses, chronic disease monitoring and treatment, and specialized surgery were all widely needed.

So Savusavu Community Foundation branched out, building and shoring up medical facilities, bringing in doctors to conduct clinics and surgical missions, and finding partners who could donate medicines and treatments, equipment and supplies. That’s when they came across Direct Relief, Ken recalled.

“I met this fellow on a Saturday, and left with four giant boxes of hand equipment” for dentistry, he recalled.

Soon, Barasch said, he was outfitting three major Fijian hospitals with equipment, medicine, and supplies from Direct Relief. Fiji’s Ministry of Health and Medical Services asked if he could scale up, equipping hospitals and health facilities throughout the country.

Anytime the foundation received a medical request — for example, a Fijian hospital searching for a specialized oncology drug — “my first call is always to Direct Relief,” Ken said.

Today, the Savusavu Community Foundation is expanded yet further. Donations pay for classrooms and school libraries, books and teachers’ salaries, hygienic community kitchens (Barasch explained that it’s common for women in rural communities to cook outside in the wind and rain). The foundation works to rehabilitate marine ecosystems, build filtered water systems, and promote and preserve Fijian culture.

But health care remains integral to their mission. Barasch is proud of procuring Covid-19 vaccines during the height of the pandemic and providing meals to quarantined households who had no way to pay for food. Education and treatment have improved chronic disease rates, dental health, and other significant health issues. Until the very end, the foundation worked to supply solar refrigerators and freezers to villages that don’t have electricity, so that patients with diabetes could safely store their insulin.

At the end of his career, early in 2025, Barasch was honored with the Order of Fiji for his support of Fijian health. Jeremaia Mataika, head of Fiji Pharmaceutical and Biomedical Services, wrote of Barasch’s “immense work” and the “respected space” he holds in bringing support to Fiji’s health system in his letter of recommendation.

Barasch, severely ill, decided to retire this year. Because running the Savusavu Community Foundation requires him to spend 60 hours of unpaid work each week, he said finding a replacement to fill his shoes was impossible. “It’s a lot of work and a lot of stress,” he said, even though it brings “a lot of joy.”

The only question was what to do with the remaining funds. “When you close a foundation, you have to zero it out,” Barasch explained.

He donated the remaining balance from the foundation, a total of $110,000, to Direct Relief.

“Direct Relief has been our number one partner for two decades,” Barasch said. “Whatever Direct Relief wants to use it for, I completely trust their decision-making.”

For Genevieve Bitter, Direct Relief’s vice president of program operations, the donation is a vote of high confidence. “It speaks volumes,” she said. “He could have given it all to anybody…He’s witnessed what we’ve done for years.”

Barasch’s long-term relationship with the organization demonstrates the key importance of partnership, Bitter said: “With any successful partnership we have, we need to have a person like Ken, who is totally committed and dedicated.”

Gordon Willcock, Direct Relief’s Asia Pacific Regional Director, said that continuing support to Fiji is an ongoing priority — not just for the country alone, but for the region at large. “It’s a strategic country in the Pacific,” he explained. “It’s a hub and connector to other Pacific Island nations”

The prevalence of archipelagos and small, outlying island nations makes Oceania a difficult region logistically, Willcock explained. During disasters such as cyclones, responders in Fiji often receive and distribute medical materials and other emergency supplies to impacted areas.

“This all makes Fiji an important area of focus for us,” he said.

Barasch is hopeful that Fijian health will continue to improve. For example, he said, while Fijians eat fish and farm vegetables, their gardens tend to be filled with starchy root crops. More education and outreach might persuade Fijian gardeners to grow spinach and other greens, carrots, beets, and other healthy vegetables.

Refrigeration for insulin is also a high priority, he said.

Bitter and Willcock are planning to travel to Fiji in April, to discuss support strategy with local officials and communities.

“It is an island nation, and there are so many rural and remote communities,” Bitter said. Vulnerability to storms — Fiji receives a large cache of Direct Relief emergency supplies each year — complicates the already high need and large number of small villages. “We want to make sure we have this continuity in donations.”

Since 2008, Direct Relief has supported the Savusavu Community Foundation with $29.9 million in material medical aid, part of a total of $159.6 million in medical support to healthcare working in Fiji.

The post A Fiji Nonprofit Began with Eye Surgeries and Dental Care. Now Its Director Is Passing the Torch. appeared first on Direct Relief.

Heading into the holiday season, Dr. Keith Winfrey was hopeful that this winter would be a mild one for colds, flus, and other respiratory ailments.

No such luck.

“It’s been a late ramp up, but it’s hitting hard now,” said Dr. Winfrey, who is chief medical officer for the New Orleans East Louisiana Community Health Center, or NOELA. “The last two or three weeks, we’ve been seeing a surge.”

In late August and September, Dr Winfrey recalled, many patients were asking for flu and Covid-19 vaccinations. Widespread shortages meant there weren’t enough booster shots to go around.

But NOELA has begun receiving flu and Covid-19 vaccines through a Direct Relief program that supplies community health providers across the country with vaccines designed to reduce the risk and severity of infectious respiratory diseases.

For the 2024-2025 winter season, Direct Relief has provided slightly above 400 partner organizations with 27,800 Covid-19 vaccines, 17,700 flu vaccines, and more than 7,500 doses of antiviral medication to treat cases of flu.

Health centers, community clinics, and other nonprofit health organizations are often trusted sources of information and consultation for patients. “When it comes to preventive services, those relationships make a difference,” Dr. Winfrey said. He can only offer the vaccine, though, if there’s enough supply to meet patient needs. “When we have individuals like that who are interested, having a source of vaccine available has been beneficial.”

Many nonprofit health providers relied on the Bridge Access Program, a CDC program that offered Covid-19 vaccines to uninsured and underinsured patients. When it ended in August of 2024, providers had difficulty sourcing enough vaccines for vulnerable patients. Direct Relief began delivering Covid-19 vaccines to partners during the pandemic to meet emergent needs. As a result of its growing cold-chain capacity and close relationships with medical company donors, the organization began offering Covid-19 vaccines as part of its ongoing programmatic support in October of 2024, in addition to its long-term provision of flu shots.

When Direct Relief announced vaccines were available in October, the organization was “inundated” with requests, said Katie Lewis, regional director for U.S. Programs.

After Covid-19 vaccines became unavailable through the government, Southern California-based clinic group El Proyecto del Barrio, Inc. was forced to buy them, said medical director and physician Dr. Karmen Tatulian. Their budget allowed them to purchase 20,000 vaccines – not nearly enough for their approximately 50,000 adult patients – to see them through a busy flu season.

“This was absolutely not expected,” she said.

Dr. Tatulian explained that, while the county provides children’s vaccines to nonprofit providers who adhere to strict regulations, adult vaccines are “fully the financial responsibility of our organization.”

Both Covid-19 and flu vaccines “help to keep the community healthier,” she said. People will often hear from a family or community member that El Proyecto del Barrio offers vaccines, and reach out to them. It’s important to have the shots available: “The help that Direct Relief is providing…it’s difficult to overestimate.”

Recent wildfires across Los Angeles County have added new challenges. Dr. Tatulian reported that people are “busy with other problems” even as poor air quality makes respiratory problems worse. “Definitely, we have more work,” she said.

For providers at the University of Arizona Mobile Health Program, receiving vaccine support has been a boon. “It’s been incredible to just have them on hand,” said mobile health coordinator Alicia Dinsmore.

As a free clinic, the mobile health program previously referred patients to the county for flu and Covid-19 vaccines. But for patients lacking transportation or reliable child care, needing to make another appointment often meant they didn’t get boosters at all. “There’s a huge dropoff” when the clinic refers out, Dinsmore said. Having the vaccines on hand “has been a really useful resource to increase vaccine uptake.”

The mobile clinic rotates between nine regular sites – schools, churches, a local soup kitchen – and patients will often visit the clinic for their vaccines while they’re getting lunch or attending a community event.

Dr. Person-Rennell thinks this has been an above-average season for respiratory infections, although formal data isn’t available. “Our respiratory season has been full of influenza, Covid, and RSV…just based on my clinical experience,” she said.

Close relationships with patients – and treating the clinical relationship as a partnership – has been key to educating patients about vaccines and helping them work through hesitation, said medical director Dr. Nicole Person-Rennell. Listening to concerns, talking through past vaccine experiences, and helping patients make a plan that works for their health needs are all key.

For Dr. Winfrey’s patients, that trust and rapport often make the difference between whether or not a patient chooses the flu or Covid-19 vaccine. “The older patients who have been my patients for years will tend to accept the recommendation and get vaccinated,” he said. “The longer we’ve been caring for them and have been their advocate, the more likely they are to…receive the care.”

Somewhat unusually, he’s still recommending flu and Covid-19 boosters to patients late in the season, especially older patients and those with diabetes, hypertension, and other health conditions that increase the risk of severe impacts from respiratory ailments.

“Where we would normally expect some of our flu to wane, it may extend well into May,” he said. “I would still recommend the flu vaccine.”

The post During a Late-Surging Cold and Flu Season, Community Providers Offer Trusted Relationships appeared first on Direct Relief.

Pharmacists at CrossOver Healthcare Ministry were excited to participate in Direct Relief’s long-standing ReplenishRx program when a staffer asked them an unexpected question: “Do you have enough refrigerator space for all your patients?”

The answer: It’s complicated. CrossOver, a charitable pharmacy in Richmond, Virginia, provides its services — medical and dental visits, labs, social work, and Medicaid enrollment assistance, along with prescription medications — entirely through volunteer time and donations. Although they’ve been a Direct Relief partner for more than a decade, their facilities were too small for a long time to house all the medications, let alone the cold-chain medicines like insulin, that their patients needed.

Now, they were in a larger facility, but medical refrigeration was an ongoing challenge. Getting enough insulin for patients was, as CrossOver CEO Julie Bilodeau termed it, “chaos.” Insulin supplies were unpredictable and took up to 12 weeks to come in. “We were finding we had to switch people from one insulin to the other,” she explained.

For CrossOver’s pharmaceutical staff, this wasn’t ideal. The pharmacy offers medications to low-income, uninsured patients who have “a much higher incidence of chronic disease,” Bilodeau explained. “Helping patients manage diabetes is really critical for us.”

Joining the ReplenishRx program, which offers U.S. healthcare partners access to a wide range of prescription medications, including commonly requested medications for chronic diseases like diabetes, was a game-changer for them. But with about 1,000 patients with diabetes registered at the pharmacy, storing enough refrigerated insulin to meet each person’s need — consistently — was a challenge.

Direct Relief offered an additional, supportive donation: two pharmaceutical-grade refrigerators from healthcare company Sanofi, which collaborates with the organization. In total, Direct Relief was distributing 32 medical refrigerators, which maintain and monitor highly consistent temperatures to safeguard cold-chain medications and vaccines, to replenishment partners across the U.S.

“The refrigerators allowed us to join the program,” Bilodeau said. “Without [the donation], we would have had to delay and raise significant funds” to be able to store enough insulin to meet patient needs.

Amiyah Newsome, medications program manager at CrossOver, said the refrigerators have made it possible to offer patients who need insulin 90-day prescriptions rather than only being able to provide 30 days at a time — making it more likely patients will have access to and reliably take their medication. They’ve also made it possible for CrossOver to add about 25 new medications to its formulary — the list of prescription medicines available to patients.

Newsome recalled a recent patient with no insurance who was overdue to see a provider — and whose A1C levels, a measure of blood sugar used in diagnosing diabetes, were “not in a safe range.” The insulin he needed was available in CrossOver’s new medical refrigerators, and “he was able to get seen by the provider and get his prescription filled all in one day,” she said.

For Bilodeau, the access the ReplenishRx program provides — and the medical refrigerators that make participating possible — are key to the pharmacy’s mission: “Our mission really is to provide access to health care to people who, without CrossOver, would not be able to access care,” she explained.

But fulfilling that mission in the face of growing demand isn’t always easy. “We’re at capacity. We’re turning people away,” Bilodeau explained. “There’s a tremendous amount of need,” especially, she said, in Richmond, where many people who can’t afford to live in Washington, D.C., settle in the hope of finding an affordable place to live.

CrossOver staff have seen patients from about 150 countries, and Bilodeau said current patients speak between 30 and 40 languages. “That’s kind of built into our DNA: All are welcome,” she explained.

While cold-chain storage isn’t always a widely publicized need, Bilodeau said many nonprofit healthcare providers can’t afford to store all the refrigerated medications their patients need. While many clinics and charitable pharmacies rely primarily on volunteers and donations — all of CrossOver’s pharmacists are volunteers, for example, and the pharmacy relies on external medication donations to stock its shelves — meeting logistical needs often poses a unique challenge.

“A number of clinics are having trouble finding refrigerators like this,” Bilodeau said.

During the past two years, Direct Relief has provided CrossOver Healthcare Ministry, a partner since 2011, with more than $738,000 in medication support, including insulin and other chronic disease medications.

The post Two Medical Refrigerators Bolster Health Care for Uninsured Patients at a Virginia Charitable Pharmacy appeared first on Direct Relief.

Doctors and medical students from Johns Hopkins University, visiting Liberia’s F.J. Grante Memorial Hospital, were horrified when a two-year-old girl arrived in respiratory distress.

The F.J. Grante Memorial Hospital depended on diesel generators to power its lights and medical equipment. In Greenville, an area often called the “Mississippi of Liberia” — the region was settled by formerly enslaved African Americans from Mississippi, USA, who integrated with the area’s indigenous groups — there is no electrical grid, and diesel generators are the primary power source.

However, the steep cost of diesel fuel limits electricity at the hospital to just a few hours per day — unless a sick person’s family can afford the staggering $100 daily expense to keep the generators running continuously.

Desperate to buy enough time for the little girl to recover with antibiotics and breathe without the aid of an oxygen concentrator, the visiting medical team pooled their money to fund 24 hours of electricity. They wondered: Would her condition stabilize, allowing her to go home with her family? Or would her oxygen needs surpass the concentrator’s capacity?

On the second day, when the diesel fuel ran out, the worst happened. The two-year-old slipped into respiratory distress and died.

“This is something that’s happening all the time when our team is not present,” explained 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, including Liberia.

Liberia has large medical centers in its capital, Monrovia, but for many patients in the country’s southeastern regions, such as Sinoe County — where F.J. Grante Memorial Hospital is located — accessing these facilities is nearly impossible. During the dry season, the journey takes about 12 hours, and in the long rainy season, travel to Monrovia is often completely cut off.

In this remote area, reliable power and medical oxygen have long been inaccessible, creating a demoralizing reality for the hospital’s dedicated doctors and nurses. Despite their extensive training, they are often unable to apply their skills effectively, forced instead to watch patients die due to lack of oxygen. The hospital’s few oxygen concentrators provide only 5 liters per minute of low-pressure oxygen — insufficient for many critically ill patients. Worse, all electricity-dependent medical technology, including these concentrators, shuts down daily due to the high cost of diesel fuel.

Even when the lights are on, Dr. Sampson recalled, the dimly lit hallways and rooms conserve electricity but create a “sad condition.”

However, the F.J. Grante Memorial Hospital will soon benefit from a new oxygen-generating facility and a solar installation, including a battery-based renewable energy system designed to power the oxygen generator. Medical equipment and systems will be reliably powered at all times. A continuous supply of oxygen will be piped directly to patients’ bedsides. The hallways will be brightly lit.

The medical oxygen facility and solar installation are part of the larger Africa Infrastructure Relief and Support, or AIRS, project — a Society of Critical Care Medicine (SCCM) 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. He also represents the Chicago-based Society of Critical Care Medicine in the execution of the AIRS project.)

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 opportunity to survive”

Beyond the immediate medical impact, the financial burden of purchasing thousands of dollars’ worth of diesel fuel and oil drains the hospital’s already limited budget. This prevents investments in essential improvements such as upgraded technology, better patient care, and fair salaries for staff. For the hospital’s determined healthcare workers, the situation is not only frustrating: It is profoundly disheartening.

“The number of patients who come to the hospital is huge,” said Dr. John Yarngrorble, the Sinoe County health officer. “You can have a surgical crisis interrupt” if the power goes out.

Dr. Sampson emphasized that many patients at F.J. Grante Memorial Hospital require urgent, life-saving care. However, unreliable power and limited access to medical oxygen pose serious risks—even for a highly skilled and dedicated team of healthcare providers.

The hospital’s maternity ward plays a crucial role in providing safer deliveries and reducing maternal and infant mortality rates in Liberia. Meanwhile, emergency surgeries and critical treatments not only save lives but also significantly improve overall health outcomes.

“If their condition is serious, they don’t really have the opportunity to survive” when the generators are off, Dr. Sampson said.

In addition, the hospital has the potential to contribute essential medical research to the global community, and provides essential education on preventive health care and hygiene practices to Liberians in surrounding areas.

Staff provide this care, Dr. Sampson said, even with shortages of medicines and supplies, a need for support and providers, a lack of reliable medical oxygen — and power that keeps going off.

“The most dramatic transformation”

Careful consideration was given to selecting an energy-efficient oxygen generation technology, Dr. Sampson recalled. The chosen system, a Vacuum Swing Adsorption (VSA) unit, consumes much less energy than traditional methods, reducing the number of solar panels required for operation. Once the project is completed — by late March, he anticipates — the hospital will be the only one in Liberia with both renewable energy and on-site oxygen generation.

Because of the hospital’s rural setting, “we had the space to create a solar farm,” Dr. Sampson said. “It will support all clinical needs in the hospital. It brings together the solar that we used for our Sierra Leone project with the climate-friendly, energy efficient medical oxygen of the Gambia oxygen delivery system that the SCCM AIRS project has constructed.”

The project, he added, is unique in West Africa. Not only will it provide reliable power and high-quality medical oxygen; it will also allow the funds previously spent on purchasing diesel for electricity generators to go directly toward patient care instead.
 
International groups have worked to supply major hospitals around the world with oxygen plants for years, but when repairs are needed and 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 and technicians, who will maintain the plant and oxygen distribution system.  

“This project will reach every aspect of the hospital,” said Dr. Yarngrorble. “The people are so happy; this oxygen project is going to do a lot in Sinoe.”

He highlighted the benefits of reliable access to computers, uninterrupted operation of lab equipment, and consistent temperature control for blood bank supplies — all critical to meeting urgent medical needs.

While the F.J. Grante Memorial Hospital does need more healthcare providers, Dr. Sampson emphasized that reliable medical infrastructure — such as power and oxygen — is an even more urgent priority.

Westerners often misunderstand healthcare in West African countries, assuming a lack of trained professionals. In reality, these nations produce highly skilled physicians and staff their hospitals with dedicated doctors and nurses. However, when essential resources or reliable infrastructure are unavailable, even the most accomplished medical providers may feel their expertise is underutilized, limiting their ability to offer effective care.

“Projects like this improve morale, effectiveness, and efficiency,” Dr. Sampson said. For instance, an obstetric surgeon trained in state-of-the-art techniques to save infant lives and improve maternal health outcomes cannot perform those procedures in darkness.

“This is the most dramatic transformation of how health care is delivered in this area,” he told Direct Relief.

The post In Southwestern Liberia, Resilient Power and Medical Oxygen Bolster Lifesaving Care appeared first on Direct Relief.

Without enough local paramedics to cover emergency calls, rescue volunteers — each a certified emergency medical technician, said Rob Klusman, a senior team member — went out into the field in teams of two to conduct preliminary medical evaluations and provide basic life support. Too many roads were blocked by debris, so rescuers evacuated people on foot. It became clear that the team needed ears in the 911 dispatch room — “the traditional mechanism of dispatching units was too much…[dispatchers] were just getting slammed,” Klusman explained — so a team member sat next to the operators, creating tickets for radio to the local command post.

“Then we’d translate that into a field assignment, we’d dispatch a response,” Klusman said. SMSR had never put a team member in the dispatch room before — they tried it on the fly, and it worked.

“We were building an airplane while we were flying it,” is how operations leader Carolyn Grumm described it.

For search and rescue teams across the country, their focus on local communities makes them an ideal responder. “We know this community,” Grumm said of the Sierra Madre area. “This is something we can do.”

But it also meant, for the 30 or so SMSR volunteers working that night, putting their own worries aside to respond to the most urgent needs. One team member’s house burned down while he was carrying out rescue operations. Grumm, dispatching team members from the command post on January 7, had to comfort herself that her 80-year-old parents were only a block away. “If anything happened, I could just run and scoop them up,” she remembered reassuring herself.

For Klusman, the vast and urgent need came into focus early that evening, when his team went to check on a medically complex patient receiving end-of-life care. The patient was medically stable but needed to be evacuated from a multi-story building immediately.

“Had the situation gotten worse, that individual would not have been able to get out on their own,” Klusman recalled. His team’s response raised a worrying question: “How many more people do we have like this, in a similar circumstance, who are in this relatively modest geographical area?”

A Grim Aftermath

Klusman couldn’t even count how many people his teammates evacuated that night, or how many dispatches he answered before the emergent phase was over a few days later. Immediately, he and his teammates moved into their second, grimmer assignment: Moving through devastated, burned-out neighborhoods, working with public agency responders, forensic experts, academic anthropologists, and other search and rescue teams to find human remains.

“The magnitude, the amount of the devastation” was astonishing, Klusman recalled. While he’s responded to mudslides and smaller-scale disasters for years, “the forces that are involved [in an Eaton Fire-level disaster] are incomprehensible.”

Searching through the burned-out remnants of backyards and outbuildings reminded him of the urgency he feels when persuading people in the line of fire to evacuate. “Anybody who does not get out and is caught in that situation, there’s very little left of a person,” he said sadly. “I don’t think people realize that…Staying behind is not going to be worth their life.”

Several times, Klusman’s team identified potential human remains, alerting the forensics workers to bring trained cadaver dogs in for confirmation. “Once that process happens, we move on. The ground crews move on,” he said. Leaving behind such devastation was difficult, he explained, but the important thing was covering ground as thoroughly and efficiently as possible: “Regardless of the outcome, if we can locate somebody’s loved one…it helps with closure, even if the outcome was not what we would like.”

Hyper-Local Expertise

During conversations with Direct Relief, SMSR was gearing up for the threat of mudslides — an ever-present risk after wildfires in California. Most immediately, Klusman said, team members are considering “what do we need to think about in a post-fire world right now?”

But on a larger scale, he explained, California search and rescue teams are thinking about the escalating severity and frequency of wildfires — and how they can be there to respond.

For Klusman and his teammates, extensive local knowledge and years of experience give an indispensable advantage. “You can’t just come in and do it for a little while. It takes a long time” to learn both local geography and community needs, he said.

Oftentimes, the information that comes in during an emergency is sketchy, even unreliable — and it’s a rescuer’s knowledge of the terrain and experience with similar responses that will help guide their decision-making.

Teammates, Not Heroes

For search and rescue volunteers, the wilderness-based missions that once made up the bulk of their early work may give some ground to new needs in an era of intense wildfire threats.

“We may need to respond to a mix of incidents that haven’t always been our norm,” Klusman said. “We’ve always been needed, and we’ve always recognized that.”

When search and rescue teams decide how — and whether — to respond, he said the most important questions are, “Do we add value? What do we need to do to be the most valuable resource we can be?” Now, the question is, “What role do we play in bigger disasters?”

Reviewing and analyzing their response to the Eaton Fire, SMSR volunteers noted that “we did not have sufficient equipment to cover all the needs we had,” Klusman recalled. “We had to field so many people, in so many different areas, that we were pressed to equip everyone.” Some of their equipment was damaged during their rescue work.

Direct Relief provided a $25,000 emergency grant to Sierra Madre Search and Rescue Team, in addition to field medic packs and requested protective equipment, to meet their increased operating costs.

As the need grows, SMSR’s team will need to expand. But choosing new volunteers carefully is crucial, Klusman said. A potential teammate who’s motivated by personal glory, rather than a desire to serve others, is most likely not a good fit.

“Search and rescue is a team sport,” he explained. “This is not individuals being heroes…It is a structure that allows for individuals, or groups of individuals, to be in the right place and the right time, to make a difference at the right time.”

He’s concerned, too, about attrition. The urgency and danger of wildfire rescue work, and the anguish of finding human remains, take their toll on volunteers. However, for the right person, “it’s incredibly rewarding.” Klusman said. “How do you bring people to the table who will understand what this means?”

Still, Grumm said, the volunteers who do this work are virtually always highly motivated. “We’re setting up for future events,” she said. “Everyone steps up in ways that aren’t their primary role.”

When she was interviewed for a volunteer role at SMSR, Grumm remembered, the interviewers asked her why she wanted to join the team. She explained that she loved the wilderness, loved a challenge, and wanted to help her community. While she was pleased with her answer, she quickly realized most of the people accepted to the team give a similar response. It’s an indication, ultimately, that they’re like-minded people: Everyone is there to serve.

“This is the way we can help our community,” she said.

The post After Eaton Fire Response, A Search and Rescue Team Gears Up for a Future of Wildfire appeared first on Direct Relief.

Paige, a retired sheriff’s deputy and a full-time volunteer on the Altadena Mountain Rescue Team (AMRT), describes the night of January 7 as a uniquely horrific time. The command post where responders’ work was coordinated moved location, then moved again, as the Eaton Fire tore through neighborhoods and grew ever closer. Firefighters were working in winds so severe that one response truck had “a pineapple-sized hole in its windshield” that Paige thought might have come from a pinecone. Streets were so filled with debris — downed trees, downed power lines — that at one point Paige feared his vehicle, transporting evacuees, might get tangled in a clump of wires hanging from a tree.

“That was my escape route,” he said.

The smoke was so thick in the air that many evacuees inadvertently fled straight toward the fire, and even Paige — a longtime resident of Altadena and a seasoned rescue worker — described trying to evacuate a medically vulnerable woman and her son without being able to see the ground in front of him, let alone the street he was driving on. “There must have been a dozen times that I got completely turned around,” he said.

For members of AMRT — 25 teammates were working in the field that night — the response was a frantic dash to get as many people safely away as possible.

“We started receiving multiple calls about people being trapped in houses,” Paige said. Many used wheelchairs or had other mobility issues. Others were so blinded by the smoke and flames they couldn’t find their way out of their homes. At a convalescent home, Paige and his partner called an ambulance company to help with transport and helped bed-bound patients into vehicles.

Paige recalled evacuating one older man who used a cane and had impaired vision: He and his partner helped the man into the car and brought him to the nearest evacuation center — only to find it newly closed. The shelter was in such danger from the fast-spreading flames that everyone had been moved to another location further away.

AMRT responders carried out rescue missions through midmorning, Paige said. Occasionally, a teammate would have to stop their work to evacuate their own families. The vegetation surrounding their own station caught fire – the building itself survived — and rescuers grabbed whatever equipment they’d need to finish the night before driving a truck through the flames.

Eventually, he recalled, the most emergent work was over. Then AMRT’s focus turned to the less frantic, but still essential, task of combing through burned-out neighborhoods. They were looking for human remains, for pets left behind, and for remaining infrastructure. Paige described being unable to rescue some frightened animals, and simply setting up feeding stations amid the devastation for them. The remains of two pet tortoises deeply saddened Paige, a tortoise owner himself.

Because so much vegetation is burned and mudslides are a serious concern, Paige said, AMRT is currently working to identify risks and prepare for further rescue work. He’s concerned about the ongoing danger — and the long-term impacts to his community.

While Paige’s current home withstood the flames, “my old neighborhood is gone,” he said. Older adults who’ve lived there for decades “are not going to come back. They’re people who have been a staple in the community.”

“How will it get back to somewhat normal?” he wondered.

Despite the dangers, the importance of search and rescue work continues to resonate with Paige. “Almost every rescue we’ve had had a positive outcome,” he said of his work with AMRT. “It’s definitely rewarded.”

But one dark image from the Eaton Fire still stands out to him.

After many hours of responding, and with teammates still carrying out rescue missions, Paige headed back to the Palisades Fire to assist. His clothes were covered with tiny holes where embers had burned through the fabric, and his skin was marked with small burns, but there was still work to do. He’d assumed it was still nighttime, but it was already midmorning: The sky was black with smoke.

“There’s nothing brighter than the first light of next morning,” he said. But “it was completely dark in Altadena.”

Direct Relief supported the Altadena Mountain Rescue Team’s response to the Eaton Fire with a $25,000 emergency grant and a range of personal safety and protective equipment.

The post A Search and Rescue Worker Recalls Evacuees in Wheelchairs, Driving Through Flames During Eaton Fire Response appeared first on Direct Relief.

Older adults were arriving at the evacuation shelter with hair and hospital gowns covered in ash. People urgently needed to be on oxygen — in a large convention hall with few electrical outlets — or their catheters were getting full but responders didn’t have gloves. Some had had time to wrap medications in bubble wrap and bring them, or they had their medical charts, but some didn’t.

“It was quite a scene,” Dr. Mosqueda recalled.

Dr. Mosqueda, a University of Southern California professor of family medicine and geriatrics, doesn’t confine herself to campus life. As an expert on geriatric care and anti-abuse advocate, she’s been a long-term care ombudsman for more than a dozen years and serves as director of the National Center on Elder Abuse. She’s also not afraid to jump in when she’s needed.

Like so many first responders, she was needed that Wednesday night. Nursing-home residents, reliant on staff and one another, had to be grouped together. Patients had to be helped onto cots, with no lifts available. Privacy screens had to be hunted out so caregivers could change adult diapers.

Dr. Mosqueda remembered one man whose wife had Alzheimer’s and couldn’t be left alone. The couple needed food, but he was afraid if they left their cot it would be taken: “It was first come, first serve.”

A woman who needed oxygen was placed far away from the rest of her group, near an outlet, but Dr. Mosqueda was concerned no one would be able to watch out for her. She found an engineer, who set up a power box near the woman’s fellow nursing home residents.

“I saw several people…who were just baffled about cell phones, or their neighbor dropped them off and they don’t know what medicines they’re on,” she recalled.

While Dr. Mosqueda was impressed by the dedication of the caregivers she saw, they had their own concerns. One paid caregiver’s shift was ending; she had to pick up her kids and couldn’t stay. (She came back the next day, Dr. Mosqueda recalled.)

“It was the worst life has to offer,” said Dr. Esiquio Casillas, a geriatric physician who was also at the convention center that night. “The flip side is it was the best of humanity in many respects.”

“You could just see how scared she was”

Dr. Casillas, a senior vice president and chief medical officer at AltaMed, oversees his health center’s Program for All Inclusive Care for the Elderly (PACE) and its senior services. He said his background in the PACE program, which works to keep older adults living independently by providing a range of health and support services, helped him provide effective care.

Patients didn’t want to go the medical area and risk losing cots and personal items, so his team went to them. “There’s a focus on meeting people where they’re at…rather than having the medical clinic be the hub of everything” in geriatric care, he said.

Some patients were in hospice and end-of-life care, and getting them placed more comfortably was an urgent priority. Others, relying on paid caregivers, needed extra attention, so Dr. Casillas said staff members made sure to spend additional time with them. One patient wanted a specific variety of dental adhesive that Dr. Casillas’s team didn’t have. “By the time I got there on Friday, she’d already been transferred, so I hope she got her Fixodent,” he said.

Los Angeles County is home to about 2 million older adults — a number that’s expected to grow in coming years. The wildfires that ripped across Southern California communities this month will hurt the health of millions — causing everything from short-term respiratory symptoms to long-term adverse outcomes from chronic disease — but older adults will likely be among the most vulnerable.

Dr. Mosqueda said immediate health impacts are a concern for many older adults, whether physical or mental.

Particles in the air during and after wildfires can trigger serious respiratory symptoms and worsen the health of people with chronic diseases. Patients will have gone without their medications — Dr. Mosqueda described an older patient who’d received an artificial heart valve but been forced to evacuate without anticoagulant medication.

An older adult may have trauma from military service or dementia. “They may have a lot of difficulty coping with all of this,” she said. “It could be very triggering.”

She’d been especially concerned about a woman with dementia who was at the shelter with no caregiver. Dr. Mosqueda asked the public health nurses to look after the woman, and checked on her frequently. “She did remarkably well,” she recalled. “But her face, you could just see how scared she was.”

One nursing home had moved patients back into their rooms as quickly as they could, even though the facility’s water was still contaminated, Dr. Mosqueda recalled. The contamination was from chemicals, not bacteria, so the water couldn’t be boiled for safety. And she was concerned older adults in urgent need of housing or care would be more vulnerable to scams, and skilled care facilities would lose vital staff members amid the displacement.

“Calm and circumspect”

But as with any disaster, the longer-term impacts, while more complex and harder to isolate, may be much more severe.

Fewer new physicians are choosing to specialize in geriatrics — the number has declined more than 25% since 2000 — in part because the specialty is lower paid. Older adults often rely on Medicare, and their appointments are lengthier and more complex.

Dr. Casillas explained that medical care for older adults is often centered on shared decision-making. A surgery or medication that might be an obvious choice for a younger patient isn’t always a good fit for an older one. His focus as a physician is on “the things that make their lives meaningful.”

An added challenge is the complexity of older-adult care. Keeping an older patient healthy and active often requires a constellation of services: regular check-ins at their home or residential facility, a combination of paid and informal caregiving, transportation, social opportunities. The Los Angeles wildfires will cause widespread financial instability and displacement, increasing the likelihood that paid caregivers may move or leave; family members and neighbors will be less likely to provide informal support; and housing, medication, and other needs will become more expensive and harder to access.

While Dr. Casillas only knew of two nursing homes destroyed by the fires, he said placing older adults in long-term care, especially for people reliant on Medicare, an ongoing problem statewide. “Placement is very hard to find,” he said. “There hasn’t been a nursing home built in Los Angeles in many years.”

The shortage may mean that more people choose to live at home for longer, even if that’s not the best fit for their medical needs. Dr. Casillas explained that the vast majority of his older patients do prefer to live independently for as long as possible, and supporting that goal is one of PACE’s aims. But he saw families pull older adults out of skilled nursing facilities during the Covid-19 pandemic, terrified of the deadly new disease, and knows catastrophes often force people to find another way forward.

“We’ve already started to do wellness calls,” he said. “I want to make sure we account for all of our patients and participants.”

Dr. Mosqueda cautioned that while older adults may be more likely to be medically fragile, many aren’t. Many have perspectives that help them navigate frightening, uncertain situations like the wildfires.

“Older adults…were among the most calm and circumspect people I spoke with,” she recalled. “They just had a lot of wisdom and life experience, and they weren’t getting freaked out. They had so many internal resources.”

Direct Relief supported first responders at the Pasadena Convention Center with requested emergency medications and supplies, and is providing $1 million in grants to frontline organizations responding to the Los Angeles area wildfires.

The post Los Angeles Wildfires Leave Older Patients Vulnerable appeared first on Direct Relief.

At this moment, the focus is on containing the flames and protecting people from the most immediate dangers. But as the smoke clears, the crews depart, and the headlines fade, millions of Southern Californians are starting an arduous journey.

Communities devastated by wildfires, like Lāhainā on the Hawaiian island of Maui or the Northern California town of Paradise, offer living proof of something the general public is only beginning to understand: Natural disasters severely damage the long-term health of the communities they harm, killing many more people and causing lifelong, indirect health problems that often go unaccounted for in formal death tolls and impact studies.

In the aftermath

With wildfires, environmental health risks persist long after the flames are extinguished. Exposure to smoke can cause or exacerbate severe respiratory and cardiovascular issues. Bacteria and hazardous chemicals can persist in a community’s water supply for long periods

Health care providers frequently report worsening physical health in the aftermath of natural disasters as people struggle to access prescription medications and manage chronic diseases like diabetes and cancer; confront infectious diseases and water-borne illnesses; and reliably access health care, nutritious food, and other essential resources.

Families lose their homes, cherished belongings, and a sense of security. Children witness the disappearance of their toys and familiar surroundings, while retirees see their lifelong investments reduced to ashes. The emotional and psychological toll is profound, with many grappling with trauma and uncertainty about the future.

Mental health practitioners working in disaster-affected communities reliably report drastically increased rates of depression, post-traumatic stress, anxiety, and other mental health impacts, and their experience is backed up by scientific research. These mental health impacts can be lifelong, and evidence repeatedly indicates that repeated exposure to natural disaster — a growing problem as climate change causes more severe and frequent wildfires and storms — can compound mental health impacts.

An exponential toll

Indirect impacts to health and mortality can be the hardest to measure, but researchers often find their impact far more severe than the immediate death toll. A recent study in the journal Nature found that tropical storms, for example, can cause 300 times the number of excess deaths over the long term than they do immediate fatalities. While researchers have not studied long-term mortality from wildfires as closely as they have storms, most of the factors thought to cause these deaths occur in wildfires too: housing loss, economic disruption, displacement, lack of access to services, and ecological changes.

Lost housing — especially in a community where housing is relatively scarce and housing insecurity widespread, as in Los Angeles County, can drive up the cost of living and make finding a home all but impossible for many. In Butte County, where the 2018 Camp Fire killed 86 people and destroyed entire communities, homelessness climbed 16% in the months after the fire, and even today, rebuilding hasn’t come anywhere near replacing the 15,000 homes destroyed.

Damaged businesses destroy livelihoods and reduce community access to essential resources like healthy food and social services. Lost jobs and barriers to access can cause further economic and health consequences, exacerbating the problems of lost housing. People who are displaced long-term from their homes and communities confront greater social isolation in addition to economic consequences. All these social and economic factors can severely impact long-term health, access to medical care and treatment, and mortality.

By communities, for communities

Nonprofit healthcare providers, including health centers, community clinics, and charitable pharmacies, have long been aware of the impacts of wildfires and other disasters on vulnerable patients. Health center and clinic staff check on patients at home, staff shelters, and spend weeks on intensive response efforts, even as they go without permanent housing and confront their own hardships. It’s often community members, in the months and years after a wildfire decimates their community, who found mobile health clinics and mental health-focused nonprofits to meet the drastic increase in need they see around them.

Direct Relief works over the long term with communities devastated by natural disasters to increase health care access, build community resilience, and mitigate the social and economic threats that can damage health for years to come. The organization is committed to working with local partners throughout wildfire-affected areas to increase health and resilience and reduce medical vulnerability over time.

In response to the Los Angeles County wildfires, Direct Relief has made more than $100 million in medicines and supplies available to healthcare providers and first responders. The organization’s emergency response teams have deployed throughout the area to deliver N95 respirators, personal care products for evacuees, prescription medications, field medic packs for responders working in the field, and other requested aid. Ongoing deliveries of requested medical aid are being dispatched to health care providers from Direct Relief’s Santa Barbara warehouse.

The organization continues its close coordination with local and state agencies, such as the California Governor’s Office of Emergency Services and the California Primary Care Association, and with its extensive network of healthcare partners throughout Southern California.

Direct Relief will continue to closely monitor health and medical needs in impacted communities, and to work with local partners to provide needed support.

The post Southern California’s Wildfires Will Impact Health for Years to Come. Here’s How. appeared first on Direct Relief.

Eaton Fire evacuees, fleeing their homes for the safety of the Pasadena Convention Center, were arriving in numbers. For Fernando Fierro, vice president of nursing services at the community health center AltaMed, and the first of his response team to arrive, it was “chaotic.”

“There wasn’t any infrastructure in place,” he recalled. More than 550 people sheltering at the convention center, in five event halls converted to dormitories, needed medical assessments. People had fled too urgently to bring their medications, or they needed canes and walkers, or they needed more intensive care than AltaMed’s response team could provide in a shelter setting.

Complicating the situation were the close quarters and the presence of animals: People had brought their dogs, cats, and birds. Fierro, a former U.S. Army combat engineer with extensive disaster response experience, knew the crowded shelter and animals would increase the likelihood of infectious diseases like norovirus and avian flu.

“My biggest fear was that we would lose a patient,” he said. “I was making sure we didn’t have that happen.”

AltaMed, where Fierro works, is a community health center with facilities throughout Southern California that cares for underserved patients in many of the communities being ravaged by the current constellation of wildfires. The health center has a detailed plan for responding in evacuation settings, so when the city of Pasadena reached out to health center staff to ask for medical support, “it was automatic mode,” Fierro said.

Nurses triaged patients — some of them so traumatized they were hiding under blankets, some of them patients evacuated from skilled nursing facilities or hospice care. Some were receiving end-of-life care: Fierro remembered the relief he felt when a dying patient was finally relocated to a hotel room from the shelter. “I wanted to make sure that’s not where she spent her final days,” he explained.

The AltaMed team set up a base station where people could pick up hygiene supplies and over-the-counter medications. Patients with chronic wounds were treated, doctors followed up on patients whom nurses had identified as needing care, and ambulances came to transport the most vulnerable patients. Dr. Esiquio Casillas, an AltaMed physician focused on older adult care, arranged placement for medically vulnerable patients.

“It was real triage,” Fierro said.

Medical crises were a feature of that Wednesday night. A child with an irregular heartbeat needed urgent attention. Nurses caught a patient as she collapsed from stress-induced vertigo. At one point Fierro — a former veterinary technician — found himself giving veterinary IV fluids to a severely dehydrated dog: “That was an interesting patient.”

With a background in combat engineering and crisis response, Fierro said “the training kicks in” during emergencies. But this disaster was different: These were his patients, his colleagues, his community. Helping in the field seemed even more urgent than usual.

“We need to be out there,” he explained. “They trust us and the care we provide in our clinics, and they need to know that we’re out here with them.”

Since the health center’s founding in 1969, improving community health outcomes — and mitigating the impacts of housing instability, food insecurity, and other factors that affect long-term health — hasn’t just been a lofty goal. It’s an urgent issue of health justice.

“We’re making sure they’re not forgotten,” Fierro said of AltaMed’s patients. “They tend to be the last ones to be thought of and the last ones to be supported.”

Because the wildfires were a local event, AltaMed’s providers and staff were heavily impacted too. One of the health center’s facilities burned to the ground Tuesday night. Staff know three more sites are damaged and at risk of burning, but they don’t yet know the extent of the damage. Many providers and staff members have been forced to evacuate themselves.

But when AltaMed asked for volunteers to staff the evacuation center, “we had an enormous response from our team members,” Fierro recalled. Once staff know their families are safe, he said, the next question they ask is, “How can I help?”

They also know the fire’s damage will last long after the flames are contained and the air clears. Now that the most emergent medical needs are met, Fierro said, his team is thinking about how best to address mental and emotional well-being, help people whose livelihoods and homes are lost, ensure kids are able to get to school…and make sure vulnerable communities are prepared for the next wildfire, pandemic, or whatever comes next.

“This won’t be the last disaster,” he said. “Organizations like AltaMed need to be able to care and support” vulnerable communities in an uncertain world.

Although Fierro knows decimated neighborhoods will rebuild, he also knows the people who were already vulnerable will be the most hurt by these wildfires — and the most at risk in a future catastrophe.

“When a disaster happens, health care doesn’t stop,” he said. “It can’t stop.”

Direct Relief has supported AltaMed’s ongoing response to the Southern California wildfires with critical prescription medications for patient care and other requested medical aid. The organization will continue to support health centers and other community organizations providing patient care across Los Angeles.

The post An Eaton Fire First Responder Recalls Patients Fleeing the Fast-Growing Blaze appeared first on Direct Relief.

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.