This storm is part of a winter weather system that is currently impacting a large portion of the country from Minnesota to Texas and moving northeastward as the week continues. Forecasts show continued ice storms and windchill warnings, with temperatures predicted to reach dangerous levels in states such as Minnesota, Wisconsin, Illinois, and Maine, among others.

Health Risks and Power

Power outages of varying durations pose a particular risk for people who use electricity-dependent durable medical equipment (DMEs), including wheelchairs, ventilators, insulin pumps, and other equipment. Devices which require continuous power may not be available, nor backed up to generators. Devices that require charging may become unavailable over time depending on the length of the outage.

Direct Relief’s Response

Direct Relief is actively monitoring the current conditions across the country and is in contact with the Texas Association of Community Health Centers and the Texas Association of Charitable Clinics to assess needs and gather additional information about conditions within the impacted communities.

Direct Relief and other members and supporters of the health care safety net will continue to monitor the exposure of medically vulnerable people to power outages throughout the ongoing winter storms both in Texas and across the United States.

Direct Relief has a long history of responding to extreme weather in Texas, including the severe weather and subsequent widespread Texas power grid failures in February 2021.

The organization continues to provide safety-net support, with more than $200 million in medical aid sent to the state since 2008.

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Although it has since weakened to tropical storm status as it makes its way across the border into northeastern Mexico, Hanna hit Texas as a Category 1 hurricane. Even as a tropical storm, it threatens Texas communities with high levels of rain.

According to Jana Eubank, executive director of the Texas Association of Community Health Centers, one health care organization in Hidalgo County reported being “walloped” by flooding, although none of its locations experienced structural damage.

Communities in coastal Texas are accustomed to flooding events due to hurricanes and tropical storms. But Tropical Storm Hanna, coming in the midst of what has been expected to be an active storm season, caused particular concern because of the Covid-19 pandemic.

“We cannot allow this hurricane to lead to a more catastrophically deadly event by stoking additional spread of Covid-19,” said Texas Gov. Greg Abbott during a Saturday afternoon news conference.

The New York Times reported that typical hurricane preparation activities in affected areas were altered by the presence of face masks, social distancing measures, and temperature checks.

According to the National Weather Service, scattered showers and thunderstorms are still expected in parts of southern Texas. Because soils are already waterlogged, the agency said, “any heavier showers or thunderstorms could result in the concern for additional isolated flash flooding.”

Direct Relief’s emergency response team is currently expediting the delivery of emergency supplies to local partners. The organization will continue to monitor the situation and respond as needed.

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Along with these acute issues, local health providers are also responding to challenges brought on by Imelda’s deluge of rain, which has dumped over 40 inches of rain in the hardest hit areas east of Houston.

“Health centers, because they are nonprofits and their percentage of uninsured patients is so large, they operate on a razor thin margin. Then you get hit with a disaster… People in health centers are genuinely committed to their communities, so it’s like those who deserve the most get the least,” said Dr. Roxana Cruz, director of medical and clinical affairs for the Texas Association of Community Health Centers, known as TACHC, which represents health centers across the state.

In anticipation of these challenges, TACHC sent out guidance this week to their members about how to prepare for the storm, including communicating with patients so that they have the latest information regarding upcoming appointments and medication refills. TACHC also shared the latest Direct Relief/Facebook disaster map with its members to provide them with as much actionable data as possible.

In 2018, 42% of TACHC patients were uninsured and 68% earned less than the federal poverty level.

“What’s difficult is that the facilities are in the rebuilding phase after Hurricane Harvey, but many people are as well. So it’s not just the health center as an organization, it’s the people who work in the health center. They’re all in recovery mode. It’s almost like getting hit when you’re down.”

Cruz said that several member clinics were closed Friday, including the Triangle Area Network, a health center in Beaumont.

In Houston, at HOPE Clinic, another health center that responded extensively during Hurricane Harvey’s aftermath, one of their newest locations was closed Friday.

Shane Chen, chief operating officer for HOPE, said locals waded through flooded streets in order to seek care at the facility.

“A mom and her daughter were coming over to the campus to try to get the to the dry spot, to higher land, and the mom scraped her foot in the water,” said Chen, describing a common injury after floods, which can raise the risk of infections, like tetanus.

Because the HOPE facility is so new, it had not received its state-issued supply of TDAP shots, which protect against tetanus. Direct Relief was able to deliver supplies Friday.

Other HOPE locations have experienced various degrees of flooding, but were able to remain open as patients continued to come for appointments and more urgent care.

“We treated everyone who came through. We tried to serve them as best as we can,” said Chen, whose group was giving out spare t-shirts from a past community benefit event, to keep people dry.

Looking ahead, Chen said HOPE has also requested mosquito repellent, because of standing water, and flu vaccines, since flu season is approaching.

Dr. Cruz said her members, and their patients, are continuing to do the best they can, even in the most difficult circumstances.

“Direct Relief has been instrumental in helping to rebuild and, more than that, to create a sense of resiliency. There’s no money attached to that – the hope given to people, to help them get over that difficult situation,” she said.

The post “Like Getting Hit When You’re Down.” Health Providers, Still Recovering from Harvey, Respond to Imelda’s Impacts appeared first on Direct Relief.

The boy and his father had migrated from violence-wracked Honduras. But instead of finding security in the United States, the child was taken away from his father by immigration authorities under the Trump Administration’s child separation policy. They put him on an airplane to New York, where he was held in a facility for several weeks.

Now, the child was staying with an aunt in Dallas, but seemed locked inside himself, refusing to eat, speak, play or interact with anyone.

“This is probably the most severe case we’ve seen so far,” but hardly the only one, says Dr. Sharon Davis, chief medical officer at Los Barrios Unidos Community Clinic, a federally qualified health center in Dallas. “We have a very high immigrant population, who are affected by the many, many traumas they get through to get here.”

Los Barrios Unidos and other Texas health centers are on the vanguard of trauma-informed care, a budding movement to recognize and respond to the widespread prevalence of trauma among patients.

The Texas Association of Community Health Centers, with up to $1 million in grant funding from Direct Relief, is working to train its member health centers in trauma-informed care. TACHC’s 73 members, with more than 400 sites across Texas, collectively provide care to 5 million patient visits per year. Community health centers typically provide primary and preventive care to medically underserved and uninsured people, the overwhelming majority of them below the poverty line.

Caring for the Health of Trauma Survivors

Trauma-informed care starts with the core assumption that a patient is more likely than not to have suffered some kind of trauma. When practicing trauma-informed care, health care providers shift from asking “What is wrong with this person?” to “What has happened to this person?”

Early detection and treatment of trauma can head off a lifetime of consequences and high medical costs. A person carrying trauma faces higher risk of substance abuse, mental health issues, heart disease and risky sexual behaviors. The trauma often goes unrecognized by medical workers, who treat the symptoms—addiction, depression, self-harm—rather than the causes.

Trauma-informed care is a relatively new field, gradually emerging since the mid-1990s and still in a formative period. While psychological trauma has always been part of the human experience, post-traumatic stress disorder, or PTSD, wasn’t recognized as a medical diagnosis in the United States until 1980, when the American Psychiatric Association added it to the third edition of its Diagnostic and Statistical Manual of Mental Disorders, the DSM-III.

Psychologists have come to believe that millions of Americans who have never been in combat are walking around carrying trauma from their own experiences. Those experiences may include sexual or physical abuse, witnessing or experiencing gun violence, or the separation of children from parents by U.S. immigration agents.

While these experiences may inflict deep trauma, “trauma can be as simple as a dog bite or a minor car wreck,” says Aimee Rachel, Trauma Informed Care Project Coordinator at TACHC. “People will often have trauma symptoms but dismiss their experience because it was not a ‘big’ trauma.”

“We recognize that the military we send into war may develop PTSD as result of being shot at with weapons of war,” says TACHC Executive Director José Camacho. But right here in the United States, he says, “we have kids today that are being shot at with weapons of war.” The duck-and-cover nuclear war drills of the 1960s have been replaced by training small children to hide from active shooters in their schools, he notes, asking whether such training itself can traumatize these children.

Children brought into a health center because of behavioral issues in school are often given medication for Attention-Deficit/Hyperactivity Disorder. But if the underlying issue is an experience of trauma, that medication will likely fail to fix the behavior and could potentially cause new harms.

Trauma-informed care doesn’t require any significant changes in health center workflows, TACHC says. Instead, it trains every staff member (especially those encountering patients) on how to recognize signs of trauma, and makes small adjustments in practice to avoid re-traumatization.

“When you drill it down, it’s caring about people,” says Dr. Roxana Cruz, TACHC’s director of medical and clinical affairs. “If we allow ourselves to care deeply about people, then they respond and tell you their deepest feelings and emotions, and thereby can be provided with support, directed to trauma-specific therapy, and taught healthy coping skills.”

Recommendations for trauma-informed care affect everything from the layout of the waiting room to the way a doctor listens to a patient’s breathing:

Because so many women have experienced sexual assault, a doctor should explain that he will use a stethoscope and ask permission before reaching toward a woman’s chest.

Because so many people have been victims of violence, parking areas and stairwells should be well-lit, and the waiting room should include chairs facing the entrance for people who fear sitting with their backs to a door.

“Health care services, with an inherent power differential between patient and physician, and which often include physical touch, removal of clothing, lack of privacy, and personal questions, can be re-traumatizing for survivors,” says Dr. Eve Rittenberg, writing in the New England Journal of Medicine.

TACHC is using a train-the-trainers model, starting this year with 10 to 12 health centers identified through surveys as being most ready. It conducted the first training sessions in April.

In each selected health center, three members are being trained: one behavioral health or substance use disorder clinician, one medical or dental provider, and one staff member “who has demonstrated ability to be a change leader within the center,” TACHC says in a fact sheet about the program. TACHC is providing full-day training workshops, monthly one-on-one and group calls for coaching, and train-the-trainer guides.

Protecting Health Workers from Psychological Impacts

Trauma-informed care extends to caring for health center staff. “Like everyone working in health care, I am vulnerable to the effects of vicarious trauma, the weight of witnessing my patients’ suffering,” writes Dr. Rittenberg. “Vicarious trauma can lead to compassion fatigue and burnout, especially when it resonates with a provider’s own prior traumatic experiences or occurs in a setting that lacks opportunities for support and discussion of the work.”

Texas clinics experienced high staff turnover after 2005’s Hurricane Katrina, which destroyed New Orleans and sent refugees flooding into Texas. While the health centers initially attributed the turnover to burnout, they eventually realized the clinicians were suffering from the secondary trauma of having to deal repeatedly with patients in crisis. When Hurricane Harvey hit in 2017, the TACHC helped train staff on secondary trauma, and the centers whose staff got training saw far lower levels of turnover, Camacho says.

While the family separation policy has officially ended, undocumented immigrants remain under stress from policies like widely publicized immigration roundups. In Dallas, no-shows spiked in mid-2018 when undocumented immigrants became afraid to drive or enter a medical facility for fear of being apprehended, Dr. Davis says.

The Dallas health center doesn’t know what became of the boy who stopped speaking. They could never get his aunt to bring him back.

The post Texas Health Centers Embrace Trauma-Informed Care for Victims of Child Separation, Disasters and Violence appeared first on Direct Relief.

The funds will help the health centers purchase mobile medical units, generators for backup power, and backup refrigeration for medicine that must be kept cold and will fund repair or replacement of storm-damaged roofs, floors and equipment, helping them become more resilient for the upcoming hurricane season.

“With storms becoming more powerful and destructive as ocean temperatures rise, community health centers in Texas and other coastal states are the healthcare safety net helping prevent natural disasters from becoming health crises,” said Damon Taugher, Director of U.S. Programs for Direct Relief. “The tremendous outpouring of support from donors, small and large, in response to last year’s hurricanes is ensuring that health centers remain strong and resilient as we head back into hurricane season.”

The grants capped a full month of activities in preparation for the 2018 hurricane season:

• Direct Relief and the National Association of Free & Charitable Clinics (NAFC) announced more than $1.8 million in hurricane recovery grants to 20 free and charitable clinics in Texas and Florida.
• On May 22, Direct Relief received a $50 million donation from AbbVie to help rebuild and strengthen Puerto Rico’s primary healthcare system, better preparing it to withstand future hurricanes and outages of power or water. Direct Relief will support more than 60 community health center sites and local healthcare facilities over a three-year period.
• On May 10 and 11, Direct Relief held a workshop for Texas community health centers on crisis mapping and communications to better inform relief efforts should a hurricane make landfall this year.
• Direct Relief also moved into its new headquarters and warehouse in Santa Barbara, quadrupling the volume of medicines and medical supplies it can collect and stockpile for distribution.

The post As Hurricane Season Begins, Direct Relief Grants $3.1 Million to Bolster Texas Health Centers appeared first on Direct Relief.