The health center model is unique. Community Health Centers offer patients and the community a seat at the table through a board that’s majority—at least 51 percent— patients served by the health center. But it isn’t just the board that represents the local population, often times the health center’s staff does too. It’s this community-focused design that propelled some health centers to go above and beyond to help following the catastrophic Hurricane Maria.
“This is our mission. These are our patients. These are our staff.”
“We immediately had a really dramatic response,” says Dr. Meredith Niess, Internist at Fair Haven Community Health Center in Connecticut. “We have a very large Hispanic population among our patients and our staff. And within that Hispanic population, it’s very predominantly Puerto Rican. So it immediately became clear that people close to us, in a lot of different ways, were very affected. They hadn’t heard from their loved ones. The few who had heard from their loved ones were dealing with people losing homes and a lot of fears for the future.”
It soon became clear to Fair Haven that for many people the only option they had was to get off the island, and with the large Puerto Rican population in their community many evacuees would be arriving soon. But that realization led to questions about how the health center could best offer support.
“We went through a rapid process to figure out how to support our community and very quickly settled on sticking with what we’re good at, which is health care,” said Niess.
The health center quickly surveyed staff about the needs of friends and family dealing with the disaster, which highlighted concerns around the interruption of medical care, housing, employment, food insecurity and, with winter just around the corner, finding cold weather clothing for new arrivals.
“And then behavioral concerns also came up both in the form of discontinued care and acute stressors in PTSD, and worsened depression in the context of the hurricane,” she says. “If we were going to respond and we were going to have hundreds of new patients coming we needed to be prepared that this would be a pretty high complexity of new patients in a short time period.”
With clinicians leading the way, Fair Haven piloted a multidisciplinary clinic within a month. At its core was the idea that patients would walk in and immediately be screened for behavioral health and social services needs, and then be routed to ongoing care.
“They would see all three department providers in one visit, which was really a novel workflow for us,” adds Niess.
It’s no secret that health centers typically operate at capacity because their mission is to provide health care access to all. It’s not unusual for health centers to offer extended hours and multiple social services to meet their mission. The new patients, the complexity of their care needs, and the changes in workflow, coupled with the arrival of new family members who would need assistance to get situated in Connecticut, could have resulted in a worn out staff. However, that was not the case.
“I honestly feel like the sense of mission around this clinic was so strong because of how connected to our community it was and how proud our staff was that our clinic was taking a leadership role in responding,” says Niess about the staff working in the clinic. “It was a place to put their emotions and their nervous energy, and the clinic formed such a wonderful team that we created this really wonderful support with that cohort.”
According to Niess, a combination of providers and behavioral health staff took the lead in facilitating staff support events, like providing lunch. They also made time to check in with people and survey how everyone was doing.
“It was a small token given the weight of what everyone was carrying around, but I think just creating a space in a busy clinic like this really meant a lot to people,” she added.
Fair Haven’s leadership was also supportive of their providers’ efforts to help. They took the lead in partnering with local organizations who were also rendering services to evacuees. The health center worked with Junta, an organization that provides services, programs and advocacy to the local Latino community. Evacuees were referred to Junta when they arrived in the community, and it quickly became the epicenter for this massive relief effort.
“We saw over 400 patients over the first four-plus months. [Junta] saw over a thousand,” says Suzanne Lagarde, MD, MBA, FACP, Chief Executive Officer at Fair Haven Community Health Center. “They saw a huge number with very limited staff, so we committed one of our care coordinators, which took that person away from [Fair Haven], but we felt it was very important in terms of the community needs.”
The health center was also critical to advocacy efforts around national programs that impacted the new patients. In January, the Emergency Prescription Assistance Program (EPAP), a program run through the emergency preparedness division of the U.S. Department of Health and Human Services, had suddenly become deactivated for those evacuees from Puerto Rico. EPAP helps displaced people access prescription drugs, vaccinations, medical supplies and equipment they need. The team quickly identified this as a problem because the program was so necessary and after the health center’s work with a congressional delegation and local representatives, the program was reactivated
Niess says that working with these patients—particularly dedicating a full day a week to seeing evacuees—allowed them to learn more about available resources for this type of situation. That knowledge meant they could focus on providing better care to these patients.
“I think what leadership had to do is say ‘we have a mission, this is our mission, these are our patients, these are our staff, this is what we exist for and we have to find the resources,’” says Lagarde. “We were fortunate to have a tremendously motivated and talented clinical leadership team who really moved this forward in lockstep with us.”
“Our world is not just Downtown Holyoke.”
Holyoke Health, a health center in Holyoke, Massachusetts, serves and employs a predominately Puerto Rican population. After Hurricane Maria devastated Puerto Rico, Holyoke’s community was anxiously awaiting information about loved ones on the island. It didn’t take long for Holyoke leadership to step in to support staff. Recognizing the connection between health centers in the U.S. and Puerto Rico, Holyoke reached out to health centers in Puerto Rico and asked them to look in on or find information on employees’ loved ones.
“We had some good health center communication back to our staff members who then understood more about what their family’s status was,” says Jay Breines, Holyoke Health’s Chief Executive Officer. “It also allowed the health centers in Puerto Rico to recognize that they could provide that service to people like us up here. I think on both sides of the phone call people were feeling we could actually do something. Even if it’s not rebuilding a house right away, at least we could track people down.”
It just so happened that in a lot of cases the family members in Puerto Rico were patients of health centers on the island. This realization made the staff’s connection to their employer and health centers stronger. While the staff was working in a health center, their family thousands of miles away were patients at a health center, and these centers were all connected through the network of health centers that spans the country and the U.S. territories.
Breines says this allowed for a big family approach to providing relief, “that’s the way we provided both some reassurance as well as some ongoing support.”
Holyoke’s support of the Puerto Rican community extended beyond making connections. Leadership was able to secure the donation of a private jet and a team from Holyoke, including Breines, made multiple trips down to Puerto Rico within weeks of the hurricane. They flew from Holyoke to Aguadilla on the northwest tip of Puerto Rico with medical supplies, water, personal messages of support and other essential items. These items were then distributed to health centers in Rincon, Cidra, Humacao, and other communities.
On those trips the plane would also return to the U.S. with patients. In total, including those evacuees that made it to Holyoke by other means, the health center enrolled about 650 new patients into its practice. These new patients needed much more than just health care. They required help resettling into the area. Holyoke took on locally connecting families, holding clothing drives, food drives, and working with local resource and sheltering centers. As evacuees began to realize that their stay in Massachusetts was more permanent, Holyoke’s efforts shifted to include helping with job training, housing and enrolling children in school.
Like Fair Haven, Holyoke also worked with a local organization to meet the needs of newly arrived patients. They partnered with Enlace, whose mission is to develop, lead and promote organizing in Holyoke. As evacuees arrived, Enlace became a welcome center within the community. Holyoke permanently placed some of their staff at Enlace and helped coordinate an orientation process that happened every day at noon and offered new arrivals information from 5 to 10 agencies they needed to know.
The health center has tried to be an organizer by asking “what happens next, who do we speak to, how do we help the school system, how do we help the housing programs, how do we help the food distribution programs,” says Jay. “I think that’s helped our staff greatly because [they] recognize that they don’t have to worry about those issues for their family members who arrived from Puerto Rico.”
Absorbing 650 new patients was no small task but the health center staff stepped up. They agreed to work additional clinic hours and the health center was able to open up evening hours to accommodate the volume without imposing on existing patients. The staff was willing to do whatever they could to be a part of the process and help.
“It was also an additional way that the staff was feeling supported,” says Breines. “It was important for us in leadership to say to our staff ‘we’re on it. We have an opportunity to really help out and we’re going to do it because it’s the right thing to do.’”
Breines says morale was lifted by the pride staff took in helping these patients.
”I’ve been here for 24 years and I think this is the most I’ve been appreciated by my own staff,” Jay says laughing and describing the messages of thanks he gets in the hallways these days.
There is still anxiety among the community and staff that something similar to Maria could happen again. But staff know that Holyoke will immediately be a resource for help.
“We’ve built into our system now, I think, more resiliency to immediately be able to absorb the next wave, if there is a next wave, of people.”
“We feel that we belong to a larger community.”
Last September, the San Benito Health Foundation, located in Hollister, CA, was offering assistance to Mexico City after it was struck by a 7.1 magnitude earthquake when they were alerted to the catastrophic scene in Puerto Rico.
“We feel that we belong to a larger community, not just the community of San Benito County, but the community of the sisterhood of clinics throughout the nation and the Caribbean,” said Rosa Vivian Fernández, MPH, FACHE, CEC, San Benito President & Chief Executive Officer. “And once again our board asked, ‘What can we do in the case of Puerto Rico?’”
It was immediately obvious to San Benito that communication was going to be a challenge, so they began to think about how they could help establish communication channels. They turned to satellite and solar technology, purchasing satellite phones and solar chargers. Fernández then set to making connections with her contacts on the island and standing by for a flight. As a native of Puerto Rico, the CEO was very familiar with the island’s communities, and through her connections, including Direct Relief and a previous match fellow, she was able to maneuver around the island to visit health centers and provide supplies.
“I was particularly concerned with the clinics in the west, which were the last to come on board in terms of communication,” says Fernández.
The CEO’s concerns were not unfounded. According to an op-ed by Jose Rodriguez, MD, Chief Medical Officer of Castañer General Hospital, in STAT News, “The first assistance was from the nonprofit San Benito Health Foundation, based in California. It sent a small team to assist with post-disaster health needs. The team helped us order medications from the mainland U.S. It also delivered a solar charger and satellite phone that were donated to us by the Migrant Clinicians Network, which has been a close collaborator with Castañer General Hospital on a number of projects to improve our community’s health.”
Fernández and her team visited a total of eight clinics, offering much-needed supplies. She had suitcases full of essentials that might be helpful including batteries, which were difficult to get on the island. “A lot of it was assessing what were those immediate needs and some were little things that people needed just for their own security,” she says.
Fernández also tearfully recounts that what providers needed most in the chaos was to feel connected and to be heard.
“We visited these clinics and they just wanted to talk about what they were experiencing,” she says. “And we would let them know they weren’t alone. Just giving them that bit of hope. You know, connectivity and hope. Being heard is really important in these times.”
The CEO says she learned the importance of connections and knowing who to call to help funnel donations to those in need in a more effective and efficient manner. She also stressed the need to be a voice for those who cannot advocate for themselves.
“It is also advocacy for those areas that sometimes people don’t know because it’s difficult to get to,” says Fernández. “I have been to Puerto Rico as recent as April and there’s still people without electricity, running water, and they’ve been in that situation since Hurricane Irma. It’s very devastating for the staff because they are not only dealing with their own losses, they are also working to assist the community.”
According to the CEO, feeling a connection and comradery to people not living the storm recovery experience is important to the staff’s mental health.
“They need to experience a bit of distance because they’re living this on a daily basis,” she says as she recounts a conversation with a mayor in one of the cities she visited. “The mayor said, ‘We so appreciate that you’re coming because you’re not coming late. You’re right on time because we feel that we will be forgotten. We continue to have these challenges. Our community has not recovered yet, and the novelty of the disaster has dissipated.’”