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Staff at the Gulf Coast Health Clinic in Port Arthur, Texas, receive critical medicines and supplies from Direct Relief in the weeks after Harvey. (Lara Cooper/Direct Relief)
Hurricane Harvey was one of the most destructive and costly natural disasters to ever impact the continental United States. The powerful hurricane made initial landfall near Port Aransas, Texas, on August 25, 2017, and continued to batter large sections of Texas and western Louisiana for days. High winds, heavy rain, and unprecedented flooding took the lives of more than 80 people and caused extensive damage to homes, businesses, schools, healthcare facilities, and infrastructure.
The storm stalled over southern Texas dumping huge amounts of rain – over five feet in some locations – resulting in extreme and treacherous flooding.
Roads outside of Beaumont, Texas, were several feet underwater in the weeks after Harvey. (Lara Cooper/Direct Relief)
Houston, the fourth-largest metropolitan area in the country, was particularly hard hit by storm-related flooding. According to the National Hurricane Center, the amount of rain that fell on the city of 6.6 million people reached record breaking levels – two feet of rain fell in the first 24 hours and by September 1, one-third of the city was underwater.
Thousands of high water rescues were undertaken by public authorities and private citizens using a wide range of vehicles from rafts to trucks to helicopters. The flooding ultimately forced more than 40,000 people in Texas out of their homes and into both official and unofficial evacuation centers, with mega-shelters housing thousands of evacuees established in convention centers in both Houston and Dallas. As many as 450,000 people in Texas would eventually need assistance.
With regard to cost, the National Hurricane Center estimates the damage caused by Harvey at between $90 billion and $160 billion with a midpoint of $125 billion, placing it second in U.S. history behind Hurricane Katrina.
Direct Relief’s Response
Direct Relief has been active in emergency storm and flood-related responses around the world for decades. The populations that Direct Relief supports on an ongoing basis are especially vulnerable in natural disasters, as low-income and underserved families often lack the financial means to escape an approaching hurricane or other emergency. And when people do flee their homes, they often are not able to bring their medications with them, particularly dangerous if they suffer from chronic medical conditions such as diabetes, asthma, or heart disease.
Approach
Direct Relief’s approach to dealing with hurricanes and other destructive storms is sequential, and includes preparedness, immediate and short-term response, recovery, and long-term rehabilitation activities. Throughout these emergency preparedness and response stages, Direct Relief works with local partners best situated to assess need, provide or support the provision of medical services, as well as to prepare and implement necessary long-term recovery and future preparedness efforts. Each emergency has specific characteristics that are dependent upon local facts and circumstances. Direct Relief coordinates with all local and national responders to avoid the duplication of effort, the wasting of resources, and logistics bottlenecks.
Hurricane Preparedness – Ensuring Access to Essential Medical Goods
Poverty and other social vulnerabilities increase the chances that people will be seriously affected by a severe storm or other disaster, as low-income populations are less likely to prepare for hazards, less likely to respond to warnings, and more likely to die and suffer injuries. This population often obtains care at Direct Relief’s partner healthcare facilities and organizations that treat all patients regardless of their ability to pay. However, these medical institutions and agencies are typically under-equipped to handle the large influx of patients that need help after a hurricane or other major storm. Prepositioning medical goods before a disaster strikes helps eliminates delivery delays and equips medical professionals with the materials needed to treat injured or ill patients.
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As it has for more than a decade, Direct Relief had already pre-positioned Hurricane Preparedness Packs, containing enough medicines and supplies to treat 100 patients for three-to-five days, at facilities located in hurricane-prone areas and on evacuation routes along the Gulf and Atlantic coasts in anticipation of the 2017 hurricane season. Direct Relief’s Hurricane Preparedness Program, launched in 2007, is an initiative designed to supply healthcare facilities and organizations located in areas at high risk for hurricanes with the resources they would need to offer an effective, rapid response in the event of a major storm. A total of 50 packs were distributed in anticipation of the 2017 Hurricane Season. These packs proved invaluable when Hurricane Harvey hit, with ten of the packs that had been prepositioned in Texas were used during or within days of the storm’s landfall. Many of the partners that have received the preparedness packs had worked with Direct Relief for more than 10 years.
Mapping Social Vulnerability
Direct Relief mapped factors of social vulnerability to show who is most at risk during a natural disaster like Hurricane Harvey. (Direct Relief map)
As the hurricane approached and the storm path became more clear, Direct Relief created several social vulnerability maps to help identify the most at-risk populations and communities. Looking at a range of vulnerabilities including socioeconomic status, racial make-up, language skills, house-hold composition, transportation options, and environmental factors, the maps helped to pin point geographic areas and groups of people that would be more susceptible to the effects of the storm.
The data which drives Direct Relief’s social vulnerability application is based on the U.S. Centers for Disease Control and Prevention’s Social Vulnerability Index model, which uses census data to understand relationships between different ways that disaster-affected communities may experience significant challenges in response and recovery in order to tailor resources, communications and planning to their needs.
Immediate and Short-Term Response
Recognizing the potential for catastrophic damage before Hurricane Harvey even made landfall, Direct Relief sent staff into the greater Houston area and had been in touch with over 60 of its local partner health facilities whose populations were most likely to be affected by the storm. These health centers, free and charitable clinics, and public health departments care for vulnerable members of the community, are part of Direct Relief’s extensive network of 1,300 safety net facilities and their 4,000 clinical delivery sites that receive regular donations of prescription pharmaceuticals and other medical goods to assist and disadvantaged patients.
As these partner health centers and clinics reopened their doors, staff immediately began to see a surge in patients in need of care. As soon as they had a chance to assess the status of their physical structures, medical equipment, and pharmaceutical and supply inventories, requests to Direct Relief for assistance began to stream in. Due to the scope and extent of the devastation, as well as the need for thousands of people to evacuate their homes, medical services and products were needed quickly and in sizeable quantities. Emergency medical shipments, some of which were packed in rugged and easily transportable containers for use in outreach and shelter situations, were quickly dispatched.
Direct Relief’s immediate response included commitments of more than $808,000 in operational grants and opening its entire medical inventory to support relief efforts. Direct Relief staff in Texas also made emergency deliveries to multiple sites, bringing essential items ranging from refrigerators for vaccine and insulin storage to basic hygiene items for evacuees.
On August 29, six shipments went out to Community Health Centers of South Central Texas, assisting communities dealing with rising floodwaters and damage from the storm. By August 30, 10 more Direct Relief shipments were bound for clinics in Houston, Dallas, Katy, Beaumont, and other impacted communities. Medical supplies also arrived that day at the George R. Brown Convention Center in Houston, where a shelter was established as a temporary space for more than 10,000 people, double its capacity. By August 31, 2017, Direct Relief had sent 60 emergency deliveries to hurricane-affected areas. This included more than $900,000 in material aid requested by 18 health centers, clinics, public health departments, and the Texas Children’s Hospital in Houston.
Galveston County
Galveston was one of the first counties along the southern coast of Texas to be affected by Harvey. Strong winds, heavy rains, and dangerous storm surge hit the area causing severe flooding, widespread power outages, and damage to homes, businesses, and infrastructure. Emergency teams in Galveston County reported making non-stop high-water rescues as well as helping hundreds of people to relocate to shelters and evacuation centers. All sea ports were closed, and flooding and downed trees made many roads, including section of the interstate, impassable.
As evidenced in past emergencies, when people are forced to flee their homes, they often are not able to bring their medications with them. With no pharmacies or doctor’s offices open, the Galveston County Health Department decided to use their mobile van to bring a team of healthcare providers directly to emergency evacuation shelters.
Dr. Philip Keiser, a professor of medicine at the University of Texas Medical Branch in Galveston who serves as the Galveston County Local Health Authority, reported that the Hurricane Preparedness Pack that Direct Relief had prepositioned with the County Health Department, along with an Emergency Health Kit sent overnight on the day the hurricane made landfall, enabled medical providers to effectively care for people suffering from both acute and chronic medical conditions.
Over the first two months following Harvey’s landfall, Direct Relief delivered 355 emergency shipments to 44 partner facilities caring for people affected by the storm and its aftermath. These shipments contained more than 70,000 pounds of critically needed medicines, insulin, tetanus vaccines, first aid and general clinic supplies, diagnostic medical equipment, antiseptics and disinfectants, and personal hygiene products with a total wholesale value of $10.4 million.
Medium to Long-term Recovery
As the disaster response moved into the recovery phase, Direct Relief continued to work closely with the Texas Association of Community Health Centers and longstanding partners the National Association for Community Health Centers (NACHC) and the National Association of Free Clinics (NAFC) to address priority medical needs. Direct Relief’s focus with partners is always on the people and organizations who not only step up in the immediate event, but those that will also be a significant part of the healthcare safety net in the months and years ahead. These partners directly provide care to the vulnerable people and communities affected by the storm, and out the critically needed medical products that Direct Relief delivers to use.
The pharmacy at Gulf Coast Health Center is stocked after Hurricane Harvey. (Photo by Felipe Luna for Direct Relief)
In total, since Hurricane Harvey made landfall nearly a year ago, Direct Relief has delivered 981 emergency shipments to 76 partner facilities in hurricane-affected communities in Texas, Louisiana, and Oklahoma. These relief and recovery shipments, valued at $21 million wholesale, consisted of more than 200,000 pounds of critically needed medications, insulin, tetanus vaccines, first aid and general clinic supplies, diagnostic medical equipment, antiseptics and disinfectants, and personal hygiene products. The donated products contained a total of 9.1 million defined daily doses or the assumed average maintenance dose per day for a drug used for its main indication in adults.
Summary of Hurricane Harvey Emergency Product Donations
Since Hurricane Harvey made landfall, Direct Relief has shipped $21,019,000 worth of donated medical products to 76 partner healthcare facilities.
Emergency shipments contained critically needed medications, nutritional products, medical and hygiene supplies, and medical equipment including:
Analgesics
Antibiotics
Asthma Medications
Antiseptics
Cardiovascular Drugs
Dermatological Products
EpiPens
Gastrointestinal Products
Insulin and Oral Diabetes Medications
Nutritional Products
Ophthalmic Agents
Tetanus, Diphtheria, and Pertussis Vaccines
First Aid and Wound Care Products
Medical and Surgical Instruments
Blood Pressure Kits
Blood Glucose Meters and Test Strips
Water Purification Supplies and Equipment
Personal Care and Hygiene Supplies
Long-Term Rehabilitation Support for Affected Communities
In addition to providing critical medical material aid and supplies, as well as emergency operating grants, Direct Relief extended its collaboration with NACHC, NAFC, TACHC and other associations to provide cash funding through the establishment of the Hurricane Community Health Fund. The fund was set up in the aftermath of the hurricane to be used solely for the benefit of hurricane-affected communities and people – particularly those who have low incomes, lack insurance, and are among the region’s most vulnerable residents.
A mobile clinic for Bee Busy Wellness Center was purchased with funds from Direct Relief. After the hurricane, a shortage of mobile clinics locally meant two had to be brought from as far as California to be used in the Houston area for medical treatment.(Photo courtesy of Busy Bee Wellness)
To date, Direct Relief has awarded $4.9 million in cash grants aimed at helping partners in Texas with near, intermediate, and long term purchases including mobile medical units, generators for backup power, and backup refrigeration for temperature-sensitive medicine that must be kept cold, as well as fund repair or replacement of storm-damaged roofs, floors and equipment, helping them become more resilient for the upcoming hurricane season. Another round of funding will be distributed by the end of 2018.
Cash grants ranging from $33,000 to nearly $650,000 were awarded to 25 community health centers and free and charitable clinics in Texas:
Amistad Community Health Center – Corpus Christi
Asian American HOPE Clinic – Houston
Casa El Buen Samaritano – Houston
Christ Clinic – Katy
Bee Busy Wellness Center – Houston
Coastal Health & Wellness, Galveston, La Marque
Community Health Centers of South Central Texas – Gonzales
El Centro de Corazon – Houston
Fort Bend Family Health Center – Richmond
Gulf Coast Health Center – Port Arthur
Health for All – Bryan
Health Opportunities for the People of East Texas – Center
Ibe Sina Foundation – Houston
Matagorad Episcopal Health Outreach Program – Bay City
Pasadena Health Center – Pasadena
PediPlace – Lewisville
San José Clinic – Houston
Spring Branch Community Health Center – Houston
Stephen F. Austin Community Health Center – Alvin
The Texas International Institute of Health Professions (TIIHP) – Houston
TOMAGWA HealthCare Ministries – Tomball
Triangle Area Network – Beaumont
Ubi Caritas Health Ministries – Beaumont
United Health Partners – Houston
Vecino Health Centers – Houston
Improving Resiliency
During the response to Hurricane Harvey, significant challenges arose in terms of understanding changing circumstances, communicating emerging needs, tracking available resources, and coordinating response activity. The Harvey response further demonstrated an increasing urgency for strong preparedness activity before disaster events, not only in terms of health programs and logistics, but also in the areas of communications, analysis and coordination. Since the hurricane struck, a number of new communication and mapping tools have emerged to address or strengthen preparedness and response efforts. For example, Facebook developed a suite of new social media tools tailored specifically to crisis response with the potential to improve emergency communications in dramatic ways for individuals and organizations alike. In addition, crisis mapping has continued to mature through improved integration of new services and social media data, as well as easier deployment of geographic information systems (GIS).
Post-Harvey Workshops
Direct Relief’s Bryn Blanks leads a session during Direct Relief’s crisis communications workshop in Houston in May 2018. (Lara Cooper/Direct Relief)
Effective use of innovative tools requires not only access to technology and data, but also skills, practice, procedures and preparation developed prior to disasters. As a result, Direct Relief, in collaboration with Texas healthcare safety net partners, the Texas Association of Community Health Centers (TACHC), and others in the technology and analytics communities, held a post-Harvey workshop on social media, crisis mapping, and public health emergency response called Innovations in Crisis Response.
The workshop, which took place in Houston in May, provided training on how to use new social media and crisis mapping, offering health centers across Texas an opportunity to learn and engage in the development of communications and crisis mapping plans in advance of the 2018 hurricane season. Attendees learned how first responders use new forms of social media and crisis mapping to connect, understand, and work in more efficient ways. The workshop also allowed safety net healthcare professionals to share effective disaster communications and analysis strategies, and to provide feedback designed to make the tools more responsive to the needs of emergency response professionals. The meeting was covered by the Associated Press and appeared in dozens of outlets across the country.
At the request of TACHC, Direct Relief will also be sponsoring an Emergency Preparedness and Response workshop at the association’s annual conference in October 2018. The workshop will consist of a full day of pre-conference training on emergency preparedness topics that were identified by community health centers affected by Harvey.
Looking Ahead
The extensive and widespread effects of Hurricane Harvey will be felt for many years to come. Both the unfathomable destruction, and the beauty of people coming together to help and support each other in their time of need, will not be easily forgotten. In response to the historic devastation caused by the storm, over the past year, Direct Relief has worked alongside healthcare providers rooted in affected communities to bring proven approaches to emergency response to an unprecedented scale, adapt to the evolving needs on the ground, and enhance the effectiveness of preparedness efforts along the U.S. Gulf Coast to ensure even more effective responses to future storms.
It is thanks to the generous support of individuals, corporations, foundations, and healthcare companies that Direct Relief has been able to deliver critically needed medical products and financial support to medical providers caring for thousands of people affected by Hurricane Harvey.
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