After the Camp Fire, Paradise Residents Got Sicker. So Local Nurses Founded a Clinic.

For the volunteers, it was trial by fire.

As the Camp Fire raged in Northern California, Butte County residents struggled to flee their homes, in some cases barely escaping as trees ignited and propane tanks exploded around them. About 250, many of them elderly and medically fragile, ended up sheltering at the East River Church.

“People who really had a lot of medical needs were dropped off there, and they needed medical care 24/7,” said Elisabeth Gundersen, a nurse.

Gundersen, originally from the Ridge – as locals call the area that encompasses Paradise and Magalia – was one of a family of nurses.

Her sister, Birgitte Randall, and mother, Denise Gundersen, both worked at Feather River, the local hospital. Randall had herded her three dogs into a Toyota Corolla and inched her way out of Paradise as the flames closed in.

But the three of them jumped into action at East River Church, part of an exhausted but determined crew of nurses, doctors, paramedics, mental health providers, and other volunteers offering round-the-clock care.

“Everybody at the shelter was just amazing,” said Steve Caput, a local paramedic. In the weeks after the fire, Caput recalled, he’d work a 12-hour shift, then head straight to the shelter for a few hours. After minimal sleep, he’d do it all again.

Then the shelter closed, and “we realized that the crisis was just beginning,” Gundersen said.

“We see that a lot of people who didn’t have health problems before the fire definitely have health problems now,” said Randall.

As the one-year anniversary of the Camp Fire approaches – it will fall on November 8 – Gundersen anticipates seeing a resurgence of mental health issues, as the community looks back and remembers what’s been lost.

Popping Up

The family joined forces with other health care providers to form a pop-up clinic, which they’ve held in a church parking lot, a local school – anywhere that’s convenient to residents.

Originally, Gundersen said, the plan was to buy a trailer that would serve as a roving clinic, but funds were slow in coming. “Eventually, we were talking, and we said ‘Why don’t we just post up in a parking lot and actually have a clinic? Let’s just do it, see how it works.’”

Over the course of a few months, the pop-up clinic became an official nonprofit organization, called Medspire. Made up of a rotating team of volunteers, including doctors, nurses, mental health providers, and even an acupuncturist specializing in trauma, Medspire provides free care to anyone who wants it – no strings attached, no identification or insurance required.

On a recent Sunday, Medspire held their monthly clinic in a historic firehouse in Magalia, treating everything from a foot injury to post-traumatic stress disorder for about 40 patients.

Health Care on the Ridge

A few years ago, Butte County had its fair share of health problems. “The farther up the hill you get toward Paradise and Magalia, the more sick people are, in the sense that they just don’t go see a doctor,” Caput said. Chronic conditions like diabetes and cardiovascular disease, mental health issues, and overdoses were all part of the landscape.

“It was, not a sickly population, but a population with a lot of health concerns already,” said Sean Biswun, also a paramedic.

But having good healthcare was a major benefit of living in the Ridge. “That was one of the reasons that people came here, because of the hospital. They could have all of their medical needs taken care of in a beautiful area, and that’s gone now,” said Denise Gundersen, Randall and Gundersen’s mother and fellow nurse.

The Camp Fire, which killed 85 people – most of them elderly or disabled – and destroyed nearly 19,000 buildings, nearly decimated Paradise. The vast majority of the town’s residents are displaced – estimates vary, but somewhere between 2,000 and 3,000 have returned.

Through the Cracks

The fire also significantly damaged Feather River, the local hospital, which remains closed.

“There was no medical care here” immediately after the fire, Gundersen said. “So the one emergency room was gone, the hospital was gone, there was a clinic that wasn’t open yet. There was nothing, there were just two [Emergency Medical Services] stations.”

“I just can’t wait for the hospital to open back up,” said June Doerffler, who has lived in Paradise all her life. “My health wasn’t too great before the fire, but it’s gotten worse since the fire because I haven’t been able to get to the hospital…I have to go all the way to Chico, and I don’t have a car. So it’s been hard.”

Maggie and Kevin MacDonald moved to Oroville – a town about half an hour away – after their house burned down. They’d received care in facilities in Oroville and Chico since the fire, but “we’re still trying to pay that bill,” Maggie MacDonald said.

Today, there are more health care options in the Ridge area. There’s a medical clinic in Paradise, and two nearby health centers. Some providers have returned to the area.

But in some ways, the damage was done.

People who had moved back after the fire – many of them living in RVs on empty properties or in parking lots, and dealing with unclean air and contaminated water – had gone months with unmanaged diseases or mental health issues, including post-traumatic stress disorder, depression, and anxiety.

“Not only are these people battling horrible chronic medical illnesses, but they have rampant PTSD that’s gone untreated,” Biswun said.

And substance abuse is on the rise. “Starting in December and January is when I noticed an absolute uptick in just constant opiate use,” Caput said. “People, they don’t care anymore, they’ve just given up… It’s not the first time they’ve overdosed, and it’s not going to be the last time they’ve overdosed.”

In addition, many Ridge residents had fallen through the cracks, losing any contact they’d had with the health care system. “People know it’s such a monumental task, getting medical care after this disaster, that they’d really just rather live in their pain in their trailer, which is unfortunate. We don’t want that to happen,” Biswun said.

That’s where Medspire comes in. Services run a wide gamut, from filling lapsed prescriptions to offering mental health care. But clinic workers, including case managers from the local health centers, are also focused on integrating people back into the health care landscape.

“The fire just kind of pushed a large number of people over the edge into these situations where they don’t even have health care or access to it,” said Ted Muller, an emergency room doctor who doubles as Medspire’s medical director.

“Just today, we’ve had multiple patients we’ve been able to help with insurance and plug them back into mental health and into the health care systems that exist here.”

A Community’s Trust

At the Sunday clinic, Doerffler was there to get a referral for an X-ray, and picked up naloxone (an opioid overdose reversal drug) for an out-of-state cousin.

Dennis Payne, a manager at a local pizza parlor, was there to see the acupuncturist – his back was bothering him, his wife, Laurie, explained. She was concerned that her husband, a former Marine, was working too hard.

Other patients were there to see the licensed marriage and family therapist working that day – Gundersen estimated that 80% of Medspire’s patients have mental health needs – and to refill prescriptions for chronic diseases and pain.

A small team headed out from clinic headquarters to go door to door to the RVs parked in a nearby parking lot, offering care to patients unable or unwilling to come to the clinic.

One patient, Charles “Chip” Baniewski, was struggling to make his way to the clinic to have several ailments treated. The team helped him walk his wheelchair – slowly – to his destination.

Not everyone is willing. “Some people, they swear at you, tell you to get lost. I mean, I’ve been threatened,” Caput said. “They don’t want help, they don’t want to talk to anybody, they just want to be left alone. I totally get it.”

Although most situations aren’t that extreme, it took a while for volunteers to earn the community’s trust. At an early clinic,
Gundersen said, a number of people drove by to look, but few came. It took time – and some social-media outreach, pavement pounding, and word of mouth – for the clinic to become a mainstay.

Starting from Scratch

Medspire feels like the little nonprofit that could. No one in the Gundersen family had any experience running an organization, but they felt that becoming a formal entity would help increase trust.

A fellow volunteer, a nursing student, filled in the IRS paperwork. MaryLisa Wood, a childhood friend of Randall’s who had a background in nonprofit management, was enlisted.

Gundersen, now Medspire’s president, figured out how to form a board of directors and develop a meeting agenda from scratch – anything that would help build what she called a “good, organized, purposeful, non-wasteful nonprofit that operates with integrity.”

It’s not without challenges. Medspire is entirely volunteer run, and its members work full time, or combine work with school.
For Randall and Gundersen, some multitasking during 12-hour nursing shifts is required. “I get three 15-minute breaks and a lunch break, and during those 15 minutes I’m checking my emails for Medspire and writing emails back,” Randall said.

But they know they’re needed.

“People up here sometimes feel forgotten. It’s a rural, low-income area, nothing glamorous about this place,” Gundersen said. “I think just having a presence, and being there when we say we’re going to be there, is super important.”

---

In response to the Camp Fire, Direct Relief has provided more than $700,000 in medical aid and over $1.4 million in funding to local organizations, including Medspire.