Birgitte Randall, a nurse in Paradise, California, remembers waking up to pitch-black skies nearly two years ago, as the Camp Fire advanced on Paradise.

On Friday morning, the skies were black again as the Bear Fire drove Butte County residents from their homes once again.

The Bear Fire is part of the larger North Complex Fire, which has burned more than 250,000 acres

“For everyone to wake up to that again and see that red glow and that darkness, it was like, ‘Here we go again,’” said Randall, a nurse at the local Feather River hospital and co-founder of Medspire, a Paradise-based organization that provides pop-up clinics for Butte County residents. “I don’t want to become pro at this, but man, I’m a pro at this.”

But there was one vital difference.

Two years ago, evacuees from Paradise and Magalia poured into the East River Church. There, Randall and her mother and sister, Denise and Elisabeth Gundersen, joined a crew of health care providers caring for those who were displaced.

It was after those weeks working in the shelter – when the three nurses saw that the fire had created tremendous, ongoing needs in their community – that Medspire was formed.

“We were all together,” Elisabeth Gundersen recalled. “We had all been through the same experience, and, if not healing, it was at least a form of support.”

Covid has made that impossible. Greg Shafer, a counselor with Butte County Behavioral Health, described evacuees sleeping in cars and on the ground outside an evacuation center in the town of Gridley. Dispersed to hotels as far away as Sacramento.

“It’s hard to look back on the East River shelter and be like, ‘We had it good!’” Shafer said.

When the Camp Fire decimated Paradise, “even with the trauma and the shock, you could still hug someone. You could still sit with them,” Denise Gundersen said. Now, “they’re alone in a car or a hotel. There’s no stranger to give them a hug.”

Even in the evacuation center, where evacuees can receive water, food, and other services, and where Shafer has been among those providing mental health services, he’s concerned about the impact his work can have. “What can I do in a 20-minute conversation with someone who’s lost their whole life?” he asked. The answers: listen, provide empathy and compassion, connect them to the county’s behavioral health services if they’re interested.

“It’s hard, because it feels a little futile, but it also feels like the most meaningful place to be,” Shafer said.

Paradise was beginning to recover before Covid hit, the Medspire volunteers said. Local stores had reopened. People were involved in rebuilding projects. “People who have a purpose, whether big or small, they were doing OK up until Covid,” Denise Gundersen said.

But local businesses were hit hard by the pandemic, she said. People struggled with the effects of isolation.

And now, another fire.

“It breaks my heart. They’re in a car, in a hotel room,” Denise Gundersen said.

“With the silence of their own thoughts,” her daughter, Elisabeth, added.

Although all the providers interviewed expressed concerns about the mental health of their community, they’re also concerned that chronic health conditions will go unmonitored as Butte County residents disperse to hotel rooms, relatives, and other temporary situations.

Many Butte County residents, they explained, are suspicious of social systems, and may be reluctant to seek help for conditions that may need to be managed. “We don’t know how to find these people, and finding them is really tough,” Elisabeth Gundersen said.

They’ve distributed fliers offering telehealth services, but had no takers thus far. They’re hoping that a Paradise pop-up clinic, with a focus on acupuncture and other stress-relief measures, will draw people.

And they’re trying to stay positive. Randall, who is eight months pregnant, spent the afternoon under red skies, preparing a nursery with her mother’s help.

“It’s not like what we were dealing with in Paradise that day. We haven’t felt that this time around,” she said. “It’s still a really good life up here in the mountains. We’re not sad about it.”