The United States Forest Services call came in on a Thursday in August, shortly after the Dolan Fire began near Big Sur, California.

“They asked us to provide medical services,” said Sharen Carey, a physician assistant and executive director of Big Sur Health Center. A veteran of seven previous fires, Carey signed the contract on Friday and by Saturday she and her team were in the field, caring for about 700 firefighters. The speed at which they were able to respond was all the more remarkable because, only a few days prior, they “had no supplies to treat anybody,” Carey said, as a result of the clinic having been stretched thin by the ongoing pandemic.

But donations from Direct Relief, turned around in about 48 hours after she and her team ordered it, and Community Hospital of the Monterey Peninsula, enabled Carey and her team to get started for the remote-based mission. “The [Direct Relief] kit came with a sufficient quantity of useful medications that allowed us to start treating the large number of firefighters right away,” she said.

The combination of the pandemic and record-setting wildfires in the western United States has challenged all manner of health care providers, emergency responders, and public health systems.

Safety net clinics, while dealing with all the same issues, have faced the added pressure of continuing to maintain adequate supplies, including medicines and personal protection equipment, to provide care to everyone who comes through the door.

“We’re a community health clinic and we serve everyone, regardless of how much money you have or what you’re going through,” said Philippa Barron, COO of Santa Cruz Community Health, a Federally Qualified Health Center.

Since the current slate of wildfires began in mid-August, Direct Relief has been able to help support safety net health centers, public emergency response offices, and county health departments across California, Oregon, and Washington with $1.25 million worth of medicines and supplies such as KN95 masks. Direct Relief created a Wildfire Kit last year, after analyzing the most requested items by health centers during these natural disasters. The kits contain nearly 100 different items and are designed to treat 250 people for three to five days.

Specific items include PPE, inhalers and nebulizer solutions to treat respiratory irritation, irrigation solutions and antibiotics for dermal and ophthalmic injuries, analgesics for headaches, bandages and wound care items for lacerations and minor injuries like sprains and strains.

To expedite the process and get first-hand impressions of the current situation, the most recent shipment was driven to Santa Cruz and Big Sur on Monday by Emergency Response Team members Andrew MacCalla and Chris Alleway, who spoke with healthcare providers and clinic leaders about the compounding nature of the pandemic and wildfires.

That delivery included protective gear, respiratory aids, ophthalmic supplies, tetanus vaccines, and other requested medicines and supplies. “They just need more of everything and have a harder time dealing with it because their staff are affected,” MacCalla said.

“There’s a lot of uncertainty, especially for staff. I personally got evacuated,” said Gladys Drummond, a medical assistant in the pediatric department of Santa Cruz Community Health’s East Cliff Family Health Center.

The wildfires “have turned it into a nightmare,” said Carey about the dual crises. Monterey County is rated at Tier 1 in the state’s ranking system. At this tier, community transmission is “widespread” with more than eight cases per 100,000 people, excluding prison cases.

“The fires have been hard because it’s our community and we are already dealing with Covid,” Barron said. Santa Cruz County is at Tier 2, or “substantial” community transmission.

Like most safety net clinics in the U.S., Big Sur Health Center and Santa Cruz Community Health Center’s locations moved most of their appointments to telehealth visits. While allowing care to continue, those visits presented challenges.

“You kind of roll with the punches, but it was hard to be away and see how many things you can’t do remotely. That was my biggest challenge, to be outside of my comfort zone and keep pace with my business and support my staff,” said Barron.

The clinics in both Santa Cruz and Big Sur said many patients had moved away during the pandemic as work opportunities dried up and, now, during the fires.

“For our patients, it was a stressful time, we lost touch with patients and babies,” Drummond said.

Beyond these practical issues, there is also the impact of witnessing tragedy, and ongoing uncertainty, in one’s own community. A patient of the Big Sur clinic recently passed away due to a lack of asthma medication, which the patient, who was uninsured, had been trying to conserve. The individual died while on a hike.

Property loss has been substantial in the mountains near the Santa Cruz clinics, where over 900 homes have been destroyed.

“It’s hard to imagine losing our place, but I didn’t own a home and I don’t have kids to explain that too. And a lot of people did. A lot of people lost their farms and it’s pretty devastating. It’s very hard to see other people suffering,” Barron said.

But there are reasons for optimism. The Dolan Fire is now at 40% containment, while two other major Northern California fires — SCU Lightning Complex and LNU Lightning Complex — are at 98% and 97% containment, respectively, which has allowed air quality to improve along the coast. Air Quality Index values are now below 100, which is rated as “moderate” and” acceptable” by AirNow, a partnership of various U.S. government agencies as well as tribal, state, and local agencies.

Though the new fires remain in the region, and the pandemic never went away, Drummond said she is buoyed by her responsibilities.

“It’s concerning, it’s a scary time. What I always go back to is the clinic supports you. It brings stability knowing you still have a job and still have people to help,” said Drummond.