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Elisabeth (blue shirt) and Denise (tan shirt) with Medspire volunteer nursing student volunteers at Comanche Creek in April 2021. (Photo Courtesy of Natalie Soto)
In just two and a half years, Medspire Health, a free mobile health clinic based in California’s Gold Country, has lived several lives.
Medspire was started by a mother and her two daughters, all nurses, as an emergency, stop-gap solution after the Camp Fire, which killed 85 people and destroyed the northern California mountain town of Paradise. The disaster left survivors without any local primary or emergency care options.
Denise Gundersen, whose nickname is “mom,” and her daughters, Elisabeth Gundersen, a nurse practitioner, and Birgitte Randall, an ER nurse, realized when the local shelter closed — mere weeks after the fire — the most vulnerable residents of the “The Ridge,” as the Butte County fire-struck region is known, would be left on their own. Medspire was created to care for those patients, who numbered in the hundreds.
About a year later, the Covid-19 pandemic came to California. As a result, the group was forced to halt in-person visits last year from March until July. The group responded with a 24-hour hotline for patients with chronic conditions. And a month after they restarted those visits, the region was hit by the North Complex Fire, one of the largest fires in California’s recorded history. Currently, the Dixie Fire is burning across parts of Butte County and is now the second-largest California wildfire, with more than 510,000 acres burned.
While monitoring that fire and assessing local needs, Elisabeth Gundersen said Medspire shifted to treating another crisis in Butte County earlier this year: homelessness. In addition to offering traditional primary health care services for the homeless community, they have also expanded their focus on addressing mental health issues.
Many residents of Butte County, where the 2018 Camp Fire killed more than 80 people and displaced thousands, are still without permanent housing. Here, volunteers from MedSpire provide care to residents in an RV community in Butte County in Nov. 2019. (Photo by Mark Semegen for Direct Relief)
“Over the last couple of months, our focus has been on street medicine with the absolute explosion of homelessness in Chico,” said Elisabeth Gundersen of Butte County’s most populous city, and where many fire refugees came after the blaze.
“We’re not expecting people to come to us. If you don’t have basic needs met, you don’t make it to a clinic.”
Elisabeth, speaking about the Comanche Creek Greenway, where the city’s largest homeless community is based, said conditions necessitate an ongoing response.
“There are really dire, really sad conditions in those camps. People walk through the camp with water, but there is no running water, no bathroom, no trash cans, and no food unless you leave,” she said, noting that temperatures had regularly exceeded 100 degrees throughout July.
“When you’re in a tent, and its 110 degrees and your main concern is bathing and getting water, primary care might not be your biggest concern,” she said.
According to a 2019 report from Butte County Continuum of Care, a consortium of government agencies and nonprofits focused on ending homelessness, “31% of all people experiencing homelessness in Chico reported being survivors of the Camp Fire.”
Comanche Creek homeless encampment. In the foreground is Medspire patient Jesse Richardson’s home. “This isn’t trash, this is what I have left, and I live here,” he said. (Photo Courtesy of Natalie Soto)
Medspire has been treating patients in the camp with a crew of between three and five clinicians and social workers. Their goal is to offer care on the spot and connect people with local primary care and mental health resources. They have also partnered with other groups, such as Lions Clubs International, to help provide more services such as eyeglasses and even acupuncture.
Denise Gundersen said the ongoing Dixie Fire and recent North Complex Fire set some of their patients back mental health-wise. The fire has also led to elevated levels of airborne irritants from smoke. A report from the California Department of Public Health’s Jason Vargas shows Chico experienced eight days of heavy smoke exposure last month.
“The town is covered in smoke,” Denise said.
‘Put Ourselves Out Of Business’
The pivot towards treating the homeless population is a sign of success for the Medspire family.
“Our focus has shifted, and I see it as a positive sign that many people have started to re-establish their lives, and part of that is getting back to getting medical care again. [Housed] Camp Fire victims don’t need Medspire quite as much, said Denise Gundersen.
The shift was actually something they hoped for in the early days of their endeavor, according to Birgitte Randall.
Medspire free clinic on The Ridge, April 29. 2019. (Photo Courtesy of Medspire Health)
“We’re not making any money out of this, but we said we’ve done a good job if we put ourselves out of business,” she said. “Reconnecting people with care and medicines post-fire… We’re not the only people who’ve done it, but we’ve done a lot.”
Randall said that the organization’s small size and lean operations had helped them quickly shift and treat the most pressing needs of their community.
Even as Medspire is now more focused on Chico’s homeless population, the Gundersen family says they are still there for Paradise and The Ridge. In addition to ongoing telemedicine visits, Denise, who lives in Magalia (a town over from Paradise), is still seeing patients in-person on the mountain and delivering medications — out of a necessity, which predates the fires.
“There isn’t a solution for people in those rural areas to get to an appointment. There’s not even a taxi service,” Randall said, referencing folks who have medical or financial conditions that make travel difficult.
A Family Legacy
During the interview with Direct Relief, it was easy to see why the three family members were able to create an impactful health care group so quickly after a major tragedy—and why they chose to offer it as a free service.
The two sisters were complimentary of one another, both in a professional sense and personality-wise as well.
“My sister is more diplomatic, and I’m more to the point. And we have to balance that and be fair to everyone else on the team since we’re sisters and also happen to like each other, not just my sister; she’s also my friend,” Elisabeth said.
Randall explained how their mother modeled community involvement from a young age through her volunteer efforts in local schools, quilting workshops, and nature walks to teach kids about foliage and wildfire.
Direct Relief CEO and President Thomas Tighe and Direct Relief staff meet with Birgitte Randall (far left), Elisabeth Gundersen (holding envelope), and local officials at Butte County Public Health, June 19, 2019. Direct Relief is helping strengthen the health system after the Camp Fire devastated the community of Paradise in November 2018. (Lara Cooper/Direct Relief)
“I took it for granted,” Randall said about her mother’s engagement with the community.
“My mom made homemade brownies and brought them to school for all the birthdays,” she recalled
“I want my little girl to see what I saw as a kid,” she said.
With evident pride, Denise said she thinks a key to their success in the workplace has been mutual respect and a recognition that they each have their strengths and weaknesses.
“We figure out best how to move forward as a group, always respecting the larger group. Seeing them as adults, working together as adults for the greater good, it’s pretty exciting,” she said.
Though Medspire is now working more in Chico, the family said they always want to be a resource for The Ridge and commemorate November 8, the day of the tragic fire, every year—even if others do not.
“All that initial press, and then the next disaster happens, and you become the forgotten disaster, but we’re still living it and experiencing it and cleaning up, and it’s really important for us to remember that day,” Randall said.
Medspire plans to host a clinic day in the area this year to mark the date.
Since the Camp Fire burned through the town of Paradise in 2018, Direct Relief has provided Butte County healthcare organizations, including Medspire, with $872.4K in medical resources and $1.2 million in cash assistance.
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