Paradise, California, Provides Window on Maui Wildfire Recovery

Watching the horror of wildfires destroying Lahaina last month on television, Elisabeth Gundersen had a “familiar, gut-wrenching feeling.”

Gundersen, a nurse who grew up in Paradise, Calif., and co-founded a free, mobile medical clinic called Medspire with her sister and mother after the deadly Camp Fire in 2018, could relate to what people in Lahaina were going through and what might be facing them in the coming days, weeks, months, and years.

“For many people living in Paradise, they couldn’t even watch the news,” she said.

With her wildfire-specific medical experience, she immediately planned to fly to Maui to support the survivors. But after taking a beat, she and her family decided they might be more helpful by sending financial support to help people pay for prescriptions and sharing their insights with local providers instead.

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“We recognized that running to a place of disaster is not the best use of resources and often takes away resources from local people,” Gundersen said, also acknowledging the differences in the two locations, including Maui’s island location, making logistics significantly more complicated, as well as the different demographics.

She connected with local healthcare providers and shared her experiences as a nurse after the Camp Fire, which killed at least 85 people and leveled the town of Paradise, Calif., and neighboring communities. One of the providers she connected with was Dr. Trina Chakravarty, a physician who practices at Malama I Ke Ola Health Center, which has a location in Lahaina.

“We never had disaster relief experience and didn’t know about large-scale disasters,” Chakravarty said. “Elisabeth and her sister were so helpful.”

Chakravarty recalled that, similar to Gundersen’s experience related to the Camp Fire, there was an acute lack of information as the wildfires were burning and in the days after. “The hospital census wasn’t that bad overnight. We learned that either they couldn’t find survivors or had to medevac burn victims to Honolulu. There was not much foot traffic to the hospital. We didn’t know about the live wires, debris, and how bad it was over there yet,” she said.

Gundersen said this kind of ambiguity lasted for weeks in Paradise, even around basic info such as whether her mother’s house was still standing. On Maui, Chakravarty said it took almost 24 hours to understand how severe of an event the fire was. This was exacerbated by the lack of traditional news sources in the area and the decision by local officials to close the area to media. Chakravarty, who was in the late stage of the second trimester of pregnancy, was forced to gather local info via Instagram.

For the next 48 hours, Chakravarty sought updates and tried to find how she could help, given the dearth of information. Three days after the fire in Lahaina, she began treating patients at a medical tent established in the area and at the War Memorial Gymnasium shelter, triaging injuries. Through a mutual friend, she was also connected to Gundersen.

In the following days, Chakravarty quickly realized that medications to treat chronic conditions would face shortages. Albuterol inhalers quickly ran out, as did other medicines needed to treat smoke inhalation. Even as inventory was in flux, a week after Lahaina burned down, Chakravarty began writing prescriptions by hand, completing 65 on the first day.

It was also in the initial days after the fires in Lahaina, which killed at least 115 people as hundreds more remain missing, that Chakravarty connected with Direct Relief. She said she received the requested medications within 48 hours of ordering them, including insulin, which must be kept cool. Chakravarty recounted how she accepted the first delivery and stored it in her garage, the only storage place accessible to her at the time.

While these refills help shore up supplies to an extent, Chakravarty said there was still a widespread need for medications, which national retail pharmacies on the island struggled to provide as demand spiked — particularly for people without insurance. Helping to increase access created by these gaps, some medicines were delivered from various parts of the island during the first week after the fire by locals on jet skis and boats. There were also challenges related to insurance. Chakravarty recalled some representatives from the private insurance provider on the island, who were not based locally, tried to limit patients to only those with insurance during mobile medical clinics. But, local outcries and support from local staffers and medical providers helped overcome this barrier.

“We treated everyone, Chakravarty said. People in Maui knew that providers from here would care for anyone despite what anyone else said,” Chakravarty said.

Mental health Issues, trauma responses emerge post-fire

Gundersen said that at this stage of the recovery from the Camp Fire, three things began to emerge.

“At this point, there was no potable water because the pipes had all been damaged and benzene leaked into the pipes. Secondly, we learned what medical infrastructure still stood in town. We only had one clinic and one ambulance bay in a fire station. Third, we started to see pictures from people’s cell phones and the trauma of moving back into a destroyed town,” he said.

From a healthcare standpoint, mental health has become a major and ongoing concern.

“In our mobile clinics, we saw a lot of people presenting in the first months with general anxiety symptoms: high blood pressure, panic attacks, insomnia, inability to focus or return to a productive life,” Gundersen said.

“We quickly realized that for people who would present with crazy blood pressure, we couldn’t just address their blood pressure. We would ask how they’re coping with the trauma they experienced. We tried to be a space where people could also talk about what they went through. Having providers who also went through it or at least lived there helped,” she said. “There was a pervasive need for medications used to treat insomnia.”

“Many people literally fled death on foot from the fire, things you read about and see in movies. This happened to many hundreds of people who were our friends and neighbors. We budgeted more time for appointments, so no one felt rushed,” Gundersen said.

On Maui, Chakravarty said many patients have presented with insomnia and other trauma responses as well. But, gaining trust will come with challenges that predate the fire.

“On Maui, people are more hesitant to seek care to manage chronic conditions. There can be mistrust of the medical community… Hawaii’s history is such that they don’t really rely on the government since the government came in and took over their economy and country. This all got exacerbated during Covid,” she said.

Chakravarty also noted trepidation among immigrant communities to seek care due to their legal status, even though FQHCs, such as the one Chakravarty works at, treat everyone regardless of immigration status or ability to pay.

“These communities were underserved already,” Chakravarty said.

Chakravarty said the hardest part of the experience so far was the horrible uncertainty of not knowing what happened to missing patients, noting that many lived at addresses in the burn zone.

Though her Maui clinic burned down, she said patients can still count on her and her colleagues to be there for them.

“It’s never going to feel like we can go back to normal, but we will continue providing care,” she said, noting that she delivered a baby a couple weeks after the fire hit. “It continues the swinging pendulum of life,” she said.

Gundersen said that while residents of Lahaina have a difficult rebuilding process ahead of them, including years of dealing with insurance companies and government agencies, one bright spot she noticed in Paradise is an increased sense of togetherness and community.

“People interact much more, people stepped up to help. People really feel a part of something, this collective effort to help and to build something that is better. In many ways, Paradise is better,” she said.

Reflecting on the last month, Chakravarty said it forced her to begin planning for future unplanned events and drafting an estate plan, with a hope that others on the island will do so as well.

“If you had to run out your door with your kids and your dog, what’s your plan?”

Direct Relief has supported both MedSpire and Malama I Ke Ola Health Center with essential medications and emergency operating grants to support their work during the Camp Fire and the Maui Fire Response.