Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

A silent killer is on the rise, growing in severity and frequency along with floods and hurricanes— and killing more people than all other weather-related disasters combined.

Extreme heat, defined as more than two days in a row above 90 degrees, can cause health problems for anyone, but it’s especially dangerous for people who are vulnerable already: children and older adults; people with pre-existing conditions and disabilities; people who experience homelessness, work outdoors, are incarcerated, or are low-income.

“This extreme heat is felt even more sharply in our cities due to the urban heat island effect,” said Jana Eubank, CEO of the Texas Association of Community Health Workers. Urban areas experience higher temperatures than rural ones due to a combination of heat-absorbing buildings and roads with a decrease in vegetation and green spaces.

This summer, as waves of extreme heat rise across different parts of the U.S., the weather phenomenon is getting plenty of attention. The federal government has released new tools and programs aimed at combating its effects. Texas and Florida made national headlines for blocking heat-related protections for outdoor workers. On-the-ground media coverage details the impacts on communities and individuals.

But for community health centers, which focus on caring for the country’s most vulnerable, heat-related care, outreach, and education are already integral to the services they provide. It’s not a question of learning the impacts or even developing new solutions, but of carrying on and expanding the work they already do.

“At the mercy of the weather”

For staff at Camillus Health Concern, a Miami-based health center that focuses primarily on people experiencing homelessness, minimizing the impacts of heat “has always been our way,” said CEO Francis Afram-Gyening. It’s the intensity and frequency of these events that has changed.

“The necessity is more than I’ve ever seen,” Afram-Gyening said. “With this heat in Miami, if you don’t have air conditioning, you are really at the mercy of the weather.”

Many of the patients Camillus Health Concern cares for are improvising shelter from cardboard or other materials. Even those in shelters often don’t have access to air conditioning, Afram-Gyening said. Patients with diabetes need to store insulin, which must be kept at cold temperatures to be safe and effective. And health conditions from hypertension to depression can be worsened by the heat.

It’s a complicated problem that requires a multi-pronged approach. Outreach teams pass out cooling towels, electrolytes, and hydration supplies — much of it donated by Direct Relief, Afram-Gyening noted. Street medicine teams arrange transportation to cooling centers, many of which are located in central areas near one of Camillus’s facilities.

At the facilities themselves, patients can access water and hydration support. Camillus Health Concern offers insulin storage itself, and also partners with local organizations, such as housing groups, who can store insulin for patients on site.

Even the process of helping patients find housing — always complex, as there isn’t enough to go around — has changed. Staff members are more likely to ask for priority housing for a patient whose health is particularly endangered by heat.

Afram-Gyening observed that nothing in his formal education prepared him to meet the needs of a vulnerable patient population regularly exposed to extreme heat. It’s through practice, experience, and partnership that he and his staff have “developed some competencies of, ‘How do we address issues like this?’”

“Until they absolutely have to”

Dr. Marsha Thigpen, CEO at Gulf Coast Health Center in southeast Texas, described seeing patients for follow-up care after they’d been discharged from the hospital this summer. Acute symptoms of heat-related illness — swollen feet, labored breathing — had required emergency care.

“A lot of people in our community don’t seek help until they absolutely have to,” she explained.

And the extreme weather is “slowly getting worse,” Thigpen said. “Most of us are really concerned about this hurricane season…We are consciously looking every time there’s a disturbance in the Atlantic.”

Worsening the situation for Thigpen’s patient population is the presence of nearby refineries, Thigpen said. Southeast Texas has a high incidence of diseases, like cancer, that often have an environmental component, and she’s concerned about the consequences for her patients.

To protect patients from the effects of extreme heat and other weather events. Thigpen and fellow providers employ a combination of preventative care, screening, outreach, and education. Patients are screened for everything from pulmonary function to behavioral health symptoms, and staff members are taught to be on the lookout for symptoms exacerbated by heat.

Making sure patients are well stocked with medications is a high priority. “If they’ve got asthma, COPD [chronic obstructive pulmonary disease]. Diabetes, hypertension, they’re more likely to have issues with the extreme heat,” Thigpen said. And during extreme weather, “they may have difficulty getting to the pharmacy.”

Gulf Coast Health Center staff also counsel patients about preventive measures such as hydration and regular breaks — particularly essential for patients who work in construction or other outdoor industries, Thigpen said — and offer advice for dealing with the heat via local radio, fliers, and on-the-ground outreach. Patients are encouraged to exercise during cooler hours and reminded not to leave children or pets in cars.

“Dehydration is going to exacerbate any symptoms they have,” Thigpen explained.

Working with partner organizations has given Gulf Coast Health Center the opportunity to provide care and education via community health fairs. They began staffing last summer, Thigpen said, and another is planned for this August.

Whatever the care being offered, Thigpen said that flexibility and availability are key. Gulf Coast Health Center keeps extended hours and a 24-hour on-call service.

If a patient is experiencing heat-related illness or the symptoms of an existing condition are worsening, “they can walk in the same day,” she said.

Direct Relief equips community health centers throughout the country with requested medications and supplies designed to protect against the effects of extreme weather. Since June 1 of this year, the organization has provided Camillus Health Concern with more than $84,000 in medical support, including electrolytes, nutrition aids, and other medical essentials. Gulf Coast Health Center has received more than $152,000 in medical support, including electrolytes, a range of essential medications, and a Hurricane Preparedness Pack stocked with medicines and supplies commonly requested after severe storms.