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

CHARLESTON, S.C. — Pastor Jay Tucker and Associate Pastor Cathy Tucker thought they had seen the worst of Hurricane Debby after it came through on August 5 and 6. Even after it went out to sea and came back towards the Carolinas on Thursday, August 8, the community of Richmond Hill, outside of Savannah, Ga., thought they were still in the clear.

But the following day, Friday, flood waters started to rise, inundating the area around their church, Richmond Hill United Methodist, and the surrounding neighborhood. By Saturday night, the city announced power cutoffs. Early Monday morning, a nursing home across a field from the church had to be evacuated in the middle of the night.

The following day, many adjacent streets looked like small rivers – even as others were totally dry – and some fields still looked like ponds.

“A congregant told me it was the only time he ever prayed for a recession,” Jay Tucker said to Direct Relief, recounting the joke as he looked out over a flooded playground after stepping outside from an impromptu, grassroots aid distribution operation his congregation had established in the church to aid displaced and impacted community members with supplies like hygiene products, towels, soap, garbage bags, and more.

In Charleston, the storm also came with surprises. Located in South Carolina’s Lowcountry, and indeed several parts of Charleston are below sea level, the leadership team at Fetter Health Care Network, the area’s only federally qualified health center, evacuated medicines and mobile units to their inland Summerville location for safekeeping.

But as the storm bore down, a video feed showed a large dumpster at the supposed safe location floating around the flooded parking lot and loading dock like an unmoored dinghy.

Hurricane Debby was a deadly storm, responsible for at least 10 deaths and, according to a report from Karen Clark & Company, a catastrophe risk modeling and consulting firm, about $1.4 billion in damage. It dumped about 15 inches of rain on Charleston and neighboring Berkeley County, according to NOAA. While the storm was not as impactful as many predicted, it did impact clinics in unexpected areas and for longer. The storm also highlighted the importance these organizations play for thousands of people in the areas they serve.

Safety net clinics, comprised mostly of federally qualified health centers, or FQHCs, and free clinics, fulfill an important but often overlooked role after natural disasters throughout the United States. Most deaths from hurricanes typically occur weeks and months after the storm makes landfall due to ailments including untreated chronic conditions, injuries, and infectious diseases.

Safety net clinics can provide continuity of care due to their accessible economic models and, oftentimes, mobile clinics and the ability to help coordinate resources for their patients. Underpinning the clinics’ disaster response, like their everyday responses, is the trust they engender in their communities – in part due to their obligation to treat people regardless of ability to pay – and the sense of mission embodied by staff members.

“There was a time in my life when going to a hotel or evacuating to another city would have been stressful and impossible. So I know it’s important to make that process as stress-free as possible. That’s what we’re here for,” said Dr. Aretha Powers, CEO of Fetter Health Care Network, referring to providing their patients with medication, continuity of care, and accessing resources, such as public shelters, available to them.

“We are blessed to be in a position where we can give back,” said Fetter’s Outreach Program Manager Ryan Hatchett. “I don’t want anyone in our community to feel no one cares about them, or that they are forgotten about… we’re going to go above and beyond to make sure you’re alright,” he said.

The process to fulfill that commitment ahead of Hurricane Debby began a few days before the storm hit for safety clinics in the area, including Fetter, Barrier Islands Free Medical Clinic on Johns Island in Charleston County, and J.C. Lewis Health Care Center in Savannah, Ga.

Leadership at each took immediate steps to initiate a multifaceted communication strategy towards their patients and staff members. Appointments during anticipated closures were rescheduled. Staff and volunteers also checked medication stocks to prepare for possible resupply delays.

“I like to make sure that I have ample amounts of certain medications in case there’s a situation where we have to use and the mobile unit and it may not have this or that on it like it should,” said Dr. Victor Allen, director of pharmacy at J.C. Lewis Health Care Center.

Across all three clinics, plans were also made to ensure medications, especially vaccines, insulin and other therapies that must be kept cold, would be kept in locations with generators or other forms of resilient power.

As they continued preparations on the day prior to Debby’s first landfall, reality set in from an unexpected source. Staff at Fetter said they knew the situation could get serious when they heard the Weather Channel’s Jim Cantore was in town.

“That weatherman, I saw he’s here, so a hurricane really is coming,” Powers recalled, referring to the celebrity meteorologist.

The following morning, on storm game day, Powers led her staff through a plan for the day to ensure that patients throughout the city and on the neighboring barrier islands would have as much time to access care and get medication refills as possible.

“The city may shut down at 3 p.m., but we can’t do that. We have to give our patients an opportunity to get off with the shutdowns and then pick up their meds, Powers said. Her staff also took vaccines off the islands in case of power outages and also coordinated with migrants to help them with supplies and to find off-island shelters.

Once the storm hit, Powers said she knew pretty quickly it would be serious, which would soon be confirmed by the inland clinic’s flooded lot. If that was the condition there, the city of Charleston would be far worse. And it was.

The clinic location in Charleston suffered roof and sewage-related damage. It was closed for two and a half days, which would have been longer if not for the cooperation of the city government, according to Powers.

With that clinic reopened, the team thought they were in the clear. However, the morning after, several staff members, who all live in the same Summerville-area neighborhood, woke up to flooded streets thanks to the storm’s reappearance and resultant flooding.

“We underestimated that storm on this side of town, that won’t happen again,” Powers said.

The experience caused the team at Fetter to reflect on what could be improved when the next storm hits.

“Could we have done more? Did we go above and beyond for our community?” said Hatchett, discussing the conversations that are taking place at Fetter as they work to find a more resilient way to store medicines. Other ongoing impacts from the storm included having to reschedule appointments across the 10 sites that had to be closed during the week of the storm.

Powers said he hopes to be able to continue deploying telehealth visits, but noted that funding had only been approved through the end of the year.

Storm Days and Every Day

The responsibility to assess best practices extends beyond hurricane response at Fetter, as well as other health care center systems, because of the patients who rely on them.

“Health centers are the nucleus of our country in terms of serving individuals who ordinarily would not have insurance to pay for their health services. Medicaid in Georgia has not been expanded, and so you have a lot of individuals that aren’t on insurance, can’t afford to get insurance, or are not eligible for insurance. And so the community health centers are here for those individuals, as well as the insured individuals,” said Dr. Rena Douse, CEO of J.C. Lewis Health Care Center and a native of Savannah.

“If we were not here, I think our homeless rates would go up. I think that our crime would probably go up because I think individuals would basically try to make ends meet, to try to get items they need to survive,” she said. “I think they would go into survival mode. We see the sickest of the sickest a lot of times.”

Powers said that even with safety net clinics being available, patients still sometimes feel reluctant to seek care.

“Our patients are sometimes in desperate need because a lot of times people don’t want to come ask for help. So they wait till the last minute but it’s that same as I would be,” she said.

At the Barrier Islands Free Medical Clinic on Johns Island, an added challenge is communicating to eligible people that they can receive free care. Like Georgia, South Carolina has not expanded Medicaid, leaving many low-income individuals without health insurance coverage.

“People are going from ER to ER and that’s not a medical home,” said Melissa Frank, Executive Director of the Barrier Islands Free Medical Clinic.

Dr. David S. Peterseim, the clinic’s medical director and a former thoracic surgeon, said patients receive directed, holistic care including preventative care, as opposed to one-off ER visits that often focus on addressing acute issues.

Summing up the underlying motivation at his clinic and across the FQHC and free clinic system across the U.S., J.C. Lewis’s Allen said, “everybody’s here to help somebody.”

As the most heavily impacted parts of the region continue to recover, a range of local community groups, health-focused and beyond, figure to play a role in the recovery which extends beyond property damage and visible physical illnesses.

“One of the things we’re anticipating is just mental health. I mean, people were coming and collapsing, [saying] ‘we’ve lost everything, we don’t know what we’re going to do,’” Pastor Tucker said.

Hurricane season continues until November 30.

Direct Relief supports federally qualified health centers and free clinics throughout the United States, including all three facilities mentioned in this story. During Hurricane Debby, Fetter Health Care Network and J.C. Lewis Health Care Center both opened Direct Relief-provided hurricane prep packs, which are prepositioned throughout hurricane-prone communities in advance of hurricane season and contain medical essentials commonly requested after storms. Direct Relief also supported J.C. Lewis with a backup power generator, and has supplied all three clinics with ongoing medical aid to support patient care.