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Direct Relief staff delivered medical support to NC MedAssist, a charitable pharmacy in Charlotte, North Carolina, on Oct. 7, 2024, as part of Hurricane Helene response efforts. NC MedAssist ships medications across the state, primarily to patients who are uninsured, and the organization recently received requested medications from Direct Relief, including tetanus vaccines to protect those involved in storm cleanup, and epinephrine injections for those allergic to bees and yellowjackets, which have been a concern, post-storm. The organization also received Direct Relief field medic packs and emergency medicines and supplies to support mobile health efforts in storm-affected areas. (Photo by David Uttley for Direct Relief)
In the days after Hurricane Helene, requests for medication poured in from across North Carolina. For staff at NC MedAssist, a charitable pharmacy that offers free medication to low-income patients statewide, it wasn’t just a question of having enough to go around. The challenge was to provide lifesaving medications in the face of collapsed infrastructure and widespread outages — at an organization that supplies aid primarily by mail.
Washed-out roads and bridges, damaged clinics, and closed post offices made it all but impossible to tell where medications could be safely sent or received, said chief operating officer Dustin Allen. Power outages were dangerous for cold-chain medications like insulin. Downed mobile networks interfered with efforts to coordinate transport, talk to partners and patients, and keep on top of an ever-shifting situation.
Community outreach manager Sandy Torres, speaking through patchy cell service in the hard-hit city of Asheville, stressed the need for more information about local needs. In Asheville, “I’m here and I’m seeing it, and I know what hospital is open or I know what free clinic is open, or they’re doing first aid by a little market over there.” But that kind of boots-on-the-ground information had been slow to emerge from rural areas, and Torres was planning to drive out to the state’s hard-hit western communities herself to assess needs and distribution challenges.
Direct Relief staff deliver medical support for Hurricane Helene response work to NC MedAssist on October 7. (Photo by David Uttley for Direct Relief)
For NC MedAssist, providing medication to large numbers of vulnerable patients isn’t itself new. The Charlotte-based organization dispenses about $70 million in medical aid each year to more than 70,000 patients in all 100 counties in North Carolina — Allen described it as having “tentacles” everywhere — and works with community health centers, nonprofit clinics, and public health departments across the state.
Asked about the pharmacy’s prominent role in North Carolina, Allen explained that the goal is to fill widespread gaps in medication access. The state didn’t expand Medicaid until December of 2023, so for years, “close to 80% of our patients fell under…the federal poverty line, but they didn’t qualify for Medicaid until recently,” he said.
Even after the expansion, many patients can’t afford the $4 copay for medications. “A patient of ours may have 15 prescriptions, and that may be $60” each month, Allen said. Nonprofit partners like health centers and clinics, which operate on slim margins, often can’t afford to provide free medicines for every patient who needs them.
There was no question that Helene’s devastation was complicating the picture.
Employees were calling individual patients to arrange safe insulin shipments through 80-degree weather and trucking medications out to impacted communities. “We’re having to do case by case [shipments] and have conversations: What do they need? What can get to them?” Allen explained.
Staff had contacted helicopter teams headed to the most rural areas to ask them to bring medicine and first aid supplies along. Local hospitals were transporting prescriptions on their mobile pharmacy units. Donations were coming in — including large deliveries from Direct Relief that included urgently requested insulin, tetanus vaccines, field medic packs, emergency medicines and supplies, and epinephrine injectors. Direct Relief staff, still responding on the ground in the southeastern U.S. this week, visited NC MedAssist on October 7 to deliver medications and supplies.
The epinephrine injectors, a lifesaving treatment for anaphylactic shock, were one of the storm’s unexpected needs. “With the pure disruption of the ecosystem, there are a lot of bees and yellowjackets,” Allen said. Emergency responders and patients in affected communities were experiencing repeated attacks.
Other common requests included over-the-counter medications like pain relief and antihistamines, first aid supplies, and treatment for diarrheal infections, which Allen said were mostly connected to water outages and contamination.
NC MedAssist staff stock Direct Relief-provided epinephrine injections for those allergic to bees and yellowjackets, which have been a concern, post-storm. (Photo by David Uttley for Direct Relief)
Noteworthy — and concerning — were the medications people weren’t requesting as often. Staff were noticing comparatively lower demand for mental health medications, anti-seizure drugs and other neurological treatments, and medicines for hypertension and high cholesterol. The focus instead seemed to be on treating the most urgent needs.
Mental health disorders, neurological conditions, and chronic diseases like hypertension require consistent management. The lack of requests suggested patients were likely going without maintenance treatments, and Allen expected the health picture to change in coming days as a result.
“We’ve always had the mindset that the priorities will evolve over time” after a disaster, he said.
Helene’s disproportionate impacts in western North Carolina, where Torres was planning a trip, were another challenge. “There’s always been a lack of trust from people outside of the region” in rural western communities, Allen said. “Typically, you almost have to be physically present there.” An outside offer of support, even of free medication shipped to someone’s home, might not necessarily be welcome.
The need for a local presence was complicated by a far-flung population, Allen explained: “You may travel 100 miles to catch [100] people in some of those areas.”
Over time, staff at NC MedAssist have made progress in the area, offering targeted outreach to agricultural workers and other vulnerable residents. But Allen was concerned about the comparatively small number of requests the pharmacy had received from some impacted communities.
“It obviously doesn’t bode well now,” he said.
Since 2014, Direct Relief has supported NC MedAssist with more than $147 million in medicines and supplies, and provided a $50,000 grant to support the charitable pharmacy’s cold-chain capacity. Six recent shipments sent in preparation for and response to Hurricane Helene focused on meeting health needs caused by the storm
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