In the days following Hurricane Helene’s landfall in western North Carolina, people gathered in the parking lot of First Baptist Church of Swannanoa for food, shelter, and medical help.

The church became the base for a pop-up medical clinic during the storm after a medical professional began impromptu health checks immediately following the storm. For weeks, physicians and pharmacists from the Mountain Area Health Education Center, or MAHEC, worked on the newly created Swannanoa Collaborative Care Clinic to ensure residents had access to care.

Five months following the storm, local leaders say health conditions remain a top concern. They’re looking for ways to alleviate the widespread emotional burdens of residents who lost their homes and businesses in the raging water. Their solution is to increase access to care by meeting people where they are and encouraging more physicians to work in the area.

“No one foresaw what happened,” said Pastor Jeff Dowdy, whose church became the hub for people needing assistance. “It caught us by complete surprise that we would end up being the site of a natural disaster of this proportion.”

Dowdy, who has led the Baptist church for 11 years, said the storm’s toll has affected the livelihood of residents across the Blue Ridge Mountains.  According to the pastor, the region’s cities face extreme economic losses, widespread misinformation, continuous scams, and impermanent housing for residents. After the success of MAHEC’s pop-up clinic in the church parking lot, Dowdy said the church plans to provide counseling services later this year to those affected by the storm.

“People are still reeling from the trauma,” he said. “Homes that were gutted with the storm are still standing but gutted. You drive past that every day. All the debris is everywhere. So, the mental aspect of it is just really hard.”

Dowdy said that the economic tolls of the storm have worsened month after month, but the situation has encouraged people to work together in ways they hadn’t before.

“Our gymnasium turned into a Costco pretty quick,” he laughed, recalling community members seeking out help from the facility.

According to the pastor, most residents have reached a “new normal” with transitional housing or have made the necessary repairs to their homes. However, they continue to share feelings of desperation. Scammers have taken advantage of elderly residents who are trying to rebuild homes and misinformation continues to be a problem.

Dowdy said it’s mentally taxing.

Meeting Needs for Mental Health

There weren’t enough doctors serving the region before the storm. According to local medical professionals, only a handful of psychiatrists address behavioral and mental health needs across the Blue Ridge Mountains. While many of the rural cities are home to fewer than 10,000 residents each, local leaders say there still aren’t enough mental health providers to support the area following Hurricane Helene’s widespread devastation.

Over two dozen counties from the Western Piedmont Region through the Asheville Metropolitan area were flooded by Helene’s high winds and heavy rains. Over 150,000 families have requested aid from the Federal Emergency Management Association.

North Carolina’s former governor Roy Cooper created an Office of Recovery and Resilience to address natural disasters, and current governor Josh Stein has made disaster recovery a top priority. The state anticipates a years-long recovery process and has budgeted billions of dollars to rebuild while requesting billions more for financial support at the federal level. Stein’s office reported over $15 million in disaster recovery donations in December and said it’s not enough to recover from what was lost.

The Mountain Area Health Education Center, which has six sites and is partnered with the University of North Carolina education system, could not open its buildings due to power outages and lack of potable, running water during the storm. Dr. William Hathaway said MAHEC providers looked for ways to conduct immediate, acute care in the weeks following Helene: the pop-up clinic was their first stage of response.

Now they’re challenged to continue providing the same level of access to care long-term. Hathaway says it’s “economically impossible.”

Hathaway is CEO of MAHEC. He said that “the economic models don’t necessarily make it viable to do this work.” Even more, the Rural Health Initiative program, which encourages medical students to fulfill residency requirements in the region, may be in danger of losing federal funding.

However, Hathaway said he feels a moral obligation to rebuild in ways that are better for the community. The CEO said it’s MAHEC’s role to provide continuity of care. The Rural Health Initiative program has graduated hundreds of providers in recent years, and many have remained in western North Carolina, post-graduation.

Hathaway admitted not knowing if doctors will continue to explore the mountain region given the current devastation makes him anxious.

The storm’s wreckage increased the vulnerability of the region, exacerbating the need for access to care. Hathaway shared that many residents were living paycheck to paycheck and relied on the area’s tourism industry. Without homeowners, the region no longer has the tax base to support infrastructure needs. He foresees an increased need for social workers, pharmacists, behavioral therapists, and community health workers to support families.

Dr. Benjamin Gilmer, director of the rural initiative program, agreed that the trauma from the storm will be long-lasting. He worked at the pop-up clinic at First Baptist and said the health concerns before and after the storm are the same—just exacerbated.

According to Gilmer, there are only four psychiatrists across sixteen counties. He said it’s a “mismatch” to the area, where the psychological trauma will be long-lasting. They’re still fighting misinformation, but Gilmer said building trusting relationships with patients will make a difference.

Gilmer said providers in western North Carolina will have to consider the social determinants of health even more, build stronger community bonds, and do more work—all while earning less than what they would make in more populated parts of the state.

“I feel like I’ve been able to bridge relationships with all my patients, despite their political belief systems and conspiracy theories,” he said. “Ultimately, if you have a relationship with your patients, they’re going to trust you. They’re going (to) believe in you.”

In response to Hurricane Helene, Direct Relief provided MAHEC with more than $300,000 worth of medical support, including medications and supplies to support mobile health for patients impacted by the storm. The organization also received a $25,000 emergency operating grant. Since the storm, Direct Relief has provided $7.6 million in medical support to organizations in the region responding to the storm and $650,000 in financial support.