HRSA Team Leads “Massive House Call” to Wilma Victims
A HRSA-led team spearheaded the Federal government’s health care response after Hurricane Wilma’s quick but devastating visit to south Florida cut off power in Broward County for more than a week and put access to health care out of reach for thousands of elderly and disabled residents of high-rise buildings.

With Wilma approaching slowly from the west, HHS established a Secretary’s Emergency Response Team (SERT) for Florida and named RADM Sam Shekar, director of HRSA’s Center for Quality, as its commander.

Aiding Dr. Shekar were CAPT David Ellison of HRSA’s Kansas City Regional Office, who acted as the SERT’s executive officer, and CDR John Moroney of HRSA’s San Francisco Regional Office as its planning officer. Working closely with partners in state and local health departments, the SERT led a group of 75 Commissioned Corps officers who provided health care to more than 6,500 Broward County residents by the time the team disbanded Nov 3.

Though Wilma struck Florida early Oct. 24 as a Category 3 hurricane, a few days earlier it had been the most powerful Atlantic hurricane ever recorded. Corps officers initially were sent to Naples, Miami, Key West and Palm Beach, but later were concentrated in Ft. Lauderdale after the devastation in and around that Broward County city proved to be the worst in the state.

The biggest obstacle to health care delivery was the power outage, which lasted up to two weeks in some spots. Although hospitals had generators, many smaller health facilities did not. And health care staff had trouble getting to work because gas pumps at service stations didn’t work. In addition, the power outage stranded thousands of elderly and disabled residents of multi-story apartment buildings whose elevators and phones weren’t operating. With those needing assistance essentially stuck where they lived, the SERT and its partners decided to use mobile medical vans to deliver care. The vans were able to fill up at designated gas stations reserved for police, firefighters and other first responders.

Seven mobile medical vans were staffed with physicians, nurses and pharmacists, who then drove to areas where care was needed most. CAPT Carol Lindsey from Primary Health Care was a van leader; CAPT Regina Bennett and LCDR Brian Griffin from HRSA’s Ready Responders and LCDR Karen Munoz from Primary Health Care also served on the van teams.

At some sites, the SERT vans were co-located with vans from the American Red Cross so that residents could get ice, water and community services while team members provided medical care.

A day into the operation, the SERT and other response teams realized that many elderly couldn’t get down from their high-rise buildings to reach the vans parked below, so team members fanned out to check on people in their apartments. In so doing, they ultimately knocked on the doors of over 14,000 housing units to see if people needed help, and many did.

“That’s what made this deployment unique,” Dr. Shekar noted. “We took the care to the people – it was a massive house call.”

About 70 percent of those treated by the response teams were elderly in high-rises; the rest lived in severely damaged mobile home parks. Care focused mainly on those with diabetes who required insulin, individuals who had injuries or lacerations, and people suffering from hypertension. Prescription refills also were a priority.

The work was hard but gratifying. “It was inspiring to see people dropping everything to make sure others received health care when they needed it,” Shekar said. “And it was very rewarding to work together as a team alongside our partners in the state and local health departments.”

Over 250,000 evacuees fled New Orleans and surrounding areas after Hurricane Katrina hit Aug. 29. Among HRSA’s health center grantees in the area, Katrina destroyed operations for some, disrupted normal operations for others, and tested their ability to pull together and help one another.

St. Charles Community Health Center, in Luling, La., saw a one-day increase of 1,000 patients. As the health center closest to the disaster that wasn’t destroyed, St. Charles bore much of the early brunt of need following the storm. Other grantees soon experienced similar surges in demand.

Equipment and supplies were quickly depleted, but HRSA staff worked to fill the need.
LCDR Brandon Wood, project officer for Louisiana’s health centers, served in HRSA’s Emergency Operations Center (EOC) for two weeks and was a vital point of contact for an additional month after the hurricane, working closely with the Louisiana Primary Care Association and individual health centers.

The grantees’ persistence in the face of disaster impressed him. “Without exception, the groups I worked with were tenacious in seeking out the resources they needed on the ground,” Wood said.

When grantees hit roadblocks, Wood worked with state officials to lend Federal weight to requests for assistance.

Sometimes, though, health centers had to rely on good old-fashioned ingenuity to fill in the gaps, giving rise to many examples of the spirit of sharing common to HRSA’s Gulf Coast grantees:

• Rhonda Litt, executive director of the Louisiana Primary Care Association, and her staff worked around the clock to seek resources and coordinate relief efforts throughout the state, Wood said, physically packing and delivering medical supplies to health centers.
• The executive director of Primary Health Services Center in Monroe, Kathryn Tonore, acquired nine mobile health units from non-governmental sources, which she shared with other health centers.
• Rapides Primary Health Care Center in Alexandria distributed cases of WIC formula to needy infants in the area, while the CEO of Iberia Comprehensive Community Health Center in New Iberia, Roderick Campbell, arranged to deliver supplies to other health centers suffering from transportation problems.
• And as makeshift camps of evacuees were formed near Baton Rouge, Lafayette, and Alexandria, health centers filled their mobile units with supplies and took them to the camps to augment the efforts of the Red Cross.

Today, supply chain issues are better, but not fully resolved. Work remains to determine issues of reimbursement for non-Medicaid recipients. And, of course, the need to rebuild physical facilities also figures into the mix.

The Healthcare for the Homeless grantee in New Orleans has been delivering services out of a mobile clinic, and hopes to secure a new permanent location soon.

Joe Dawsey, executive director of Coastal Family Health, a network of health centers based in Biloxi, Miss., reports that of their 11 clinics – all of which were damaged or destroyed – three are back up and running on site, while the other eight are operating from mobile vans and tents.

Compounding these difficulties are the personal tragedies suffered by Coastal’s 172 employees, half of whom lost their homes. Sixty-six staffers haven’t returned to work, and everyone is having trouble finding nurses.

To speed help to the region, HRSA asked impacted grantees to send in recovery strategies that the agency will use to formulate long-term plans.

With those plans, and with the spirit and determination shown by local staff, the future for the hardest-hit areas – once as dark as the water that flooded New Orleans – is beginning to clear.

Lauver, director of HRSA’s Division of State and Community Health and a clinical social worker, served two weeks at the end of October as the leader of a small team of mental health professionals -- social workers, a psychiatrist and a psychiatric nurse. The team collaborated with FEMA and an HHS medical team to re-establish services in Pascagoula and the surrounding area, including Ocean Springs, Gulfport and Gautier.

On her first day, Lauver assessed the enormous task at hand – to help restore the lives of more than 1,400 people onboard with health issues ranging from diabetes to depression caused by the trauma of the storm. Later, a local doctor drove her west of the city on an eerie sight-seeing tour.

“It looked like a bomb had hit,” Lauver remembered. “There weren’t even things recognizable. It looked like a huge mud flat, right to the shoreline. The surge had come in and sucked everything out, and what was left behind was a splintered mess.”

Families displaced by the devastation lined up daily at the MS Holiday’s gates. And the ship, already filled to capacity, took on even more temporary residents.

“I was stunned seeing people line up outside a fence to get shelter while mothers quieted babies on their hips,” Lauver reports. “It was hard to believe that people were having such difficulty finding places to live.”

As part of her daily duties, Lauver met with FEMA staff in the morning, held phone conferences with high-level HHS medical staff in the afternoon, and consulted with Mississippi health and mental health directors. The state’s centralized system of delivering health services allowed officials to make significant headway in coordinating care, Lauver said.

Lauver worked with FEMA to arrange for a state team to take applications for Medicaid, WIC and prenatal services, helped sign up young children for Head Start, and arranged screening and intervention services for children with special health care needs who, under normal circumstances, most likely would not have received such care.

And with FEMA providing transportation, Lauver’s team sent ship residents requiring follow-up care to professionals at the health department in Ocean Springs, some 20 miles to the west, the closest one operating. This helped ensure continuity of future care and re-establish families in the community.

By the end of her deployment, Lauver said she understood well the look of exhaustion on the faces of departing colleagues she’d met upon arriving. Despite the strain, Lauver said the Federal team she was part of played an important role in re-establishing a health care safety net in local communities.

“Most of the volunteer workers coming out of clinics wouldn’t have known how to do that, to put that together,” she said. “The health care professionals serving with us were relieved to have our expertise. We knew who to go to and what to do.”

Although she remains excited about her experience in Mississippi, Lauver urges colleagues considering disaster duty to prepare themselves. “It's hard work and stressful, and there’s nothing wrong with saying ‘I’m not up to it at this point.’ You can’t contribute to the problem.”

Lauver summed up her time onboard the MS Holiday as “the ultimate take-away – because I took away the certainty of having helped the people there.”

Before HRSA employees began coordinating the event, only a few scattered faith communities held donation-related services. Today, HRSA brings national cohesion to the Donor Sabbath by providing reminders and resources to Organ Procurement Organizations (OPOs), supplying sample articles for congregations to promote their own activities, and distributing thousands of customized pins that participants use to encourage donation among friends and colleagues.

Begun in 1996, the Donor Sabbath asks members of all faiths to talk about donation in weekend services, scheduled two weeks before Thanksgiving each year. The weekend includes Friday, Saturday, and Sunday to cover most religions’ days of worship.

“This year we sent out more than 275,000 pins and organ/tissue donor cards, and some OPOs had trouble supplying materials to all the new congregations interested in participating,” said Joy Demas, who coordinates Donor Sabbath activities out of the Education Branch of HRSA’s Division of Transplantation.

Demas said an OPO in Ohio created 500 yard signs to publicize local weekend activities, but faith communities took so many that the organization made another 1,000 signs to satisfy demand. “That concept has now been replicated in other areas around the country to promote the weekend,” she said.

At Saint Leo the Great Catholic Church in Lincroft, N.J., each of five Masses for the church’s 3,000 member families featured a special “interview” homily between the priest and a young parishioner who underwent a life-saving double lung transplant a year ago.

“So many organ donors have inspiring stories, and when these modern-day miracles get up and share them, they have a tremendous impact,” Demas said. “And since they are speaking in a house of worship, the audience really has a chance to take in the donation message.”

Recent efforts to promote the Donor Sabbath among African Americans, who historically have lower levels of donation than whites, have been encouraging, Demas said.

One campaign, called “Linkages to Life,” raises awareness about the need for organ donation by blacks, particularly for livers and kidneys, by focusing on the importance of having family conversations about donation. Now in its fourth year, the campaign is sponsored by a black women's volunteer service group, The Links Inc., which has a membership of 10,000 African American women, and the Roche pharmaceutical company.

This year more than 60 predominantly African American churches participated in Donor Sabbath activities in conjunction with The Links program, an increase of nearly 50 percent over the previous three years combined. Copies of Can We Talk?, a guide developed by The Links and Roche, were distributed to spark conversations about donation, because not knowing a loved one’s wishes is one of the biggest reasons people decline donation opportunities.

The National Donor Sabbath weekend for 2006 is set for Nov. 10-12. For more information on donation, go to www.organdonor.gov.

Since its beginning in 2001, the HRSA Scholars program has recruited, trained and hired 186 new employees. The program’s year-long curriculum offers Scholars learning experiences that emphasize the acquisition of skills and knowledge needed to confront emerging health challenges and support HRSA’s mission of expanding access to quality health care for all Americans.

HRSA Administrator Betty Duke created the Scholars program after examining retirement projections that predicted workforce shortages for the agency during the first decade of the 21st century.

The 37 graduates of the 2005 class of Scholars completed their rotations and were placed in permanent positions in October. Of that total, nine found positions in the Bureau of Primary Health Care and the same number was hired by the HIV/AIDS Bureau. Six graduates were placed in the Office of Financial Assistance Management and four found positions in the Healthcare Systems Bureau. The other nine graduates were split among seven HRSA offices and bureaus.

Many others were cited for their performance by winning Administrator’s Special Citations, Citations for Outstanding Group Performance, Awards for Outstanding Support, and Commissioned Corps Awards.

Several employees won Length of Service Awards, led by four 40-year Federal employees: Willard Brown, Cecilia Butler, Jesse Leighton and Brenda Selser.

HRSA Administrator Betty Duke reviewed the agency’s many accomplishments during 2005, emphasizing employees’ efforts to provide emergency health care to evacuees and other victims of Hurricanes Katrina, Rita and Wilma. Bill Robinson, director of the Office of Minority Health and Health Disparities and HRSA’s Chief Medical Officer, hosted the event.