| Perspectives on Texas

When natural disasters create public health emergencies, the demand on responders is high. As are the stakes: without vast expertise and resources — and without careful planning and coordination — outbreaks and fatalities inevitably increase.

This is why officials are compelled to closely track the status of hospitals. After Hurricane Harvey, the Texas Department of State Health Services kept tabs on whether hospitals evacuated, closed or experienced internal disasters as a result of the storm. In 1989, Texas instituted Regional Advisory Councils to support hospitals preparing for and responding to disasters.

But what about community health centers? Free and charitable clinics, federally qualified health centers and local health departments are integral to disaster response, yet their life-saving importance is not as clearly understood.

After Harvey, when HIV patients were displaced and unable to renew prescriptions because of jurisdictional and funding hurdles, it was primary care providers who expressed the urgency of finding where they were. When Harvey destroyed millions of personal cars and stranded families, these same health centers deployed mobile medical units to bring tetanus vaccines, flu shots and state-registered nurses and doctors into neighborhoods that had no other access to healthcare. Community health centers respond to individuals in crisis every day, reducing non-emergency visits so that emergency rooms can focus on life-threatening trauma, and while Texas experiences more rural hospital closures than any other state, local health centers often provide the only healthcare option for miles.

Within the 41 FEMA-declared Harvey-impacted counties in Texas, there are more than 250 of these organizations, with over 650 locations. State planners should look to local health center employees as pre-positioned experts, prepared to mobilize on behalf of the most vulnerable community members after a disaster. Long after responders return home, those employees become the steady workforce of recovery, treating individuals as they navigate a disaster’s invisible aftershocks: homelessness, economic uncertainty, chronic stress, hypertension, and substance and domestic abuse.

Yet following Harvey’s landfall, information concerning local health centers flowed only through decentralized networks. The Texas Primary Care Association, Texas Free and Charitable Clinic Association, and Health Resources Services Administration (HRSA) inquired after their respective centers, producing insights that could be part of a larger coordinated effort. But no unified body or reporting mechanism existed to broadly communicate damage and leverage outside assistance (think volunteers, funding, translators, medicine and medical supplies). Unless a health center applied for FEMA’s Public Assistance Program (not all were eligible) or a grant from another public or private funder (a process that can take months), there was no way for outside responders to quickly distinguish who faced the most pressing need.  

Documenting closed or damaged clinics in a way that integrates other response functions would save time — emergency’s most precious commodity. It would allow responders to identify urgent health gaps in under-resourced areas, maximizing energy spent dispensing life-saving medicines and supplies rather than searching for and verifying potential partners. Instead of providing individual meetings and needs assessments to each relief organization, reporting once to a central body would allow health centers to focus on direct patient care.

It would also provide oversight into how outside donations are distributed. In the Golden Triangle, for example, where FEMA declared some communities as high as 90 percent impacted, community members who normally donate were too overwhelmed by their private tragedies to support a public one. As a result, small health centers in these areas lost as much as 20 percent of their expected revenue. A coordinating body could alert outside funders to organizations such as these and leverage the deluge of national support at a moment when it would have the most impact.

Texas already has the expertise to establish these channels, and the National Association of County and City Health Officials reports existing models that could be adapted to meet local and state needs. Expand current Public Health Emergency Support Functions from hospitals and long-term care facilities — such as nursing homes — to recognize the role of community health centers. By recognizing their importance and connecting them to resources at critical moments, we can increase the speed of community response in future disasters and decrease the length of recovery.