In Western North Carolina, Helene’s Devastation Is Threatening Health Care Access

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Source: New York Times
Author: Emily Cochrane
Date: October 28, 2024

Tina Abbott had already been struggling to stay on top of her medical issues. There was the pain from a tear in her arm tissue, the cyst on her spine and the chronic breathing problems that required a portable oxygen tank, which she had refinanced her car to afford.

Then Hurricane Helene hit western North Carolina, forcing her to cancel an appointment for lab work. When a trio of volunteer doctors arrived at her home days later, Ms. Abbott, 67, was sitting in her dark living room, without reliable cell service or running water.

With the region essentially shut down, she was worried about how she would get oxygen refills and blood tests to monitor the impact of her many medications on her organs.

“If this goes on forever,” she told the volunteer doctors, “it’s going to be a problem.”

Even before the storm sent floodwaters raging through this slice of mountainous Appalachia, the largely rural region had a lot of people in poor health, with medical care often challenging to get. And while North Carolina’s recent expansion of Medicaid has allowed many more residents with limited income to get health coverage, the hurricane’s devastation is hindering that progress, at least for now.

The storm is among the deadliest in the nation’s history. After making landfall in Florida’s Gulf Coast in late September, Helene tore through the Southeast, killing more than 200 people and decimating hundreds of homes and businesses. The devastation is particularly acute in western North Carolina, where floodwaters swept away entire communities and destroyed much of its mountainous infrastructure.

“The health care infrastructure in western North Carolina is already so fragile,” said Kody H. Kinsley, the North Carolina secretary of health and human services. The hurricane, he added, has shone “a bright light on that already fragile system.” Several hospitals in both North Carolina and Tennessee remain closed, including one in Erwin, Tenn., where dozens of patients and staff members had to be rescued on the day the storm hit. In western North Carolina, some hospitals are still relying on bottled water or mobile water units. Nancy Lindell, a spokeswoman for Mission Health in North Carolina, said that the hospital in Asheville still lacks potable municipal water, and tanks are pumping in more than 200,000 gallons into the hospital each day. In a region where it was already difficult to recruit and retain medical staff, some providers are also worried about the consequences of lost revenue, and about supporting staff members who may have suffered personal losses from the storm. “How do we attract someone to come into the area at this moment?” said Kim Wagenaar, the chief executive of Western North Carolina Community Health Services, which serves 13 counties in the region. She added, “It’s just going to take a long time to really mitigate the effects of this disaster.” The health disparities in the Appalachian region can be traced in part to the 2008 recession, which dealt an economic blow from which many of the area’s rural communities have not fully recovered. Increased levels of poverty heightened health challenges, including depression and addiction.

“When something like this happens in vulnerable communities,” said Michael Meit, the director of the Center for Rural Health and Research at East Tennessee State University, “it tends to have worse outcomes, and the recovery is harder.” The aftermath of the storm could create new health problems, such as injuries sustained during cleanup and issues from contaminated water. Health officials have called for storm survivors in flood-damaged homes and people cleaning up debris to take extra precautions. Dust from the mud could exacerbate asthma and breathing issues, for example. Many residents are also experiencing the psychological stress of grief, loss and trauma, with the death toll at nearly 100 in the state. Even the constant sound of helicopters overhead, many of which are delivering aid, has made people anxious. One doctor described an uptick in anxiety stemming from the financial toll the storm took on many residents, after it snatched away homes, cars and jobs. Shortly after the storm, Richard Ball, 60, was helping his sister-in-law clear away some of the waterlogged debris inside her home. He suffered two heart attacks earlier this year, he said, adding, “If I get tired, I’ll sit down.” His sister-in-law, Brenda Ball, had fallen days earlier, and the bruise and cut were still visible above her right eye. But she could not seek treatment with her car buried under a collapsed part of her house. Dozens of volunteer doctors, nurses and psychologists have driven or flown into the region to treat people still lacking reliable transportation, roads or access to medical care. Their work is meant not only to relieve the strain on local emergency workers and hospitals, volunteers said, but to keep a log of residents’ health problems while regular appointments remain hard to get.

“I’ve been chomping at the bit to get out here,” Pat Tucker, 61, an urgent care doctor from Oxford, Miss., told Ms. Abbott, the 67-year-old with several medical issues, when he knocked on her door in Swannanoa, one of the worst-hit towns. Along with two family medicine doctors from the Asheville area, he gently pressed her about her health problems, made sure that neighbors could help her and promised to see if he could get her an oxygen regulator. In Swannanoa, which has about 5,500 residents, an athletic trainer, a school nurse and a number of family medicine specialists worked in the parking lot of a church to set up a temporary clinic and filtered through reports of residents who needed medication refills, oxygen, insulin or simply a wellness check. Pharmacists raced from store to store, calling in prescriptions and determining how best to get them distributed. Some people were going into withdrawal, several providers said, because they could not get the addiction medication they normally took to stave it off, or the substance they were dependent on. About a month after the storm, the makeshift clinic had seen about 500 patients, not counting home visits. “You just jump in and figure out how,” said Shanda Bradley, 47, an athletic trainer from outside Asheville. Mr. Kinsley said the work the volunteers were doing could help build faith in medical providers in a deeply independent community. “True health care access moves at the speed of trust,” he said, adding that “it’s just going to be a long haul.”