Close to Home: Delivering health care in a disaster zone

Before the 2017 wildfires, I never gave much thought to how health care would be provided in a disaster shelter. I had imagined that the shelter population would be very much like the general population - mostly young and healthy. When I arrived at the Elsie Allen High School gym as a volunteer medical provider, I was shocked to find hundreds of elderly, frail and disabled people in their night clothes. The majority had arrived without medications, glasses, walkers or any medical records.

As I soon learned, the Red Cross focuses on establishing a safe shelter for people in need. While Red Cross nurses provide basic care, the usual model is to send anyone who needs much more than an aspirin to a local hospital or clinic. Unfortunately, the recent disasters have been so big that two out of three hospitals and most of the local clinics were closed.

Under these conditions, the usual model wasn't viable, as patients from the shelters would have quickly overwhelmed the remnants of our emergency medical system. So, over the course of a few days in 2017, a group of volunteers turned a high school gym without Wi-Fi, phones, hot showers or even the most rudimentary medical supplies into a makeshift clinic where care could be provided to medically frail evacuees.

Fast forward two years. Again, we found ourselves in an emergency with large-scale evacuations, but this time we knew what we were in for and were better prepared.

The county Public Health Department had been working diligently to create a better system for shelter management. The department signed agreements (unfortunately without clear funding support) with community health centers to assume responsibility for shelters - Petaluma Health Center was responsible for the Petaluma Veterans Memorial Hall shelter and Santa Rosa Community Health took on the fairgrounds (which had two shelters) as well as the shelter at the veterans hall across the street. The Santa Rosa shelters alone housed about 1,000 people.

The local Red Cross medical team worked almost around the clock throughout the evacuation period. Adding to the challenge, two-thirds of the Santa Rosa Community Health staff had been evacuated out of the county, and those who were left were needed to keep clinics open and staff the phones.

Luckily, our primary care community is tight knit and interconnected, largely due to the venerable Santa Rosa Family Medicine Residency, which has been training doctors for the past 100 years. Graduates from that program, which now partners with both Sutter Hospital and the community clinic, work in all the health systems in the county.

In addition, the Department of Public Health's Committee for Health Care Improvement brings together top leadership from local health care institutions on an ongoing basis to tackle big issues affecting the health of everyone in the county and strengthen bonds across institutions.

When the call for assistance went out, volunteers leaped to help. From Oct. 28 until the last shelter closed on Nov. 3, more than 185 medical staff shifts were filled by volunteers - 91 by doctors and other providers, 31 by nurses and 60 by Santa Rosa Junior College nursing students.

As I reflect on my experience in the shelters, I realize that, given the reality of climate change, there is going to be a “next time,” and we need to prepare now. Preparation for the next disaster requires stable and ongoing investment in the Public Health Preparedness Unit, which is understaffed and underfunded. As generous as this community is, we can't continue to rely on volunteerism to support such huge efforts forever. At the same time, the ability to keep our hospitals and emergency systems functional is an issue that affects our whole community.

Funding shelter care is a social justice issue and not just a practical consideration. It is important to emphasize that people end up in the shelter system because they aren't able to go somewhere else, often because they are sick or elderly or poor. Then, when the evacuation order is lifted and many return home, what happens to those who don't have a stable home to return to? How can we prevent the marginally housed who get displaced in these disasters from becoming homeless?

We need a new model for shelter care that recognizes that providing medical care in shelters is key to protecting the most vulnerable among us while ensuring that our remaining hospitals, clinics and emergency medical services are free to deal with acute issues.

Panna Lossy is a UCSF clinical professor, faculty member at the Sutter Santa Family Medicine Residency and physician at the Santa Rosa Community Health Center.

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