Weathering The Storm: Lessons Learned from The Healthcare Response to Hurricane Helene, Part 1 - WNC Health Policy Podcast Ep. 14
Image Credit: NCDOTcommunications, licensed under the Creative CommonsAttribution 2.0 Generic license.
A year after the storm, the WNC Health Policy Initiative, in partnership with the NC Center for Health and Wellness, has launched a study to explore how health system leaders navigated the challenges of Hurricane Helene: what worked, what didn’t, and what must change to strengthen our regional response in future crises. Through interviews and qualitative research, the team is gathering critical insights to shape smarter, more resilient practices for health organizations, communities, and governments across WNC.
This is the first episode in a non-consecutive series that will appear throughout the WNC Health Policy Initiative podcast feed. Over the course of this series, listeners will hear from our research team share:
Behind-the-scenes looks at how the research was designed
Emerging findings and reflections from interviews with healthcare leaders
Final takeaways and policy implications from the study
In this first episode, WNC HPI Audio Producer Andrew Rainey speaks with our research team to learn how this study was developed, why it matters, and what they hope to achieve.
Listen via the audio bar above, or via Apple Podcasts or Spotify
About the WNC Health Policy Podcast: In each installment, we speak about different public health strategies for improving health and well-being in Western North Carolina (WNC). The WNC HPl is a collaboration between the NC Center for Health & Wellness at UNCA and MAHEC, with generous support from the Dogwood Health Trust.
Individual opinions, findings, conclusions, or recommendations expressed in this podcast are those of the author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative or its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders.
Transcript
AR: Andrew Rainey (WNC HPI)
SP: Soni Pitts (WNC HPI)
AM: Alex Mitchell (NC Center for Health and Wellness)
INTRO
Soni Pitts: We need to have a regionalized approach to how we deal with resilience to those increasing weather phenomenon that isn't necessarily relying on how they did it over in the beach area or in the flatlands.
[sound of running creek overlayed with banjo music]
Andrew Rainey: You're listening to the Western North Carolina Health Policy Initiative Podcast, a collaboration between the North Carolina Center for Health and Wellness, and UNCA, and Mahec, with generous support from the Dogwood Health Trust. I'm Andrew Rainey.
In each installment, we speak about different public health strategies for improving health and well-being in Western North Carolina.
Individual opinions, findings, conclusions, or recommendations expressed in the podcast are those of the participants and do not necessarily reflect the view of the Western North Carolina Health Policy Initiative or its host institutions of the University of North Carolina Asheville, Mountain Area Health Education Center, or our funders.
In this introductory episode of a non-consecutive series of the podcast, we're turning our attention to lessons learned from health care leadership following Hurricane Helene.
[soft music]
AR: When Helene swept through the region, it left behind more than damaged roads, flooded homes, and the immediate devastation to so many of our lives. It disrupted hospitals, clinics, care networks, and emergency systems, exposing vulnerabilities across the entire healthcare infrastructure that continue even a year after the storm. It also revealed strength, innovation, and leadership.
This series will explore a project titled Lessons Learned From Healthcare Leaders During Hurricane Helene. Part of the Western North Carolina Health Policy Initiative and born out of one of 21 grants supported by the NC Collaboratory, this project aims to document how health system leaders navigated the crisis, what worked, what didn't, and what needs to change.
Through interviews and research, the team is gathering insights from a range of our region's healthcare leaders to inform resiliency planning for future disasters, as well as identify best practices for leading in disaster and post-disaster settings.
Throughout the series, we'll hear how the study started, the way the research is unfolding, updates about findings, and final takeaways of the lessons learned from Hurricane Helene in healthcare.
INTRODUCTIONS AND BACKGROUND
AR: To start us off, let's meet the research team.
SP: Well, my name is Soni Pitts, and I am the program manager for the Western North Carolina Health Policy Initiative, which is a group of policy makers, health and health care leadership and professionals, community-based service organizations, educational research institutions, and other members of the community who get together on a regular basis to talk about challenges, needs, and opportunities related to health policy in Western North Carolina, how we can address those issues, collaborate, and otherwise work together to see if we can make health and wellness in Western North Carolina better.
And the Western North Carolina Health Policy Initiative is a program of the North Carolina Center for Health and Wellness at UNCA. We partner with Mahec and we do a lot of good work with them, and they're really wonderful partners. And of course, we are funded by the Dogwood Health Trust, and we really appreciate the ability we've had through that funding to hold these discussions and move these issues forward.
AR: Which also allows these podcasts to be on this platform for all of our listeners. How about you, Alex?
AM: I'm Alex Mitchell. I'm the Senior Project Manager of the Culture of Results team at the North Carolina Center for Health and Wellness at UNC Asheville. We are the research and evaluation arm of the North Carolina Center for Health and Wellness. So we do a lot of community-based research, learning stuff we can about public health in Western North Carolina. And we're excited to partner with Health Policy Initiative on this project.
AR: Great. So for everyone out there, this is sort of a super group collaboration of two different parts under the Center for Health and Wellness. Could y'all talk about the name of this project and what the goals are that you have for it?
AM: So, this research is lessons learned from health care leaders during Hurricane Helene.
SP: Sort of like if you could go back and tell yourselves, you know, what you know now, what would you want to know if another disaster hit? And the goal for this was sort of two part:
One, to just collect these lessons so that we can help the area prepare and be more resilient, looking forward to potentially future disasters or other incidents that would require this information.
And two, to be able to pass this information off to our long-term recovery groups, our recovery task force, and others who may be working on parallel projects to build more resilience in the region more generally and how those lessons might inform those discussions.
So, we had those original discussions at HPI on the 8th of November, which was our first team meeting after. And then on the 11th, we learned about the potential for this grant from the Collaboratory, which were like little 10K mini-grants to assist state and federal agencies with mapping things related to the hurricane and the recovery effort. We heard about this from Dr. Herman Holt.
AM: He's our Chief Research Officer at UNC Asheville.
SP: And at the time, our Senior Project Manager, Mikal Giancola, aka ‘Mack,’ wrote up a proposal to the Collaboratory and submitted that. And then in March of this year, we learned we had been awarded the grant to begin research in May.
AR: Could you talk some about how this Helene research lines up with some of the existing focus points of the Health Policy Initiative?
SP: So, our three pillars of focus are health care workforce development, social determinants of health, and access to health care. And since this is lessons learned by health care leadership, I feel like it crosses both the workforce area as well as the access to health care, because I just know from our general conversations there were major struggles in getting back to business as it were, as a health care system in Western North Carolina after the hurricane, both along workforce needs and also getting to patients and getting patients to their providers. So, I think it touches very much on those two, and it definitely touches on social determinants as well, since the social determinants like housing, transportation, power, and technology were all a part of getting both the workforce and the patients together in the same room.
So, I think it probably crosses all three. I'm not sure that it in particular related to any priority project that was ongoing at that point, but it definitely emerged as a priority afterward in alignment with those focus areas.
AM: I definitely agree with Soni. I think it cuts across all of HPI's priorities. I would be shocked if social determinants of health weren't just like the number one thing that we learned lessons about because people lost access to everything. They lost access to, like Soni said, all technology basically- lots of people didn't have access to food, water, like just basic necessities. So, I think that that's going to be something that we hear a lot about.
SP: I also remember hearing child care was a huge gap for health care systems. Heard that in our recent summit on child care, that was one of the priority things for getting people back to work in the hospitals. So, yeah, a lot of social determinants of health played a role in this. And I'm interested to see the results of the interviews around this.
AR: Yeah, those social determinants of health were massively impacted for everyone. I remember personally how intense it was to have basic communication cut for so long. Going back to kind of door-to-door word of mouth, especially given how the roads were flooded and the transportation was relied on was just not available. For folks needing medical care, our region already struggled getting folks to providers given our pre-existing transportation challenges and being in such a rural location. But some of the big-picture strategies that had been explored to manage access, like telehealth, were totally wiped out.
AM: Yeah, I want to say something quickly about the telehealth thing. I think that's an interesting issue to bring up because telehealth became such a big deal in Western North Carolina during a different disaster during COVID, and then was completely useless during this second disaster. So it's interesting to see how I'm sure there's going to be some cross-cutting lessons learned across, like, I doubt people will be able to not talk about COVID at all and, like, compare and contrast, and it will be interesting to see how some things worked for both and how some things could not be applied to this second disaster.
AR: Just in the past five years, we've seen a pandemic, wildfires, and then tropical storm Fred in 2021, which Haywood County was still recovering from when Helene hit. It will be really useful to compare all of these disasters to see how to improve. Alex, could you talk some about how this new research compares to the work that you've been doing with the Culture of Results team, and how it was that you joined the Health Policy Initiative for this project?
AM: Yeah. So Culture of Results…we do research, we conduct focus groups, interviews, surveys, with community members, with health professionals, with all types of people across the community. And when Mack was writing the proposal, he suggested that we partner on this project using our research experience and just felt like a natural fit.
So Culture of Results does work with HPI on program evaluation and just supporting Soni in different ways. But yeah, this is the first maybe formal project partnership that we've done.
AR: It's always great when different initiatives can come together like this and share skills without having to look too far. Now that you're working together, could you break down how this research will be done?
AM: So the plan is to interview six to eight health care leaders around the region, creating these questions in collaboration with the leadership team, as well as what we've learned from doing a rapid lit review. So looking at what happened in other places when other disasters, occurred and how those health care leaders or health care teams responded to them.
AR: As you mentioned, COVID also threw a monkey wrench in health care systems pretty recently, but it's not quite the same kind of challenges that we faced right after and continue to face due to Helene. What kind of previous work are you reviewing to set this study up?
AM: I can go over some of the search terms I've used. So we've done disaster response in health care. I've noticed that I needed to add United States to that most of the time because I was getting a lot of things that were outside of the country. We're limiting it to the last 20 years. So we wanted to include lessons learned from Katrina. So picked that going back to 2005. I also searched just Hurricane Helene and found a couple articles that have already been written by local health care providers about their experience and responses. Hurricane response, flood response, those are the types of things that we're searching.
AR: Okay, so 20 years, natural disasters and in the US. And then y'all move into doing interviews?
AM: Soni and I are going to be doing these interviews. I think we're most excited about that part. Also we'll be supported by Dr. Ameena Batada to analyze the interviews, look for common themes and present that research back.
And we're hoping to have the research largely wrapped up by the end of September, which actually is when Helene occurred last year. So sort of coinciding with the anniversary of Helene.
AR: It's hard to believe we're already coming up on a year after the storm. You know, grass roots response carried so many folks along in the immediate aftermath of the storm with groups like the Mutual Aid Wellness Collective (MAWC), Asheville Survival Program, Beloved Asheville, Mutual Aid Disaster Relief (MADR), Rural Organizing and Resilience ROAR), and others who jumped in to meet the needs when the bigger systems fell apart. Thinking about the scope of this study, could you talk about why you put the emphasis on health care leadership versus, say, street level or provider experience?
SP: Well, to some extent, the scope of the research is, of course, constrained by how much money is in the grant to fund the hours. So some of that is just simply a matter of logistics to make sure that we're able to fit the research within the scope of the grant we've been awarded. Also, I wouldn't look at this as a definitive research project.
This is more of a way to get a top-level feel for some of the big picture needs and resilience-based components that would help us start looking regionally at a plan for how can we make our health care system more resilient to disasters. What are across six to eight major health care leadership, interviewees, what are some of the major themes that come up, and the key priorities that get mentioned over and over again. Also, what are the differences?
Which may give us a way to examine, for example, a really big system like Mission compared to perhaps a small FQHC and how those needs and challenges differed. So this is, I won't say like a pilot research, but it is a smaller study designed to just get those top level ideas and big picture look at what resilience looks like. So we can start building toward that.
AM: Yeah. And I would just add that interviews are one of the more time consuming forms of research. So you're talking to a variety of different people, hopefully getting a variety of opinions and experiences and having the opportunity for a little more depth versus breadth. So I would say like, you know, you might be thinking of like, why aren't we just surveying everybody who works in health care in Western North Carolina? That would give us a certain kind of information. I think a very broad sort of what we call quantitative type of information, very numbers focused. But I think we're hoping to really hear more about individuals' experiences and what they learned and how we can apply their experiences to the future.
AR: So this is seeking to get a deeper breadth of knowledge on how systems were working or not working across Western North Carolina from a top level perspective. What kinds of questions will you all be asking?
SP: Just a few of the sort of general category of questions that came up during the leadership team meeting would be things like how did we respond from a health care perspective and what are the health care needs in a disaster and how do we address this from like a workforce perspective when the workforce has so many challenges. The leadership team also was curious in looking at things such as what's essential to a health care response in another disaster. How do we as medical, public health, etc. have a disaster plan that is robust and agile? How do we plug into existing groups that are looking at a regional perspective and how can we elevate Western North Carolina to address needs and allocate resources in a just and sustainable way in the long term? So these may not be the exact interview questions, but these are sort of the questions we'll be building those questions to address.
AR: There's a lot of scrutiny of disaster response after Helene coming out of a general mistrust of institutions. Some scrutiny was well placed as a number of folks went quite a while without access to water or any kind of outside support. But of course, some legitimate scrutiny got co-opted and spun some tales that weren't rooted in what actually happened here.
Recently though, FEMA is facing major disinvestment, grant cuts, staffing reductions and a push to shift disaster response to the states, all weakening national disaster preparedness that could make future disasters even harder to navigate, if not just different.
I know Western North Carolina is long familiar with being on the outside of political power and has a history of self-organizing here in the mountains. I'm curious how y'all see this study getting used, whether for a higher level policy or local level organizing.
SP: Yeah, one of the things you hear over and over again in the HPI, both within the participant group and from outside presenters and outside people coming in to talk about issues, is that Western North Carolina is very special in the way we respond to things. We are a large-ish region, but it feels very much like a community and our response is very community focused. Another thing I've heard is that a lot of people imagine in a disaster, that the immediate response will be top-down: FEMA, federal government, state government coming in. And the reality is, most of the time, the response in the immediate aftermath of a disaster is ground up. It is neighborhoods coming together to support neighbors.
It's community organizations coming together to support their communities and partnering with neighborhoods to support more regionally. It's counties on the ground doing what they can do to bring in resources from other counties that may not have been so heavily hit, and to communicate across law enforcement and search and rescue at a regional level so that as we go higher up the system, as the state and as the federal government are able to get resources into the region - which I might add they were not able to do in those first few days - as those higher level resources come in, the community response is already on the ground, going, and we have some idea of what is needed, where it is needed, and what we're able to do and not do that we can then share with those higher level entities to get them up to speed. But you will almost never see that immediate response happening at that top level, just because it takes time to ramp that up and get that going, and they're not here on the ground.
AM: Western North Carolina is geographically different than places that are more often hit by hurricanes. I mean…
SP: Very much so.
AM: I'm really glad that you said that, you know, the state had trouble getting water to us for the first several days. It was like three days before tankers were able to access the region. We were cut off. We were cut off by [Interstate] 40, by [Interstate] 26. There was just no access because of mountains, because of mudslides and landslides. So I think that that's something that's more challenging about Western North Carolina in this type of disaster.
And one of the reasons that we have this very community focused response that happened. And I think that that is like a mountain response. And I think it's probably due to historical isolation in this region and not having easy access. And it just played out in a crazy way during the hurricane. It was shocking to see like how isolated we were.
SP: It really was. Also, you know, being on the ground in those first few days, it was so gratifying to see how everyone was coming together.
AM: Yeah.
SP: When neighbors helping neighbors, you know, everyone getting together and taking everything out of their freezer and having hurricane barbecues in the backyard. We had a lot of that going on in our neighborhood. And I know other communities and neighborhoods did as well.
And, you know, as Alex says, that has a lot to do with the geography of the region. You need to know the area, to know how to get around the area. Especially, you need to know where it always floods. You have to know, you know, where the bridge is always going to reliably be out, where the high ground is going to be, where the trees are likely to have come down. You need this innate knowledge to know how to navigate post-natural disaster in Western North Carolina, or post-snowstorm or whatever. But you also do have, very historically, and in some cases for very good reasons, a historical distrust of the larger government.
And I think while it would be great if that were not the case, I think historically it has led to that sort of intra-regional self-reliance and resilience and self-sufficiency. So in that sense, it is a silver lining to that historical perspective, and I think it served us really well.
AM: And I think we might have like a higher chainsaw per capita than anywhere else in this state. Like everywhere you turn, there was just truck fulls of people with chainsaws clearing things. That was helpful as well.
SP: Yeah, definitely the chainsaw to population ratio, super helpful.
AR: Chainsaw prevalence is really as determinant of health here, allowing transportation and access where it wouldn't be otherwise.
SP: Absolutely. And as Alex had said, Western North Carolina does not at all represent the typical geographical profile of a hurricane impacted region. And so this is why it's doubly important for us to be looking at these regional health systems and health leaders from this region, and how that response will differ from, say, Louisiana and Hurricane Katrina, or, you know, Wilmington or any of the other places that are typically hit hard with hurricanes.
Those responses are going to look completely different, and that is something we've not had a lot of insight into for our region.
AM: But I think we are sensitive to the fact that there's, like, a high likelihood that this is going to happen more often and more frequently. And I think that is one of the reasons for the research.
SP: Absolutely. We are looking at increasingly violent storms, increasingly heavy rainfall, increasing shifts in temperature. So this could also be massive ice and snow storms.
But, I mean, as a region, it floods often, and flooding is likely to be higher in the future just simply due to the levels of rainfall and the changes that have been wrought by Hurricane Helene and how our waterways flow. So we are potentially going to be seeing more of this, and we need to have a regionalized approach to how we deal with resilience to those potentially increasing weather phenomenon moving forward that isn't necessarily relying on how they did it over in the beach area or over in the flatlands.
AR: I wonder if you could also talk more about the specific health care aspects that you anticipate maybe coming up in the interviews.
SP: Yeah. After a natural disaster, health care needs skyrocket while access decreases significantly. And that can be due, as I said, to either providers being unable to provide or patients being unable to get to people.
One of the things we had with this disaster that virtually no one had really considered is that a lot of people who are on oxygen no longer use tanks. They use electrically powered compressors that create the oxygen as needed. And there simply were not enough tanks in locations where they were needed.
And many places did not have electricity for a week or more after the storm. That was one of the things that just emerged as an example of ways we need to prepare better. Is to have more of those tanks, more spread out, and in places where they would not be washed down river into Tennessee, which is a thing that happened to some of the gas canister stores, especially in Asheville.
So when you're looking at it from a health care perspective, it's not just about getting the health care systems up and running. It's about making sure that access is there, not only for the ongoing need of patients dealing with their current conditions, but also the immense acute need following storms in terms of accidents, impacts from the storms, worsening of health conditions due to conditions after the storm, and so on
AR: A stat from the WNC Health Network demonstrated that just a few years ago, some 13% of residents in Western North Carolina live below the poverty line. Illustrating how getting basic needs like health care access amounts to something of a daily disaster even without an additional natural disaster like Hurricane Helene. It also makes me wonder how when resources are cut for everyone and folks have to organize across social classes like we saw during Helene, how that may actually improve some services or access to services for folks typically unable to get care and could serve as a model for how health care could work better.
SP: As a result of the storm, we had free clinics popping up. We had community organizations out in communities, making sure people were getting health care. As you said, there were people whose health care access actually improved after the storm due to those grassroots efforts.
AM: And I mean, you saw things like that in COVID too. You saw rates of food insecurity going down because they increased access to things like SNAP benefits. There were just more food resources available. You saw region-wide instances of food insecurity going down. I really hope that there is a silver lining to the disaster and that that silver lining might be that people are getting better health care now.
SP: One of the things people were doing during both COVID and after Helene was enrolling people into Medicaid and now Medicaid expansion as part of these on-the-ground health care provisions after the disaster. So people would come in for, you know, maybe they were suffering from heat exhaustion or had some other need, hidden mobile clinic and not only got that attended to, but “hey, by the way, did you know you are eligible for Medicaid?” And through that, you can get Healthy Opportunity Pilot services such as food boxes or transportation to your doctor once we get the roads back open again.
So that is one of the silver linings that could come out of disasters, is this improved access to health care, which is quite a bit of a bump in the immediate aftermath, and no doubt goes down after those clinics shut down. But there is a leveling up of people who have been navigated into health care systems, who have been navigated into Medicaid, who have been navigated into social determinants support, and hopefully we can keep those levels.
AR: Yeah, so these moments offer an opportunity to create hubs to existing health resources. Unfortunately, the connections to Medicaid you mentioned may not be as meaningful over the next two years as North Carolina officials estimate that more than 255,000 North Carolinians will lose coverage due to the recent federal bills, work requirements, and general cuts to Medicaid. NC Health News writes that many folks will be kicked off Medicaid, not because they're unemployed, but because of the red tape and paperwork.
We'll be looking a little more at state and federal health policy in several upcoming HPI installments, but regarding this research into the lessons learned from Helene, what can we expect to hear from y'all in our next installment?
AM: Yeah, so I know we will definitely know what we're asking folks, so we'll definitely be able to describe our interview questions. I imagine we will have done some initial interviews, so be able to share some first impressions. And then I think we can probably describe who we've decided to talk to as well. So giving folks a picture of the types of leaders that we're talking to. And yeah, I think those are the main things.
AR: For folks listening who may have stories to share about their own experience with health care during and immediately after Helene, is it possible for them to reach out to you and bring in more perspectives?
AM: Yeah. If you are a health care leader that has something to say about your experience during Hurricane Helene, we'd love to hear from you. You can just email us. My email is anielson@unca.edu.
SP: And my email is spitts@unca.edu.
AM: We'd love to hear from you. We'd also love to hear from anyone that's excited about this research, not just health care leaders.
AR: It's interesting to hear how the study is being done and what we may expect to hear moving forward, and how that may inform generally how as a region we prepare for future disasters.
AM: Yeah, and I think one of the hopes when this was initially imagined was that it might be a jumping off point for more research, so we hope that's the case. And tell us your questions, tell us your burning questions about health care response post-Helene.
AR: Thank you both, and good luck with the next steps. We look forward to bringing you back to hear more as the study moves along.
AM: Great, thanks, Andrew.
[soft jazz music plays]
OUTRO
AR: You've been listening to The Western North Carolina Health Policy Initiative Podcast, the collaboration between the North Carolina Center for Health & Wellness at UNCA and MAHEC, with generous support from the Dogwood Health Trust. Thanks to the NC Collaboratory for helping our region learn more from Helene. To reach out to our research team, you can visit our website's blog to find their emails and revisit our conversation.
To listen again or learn more about public health issues in Western North Carolina, check out the website at wnchealthpolicy.org, or listen to more of our shows on Apple Podcast or Spotify. If there's a Western North Carolina health issue that you'd like to hear more about, speak about or have comments about anything you've heard on an HP I podcast, feel free to send us an e-mail at info@wnchealthpolicy.org, or write a comment on wherever you listen to podcasts.
Music featured in this podcast includes old ballad “Little Margaret,” performed on banjo by Kath and Phil Tyler, found on the Free Music Archive, is licensed under an Attribution Non Commercial Share Alike 3.0 United States license. Additional music on the podcast included the tracks, The Cost of All Things, and Night Watch by The Blue Dot Sessions. These tracks are found on the Free Music Archive under license attribution International CBY 4.0.
As the first of several installments in this series, stay tuned as The WNC Health Policy Initiative podcast releases several episodes about recent health policy changes on both the state and federal levels that impact Western North Carolina. Then we'll be back with Alex and Soni to hear more about how this research is going.
Thanks for listening.
