Inside an emergency medical hurricane shelter

By Rose Hoban

For the five months that members of the U.S. Public Health Service are on call every year, they’re required to keep a bag packed and be ready to deploy wit 12 hours’ notice.

three people sit smiling at the camera — Team Commander and physician Keren Hilger (left) sits with Captain Holly Williams, RN and C3 Pastor Matt Fry. Photo credit: Rose Hoban

That’s what happened recently for about 73 members of the USPHS who deployed to North Carolina last week as Florence bore down on the state. The team arrived from all over the country, including Commander Keren Hilger, an emergency physician from Alaska, and another member who flew in from Hawaii.

The entire team was in place by Thursday, so by the time the storm blew ashore, state officials had created a medical shelter for some of the most medically fragile people in eastern North Carolina who needed to evacuate. All that was needed was the people to staff it.

shows a row of cots, each with bedding supplies folded up in a neat pile at the foot of the bed — Cots in the medical shelter have been cleaned up after some patients were discharged back to their communities earlier this week. But they’ll be filled again with more than 20 patients being transferred from the state shelter set up at the old Cherry Hospital in Goldsboro. Photo credit: Rose Hoban

Several 18-wheeler state and federal supply trucks contained everything needed to create a facility for 50-75 beds to serve a variety of patients, such as Evelyn Campbell, an elderly woman from Fayetteville who uses a motorized wheelchair.

a simple black cot, with a stack of linens and chux — A typical cot with its supplies. Photo credit: Rose Hoban

“When they knocked on my door to say we come to evacuate you… they said water about a half a mile from here,’” remembered Campbell. “I said ‘Oh no,’ and they said, ‘You got to get out because your place might flood.’

“So they brought me here,” she said. “All I can say is Glory Hallelujah, they’ve been great.”

“Part of our mission”

“Here” was a sparkling clean and modern megachurch and conference center on a 47-acre former tobacco field in Clayton. Pastor Matt Fry of the C3 Church said after seeing the devastation from Matthew in 2016 and providing recovery services, he and his congregation wanted to be more proactive as Florence approached.

So, Fry’s staff contacted county officials and said, “If you need a shelter, we’re here to help.”

They had never used the facility as a shelter – much less a medical shelter – before.

shows a woman with a t shirt reading US PUBLIC HEALTH SERVICE on the back leaning ovr a woman who is sitting — A physical therapist works with one of her patients at the medical shelter housed at the C3 church in Clayton. Photo credit: Rose Hoban

“One thing lead to another… to now where we have a hospital here,” said Fry as he sat in the high-ceilinged lobby of the facility with Hilger and Capt. Holly Williams, who are leading the USPHS team. “We were already set up before the storm even hit.”

Having the medical shelter on campus has meant a lot of work for Fry’s staff and congregation. It’s meant fewer services on Sunday and having dozens of patients and their caregivers taking up the preschool and the event space, using about 30,000 square feet of the facility.

“We don’t see this as an inconvenience, we see this as part of our mission, that’s why we’re here,” said Fry, who had red-rimmed eyes from lack of sleep. “Our staff has adjusted to,” he paused and looked around, “this. It’s not in their job description to do hurricane relief but everybody is kind of making themselves available.

“I just had a meeting with the creative arts team,” he said. “They sing songs and do creative things, but I said, we have got to continue to be available… do whatever it takes to serve the people that are on our campus.”

Tweet reads: Meet Betty and Sarah, who are two sisters, pictured with their treatment team at the medical shelter in Clayton, NC — Tweet posted by the U.S. Public Health Service team at the C3 shelter.

That’s included members of the creative team playing music for patients, having sing-alongs of familiar hymns, a video stream of the Sunday service into the patient care area and countless encounters between congregants and visitors.

Fry said he thinks the experience will be transformative for his congregation.

“I’m already seeing Facebook posts, like, ‘Why can’t this be like my everyday life? Why do we have to wait for a hurricane to get involved in helping hurting people?’” he said. “ I can’t predict the future, but I feel like this is going to create some healthy momentum for our church.

“Because this is the heart of our church, to provide help and provide hope.”

Starbucks shelter

“We have slept in facilities that definitely were not as nice,” said Lt. Cmdr. Clara Stevens, the USPHS press officer for the deployment whose day job is as a physical therapist at a federal women’s detention center in Texas. “Facilities that had basically damage from the storm, had leaking, had other critters that you necessarily wouldn’t want to sleep with, because when we deploy, we deploy to buildings of opportunity.”

shows a long set of folding tables with piles of boxes behind — A hallway in the C3 Church becomes a supply center. Photo credit: Rose Hoban

Williams, whose day job is at the Centers for Disease Control and Prevention in Atlanta, has been going out on medical relief missions her first one on the Cambodian border in 1981. Usually, she and the other nurses, physicians, nurse practitioners and physician assistants, therapists, logisticians and others are billeting in tents or dilapidated buildings.

The USPHS’ team’s first destination was the old Cherry Hospital campus in Goldsboro, where there was a medical shelter set up in the aging, somewhat dilapidated buildings there. Then they were reassigned to C3.

a smiling woman dries her hands at a portable sink, a big grey cabinet of medical supplies sits next to her — Dr. Grace Marx, from Denver CO, cleans up at a portable handwashing station positioned in the patient care area of the medical shelter located in the C3 Church in Clayton. The supply cabinet next to her comes from North Carolina cached medical supplies, and comprises everything needed for a portable clinic. Photo credit: Rose Hoban

Williams said she’s never been assigned to a shelter building that includes a Starbucks.

Supplies came from warehouses throughout the East and some supplies cached by the state of North Carolina.

Other parts of the facility are equally clean, well lit and comfortable. The patient care area is in a performance space with a stage, where the group lined up rows of cots. Some patients were in hospital beds. Inside the gymnasium-sized space, the USPHS team had set up nurses stations, they were using supply carts provided by the North Carolina State Medical Assistance Teams and they even had portable hand-washing stations set up around the room.

smiling woman stands outside the door of a brightly colored room with a cart full of clothing in it — Physical therapist and press officer Clara Stevens shows off the gift shop which became a distribution spot for donated clothing. Photo credit: Rose Hoban

Patients were mostly those with chronic diseases, ranging from people in hospital beds to a young man with a recent spinal cord injury, or a pair of older sisters, one blind, the other on a walker, who needed a little more than what a regular shelter could provide.

“The people who come to shelters are those that don’t have resources, often, to be cared for by aides, or they don’t have family,” Williams said.

The church’s gift shop was converted into distribution center for clothes and household items lost to flooding, the preschool classrooms became sleeping quarters for the USPHS staff, hallways morphed into logistics centers, an office transformed into a pharmacy.

Laundry? Lack of showers? A few days into the mission, trailers to perform those functions arrived and were parked outside.

Discharge planning

Williams said that on each mission, she and her team set off not knowing what will be at the other end.

shows several cots sitting in a brightly painted hallway — The hallway and classrooms of the C3 preschool became dormitories for health care workers during the shelter deployment. Photo credit: Rose Hoban

“We have general expectations of what we’ll get, it’s a little different than what we actually get,” she said. “We have a scalable field medical station. Usually we have a cache we do that with.”

“We’re equipped to set up our own scalable field medical station, anywhere from 50 beds to 250 beds,” Hilger said.

In Clayton, however, the federal staff were working in conjunction with some state workers, using North Carolina supplies and equipment and assisted by people from other states.

And it was largely state-based staff, often social workers who know the local resources, who were handling what to do with patients who were being discharged. While some can go home once their power comes back on, others won’t have viable homes to go back to.

Plans for discharge start happening right away. Hilger said the state was on top of getting those plans in place.

“They came early,” she said. “It seems like North Carolina, we get phone calls saying, ‘Hey, we want our patients back.’”

The shower pod in the foreground, with a portable laundry facility in the background. Photo credit: Rose Hoban

Both women laughed. “We’ve never heard that before,” Hilger said. “It’s been really remarkable that the state has been really focused.”

Dave Wickstrom, from the Alliance for Disability Advocates, has been working with the team to find places for patients so they don’t permanently end up in institutions.

shows a woman displaying vials in a olive drab backpack — Pharmacist Carrie Ceresa displays a Mobile Lifesaving Kit (MLK) that has IV fluids, injectable medications, pills and other supplies to create a portable pharmacy. “There’s a federal prescription cache that gets delivered to us, but in this case, the state also had an emergency cache, so we actually got that too,” Ceresa said. Photo credit: Rose Hoban

“Our hope is that with our partners at this shelter that we have set the standard across the state and country in how people with disabilities are treated in shelters during and after a natural disaster as well as how to effectively transition people back to homes in the community of their choice,” he wrote in an email.

He said that in coming days, the state will be closing the medical shelter at Cherry Hospital and moving 22 of those patients to Clayton.

But for some of the patients, there might not be a “back” to go back to.

“There aren’t a lot of immediate options, so sometimes you do the next best thing,” Hilger said. “We try to send them back to the equivalent or better than what they have.”

“The bad thing about being a compassionate person is that we’re trying to solve all their problems, but the hard thing for us is realizing that we can’t do that. We’re not going to fix their chronic problems, but we try to make it a little bit better. That’s where the state comes in.”

Both women said they’ve been impressed with the assistance they’ve gotten from state health authorities. But they admit there’s only so much they or state workers can do for some of the patients.

“We are in a disaster situation with limited resources and you have to adjust your expectations for what we can do,” Williams said.

see a woman from behind who is in a wheelchair talking to an african American man in a jaunty cap — Fayetteville resident Evelyn Campbell chats with Pastor Kirk Crowder. Campbell said, “I never been in a shelter before but all I can say is Glory Hallelujah, they’ve been great.” Photo credit: Rose Hoban

Note: To preserve the privacy of patients, none of their faces were photographed as we reported this story.

Clarifications: The third and fourth paragraphs were altered to highlight the state’s role in creating the medical shelter staffed by USPHS personnel, and provide updated numbers for the total capacity of the shelter.