By Will Atwater

One gift North Carolinians can be thankful for this holiday season is that the 2022 Atlantic hurricane season was a quiet one. This is not an insignificant gift when you consider how many residents are still recovering from hurricanes Matthew and Florence, which struck the state in 2016 and 2018 respectively, not to mention 2019’s Dorian and 2020’s Isaias

Beyond the environmental and property damage that occurred during the storms, many people are still grappling with the emotional trauma of having their lives altered — whether temporarily or permanently.

While North Carolina didn’t experience major storm-related flooding events this year, a 2019 study predicts that there will be more frequent coastal flooding along the mid-Atlantic U.S. in the future due to climate change.

Not only do major weather events pose future threats, so do pandemics — consider how COVID-19 is affecting the world three years after the first case was reported.

To respond to pandemics and more frequent climate-related threats, such as hurricanes, coastal communities and the clinics that serve them need more tools. 

A study published in 2021, suggests a possible link between exposure to the effects of climate change, pollution, and pandemics and increased mental illness. People with pre-existing conditions, low-wealth individuals and the elderly are particularly vulnerable, according to the study.

These multiple and overlapping threats make responses more complex and pose unique challenges for both responders and people in the path of storms and disasters. 

A new tool to combat multiple threats

In response to these threats to human health, on Dec. 6, 2022, the Center for Climate, Health and the Global Environment at Harvard T.H. Chan School of Public Health (also known as Harvard Chan C-CHANGE) partnered with Americares, a health-focused nonprofit relief organization, to produce a Climate Resilience for Frontline Clinics toolkit. The toolkit has resources designed to help health care providers who serve in community clinics that cater to residents living in under-resourced communities and the patients they serve.

“What we hear time and again is that frontline clinics are the glue that hold their communities together when disasters strike,” said Dr. Aaron Bernstein, Interim Director of Harvard Chan C-CHANGE. “But with limited resources, and an ongoing pandemic, many don’t have the funding, training or tools they need after a climate shock.

“We’re meeting clinics where they’re at with the resources they need so we can help prevent disease in the first place, make people more resilient to climate change, and reduce the health care sector’s greenhouse gas emissions.” 

Harvard Chan C-CHANGE and Americares worked with frontline health clinics in California, Massachusetts, North Carolina and Texas to develop resources to help keep clinics – and patients – healthy before, during and after climate shocks. The toolkit includes clinical guidance and information on how to develop action plans and alert systems, tip sheets for patients, checklists for clinic staff and more. 

Materials on extreme heat are dedicated to protecting patients with certain health conditions that require tailored guidance, such as asthma, cardiovascular disease, chronic respiratory and  kidney diseases, end-stage renal disease, diabetes, dementia, multiple sclerosis, pregnancy and mental health conditions, according to the Americares press release.

Preparing Outer Banks patients for the worst

The Community Care Clinic of Dare in Nags Head, is the only free clinic in Dare County and serves many low-wealth and uninsured residents. It was one of the pilot sites for the toolkit. 

Eric Doheny, 60, is the owner of a handyman business in Dare County where has lived for the past 20 years. Doheny, who lacks health insurance, utilizes the free services provided by the clinic. He says the information in the toolkit will come in handy for people who have not experienced events such as hurricanes and will serve as a helpful reminder for those that have.

“One thing that I remember [from the toolkit] is like evacuation [tips] and you know, knowing to have water and essential foods, nonperishables and stuff like that.”

Given that the average patient and provider interaction lasts for about 20 minutes, between patients according to a 2017 report by Reuters, it’s vital that providers have a plan before walking into the room. The toolkit rollout is another example of more health care providers acknowledging the need to incorporate climate-change awareness into their medical practice. 

Medical students are asking for the topic of climate change to be reflected in their training curriculum. That trend is catching on in North Carolina, NC Health News reported in April.

But Alexis Hodges, who works as a volunteer nurse practitioner in the clinic, has been putting that climate change awareness into action already. 

“I see a wide variety of patients, including those with diabetes, high blood pressure and high cholesterol as well as asthma and COPD or chronic obstructive pulmonary disease,” Hodges said.

Environmental disasters, such as forest fires and the smoke that is generated as well as hurricanes and the flooding they cause, have “very long lasting consequences on our patient population that’s already so vulnerable,” she added.

Hodges also said that Dare County is a tourist destination and many of the clinic’s patients work hourly jobs in the hospitality, construction and fishing industries, among others.

“It isn’t just patient education,” she said. “It’s the tools to educate the person that has been educating the patient, and helping those that are seeing these patients make better informed decisions based on evidence-based practice. And providing quality care, which, in the long term improves the overall health of our populations.”

The project toolkit was shaped by the responses of more than 450 clinic staff from 47 U.S. states and territories to the 2021 survey, which was designed to identify knowledge gaps and real-world challenges of caring for patients during and after climate shocks, according to the press release. The data revealed that: 

  • A majority of clinic staffers said their clinic was impacted by extreme weather within the past three years. 
  • Nearly 1 in 5 clinic staffers felt their clinic wasn’t prepared to face extreme weather.
  • Around three-quarters of clinicians said they weren’t equipped to facilitate climate change preparedness at their clinic 
  • A majority surveyed said they wanted to learn how to protect their patients from climate-related events.

The toolkit provides resources for a clinic’s administration, health care providers and patients, Hodges said. For administrators, the toolkit offers a preparedness list in case of a hurricane, such as making sure that there are enough backup generators and sandbags on hand to keep the power going if needed and to protect the facility from water surges due to a storm, she said.

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Will Atwater

Will Atwater has spent the past decade working with educators, artists and community-based organizations as a short-form documentary and promotional video producer. A native North Carolinian, Will grew...