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Thursday Jun 30, 2016

Stranded Patients, Lost Meds Are Just the Beginning of Flood Disaster

In medical school I took a wilderness medicine course, but after two years of practice in rural West Virginia, I think of that training as "West Virginia medicine."

In a relatively short time, our community experienced a chemical spill in our water supply, blizzards that stranded patients at home, and the temporary loss of our grocery store. The latest crisis, however, is far worse, and its results could be long-lasting.

On June 23, areas of West Virginia received as much as 10 inches of rain in just a few hours. The flood that followed was the most devastating in the state since the Civil War and resulted in at least two dozen deaths.

Photo courtesy of Tabitha Clendenin
A church and cars in Clendenin, W.Va., are surrounded by floodwaters. The state suffered a 1,000-year flood on June 23.

The topography of West Virginia demands development at lower elevations because the mountains are often too steep, too prone to slips or mudslides, or just too difficult to build roads or housing on. Many of the state's residents live at low elevations, and the steep surrounding mountains create sluices for rainwater. 

When I got to work on Thursday, June 23, my office had no electricity or broadband connectivity, but that isn't a rarity. We can function with a propane-powered generator, and we often do. But as the day went on, the rain did not stop.

I made it home that evening, but within a few hours water was running over the top of my pond's dam. My house is at the top of a hill, but I knew my patients and neighbors were in serious trouble because the strongest of the expected storms had not yet arrived.

Water rose so quickly out of stream banks that people didn't have time to leave their homes, move their cars, or grab valuables or medications. By Friday morning, I couldn't leave my house because all routes were under water. I had cell phone service, so I could see news reports and photos of the devastation as rivers continued to rise. I saw my own town in aerial photographs broadcast on the Weather Channel's and CNN's websites. I recognized some of my patients' submerged homes.

I was able to log into my electronic health record on my phone and looked up patient phone numbers, but the landlines were long gone and I was unable to reach anyone who didn't have cell phone service. Still, I was grateful that those who I had shared my cell number with were able to update me on their conditions. 

I was scheduled to work Saturday, and the water receded just enough for me to trudge through mud-covered roads. Around every turn was one heartbreaking sight after another. Floodwater isn't just a wet mess, it carries raw sewage, chemicals and everything else imaginable. The water leaves behind foul-smelling mud that coats everything it touches. 

Before going to my office, I stopped at the gas station for water. Within 15 minutes I was able to find out news about quite a few of my patients because the store and its parking lot were full of them, their friends and their relatives since it was the only business in town with power and water.

My office remained dry, so other than having no power, phone, Internet or drinking water, it was not affected by the flood. On Saturday, I only saw a handful of patients, but I also wrote paper scripts for those who had lost theirs or were unable to access meds. 

One of my patients was seen driving around town. I knew her trailer had been damaged, and I was really worried because she had recently had a stroke and struggled to control her blood sugar. I feared she would be homeless. When I managed to find her Saturday, she was disoriented and dehydrated because floodwater had breached her trailer, knocked over her refrigerator and prevented her from accessing her insulin. 

It's rare for me to see just one person in a given family. One of my patients called Saturday distraught because she had lost everything and was stranded in an area left completely inaccessible due to road damage. I also care for her brother, a complicated patient who lost all of his home health equipment. I wrote them new paper scripts because no pharmacy had e-script or fax capacity. A friend picked up the prescriptions for the patient, but they didn't know when they would see each other. 

By the end of the day I had written 50 scripts for meds lost in the flood, and those were for the more fortunate people who still had phone service or were able to relocate to a safe place. I also saw families with sick children who were depending on the good will of friends for a place to stay.

I had no water at home so I went to the grocery store but found none. I stood in the drink aisle with my patients, all of us deciding which flavor of Gatorade to buy. 

In the parking lot I saw 10 more patients, all making it out of their hollows for the first time since the rain started, still in their mud-covered clothes, not sure where they were going next.

On my way home, I passed countless people walking along creeks looking for belongings, retrieving dog houses. 

One of my former residency classmates called and offered to take me on horseback to any patients I knew were inaccessible by motorized vehicles. I have almost all of my homebound patients accounted for so I haven't yet taken her up on the offer, but I will definitely keep it in mind. 

Yesterday we ran reports of patients on meds for high-risk conditions and called each of them to ensure they had their medications and could get out of their homes if an emergency were to arise. Many people live near privately owned bridges that have been damaged or completely destroyed, so they are safe but isolated.

As I sit in my office typing this, emergency storm sirens are going off and rain clouds are rolling in. It literally looks and sounds like a war zone. The number of people reaching out to offer help has been impressive, but with so much destruction and so much unknown (What will the Federal Emergency Management Agency condemn? Will there be emergency housing? When will the water lines be repaired?), it's hard to know where to start or what is most urgently needed. 

Some families I care for are sleeping in tents because they have absolutely nothing, and unlike an isolated event such as a house fire, this flood has left an entire community in need. So I've focused on little things with direct impact, like buying people socks and underwear, providing manual labor to carry damaged furniture and carpet out of houses, or delivering pizza and water to people who have no transportation to get to distribution centers. 

The governor has encouraged anyone wanting to contribute to flood relief to use the West Virginia Voluntary Organizations Active in Disaster website(wvvoad.communityos.org). I've also suggested contributions to the Clendenin Volunteer Fire Department. Not only did these volunteers save many lives via water rescues, but their station was damaged by 5 feet of floodwater. Some fire engines were still inside because crews were out on boats. One of my neighbors continues to take vacation time from his paid job to volunteer extra shifts for the fire department.

I feel like a broken record, but we must all be prepared for disasters. We all should have a plan for addressing the possibility of losing access to food, water or electricity. And as family physicians, we need to be familiar with disaster response protocols for our communities  and our practices, or at least know where to find necessary resources or guidelines

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va.

Posted at 03:52PM Jun 30, 2016 by Kimberly Becher, M.D.

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