Americares CEO Michael Nyenhuis on the Relief Agency’s Recovery Efforts in Hurricane-Ravaged Regions

Michael Nyenhuis CEO Americares

[Music]

Mark Masselli: This is Conversation s on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, I know we’re in hurricane season, but we’re
already up to N.

Margaret Flinter: Well, it is j ust astonishing to have this many back to back
storms, Mark, and this latest storm, Hurricane Nate, hit the coast of Alabama and
the good news is it was far less devastating than the previous storms to hit the
U.S. and American territories this season.

Ma rk Masselli: The greater Houston area, Puerto Rico, and U.S. Virgin Islands
were all hit by category four storms or higher complete destruction in some
cases.

Margaret Flinter: Well, in Puerto Rico, we’re seeing emergency evacuations of
vulnerable patie nts to nearby hospital ships as a strategy to take care of those
people. These kinds of interventions and disaster areas are all too familiar to our
guest today. Michael Nyenhuis is the CEO of the nonprofit relief agency,
Americares, and right now, they’ re on the ground in Puerto Rico, in Texas, in the
Caribbean, all places that have been hard hit by the summer’s hurricanes.

Mark Masselli: Really looking forward to hearing from our guest today.

Margaret Flinter: And Lori Robertson will stop by. She i s the managing editor of
FactCheck.org. But remember, no matter what the topic, you can hear all of our
shows by going to CHCRadio.com.

Mark Masselli: And as always, if you have questions or comments, please email
us at [email protected] , or find us on Facebook or Twitter. We love
hearing from you.

Margaret Flinter: We’ll get to our interview with Michael Nyenhuis in just a
moment.

Mark Masselli: But first, here’s our producer, Marianne O’Hare with this week’ s
headline news.

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Marianne O’Hare: I’m Marianne O’ Hare with these Healthcare H eadlines. The
Trump administration released rules that paved the way for broad restrictions of
the Affordable Care Act’s contraception mandate, allowing for exceptions based

Michael Nyenhuis CEO Americares

on religious beliefs. The mandate required all employers providing insurance
coverage to make birth control and other contraceptives available to all women
with no copay. A number of religious institutions filed suit against the Obama
administrati on over that mandate. Accommodations were made for such
institutions to outsource providing contraceptive services, but this new angle
gives much broader reach for organizations to refuse to provide the benefit. The
broader scope includes nonprofit organ izations, for profit colleges, and other
institutes of higher learning that provide health benefits for students. The
American Civil Liberties Union and spade [PH] of attorneys general around the
country are vowing about legal challenges against the lifti ng of the contraception
mandate. Advocates for women’s health say this move could affect possibly
millions of American women who get their coverage through their employers.

California Governor, Jerry Brown, considering a bill that would require drug
comp anies to give the state 60 days’ notice before raising the cost of a drug by
more than 16%. The Drug and Price Transparency Bill would also force
pharmaceutical companies to explain why the increases were necessary. In
recent years, a handful of commonly prescribed drugs have seen price hikes
from hundreds of times to much higher in some cases.
st
November 1 is opening day for open enrollment on the insurance exchanges.
The Trump White House has cut the marketing budget this year by 90% and cut
the lengt h of time Americans can sign up for health coverage from three months
to six weeks, due to many uncertainties being left by the current administration.
There are likely going to be many insurance rate hikes and higher out of pocket
costs for consumers nex t year.

Veteran soldier turned mental health advocate, Britain’s Prince Harry, has turned
his sights on mental health in the military. The Prince, who served for ten years
in the military, including two tours of duty in Afghanistan, said the military
est ablishment needs to do more to prepare soldiers for the rigors of war and the
devastating toll it can take on mental health. Prince Harry, his brother, Prince
William and his wife, Kate, have all made mental health a platform for their
advocacy.

I’m Mari anne O’Hare with these Healthcare Headlines.

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Mark Masselli: We’re speaking today with Michael J. Nyenhuis, President and
CEO of Americares, a nonprofit global health and relief organization offering
support to over 90 countries around the world. Mr. Nyenhuis oversees a half a
billion dollar budget and manages offices in multiple continents. He has an
extensive background in global health, having previously served as CEO of MAP
International, which provides lifesaving medicines and health suppli es to people

Michael Nyenhuis CEO Americares

in need. He earned his Bachelors of Arts at the University of Wisconsin, and his
MBA from Emory University. Michael, welcome to Conversations on Healthcare.

Michael Nyenhuis: Thank you so much for having me.

Mark Masselli: Yeah, you know it’s dizzying, the number of disasters worldwide.
I’m not sure how you all manage this, but they seem to be tapping the resources
of disaster relief community to its limits. And fortunately, your team in
Americares is not alone in this space of deliveri ng aid to areas grappling
disasters. We’ve had leaders from Doctors without Borders, International
Rescue Committee, and Save the Children on our show, talking about the work
they do in this space. I understand Americares’ primary focus is getting medica l
supplies and drugs to areas hard hit by disaster and war, and I’m wondering if
you could share with our listeners more about your mission, the work you do
around the world, and where your teams are handling some of the most critical
challenges right now.

Michael Nyenhuis: Yeah, so thank you for that, and you’re right, it does take a lot
of different organizations with different areas of focus to sort of complement one
another to get everything that needs to be done, done in a situation like a
disaster. Just to broaden a little bit, sort of the sense of -- sort of the core of our
mission, we’re really focused on supporting local health infrastructure before
disaster, in the midst of it, afterwards in recovery, and then sort of ongoing in a
longer term wa y. We focus on local health centers, building their capacity to
serve the health needs in their community. And one critical way that we do that
is making sure they have access to medicines and medical supplies. So we do
have a large logistical operation that distributes medicines and supplies, and then
our work goes beyond that to build the capacity of these local health centers that
are really the backbone of health service for people in communities of poverty or
communities affected by disaster. So th at’s where we go. That’s where we work
first, right alongside the health workers and others that are manning those health
centers.

Margaret Flinter: Michael, I agree with Mark, it seems logistically very daunting
to meet the needs of so many communities simultaneously. And I don’t ever
recall something like Hurricanes Harvey, Irma, and Maria causing such
devastation, along with an earthquake in Mexico, and then of course we have not
natural disasters, but manmade, such as what we’ve just seen in Las Veg as. But
we’ve been reading about your three pronged approach, this three pronged
approach of prepare, respond, and recover as a way of addressing a variety of
emerging disasters, as well as the humanitarian crises that just seem to go on
and on. Maybe ta lk with us just a little bit more about what that prepare,
respond, recovery approach is and are you using that now in the deployment of
the recently hard hit areas?

Michael Nyenhuis CEO Americares

Michael Nyenhuis: Yes, certainly and I’ll give you maybe a real tangible example
of how that might work in a disaster situation like this. So as I mentioned, we
focus on and work alongside local health centers that serve people affected by
these sorts of things, and then Texas, we have a network of charitable clinics that
have been there bef ore these hurricanes hit certainly and will be there
afterwards. We come alongside them and make sure they get -- they can
respond effectively to the disaster and then get back up on their feet. So we’ve
been doing that. We responded with them. Many of them need recovery from
the disaster and we’re helping them do that. And then another part of our
programing is to help them prepare for the next disaster. These are great
moments for people who have been affected to think carefully about, “Do we
have a good disaster plan? Do we know what we’re going to do next time there’s
a hurricane come through? What are the steps we want to take? What are the
policies, procedures we need in place?” And so we will help them do that. So
it’s a complete cycle. Th ere are other places where we start with the prepare
work in disaster prone areas to help health centers and communities think
through how they can best be prepared and then respond. But it is a complete
cycle and we’re not one of those relief agencies th at jumps in, does a little bit of
relief work, and leaves and goes home. But we typically stay for a longer period
of time to do that recovery and then bring the circle back around to
preparedness.

Mark Masselli: Well, I really like the accentuation on the preparation and
obviously there have been far too many opportunities of late to see what
happens when an entire region is brought to its knees after a disaster. And as
we look at the devastation in Puerto Rico, for instance, you realize that until the
infrastructure is made functional again, it’s nearly impossible to bring aid to all
those affected by the hurricane, and ensuing devastation. And I wonder if you
could talk with us about the ways you’ve managed to bring your important
lifesaving medicine s and medical support to these hard to reach areas. Just sort
of how the logistics of that obviously require a whole team of people working
together, but how do you overcome these barriers? And maybe Puerto Rico is a
great example to use.

Michael Nyenhu is: Yeah, I think it is a great example. So we sent a team there
immediately. Actually, we had a team in Puerto Rico before Hurricane Irma
came through and Hurricane Irma hit more of the islands a little bit to the north
and east of Puerto Rico. So it didn’t take quite as much of a hit. And then, of
course, Maria came right behind it and hit Puerto Rico really hard. So we were
already stationed there and ready to go. And how we operate is to immediately
go out and do assessments of health centers tha t have been impacted by the
storm, and of course, we outfit our team with satellite phones and put in place the
logistics for them to get around. With no communications on the island, they
were going from place to place, health center to health center, lo oking for what
the needs might be and were able to communicate that back to us and to other
officials with satellite phones that they were using. We do a really quick

Michael Nyenhuis CEO Americares

assessment and work with the Department of Health there and these health
centers develop a needs list, like what do they really need in terms of medicines
and supplies immediately? And then we build shipments based on that needs
list. We want to make sure that we’re only sending in the things that are actually
called for, asked for, and nee ded. So we have put thousands of pounds of
medicines and supplies into Puerto Rico already. We landed an airlift there over
the weekend with eight tons of material on it to distribute to the centers and lined
up the logistics to make that happen. But th e key thing is being there early,
being on the ground, having communication tools to make sure that you can
communicate with the team and with the officials in the country, and then to build
and use needs lists to make sure that the exact kinds of material s get where
they’re needed to go.

Margaret Flinter: Well, I’m imagining you have an incredible playbook for people
to follow that’s been developed from your years of experience. You know, I want
to pick up on something you said and just ask you to talk about a little more. You
referred to health centers, and my guess is you’re being inclusive of all kinds of
healthcare facilities, and that from free clinics to perhaps Americare clinics, to
community health centers, to maybe hospitals and independent, pr ivate provider
practices. Tell me what you mean by health centers, who you really reach out to
and maybe you could also, if you would, just talk a little bit about -- between
getting medications to a place and then dealing with the fact that the
infrastru cture around refrigeration and clean water is down. We’ve heard such
stories about diabetics, people have lost their ability to refrigerate their insulin or
the vaccine and immunization supply. How do you bring those health centers
together to address th ese big issues?

Michael Nyenhuis: So just yeah, maybe a clarification on the health centers, so
you’re right, it could be a small health post, it could be a community clinic, it could
be a hospital. We’re certainly targeting those that serve the communi ties most in
need. So our ongoing work, sort of everyday, which actually is about 80 % of our
work is non - disaster related, is working with those health posts, hospitals, clinics
that serve communities of poverty. So that’s what our mission is focused on,
trying to bring good health to people who are underserved. So those are our
targets , the health centers that serve that population. So even in a disaster,
that’s the first places we’ll go, though certainly main hospitals that serve a
broader population are part of that as well. And when we make our
assessments, we’re looking for where’s the neediest place? Where’s the place
that’s sort of been left off the grid, the place that is not getting assistance, and
how can we help there the most? There are al l kinds of complications, and you
pointed to a couple of them, electricity, cold chain, all of that is really important.
You don’t want to send materials that need refrigeration to a health center that
doesn’t have electricity, either by regular means or a generator, until it’s ready for
that. So that’s why we have people on the ground, why we do assessments to,
again, make sure the right things are going to the right places, at the right time.

Michael Nyenhuis CEO Americares

Mark Masselli: We’re speaking today with Michael Nyenhuis, President and CEO
of Americares, a nonprofit global health organization. You know, I was thinking
as you were talking about your real focus on populations living in poverty, that
this is not just outside of the United States. But Americares has built hea lth
clinics here in the United States, really again focusing on that underserved
population and it aligns with your mission statement that every person deserves
access to quality care. I wonder if you could talk to us about this primary care
delivery arm of Americares and its core mission and how are you providing
access to primary care in underserved communities?

Michael Nyenhuis: So we actually own and operate four charitable clinics here in
our home state of Connecticut and they serve uninsured patien ts. So people that
are falling all the way through the cracks, they don’t have health insurance from
employers, Medicaid, typically these are working poor who are day laborers.
They don’t have health insurance from an employer, and frankly, they don’t get
sick days from employers either. If they’re not healthy, they’re not working. If
they’re not working, they’re not making progress for their families. So our job is
to help keep them healthy. And then, we have a broad program across the U.S.
where we w ork with a network of more than a thousand similar clinics that are
run by other nonprofits, usually community nonprofits that run off charitable clinic,
and this is all 50 states, and we provide them medicines and medical supplies
that they would not norm ally have access to and other kinds of programing to
increase their ability to do chronic disease care well, to do mental health
services, to do improvements in their inventory management and control. So, we
believe effective primary care at the community level is really the basis for good
health in a community. If you have what we like to call a thriving local health
center, it will keep people in their community healthy, and if those people are
healthy, they have a shot at all kinds of opportunity that they would otherwise not.

Margaret Flinter: Well Michael, one thing that we can be certain of in the wake of
disasters like the hurricanes, earthquakes, refugee crisis, massacres that we’ve
seen, is that it takes a huge toll on the behavioral health of t he people in these
communities, and that underpins all other health issues. And at Americares, I
know that you have a program that specifically targets emotional health for those
who have been through a trauma. Can you talk with us about your mental heal th
initiative?

Michael Nyenhuis: Yeah, I’ll give you an example from Nepal and our response
to the earthquake there a couple of years ago. It was a big disaster and caused
a lot of traumas for people, and what we found out is when there’s not good
menta l health services available, people who are traumatized tend to go to a
primary care clinic. And what you find is that the health professionals, or the
community health volunteers that man those primary care clinics are completely
ill - equipped to be able to deal with mental health and psychosocial issues. And
the work that we’ve done there is twofold. One is to provide training to the
community health workers and the medical staff at a number of clinics so that

Michael Nyenhuis CEO Americares

they have at least the ability to recognize , diagnose to a simple level, and do
basic treatment and referral for people who are coming to them but don’t have
physical ailments, but really have mental or psychosocial issues. So that’s that
first line of care, taking them from ill - equipped to deal w ith this, to equipped to
deal with this, which we think is making a big difference there. And then
secondly, we’ve done a lot of community sensitization about mental health issues
through a theater program that we’ve done in many communities, where we’re
just putting out on the table the issues, trying to put stigma down and help people
in the community to recognize that they have a place to go to deal with these
sorts of issues. So community sensitization of it and then equipping of the health
profession als to be able to manage it, at least at a basic, level. And right now in
Texas, we are looking at launching a similar kind of program on people who were
affected there and frankly, in every major disaster that we respond to now, this
will be a key part o f it. We have a completely unmet need and something that’s
real, and if not dealt with, can have long term negative impacts for people and
their communities.

Mark Masselli: As an international organization, raising money largely through
charitable donat ions, I would imagine that with so much going on in the world
right now, there’s probably a bit of disaster fatigue. Could you tell our listeners
what your greatest need is and for those who want to help, and I know there are
so many wanting to help out t he disasters that are close to home and around the
globe, what’s the best way for people to help?

Michael Nyenhuis: Well, certainly the best way for people to help is to donate
funds to reputable organizations that they trust, that are doing good work in a
disaster zone. This work requires professionals who know what they’re doing
and there are organizations like ours that can do that with the resources that are
provided to us. Often time, people have felt need to gather up clothing and
bottled water an d try to ship it down to these disaster zones, but I’ve been in too
many disaster zones where uncoordinated relief aid arriving actually creates
more problems than well - coordinated relief aid can even solve. We need to do to
this in a way that’s really pr ofessional and well - executed and there are groups
like Americares that can do that. I will say, having so many of these in a row,
gratefully we have not really seen kind of a fatigue yet among donors. We
continue to see donors giving resources for us for Hurricane Harvey, and that
was the first of the three. So we’re really grateful for that support and it’s going to
allow us to do a lot of really great work.

Margaret Flinter: We’ve been speaking today with Michael Nyenhuis, President
and CEO of Americ ares. You can learn more about their important work by
going to Americares.org, or follow them on Twitter @americares.org. Michael,
thank you so much for joining us on Conversations on Healthcare today and best
wishes to you and all of your teams across the globe working to make things
better.

Michael Nyenhuis CEO Americares

Michael Nyenhuis: Thank you very much and appreciate the attention you bring
to these sorts of issues.

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Mark Masselli: At Conversations on Healthcare, we want our audience to be
truly in the know when it comes to the facts about healthcare reform and policy.
Lori Robertson is an award winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
weekend?

Lori Robertson: In early October, the Trump administration broadened an
exemption to the Affordable Care Act’s requirement that health insurance plans
cover birth control with no cost sharing. The new rule wo uld allow any business
or nonprofit organization to exclude such coverage on religious or moral grounds.
The ACA required that all private, non - grandfathered insurance plans cover
contraceptives approved by the FDA for women without cost sharing starting in
2012. The plans must cover without cost sharing, at least one form of the 18
FDA approved contraceptive methods. That includes IUDs, the pills, diaphragm,
emergency contraception, and more. But if a doctor recommended a specific
product for a patient , that must be covered cost free too. The requirement
prompted litigation from those citing religious reasons for their opposition. The
Obama administration allowed houses of worship to claim an exemption from the
requirement, but nonprofits and closely held for profit businesses could only get
an accommodation, allowing the employer to not pay for coverage of birth
control, but the insurer would then cover the cost. It’s unknown how many
employers will now opt for an exemption and how many women will lo se birth
control coverage with no cost sharing. The Trump administration said the
change could only affect 200 organizations, the ones that filed lawsuits. But the
original requirement did save women money, to the tune of an estimated $1.4
billion per ye ar just on the pill according to a study by the University of
Pennsylvania researchers. Before the requirement, birth control costs had been
30% to 44% of women’s out of pocket health spending. Before the ACA, 85% of
large firms covered birth control, th ough cost sharing may have been involved,
according to the Kaiser Family Foundation report. Eight states have some
requirements for no cost sharing contraception coverage. And that’s my fact
check for this week. I’m Lori Robertson, managing editor of Fa ctCheck.org.

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Margaret Flinter: FactCheck .org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com . W e will have FactCheck.org ’s , Lori
Robertson, check it out for you, here on Conversations on Healthcare.

Michael Nyenhuis CEO Americares

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Mark Masselli : Ea ch week, Conversations highlights a b right idea about how to
make wellness a part of our communities and everyday lives. Of the 6.6 million
births per year in this country, over half are unintended. Colorado has been
conducting an experiment for several years to examine what might happen if
sexually active teens and poor women were offered the option of long term birth
control, such as IUDs or implants.

Dr. Larry Wolk: What was so striking was the word of mouth amongst these
young women to each other and the network of support that was bui lt to access
this program to help the tens of thousands of women, really did then result in
these significant decreases in unintended pregnancies and abortions.

Mark Masselli: Dr. Larry Wolk, Medical Director of the Colorado Department of
Health and Envi ronment.

Dr. Larry Wolk: The result in decrease is 40% plus or minus in both categories,
pregnancy and abortion. When you extend this out over an additional year, even
approaching 60% reduction.

Mark Masselli: There was a significant economic benefit to the state as well.

Dr. Larry Wolk: We have seen a significant decrease in the number of young
moms and kids needing public assistance, whether that’s public insurance, the
WIC program.

Mark Masselli: A free long term contraception program offered to at - risk teens
and women, trying to avoid the economic hardship of unplanned pregnancies,
leading to a number of positive health and economic outcomes for all involved.
Now, that’s a bright idea.

[Music]

Margaret Flinter: This is Conversations on Healt hcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University , streaming live at www.wesufm.org and brou ght to you by the
Community Health Center.