Two Community Health Centers Almost Destroyed Rise Up to Serve Their Communities: Puerto Rico and California

Naomi Fuchs and Gloria Amador

[Music]

Mark Masselli: This is Conversations on Health Care I’m Mark Masselli.

Margaret Flinter: I’m Margaret Flinter.

Mark Masselli: Well, Margaret after a brief government shutdown in Washington
we’ve seen some winners and losers , while there was no action on DACA the
Obama era legislation aimed a t accelerating citizenship for immigrants brought here
illegally as children . S ome other children were given a reprieve . A fter be e n in limbo
for months f u nding for the Children's Health Insurance Program was reauthorized in
the bill that's good news .

Ma rgaret Flinter: T his is welcome certainty for coverage for the nine million
American kids but also thousands of pregnant women who rely on CHIP. O n every
level Mark I think this is a smart policy and p ublic health decision as happy and
relieved as we are at the CHIP funding the nation's community health centers are still
in a state of uncertainty . T he health center funding has not yet been reauthorized for
the nation's 1400 community health center organizations which care for about 24
million people acro ss the country . T hat brings us to our guests today t w o community
health center leaders who are delivering exceptional quality care against some very
daunting o dds.

Mark Masselli: Naomi Fuchs is the CEO of Santa Rosa H ealth a consortium of
community health centers in Northern California struck by last year's devastating
wildfires .

Margaret Flinter: Gloria Amador will also be joining us she runs a group of
community health centers in Puerto Rico that were devastated by Hurricane Maria
which left most of the island without electricity , water , communications or health care
infrastructure . T hey've conti nued to deliver care among some amazingly challenging
conditions and not surprisingly you may notice a little more static as telephone
infrastructure hasn't been fully restored there yet . L ori Robertson will check in with
us she's the managing editor of F act C heck .org.

Mark Masselli: No matter what the topic you can hear all of our shows by going to
chcr adio . com , a nd as always if you have comments please email us at
[email protected] o r find us on Facebook or Twitter. We love hearing from you .

Margaret Flinter: W e'll get to our interview with Gloria Amador and Naomi Fuchs in
just a moment .

Mark Masselli: F irst here's our producer Mari anne O'Hare with this week's h eadline
n ews.

[Music]

Marianne O’Hare: I'm Marianne O'Hare with the se health care headlines . A short
lived government shutdown has come to an end the s enate passed a stopgap

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Naomi Fuchs and Gloria Amador

funding measure that will keep government running temporarily . T he deals are far
from done d emocratic leadership agreed to end the shutdown based on assurances
that there would be a decision on how to move forward with the dreamers act DACA
which would provide a pathway to citizenship for illegal immigrants brought here as
children by their parents . F unding for the nation's community health centers still
hangs in limbo and many of the nation's health centers are living on dwindling
budgets with no certain path forward .

M eanwhile , more states are looking at ways to recalibrate their insurance laws in the
wake of changes to the Affordable Care Act . Kentucky Governor Matt Bevin ’s waiver
allowed for work requirements for all Medicaid recipients who are able bodied . The
state will require 20 ho urs a week or their benefits could be denied . T he state is also
considering eliminating the Medicaid expansion which helped about a half a million
residents in that state gain coverage . A nd Maryland is responding to the elimination
of the i ndividual mandate that was snuck into the tax reform bill concerned it will lead
to lost coverage for many of its state residents . T hey're considering legislation that
will require all state residents to carry insurance . I’m Marianne O'Hair with these
he alth care headlines.

[Music]

Mark Masselli: We're speaking today with Gloria Amador Executive Director of
Salud int eg ra l en la Montana a private network of federally qualified health centers in
Puerto Rico . S he is continuing to provide care to tens of thousands of r esidents of
Puerto Rico in the wake of the extreme devastation from Hurricane Maria . W e're
also joined today by Naomi Fuchs CEO of Santa Rosa Community Health a n etwork
of clinics serving the northern California region devastated by the mass ive wildfires .
S he too is continuing to deliver care to thousands of residents who were impacted by
the fires which burned thousands of homes as well as their primary care clinic .
G loria and Naomi welcome to C onversations on Health Care.

Naomi Fuchs : T hank you so much pleasure to be here.

Gloria Amador : Thank you Mark.

Mark Masselli: Yeah Gloria let's start with you . I n September Puerto Rico was
battered by two back to back hurricanes and the second hurricane cause total
devastation across the isla nd leaving millions of residents without power , water , food
or safe shelters . H elp us better understand the scope of the devastation and the
challenges that you faced since then ?

Gloria Amador: Hurricane Maria [inaudible 00:04:50 ] almost a century ca using
devastation and experience damages across the island . T he aftermath of Hurricane
Maria reveals to us that health infrastructure software expensive damages.
Co mmunity health centers who were left without electr icity, with limited access to f uel
for generators, lack of – water to run the operations. We have long term affects on
the public health. Even today four months after Mar ia many basic services are still
not fully functioning . Limited access to food and s afe w ater , also we're seeing a lot
of sanitation disruption on services to access health care , medicine and other

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Naomi Fuchs and Gloria Amador

essential health items due to medical office has shutdown and a lot of vendors that
have shut it down due to the damage they receive. That have increase the infectious
diseases [i naudible 00:05:43 ] mosquito born diseases and mental health issues
[inaudible 00:05:47 ] that have increased sharply in the first months s ince the
hurricane struck us.

Margaret Flinter: It really seems almost impossible that just a few weeks later Naomi
w e a re watching this record breaking wild f ire raged across northern California
leaving scores dead and thousands homeless . W e know that your primary care
clinic the Santa Rosa Community Health Centers Vista C ampus a large primary care
facility was lost . Help us understand the impact of this devastation Naomie for your
clinic and your community .

Naomi Fuchs: W hen 6000 people lose their homes and a 100,000 people are
evacuated for days sometimes weeks , it really is a trauma to the whole community .
H alf o f our patients lost their medical homes just at the time when they needed it the
most , and many were evacuated into shelters in a great duress people had minutes
to escape the fires , and of course they left without their medications . T hen in the
meantime we lost our largest facilities and a 180 people worked at that facility , so
they also lost their primary place of work while the fires raged on . W e were working
in the shelters which were really often like a MASH unit many of the nursing homes
and other v ery medically fragile people were evacuated into gymnasiums . W e
deployed many of our physicians to all these shelters and our nurses . T hen we set
about the business of tryin g to convert every usable space, so we had eight other
much smaller clinics that we converted into medical facilities or exam rooms . W e
just opened our door to whoever needed care and we also are pharmacy with
tremendously helpful to place in medications for hundreds of thousands of people .

Mark Masselli: W ondering Gloria if we could talk more about the scope of your
health system SIM and the network of clinics you have in Puerto Rico and how
you're managing the continuum of care .

Gloria Amador: W e right now operate seven sites in the mo untain region of Puerto
Rico right in the center . W e have a home care and hospice programs, SIM serve
over 55,000 patients yearly so the disruption of the normal services have exposed
weaknesses that now we cannot rely on traditional modest operations . T he
beginning of the emergency SIMs operate with limitations such as lack of e lectricity
in all our h ealth centers, no water , no telecommunication . SIM have been the first
line responders d uring emergency to almost all their primary held needs due to our
e xtensive s cope of service with populations we serve, so SIMs have already starting
overcome limitations. Now we we’re working to strengthen our infrastructure and
preparing our emergency plans for future disaster considering that every year
[inaudible 00: 08:40 ] . Six months hurricane season, and now that is so clear the
fragility of the basics utilities in the island. SIM along many volunteers medical
mission that have been working together for all the private sector organization help
us speed the respons e and recovery efforts following both hurricanes here.

Margaret Flinter: Well, Gloria and Naomi I think you're conveying a really important
message to people all across the country the degree to which community health

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centers are such a essential part of the fabric of communities , and the ability to step
forward and respond in a crisis like this . You’ve really have to be pretty innovative
pretty quickly . Naomi I know that one of the ways that you've innovated in Northern
California where you had so man y people suddenly homeless . I understand you
took a mobile clinic on the road while your main facility was out of commission . T ell
us what that was like for your clinicians and your staff and their patients ?

Naomi Fuchs: O ur sister house centers intact five mobile clinics to see patients that
lost their medical home . M ost of those mobile clinics were actually co - located with
some of our smaller health centers so that we could have access to things like labs
and pharmacy and waiting rooms . I n addition we purchased a little known resource
which I ’m very excited to say has working out very c alled C linics A nd I t C an , t hese
are converted shipping containers that ar rive fully equipped as a medical exam
room. We 've got seven of those to add seven exam rooms so these have been an
outstanding way to respond to emergencies to set something up very quickly . M any
of the people particularly if they were not documented did not want to go into the
community based shelters and so they fled to the coast where they cam ped or slept
out in their cars . W e sent out reach staff and medi cal staff out to those who
encampment to make sure that people have the medical resources they need ed
basically doing what we call street medicine , assuring people that they do need
medical ca re so that there's a place for them to go to the S tates .

Mark Masselli: W e're speaking today with two directors of two community health
center organizations valiantly serving their patient population in the wake of major
disasters Gloria Amador of Salud Integral in Puerto Rico and Naomie Fuchs of Santa
Rosa Community Health Center in Northern California . I’m wondering if both of you
might comment on just the financial burden after th ese tragedies . Gloria you've been
without power for four months , I'm wo ndering how you have managed in your regular
daily operations of getting revenue when and Naomi you've lost 50,000 square foot
facility that has to be rebuilt . This is an enormous lift, Naomi let's start with you
about how you're managing through this in ways that people might be able to help
out .

Naomi Fuchs: Y es we lost basically 50% of our income at least in that first six
weeks , we are looking at about a 15 million dollars t hat is not goi ng to be covered by
insurance , so w e are on a big fundraising drive and you're welcome to go to our
website at SRh ealth . org and see what our needs are to the cover . What Puerto Rico
is going through in terms of the devastation of their res ources it’s real ly far greater
and my heart goes out to all of you without power electricity. W e do have power
back we do have c ommunication s back. M ost of the rebuilding , the renovation will
be covered by insurance but there are just obviously millions of dollars in lo st
revenue and millions of dollars in these interim f acilit ies that we need to set up . W e
have not received any federal funding or federal disaster relief at this point either.

Mark Masselli: Gloria?

Gloria Amador: Yes I must say that many people have been donating resources to
aid our reco nstruction and still [inaudible 00:12:26 ] donations of the neediest articles
are flashlights batteries [inaudible 00:12:33 ] bed sheets , towels among others.

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Naomi Fuchs and Gloria Amador

Monitory help will allow us to buy the news article to kee p helping the community and
keep running our operations . W e have been receiving a lot of donations from F EMA
and from many other organizations have contact us as the main first responder to
the community. Those who want the help their communities in the mountain of
Puerto Rico can send donations to Salud Integral de la Montana and then gave the
donations to the community. Every instances that we identify needs on specific
families we make the donations to them. It’s important for us not to only think on
how we can help our own community but how we can make our patients to be in the
best capacity to them to get back to their normal lives, to get back to our health
centers to take care of their health. If they don't have any health they don't have any
lif e.

Margaret Flinter: Well I'd like to ask both of you, so also comment on something I
think has been just at the very top concerns we've all had. We've all been aware of
from the very beginning that there was another problem that was going to last long
after power was restored and homes were rebuilt, and that was the impact of trauma.
On really large populations children, adults, kids who've relocated up to states like
ours in the Northeast often parents staying behind in Puerto Rico. Certainly as
comm unity health centers your centers have great behavioral health systems
imbedded within primary care how has the teams in your organization’s been able to
respond to this trauma?

Naomie Fuchs: Sure, I do think that this is one of the most serious concerns on a
long term basis. We have to rebuild the homes but if we don't give people the tools
to rebuild their lives we will have failed and giving them the tools for emotional
resiliency and recovery from this trauma it is essential. At our health center we have
an integrated behavioral health program it's a physician or nurse practitioner is
talking to a patient who is expressed some -- we screen them as well and ask about
trauma and how they're doing emotionally. If there's an indication that they're real ly
struggling we do what we call a warm handoff we call in a behavioral health person
like during that visit they don't have to wait for a follow up appointment and transfer
some of that trust to a behavioral health counselor so that we can begin to start to
address their concerns. We've also greatly expanded our groups for people to be
able to get support and ongoing rate for anxiety, depression because if there's
something that we have learned from other disasters [inaudible 00:15:17 ] if this is not
addressed that there is a spike in chronic disease things like domestic violence,
suicide as well as other mental illness. We want to prevent a secondary disaster as
best we can.

Margaret Flinter: Gloria would you like to comment?

Gloria Amador: Yes there's a lot of concerns on emotional trauma. It's been very
dramatic to see a lot of heart attack, chronic attack, anxiety depression due to
devastation. Even to see in our employees it was worse, so the first being after the
hurric ane was to manage our employees many of our employees lost everything,
their houses, their belongings even their kids' school clothes so we have seen a lot
of devastations among our own employee. SIM contracted a behavioral health
company to provide group sessions for our employees. The most affected
employees were sent on vocational leave to deal with their own situations while

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mainly the clinical staff were deployed to emergency rooms and psychologist and
clinicians to their load [inaudible 00:16:18 ] th e block access to get to the health
center. Then we start bringing and at the health center to manage our patients while
making them need assessments of their damages to provide them donations. Even
in the community clinics a lot of patients ask for beha vioral health aid. A lot of
people who are in critical economic conditions now have all their determinants on
health affecting their life. Bringing other organizations like universities that provides
behavioral health classes or students so they can help us during the process of
helping our patients.

Mark Masselli: I was thinking about what we go through in a normal preparation to
making sure our emergency preparedness plan is set in place. I'm wondering how
well did the plan work for you, do you have some advice for other health care
providers but what are your thoughts about preparation as people think about it
preparing for future emergencies?

Naomie Fuchs: I have to admit I was definitely one of those people that had the
binder on the shelves and never really paid that much attention to it before, and now
I’m meeting regularly our safety officer on a regular basis. There were two things,
one is making sure people are trained in their various roles. A major disaster means
everybody's doing a new j ob, you want to make sure that the right people are doing
those jobs, you know where people are going to be, where knowing that your staff is
-- who can come in and who can't come in which changed hourly. I mean we would
have a set of staff onsite and the re'd be an alert and 20 people would have to leave
because their homes were being evacuated. To be able to be absolutely nimble is
really the second and it’s sometimes hour by hour. Communication across all your
stuff and then we have 500 employees findi ng ways to reach people when the
normal communication systems are down. All those kinds of things became critical.
While you do your very best to plan just know that you also have to have plan B and
plan C when those people aren’t available that ability to be flexible, so
communication was a number one priority whether it was the wind changing, the
smoke in different facilities all those kinds of thing. I also want to just go back to
something Gloria said about staff because not only did our staff lose h omes, 20 of
our employees lost their homes. They are also hearing the stories of everybody
else's pain and suffering as they come through the door and experiencing the
vicarious trauma on top of their own trauma. Having resources available, having all
ki nds of ways to help people manage their stress and their trauma, our staff can’t
take care of other people unless they’re taking care of themselves as well, so.

Mark Masselli: Great, Gloria lessons learned?

Gloria Amador: We hear there’s a hurricane co ming, every week we hear
something's coming. Sometimes people lay back and do not take care of that, in our
case we prepare our health service centers three days before. We make all the
preparations we have in our binder, but nobody expect to get the dev astations we
had. The government was not prepared, even we that have emergency rooms and
we are the one supposed to be prepared, we have employees there for five days
because we cannot get to them because there was no way to get to those health
centers. The roads were blocked, we lose all kind of telecommunications, there was

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no communications at least for the first week. It was very difficult, we just we’re
waiting there for people to show up deciding where we're going to pick the people.
We move to on e of our health center so we can be with the people and with the
employees over there. We visited all our health centers, we sat down with the
emergency officers, after the hurricane we went to the governmental emergency
office. We get all the informatio n from FEMA from the electricity power from the
utility companies. We can tell our patients and our employees where we have to
start first. We have to -- to get our own truck with diesel, now we understand that we
really need that. You will never be pre pare for what happened during that hurricane,
but now we are waiting to face another category five preparing ourselves making all
our emergency plans, preparing our employees, making sure that we can get to
know where our employees live so we know how to g et them. Understanding that
we are human beings that to serve the people we need to comply with our needs
and our families and our homes so we can go back to our working place. We will
have to do it every year so we are prepared to keep serving the commu nity.

Margaret: We've been speaking today with Gloria Amador Executive Director of
Salud Integral en la Montana a network of community h ealth centers in Puerto Rico .
You can follow their work by going to SIM PR.org or follow them on Twitter @ S IM
Puerto R ico . W e've also been speaking with Naomi Fuchs CEO of Santa Rosa
Community Health Center. Y ou can follow their work at SR Health . org or on their
Facebook page Santa Rosa Community Health . Naomi and Gloria thank you so
much for your incredible leadership and for joining us on C onversations on H ealth
C are today . T o our listeners if you've been moved as we are by the story of
incredible resilience and recovery it's a long slog we encourage you to go to their
w ebsites and consider a donation , thank you both .

Naomi Fuchs: Bye - bye.

Gloria Amador: Bye - bye.

[Music]

Mark Masselli: At Conversations on Health C are, we want our audience to be truly in
the know when it comes to the facts about health care reform and policy . Lori
Robertson is an award - winning j ournalist and Managing Editor of FactCheck.org, a
non - partisan, 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 week?

Lori Robertson: P resident Donald Trump has been in office for a year and we've
now published our first story on Trump's numbers under his presidency . W e will
publish quarterly updates to this series . O ne measure we examine is the number of
people without health insurance , under Trump’s presidency so f ar that number has
gone up . T he most recent report from the National Health Interview Survey
estimates that during the first six months of 2017 28.8 million people were uninsured ,
that's an increase of only 200,000 from 2016, and it’s still 19.8 million f ewer than
were uninsured in 2010 the year Obama signed the Affordable Care Act into law .
Latest National Health Interview Survey only includes figures for the first half of last
year . Mo re recent polling by the Gallup organization covered the last three months

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Naomi Fuchs and Gloria Amador

of 2017 and found a much larger increase in the uninsured . I t estimated that 3.2
million Americans entered the ranks of the uninsured last year . Trump failed to
repeal and replace Obama's Affordable Care Act as he promised to do , but the tax
bill he signed into law in December will end Obama C are ’s tax penalty for people
who fail to obtain coverage . R epealing the mandate will increase the number of
uninsured by millions according to the nonpartisan Congressional Budget Office .
CBO estimated that ending the mandate will cause four million people to lose or drop
c overage in 2019 rising to 13 million by 2025 quote , “H ealthier people would be less
likely to obtain insurance .” CB O said . That’s my f act c heck for this week I'm Lori
Robertson Managing Editor of F act C heck . org.

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 ’d like checked, email us at
CHCradio.com we ’ ll have FactCheck.org’s, Lori Robertson, check it out for you, here
on Conversations on Healthcare.

[Music]

Margaret Flinter: This is Conversations on Health Care I’m Margaret Flinter.

Mark Masselli: I’m Mark Masselli, peace and health.

Conversations on Health C are broadcast from WESU at Wesleyan University,
streaming live at www.wesufm.org and brought to you by the Community Health
Center.

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