by Christine Fisher, Alaina Strobel and Maryanne Strobel
Looking for the tools to deal with diabetes during a disaster? Find them at DiabetesEducator.org/disastertool.
As Hurricane Harvey was approaching the Texas coastline, members of the southeast Texas local networking group (STADE) began discussing how we, as diabetes educators, could help those with diabetes in Houston/southeast Texas successfully manage their condition through the storm and recovery period. From the weather forecast information, STADE knew there was great potential for severe wind damage and flooding throughout the region. As such, that would likely translate into many people losing or not having access to their blood glucose testing equipment/supplies, diabetes medications, insulin, injection supplies, and emergency/rescue resources (e.g. glucose tablets, glucagon kits); vital components of diabetes self-management and survival. Availability of food and adequate drinking water would also be in question, as would access and transportation to health care services, for an indeterminate amount of time. We knew we needed to be proactive in anticipating the needs of our diabetes population and act to prepare as soon as possible.
The coalition was instrumental in helping to ensure clear communication between all parties, maximizing the effectiveness of our efforts across southeast Texas, and providing us with support as we went out into the local communities.
We began by assessing our current supply of sample products, equipment, medication/insulin coupons and vouchers, and educational materials. We discussed the various possibilities for how we could build our available resources quickly and help mobilize them to the areas in need. We then started sending e-mails and making phone calls to various manufacturers of blood glucose meters, pharmaceutical company representatives, and local grocery and drug stores that carry diabetes supplies. Knowing that Hurricane Harvey would affect many people across the entire southeastern Texas region, and that the needs would be great in a number of communities, we would most certainly need help from additional outside agencies and resources.
We contacted state and national officers for the American Association of Diabetes Educators (AADE), explained our concerns, and asked for their assistance. AADE gave us permission to send out a mass e-mail to the other members of the association across the country, asking them to send any available supplies that they could spare to help with the hurricane relief efforts in Texas. We were so amazed and humbled by the generosity and outpouring of support from our colleagues! We received many boxes filled with meters, testing supplies, glucose tablets, healthful, higher-protein/lower-carb snack foods, and other much-needed items.
Our colleagues at AADE (state and national) also helped us make connections with senior leaders at the American Diabetes Association, the Endocrine Society, the Juvenile Diabetes Research Foundation, Research America, and Insulin for Life. Together, we formed a coalition to work together in assessing and actively addressing the needs in Texas: the Diabetes Emergency Relief Coalition (DERC). The coalition grew further, to include the American Association of Clinical Endocrinologists, the Centers for Disease Control and Prevention, and others; even some from outside the United States. The coalition was instrumental in helping to ensure clear communication between all parties, maximizing the effectiveness of our efforts across southeast Texas, and providing us with support as we went out into the local communities.
One of the areas dramatically affected by Hurricane Harvey was Wharton, Texas. Eighty-five percent of the town’s population carry a diabetes diagnosis. The majority of residents in the town were very poor/working poor and either do not have any medical insurance coverage or—at best—minimal assistance from federally funded programs. They had very few resources to begin with, but the storm absolutely devastated this community; leaving many homeless and literally without anything. The residents were unable to afford to replace their meters, testing supplies, diabetes medications/insulin, or injection supplies; even medications on the four-dollar prescription list. Many did not have any source of available transportation to get to a functional clinic, even if they could afford to pay for care, and only one pharmacy in town was operational for limited hours after the storm.
When we received word of the desperate need for medications and supplies in Wharton, we worked through AADE and DERC to send a request to Insulin for Life, who were able to very quickly assemble the needed items and arrange for them to be on a flight to us within hours. The catch? The closest place the plane could land was in Austin (about 3 hours, one-way, from Houston), and it would not arrive until 9:30 pm. We sent a team from Houston to Austin to pick up the boxes in the middle of the night and deliver them to a member of the Texas Search and Rescue team in Katy, Texas, who would then get them out to Wharton via boat.
As soon as there was a passable route, AADE members Christine Fisher, Maryanne Strobel, and Alaina Strobel, went out to the town of Wharton to volunteer at a makeshift clinic set up in one of the town’s shelters. They were desperate for experienced diabetes clinicians/educators, as those in town were not knowledgeable or comfortable with diabetes management and not aware of available resources or how to help residents access them. The team also wanted to follow up with the Insulin for Life package delivered earlier. When the team arrived, staff at the clinic/shelter was having difficulty organizing the delivered supplies and knowing how to use them properly.
The goal was to help those with diabetes make a successful transition from supported care back to self-management.
The AADE team was able to get things organized, provide staff with education, set up a process for care and supply management, and deliver diabetes care and education to patients in the clinic. Most we saw that day had been without their medications for several days and experiencing notable hyperglycemia. Access to adequate food and clean drinking water was also a concern in Wharton, creating a number of serious issues for those with diabetes. One resident presented with a sustained blood sugar of > 600 mg/dL, and we helped facilitate his emergency transport to a hospital in a neighboring town for more intensive glycemic management and hydration. Some needed insulin administered and subsequent observation in the shelter area to address their hyperglycemia. We were able to FaceTime with a physician who provided us with direction on insulin dosing. Others presented with various injuries sustained in falls, from objects that hit their legs/feet in the water and broke the skin, or foot concerns related to standing in water for extended periods of time. The floodwaters were extremely dirty and contaminated. That, combined with elevated blood sugars, presented concern for infection as well. Maryanne, Alaina, and Christine were also able to provide residents with some much-needed diabetes education, supplies, and medications, as they carried out their tasks and duties.
Christine and Maryanne returned to Wharton later to work with another volunteer physician, provide residents with meters, medications, resource information/assistance, care, and education. The needs of the community remain great, and they are planning to continue their diabetes support and education efforts there as the residents move forward beyond Harvey. They also arranged - under ADA oversight, and with AADE support - to set up resource information tables in highly trafficked, public areas over the weeks after the hurricane, and recruited other diabetes educators around the greater Houston area to participate with them. Their goal was to help those with diabetes make a successful transition from supported care back to self-management.
The disaster response protocol developed through the work of the coalition carried over and continued through to the areas affected by Hurricane Irma as well. Christine, Maryanne, and Alaina remain on DERC’s logistics and communications teams to give their input and recommendations based on our experiences with Harvey, as well as gain additional experience and expertise in disaster response. They were confident that their work and efforts in the area of disaster relief for those with diabetes helped to make an important contribution that can continue into the response for future disasters anywhere. AADE requested a tool be created that all diabetes educators could use during each phase of future disasters: readiness, response, and recovery. You can find it here: DiabetesEducator.org/disastertool
About the Authors:
Christine Fisher, MSN, RN, CDE, is an inpatient diabetes educator at Houston Methodist Sugar Land Hospital in Sugar Land, Texas.
Alaina Strobel, RD, LD, CDE is a diabetes educator at Texas Children's Hospital Pavilion for Women in Houston, Texas.
Maryanne Strobel, MSN, RN, CDE is the diabetes program lead at Houston Methodist Willowbrook Hospital in Houston, Texas.