An elderly woman struggles at a community health clinic in rural Texas amid a record heat wave. She has a severe asthma attack, wheezing and gasping for air. As medical staff rush over the lights and air conditioning shut off due to an overtaxed power grid.
Scenarios like this are becoming more worrisome as the planet warms and weather events become more frequent and extreme. In response, Harvard experts on the health impacts of climate change have teamed up with the disaster relief nonprofit Americares to create a climate change “toolkit” that provides information, advice and support to the frontline health clinics that serve them. tens of millions of low-income Americans. .
of Climate Resilience for the Front Clinic Toolkitunveiled this month, was created by specialists working with Harvard School of Public Health TH ChanS ‘ Center for Climate, Health and the Global Environment (C-CHANGE), for distribution from American, which works with community health centers and free clinics across the country. The toolkit contains checklists for clinic staff, instructions on how to develop action plans and direct advice for patients struggling with diabetes, kidney disease, dementia and other illnesses during extreme heat.
Aaron Bernstein, the interim director of C-CHANGE and a pediatrician at Boston Children’s Hospital, said it is clear to him that planning for climate-related health impacts has not progressed as quickly as the risk. Climate change, Bernstein said, could not only affect patients with conditions like asthma and pregnancies, but some disasters — such as those that affect power supplies — could hamper the ability of health care personnel to respond.
“I was motivated by how little work has been done at the intersection of climate sustainability and health care,” Bernstein said. “And when we dug into this issue, it became clear that what little has been done has been done in the area of big hospitals in big cities. If there is a way to make health care resilient to climate shocks, it may not actually be the best place to invest, because our guess is that most of the health care need around these disasters is happening on the front lines. these clinics around the country.”
Kristin Stevens, America’s senior director for climate and disaster resilience, said the clinics are an important part of our health care system, serving the same largely low-income population that is most vulnerable to hurricanes. heat, floods and other climatic disasters. In addition to bearing the responsibility of caring for this vulnerable population, the clinics and centers themselves are vulnerable, often lacking emergency managers and often struggling with scarce resources and overburdened staff.
“One thing to understand about these health centers is that they don’t have their own emergency managers. They are tied for time; they are tied for money; they are strapped for staff,” Stevens said. “They’re not able to do basic emergency planning, let alone think about how their environment and community is going to change over the next five, 10, 20 years.”
The effort has its roots in 2017’s trio of damaging storms: Hurricanes Harvey, Irma and Maria, after which Americares began ramping up its preparedness planning. A couple of years later, Stevens said, then-C-CHANGE director Gina McCarthy spoke at an Americares conference, which sparked the partnership between the two organizations.
Today, C-CHANGE brings clinical knowledge about the health impacts of climate change, while Americares brings operational knowledge about disaster response.
The toolkit was developed after surveying clinics and conducting focus groups to understand the state of preparedness at the local level. Surveys showed that 81 percent of clinic staff said they had experienced an extreme weather-related outage in the past three years, that less than 20 percent felt their facility was “very resilient,” 77 percent said they had no knowledge enough. or tools to prepare for climate-related disruptions, and 80 percent wanted education and training to help them serve patients when faced with climate disasters.
The toolkit, available on the Americares website, has resources specific to extreme heat, wildfires, hurricanes and floods. Clicking on Heat, for example, creates three document lists, one for providers, one for patients, and one for administrators. These categories have lists of tip sheets, operational guidelines and action plans for each category, covering things like — for administrators — what to do in the event of a power outage; for providers, how to treat patients with chronic obstructive pulmonary disease, asthma, or dementia; and, for patients, tip sheets for those managing heat and their diabetes, multiple sclerosis or cardiovascular disease.
Bernstein said clinics are not just places of need, they are also important resources themselves. Providers there know their patients and can tell if someone, for example, is elderly, lives on the top floor of a walk-up, doesn’t have air conditioning, and might need extra help during an extended bout of heatstroke. the heat.
“A lot of the damage from these disasters is preventable, and no one has thought about how these clinics can really help prevent damage before a disaster happens,” Bernstein said. “We realized very quickly that there was an opportunity to not only help the clinic deal with disasters as they happened, but to keep people out of harm’s way in the first place.”
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