Diabetes in Disaster Mode: One Town's Tale of Evolving Relief Needs
We're all reeling from the news about the historic devastation doled out by a line of hurricanes and storms, hitting the Gulf Coast and southeastern states along with the Caribbean islands -- not to mention the catastrophic earthquake rocking Mexico and so many other natural disasters happening across the globe.
For people with diabetes, both grassroots and large-scale relief efforts are underway and it's inspiring to see how our community's stepped up to help out. The latest is that at least one new non-profit has blossomed from those efforts, and a diabetes educator hopes to build a network of relief centers to help in the aftermath.
This takes us to eastern Texas, where one town stands out as symbolic of all the D-Community has experienced and what many might face in the days, weeks and months in the wake of these catastrophies.
Wharton, TX: 'Diabetes is Everywhere'
Wharton is a tiny community 60 miles south of downtown Houston, along the Interstate 69 corridor, with a population of less than 10,000. But a whopping 85% of residents there live with either type 1 or type 2 diabetes (!) It's a diverse population -- 40% Hispanic, 30% African-American, and 30% Caucasian -- largely low-income and working poor, farmers, ranch workers and small business owners who don't have health insurance.
With very few resources existing in Wharton to begin with, you can only imagine how it played out after Harvey hit, when the flooding began thanks to the nearby Colorado River overflowing and filling Wharton's streets. So many people were left homeless without any belongings -- of course including the insulin and other medical supplies critical for life with diabetes.
What they experienced mirrors what happened to PWDs affected by disasters everywhere:
- Many PWDs are unable to afford replacement glucose
meters, test strips and supplies, insulin and other meds -- even the
low-cost $4 versions. - People lost their cars, from flooding and evacuations, so are unable to travel to pharmacies or a clinic.
- Access to clean drinking water and food remains a concern, and gets worse as time progresses.
- The overall stress and uncertainty messes with BG levels, and combined with the dirty and contaminated floodwater and mold situations that may arise, it's not a pretty picture.
Diabetes advocates and educators on the ground have been quick to take action, and we've reported on ongoing relief efforts happening in Texas and Florida (Urgent Need for Insulin and Diabetes Supplies in Wake of Major Disasters). The American Diabetes Association is leading what's called the Diabetes Emergency Relief Coalition (DERC) made up of JDRF, AADE, AACE, Endocrine Society, and Research America groups to provide large-scale relief in affected areas, and while that's great to see, there's been some question about how quickly and effectively that help is being implemented.
Certified diabetes educator (CDE) Maryanne Strobel in Houston and her daughter Alaina, who is also a diabetes educator and lives with T1D herself, traveled to Wharton with a group on Labor Day to help out along with other educators such as Christine Fisher. Maryanne Strobel has experience with diabetes in disaster mode, as she assisted in other emergencies such as the aftermath of Hurricane Katrina in 2005.
Half of the supplies their group brought stayed with a local doctor, and the other half went to the shelter at the American Legion Hall. In the middle of that hall, Strobel says a table served as a makeshift clinic for people with diabetes. It was strewn on top with general medical supplies such as bandages, aspirin and alcohol swabs, and underneath were the diabetes supplies – meters, strips, pump supplies, pen needles and syringes, and insulin in cold packs.
They were doing their best, but the general nurses on hand didn’t know the basics of diabetes, how meters work or what type of insulin people should receive.
“At one point they thought all the meters were broken because they wouldn’t turn on correctly, and it turns out they were using the wrong test strips from another company that didn’t match the meter,” Strobel said.
The helpers Facetimed with a physician at one point to consult with a man whose BGs were in the high 500s, to get him on insulin and eventually evacuated by EMS to a hospital for concerning chest pains.
Another single mom with diabetes shared that before Harvey, she was caring for her ill mother and money was tight so she hadn’t bought her metformin. She couldn’t afford the $4 to get her medication from Wal-Mart. After a doctor-Facetime interaction, Strobel's group gave her insulin, glucose tabs and other supplies, along with some money to get other needed medications.
In the words of those in the ground in Wharton, "diabetes is everywhere" in some form and the medical needs have been quite visible to relief volunteers.
Quick Enough Relief?
In the first week after Harvey hit, tension began surfacing locally about how quickly relief was getting to those with diabetes in need.
There was some chatter that local volunteers pushing to get needed insulin and supplies to people stranded by the storms should've waited, in order to go through "official channels" such as those led by the growing coalition of non-profit orgs led by the ADA.
Meanwhile physicians and educators on the ground, and even local ADA and JDRF volunteers, were voicing frustration that it wasn't happening fast enough.
Enter Kelley Champ Crumpler, a diabetes educator north of Houston and type 1 herself for more than 25 years, who began a grassroots effort with the help of D-Mom Anne Imber and well-known endo Dr. Stephen Ponder in northern Texas. That group began getting help to people immediately in Houston and the Gulf Coast region, and now that's evolved to helping those hit by Irma.
Waiting wasn't an option for Crumpler, who says the community was turning to her group because people needed immediate relief and couldn't wait. It wasn't actually until several days after Harvey hit -- from Aug. 25 to Sept. 1 -- when the first ADA coalition shipment of donated supplies reached Texas.
"Those of us with medical licenses were saying, 'These people have no other choice,'" Crumpler said. "It's a very desperate situation. Had we not stepped in, people literally would have died."
The stories they've shared warm the heart.
"We had one woman who had been without insulin for two days. She was flooded in and her cars were flooded and our volunteer, Melissa Howell who is a mom to a T1, waded in the water to reach her," Imber told us. "Melissa also dropped diabetes supplies to Holy Family Catholic Church which was serving as a shelter."
Imber also says that her house, the supplies were moving in and out so quickly that trying to take inventory was fruitless.
The supplies had to be sorted, with expired items being disposed of and prescription labels removed, and matching items such as meters and strips and lancets packaged together.
But at one point, Crumpler estimated that easily $1.5 million worth of supplies -- including more than 110 pounds of insulin donated by Insulin for Life -- had come in as of last week.
"Our number one priority was meeting the needs of people with diabetes," she said.
On Sept. 8, Crumpler announced that she was starting a non-profit to continue diabetes disaster relief efforts in that area and beyond. They've been trying to finalize those details and come up with a suitable name (currently T1 Team Texas), but already the group is sending supplies to Irma-hit areas in Florida and into the Virgin Islands.
That's incredible to hear -- thanks so much to Crumpler and team for moving mountains to help PWDs affected by these historic storms!
Next Phase of Relief
Getting supplies and immediate relief to the D-Community in a disaster-struck area is one thing. But then comes the transition back to self-management, where later waves of disaster mode mindsets start to kick in.
Maybe people have enough supplies to last initially, but what happens when they run out and the relief efforts dry up? Many no longer have a car or even a home mailing address to receive more supplies.
That's what Strobel and her team of educators in Texas are thinking about now.
"We’re going to start seeing implementation issues, exacerbating conditions for those with diabetes," Crumpler says. "People will be overwhelmed with so much information coming at them and dealing with what they have to, and they don’t know where to go for help. That will be a second wave where they need help navigating all of this.”
She and a larger group of educators in the greater Houston area are establishing a network of recovery support centers, to help offer ongoing support services to affected PWDs. That involves information and education, providing resources on Patient Assistance Programs and financial resources aside from just supplying them with needed items and medication.
"Disasters can happen to anyone with any medical condition, but my professional opinion and from having a daughter with T1, is that because people with type 1 can’t live without insulin, there's a need for an especially high level of preparation," Strobel says. "Type 1s do have a survival skill built in, and that kicks in very quickly. But things happen on the way -- people lose stuff just trying to get in a boat or on a helicopter, or if they’re quickly loading everything into a car. There is also a shock experience, where people come in dazed, with a shell-shocked look on their face.”
The aftermath relief efforts are being coordinated under the Diabetes Emergency Relief Coalition led by the ADA with the support of AADE. Recovery support groups are being set up around the metro Houston area, and even some in Beumon and Wharton and other areas around the Gulf Coast. These would be in effect until roughly the first week of November.
“If that can come to fruition, maybe that could become a new model for post-disaster relief in diabetes,” Strobel says. “It’s not just post-event, or the preparation prior to, but we have to be cognizant of the extended recovery afterward.”
This article originally appeared on DiabetesMine in September 2017.
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