Tracie Kirkland and Laura Cardinal discuss their personal experiences responding to community health needs in the wake of Hurricane Harvey.

When natural disaster strikes, there is always a need for immediate aid in the form of food, shelter and medical services. But providing long-term relief and helping a community to rebuild can take months — sometimes years — as residents come to grips with their losses and strive to make a full physical and mental recovery.

Clinical Assistant Professors Tracie Kirkland and Laura Cardinal were part of a team of health care professionals who provided services in Texas following Hurricane Harvey. We spoke with them about their experiences there, as well as some of the insights they’ve gained for nurses and social workers who want to help disaster-stricken communities.

USC Suzanne Dworak-Peck School of Social Work: Could you start by telling us a bit about each of your professional backgrounds?

Tracie Kirkland: I was trained as an adult and pediatric nurse practitioner, and I maintain dual certification. I’ve worked all over in private practice, academics, residential and military settings, family practice, internal medicine and pediatric clinics. I’ve lived in Houston for the last three years, so Hurricane Harvey hit close to home. In the aftermath, I’ve used my training to provide care to patients of all ages.

Laura Cardinal: My clinical background has primarily focused on medical social work, from the ER to perinatal social work, new families, addiction and child welfare interface, as well as oncology and hospice. A lot of my love for disaster work comes out of the model of medical social work — rapid response, crisis-oriented trauma work that often deals directly with grief and loss.

USC: What have been your experiences to date responding to communities affected by natural disasters? Was Hurricane Harvey your first experience with this type of work?

TK: This was my third disaster relief experience. The first was following a tornado in Petersburg, Virginia, in the early 1990s. Then, during 9/11, I was at Fort Meade Outpatient Ambulatory Care Center, which is adjacent to the NSA building. We went into alert preparedness and readiness mode, which involved providing emergency care to active duty soldiers, retirees and their family members in the community.

What’s interesting about Harvey is that many of the people who lived through Hurricane Katrina ended up relocating and transplanting to Houston. So, they’re actually reliving the experience and that trauma all over again.

LC: Harvey was my first experience, so it’s very fresh for me. I’ve handled crisis response in the form of wilderness first aid and as an EMT, but Harvey was my first deployment. Just over a year ago, there was a shooting at a mall not too far from where I live that had a significant impact in our community. Without the support of an organization like the Red Cross, it was really difficult to provide services to those who were struggling. That’s when I realized I needed to seek affiliation with a disaster response organization and get to work.

USC: Have you gained any valuable lessons from these experiences that have informed your approach?

TK: With Hurricane Harvey hitting so close to home, I’ve had the opportunity to provide continuity of care to patients who were affected by the storm. Many patients with health concerns like diabetes, depression, and hypertension ran out of crucial medications in the wake of the storm. Meanwhile, some clinics that had been damaged remained closed, and access to Electronic Medical Records (EMR) was limited, so we had to gather background information on each patient from scratch. Just trying to resume regular healthcare is difficult.

LC: My undergraduate work was in environmental studies, so it was incredibly eye-opening to observe these issues of environmental justice firsthand. I had read about the environmental fallout of previous natural disasters like Hurricane Katrina, but to see environmental racism in action immediately after a disaster was sobering.

This doesn’t just apply to natural disasters, either. Low-income people, people of color, older adults and people with disabilities often live in areas that are more likely to experience hardship after a disaster, but they also may have fewer resources in general. It’s harder to bounce back when coming from a place of disadvantage.

This is really where social work comes into play — we’re using our values and ethics to figure out how to serve those at highest risk.  During future prevention and relief efforts, I want to make sure that we’re supporting the most vulnerable populations.

USC: Tracie, we know that you’ve had experience working across all age groups to provide relief. Could you speak to how needs differ across demographics?

TK: Harvey happened right at the start of the school year. This impeded the administration of vaccines and routine physicals for many pediatric patients. In Katy, one suburb of Houston, school superintendents reported more than 13,000 displaced students. From an adjustment and mental health perspective, the children have been uprooted into a completely different environment, where overcrowding and limited access to resources were real concerns. For the first six to eight weeks, it was incredibly difficult for many students to purchase school lunches. As a result, the Katy School District opened up a free lunch program that extended until late October.

Young adults also struggled with health access. They were out of work, and in many cases were unable to receive regular medical services simply because they couldn’t pay for them. But the group that was affected most drastically was the geriatric population. Many individuals lost access to medication for conditions that could become life-threatening if left untreated. Providers were hand-delivering healthcare supplies and services by boat, but struggling to meet demand.

USC: How do medical first responders and social workers work in tandem in these situations?

TK: We tag-teamed. It’s difficult to meet the demand for things like mental health counselors during this kind of crisis period. But I work within a large organization here in Houston, and they did everything in their power to make resources available.

LC: I really felt at home in the work I was doing with the Red Cross. Most days, I went out with a nurse so we could address people’s physical and mental health needs simultaneously. As a result, we could provide more comprehensive care.

Initially, I was just bearing witness to people’s stories — providing them the space to share and process. But after the immediate shock was over, our focus shifted towards the longer-term effects of trauma. For a variety of reasons, some people are able to rebuild and return to close to their “normal” functioning quite quickly. But for those with preexisting mental health or medical conditions or limited access to services and social supports, the effects can linger long after the rubble has been cleared and the floodwaters drained. Our goal is to set residents up with mental health and other resources that can serve their needs long into the future.