In the days before Harvey, the San Jose Clinic was on hurricane watch. The safety net clinic, which serves uninsured and low income-patients in Houston and Fort Bend County, had been through this many times before.
The clinic moved all of its temperature-sensitive vaccines and medications to a sister clinic that had a generator. It also gave patients advice on how to store medication in the case of a power outage.
"We ended up taking precautions," said Dr. Adlia Ebeid, the clinic's director of pharmacy. "We weren’t sure if we’re going to get flooded. We weren’t sure if we’re going to lose power."
Luckily, the clinic was unscathed by the storm, but the pharmacy's weekly shipments were delayed. Dr. Ebeid scrambled to find a solution for her patients.
The CEO of the company that supplies their medication agreed to drive down from Nashville to personally deliver the shipment.
"He literally packed his car in the middle of the night," Ebeid said. "He had all his paperwork in case he got pulled over. There was a curfew at the time."
San Jose Clinic was able to avoid 100-200 patients going without crucial medication.
Challenges like these are the subject of attention for a group of researchers at the Harvard School of Public Health, who are using Greater Houston and other areas in Texas and other parts of the country to study how climate change impacts safety net clinics and the populations they serve.
The researchers teamed up with the San Jose Clinic, the Matagorda Episcopal Health Outreach Program and other health centers in disaster-prone regions to craft best practices for how clinics should react to climate change.
"There’s no guidance here," said Dr. Ari Bernstein, the interim director of the Center for Climate, Health, and the Global Environment at Harvard. "There’s nowhere for these clinics to turn for. Even if they wanted to, there would be no information for them to pick up easily."
Dr. Bernstein conducted a literature review of government documents and peer-reviewed articles with information on how clinics should prepare for climate change events. The only checklist he found was tailored to Canadian health clinics.
This dearth of resources may be contributing to a lack of preparedness, Bernstein fears.
"What concerns me most is that at this late date, we haven’t even started," Bernstein said. "I mean, we wouldn’t be doing this (research) if we had well-laid plans."
The health care challenges faced by climate change are expected to intensify. According to the National Oceanic and Atmospheric Administration, last year marked the most hurricanes on record in the Atlantic. Recent data also shows that Houston has gotten hotter and wetter over the past 30 years.
There are a host of climate-related illnesses that health care providers must prepare for, such as heat stroke from rising temperatures, respiratory problems from untreated mold after flooding, frostbite during Winter Storm Uri and PTSD.
Past disasters have shown that these burdens are not evenly distributed. People of color and low-income Houstonians are more likely to feel the impacts.
Surveys from the Episcopal Health Foundation two months after Harvey showed that 13% of respondents suffered health problems due to the hurricane. Twenty-five percent of those respondents were Black, compared to 20% that were white.
People of color are also more likely to suffer from certain chronic conditions, which put patients at an even higher risk during a disaster. These patients often rely on treatments or medications to prevent trips to the emergency department.
During Winter Storm Uri, dialysis centers across the state lost the ability to operate due to power and water outages. Officials had also warned the public to stay off the road. Public transportation was suspended due to icy conditions.
Some kidney patients in Greater Houston who missed treatments resorted to the emergency rooms at the Harris County safety net LBJ and Ben Taub hospitals, according to Lori Timmons, the director of Riverside Dialysis Center in Third Ward.
"It had a huge impact on the city," Timmons said. "If they had power, maybe they didn’t have water. If they had water, maybe they didn’t have power."
Many of her patients were able to avoid trips to the ER because the center opened up the Sunday before the storm and pushed up appointments.
However, San Jose Clinic wasn't as lucky during Winter Storm Uri as they were during Hurricane Harvey. The clinic experienced power outages and lost more than $100,000 in vaccines and medications.
That’s a lesson that the researchers at Harvard hope to learn from and share with safety net clinics across the country.
"Winston Churchill has a famous quote, which I’m going to butcher," Dr. Ari Bernstein said. "‘Men occasionally stumble upon the truth, but not to worry, he picks himself off, dusts himself off and walks on as if nothing ever happened.' And that’s what I worry about."