As floodwaters continue to rise in parts of Houston, health workers are trying to keep people safe and well, though that challenge is escalating.
"The first and foremost thing that everybody's concerned about is just getting folks out of harm's way with the flooded waters," says Dr. Umair Shah, Executive Director of Harris County Public Health, whose own home came under mandatory evacuation Tuesday morning.
Before the storm hit, Harris County Public Health sent out a number of messages warning residents of to avoid hazards presented by flood waters: downed power lines, sewage contamination, rusted nails and the possibility of critters in the water — everything from snakes to spiders to alligators.
Now that people are showing up in shelters, efforts are turning to helping people with both health issues arising from the flood — including respiratory and gastrointestinal problems — and with getting care for preexisting conditions, some of which can be life-threatening if not treated promptly.
"That doesn't even obviously take into account the numerous injuries and the mental health issues that all come into play. So it's a very complicated response system," Shah tells All Things Considered host Ari Shapiro.
Shah remembers that after Hurricane Katrina in 2005, health workers set up clinics in shelters and asked people with anxiety or schizophrenia to come forward. Many were not willing to do so. "So we actually had to fan into the shelter to identify ourselves mental health issues," Shah recalls. "That's a big component and something we're also mindful of now."
At the George R. Brown Convention Center in downtown Houston, licensed clinical social worker Brittany Burch showed up to help some of the thousands of people who have taken shelter there. As she tells NPR, she's already seeing and hearing a lot of distress.
"A lot of people really overwhelmed, stories of having to jump in a boat or get a helicopter out, wade through waist-high water, losing everything," she says. "So just a lot of people in shock, trying to adjust to what's happened and what happens from here."
Burch has heard from people who, before the storm, already suffered from chronic depression, post-traumatic stress disorder, bipolar disorder and other illnesses. "Some people haven't been on their medications for a few days," she says. "So there's a lot of stress just being here, and then the extra mental health needs that arise in the midst of this [are] also very challenging."
"There is such an unmet medical need," says Kristin Malaer, another social worker who also showed up to volunteer. "Just going and connecting with people, you find out so many of them are diabetic or so many of them have chronic medical illness, that serving them all is pretty overwhelming."
Among the more pressing medical issues is getting treatment to the sizeable population of people on dialysis.
DaVita, a leading provider of dialysis services nationwide, says the company normally serves approximately 6,700 patients in Houston. About a third of their 100 or so centers in the city remain open for all patients who need dialysis, according to Chakilla Robinson White, who oversees operations at DaVita's dialysis centers in Texas and neighboring states.
"We are trying to call proactively and ensure that those patients we know need treatment are seeking treatment, either with us or within a hospital system," White says. "We're like, 'Hey, we would like to see you in a center. What do we need to do to be able to get you here?' "
For patients they reach who are stuck in their homes, surrounded by flood water, they're trying to arrange transportation. "We're alerting the authorities that this is a medical emergency so that they can get prioritized," she says.
Gail Torres, senior clinical communications director for the National Kidney Foundation, says forgoing dialysis treatment for even a day can be extremely dangerous, particularly to the heart.
"Certain toxins can build up, but most importantly, potassium and fluid can affect the heart," she says. "If you have a buildup of potassium, depending on what their baseline is, it can send them into cardiac arrest." She says that delays in treatment can result in cumulative damage, as they saw after Hurricane Katrina in 2005 and Superstorm Sandy in 2012.
In Houston, DaVita is working to bring in enough staff to keep dialysis centers open, calling in workers from other cities and states and also finding ways to get their Houston-based colleagues to work.
"We're working on bringing in boats to actually get our teammates in some of the neighborhoods where they're unable to escape through the flood," White says. "It's amazing how many teammates have had hardships themselves, losing part of their homes and still showing up to treat our patients."
ARI SHAPIRO, HOST:
A disaster as big as Harvey poses a wide range of health hazards. And joining us now is Dr. Umair Shah, executive director of Public Health in Harris County, Texas, which includes Houston. Welcome, and thank you for joining us.
UMAIR SHAH: Thanks for having me.
SHAPIRO: What's your top health concern in Houston right now?
SHAH: Well, right now I think, as you can imagine, the first and foremost thing that everybody is concerned about is just getting folks out of harm's way with the flooded waters. Whether it's in their homes or if they're stranded somewhere, we are just very concerned about getting people out through search and rescue operations and all the fantastic, incredible work that our partners have been doing - emergency management and law enforcement and the like. We're really, really wanting to get people out of harm's way.
SHAPIRO: And tell us about the health conditions in shelters. With tens of thousands of people in close quarters, are you concerned about communicable diseases or other health issues that might spring up there?
SHAH: That's absolutely one of the - you know, the bigger issues that all of us think about. So we have a lot of experience. You have to remember Tropical Storm Allison, obviously Hurricane Katrina when we had the 27,000 at the Astrodome in 2005 - and then certainly Hurricane Rita and then Hurricane Ike and then multiple storms over the last couple of years. And so during many of those shelter operations, we - very early on, we learned that there was that potential for communicable diseases.
And what our biggest challenge is - that you have a lot of folks that need to get out of harm's way, as I said earlier. And when they get to the shelter and they do have close proximity, you are starting to think about things that are either related to what conditions they were in, whether the waters or what have you, or respiratory illnesses.
GI and respiratory are probably the two most that you're concerned about. That doesn't even take into account the numerous injuries and the mental health issues that all come into play. So it's a very complicated response system, and we are certainly doing our best to navigate that as these shelters throughout the community start to open.
SHAPIRO: Apart from the risk of drowning, do the flood waters themselves present a health problem with potential chemicals or sewage or other things that might be in the water?
SHAH: Absolutely. Pre-storm, we at the health department and through emergency management at the county sent out a number of messages and got information up on our website and even information that can be downloaded so that our community members could get to those resources in advance of the flood. So we really wanted it...
SHAPIRO: So what is the message for them?
SHAH: So the message was, avoid floodwaters. You don't know what's in the floodwaters - could be downed power lines. You can have critters, everything from snakes to some spiders to actually even gators. I mean there are some potential for getting bitten. Certainly you also think about contamination with sewage and things of that nature, especially when kids jump into waters that they don't know what's going on or they put their toys in them - and then finally, as you can imagine, rusted nails or other kinds of things that can cause injuries and certainly the concern for tetanus.
SHAPIRO: I also want to ask you about the condition of the city's hospitals. We saw during Katrina how unprepared so many hospitals were for a disaster of that size. Were there lessons that you learned from that that you are applying today, and do hospitals have the supplies and power that they need?
SHAH: Our health care system has actually been for the most part, especially in Texas Medical Center - all major hospitals are operational. Now, we do have smaller facilities that have had to move patients or have had to say, hey, we're not able to do things. But we're learning that it's better to say that early or earlier than to wait till it's too late in the process. And so we're actually very fortunate to have an incredible amount of investment that's happened in our community.
SHAPIRO: Before we let you go, how are you and your family doing?
SHAH: Well, it took about an hour and 10 minutes for me to traverse with eight people in an SUV across sidewalks in front yards to be able to actually get out of our actual street this morning. And so we have just evacuated today. And so while we're also mindful of all the things that we personally are dealing with in our own lives, we're also wanting to make sure that we can respond appropriately to the community's needs. And so it's a really challenging situation for not just me but a lot of us out there - county, city, all the folks that are impacted because we are also part of the impacted group while we're also responding.
SHAPIRO: Dr. Shah, thank you very much for your time.
SHAH: Thank you, and thank you for asking about my family as well. I appreciate it, Ari.
SHAPIRO: Dr. Umair Shah is executive director of public health in Harris County, Texas. Transcript provided by NPR, Copyright NPR.