Morovis Community Health Center Uses Home Visits to Manage Diabetes after a Hurricane

Morovis Health Center Staff conducts a home visit to manage diabetes after a hurricaneMorovis Community Health Center HRSA BPHC exit disclaimer (Morovis) is a HRSA Health Center Program grantee, which serves patients at two health center sites in a mountainous region in Central Puerto Rico. It is the only primary care provider within the service area that serves the low-income, uninsured population, and provides access to all services regardless of patients’ ability to pay. Morovis was designated as a 2018 HRSA Diabetes Leader.

In 2017, Hurricanes Irma on September 13 and Maria on September 20 struck Puerto Rico and affected all health services on the island. Morovis was the only healthcare facility that stayed open during and after the storm in their service area. They are the only provider in the area to have a heliport, which allowed the U.S. military to bring in supplies with a state of emergency declared. Morovis has an extensive emergency plan that includes care and priority attention to all patients, especially the population with diabetes.

Emergency Plan

Morovis activated their emergency plan before Hurricanes Irma and Maria arrived. They gathered supplies (including medications, food donations, water, and ice), set up two generators, and began health education to patients with diabetes and other chronic conditions. Their diabetes-specific efforts included:

  • Holding education sessions on nutrition and food safety guidelines during emergencies to help patients with diabetes learn how to properly prepare and store food without power and water for an extended time. They also discussed portion control and insulin dose adjustment since packaged, donated food is often high in carbs, sodium, and sugar.
  • Multidisciplinary teams that include doctors, nurses, social workers, health educators, nutritionists, psychologists, and others were organized when the emergency plan was activated. These teams used the electronic health records to identify patients with diabetes who will need support after the emergency.
  • As part of the emergency plan activation, Morovis made the administrative decision to increase its inventory of medications, insulin, and other supplies and materials.

Community Visits

Morovis realized that patients with diabetes would be unable to come to the health center for the continuity of care due to a lack of communication and transportation. In response, the health center’s multidisciplinary teams deployed into their service area to provide home visits to these patients. The team coordinated with local leaders in the community to find patients since most homes were damaged or completely destroyed. Some patients were living with relatives or in temporary settlements in open fields, schools, or other public buildings. They provided insulin and medications, ice, water, and food to patients as needed. The social workers and psychologists addressed mental health and other material needs.

Lessons Learned

Morovis said that island-wide, people have realized they need to be better prepared for storms (or other natural disasters). Morovis also received Capital Assistance for Hurricane Response and Recovery Efforts (CARE) funding from HRSA to help with capital assistance post hurricanes. Here are some of the steps Morovis is implementing for the future:

  • Activating the emergency plan from the beginning of the season on June 1 each year.
  • Entering into a fuel contract with the government, so they will have enough gasoline to run three generators.
  • Applying for a grant to build a well, so they will have their own water supply.
  • Helping patients prepare for the storm by ensuring they have a supply of food, water, ice, and medications before the storm.

How to Implement

While Morovis had unique challenges due to their remote location and the severity of Hurricanes Irma and Maria, other health centers can adopt the following parts of their emergency plan for patients with diabetes:

  • Create an emergency plan for your health center as a whole, and then sections to support patients with chronic conditions like diabetes.
  • Activate the emergency plan at the beginning of the hurricane season (or other natural disaster season, if applicable) or at the start of any emergency.
  • Ensure everyone has access to the action plan in case a communication system fails.
  • Ensure electronic health records are available during and after an emergency by using generators.
  • Meet with local leaders to find patients if homes are destroyed.
  • Prepare to provide both education and supplies to patients. Morovis taught patients how to safely store insulin without power and how to make healthier meals out of donated food.
  • Ensure vital medications such as insulin are readily available. Morovis was able to supply insulin to others in addition to their patients because they had a large enough supply. They were able to do so because the active emergency plan for hurricane season includes obtaining a specific amount of supplies, medication, vaccines, lab reagents, and x-ray supplies. Morovis received a series of donations, and the Department of Health issued an administrative order so all patients could receive their medications, regardless of which medical group they belong to.
  • Assist patients with chronic conditions such as diabetes to create their own emergency plan and stockpile of supplies.
  • Implement a home or community visit strategy for patients with diabetes who may not be able to travel after an emergency. Consider safety as part of the strategy. Morovis used employees who live in different communities to work with neighborhood leaders and establish a work plan since they are already known and trusted. Visits to the communities were always during daytime since there was no electricity. Employees received patients’ information including safety and environmental issues before each visit. Official vehicles were used, and employees always visited patients in teams. Morovis also worked with the Municipality of Morovis to get safely into areas obstructed by debris and other safety issues.
Date Last Reviewed:  February 2019

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For more information about this promising practice, contact:
Dr. Jorge Guzman Ortiz, CMO
William Rodriguez Castro, CEO