By most standards, West Yellowstone, Montana is brimming with abundance: wildlife, nature, open space. The small town sits on the border outside Yellowstone National Park. It’s a haven for outdoor enthusiasts.

But when it comes to health care, options are few.

“We’re the only health care entity in town,” said Buck Taylor, the director of community development at Community Health Partners, or CHP, in southern Montana.

The nearest hospital is 45 minutes away. For CHP’s West Yellowstone clinic, that has meant adopting a can-do attitude. “Everything walks in the door and we deal with that as we can.”

But this year, Covid is pushing the health center beyond its typical primary care role. “We’re not an ER. We’re not even really an urgent care. But we have had to transform our clinic,” said Taylor.

When Yellowstone National Park opened in August, the small town swelled with tourists and Covid-19 followed. As the virus propagated throughout West Yellowstone, those who fell ill rushed to the nearest point of care. Community Health Partners absorbed the influx. “We felt like we had to do it ourselves,” Taylor said.

Staff quickly converted the clinic to accommodate the rush. “We’ve built a wall down the middle of the clinic and we’ve got a green side for well patients and a red side for sick patients.” The center’s staff of four rush back and forth, donning and doffing PPE as they go.

Of the roughly 400 patients tested at the West Yellowstone clinic, about 15% have come back positive. Most of these patients are service workers. “While we did have some tourists testing positive, the majority were locals,” said Taylor.

For mild cases, the health center is providing supportive care: helping reduce fever and ease coughing – and mandating rest. “Sometimes we’ll send patients home with a pulse oximeter just so we can keep track of their oxygen saturation.”

But when a severely ill patient comes through, there’s not much they can do to help. As a primary care facility, they don’t have ventilators or oxygen concentrators on site. This summer, a woman passing through Yellowstone came into the clinic with shortness of breath. “Her oxygen saturation was very low,” recalled Taylor. “We knew she needed a higher level of care.” It took two hours to transfer her by ambulance to the nearest available hospital bed.

However, limited health care is not an issue unique to West Yellowstone. Health care options are scarce throughout the state. Montana has 10 hospitals outfitted with intensive care units. The rest are critical access facilities, which serve rural communities on a tight budget. They have a maximum of 25 beds and the majority don’t provide respiratory care, which includes the use of breathing machines, according to a study by the Rural Health Research Center at the University of Minnesota.

In the beginning of the pandemic, this lack of intensive care didn’t seem like a problem. The state was spared during the first wave as the virus overwhelmed big cities, like New York and Los Angeles. While hospitalizations were projected to peak in late-April, Montana’s hospitals only admitted a handful of severe cases. “’Maybe we lucked out’,” Taylor had thought to himself.

Then October hit. Cases counts shot up. Hospitalizations soared. And deaths mounted.

For communities like West Yellowstone, the autumn surge has strained rural health facilities, forcing providers to shuffle patients, sometimes across the state, to hospitals with more resources. As ICUs fill to capacity, receiving the necessary level of care may not be possible. “Sometimes they’re transferring patients to much smaller, less well-equipped hospitals just to get more room,” said Taylor. “It’s a bit of a cat and mouse game.”

In a rural area, meeting the demands of a Covid surge looks different from the way it might in an urban area. With fewer resources that are more spaced out, health care facilities must get creative. Luckily, the can-do attitude is not in short supply. “These rural, Western States, they’re pretty independent,” Taylor said.

Since October, Direct Relief has sent Community Health Partners more than 21,000 masks, including N-95 respirators, and hundreds of face shields, protective gowns and coveralls. In total, Direct Relief has sent over $1.4 million in medical aid to Montana since the beginning of the pandemic, including 108 shipments of PPE and ICU medications delivered to more than 20 health centers, clinics and hospitals across the state.