Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

WESTERN NORTH CAROLINA — In a serene wooded area near Celo Health Center in Burnsville, North Carolina, a stark reminder of Hurricane Helene’s power looms overhead.

The “flood tree” is about a five-minute walk from the health center, one of six locations within the Mountain Community Health Partnership, which serves rural communities in western North Carolina.

The tall tree sits between the Cane River and a nearby road, and the wooden plaques nailed to the tree mark the dates and heights of past flood waters, ranging from a storm in 1940 to Helene’s inundation on September 27, 2024. The marker for Hurricane Helene’s destruction is so high it’s almost unnoticeable from the street, 38 feet high and dozens of feet higher than any other marker on the tree.

It’s a small, yet horrifying, reminder of the catastrophic event that changed lives and altered the landscape.

More than eight months since Hurricane Helene inundated communities in western North Carolina with those rushing floodwaters, signs of destruction and talk about how to best rebuild are the new normal. Direct Relief recently met with health organizations in the region focused on recovery and continued care for patients.

For Mountain Community Health Partnership, a health center with six locations in the region, the loss of its Micaville location from excessive flooding is an ongoing challenge. While the center’s leadership team is planning to rebuild, staff said the area is still in a state of early recovery.

For weeks after the storm, staff looked for colleagues and loved ones after Helene knocked out power and water sources, washed away homes and vehicles, and trapped people inside buildings. The North Carolina Department of Health and Human Services reported 107 storm-related deaths as of April 2, 2025. While recovery continues, health centers in Appalachia are finding new pathways to normalcy with the priority of providing ongoing care to patients.

During a recent visit with Direct Relief, Tim Evans, CEO of Mountain Community Health Partnership, pointed to the river basin and a small bridge nearby that had to be reconstructed following the storm. The high marks on the flood tree area are a reminder of how people were able to navigate the area in the days that followed the storm.

Evans said even as streets were “washed away,” residents bonded together, he said, by cooking together and serving food to people in need, sometimes 50 to 60 people at a time, to make sure they had something to eat.

“Locally, just about anybody in the county would give you the shirt off their back,” he said with tears in his eyes.

The federally qualified health center’s Celo location was spared because of its hilltop location, and the center staff were able to provide care in the parking lot. In the days following the storm, a helicopter brought donations that allowed the health center to refill medications and provide basic medical care, like providing tetanus shots, bandaging and stitching wounds for people caught in debris.

Because of the loss of the Micaville site, the health center has temporarily relocated services to its Bakersville and Celo locations. Given its FQHC status, MCHP helps any resident who shows up for care, regardless of ability to pay, even during an emergency.

The health center serves patients who live across a wide geographical area and who might otherwise struggle to afford care. In Yancey County, one of the counties where the health center’s sites are located, the poverty rate is about 10% higher than North Carolina’s statewide rate. The rural area has a population of less than 20,000 people over a span of 312 miles. Mitchell County is smaller, with a population just under 15,000 across 221 miles, but the median household income remains below $60,000.

After the health center’s Micaville site was inundated with flood waters that prevented access in and out of the building for days, staff got creative to communicate. Without access to phones or the internet, health center staff said they left sticky notes on doors and windows to share their location and updates with others.

“If you’ve been here, leave us a note. And here’s the wi-fi password if you need it,” said LaCosta Tipton, chief operating officer.

By Sunday afternoon following the storm, they learned that they wouldn’t be able to access the building anytime soon.

“It was quite overwhelming,” Tipton said.

Water had seeped into the walls, leaving dangerous mold. Two company vehicles, which were used to transport patients, were found in eight feet of water. The health center also used space for Narcan storage, a medicine that reverses the effects of an opioid overdose, which was lost to water damage.

MCHP staff spent the following two weeks looking for their colleagues and patients. Tipton said they had a list of 140 people to find.

“It was hard,” she said. “We’re so blessed that everyone survived.”

Tipton said many were able to temporarily stay or move in with other family members and friends.

In the six to eight weeks that followed, they worked in the parking lot of their brick-and-mortar locations until the power, sewer and water sources were restored. The health center was able to pay staff the entire time.

In the months that followed, struggles with misinformation have continued. Aid through the state and federal government has been difficult to secure. Information on resources and general safety have been clouded with incorrect or misleading information.

Nonetheless, MCHP is moving forward.

Evans said they spent nearly $1.2 million to renovate the Micaville location before Helene and plan for construction on the new site to begin in June.

The new Micaville location will be a 20,000-square-foot facility with more exam spaces for patient care, including medical and behavioral health wings and a pharmacy. Evans said they intended to provide dental health at the location, but it’s a greater expense that will have to wait. Currently, Evans said they are just trying to sustain operations.

“Right now we’re learning to say no or maybe someday,” he said.

Direct Relief supported Mountain Community Health Partnership with more than $138,394 in medical support since 2019, including essential medicines and supplies in the days and weeks following Hurricane Helene’s impact. The health center has received more than $440,000 in financial support since 2020, including an emergency operating grant to pay for immediate costs incurred after Hurricane Helene and partially fund a new facility replacing the destroyed Micaville site.