To mark the 20th Anniversary of Hurricane Katrina, NACHC and Direct Relief look back on the storm that changed Community Health Centers and forged a lasting partnership. This story was first published in the Community Health Forum on August 16, 2025.

In early August of 2005, I was marking my third year as the Communications Director for the National Association of Community Health Centers, or CHCs. The program, originally launched by President Lyndon Johnson as part of the War on Poverty, was experiencing unprecedented growth and bipartisan support. President George W. Bush had made expanding CHCs the centerpiece of his healthcare agenda, calling for more than 1,200 new sites and service expansions in mental health, substance abuse, and oral health. National Health Center week (August 8-14) had just wrapped a celebration of hundreds of local events around the country. Three weeks later, on August 29, Hurricane Katrina struck.

When weather forecasters began issuing warnings about the storm, my initial worry was about my own family. My sister Janelle, a social worker, was a longtime New Orleans resident and had a five-year-old son, Max. Like most Crescent City dwellers, she was a seasoned hurricane veteran and calls to evacuate were generally met with skepticism. The grim reality of what was to come was framed in this unprecedented warning by the National Weather Service in Slidell of the storm’s “catastrophic and devastating impact.” The warning went on to describe the danger in powerful detail:

“Power outages will last for weeks… as most power poles will be down and transformers destroyed. Water shortages will make human suffering incredible by modern standards.”

“I was resistant to leaving because we had been through hurricanes before unscathed,” Janelle recalled in a recent conversation. “But Max’s father was adamant that we evacuate because he said this time would be different and much worse. We left early in the morning two days before Katrina was supposed to hit.”

For many parish residents, evacuation was daunting. More than a quarter of New Orleans residents lived below the poverty line, and 27 percent didn’t own a car. Janelle also noted that riding out storms was part of parish life for residents reluctant to leave their neighborhoods.

Katrina first made landfall on the Gulf Coast on August 29 at 6:10 a.m. as a Category 4 hurricane with winds of 145-175 mph. It was only a few hours before the levee system broke under the massive storm surge and the waters poured in. In two days, 80 percent of the city was underwater. Katrina also traveled northward and made a second stop over Hancock County, MS, near the mouth of the Pearl River with wind speeds as high as 132 mph and storm surge that reached an estimated 27 feet.

Katrina left the region in shambles: 1,833 lives were lost and 2 million people were evacuated or displaced. Approximately 350,000 homes were destroyed. The hallmarks of normal life — clean water, electricity, roads, and intact neighborhoods were simply erased.

Rising from the Wreckage

The hurricane destroyed 11 CHC sites, and more than 80 facilities across Louisiana and Mississippi were significantly damaged, with losses totaling $65 million. Yet despite being victims themselves, CHCs immediately swung into action as responders.

In Louisiana and Mississippi, CHCs treated more than 37,300 people—19,300 in Louisiana and nearly 18,000 in Mississippi. Among those on the ground was Dr. Gary Wiltz, a physician and CEO of Teche Action Clinic in rural Franklin, Louisiana. As a Louisiana native, Wiltz was no stranger to hurricanes, but Katrina presented monumental challenges.

“One of the problems we saw was that the hurricane struck near the end of the month, before people got paid,” Wiltz recalled. “Most people get their paycheck near the third day of the month. They had only a couple of days of medication left and were waiting to get paid before refilling their prescription bottles. Now we have a practice of giving 30-day prescriptions to patients before weather events happen.”

Teche Action Clinic cared for nearly 600 evacuees and filled over 731 prescriptions. “I have always said there should be a Statue of Liberty in front of every health center because we’ve always dealt with the huddled masses,” said Wiltz. “That experience changed everything. We began a partnership with Direct Relief that exists to this day. We receive their regular medical supplies in tubs and have those available for crises. As a result of Katrina, there were also policy changes, such as the Federal Tort Claims Act restrictions, which created a lot of red tape that made it hard for health centers to send or receive help. We learned important lessons to prepare for disasters, but then of course, we didn’t predict that a global pandemic would come years later.

Another CHC that rose to the challenge was EXCELth, a New Orleans-based center. Though the center lost four of its six sites, CEO Michael Andry and his staff organized a relocation effort to Baton Rouge, where many storm victims fled. They cobbled together supplies, volunteers, and a mobile unit donated from Siouxland Community Health Center in Sioux City, Iowa, and loaded with supplies from the Iowa and Nebraska Primary Care Associations.

“We needed to be where our patients were,” said Andry. “So we packed up what we could salvage and followed our patients. We, too, were like our patients — homeless and struggling to find our way. It taught us how to be flexible and reaffirmed our purpose of why we are here.”

In Mississippi, Coastal Family Health Centers lost several sites, including its administrative office in Biloxi and Bay St. Louis. CEO Joe Dawsey described the scene he returned to in Nonprofit Quarterly:

“The door itself was open… A desk was jammed against it, so I had to break through. When I did get inside, the mud was probably six or eight inches deep on the floor, and the furniture was just scattered everywhere. Everything had been ruined. All that was left were the top two shelves of the pharmacy in that building. A couple of other staff people were there just standing outside. I don’t know how to describe it except that they were in shock. Not just because of this, but because their own homes had been flooded. One of those people and I drove over to the Biloxi clinic, and it was even worse. Water and mud and stuff was up over the top of it, and everything in that building was ruined. Then we went over to the Gulfport clinic, and the roof had been blown off.”

The center managed to open three more sites without support or contact from the state or the federal government, thanks to reserves and contributions, and volunteers.

CHCs Step Up as First Responders, Addressing Acute Primary Care Needs

Katrina was a transformative force in the scale of destruction and in defining an evolving role for CHCs as responders to the complex and immediate needs of communities. Damage from the storm overwhelmed federal and state resources, which made national headlines. The public health infrastructure, especially hospitals, essentially broke down. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage contamination, according to a report by The Urban Institute. Many hospitals required external assistance that was slow to arrive, and there were reports of medical staff confronting terrible conditions, such as failed generators and waist-deep water, while trying to care for patients

Though not widely viewed in the public eye as responders, CHCs had the local advantage to act in that role because of their fundamental structure. Built from the bottom up rather than top down, and anchored in the communities they serve, CHCs didn’t parachute into the crisis. It was around them. CHCs also operate under the leadership of patient-majority community boards and, by design, are unfettered by bureaucracies when targeting public health needs. This flexibility allowed them to respond rapidly and effectively, even unconventionally at times, to the complex, immediate needs of disaster-affected communities. CHCs’ role as effective responders to public health emergencies was noted by Health Affairs, which found they are “situated in some communities to be the first line of response to public health emergencies,” and that they may be best utilized in “providing risk communication with the public, particularly in communities with diverse languages and cultures.”

Since Katrina, it’s been widely understood that primary healthcare needs, especially among low-income and chronically ill populations unable to evacuate, took precedence over traditional emergency care and triage for the injured. The most pressing need among survivors wasn’t treating storm-related injuries—it was medical attention for chronic conditions that went untreated during the chaos.

People desperately needed insulin for diabetes, blood pressure medications for hypertension, and mental health counseling after experiencing one of the worst storms to hit the United States. This reality revealed a crucial gap in disaster response planning and highlighted the unique role that CHCs could fill, not just in the affected Gulf States, but also among the diaspora of evacuees who fanned out to surrounding states.

Marc Wetherhorn, National Advocacy Director at NACHC during this period, recalled that, “An important, but little recognized role that CHCs played post-Katrina was that they were there for all the Katrina evacuees around the country. In addition to providing care to the Louisianans who remained, CHCs in places like Houston and Atlanta were there for the displaced. Those whose medical records and prescriptions were lost, those with chronic conditions, and those suffering from the mental trauma of Katrina turned to CHCs as the only providers available to them. Without CHCs, the human cost of the Katrina disaster would have been even greater.”

NACHC Forges Partnerships

Immediately after the storm, NACHC established a special Health Center Hurricane Relief Fund, which provided $1.8 million in monetary contributions to 34 CHCs serving over 400,000 evacuees across Alabama, Mississippi, Texas, and Louisiana. The funds helped purchase needed equipment, supplies, and medicines. Among the donors was Direct Relief, now marking its 20th year helping CHCs in the trenches of crises — from hurricanes to a global pandemic.

When CHCs confronted dire shortages of protective gear, Direct Relief, working with NACHC, helped replenish the supply with donations. Recognizing that CHCs would increasingly be in the eye of disasters, Direct Relief also provided centers with resources through its Power for Health Initiative to ensure they are solar-ready when disasters strike.

“Hurricane Katrina revealed the critical health needs that arise after disasters, and the ways CHCs often act as first responders in their own communities,” said Katie Lewis, Regional Director of U.S. Programs for Direct Relief. “CHCs are intimately aware of the health issues facing their patients each day, making them uniquely qualified to provide care and support during emergencies, just as they did during the hurricane and in the years of recovery afterward. Direct Relief and NACHC connected in the days following the storm, forging a critical partnership in support of CHCs working tirelessly in Katrina’s aftermath. That partnership is still just as strong 20 years later.”

The partnership goes beyond initiatives and agreements — it’s built on relationships, seamless communication, and bearing witness to remarkable acts of human courage in the most savage moments the world offers.

“Hurricane Katrina kicked off a partnership that began with NACHC’s long-time SVP of Development, Malvise A. Scott, who set forth a vision of collaboration and respect for each other that continues today,” recalled Jason Patnosh, then Director of NACHC’s AmeriCorps program and today Vice President of Development, “Whenever disaster strikes, the first calls we would make were to our partners at Direct Relief. It was the care and sensitivity that went into that relationship building that has grown over 20 years, and today, is stronger than ever. The future is bright for what NACHC and Direct Relief will be able to do together.”

Documenting History

Katrina rewrote the playbook on disaster response and threw the spotlight on CHCs as an essential partner. NACHC seized this pivotal moment to chronicle their extraordinary mobilization efforts, ensuring CHCs wouldn’t remain unsung heroes and—more critically—that they would be adequately resourced to rebuild and prepare for future disasters. This documentation effort proved no easy task.

“At the time, CHCs had not yet widely adopted electronic health records, so patient data and documents were literally underwater or destroyed,” said Michelle Proser, former NACHC Director of Research. “When we set out to write the NACHC report, we relied heavily on eyewitness testimonials and interviews with providers, patients, responders, and organizations who were on the scene. We understood then, as we do now, that it was critical to maintain a historical record of what happened and document CHCs’ extraordinary response efforts to ensure that Congress and the Administration recognized the essential role CHCs must play in future disaster preparedness.”

Exactly one year later on the anniversary, NACHC issued a report titled “Legacy of a Disaster, Health Centers and Hurricane Katrina” and unveiled the findings at a news conference, along with policy recommendations that included FTCA flexibilities, Health Information Technology acquisition, and changes to Medicaid laws to protect evacuees.

Looking Forward

For CHCs, there are few certainties ahead greater than the likelihood of more disasters. CHCs have never retreated from challenges; in fact, over the course of 60 years, they have run toward them, reaching beyond the walls of the traditional exam room to address the needs of communities. They are the only federal program that calls itself a movement, always adapting and directing their mission where it is most needed.