The power was out, the pipes had frozen and burst. Even if doctors could have cared for patients in the dark, it wouldn’t have been possible: The snow was so deep they couldn’t get into the buildings.
For the staff at VCare Clinics – a nonprofit provider, founded by the Texas International Institute of Health Professions, that cares for the most vulnerable patients in the Houston and Dallas areas – Winter Storm Fern wasn’t just an inconvenience. It was reason to worry gravely about their patients.
“If we are closed, they don’t have anywhere to go,” said Dr. Maqsood Ahmed, a program director at VCare.
One patient who urgently needed insulin came to a VCare clinic on January 26, only to find the parking lot snowed in and a “Closed” sign on the door. “I was stranded without my medications,” they told providers. When VCare was able to open three days later, “I practically ran to the clinic with lethargy, sweating, shaking, and shivering,” the patient recalled, “and there you were, ready to help.”
Dr. Mustafa Chagani, VCare’s CEO, explained that for many of their patients, VCare isn’t just a primary care provider: It’s their only option. Low-income patients who are uninsured or underinsured often come into the clinic on their one day off, sometimes with emergent issues. Many have taken public transportation from 30 or 40 miles away. They’re unwilling to go to an emergency room, because they can’t afford it or can’t risk missing a work shift.
But the winter storm closed all four of VCare’s locations for two to three days, in addition to leaving hundreds of thousands of people without power amid freezing temperatures.
Azra Rashid, a clinic manager, said those days of closure were filled with frantic patients calling her cell phone.
Some were injured by falling in the snow or had health complications from the freezing temperatures and power outages. Others needed to be referred to a homeless shelter or a food bank – they had no way to feed their families.
“If we were not telling them [what was available], they would not know where to go for resources,” she explained.
When VCare’s providers were finally able to hire a crew to clear away the snow – public resources wouldn’t be available until later, after the snow started to melt, Dr. Ahmed said – the waiting rooms were full.
Direct Relief provided Texas International Institute of Health Professions with a $50,000 emergency operating grant for VCare Clinics, allowing them to open their doors more quickly to meet urgent patient needs. The funds will be used to repair damage and cover other winter storm-related expenses.
“They become our permanent patients”
Physician members at the Texas International Institute of Health Professions established the VCare clinics because of the urgent needs they saw in Texas communities, Dr. Chagani said. Ninety-four percent of their patients are uninsured. Many are housekeepers or service workers, or they work odd jobs, and missing a shift means losing pay they can’t afford to go without.
In total, VCare Clinics treats about 36,000 individual patients each year, Dr. Ahmed said.
The clinics, each located on a bus route, are specifically designed to meet local needs. In addition to primary care services, VCare offers dental care, psychiatry, family planning, maternal and child healthcare, and endocrinology. (Many of their patients have Type 2 diabetes.) Clinicians screen for breast, colon, and skin cancer. They offer these additional services because they know otherwise patients won’t seek them out, Dr. Chagani explained.
Dr. Chagani told what he described as a fairly typical story: A patient came to the clinic with chest pain on his day off. VCare providers did an EKG and insisted he be transported to a local emergency room. He didn’t want to go; he was afraid of missing work. Two days later, he underwent a complex open-heart surgery.
Another patient came in with a lump in her breast that VCare’s physicians immediately diagnosed as cancerous. She was referred to a specialist the same day.
“If that would not have happened on that day, the patient would not come back,” Dr. Chagani said.
Many of their patients come in at first with urgent issues. “We have seen patients coming into our clinics with an A1C of 12 and above,” Dr. Chagani said – a state of severe hyperglycemia that can quickly become diabetic ketoacidosis, a life-threatening complication of diabetes. Other patients have come in with blood pressure so high it amounted to a hypertensive crisis.
Providers say educating patients about preventive care, and making routine visits as accessible as possible, are urgent priorities. “Their priority is not their health,” Dr. Ahmed said of the most vulnerable patients, many of whom are struggling just to make ends meet day-to-day. “We are trying to improve the health of the community.”
“We try to control their immediate need here at the clinic, and thereafter they become our permanent patients,” Dr. Chagani explained.
“Not ready for cold weather”
On January 28, Rashid recalled, the clinic was bursting.
The equipment in the dental clinic wasn’t fully operational – the burst pipes weren’t yet fixed – and the clinic had lost thousands of dollars in vaccines and insulin. A roof was damaged at one facility, an exam room in another. While they have a protocol to protect medicines during power outages, Dr. Chagani explained, staff members can only implement it when they are able to get into the clinic.
One mother came in with a young child whose fever had reached 104 degrees. When clinicians urged her to bring her child to the emergency room, she said she simply couldn’t afford to.
Another patient’s face was swollen with a severe toothache. They’d been waiting two days for the dental clinic to reopen. The equipment wasn’t working, but the patient was grateful to see a dentist, and to receive antibiotics and analgesics.
Many people were new to the clinic, Dr. Chagani said. Their regular doctors’ offices were still closed because of the storm.
“We spent a lot more time than usual” caring for patients in the days after the storm, Rashid recalled.
Days of caring for people who’d been living in the cold and dark, who’d gone without medication, or who’d struggled to locate food or shelter concerned Rashid. Texas communities are used to hurricanes and tropical storms, she explained, but severe winter cold events used to be rare. That’s starting to change as extreme weather events become more common.
“Texas is not ready for cold weather,” she said.
Since 2019, Direct Relief has provided VCare Clinics with $1.4 million in material medical support, and $136,000 in additional grant funding.
