When Hurricane Harvey Arrived, They Kept the Diabetes Community Afloat
By James Hirsch
By James S. Hirsch
Jim Hirsch tells the story of how Type 1 Team Texas emerged to meet the diabetes community's needs in the face of the hurricane
The rain began on Saturday. It continued on Sunday, then on Monday, and still more rain fell on Tuesday.
“It was like standing in a shower, that’s how hard it was raining,” said Anne Imber, of Cypress, Texas, about 25 miles northwest of downtown Houston. “And it did that for four days.”
On Monday night, August 28, with the flood waters rising in her neighborhood, with the bayous spilling over across the city, and with the full blast of Hurricane Harvey beginning to swamp southeast Texas, Imber received a group text – she’s not even certain who sent it – with a simple message: “We need to do something.”
She did, and they did.
Imber, 53, has been heavily involved in the diabetes community since her son, Tristan, was diagnosed with type 1 in 2002. She founded two different advocacy organizations that center on non-medical issues for teenagers. She runs the web sites, sponsors programs – her expertise is in setting up 504 plans (which spell out the legal rights for any student with a disability) – and she speaks at JDRF events, camps for diabetic children, and support groups. She even gives lectures at Texas Children’s Hospital about teens with diabetes.
Her basic point: If you have diabetes, you have to be prepared, whether you’re playing sports, traveling, driving, or going to college.
She can now add one more to her list: Surviving 50 inches of rain.
Hurricane Harvey, and the subsequent floods, has killed at least 71 people while devastating 300 miles of the Texas coast and parts of Louisiana. More than a million people have been displaced, and the financial cost to rebuild is expected to exceed $100 billion. The pain, the heartbreak, and the loss have been widely shared, just as they will be in Florida from Hurricane Irma.
Anyone with a medical condition faces unique hurdles in a natural disaster, and that is obviously true for people with diabetes. Type 1 patients, and many type 2s, need insulin to live. They need a host of medical supplies to live safely. They need the right kinds of food and a predictable schedule and routine. And in many cases, they need electrical power, dry storage, transportation, and refrigeration to replicate their daily regimens.
Houston itself is 667 square miles, but the metropolitan region is more than 10,000 square miles (bigger than New Jersey), with 6.7 million people. The floods turned the often-arid flatlands into an archipelago, forcing some 30,000 residents to seek shelter while immobilizing countless others. Imber herself, along with her husband, Ed, their 17-year-old daughter, Arabella, and their three dogs, were trapped in their two-story, 2,500-square-foot house for two days. But at least they were safe. (Tristan was at college at Texas Tech University in Lubbock.)
Even on that first Monday night, with the streets swelling with water, Imber knew that trouble was at hand. Messages on social media were rushing in: diabetes supplies were running low.
For whatever reason, insulin that was supposed to have been shipped the previous week never arrived. Many students, meanwhile, had just brought their supplies to their school for the start of the new year. So by the time the rains began, many homes were already in short supply of insulin pens, test strips, and other items. Even if their pharmacy was open, people had difficulty getting to it – cars were routinely washed away in the floods. FedEx stopped. UPS stopped. The airports stopped.
The government agencies and other entities that would typically help – the police or fire departments, the ambulance services, the public safety officials – were also stymied by the water. Even the major diabetes organizations with offices in Houston, including the JDRF and the American Diabetes Association, were not initially equipped to jump into the fray.
“Every emergency plan for the city, you had to tear it up,” Imber said. “Our city became inoperable.”
So on that Monday night, Imber spoke with several like-minded friends and decided they would take it upon themselves to distribute insulin vials, insulin pens, meters, test strips, infusion sets, CGM sensors, pods, glucagon, syringes, and whatever else they could. Their focus was on type 1 patients, who were at more immediate risk, but type 2 patients were also in danger. The endeavor required the savvy use of social media and the generous donation of diabetes supplies from people in Houston, from across the state, and ultimately from all over the country. It also required the hard work of volunteers who delivered supplies over sodden roads to those in need.
The group created a new organization to carry out the mission: Type 1 Team Texas.
“We’re one big family,” Imber said.
Imber woke up on Tuesday morning, at 7 a.m., and called her brother, an architect. She explained that their new organization needed a logo for consistency in all communications, and she asked her brother if one of his graphic designers could help. By 9 a.m., she had five logo options, and she chose one that featured the Texas star inside a drop of blood. The tagline read, “Diabetes Disaster Relief.”
Imber was one of three leaders in the group, each with distinct responsibilities. There was Dr. Stephen Ponder, a well-known endocrinologist who lives in Temple, Texas, about 170 miles northwest of Houston. A type 1 patient himself, Dr. Ponder conducts “Sugar Surfing” workshops – he also has a book by that name – on diabetes management. He volunteers at the Texas Lions Camp for children with diabetes, he’s been widely published, and – most important, for the Harvey disaster – he has a large following on social media. Working from Temple, and relying on phone calls, text messages, emails, and Facebook, he requested help. Friends, colleagues, and patients responded, some by driving supplies from Dallas, Austin, and other places from Texas. Other donors shipped their supplies. At one point, Team Texas had more than 100 packages at the post office.
Then there was Kelley Champ Crumpler, a nurse who also has type 1 diabetes and lives in the Woodlands, about 30 miles north of downtown Houston. Her house was the primary hub to receive donated supplies. Given her knowledge of the products, she was able to coordinate their redistribution. Patients found Crumpler through social media, and she found them the same way. As the operation expanded, Team Texas would have four other homes across the metro region that served as distribution hubs.
Imber was in charge of creating a database and coordinating the response. She drafted two different .pdf forms – one for patients in need of supplies, one for donors who had supplies to give. She relied on a private Facebook page, of parents with type 1 children, to help spread the word that she was looking for both patients and donors. The forms were meticulous. The donors, for example, were asked not only for their addresses but also for “landmarks,” in case the front of their house was under water.
Initially, Imber connected the individual patients with individual donors. “I would hear that someone needed Novolog right now, and I’d figure out who could help them,” she said.
Once supplies arrived from outside the city and were taken to one of the hubs, Imber arranged for volunteers to serve as runners who would pick up the supplies and deliver them. (A volunteer ultimately took over as the “volunteer coordinator.”)
The system was hardly perfect. One night, Imber received an urgent message that a young boy needed Lantus, but she didn’t have any runners in that area. “I just put it out there on Facebook. ‘Someone in this area needs a Lantus pen.’ And someone took care of it.”
Another night, someone showed up at her house in need of Novolog. She gave him two vials of her son’s Humalog. “We’re not meeting everyone’s full needs,” she said. “We’re just trying to keep them alive.”
Imber’s own home became a hub, and the mounting boxes were a vivid display of the complexity in diabetes care, not to mention the redundancy – different strips for different meters all doing the exact same thing. In some cases, Imber amassed more items than she could possibly distribute.
“We have enough lancets to fill the Alamo,” she said.
She received calls from type 2 patients, including from one who spoke Spanish. Imber tried to use her “broken Italian” to speak to her. That didn’t work, but Imber’s cleaning lady was there. She spoke to the caller, and Imber helped her out.
Imber also coordinated a phone bank, comprised of about 20 or 30 people, though it wasn’t a traditional phone bank. The volunteers were people, Imber said, who were “stuck in their homes,” but they were willing to talk to those who were experiencing difficulties. Imber also took calls (often in her slippers because she didn’t have time to put on her shoes). “Part of it was just listening to their story,” she said, “and assuring them that the diabetes side would be okay.”
By Wednesday, some of the shelters were calling Imber seeking supplies, and she and her team were doing all they could to meet the demand. The George R. Brown Convention Center in Houston drew more than 10,000 evacuees. Imber offered to deliver supplies there, but they told her no – they didn’t need her help. But the demand was too great. The Convention Center soon called her back, and she started filling orders, which were surely used to help far more type 2 patients than type 1s.
Then she got a call from Texas Children’s Hospital. It ran out of diabetes supplies and had nowhere else to turn.
“When the hospital is asking you for supplies,” Imber said, “you know the system is broken.”
On Wednesday night, the storm spun away from Houston, returned to the Gulf, and barreled back toward the coast, dumping more than two feet of rain on the Golden Triangle of Beaumont, Port Arthur, and Orange. “We need boats, we need large trucks, and we need generators,” a Port Arthur official told a reporter.
As if on cue, on Thursday Imber started receiving calls from that area (Beaumont is about 85 miles east of Houston). But with most roads leading into Beaumont under water, getting in or out of that city or surrounding towns was nearly impossible. As was initially the case in the Houston area, help had to come from within each community, all volunteers, neighbors helping neighbors, with Imber making the connections. She received a call from a father in Lumberton, who was running a shelter at a church. He had one person going into diabetic ketoacidosis, but no car or even a boat could reach him.
Calls were made, and on Friday night, a helicopter from the Texas Department of Public Safety, already being used to rescue stranded residents, was loaded up with diabetes supplies and delivered to Lumberton. A newspaper took a photograph of the copter, with the supplies, and Imber and her team repurposed it as a thank you to the agency, with the message: “Neither snow nor rain (NOR hurricane) nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds.”
On Friday, Imber received the group’s first shipment from Insulin for Life, a non-profit that provides insulin to patients in the United States and around the world. The immediate crisis – having enough insulin – began to abate.
On Monday, September 2, a full week after Imber began her work, she and her team began to hand over responsibilities to the large diabetes organizations and government agencies – “the big guys,” she called them.
Team Texas weathered the storm. “It was intense,” Imber said of that first week, which included 16-hour work days. “If lucky, I got to bed by two, then was up by four, I texted, and then I was back up by seven. No eating. Didn’t have time. One day someone showed up with Chick-fil-A Fillet sandwiches. If not, I wouldn’t have eaten for two days.”
Most important, there have been no reported diabetes-related deaths as a result of Hurricane Harvey, and Team Texas – which includes dozens of volunteers – deserves credit for ensuring that outcome. Every diabetes community relies on resilience, resourcefulness, and courage, not to mention the kindness of strangers, but few communities have been tested like this one.
Nonetheless, Imber isn’t ready to celebrate. While the region is beginning to dry out, the losses are devastating – in homes, cars, businesses, jobs, infrastructure, and income. The challenge will be even greater for anyone with diabetes. Said Imber: “People call me and say, ‘I can’t afford my groceries. How am I going to afford my insulin?’”
While the large organizations will take care of the largest needs, she said, “we’ll still do the micro needs.”
Type 1 Team Texas lives on.