By Emma Unger
About two weeks after Hurricane Helene devastated western North Carolina with historic rainfall, flooding, landslides and strong winds, Jessica Muldowney sat alone in her home. With her husband, a police officer, at work, and her two kids in bed sleeping, she was surrounded by a moment of silence that had recently been rare.
As the director of operations of AppHealthCare, a public health organization made up of seven care centers and clinics, Muldowney had spent the days after Helene’s landfall in western North Carolina providing care for affected residents in Watauga and Ashe counties.
During long workdays, Muldowney shuttled vital resources across the county from distribution sites to shelters, where she spent hours every day. “So much so,” Muldowney said, “that my kids were asking to go to the shelter because they had formed relationships with people there.”
When she returned home after caring for community members in need, Muldowney shifted her focus to caring for her own loved ones. Whether at work or home, the response was nonstop.
“[My husband is] sending me stories, trying to check on everybody that we work with,” Muldowney said. “[You] can’t get a hold of people, you’re just worried about everybody. Family’s trying to call and get a hold of you.”
Fourteen days of Helene’s chaos behind her, Muldowney found a moment of quiet. As she sat in her house, an AppHealthCare colleague texted a simple question – another check-in necessitated by the disaster’s fallout.
“How are you?”
“I lost it,” Muldowney said.
The days of moving from one task to another, constantly focused on how best to help people in need, hit Muldowney all at once. “I did not realize I was holding all the things,” she said. “Even as a non-provider. … That moment of release of emotion was really powerful.”
Muldowney’s experience is not one-of-a-kind. Health care workers, first responders and volunteers who assisted in western North Carolina’s Hurricane Helene response spent days and weeks caring for others, even while often suffering themselves.
Stephanie Greer, president of the Avery Healthcare Market for UNC Appalachian, saw it in the workers at her facility. “Our employees were showing up on four-wheelers and ATVs and leaving their families in treacherous situations to do so,” Greer said.
Over a year after the height of the storm response, some of those responders are ready to move forward, while others are still recovering from their experiences.
‘Do the right thing’
Hurricane Helene reached North Carolina on Sept. 27, 2024, bringing historic disastrous effects to western North Carolina. After the storm’s impact, several organizations immediately mobilized to provide emergency care to the affected areas.
Cannon Memorial Hospital, UNC Health’s Avery County hospital, set up overflow care spaces and became a resource center for items for needs like food and oxygen tanks. The hospitals converted building space into staff housing – both to address staff needs and provide close proximity to work given irregular work hours and needs.
When mudslides prevented ambulances from driving up to the hospital, volunteers drove pick-up trucks, four wheelers and ATVs to transfer patients from ambulances to the emergency room. Greer said the response was a whole community effort.
“I will forever be in awe of that community response,” Greer said. “I will forever be in awe of the employees that showed up. That just showed up and wouldn’t leave. I will forever be in awe of the people that responded to requests for water and food and supplies and resources.”
AppHealthCare deployed nurses and other staff to shelters, which saw an influx of people who were displaced by the storm. Providers spent 12-hour shifts doing triage, administering Tdap vaccinations for people exposed to flood waters, managing medication and more.
“If you can imagine having an emergency room for public health in the field, that’s what it was,” Muldowney said. “Everything that you could possibly see in the way of someone’s health care came to the surface.”
Outside organizations also came in to assist the area in its emergency response, including Samaritan’s Purse, a Christian organization that provides physical and spiritual aid following natural or manmade disasters.
Jason Kimak, the vice president of North American disaster relief for Samaritan’s Purse, said the organization’s volunteers and staff were tasked with forming connections with affected families and individuals to understand their needs and provide comfort.
After immediate response, Samaritan’s Purse then took requests for ongoing care. “We’ve had over a thousand people ask for assistance in that area,” Kimak said.
Behind the diverse and extensive response at each organization were employees and volunteers who worked day and night, ignoring or putting on hold their own emotions of fear, anxiety and loss. “In the initial crisis time, it was simply, do the right thing for the people we serve in the best way we know how to do that,” Greer said.
For most, it wasn’t until the chaos of the response began to slow down that they started to become aware of their own needs.
‘Mountain strong’
During the Hurricane Helene response, health care workers and first responders were asked to serve the community while suffering themselves. Greer remembers the fear and angst she saw in the storm’s aftermath. She said community members looked to care providers for understanding.
“When you’re a leader, it’s much like being a parent,” Greer said. “You’re expected to know the answers even when you don’t.”
Even when feeling fear and searching for answers themselves, workers largely ignored their overturned lives to serve western North Carolina, attempting to understand and respond to the community’s needs.
The response necessitated by the hurricane left little time for responders and care providers to tend to their own needs. “When you’re in the throes of it, you’re very busy taking care of everybody else,” Greer said.
Nurses were asked to make sacrifices to provide lifesaving medical care, working 12-hour or longer shifts. “They put themselves and their family second, and they show up for our community and our patients,” Muldowney said. “And they do it just because they want to and they can.” One AppHealthCare nurse drove an hour and a half out of her way for overnight shifts after the storm destroyed the roadway on her normal route.
First responders often spent entire days responding to panicked calls of fallen debris or residents trapped in their home. Muldowney’s husband, a police officer, came home at Muldowney’s request to move a tree that had fallen on their house and immediately returned to service, soaking wet from the rain. “[They] were out there working 24 hours a day trying to make sure everybody was safe,” she said.
Volunteers and others who extended assistance formed bonds with those hit the worst by the storm – people who had lost loved ones, whose homes were destroyed, who were fighting for their own lives. “There comes a time when you’ve seen a lot of hurt and loss and hopelessness,” Kimak said. Workers pushed past their own emotions of hopelessness and despair to provide for others.
Workers and responders became what the community needed in that time. “They very innately look for the good,” Greer said. “And they become it.”
Though they allowed themselves little time to feel anything during the initial response, the providers and responders’ experiences eventually caught up to them. Greer said UNC Health Appalachian saw employees struggling about six months after the storm.
“After the fact, things have settled back down, operations have resumed,” she said, “and then the grief hits for the things that they lost individually or the people that they lost individually and what that looks like.”
Others began to have an emotional reaction earlier. “There were days after the hurricane that we all cried together, or we had our moments,” Muldowney said. What is clear is that the total mental and emotional impact of Hurricane Helene is still unknown.
George Lindenfeld is a private practice psychologist who specializes in trauma, primarily working with veterans. He conducted a case study of a patient who was a first responder during Hurricane Helene and identified a diagnosis of PTSD. When asked if his PTSD findings for veterans and first responders might apply to health care workers and volunteers, Lindenfeld’s answer was simple: “Absolutely.”
Lindenfeld said the western North Carolina area could expect to see symptoms of trauma such as substance abuse, anxiety, depression and a lack of socialization in the community for an uncertain amount of time. “It’s dependent on what kind of treatment intervention is used,” he said.
Over a year removed from the impact, the post-traumatic responses are starting to take shape. “When it rains here, people start to freak out a little bit because so much rain came down,” Muldowney said.
Care organizations attempted to provide support as best as possible both during and after the storm. Samaritan’s Purse utilized its partnerships with local churches and the Billy Graham Evangelistic Association to provide spiritual comfort to its workers and others in the area.
“[The chaplains have] been trained in working with families who’ve gone through a traumatic event, but they’re also trained and they’re there to provide support to the volunteers and to our staff as well,” Kimak said.
Greer said UNC Health Appalachian recently brought in a program called Struggle Well to support providers and first responders who are experiencing any form of emotional distress. The hospital also implemented support through critical incident response, stress debriefing and more.
However, as the storm’s traumatic impacts linger, workers and residents alike are leaning into their own form of support – their community.
“The mentality here in the mountains is always, ‘I’m fine, I’m more worried about you,’” Muldowney said. “And when everyone is ‘I’m fine, and I’m worried about you,’ at the end of the line, there’s no one to worry about.”
People from across the region, the state, the country and the world showed up during and after Hurricane Helene to provide support in the smallest and largest of ways. Muldowney recalled a plane full of bread being flown in from New York early on, and she and Greer both remember the outpouring of resources from people’s personal belongings. Samaritan’s Purse received over 1,000 local volunteers every day for the first few weeks, with more coming from out-of-state and other countries.
“We had over 40,000 volunteers come out to serve across all of our sites during Helene,” Kimak said. “I mean, it was an amazing amount of people that came out.”
Western North Carolina will likely struggle with the effects of Hurricane Helene for years to come. But in the past 14 months, they have seen what Greer says is the very real phenomenon of “mountain strong,” and they continue to support one another as the healing process unfolds.
“It was an incredibly trying time. It was an incredibly scary time,” Greer said. “But it was also a time of really incredible teamwork and commitment to the community as a whole and to each other.”
‘Post-hurricane, even closer’
On the weekend of the one-year anniversary of Hurricane Helene hitting western North Carolina, UNC Health Appalachian celebrated the response, the people behind it and the rebuilding that has happened since. They honored the event and those impacted. And now?
“We’re ready to kind of move on,” Greer said.
After Hurricane Helene, the western region of North Carolina overwhelmingly shifted to growth and restoration. Samaritan’s Purse employees and volunteers have constructed 640 bridges, driveways and culverts, provided furniture packages, built homes and more. UNC Health Appalachian made changes to its infrastructure and emergency action plans based on lessons learned.
A new electricity and generator system, copper telephone lines that can operate without reception, practice scenarios and more are helping to ensure that the hospital is more prepared for emergencies in the future. “I can’t tell you that this community won’t have more natural disaster-type events,” Greer said. “What I can tell you is that we will never struggle in the same way that we did this time.”
Greer said she has noticed people from all levels of the community turn from anger and frustration to a solution-focused approach and celebratory mindset. Whether it’s a widely held sentiment or not, at least Greer herself is moving forward. “This will probably be the last conversation I have about it, if I’m being really frank,” she said about the storm.
However, some community members are still struggling with grief and unable to start the process of moving on. “There will always be individuals that may not make it out of recovery mode or may be slower to make it out of recovery mode,” Muldowney said.
Lindenfeld said the stages of grief and trauma can look different for different people, depending on care received and other mental factors. Muldowney encouraged people to pay attention to their personal response.
“I think just being aware of yourself and what you need to process the grieving of what used to be pre-Helene and what we live in now – which is just as beautiful, but in a different way – is how I walk away from that experience,” Muldowney said.
While some prepare to put the pain of Hurricane Helene behind them and others continue to work through what they lost, the community continues to work together to identify the needs of themselves and others.
“I can say without a shadow of a doubt that pre-hurricane, this was a close community,” Muldowney said. “Post-hurricane, even closer.”
