Key Informant Qualitative Themes

Infrastructure changesFood Access“In this county, people don’t really have access to steak or chicken or stuff like that.”RN
“People came into the ER and they didn’t have [food]. I would give out boxed lunches, which was a sandwich and some apple sauce.”RN
“I was looking for them to have a good source of complex carbohydrates such as fresh fruits and vegetables, which we did not have access to at all during Hurricane Matthew.”RN and Professor
“We have a program in the school system that will pack a bag lunch for a kid over the weekend. I mean if a kid can’t eat over the weekend, what will they do over five days?”RN
Community“[For Hurricane Florence] they brought along people from other organizations. The Cajun Army were here for four or five days… you didn’t see that during Hurricane Matthew.”RN
Disparities“Definitely [some] areas were hit harder. I mean MLK [was hit] so bad and well no one can afford to be flooded, but that area definitely couldn’t afford [it].”RN
“Jim Crow segregation: [Certain] populations around the county… have been pushed to the less desirable, low-lying areas of the county and were more affected by the storm.”RN
Utilities“Yeah I think most people would agree that water is more important than electricity because you can’t take a shower, you can’t flush your toilet…”RN
“There was a large tower carrying lots of power lines in a low-lying swamp that collapsed. The power was out for everywhere and it was nearly a week before they got it back up.”Community Center Leader
“Most of the grocery stores were closed due to the lack of power.”Community Center Leader
Flooding“[For Matthew] the river was rising in South and West Lumberton, people were pulled from their houses by helicopter and boat.”Community Center Leader
Clinical Access and ResourcesMedications“[When those with a chronic disease] don’t get their meds, [they] go through withdrawals.”RN
“No, I don’t think people packed emergency kits. I worked in the ER and people were coming in and wanted their HIV medicines, insulin was a big one, and Lasix for heart patients. Another is oxygen, people came in to [use] our oxygen because they didn’t have it at home.”RN
“It’s tough for shelters to dispense medications because they aren’t a pharmacy…”RN
“Most of our folks who were flooded may not have had access to their insulin for weeks.”RN
“It’s hard for someone who lives day to day to prepare. They may be buying medications a week at a time [and] may not have insurance. They had trouble with transportation.”RN
“We had several patients that their only way out is to go to the emergency room because they are in DKA and the only way to get medications would be to go to the emergency room.”RN
“I can’t imagine being a mother and your child just came out of DKA and [now you] are wondering how they are going to get their medications or keep them cool. The insulin analogs will stay viable up to 28 days, [but] knowledge about that… is key.”RN
“I couldn’t help you if you didn’t know the name of your medications. Many of them came with no medications [and] often they didn’t know the name or dosage of the medications.”RN
“When you just refilled your prescription last week, so you can’t refill your prescription for another month, but it just went bad, that’s when you have to evacuate your home.”Community Center Leader
Disparities“Now for Florence, those who have wealth were more prepared and able to go out and spend some of that money that was socked away for a rainy day.”Community Center Leader
“Folks who had 400% below federal poverty guideline were the ones that got it so bad [with Matthew]. The folks tended to be uninsured, so they don’t necessarily have access to medications all the time, not just during a natural disaster.”RN
“Medical care was hindered for the entire population, [but] more critical for those with symptoms related to kidney and renal diseases because health care was non-existent during Hurricane Matthew. The hospital wasn’t open. For Florence, most clinics were closed.”RN and Professor
Food Access“Patients were on a specific dietary regimen and doing well, and then boom, they would eat whatever they could eat and then complain about their high [blood sugar] numbers.”RN
Emergency SheltersMedications“[Shelters provided] food, water, and things like that, but medications and supplies. no.”RN
Community“Matthew, we staffed shelters. Florence was not as bad, structurally, for many of the clinics.”RN
“Shelters were set up [in precaution], and staff thought they would only need them for very few days. We did not think Hurricane Matthew [would] actually impact our area much.”RN and Professor
“The purpose of the shelters isn’t to provide medical services. The way they’re putting [them] up, according to the law, they’re doing a good job. I think the law is inadequate.”RN and Professor
“I strongly disagree [that emergency shelters provided adequate resources]. I think [the emergency shelters] did a terrible job. In my opinion they did not provide adequate resources.”RN and Professor
Flooding“Matthew affected more people and put more people out of their homes and into shelters.”RN
Food Access“[Shelters] tend to have one simple menu that does not address the needs of the diabetic. I think we need to stop and have a different type of program for those populations.”RN and Professor
  • Participants included three registered nurses (across the Southeastern Health system), one professor from UNC-Pembroke, and one community leader (n = 5).