More inundation expected through May

By KEN LEISER
Widespread spring flooding forced Catholic health systems in Nebraska, South Dakota and Iowa to take swift action on March 14 and the days that followed — from providing temporary housing to staff to offering free tetanus vaccinations to first responders. 

A farm home is surrounded by water near the Platte River south of Fremont, Neb., during the devastating March flooding in the Midwest.
State of Nebraska

The combination of melting snow, frozen ground and heavy March rain from a massive "bomb cyclone" weather system touched off widespread flooding across the Midwest. Floodwater washed out roads and bridges. Thousands of families evacuated their homes. Published reports placed the death toll at three and two men still were missing as of March 25.

Health system officials described huge chunks of ice that broke free from frozen creeks and rivers, being propelled by surging floodwater, destroying homes, buildings and highway bridges.

Nebraska Gov. Pete Ricketts and South Dakota Gov. Kristi Noem activated those states' emergency operation centers. Iowa Gov. Kim Reynolds issued a disaster proclamation. Within a week as floodwaters moved downstream, Missouri Gov. Mike Parson declared a state of emergency due to flooding on the Missouri and Mississippi rivers.

"For us right now, we're trying to identify all the problems and we don't know if this is all completely over yet," Todd Consbruck said in an interview March 20. He is president and chief executive of Avera St. Anthony's Hospital in O'Neill, Neb., and Avera Creighton Hospital and Avera Creighton Care Center, both in Creighton, Neb.  

Water wall
On March 14, a 95-year-old dam broke on the Niobrara River, generating a "massive wall of water" carrying chunks of ice on an 11-foot-tall pulse of water down the river in the Verdigre Creek valley in northeastern Nebraska near Creighton, Consbruck said.

Because of forecasts of blizzard conditions, both Avera St. Anthony's and Avera Creighton had activated their emergency plans and medical staff spent the night at the hospitals or in hospital housing.

"We actually were lucky that we had staff coming in for the blizzard and then the flood hit," Consbruck said. Floodwaters washed out roads and bridges that staff members rely on to get to work. "So, we have employees now who are on the wrong side of bridges that are either gone or are undergoing inspections, or roads that had water running over them that aren't safe to go across" due to flooding.

Despite the reopening of some bridges and roads in the days that followed the flooding, in the final week of March some staff still were driving an additional 50 to 100 miles to reach their jobs, particularly at St. Anthony's.

Avera Health plans to use its Helping Hearts Fund to assist employees in need because of the flooding, Consbruck said.

Flooding did not force the closure of any Avera hospitals in the region. But Avera Medical Group had to temporarily close clinics in Niobrara, Neb., and Verdigre, Neb. The Niobrara clinic lost some supplies due to a power outage. All facilities were reopened before March 20, a spokesman said.

Stress mounts for farm families
"Our infrastructure for our hospitals at Avera is really in very good shape for the most part," Consbruck said. "We're most concerned about our employees. Extra driving. Stress. Many of them are from farm families. Their spouses have lost livestock. They don't know if they're going to be able to plant their fields this spring. Our concern is our staff and our communities."

Flood damage adds to the pressure on Midwest farmers, many of whom already face financial headwinds. Avera officials urged farmers to make use of its Farmer's Stress Hotline, a toll-free number that provides access to licensed mental health professionals. (See sidebar.)

Avera Creighton and health system clinics provided free tetanus shots to those tasked with cleaning up flood debris. Avera also provided masks, gloves, and antibacterial wipes to those helping with the cleanup and rescue materials. The system shipped 230 cases of bottled water to Nebraska communities that didn't have safe drinking water.

CHI response
Officials at Omaha, Neb.-based CHI Health, a division of CommonSpirit Health,  said none of the regional system's hospitals or health clinics in the upper Midwest were closed or damaged by the mid-March flooding.

CHI Health has several hospitals in areas of Nebraska most affected by the flooding. They include CHI Health Lakeside, CHI Health Creighton University Medical Center — Bergan Mercy, CHI Health Immanuel Hospital in the Omaha region, and CHI Health Midlands Hospital in Papillion, Neb., said Brian Smith, division facilities compliance coordinator for CHI Health and the health system's liaison to the Omaha Health Care Coalition.

Smith said the coalition includes CHI Health, Nebraska Medicine, Methodist Health System and other hospitals in the area. The coalition members monitored the flood threat to Methodist Fremont Health Medical Center, which was surrounded by water when Fremont, Neb., was cut off from the metropolitan area. (The city of Fremont is about 35 miles northwest of downtown Omaha.)

Beginning on March 14, coalition members evaluated whether Methodist Fremont Health Medical Center could be evacuated and how they could assist in transferring patients. CHI Health and coalition partners provided updates about available hospital bed space in the event the Fremont hospital needed to be evacuated.

During the week that followed, CHI Health through its partners coordinated the delivery of more than 150 hepatitis B and tetanus vaccines for first responders who came in contact with bacteria-laden floodwater.

Smith said it was one of the first times that the Omaha Health Care Coalition was activated in a region-wide emergency response.

"We've had a lot of lessons learned," he said. "But it has been an excellent response. And we've had a lot of participation from what would normally be competitors. They've all shaken hands and been partners."

CHI Health also donated $10,000 to the flood relief effort and more than 5,000 bottles of water to the Glenwood, Iowa, Community School District, according to a spokeswoman.

More flooding expected
The National Oceanic and Atmospheric Administration cautioned in its U.S. Spring Outlook that nearly two-thirds of the lower 48 United States face "an elevated risk for flooding through May." Twenty-five states face the potential for flooding risks that range from moderate to major.

"We still have the spring rains," Smith said. "There is still snowpack up north. The one thing that was unique about this (mid-March) incident was it was a perfect confluence of weather events. Most flooding events can essentially be somewhat predicted with the amount of rainfall that is coming and that sort of stuff. This event unfolded very quickly and was to an extent more severe than the 2011 floods that we had."

In 2011, the Missouri River was the primary river that flooded, Smith recalled. This year there also was flooding on the Elkhorn and Platte Rivers, in addition to the Missouri River, rendering the Omaha metropolitan area an island for about four days.

Avera's Farmer's Stress Hotline offers mental health triage for overburdened farmers, ranchers

By ELLEN FUTTERMAN

Farmers have always had their share of challenges, but with trade turmoil, unprecedented flooding, and record-low commodity prices, recent times have been particularly stressful for many in the agricultural community.

That's why in January, Avera Behavioral Health, based in Sioux Falls, S.D., started the Farmers' Stress Hotline, which is available to farmers, ranchers and their families and friends. It's a free 800-number that operates 24/7 and is staffed by licensed mental health counselors. The hope is that the ability to connect with a mental health provider confidentially will appeal to stoic rural residents, who otherwise might not be willing to reach out for help. The triage service is open to anyone. Avera's target market is people living in its rural service areas in South Dakota, Nebraska and Minnesota. Callers can be linked to mental health providers for follow-on care that can be delivered in person, over the phone or through telemedicine.

Karl Oehlke, a farmer and physician’s assistant with Avera Medical Group Psychiatry, helps farmers facing anxiety and depression to access behavioral health services. He is shown here with two of his children. Kayna is on his lap and Kwyn is by his side.

"Farmers and ranchers typically don't want to drive up and park in front of a mental health center or a doctor's office and everybody's wondering why they're there," said Dr. Matthew Stanley, clinical vice president for the Avera Behavioral Health service line. "So, we needed something that was easily accessible but also very confidential and anonymous."

Karl Oehlke knows firsthand the stresses that farmers face. A physician's assistant with Avera Medical Group Psychiatry, Oehlke staffs the hotline. He also farms, growing corn, soybeans and hay. He said many of the hotline calls are from farmers concerned about the "drastic reduction" in their income. Spouses and children also call the hotline with concerns about the mounting stressors on a loved one.

"The crop crisis, natural disasters, flooding — all of these things are taking a significant toll," said Oehlke, 42. "We can't control levees breaking or hail coming down from the sky. So many of these things are out of a farmer's control. It can be quite frustrating.

"They can only do so much. They can be out there 24 hours a day watching their cows having calves but a single levee breaks and the next thing you know your whole herd is gone."

Oehlke notes that many of these farmers are not only worried about present conditions but the future, as well.

"Trade tariffs come into play, with the lack of exportability with China," said Oehlke. "And now you have to think globally (about market competition) with Argentina, Brazil and much of South America growing record crops. That has taken another element away from us. Potentially if these trade avenues do open back up, will those even be options or has South America taken that portion of crop (sales) that we used to send overseas? There are just so many uncertainties right now."

Often it is an amalgam of significant fear, such as worrying about being able to put food on the table or pay for college, which leads to depression and anxiety. Thankfully, says Oehlke, most hotline callers do have family support, though obviously the most concerning are the ones who are alone.

"The hardest part for farmers is letting their guard down," said Oehlke. "There is still a certain stereotype that we try to break down, which is that as a farmer I should pull-myself-up-by-the-boot-straps and get through this. We've survived the '80s, we survived the floods of '11, the drought of '12. But all that stuff starts to add up."

In most cases, hotline assessment counselors listen to callers' concerns, then refer them to Oehlke, who sets up a "game plan," which may include medication options and/or counseling or even hospitalization in the most severe, at-risk cases.

"I try to set the stage and let them know, I'm right there with them, that they are not alone as a farmer or as a person," said Oehlke. "Farmers are a surviving species, but we need to start with the things that we can control. We can't control China, we can't control the weather, but what we can control is you getting help and I'm here to figure that out with you."

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