When Hurricane Florence flooded the Carolinas, the VA's sorely tested outreach programs for needy and homeless veterans relied on mobile units, evacuations, social workers and the likes of a former Army staff sergeant and Iraq veteran known to street veterans as "Mama Z."
"They have to know we're here, they have to know they're not alone," said the VA housing specialist whose proper name is Zenia Delgado. She works with several hundred veterans across 21 counties in North Carolina.
The efforts of Delgado, and the social workers, case managers, nurses and administrators who coordinate with a bewildering array of agencies, have formed the core of the response of the Department of Veterans Affairs to Hurricanes Florence and Michael, and now to the California wildfires.
Over Veterans Day weekend, VA Mobile Vet Centers, nursing and social work evacuation teams, pharmacy representatives, and dual-use vehicles were deployed across northern California "to provide health care and emergency support to veterans," VA's Northern California Health Care System said in a statement Monday.
At a recent Senate hearing, and again Nov. 9 at the National Press Club, VA Secretary Robert Wilkie hailed the performance of the VA's platoons of de facto first responders, while acknowledging that he needs more of them.
"The case managers are part of a larger issue we have in retaining those individuals, particularly in the social work field," Wilkie said at a Senate Veterans Affairs Committee hearing in October.
Following Hurricane Florence, Military.com interviewed more than a dozen of those first responders who were on the ground when Hurricane Florence came ashore on the morning of Sept. 14 near Wrightsville Beach, North Carolina, and then hung around for a week, dumping record rain across North and South Carolina and parts of Virginia.
"Mama Z" Delgado said her first task was to combat the despair of veterans who were homeless to begin with, or who went to the shelters when their own homes were damaged or destroyed.
"My job is to remind you that you have dignity. You're a soldier, you're a sailor, you're a Marine, you're an airman ... [and] nothing can take that away from you," she said.
When they feel lost, overcome by the loss of a home or a job, or possibly battling an addiction, the task is to "make you understand that this is just a situation, a set of circumstances, and we're here to bring you forward," she said.
"You should never feel that way again" if the system functions, said Delgado, who works out of Fayetteville, North Carolina as a coordinator for the joint housing voucher program of the Departments of Housing and Urban development and Veterans Affairs known as HUD-VASH, or HUD-VA Supportive Housing.
The "situation" of the hurricane, as Delgado put it, changed daily in coastal North Carolina, where roads and bridges were washed out, and Wilmington and other communities were cut off from the rest of the state for a time.
Some VA clinics were closed, thousands of appointments and surgeries were canceled at medical centers and more than 200 patients were evacuated from the Hampton, Virginia VA Medical Center, which sits right on the waters of the Chesapeake.
The governors of North Carolina, South Carolina and Virginia declared states of emergency.
Knocking On Doors
"It came in and it did a lot of damage. Our clinic was damaged as well, and it was closed down for 10 days," former Army Sgt. Josh Huggins, 57, a VA peer support specialist, said of Florence.
It was a scramble before, during and after the storm with power out and communications iffy, he said. Before Florence came ashore, Huggins tried to keep contact with those veterans in his caseload -- about 80 veterans in the Wilmington area and another 43 in Jacksonville -- and "make sure they're in a safe place and have food and water."
The calls to the VA's hotlines kept coming in and some of the shelters themselves went down. One of the four in the Wilmington had to be evacuated when the plumbing stopped working, he said.
"We call them, and if we can't contact them, I go personally and knock on the doors and make sure they're okay, their medications are up to date," he said. "You try to be a bridge to get them to the providers."
For those veterans who run out of their medications, "I'll actually run back and pick it up for them," Huggins said.
When a veterans lacks transportation, Huggins said he will first check with the clinic and the pharmacy on the prescription and then "pick it up and take it to them."
One of the recurring problems for the VA made worse by the storm, he said, is that "I run into veterans on a daily basis who don't know about the community services."
One of the jobs the of VA's social workers is trying to make contact with veterans and increase awareness of these services.
"I was actually assigned to go out with a nurse to the shelter in Kinston, [North Carolina] and identify veterans there and assess their needs," said Nadia Williams, a provisionally licensed clinical social worker with the VA.
"We did run into a good amount of veterans who either had been displaced from their homes or were homeless beforehand. So the thing was to identify then and assist them as best we could," she said. "The area had a lot of flooding, and there was the continual threat that the waters would impact people further inland. We were on the phone, checking, calling in with those we could reach by phone or going face-to-face to assess their needs."
Finding the Urgent Cases
Alexander Averell, a licensed clinical social worker with the VA, said "my role as an outreach social worker is to go into the community where the homeless go for help -- the soup kitchens, the shelters, the libraries, the streets."
To do that, "I definitely had to take some alternate routes to make sure I did not go through any standing water," he said. "I had to be creative with the GPS."
In Carteret County, "the main bridge was closed off. That was the area that was hit the hardest," he said. "I cover 13 counties for outreach, just me. That's my main focus, outreach. If someone doesn't know about a program, the details and such, they at least have my number and they can call me for follow-up."
The veterans he does reach can sometimes be astounded that there is someone there trying to help, even before they ask.
"Actually, that does happen, that surprised reaction," he said.
Shortly after the storm passed, the VA posted a Facebook a video of Navy veteran Mark Steffans, who had been evacuated from the Jacksonville area and taken to the shelter at the Friendly Conference Center of the University of North Carolina at Chapel Hill.
In the rush to leave, Steffans left behind his oxygen supplies. VA social worker David Jenkins went to Steffans' home and brought the oxygen supplies to Chapel Hill.
"He brought it up here," Steffans said of Jenkins. Without him, "I wouldn't have the things I need right now, the oxygen."
To many veterans during the storm, it may not have seemed like there was a plan to deal with Florence, but the VA had a list of potentially vulnerable veterans that was updated three times daily during the storm, said case manager Ellicia Thompson.
She said the VA kept in close contact with local law enforcement and the North Carolina Department of Transportation, particularly for areas such as Wilmington where access was difficult.
"If we couldn't get in, we could get an escort,' she said.
The effort required the baseline work of coordination with other agencies and organizations, beginning with state and local authorities.
Then there was the additional coordination needed with other agencies from the Federal Emergency Management Agency, the Departments of Health and Human Services and Housing and Urban Development, the Small Business Administration and the National Guard, to the Red Cross and volunteer groups.
At the Durham VA Medical Center, public affairs specialist Sharonda Pearson set up a virtual command center to keep track.
More Homeless Veterans
Jeff Doyle, a licensed clinical social worker and homeless program coordinator at the Veterans Integrated Service Network in Durham, said disaster response is a constant learning process.
"We've got to get into every shelter, meet with everybody in the shelter and come up with a housing plan," he said.
The VA had its lists of the homeless, "but we don't always know where they are. We are most effective when we're working with the communities [which often have their own lists]," he said.
Doyle said there were an estimated 1,500-1,600 homeless veterans in North Carolina before the storm, and those numbers were bound to increase in the aftermath, although the scope of the problem was not yet clear.
He said Florence was estimated to have destroyed about 10,000 housing units in North Carolina.
"The challenge we find is that there just aren't enough places to move them into right now," Doyle said. "If the units aren't there, what do you do? That's the challenge ... every veteran has a different story, a different need."
"And a lot of people don't think the VA can help," he said, which puts much of the onus on the powers of persuasion of Zenia Delgado and the other VA housing specialists.
"I do landlord briefs," Delgado said.
These are efforts to disabuse some of them of the misconceptions they may have of combat veterans, including that they're suicidal and prone to violence.
"There's still that stigma that comes with combat veterans," she said.
Delgado wouldn't elaborate on her own experience, but said she could relate to the situation of the homeless veteran. When she's successful in getting a veteran into an apartment, the reward comes from the bond that's been developed with another former service member in need, she said.
Delgado said there's a story about her first year on the job that she sometimes shares with discouraged homeless veterans.
"There was a veteran who came to me my first year. I'll never forget him," she said.
When she succeeded in getting him a home, he was in a wheelchair, she said.
"Can you pray with me?" he asked.
Delgado said "of course."
The veteran asked if she could get in trouble for praying with him. She promised him that she wouldn't.
Then the veteran offered his prayer, she said: "Thank you, God, for letting me die with dignity."
At the National Press Club last Friday, Secretary Wilkie said the VA has become the "foundational" agency for the federal government's response to natural disasters.
"We're the ones who deploy the mobile pharmacies," and send "teams of nurses, engineers and doctors" into the hardest hit areas," he said. During Florence, "thousands of VA employees went into these communities."
He also related the "best story I heard" on the VA's Florence response. There was a veteran with spinal cord injuries in the Wilmington VA who had to be evacuated to the Athens, Georgia, VA Medical Center during the height of the storm, he said. But the veteran's specialized bed had to be left behind.
"Our VA in Athens did not have the proper bed," Wilkie said, but "our VA employees in Wilmington got that bed to Athens."
-- Richard Sisk can be reached at email@example.com.