As I write this Friday morning, Hawaii's Big Island is bracing for Hurricane Nolo. Forecasters now expect it to pass south of the island, but it could still bring 15 to 30 inches of rain to the east and south sides, with up to 35 inches in some spots (Honolulu Star-Advertiser). Nolo is following almost the same track as Hurricane Lala, which flooded the Kaʻū district just six weeks ago.
I started this blog to learn about rural health, tribal health, and disaster response in public. This week, those three topics kept running into each other. So today's question is a simple one: when disaster hits a rural place, what does it take to keep care open?
A rural clinic in the path, twice
Hurricane Lala brushed the Big Island August 14 to 16. The flooding in Pāhala and Nāʻālehu killed two people and swept away homes and vehicles (Star-Advertiser). A federal emergency declaration for Hawaii County followed on August 25 (FEMA).
The local community health center had to temporarily suspend operations at two clinics because of power and communication outages, and its Kaʻū location took significant flood damage (Direct Relief). A health center leader told Direct Relief they can manage short outages by safely storing temperature-sensitive medications and switching to paper records. The problem was that these outages lasted days. So the team reopened the sites it safely could and sent mobile health clinics to areas where clinics couldn't operate. The fire department hand-delivered prescriptions to isolated patients.
Ahead of Nolo, Governor Josh Green urged people to consider staying with family in larger communities, partly because flooding could cut off roads and bridges and make it harder to move people who need medical care (KITV).
What stands out to me is how much of the response ran on improvisation: mobile units, firefighters, paper charts. That is a credit to the people involved. It also tells me the buildings themselves were not set up to ride out several days without power.
Pine Ridge: a long road from storm to declaration
On September 1, the President approved a major disaster declaration for the Oglala Sioux Tribe after severe storms, straight-line winds, and flooding hit the Pine Ridge Reservation June 2 to 4. Help can include grants for temporary housing and home repairs, plus cost-shared funding for emergency work and for repairing or replacing damaged facilities (FEMA via TSLN). The SBA's disaster loan notice was published in the Federal Register today, with a November 27 deadline for physical damage loan applications (Federal Register).
That is about three months from storm to declaration. I'm still learning how damage assessments and tribal declarations work, so I can't say whether that is typical or slow. But for families on the reservation, it's a whole summer of waiting. I'd really like to hear from tribal emergency managers about what that gap looks like on the ground.
Betting on local people
Two workforce announcements this month point in the same direction. The Indian Health Service awarded $2.3 million over three years to four Tribes and Tribal organizations to expand the Community Health Aide Program into the lower 48 states. CHAP builds a local workforce of behavioral, community, and dental health aides who work alongside licensed providers (IHS). In Missouri, new Rural Health Transformation funding will put 437 people into funded EMT and paramedic training (CMS).
Both bet on the same idea: the people who live in a community are the ones still there when the road washes out.
The money is moving. Is resilience part of it?
Rural health dollars are flowing fast right now. Missouri's announcement includes about $35 million for 20 rural hospital projects, covering facility improvements and building system upgrades (CMS). Connecticut is directing $50 million to help four rural hospital systems modernize facilities (CMS). HRSA awarded nearly $25 million to 132 small rural hospitals in 13 states (HHS). And states have to obligate their first-year Rural Health Transformation funds by October 30, 2026 (KFF).
On a separate track, FEMA announced more than $160 million in Pre-Disaster Mitigation grants for 115 projects in 39 states and one Tribal Nation, most of them focused on flood risk (Homeland Preparedness News).
So there are two big funding streams, one for rural health and one for disaster resilience, running side by side. From what I can tell reading these announcements, they rarely mention each other. But a rural hospital's "building system upgrade" could also be its backup power plan or its flood plan. I don't know how often those conversations happen in practice. I want to find out.
What this suggests about the gaps
Here is where my thinking is after this week:
Facilities that can run for days, not hours, without the grid. Paper charts and mobile vans are a bridge, not a plan.
Local people trained to deliver care when outside help can't get through.
Funding that treats access and resilience as one problem. A clinic that closes every time it floods is not really open.
Shorter waits between a disaster and help, especially for tribal nations.
Let's compare notes
If you run a rural clinic or hospital, lead a tribal health program, or work in emergency management, I'd love to learn from you. What broke the last time disaster hit? What would you build if you had the chance? You can reach me at contact@loucoindustries.com.
And to everyone on the Big Island this weekend: stay safe, and look out for each other.
Lucas Righetti, Founder, LouCo Industries