News publications and other organizations are encouraged to reuse Direct Relief-published content for free under a Creative Commons License (Attribution-Non-Commercial-No Derivatives 4.0 International), given the republisher complies with the requirements identified below.

When republishing:

  • Include a byline with the reporter’s name and Direct Relief in the following format: "Author Name, Direct Relief." If attribution in that format is not possible, include the following language at the top of the story: "This story was originally published by Direct Relief."
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  • Maintain any tagline at the bottom of the story.
  • With Direct Relief's permission, news publications can make changes such as localizing the content for a particular area, using a different headline, or shortening story text. To confirm edits are acceptable, please check with Direct Relief by clicking this link.
  • If new content is added to the original story — for example, a comment from a local official — a note with language to the effect of the following must be included: "Additional reporting by [reporter and organization]."
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Republishing Images:

Unless stated otherwise, images shot by Direct Relief may be republished for non-commercial purposes with proper attribution, given the republisher complies with the requirements identified below.

  • Maintain correct caption information.
  • Credit the photographer and Direct Relief in the caption. For example: "First and Last Name / Direct Relief."
  • Do not digitally alter images.

Direct Relief often contracts with freelance photographers who usually, but not always, allow their work to be published by Direct Relief’s media partners. Contact Direct Relief for permission to use images in which Direct Relief is not credited in the caption by clicking here.

Other Requirements:

  • Do not state or imply that donations to any third-party organization support Direct Relief's work.
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  • Advance permission is required to translate Direct Relief's stories into a language different from the original language of publication. To inquire, contact us here.
  • If Direct Relief requests a change to or removal of republished Direct Relief content from a site or on-air, the republisher must comply.

For any additional questions about republishing Direct Relief content, please email the team here.

California Power Blackouts Reveal Widespread Vulnerability in Health Care System



With wildfires in California increasing in frequency and scale, preemptive power shut-offs have begun to take place in order to prevent future blazes. However, lack of power can bring its own health risks, and many health centers across the state lack the necessary back-up power options to sustain health operations for an extended amount of time. (Photo by Donnie Hedden for Direct Relief)

Last week’s widespread electricity blackouts across California revealed a dangerous vulnerability in America’s health care safety net.

Modern health care is built on the assumption of steady power from the electricity grid. But a Direct Relief survey during last week’s outage revealed that only 44% of California’s community health centers have a back-up energy source available when the electricity grid fails. Even clinics that had back-up generators found they didn’t provide enough power to operate all their systems, forcing operational triage. Seven million Californians depend on nonprofit community health centers for primary health care, especially in rural and low-income urban areas.

Pacific Gas & Electric, California’s biggest electric utility, last week shut down its power grid in 34 of California’s 58 counties, warning that some customers could be cut off for up to a week.

More than 730,000 locations were cut off, leaving an estimated 2 million people without power. PG&E took the drastic step during a period of severe wildfire risk, with strong dry winds matching conditions when downed power lines sparked devastating fires in 2017.

PG&E has acknowledged that many of its long-distance transmission lines and towers crossing California’s forests are in decrepit condition, and that its equipment ignited several of California’s massive wildfires in recent years. While this was the first preventive power cut of this scale in the United States, many more are expected to follow. PG&E plans to continue preventive shutoffs when conditions demand, as do other utilities such as Southern California Edison, the state’s second-largest power provider.

Modern health care is almost entirely dependent on availability of electricity:

  • The government-mandated shift to electronic health records means little or no patient health information may be available if local power or data transmission fail.
  • Direct Relief’s survey found that 97% of health centers have medications on site requiring refrigeration. Insulin, vaccines and many other medications must be kept within a specified temperature range; if they fall out of that range for more than a short period they must, by law, be discarded.
  • Much of the equipment in a modern medical office requires electricity to operate.

Direct Relief’s survey was shared with 114 health center partners in California, as well as with 175 health center members of the California Primary Care Association. Of the 70 that responded, 97% (68 health facilities) store refrigerated medications on site, but only 44% (31 health facilities) have a back-up energy source available.

Of those 31 health facilities with a back-up source:

  • 68% (21 sites) have diesel back-up generators,
  • 13% (4 sites) use propane,
  • 10% (3 sites) use natural gas,
  • 10% (3 sites) have solar, and
  • 3% (1 site) have both diesel and solar

Even among the 44% that had back-up power, that power is limited. Back-up generators powered by propane, diesel or natural gas are often able to provide only a limited amount of power. Direct Relief last week spoke with several health centers that had to make power triage decisions: they could either keep their pharmaceuticals refrigerated, or could run their computer networks to access health records, or power their air conditioning and lights.

In comments in their survey responses, clinics that do have back-up power generation available said:

  • “But we are not able per PG&E to have back-up batteries to store our solar power as we feed back into the grid which has forced us to get a diesel generator which will not quite meet all of our needs.”
  • “We only have power back-up generators for our vaccine units and they can provide only 12 hours coverage at a time.”
  • “The solar is only at one site and only backs up certain items, and the system only can supply 4 hours of lighting – not all night.”
  • “Portable generators gas and propane for powering refrigeration, have to be run outside with cord to fridges.”

Winters Health Care, which serves an overwhelmingly poor population in rural Northern California, chose to power their medical records system, lighting the clinic with whatever they could find at the hardware store and transporting their expensive, temperature-sensitive vaccines for safekeeping to a nearby health facility unaffected by the outage.

At LifeLong Medical Care in the East Bay, staff quickly moved vaccines and other temperature-sensitive medications to a nearby hospital for storage as their Oakland clinics lost power, and a clinician kept each location open in the darkness.

An estimated 3,000 people died due to loss of access to health care after Hurricane Maria struck Puerto Rico in 2017. Dozens of community health centers across the territory lost power for weeks or months. Direct Relief has since been setting up self-sufficient micro-grids for the centers, combining solar power, battery power storage and back-up generators to keep them in operation during future outages.

Power technicians work on downed lines in Puerto Rico after Hurricane Maria, which crippled the island's power system. The long-term power outage was linked to thousands of deaths on the island, including of patients without access to medical treatments like dialysis or oxygen that require electrical power. (Photo by Erika Rodriguez for Direct Relief)
Power technicians work on downed lines in Puerto Rico after Hurricane Maria, which crippled the island’s power system. The long-term power outages and interruptions in health care were linked to thousands of deaths on the island, including of patients without access to medical treatments like dialysis or oxygen that require electrical power. (Photo by Erika Rodriguez for Direct Relief)

Direct Relief itself has turned its own Santa Barbara headquarters and pharmaceutical warehouse into a self-sufficient power island/micro-grid that can run off the grid for months. With potential outages scheduled over the coming days in Southern California, Direct Relief is making its facilities available to the public to charge devices and small electronics while power is down.

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