‘A place connected to grief’: How integrated health care aids healing in Blue River

Editor’s note: Five years ago this month, the Holiday Farm Fire ripped through the McKenzie Valley, destroying hundreds of homes and leaving enduring scars — physical, psychological and on the land itself. This is another in a series of Lookout Eugene-Springfield stories examining the fire and its aftermath. 

“There’s hardly ever a time where I say, no, that’s not in my scope,” Daisy Cruz said. 

So she helps her neighbors fill out housing and benefits forms. She supports residents in ordering medical equipment like blood pressure monitors. She assists them in having their prescriptions mailed to their homes so they don’t have to drive long distances to a pharmacy. 

Cruz is a community health worker, helping to coordinate care and connect patients to needed support. She works at the Orchid Health McKenzie River Clinic in Blue River, a small, unincorporated community between Finn Rock and Rainbow.

The clinic provides integrated services — access to community health workers and behavioral health consultants, as well as medical practitioners. Integrated care is fundamental to how the clinic works, because it is the only health care provider in the rural McKenzie Valley area. 

When a patient sees their primary care physician and expresses a nonmedical barrier to care, such as housing, transportation or food access, Cruz connects them with resources. 

The clinic’s behavioral health consultants are also available during medical visits, which reduces stigma and increases access to mental health care, Cruz said. This is critically important in a rural area with scarce speciality services. 

It’s also increasingly important as the community continues to recover from the devastating 2020 Holiday Farm Fire, which destroyed many of Blue River’s homes and businesses. Cruz is among the people tending to the physical and mental health of residents still coping with the fire’s aftermath.

In the months following the Holiday Farm Fire, clinic providers heard daily from residents who had lost homes, jobs, pets and a sense of safety. Five years later, community members are still struggling with post-traumatic stress, anxiety, depression and grief. She said providers are seeing an increase in substance use related to trauma and stress. Each year’s rash of wildfires brings a new rush of worries.

“Fire season is very triggering, whether it’s very local or we just get smoke from another fire,” she said. 

While Cruz did not experience the Holiday Farm Fire, she said she does understand what the community went through. She lived on Woolsey Canyon in California during the 2018 Woolsey Fire, which damaged her house. 

“Just the sound of the fire, I get chills thinking about it,” she said. “There’s a distinctive roar that you don’t forget, the crackling, the smell, the want to fight it with your own hoses.”

She said providers at the McKenzie River Clinic do mental health check-ins with patients during fire season, guiding them through emotional and practical preparedness. The clinic hosts Alcoholics Anonymous meetings weekly in its community room. 

In an effort to inform more people in the community about clinic services, Cruz attends local events such as a disaster preparedness fair at the Upper McKenzie Community Center. She’s also planning a Halloween trunk-or-treat event on the street in front of the clinic. 

“Our work supports not just individual patients, but the larger healing process of the community,” she said. 

This work has been ongoing for the clinic — despite its own destruction. The original McKenzie River Clinic burned down in the Holiday Farm Fire. Providers quickly established a mobile clinic in a bus before moving into a quilt shop upriver. This October marks one year since the newly built clinic opened in the same spot as the original facility. 

Nonprofit organization McKenzie Valley Wellness built the new $2 million clinic, funded by insurance money and a state grant from the Fire Relief Act, according to Orchid Health, which has five other clinics in rural areas in Oregon. 

“It’s so hard not to get choked up, just seeing where this community has come from and where they’re headed,” Cruz said. 

‘Resiliency comes in community’ 

There’s a comfort that comes from going home to someplace predictable.

Kelly Shaw is a third-generation graduate of McKenzie High School in Blue River. The Holiday Farm Fire destroyed homes, shops, the health clinic and the library in the community. It left a noticeable burn scar on the forest. Some residents are rebuilding their houses. Others chose to rebuild their lives elsewhere. 

“That place that seemed like it would never change did, and that’s unsettling,” Shaw said. “And it’s also a place for me that is connected to grief. But, with hope, people are still here. Things are coming back. But being able to roll with that change is sometimes clunky and hard.”

Shaw is a PeaceHealth licensed professional counselor. Her office is at the McKenzie River Community School, where she works with students and their families to process the grief that the fire left in its ashes. 

The school-based therapist position was created by a grant the school district received to provide behavioral health services to students. Shaw planned to start working at the start of the school year in September 2020, but the fire broke out on the eve of the first day of school. 

At the time, Shaw was a mental health provider at the Orchid Health McKenzie River Clinic. She evacuated from her home in Vida to her sister’s house in Eugene, where she started calling clinic patients to check on them. 

Shaw started counseling students at the school full-time in January 2021. She said parents can fill out new-patient paperwork for their children to see her; students 15 and over can fill out the forms for themselves. She meets with students during the school day. Having her office integrated into the school makes it easier for youth in a rural area to access mental health services.

Shaw said she tries to gauge how a student is doing when they visit her office. She then works with the student to figure out what they think they need.

“Sometimes kids are really clear about what they want or what they need, and sometimes they’re still figuring that out,” she said. “So I feel like I get to be their guide.”

Shaw said kids process a lot of emotions through play, so her room is furnished with a sand tray, a dollhouse, bouncy balls, art supplies and yoga mats. She works with students to name their emotions using an emotion wheel and helps them manage conflicting emotions, like gratitude and grief. 

Since youth who experienced the fire are five years older and have changed developmentally, they’ll have different language for their experiences than they did at the time, Shaw said. With some students she may not necessarily talk about the fire.

“The really cool thing about our brains and the mind-emotion connection is that today I can be feeling sad over my friends leaving me out on the playground, and as I process through those feelings of sadness, it helps me learn how to process through many feelings of sadness,” Shaw said.  

With other students, especially older ones, they might talk about having a more narrow tolerance for stress because of the wildfire and the compounding event of the COVID-19 pandemic. 

“We’re still learning and understanding how much (COVID) impacted our children,” Shaw said. “And depending on where they were developmentally, and then the fire on top of that, it’s OK if our bandwidth for stress is more narrow than what it could have been.”

She talks with the students about building self-awareness and learning what tools work for them, like deep breathing, grounding exercises, taking breaks and physical exercise. She helps them translate the tools they’re learning in counseling to the classroom and home. 

Shaw said wildfire smoke in the air can trigger anxiety for students. 

“I think we all just sort of grit our teeth a bit during fire season,” she said. 

Having a sense of control can help mitigate feelings of anxiety. Last year Shaw worked with an organization called Locals Helping Locals to host an event for students to pack “go bags” to get them thinking about what they would want or need to take in the event of another evacuation. 

She said it’s also important that kids feel connected to each other and themselves. She encourages students to foster community in their classrooms. 

“I think resiliency comes in community and learning how to be supported, plus support one another,” Shaw said. “I often tell kids just be kind to yourself and be kind to others. This could be hard for you in ways you don’t know.”

She said she’d like to raise awareness about getting help from a counselor before tolerating stress becomes too difficult. 

“Sometimes the tools that serve in one area of life don’t work a year later, and we need some different tools,” Shaw said. 

That’s where she can help.