Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster.
In 2005, a train derailment and subsequent chlorine spill ravaged the rural town of Graniteville in South Carolina, resulting in one of the worst chlorine gas exposures in US.



Significant health and economic challenges persist in the community more than a decade later. Healthcare providers offered healthcare services to community members in the immediate aftermath of the disaster, and many still live in the community and continue to provide healthcare services. As such, healthcare professionals provide a unique and important perspective to help understand the impact of the disaster on the community's health. The purpose of this study was to explore healthcare providers' perspectives about the long-term effects of the disaster on community health, healthcare access, and wellbeing.



Semi-structured interviews were conducted with 30 healthcare providers who treated survivors of the Graniteville train disaster. A qualitative, essentialist, inductive thematic analytic approach was used to analyze study data.



Four themes emerged regarding the disaster's long-term impact: effects of chlorine exposure on physical health, issues with healthcare access, residual effects of the disaster on personal and community wellbeing, and improving health and community wellbeing.



Disaster recovery should not be considered solely an acute event; agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities. Efforts to address the long-term health needs of communities post-disaster should consider the perspectives of healthcare providers to offer a well-rounded assessment of community needs. Study findings can help inform future disaster response strategies in communities locally and globally.
University of South Carolina, Department of Health Promotion, Education, and Behavior, Columbia, South Carolina, USA. lannang@sc.edu.
Lucy
L
Annang Ingram
University of South Carolina, Department of Health Promotion, Education, and Behavior, Columbia, South Carolina, USA. tinago@email.sc.edu.
Chiwoneso B
CB
Tinago
University of South Carolina, College of Nursing, Columbia, South Carolina, USA. robin.estrada@sc.edu.
Robin
R
Estrada
University of Maryland-College Park, School of Public Health, College Park, Maryland, USA. swilson2@umd.edu.
Sacoby
S
Wilson
GRACE Study Center, Graniteville, South Carolina, USA. louwright@earthlink.net.
Louisiana
L
Wright Sanders
GRACE Study Center, Graniteville, South Carolina, USA. bevington1959@hotmail.com.
Tina
T
Bevington
171 Ashley Avenue, Charleston, SC 29401. carlosb@musc.edu.
Bethany
B
Carlos
University of South Carolina, PASOs/CLIS, Columbia, South Carolina, USA. ecorneli@mailbox.sc.edu.
Evangeline
E
Cornelius
Tulane University School of Public Health and Tropical Medicine, Department of Global Environmental Health Sciences, New Orleans, Louisiana, USA. esvendse@tulane.edu.
Erik R
ER
Svendsen
University of South Carolina Aiken, School of Nursing, Aiken, South Carolina, USA . JuliaB@usca.edu.
Julia
J
Ball
D000328:Adult; D001291:Attitude of Health Personnel; D055884:Chemical Hazard Release; D002713:Chlorine / Q000009:adverse effects*; D004190:Disasters; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D011890:Railroads; D019035:Rural Health Services / Q000458:organization & administration*; D013022:South Carolina; D013997:Time Factors
D002713:Chlorine
Environmental Health; Medical; North America; Primary Health Care; Public Health; Qualitative Research