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What do we mean when we talk about community?

The hospital’s own family, of course, is a community — the employees, patients, doctors, nurses, allied medical and support personnel, spouses, children, relatives and friends whose well-being, purpose and livelihood center on this complex organization.

But the term is usually applied much more broadly. You hear it used to describe the residents of the hospital’s surrounding neighborhood, especially if controversial expansion plans are under discussion. Commonly, it’s a synonym for the hospital’s home city. Sometimes it stretches to include the Standard Metropolitan Statistical Area, sometimes the entire state, sometimes a sprawling region, like the South. Sometimes it means the nation.

How far, ultimately, does a hospital’s “community” extend?

In times of great distress and great need, it may encompass the world.

Shared Spheres

One hospital community is made up of institutions with identical missions. So, for example, when Children’s Hospital of New Orleans found itself in crisis in August 2005 —without water or air conditioning in the wake of Hurricane Katrina —children’s hospitals in Florida, Arkansas, Missouri and Texas flocked to the rescue. They rushed planes, helicopters and personnel to evacuate the severely ill young Louisiana patients. In addition to paying for this remarkable airlift, the participating pediatric hospitals spent millions of dollars caring for the children and their families in the following months.

Closer, but still an hour’s drive inland in light traffic and as much as five hours away when the freeway is clogged with a stop-and-go exodus from New Orleans, Woman’s Hospital in Baton Rouge opened its doors to 140 premature babies from facilities devastated by the flooding in Katrina’s wake. As many as 53 nurses worked each shift to cope with the influx of fragile infants from outside the hospital’s narrowly delineated community. Under normal conditions, 27 nurses would have been working.

Many hospitals across the country mounted relief missions to fill in the gaps for the hospitals wracked and shuttered by Katrina. The Mayo Clinic, which traces its founding to a 19th-century tornado that razed Rochester, Minn., was among them. Teams of doctors, nurses and supporting clinicians from Mayo shuttled in and out of New Orleans on two-week mercy stints after the disaster, providing necessary inoculations, urgent and primary care, and mobile pharmacy services to refugees in emergency shelters throughout the area.

Five years later, Mayo made an even more ambitious commitment to helping victims of a terrible act of nature: the magnitude-7.0 earthquake in January 2010 that took nearly a quarter of a million lives and displaced more than 3 million people in Haiti. Mayo immediately donated a half million dollars toward the relief of survivors and, ultimately, dispatched eight teams of volunteer physicians, nurses, paramedics and pharmacists, along with medical supplies, to the Caribbean nation. Ongoing ties such as weekly consultations via Skype were established between Mayo specialists and doctors coping with tough cases in Haitian hospitals.

Community had now been defined by a shared hemisphere.

In fact, Mayo long has cultivated a transglobal clientele of patients willing and wealthy enough to travel to a small city in the American heartland seeking its care. Mayo clinicians already share their research and expertise with counterparts at health care organizations in the Czech Republic and China.

The international community has been wooed by many American hospital systems. The Cleveland Clinic runs an outpatient facility in Canada and will open a specialty hospital in Abu Dhabi this year with funding from its crown prince, Mohammed bin Zayed Al Nahyan. Further overseas expansion into Austria and Singapore is under consideration. Johns Hopkins Medicine International recently announced significant collaborations with health care institutions in China and Peru. The Mayo Clinic reportedly has discussed the operation of a hospital in India.

Communities pay back their hospitals generously in return. Organizations that operate as nonprofits are exempted from taxes in light of the charitable care and health-promoting benefits they provide. Volunteers flesh out staffing levels, fill important patient-satisfaction roles and carry out key governance functions. Patients and friends of the hospital donate to capital and operations campaigns in gratitude for the services delivered.

And, occasionally, a donation redefines the idea of community.

An Ill Wind

That was the case a few days after a deadly tornado gutted St. John’s Regional Medical Center along with 8,000 other buildings as it rampaged through Joplin, Mo., in May 2011. St. John’s personnel had resumed makeshift operations in a military field hospital tent set up in the parking lot, but phones were still out. So the call from Washington, D.C., was routed to the headquarters of parent organization Mercy in St. Louis.

“At first blush,” recalls St. John’s CEO Gary Pulsipher, “the people who took it were skeptical.”

Who wouldn’t be? The caller claimed to be from the embassy of the United Arab Emirates. The crown prince of Abu Dhabi —the largest of the seven principalities that make up the UAE —was said to have seen images of Joplin’s destruction on CNN. He’d been moved to offer help in rebuilding. A gift of millions of dollars toward restoration of St. John’s was proposed.

The call was no prank. “An incredible day!” Pulsipher says.

According to a story in The Washington Post, UAE Ambassador to the United States Youssef Al Otaiba had told his representatives to encourage Joplin officials to “think big” in planning how to use the promised money. Six schools also had been leveled by the tornado, their expensive textbooks scattered or ruined; Otaiba agreed to contribute $1 million so that every high school student in Joplin could have a laptop computer in lieu of restocking the lost books.

Similarly, Mercy officials were committed from the day after the tornado to erecting a new and improved St. John’s, says Pulsipher —from the ground up, on a fresh site, the old site turned over free to the school district for its recovery. But all the components hadn’t yet been penciled in. A major lack at the pre-tornado facility had been a neonatal intensive care unit, Otaiba noted. So he suggested that a $5 million donation from the UAE be used to build a 12-bed NICU — Joplin’s first.

It will open in 2015, when construction of what is now known as Mercy Hospital Joplin is scheduled for completion. Meanwhile, Pulsipher and a delegation of Joplin health system, school and city officials have just returned from a trip to the UAE at their benefactors’ expense. It’s no secret that the small, rich Arab nation, a staunch U.S. ally in the Middle East, is motivated by political considerations as well as altruism when it underwrites heart-and-mind-winning American causes. (Among other grants in aid, the emirates have given $150 million to establish a pediatric surgical research center at Children’s National Medical Center in Washington, D.C., and $100 million for Katrina recovery.)

“We went to Abu Dhabi, Dubai and Sharjah,” Pulsipher says. “They wanted us to see how their health care system works, how the government works … the only purpose was for us to get to know their culture. And it’s a wonderful culture. Very generous.”

Just what a hospital needs.

For more on how hospitals serve their communities after a disaster or mass casualty event, read our cover story, “After the Storms.”

David Ollier Weber is a principal of the Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily