Charlie Riedel / AP Five days after a fertilizer plant explosion, volunteer Albert Saenz, from China Spring, Texas, clears debris from a home belonging to Ray and Patti Rosales on April 22, in West, Texas.

The Red Cross, the Salvation Army, the Knights of Columbus and the Veterans of Foreign Wars are all in West, Texas, to help victims of this month’s fertilizer explosion. They've collected tens of thousands of dollars, piles of clothes, toys and food.

It’s been almost chaotic, with volunteers piling in and shelters popping up everywhere. But instead of clamoring for the aid, many of the 3,000 or so residents of this small, central Texas town are instead fighting to help one another. That’s just as well in Texas, where the official government line is self-sufficiency.

“Right after the explosion happened that evening, there were shelters opened up all over the place,” said Ryan Adams, Grand Knight of the Knights of Columbus Council in West. “They originally evacuated the entire town. But those shelters were empty because we all help one another in our community. Most of the people that are displaced from their homes, being such a small, tight-knit community, they are staying with family. They are staying with friends.”

While the help is pouring in, it's still not entirely clear to anyone who's in need, what, precisely, they do need or where the money should go first. Coordinating all that is still a work in progress.

The April 17 explosion at West Fertilizer killed 15 people and injured as many as 180. Investigators are still trying to figure out what caused it, but the blast at the 10-acre plant left a crater 10 feet deep and more than 90 feet across, destroyed two schools, a nursing home and a nearby apartment building and shook homes 50 miles away.

Most of those killed were volunteer firefighters rushing to help put out the fire that preceded the explosion, while many of the injured were elderly residents of a nearby nursing home who couldn’t be moved quickly when the fire started.

Nurse Tammy Adams says she still has blood in her car from patients she ferried from the nursing home to a community center, where ambulances picked them up and took them to nearby hospitals. It all happened so quickly, Adams didn’t have a chance to take note of who went where. “I don’t know what happened to any of them,” Adams said in a telephone interview.

'Regulate-yourself' environment

While victims are turning to their friends and relatives, by most accounts, they are not looking to the government for help – something citizens of this deeply conservative area scorn. And that’s just as well, because there’s not much help on offer – especially when it comes to medical care.

“I haven’t had any calls requesting assistance,” said Eva Cruz Hamby, who heads health services for McLennan County. In Texas, the counties pick up indigent health care. If the calls do start coming in, the available money won't go very far. “There is a limit of $30,000 per fiscal year. That is not much care,” Hamby added.

Slideshow: Fertilizer plant explosion in Texas Kevork Djansezian / Kevork Djansezian / Getty Images A huge blast rocked a small Texas town causing an unknown number of deaths and destroying nearby homes. Launch slideshow

Nearly a quarter of the population of Texas lacks any health insurance. That means many of the 160 or more people treated at area hospitals will end up getting charities to pay for their care. Most of the nursing home residents are almost certain to have been covered by Medicare, the federal health insurance plan for the elderly.

Hospitals will likely pick up a big part of the tab for those they have treated. Providence Health Center in nearby Waco treated 87 of the injured, 21 of them who were admitted as patients. Spokeswoman Heather Beck says all have since been discharged.

They treated many minor burns, cuts, broken bones and head injuries. At least one seriously ill patient had respiratory distress from breathing in caustic ammonia fumes.

Beck won’t comment on how patients will pay their bills. Nor would other hospitals that treated patients from the explosion, including the not-for-profit Scott & White Healthcare system of hospitals. “Providence does do charitable care all the time,” Beck said, adding that the hospital provided about $35 million worth of charity care last year.

Eva de Luna of the Center for Public Policy Priorities, which is pressing for more government regulation in Texas, says 31 percent of McLennan County’s residents are poor and uninsured. “This is what happens when you have a low taxes, low government, regulate-yourself type of environment,” she said. “Food stamps and Medicaid are pretty much it in Texas.”

Some help has also arrived for victims in the form of financial donations from people around the country.

"It has been a terrific outpouring,” said a spokesman for State National Bank, one of two banks in West collecting donations. The spokesman, who declined to give his name, said tens of thousands of dollars had been donated. “It is unbelievable, the support,” he said.

Charles Nemec, president of PointWest Bank, agrees. “I have got all I can handle,” he said. “We have handed out a lot of money.” He won't say precisely how much, but says it's "thousands".

The Knights of Columbus has collected $100,000, but all the aid groups agree the cash won't go too far as people seek to rebuild homes that may have to be razed and started from scratch.

'Everybody is family here'

Town officials are planning to meet with the various charitable organizations this week to work out a way to distribute the aid fairly, without duplicating efforts, Ryan Adams of Knights of Columbus says.

“There were a lot of people that the only clothes they had were clothes on their back,” Adams said. “Now that we have made it through that first wave of immediate need, we as a council are working with the mayor’s office to take inventory of the need.” Knights of Columbus is still accepting donations online.

Like so many other residents of West, Adams, the nurse, is both victim and volunteer, striving to help those even worse off than her.

She lost her job when the West Rest Haven Nursing Home was damaged beyond immediate repair. “We all have to find work,” she said. “I looked at three places today for a job.”

Yet Adams is collecting donations from friends and family for her homeless neighbors. “I have toothpaste, toothbrushes, clothes, water. I gave out bicycles to kids,” she said. “That’s how we work. Everybody is family here."

Related: How you can help

Tom Smith, director of the Texas office of consumer advocacy group Public Citizen, says Texas policies will leave many of West’s residents reliant on charity.

“The average income of people in West is substantially below the state average,” Smith said.

Texas has declined to expand Medicaid to more low-income people who lack health insurance. Adams is now one of them. “My kids are on Medicaid now. They say I don’t qualify,” she said. “There’s nothing I can do until I get another job.”

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