This commentary draws attention to a number of factors that may have converged, and in the process, exacerbated the effects of hurricane Katrina on the health and wellbeing of the people of New Orleans.
Hurricane Katrina's impact on the infrastructure of public health and the health care system in the affected areas was unprecedented in the United States. Many dental offices were flood-bound in New Orleans and over 60% of dental practices were partially or completely damaged in affected counties in Mississippi. Most needs assessments conducted during the initial recovery operations did not include questions about access to oral health care. However, the extent of the destruction of the health care infrastructure demonstrated the need for significant state and federal support to make dental treatment accessible to survivors and evacuees. The Katrina response is one of the few times that state and federal government agencies responded to provide dental services to victims as part of disaster response and recovery. The purpose of this paper is to share our experiences in Mississippi and the District of Columbia providing urgent dental care to disaster victims as part of a crisis response.
In the days after Hurricane Katrina struck and New Orleans's infrastructure failed, hospitals and other organizations that have custodial responsibility for human beings (such as nursing homes and jails) faced special difficulties. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage service, and many of these hospitals required external assistance, which was slow to arrive. Meanwhile, patients' needs for care continued unabated. Some hospitals evacuated all patients successfully, but by the end of that long week, some had become places of death. This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences. We conclude with lessons based on the Katrina experience.
Five agencies providing home health care to indigent populations in New Orleans, Louisiana were evaluated in terms of emergency planning and implementation. This was to help improve response to community disasters for indigent populations. Preparation for Hurricane Katrina was examined looking at interaction with local and state departments of health. It was found that the state dept of health provided leadership in making the emergency plans, but not in implementation. Local departments of health appeared to have very little responsibility in emergency planning. Although every agency had a plan, when it came to implementation there was lack of coordination and breakdown in communication at all government levels. Recommendations for future policy include: 1) early evacuation of special needs patients; 2) improved training of staff to include practice drills; 3) improve communication systems; and, 4) increased funding of state and local departments of health to provide training.
The immediate aftermath of Katrina focused the world's attention on the vulnerability of the urban poor and racial/ethnic minority groups in New Orleans. This vulnerability can be viewed in terms of site, the proximity of a neighborhood to a hazard, and situation, the social context of that neighborhood. Vulnerabilities, associated with demographic characteristics such as being poor, being a member of a racial/ethnic minority group, and being female, will strengthen the force of a disaster. This paper uses a site and situation approach to show how maps of the five main sources of disaster-related stress in New Orleans can be used to predict where counseling resources should be targeted.
On August 29, 2005, Hurricane Katrina devastated the Gulf Coast Mississippi region, damaging health care infrastructure and adversely affecting the health of populations left behind. Operation Assist, a project of the Children's Health Fund and the Columbia University Mailman School of Public Health, operated mobile medical units to provide health services to underserved populations in the affected areas. Data collected from all patient encounters from September 5–20, 2005 demonstrate that in addition to common respiratory illnesses, skin conditions, and minor injuries, a high proportion of visits were for vaccine administration and chronic medical problems including hypertension, diabetes, and asthma. Mobile medical units staffed by primary care clinicians experienced in dealing with the clinical and social needs of the underserved and comfortable working in a resource-poor environment can make a positive contribution to post-disaster care.
Hurricane Katrina has drawn increased interest in coping strategies, spirituality, and mental health among low-income Blacks. Given the paucity of information available regarding the role of spirituality in surviving Hurricane Katrina, this qualitative study explores active coping strategies of older Blacks. Older respondents who were evacuated to a Texas retirement apartment complex participated in a series of three in-depth interviews (starting approximately three weeks after their arrival in the host state and continuing weekly). Without exception, the findings indicate that this population coped with Katrina and its aftermath through reliance on a Higher Power. The relationship to a Higher Power did not necessarily translate into church membership. The conclusions of the respondents' spiritual coping mechanisms revealed the following themes: 1) regular communication with a supernatural power; 2) miracles of faith through this source of guidance and protection; 3) daily reading of the Bible and various spiritual and devotional materials; and 4) helping others as a consequence of faith and devotion to a supreme being. This study indicates that spirituality promotes emotional resilience in the aftermath of traumatic events such as Hurricane Katrina. These findings also point to the need for researchers to reconsider expressions of spirituality based solely on church membership/attendance and prayer, and to consider redefining spiritual coping as a form of cultural capital.
During September 2005, 3,600 Gulf Coast evacuees arrived in metropolitan Denver, in the aftermath of Hurricane Katrina. To better meet the medical and non-medical needs of this displaced population, a rapid needs assessment was conducted among 106 evacuee households. The assessment identified a large need for prescription medications, with 60.2% of households requiring prescription medications and 38.8% of these households lacking these medications at the time of the survey. The assessment also identified self-reported symptoms consistent with altitude sickness and the region-specific need for education on the effects of Denver's mile-high altitude. Finally, the assessment identified differential needs based on race; non-Hispanic Black households were more likely than non-Hispanic White households to require employment, housing, and dental services. These findings illustrate the importance of conducting rapid needs assessments in displaced populations, to identify unique regional, cultural, and other unanticipated needs, as well as to recognize the needs of specific sub-populations.
On August 29, 2005 Hurricane Katrina struck Louisiana, Mississippi, and Alabama. During the aftermath of the storm, hurricane victims were evacuated to over 1,000 evacuation centers in 27 states. Three-hundred and twenty-three evacuees from 220 households were provided housing, food, and medical care at an evacuation center in West Virginia. A needs assessment followed to identify current needs of the evacuees. One-hundred and sixty-four evacuees were interviewed. Twenty-five percent reported an acute illness, while 46% reported having at least one chronic medical condition. The greatest need reported was for dental care (57%), followed by eyeglasses (34%), dentures (28%), and medical services (25%). Two weeks after the hurricane, the basic needs of food, shelter, and hygiene were met. The assessment identified and led to a successful response regarding the ongoing need for durable medical equipment (dentures and eyeglasses), as well as dental care.
Objective. Hurricane Katrina, making landfall in the U.S. in late August 2005, disrupted the medical infrastructure of New Orleans. We hypothesized that Hurricane Katrina measurably affected the ability of patients with sickle cell disease (SCD) to receive necessary and adequate health care. Differences in health care delivery among children and adults in New Orleans prior to the hurricane prompted our interest in these two groups. Methods. In May 2006, an anonymous survey was administered via either telephone or written questionnaire to patients in the greater New Orleans, Louisiana area with SCD and/or their guardians. The survey was intended to gauge patients' access to and satisfaction with specialized health care in the months following Hurricane Katrina. Conclusions. Adult patients with SCD who relied almost exclusively on New Orleans' main public hospital (Charity Hospital) for specialized sickle cell services reported significant frustration/dissatisfaction with their medical care eight months after the storm. In contrast, pediatric patients with SCD and their guardians, who rarely received care within the public hospital system, reported more satisfaction with their care. There was a statistically significant difference between the two groups in their responses to the perception of quality of their health care.
This study examined differences in evacuation, crisis preparation, information-seeking patterns, and media use among the communities of disabled and non-disabled evacuees in the aftermath of Hurricane Katrina. Surveys were collected from 554 Katrina evacuees temporarily relocated in different areas of the United States. Results indicate differences in crisis preparation and evacuation plans, with disabled subpopulations being more likely to prepare emergency supplies but less likely to have an evacuation plan. Differences between the disabled and non-disabled subpopulations also existed in information-seeking habits. Media use was similar between disabled and non-disabled respondents.
Children with chronic conditions may be at risk of increased disruptions in health care following natural disasters such as Hurricane Katrina. The objective of this cross-sectional study was to evaluate differences between children and adolescents with and without chronic conditions immediately following Katrina. Of 531 participants, there were 79.8% younger than 13 years old, 50.5% male, 42.8% African American. Participants with pre-existing conditions (39.4% of the total sample) were more likely than those without to be at the clinic for a non-chronic health condition rather than another problem (43.5 vs. 16.2%), to take asthma medication (37.4 vs. 3.9%), to have asthma worsen (16.3 vs. 1.9%), to miss a visit (49.2 vs. 39.8%), to run out of medications (33.9 vs. 7.9%), to live with flood damage (19.7 vs. 11.3%) or mold (23.6 vs. 15.8%), and to experience disruption in care (58.4 vs. 38.3%) or negative psychological consequences (ranging from 2.5% to 12.9%). While the medical differences are unsurprising, given the groups being compared, the other differences between the groups merit attention from policymakers and health care providers. Children and adolescents with chronic conditions are at increased risk of adverse outcomes following a natural disaster. Providers may be able to reduce negative effects on this population by developing condition-specific preparedness care mechanisms.
This study assesses the public health functions played by news information and social capital in the context of Hurricane Katrina. In-depth interviews were conducted with 57 hurricane shelter residents between 4 and 6 weeks after the hurricane. Depression was more common for participants who relied more on news information than for other participants after the hurricane (adjusted odds ratio [AOR], 5.49; 95% CI, 1.29 to 23.35; p=.021). Depression was more common for participants with relatively low levels of pre-hurricane positive social interactions (AOR, .16; 95% CI, .02 to 1.83; p=.046) and post-hurricane positive social interactions (AOR, .02; 95% CI, .00 to .74; p=.033) and high levels of post-hurricane negative social interactions (AOR, 17.05; 95% CI, .92 to 315.64; p=.047). Illness and injury were more common for participants who had relied more on news information than for other participants after the hurricane (AOR, 1.13; 95% CI, 1.02 to 2.77; p=.046).
The Regional Coordinating Center for Hurricane Response (RCC) collaborated with the EXPORT Centers (Centers of Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training) to rebuild, revitalize, and improve the health care infrastructure in the Gulf Coast states damaged by Hurricanes Katrina and Rita. This initiative aims to enhance the provision of health care by installing Electronic Health Records and Telepsychiatry systems throughout the Gulf Coast. Through the EXPORT Centers, the RCC plans to perform screening and surveillance projects within the communities and develop research projects focused on eliminating health disparities affecting underserved populations in the region. Another goal is to establish partnerships with EXPORT Centers, Community Health Centers, and other essential primary care practices in hurricane-ravaged communities. Through these partnerships, the overarching goal is to create a balanced health care system model that academic institutions can integrate into preventive care for emergency planning and research.
This article examines health concerns identified by Latinos who resided in the path of Hurricane Katrina in New Orleans and Mississippi. Data were collected for this qualitative descriptive study through individual, open-ended interviews with 93 Latino survivors and evacuees in Louisiana, Mississippi, and Georgia. Findings describe health concerns and experiences, including hunger, environmental health risks, sleep disturbances, and access to health care for acute and chronic conditions. Health and illness factored into personal and family decisions on whether or not to stay, evacuate, or return home following the storm. Problems accessing health care were compounded for the undocumented and uninsured. The findings have implications for further disaster research and may inform emergency preparedness policy development and the planning and implementation of disaster-related health care services for Latinos and other minority and underserved groups.
This paper describes the level of public emergency knowledge and perceptions of risks among Latin American immigrants, and their preferred and actual sources of emergency preparedness information (including warning signals). Five Latino community member focus groups, and one focus group of community health workers, were conducted in a suburban county of Washington D.C. (N=51). Participants came from 13 Latin American countries, and 64.7% immigrated during the previous five years. Participants had difficulty defining emergency and reported a wide range of perceived personal emergency risks: immigration problems; crime, personal insecurity, gangs; home/traffic accidents; home fires; environmental problems; and snipers. As in previous studies, few participants had received information on emergency preparedness, and most did not have an emergency plan. Findings regarding key messages and motivating factors can be used to develop clear, prioritized messages for communication regarding emergencies and emergency preparedness for Latin American immigrant communities in the U.S.