Although it could eventually lead to a more equitable and effective health care system in New Orleans, Hurricane Katrina destroyed the city's already fragile health care safety net and left many of the poor lacking vitally needed services.
That was the assessment of a panel of health care providers and policymakers brought together in Washington Aug. 8 by the Kaiser Family Foundation to discuss "Health Care One Year After Hurricane Katrina."
"People are not getting the routine things we all take for granted," said Dr. Karen DeSalvo, chief of general internal medicine at Tulane University Health Sciences Center in New Orleans. "That can only go on for so long before impacting public health."
Major problem areas include mental health services and diagnostic services such as X-rays, she said.
Dr. Fred Cerise, secretary for the Louisiana Department of Health and Hospitals, said there was "a significant loss of physicians" in New Orleans and the surrounding area, estimating that the current number of doctors is 35 percent to 50 percent of pre-Katrina levels. Psychiatrists, dentists and nurses are especially scarce, he said.
Although it is "difficult to put your finger on a lot of demographics," Cerise said about 650,000 people live in New Orleans a year after the hurricane, compared to about 1 million in August 2005. Approximately 20 percent of the population --- before and after Katrina --- has no health insurance, he said.
The Louisiana official said the state had a "high-cost delivery system" for health care before the hurricane and needs "an overall delivery system fix" as the health care infrastructure is rebuilt.
Dr. Irwin Redlener, president of the Children's Health Fund and director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health in New York, said Katrina has had "one of the most dramatic mental health impacts we've ever seen," particularly among children.
"The uncertainty factor is devastating," Redlener added. "It's the worst child health crisis that we have seen in American history."
Following Hurricane Katrina and the subsequent flooding of New Orleans, the Children's Health Fund set up Operation Assist, which sent a caravan of mobile medical units to Gulfport, Miss., and New Orleans; trained mental health professionals to understand and assess trauma in children; studied mold exposure and respiratory health among school-age children evacuated from New Orleans; and established three permanent clinics in Louisiana and Mississippi.
Surveys of children following the storm showed that 14 percent had witnessed the death of a relative, said Dr. Dominic Mack, project director of the Regional Coordinating Center for Hurricane Response at the National Center for Primary Care of Morehouse School of Medicine in Atlanta.
His center is working on five ways to improve health care in the region --- increased use of telemedicine, community-based screening and surveillance, greater use of electronic health records, development of a research network and a more equitable health care system.
"We need to put a health care infrastructure in place that responds to the needs of the underserved population," Mack said.
Attention must also be paid to the needs of the elderly and disabled living in long-term care facilities, said Dr. David Dosa, assistant professor of medicine at Brown Medical School in Providence, R.I., and an expert on nursing home regulation and emergency preparedness.
"In some cases local communities came to the rescue" of nursing home residents after Katrina, he said. "In other cases they didn't."
But interviews with nursing home administrators months after the hurricane showed a universal belief that "we are on our own for future evacuations," Dosa said.
When government officials initially ordered the evacuation of New Orleans, residents of long-term care facilities were exempted, he noted. But by the time evacuation became essential, roads were already clogged and the specialized transportation needed was unavailable, he said.
"I don't know if evacuating or not evacuating is the best option," Dosa said. "But we have to avoid hysterical evacuations."
He also called for legal reforms to protect those working to help nursing home residents in such situations, saying that the first billboards to go up in New Orleans after Katrina advertised lawyers offering to help people sue.
In addition to hosting the panel discussion, the Kaiser Family Foundation released a video and booklet based on interviews with more than 40 survivors of Hurricane Katrina about their health experiences, as well as the results of a survey about Americans' attitudes about the response to Hurricane Katrina.
Although "the feeling on the street (in New Orleans) is that the country has moved on," the survey found that 70 percent do not think the hurricane victims have gotten the help they need and 60 percent think about Hurricane Katrina and its aftermath very or somewhat often, said Drew Altman, president and CEO of the Kaiser Family Foundation.
On New Orleans specifically, 52 percent of respondents said "there is still major work to be done to get the city up and running again" and another 30 percent believe that "the city is still in crisis and not functioning well at all," he said.
The margin of error for the survey, conducted in June, was plus or minus 3 percentage points. ---CNS |