Samuel Lowenberg - Independent Journalist biography articles articles

Louisiana looks back on a week of disaster

The Lancet  September 10, 2005

As the stagnant waters submerging New Orleans start to be pumped away, officials are ending their search for survivors and counting the dead. One of the most shocking aspects of the crisis has been the poor emergency response. But, says Samuel Loewenberg, the failure is no real surprise.

The inundation of the American southern coastal states by Hurricane Katrina was described in its first days as a “disaster of biblical proportions”. In New Orleans, a city that was 80% underwater, as many as 10,000 people may have died, according to Louisiana officials. With the water now finally being pumped away, it has become clear that the terrible human toll of the devastation was not just due to the unknowable workings of mother nature, but the result of action, and inaction, by man and his institutions.

In fact, the scope of the destruction was no surprise; it had been predicted. The casualties were not equally spread throughout the population, but were concentrated on the black and poor. The failed emergency response was not due to lack of resources, but to a lack of coherent planning. The result was a complete breakdown of the publichealth infrastructure and civil society. Ambulance crews were shot at, tourists were raped in hurricane shelters, and the elderly and infirm were abandoned by their caretakers. Emergency response trauma teams from other states reported driving hundreds of miles only to be met with blank stares by uninformed federal disaster officials.

On the fourth day of the hurricane, Michael Brown, head of the Federal Emergency Management Agency, told CNN that the US Government had only just learned that thousands of people were stranded in the New Orleans convention centre without food or water. By the weekend, the world’s only superpower was so overwhelmed by the crisis that it appealed to the EU for blankets, tents, and food.

“People in the medical and health professions have got to be stunned watching people for 5 days without medical assistance and water”, says Irwin Redlener, director of the National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health.

The victims of the hurricane were overwhelmingly black and poor. This is a reflection of the population of New Orleans and the public health and emergency systems that failed them, both before and during the crisis. Now that the immediate crisis is coming to an end, that same population will bear the brunt of the public-health aftermath: lack of water and food, an absence of medical care for new and pre-existing health problems, and infections caused by the polluted flood waters.

“This is the classic public-health vulnerability of undeserved and disadvantaged populations”, says Redlener. “We are seeing the horrible outcome of a health and economic system that has left so many people out.”

One of the most dramatic, and horrible, examples of the inequality of the disaster was that of Charity Hospital, where 600 patients and medical staff were trapped for more than 4 days behind torrents of sewage and contaminated water, cut off from electrical power, clean water, and medical supplies. While Charity, the largest public hospital in Louisiana, went without relief in the days after the hurricane, the private facility across the street, Tulane University Medical Center, hired 20 private helicopters to evacuate its 1400 patients and family members.

The public hospitals, though, were left to fend for themselves. After 4 days of isolation, doctors from Charity called the Associated Press begging for assistance. “We have been trying to call the mayor’s office, we have been trying to call the governor’s office . . . we have tried to use any inside pressure we can. We are turning to you. Please help us”, Norman McSwain, chief of trauma surgery at Charity Hospital, was quoted by AP as saying. Another public hospital a few blocks away, University Hospital, was similarly left on its own. Lee Hamm, chairman of medicine at Tulane University, took a canoe check on the two public hospitals. Speaking to AP after the trip, he said: “The physicians and nurses are doing an incredible job, but there are patients laying on stretchers on the floor, the halls were dark, the stairwells are dark. Of course, there’s no elevators. There’s no communication with the outside world.”

“We’re afraid that somehow these two hospitals have been left off . . . that somehow somebody has either forgotten it or ignored it or something, because there is no evidence anything is being done”, said Hamm.

The breakdown of the public-health infrastructure in the wake of the hurricane was neither new nor unexpected. New Orleans residents were accustomed to living with the prospect of disaster—much of the city sits below sea level, protected by a fragile system of levees, pumps, and canals designed in the 1960s to withstand a weaker storm.

Each problem resulting from the flood was exacerbated by the city’s extreme poverty. 28% of New Orleans residents live below the poverty line— three times the national average—and 24% of adults are disabled, compared with 19% nationally.

Government officials had warned about the disastrous results of a major storm for years. A particularly detailed briefing was given 2 years ago by a group of scientists at the Center for the Study of Public Health Impacts of Hurricanes at Louisiana State University (LSU). “Flooding in New Orleans from a major tropical storm is a disaster waiting to happen”, warned Kevin Robbins of the Southern Regional Climate Center.

In a Sept, 2003, briefing, researchers told local and federal officials, including representatives of the US Centers for Disease Control and Prevention and the Environmental Protection Agency, that in the event of a major hurricane, hospitals would be isolated and that evacuation procedures in poor areas would fail.

25 hospitals in the New Orleans area were effectively cut off by floods during a deluge in 1995, according to research presented by Jim Diaz, a director of the Public Health and Preventative Medicine at the LSU Health Science Center. Diaz presented research showing that ”44% of hospitals cancelled all elective procedures, cancelling all surgical procedures, 32% had nursing shortages, 25% had doctor shortages, 18% had no sewage, 11% had no potable water, 7% had medical supply shortages, and 4% had food supply shortages.”

The failure of evacuation procedures was also predicted—with low-income residents being the primary losers. While 87% of those earning over US$50 000 said they would evacuate, only 44% of people earning under $15 000 said they would leave. That correlated with the number of people who owned cars: 74% of those who did would leave, compared with 50% of those who did not. And devastatingly, only 43% of those describing themselves as in “poor” health, said they would leave, as opposed to the 68­73% of those in “fair” health or better who said they would flee. That study was based on the preliminary findings of a study by researchers based at LSU and at the University of Calgary, Canada.

In the aftermath of the storm, doctors moved from patients who had sustained injuries during the storm to its after-effects. “Now we’re seeing posttraumatic stress-type stuff, a lot of babies with fevers, general viral-type stuff, and dehydration”, George Ward, director of the emergency room at Memorial Hospital told The New York Times.

The problems are compounded by the vast geographical spread of the catastrophe, says Redlener. “We’re not used to this at all. Normally you have neighbouring communities that can help. Now, there is no 911. You have a situation of the non availability of a health care system. It’s like we are dealing with medical care of 150 years ago”, he says.

While New Orleans city officials have expressed concerns about infectious disease outbreaks caused by the hundreds of dead bodies decomposing in the flood waters, public health experts say that they do not expect such outbreaks to occur. In the aftermath of similar disasters, like the Asian tsunami, episodes of cholera were very limited. The problems posed by infection from exposure to the water are very high, however. “Probably the more immediate health risk to the people is that whatever was in the sewer is in the water”, John Pardue, director of the Louisiana Water Resources Research Institute at LSU in Baton Rouge, told AP. New Orleans, incidentally, had been set to host a major infectious-disease conference this month.

The medium and long term effects of the disaster are now beginning to play out. Experts warn that the evacuees may be cut off from medical care and drugs are they are moved to makeshift relocation centres across the country. “What is unfolding now is an absolute formula for disaster”, says Redlener.

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