Early in the morning on August 29, 2005, Hurricane Katrina made landfall near the Louisiana–Mississippi border, along the Gulf Coast. More than 1,800 people died (hundreds are still considered missing); thousands were left homeless; and Katrina went on record as one of the most destructive storms, in terms of economic loss.
Figure. Broken furni...Image Tools
But five years after Katrina, Gulf Coast residents find themselves facing another threat. The British Petroleum (BP)–Deepwater Horizon oil spill is taking a toll on both the tourist and fishing industries, has caused extensive environmental damage, and may even present a health threat to residents. This devastating event has already undermined some of the progress made since Katrina came to shore, and its ultimate toll will be unknown for some time to come.
HEALTH CARE EVOLVING
Katrina severely damaged the health care infrastructure in the regions affected by the storm, and the availability of health services declined significantly. The city of New Orleans was particularly hard-hit as a result of the failed levee system and subsequent catastrophic flooding. Medical Center of Louisiana at New Orleans, which consisted of Charity and University hospitals and was the primary health care safety net for many of the uninsured and Medicaid patients, closed its doors. There was an exodus of health care workers from the city, including physicians and nurses, resulting in severe staffing shortages. Overall, the city's inpatient bed capacity dropped by more than 50%, and only 19 out of 90 ambulatory care clinics remained open.
Charity Hospital remains shuttered, but the city's health care system hasn't been idle—it's been evolving. Two years after Katrina, the U.S. Department of Health and Human Services awarded the Louisiana Department of Health and Hospitals the $100 million Primary Care Access and Stabilization Grant (PCASG) to help restore and increase access to primary care in the Greater New Orleans Area. (See www.pcasg.org for more on the program.)
The result was the creation of a network of more than 90 independent, neighborhood primary care clinics. And findings of a survey conducted in 2009 by the Commonwealth Fund are encouraging. (For primary findings and links to the full report, go to http://bit.ly/4KFZyj.)
"The report clearly lays out that in New Orleans clinics that received PCASG funding, patients experience fewer problems with accumulated medical debt and accessing care because of cost than adults in the country as a whole," said Michelle M. Doty, PhD, assistant vice president and director of survey research for the Commonwealth Fund and first author of the survey report.
"Almost all surveyed clinic patients reported that they had easy access to care, indicating that they were able to make same- or next-day appointments when sick, that it was easy to get medical advice over the phone during regular practice hours, or that it was easy to get after-hours medical advice."
Doty pointed out that 79% of patients reported excellent patient–clinician communication and that nearly all patients (98%) said there was a physician or other health provider at their clinic who understood important features of their health or medical history.
A major challenge to the program, however, is finding continued funding for the clinics. "The funding was from a one-time $100 million infusion that's now running out," said Lisanne Brown, PhD, MPH, director of the Division of Evaluation and Research at the Louisiana Public Health Institute. "What's going to happen next is up in the air."
The goal was for the clinics to become sustainable, and some have been more successful than others. "Part of the problem is that we have such a huge uninsured population," said Brown, who added that many adults in the area aren't eligible for Medicaid. "Hopefully, health care reform will change some of that, but that's not going to start for another three years. In the meantime, we're looking into other funding sources to keep the clinics from going under."
Charity begins at a new home. There are also plans to rebuild Charity Hospital, although that project is being hotly contested. The new site is about half a mile away from the old hospital, in a lot adjacent to a Veterans Affairs hospital; the new Charity Hospital will be a much larger facility.
"It will be at least 10 times larger and take up about 20 city blocks," said Brown. "The problem is that they're going to have to tear down some neighborhoods in order to build it."
There are arguments on both sides of the issue, Brown said. "Charity Hospital was in pretty poor shape before the hurricane, and it was never well maintained." It would also be impossible to rebuild it on the current site, she said, because the new facility is going to be so much bigger than the old one.
MENTAL HEALTH ISSUES
Providing adequate mental health care is still an ongoing problem that's been further compounded by recent changes to the state budget; the state's health care budget was slashed across the board, and that included mental health services, said Brown.
Many of those who survived Katrina suffered consequent psychological problems, and studies show that these haven't all been resolved. "There's still a lot of anxiety and depression and posttraumatic stress syndrome. And there are still higher rates of child abuse and substance abuse," said Gina Solomon, MD, MPH, a senior scientist at the Natural Resources Defense Council and an associate professor of medicine at the University of California, San Francisco. "These people were hit hard, displaced from their homes, set back economically—and many developed mental health problems."
The BP oil spill is like a "second hit" and will most likely worsen mental health concerns, said Solomon. "The shrimp and fishing industries were destroyed by Katrina and Wilma and Rita. The industries were closed and took a major economic hit, and when they were just starting to get back on their feet, this happened. The economic and subsequent emotional toll will be enormous."
The oil spill has the potential, added Brown, to undo much of the progress that had been made toward resolving mental health issues that emerged in the wake of Katrina.
"For people who've lived their entire life on the water and made their livelihood from it," she said, "suddenly, it's gone, and we don't know if it will ever return." Psychiatrists who worked with Katrina survivors, and who are now holding group sessions in areas affected by the oil spill, report that they're seeing many of the same symptoms, including depression, anxiety, anger, increased alcohol use, and suicidal thoughts. The suicide of an Alabama charter boat captain in June was a jolt to the community, and authorities expressed hope that his death would motivate others to seek appropriate help.
Many of the environmental issues that surfaced immediately after Hurricane Katrina have largely been resolved. The problem of soil contamination has been addressed, water-damaged structures have been removed, and moldy areas have been cleaned up, said Solomon.
The oil spill now presents a whole new set of problems. The devastating effects on the area's wildlife and ecosystems are well documented, but the ultimate effect on human health is as yet unclear.
Brown also pointed out that members of the fishing community have been hired by BP to help in the cleanup operations. Although this can bring in desperately needed income, and they're being paid well, their health may be endangered.
"The fishermen haven't been fully trained in how to work safely with hazardous materials," she said. "They're given a four-hour course, and we've heard reports that they may not be getting adequate protective equipment. So now their health is at risk, in addition to their livelihood." —Roxanne Nelson, BSN, RN
© 2010 Lippincott Williams & Wilkins, Inc.