Disaster Recovery: Public Health Challenges 10 Years After Hurricane Katrina
By Juanita Graham, DNP, RN, FRSPH
Faculty Member, School of Public Health at American Public University
On August 29, Mississippi will commemorate the 10th anniversary of Hurricane Katrina, the single greatest natural disaster ever experienced by the state.
Damages exceeding $125 billion encompassed all 82 Mississippi counties. A 30-foot storm surge wiped out 90 percent of the buildings along the Gulf Coast, 238 people died, and 67 people went missing.
Public health nurses from all over the state were deployed for disaster recovery efforts. I first saw the damage on September 1, 2005, just two days post-storm, after a nurse friend and I climbed through nearly a mile of debris to get to the beach. We saw what seemed like an endless line of bare foundations where stately and historic coastal homes had stood just a few days before. This past June, I spent three days on the coast and, regretfully, I must report that 10 years later, many of those slabs remain bare.
Mississippians are no strangers to challenges. The state has some of the worst health outcomes, including decades of leading the nation in the highest rate of infant mortality, a key indicator of the overall health of a population. We employ our humor and strength to get us through trying times like the Katrina disaster, which is well illustrated by this photo I took of a Rolls Royce and fern pillar parked next to the FEMA trailer that replaced these resident’s beach-front home. The photo also illustrates another point: The social determinants of health do not apply in times of disaster. One’s personal resources or attributes do not increase or decrease the risk of being the victim of a natural disaster.
Assessing Health Needs After Katrina
The state sought partners and resources to rebuild. One partnership was sought with the CDC’s Division of Reproductive Health (DRH) to help assess the needs of the Gulf Coast maternal and child health population. My research team was delighted to help CDC DRH pilot a survey tool designed for just that purpose. Utilizing a group of local nursing students as data collectors, the team interviewed more than 100 coastal women in waiting rooms of six federally qualified community health centers. The women were eager to tell their stories and many stood in line waiting to speak to a student, even after all of the small incentives had been disbursed.
There were weaknesses and limitations to the pilot project, but, as a team, we did the best we could, given the sparse resources in the region. It was those weaknesses and limitations that provided valuable insight as to what challenges a researcher might anticipate in a significant post-disaster setting.
Impact of Disaster on Infant Mortality Rates
As expected, many women described long waiting periods for appointments and low availability of services. Most notably, about 40 percent of the women said they usually got their family planning services at a hospital emergency room, certainly not the best setting for quality reproductive healthcare. Given Mississippi’s history of high rates of infant mortality, this finding was a grave concern.
As it turned out, the state recorded an infant mortality rate (IMR) of 11.4 per 1,000 live births for the calendar year 2005, the highest rate during the 20-year span of 1994 to 2013. There was insufficient data to confirm any correlation between the high 2005 IMR and Hurricane Katrina. But, the limited findings derived through the DRH pilot study suggest that risks for infant and maternal health were present on the coast, long after that dreadful day in August 2005.
Prepare for Disaster: Know the Health of the Population
As an adjunct nursing instructor for American Public University, I teach Community Health I & II. Part of that curriculum includes nursing for populations affected by natural disaster. Public and community health nurses should have an ongoing understanding of the overall health of the population they serve. Thus, when disaster occurs, there is already baseline data available to inform decisions regarding disaster response and recovery.
For example, prior knowledge that a population has high rates of diabetes (like Mississippians), informs disaster response efforts that access to critical medications like insulin, including access to refrigeration to store insulin, could be an immediate need for disaster-affected communities.
As we approach the 10-year anniversary of Hurricane Katrina, those vacant foundations and slabs serve as reminders that disaster recovery may present long-term issues for disaster-affected communities. No social groups are immune to disaster. But, social issues may well facilitate or impede the ability to recover from disaster. Nurses and other health professionals should remain vigilant that disasters may occur within seconds, but effects may remain for a lifetime.
About the Author: Dr. Juanita Graham works for the Office of Women’s Health at the Mississippi State Department of Health, specializing in forensics and mortality surveillance. Dr. Graham is professionally active, including currently serving as an International Board Member for Nursing Knowledge International, a subsidiary of Sigma Theta Tau International Nursing Honor Society. Dr. Graham is a Fellow of the Royal Society for Public Health, London, UK.