HSPH: HSPH-CPHP Program Manager Gives First-Hand Account of Hurricane Recovery Efforts in Mississippi

HSPH-CPHP Program Coordinator Gives First-Hand Account of Hurricane Recovery Efforts in Mississippi

--from advance online issue of Harvard Public Health NOW

EMT Joshua Frances was deployed to Mississippi by FEMA to aid Hurricane Katrina survivors. Frances is a program coordinator at the HSPH-Center for Public Health Preparedness.

Click here for photos provided by Joshua Frances of Biloxi and Gulfport, Mississippi.

EMT Joshua Frances has a clear view of the ocean from the hospital where he is working. Problem is, he shouldn't. The ocean is four blocks away, but the buildings that normally would obstruct his view no longer stand. They were literally blown away when Hurricane Katrina hit Biloxi, Mississippi, leaving behind a rutted, debris-strewn wasteland.

"There was a 30-foot storm surge here, and when the ocean rushed back, it took a lot of things with it," said Frances, who spoke to HPH NOW from the Gulf Coast Medical Center in Biloxi. "Now, when the tide goes out, it reveals cars, tractors, and pieces of buildings like McDonald's scattered in the sand. The storm surge was sort of like the December tsunami–but add 150 mph winds."

Frances was deployed to the medical center as part of a Federal Emergency Management Agency (FEMA) response and a Massachusetts-based Disaster Medical Assistance Team (MA-1-DMAT). He is a program coordinator at the HSPH-Center for Public Health Preparedness and is studying for a masters of public health focusing on emergency preparedness at the University of New England. Frances started his career with a paramedic service in New York doing disaster preparedness, and more recently, working in the Boston Police Command Center for the City of Boston before joining HSPH.

"Whatever you are seeing on TV, the devastation is worse," said Frances. "There are 40-foot piles of rubble lined up along the streets, like snow banks after a big winter storm in Massachusetts, but the rubble is made of people's property. The piles are what made people's lives."

Frances was in New York when he got the call that the DMAT team would be deployed two days before the hurricane struck. On Saturday, August 27 the team flew to Atlanta, Georgia, and then drove three hours to Aniston, Alabama, where FEMA, which had activated all of the DMAT teams, gathered some of them. Then, the hurricane hit. The nation's worst natural disaster was also Frances' trial by fire. This deployment was his first with the DMAT team. The next day, the Massachusetts team traveled to Mississippi.

The 35-member group, made of doctors, nurses, paramedics, pharmacists, and other health care workers, train together several times a year and can be tapped at any time to respond to disasters in the U.S. or in other parts of the world. In the past, the Massachusetts team has been deployed in response to Hurricane Andrew in Florida, Hurricane Marilyn in St. Thomas, and an earthquake in Bam, Iran. They bring with them a 35-bed mobile hospital that can sustain itself for 72 hours before needing more supplies. All DMAT teams are in the National Disaster Medical System, part of the U.S. Department of Homeland Security.

In the hurricane's aftermath, the Massachusetts team drove along damaged roadways to Forrest General Hospital in Hattiesburg, Mississippi, where they helped evacuate numerous critically ill patients using J-Hawk helicopters, buses, and ambulances. The hospital had lost electrical power and water pressure, crippling medical equipment. The emergency room managed to stay open, and the DMAT team set up their mobile hospital for three days, treating about 100 to 150 patients, until the hospital regained its electricity.

"At that point, our work is done, and it's time to go to the next site," explained Frances.

The team moved on to Biloxi and neighboring Gulfport, where Frances is deployed now and where the huge storm surge and winds have knocked out the lower halves of some buildings, leaving the upper halves perched on surviving support beams. The recessed water has left behind a layer of sludge baking in 100-degree heat, and the air smells of sewage, sea creatures, and decomposing matter, said Frances.

"The emergent disaster response has evolved into a public health mission," said Frances. "You have two categories of patients: people who were injured by the storm and the initial clean-up and, now, people who are coping with pre-existing conditions, such as diabetes, who kept their prescriptions in their bathrooms, only to find their bathrooms don't exist anymore."

The team has dispensed prescriptions for chronic conditions and has provided oxygen to patients whose home units depend on electricity. In three days, the team has delivered over 250 doses of tetanus vaccines, trying to treat and protect relief workers and residents who are picking through jagged, filthy debris.

And then there is the simple human factor. Frances has seen hundreds of survivors, each with a story to tell. "I remember giving a tetanus dose to an elderly woman who had gone back to her house to find a family photo album," said Frances. "The first floor was filled with water, and I knew that album had probably been swept away. She had lost everything, but what she really wanted was that album."

Frances is unsure when he will return home. A usual deployment lasts no longer than 14 days, but, Katrina was no usual hurricane. Frances and his colleagues have been sleeping on floors and showering with cold water from make-shift showers. "I'm not complaining," he said. "I signed for up this."

An expert in rural bioterrorism preparedness, Frances will bring back lessons learned to the HSPH-Center for Public Health Preparedness, as well as to state officials in Maine, with whom he works as part of his Center duties. He has not watched much television but knows that FEMA, of which he is a temporary federal employee, has come under heavy criticism. Safety is the number one concern for the team, said Frances. As it is, the team is constantly guarded by federal agents. "Disasters bring out both the best and the worst in people," said Frances. "I know that people have seen some really bad stuff on TV, horrible stuff, but I have also seen how communities pull together."

While at the Gulf Coast Medical Center in Biloxi, Frances found photos of the surrounding neighborhood. "This was a beautiful place," he said. "Now, there is nothing."

--September 12, 2005

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