Michael VanRooyen (left) and Robert Blendon

"If we do not have an independent investigation of what happened at the national and state levels, we will never fix this problem," said panelist Robert Blendon, professor in the Department of Health Policy and Management. In September, it was announced that a Congressional committee would review the government's response to Hurricane Katrina. By comparison, an independent, bipartisan commission was appointed to investigate 9/11.

"At the moment, I'll be quite frank, there is a bipartisan agreement to have a 'forget about what happened, and let's go on and talk about rebuilding,' and this is a disaster because [the confused response] will happen again," asserted Blendon, who helped conduct a survey of evacuees shortly after the hurricane hit (http://www.hsph.harvard.edu/press/releases/press09162005.html). The researchers found that half of the evacuees who were trapped in their homes spent three days or more waiting for rescuers. "This is unacceptable in the United States," he said.

The teach-in, "Public Health Priorities in the Aftermath of Hurricane Katrina," is available for viewing. Howard Koh, director of the HSPH Center for Public Health Preparedness, and Jennifer Leaning, co-director of the Harvard Humanitarian Initiative, served as moderators. The event was co-sponsored by the Division, the Initiative, and the Office of the Dean.

James Ware, Dean for Academic Affairs, introduced the teach-in: "Despite a considerable amount of discussion and effort, we saw in the events surrounding Katrina and Rita that our systems do inherently have limitations when it comes to dealing with events on the scale of those two hurricanes, especially Katrina, which displaced perhaps a half a million people."

	Ed Peters

More than 100 of those displaced people ended up at East Jefferson General Hospital in Metairie, Louisiana, a New Orleans-area hospital that remained open during the storm. Frannie Kronenberg, HSPH alumna and the hospital's senior vice president, described how health care professionals, patients, and their families rode out the storm.

"If I leave you with nothing else today, it is my hope that you'll believe me when I say that communication, coordination, and creativity are absolutely vital to an effective disaster response," said Kronenberg, who began her tenure at the hospital just four weeks before the hurricane hit.

The hospital itself was not significantly damaged. Floodwater came within 25 feet of the front door but spared the building. Generators were used when the city lost electricity, and water was drawn from the hospital's own 400-foot well. Telephones worked intermittently on the day of the storm, and then on Thursday, September 1, the hospital lost all phone and Internet connections for 21 hours.

Above, from left to right, Paul Biddinger, Hilarie Cranmer, and Frannie Kronenberg

"When I reviewed our disaster management plan in preparation for this talk, one thing that really stood out was that there is a general assumption, in our plan at least and I would bet in those of others, that there is going to be some form of communication with the outside world," said Kronenberg. "What I would hope for those of you who are involved in these kinds of things is that you would go back and review those [plans] because you may not have open, easy communication with the outside world, and you really need to develop contingencies."

The hospital ended up supporting about 2,000 people, including evacuees, families of staff and patients, policemen, firefighters, National Guardsmen, and U.S. marshals. Extra beds, toiletries, and food needed to be found and distributed at the same time when patient care was being provided.

Now, hospital staff members are dealing with the public health implications of the hurricane's aftermath, such as immunizing workers who are cleaning up debris, as well as putting their own lives back together. Many have lost their homes, and some medical practices have been jeopardized by the loss of patients who are now reestablishing themselves in other parts of the country.

Another HSPH alumna, Hilarie Cranmer, spent two weeks in Louisiana working with the American Red Cross to assess health needs in 160 emergency shelters. A physician, Cranmer was deployed through the Harvard Humanitarian Initiative. She described how "public health toolkits" were developed for three states where many evacuees ended up. In Mississippi, a toll-free number was established for Red Cross members to call if they had any questions or needed a team to be mobilized. In Texas, teams were sent to assess shelters. In Louisiana, teams helped officials anticipate health threats, assess patients, communicate with state and federal public health officials, and educate workers.

"We took chaos, and we applied science," said Cranmer. "We were able to use what you are learning now in the School of Public Health directly in the field through our relationships with other experts in the field of public health."

Fellow physician Paul Biddinger traveled with the non-governmental agency "Project Hope" to care for Katrina survivors who gathered at the U.S. Navy hospital ship Comfort, docked at Pascagoula, Mississippi. He reported that more than 200 patients were treated on the ship every 12 hours.

The major challenges the Comfort team faced were identifying where help was most needed in the community, getting medical specialists reoriented toward providing primary care, and separating acute treatment needs from pre-existing conditions. Biddinger said that the team spent much of their time caring for chronic health conditions, which were exacerbated by the loss of access to prescriptions.

	Ichiro Kawachi

For social epidemiologist and HSPH Professor Ichiro Kawachi, Hurricane Katrina exposed underlying cleavages in U.S. society. "We often think of natural disasters as being more or less random events, but the people who are victimized-who is victimized and who escapes-is certainly not a random lottery," he said. "There is a systematic patterning to vulnerability." The overwhelming majority of those who did not escape Katrina were poor and African American, he observed, demonstrating a fault line in the U.S. between race and class.

Michael VanRooyen, co-director of the Harvard Humanitarian Initiative, struck a similar chord, asserting that "our ability to identify populations and realize that they're there, but not provide for their assistance, really is in many ways complicit to condoning survival of the fittest."

Howard Hu

HSPH Professor Howard Hu discussed the environmental health hazards associated with the hurricane's aftermath. The nation has never faced a crisis like Katrina in terms of mold in homes, businesses, public places, and schools, he said. Mold can exacerbate some kinds of allergies and, in rare cases, cause infections, said Hu. Other concerns, like exposure to spilled petrochemicals, are being studied. "We have to appreciate the fact that a lot of things we're putting into our air are contributing towards global warming, climate change, and what we now understand are extremes of weather and a propensity for that," said Hu. "I'm sorry to say that we can expect these kinds of climate disasters in increasing frequency and intensity in the years to come until our society understands, appreciates, and moves, particularly in this country, on the inevitable consequences of climate change and pollution."

Ed Peters, an assistant professor at Louisiana State University School of Public Health, said that he is worried about Louisiana's capacity to address issues raised by Hurricane Katrina. He pointed out that the state ranked last in major health measures for 14 of the past 15 years, according to a report by the United Health Foundation. One quarter of Louisiana's children live in poverty. Twenty percent of the state's residents have no health insurance. "At the same time, we know there is hope, and I think there's opportunity," he said. "I look to people such as our panelists, other panelists, and to the leaders of institutions such as the Harvard School of Public Health and Johns Hopkins School of Public Health to help make New Orleans and Louisiana a new laboratory, a classroom, to really improve public health in the United States-to make it a model for what we can do as a nation."