"We must never forget this picture," says Harvard School of Public Health Professor Jennifer Leaning. An expert on humanitarian crises, Leaning has witnessed epic calamities around the world first-hand, from Afghanistan and the West Bank to Rwanda and the Chad-Sudan border. Sadly, the disaster of Hurricane Katrina that took America by surprise was in many ways straight from the textbooks, says Leaning, who directs the Program on Humanitarian Crises and Human Rights within the School's François-Xavier Bagnoud Center for Health and Human Rights. Exposing the vulnerable, she says, is "what disasters always do, particularly when they're not well managed."

Whether speaking of a poorly maintained dam threatening to crumble in Taunton, Massachusetts, or the long, bloody conflict in Darfur, Sudan, the mantra of disaster- response planners is always the same. "Crises show society speeded up," its evolution compressed into a moment in time, Leaning says. The poor and dispossessed, the weak and the sick, always suffer disproportionately. And how society responds--or doesn't--is a reflection of its values, "its way of organizing and caring for people."

Relief from government is almost always slower in coming than victims expect, owing to a combination of insufficient resources, too little advance planning, and logistical hurdles that arise amid chaos. In these respects, many believed the U.S.--the leader of the industrialized world--would perform vastly better than developing nations in a disaster. Yet its response was, as many within and outside the HSPH community noted, a catastrophe unto itself.

Hurricane Katrina, perhaps the greatest natural disaster in American history, exposed what Leaning calls a "deep, ugly secret": the fault line between whites and blacks, rich and poor. It also raised unsettling questions about the country's ability to protect its own against calamity, be it natural or man-made.

In the wake of the storm, Leaning and HSPH Lecturer Leonard Marcus, another expert in disaster preparedness, reflected on what the U.S. must do next.

BASIC PRINCIPLES

In an address to HSPH supporters at a Leadership Council meeting in October, Leaning outlined key principles in preparing for and dealing with disasters--principles that the U.S. clearly violated. They apply to events large and small, in what she calls their impact and recovery phases.

  • Educate the public. We Americans have underestimated the extent to which advance education is crucial to population response, Leaning says. A knowledgeable, self-reliant local population will take instructions on the move. In California, people know what to do in the event of an earthquake. But in coastal regions beset by storms and floods, she says, "we have not done nearly as good a job of alerting people to potential risks or how they must behave in an emergency."
  • The first 72 hours, people must be able to survive on their own. In the case of Katrina, tens of thousands of Gulf State residents were helpless in the face of delayed rescue efforts. Yet the first three days of any calamity are always chaotic, Leaning says.
  • Preparedness is more than just advance warning. Rigorous planning can mitigate catastrophe, Leaning says. What are you going to do about the vulnerable? How will you maintain security? Protect human dignity? How will you save the hurt and the stranded? At all levels of government, planners must invest in early warning systems and professional-level training. Planners had run an elaborate training session for a disaster that was eer-ily similar to Katrina about a year before the hurricane struck. Yet once the drill was completed, one huge question remained: "What will we do about those who are unable to evacuate?" The failure of any and all agencies to address that gnawing question had calamitous results when New Orleans' levees gave way.
  • Perceptions become reality. "Even if you feel confused and on the verge of collapse, never show it publicly," cautions Leaning, referring to televised appearances by some senior officials in the wake of Katrina. Effective public communication depends on clarifying your message, then working with the media. Don't forget that "the story that unfolds will be remembered as history," Leaning says. "The world will be watching."
  • Treat the dead with dignity. "The long tale of disasters is a psychological one," Leaning cautions, recalling lingering images of bodies in the press for days following the hurricane. "The living will be focused on their missing and dead. If you are not careful, survivors will hate you," Leaning warns.
  • Let the local population take charge of salvage and recovery efforts. Local people cope, Leaning says. Stranded families climbed to rooftops, forded rivers, banded together. Be it Louisiana and Mississippi or Pakistan, outside help should come in the form of aid to the local economy. "We cannot dictate or run the reconstruction," Leaning says, because it sets in motion "a cycle of dependency and need, and a cycle of grievance that is hard to come out of."
  • Don't set up shelters far from home. "By moving people out, you are disrupting the chances for a coherent policy on rebuilding," Leaning warns. People will have difficulty coming back, and they will be "bereft." In the aftermath of the evacuation of New Orleans, half the population is setting down roots elsewhere. "There are people in Alaska. Is this a good idea, or not?" she asks.
  • Put the right people in the right roles. Leadership is partly a gift, but it is also a matter of training and practice, Leaning says. The best-laid disaster plans go awry in the absence of effective implementation. It is on this final point that Leaning and her colleagues linger. Training leaders is, after all, what HSPH, and Harvard, do. With Brigham and Women's Hospital physician Michael VanRooyen, Leaning recently launched a new Harvard-wide alliance, the Harvard Humanitarian Initiative. Its mission is to further the study and practice of response to major disasters and war, as well as the professional development of emergency responders worldwide.

It is public health's job to train rapid-response teams that can go out and gather data early on, Leaning says. Without statistically meaningful numbers, you cannot know where the greatest needs are. That's why Leaning and VanRooyen teamed with the American Red Cross to bring public health expertise to Red Cross teams for the first time, within three days of Katrina's landing (see related story). Resources must be distributed on the basis of need, not who gets there first, Leaning adds. "When that standard crumbles, there is community outrage," she says.

THE MAKING OF META-LEADERS
From a U.S. army helicopter above the Superdome and Jefferson Parish in New Orleans early in September, HSPH's Leonard Marcus got a wide-angle view of the post-Katrina devastation. As the associate director of the Center for Public Health Preparedness, Marcus also took a close-up look at U.S. leaders' response to the crisis.

Marcus was on board at the invitation of former Federal Emergency Management Agency (FEMA) Director Michael Brown, gleaning insights during Brown's final days on the job. During a three-week period between hurricanes Katrina and Rita, Marcus sat in on Brown's meetings with senior staff and spoke one-on-one with Pentagon and White House Homeland Security officials, meeting with Secretary of Homeland Security Michael Chertoff; Chertoff's predecessor, Tom Ridge, and Coast Guard Vice-Admiral Thad Allen, special deputy for the Katrina recovery effort, among others.

Looking beyond systems failures and blame-slinging by politicians, Marcus is focused on the failure of leadership--what he calls "the human factor." With David Gergen of Harvard's Kennedy School of Government, a former adviser to four U.S. presidents, Marcus co-directs the National Preparedness Leadership Initiative (NPLI), a program created in 2004 to train senior government officials to thwart and manage disasters, including acts of terrorism. A chief aim of Harvard's NPLI is to turn out "meta-leaders," individuals capable of marshalling cooperation across a vast web of local, state, and federal agencies.

A key problem in the response to Katrina was the inability of the federal government to quickly engage the collaboration of local and state officials, Marcus notes. In the U.S., where checks and balances serve to prevent the federal government from becoming too powerful, the idea of the feds' seizing control, even in an emergency on this scale, is "a significant Constitutional issue," he says.

Going forward, better communication and coordination among all levels of government, or "connectivity," will prove crucial. That means not just harnessing electonic technology to forge links among agencies, but also building relationships between people--transforming a culture that champions independent decision making into one that values cooperation. Civilian agencies and the military must also work together. Historically, Americans have resisted the deployment of armed forces on home soil, Marcus says. But Congress may envision a new role for military personnel--disciplined, well-trained, swift to act--given threats to security akin to Katrina and now, avian flu (see related story).

Katrina highlights another novel concept--acceptable losses. In the quest to save as many lives as possible, some deaths may be inevitable, Marcus says. "If moving 30 nursing home patients puts 10 frail people at risk, what do you do? What happens if a terrorist attack injures 200,000 people, but the medical system can only handle 50,000?"

No amount of planning can compensate for the absence of strong leadership, Marcus believes. Anarchy, a breakdown of the social order, impeded relief efforts. Cultural differences influenced whether people heeded or ignored hurricane warnings. But ultimately, he says, Katrina exposed an "epic failure of the imagination" on the part of senior officials. Worst-case scenarios, including chaos in the Louisiana Superdome, weren't even anticipated, let alone planned for.

Tomorrow's meta-leaders, Marcus says, must be able to envision eventualities "almost too horrible for the mind to grasp," and of a nature this country has not yet seen. "Those leaders are made, not born," he adds.

Editor's note: On April 26–28, HSPH will host an international conference on preventing disasters and minimizing their consequences, intended for decision makers and researchers from government, business, universities, and other organizations. To find out more, email brain@hsph.harvard.edu or visit www.hsph.harvard.edu in January for a link to updated information.

Karin Kiewra is editor of the Review and associate director of Development Communications at HSPH.

 

 


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