One year after Hurricane Katrina made landfall last August 29, devastating the coasts of Alabama, Mississippi, and Louisiana, the health care infrastructure in New Orleans remains tenuous.
Hospital capacity is at about 50% of what it was before Katrina, according to John A. Matessino, president and CEO of the Louisiana Hospital Association. Several facilities are still closed, including Charity Hospital, the city's main health care provider for the poor. The wait for a hospital bed can be as long as 24 hours.
The focus shifts. In the first weeks after the storm, there were concerns about toxic waste, infectious diseases, mold and mildew, and respiratory problems. While some of these concerns persist, says Christopher Beaudoin, an assistant professor of community health sciences at Tulane University in New Orleans, more urgent health and safety problems now result from household cleanup and reconstruction, mental health issues, and chronic health conditions.
Mental health. "Stress and depression are pervasive," says Beaudoin. This is no surprise in a city where reminders of Katrina's destruction are inescapable. Rates of posttraumatic stress disorder, suicide, depression, and substance abuse have increased, and many of the small facilities specializing in mental health care have not reopened, substantially compromising the city's ability to treat patients with mental health disorders.
Chronic illnesses. Many people with chronic conditions who depend on regular care and medication have experienced complications as a result of the loss of clinics and other sources of health care. EDs find themselves strained by patients with diabetic ketoacidosis, HIV-infected patients suffering symptoms of AIDS, and patients with acute psychosis. Half of those diagnosed with HIV in New Orleans before Katrina have still not been located since the storm.
Displaced children through-out Louisiana are living in trailer parks and shelters set up by the Federal Emergency Management Agency and are receiving little systematic care for asthma, behavioral disorders, developmental delay, or physical impairment. "On The Edge," a study by Columbia University's Mailman School of Public Health and the Children's Health Fund, revealed that 34% of these children have at least one chronic medical condition, which is one-third higher than that of the general U.S. pediatric population.
A shortage of health care workers. New Orleans lost over a thousand RNs as a result of Katrina, as well as many physicians, dieticians, and laboratory technicians. (See Profiles, page 102.) Coastal Mississippi suffered catastrophic damage as well, but its health care infrastructure survived in a far more intact state than did that of New Orleans. Even so, it is contending with staffing shortages that are exacerbated by insufficient housing in the region, and one-third of nurses have said they are considering leaving the area, according to Information and Quality Healthcare, a Mississippi-based nonprofit organization.
The Kaiser Family Foundation has issued a report and video, documenting "survivors' health care experiences" (both are online at http://www.kff.org/uninsured/080806pkg.cfm); the uninsured faced some of the biggest obstacles.
Some hope? The U.S. Department of Health and Human Services recently announced the establishment of the Louisiana Healthcare Redesign Collaborative, made up of a wide array of state and local officials and experts, which aims to comprehensively reshape the health care system of Louisiana. Its first proposal is due in October.
Roxanne Nelson, BSN, RN