DIY Disaster Relief

Don’t let anybody kid you. The government response to Hurricane Katrina was not only a disaster when the storm first hit. It’s still a disaster now.

I’ve been talking to medical professionals who have been to the Gulf Coast in the past couple of weeks, and this is what they have told me.

First, FEMA continues to be next to useless. It is not providing relief workers with the access they need to areas crying out for their help. It is not keeping up with bills for the emergency work it has authorized so far. A shockingly large number of doctors and nurses are being told that their services are not needed. Those with the guts and the initiative to go ahead regardless are finding that the exact opposite is true –- thousands upon thousands of storm evacuees who have run out of their prescription medications, or require new prescriptions, or need help with a panoply of storm-induced problems, from simple cuts and bruises to infections and depression and suicidal feelings.

Secondly, FEMA and the Red Cross are not talking to each other to sort it all out. At the Cajundome in Lafayette, Louisiana –- home to more than 5,000 evacuees –- there was, as of a few days ago, no formal on-site medical care. That meant people had the unenviable choice of going to the emergency room of a Lafayette hospital, waiting in line for hours and hoping for the best, or somehow fending for themselves.

Thirdly, the failures of the first six weeks or so since Katrina struck are likely only to compound the problems down the road. Sanitation in the shelters is a nightmare. Some professionals don’t exclude outbreaks of tuberculosis or other diseases one might have associated, pre-Katrina, with an earlier, more backward era.

Don’t take it from me. Here’s Paula Criscenzo, a Californian nurse, who recently traveled to the Gulf with her sister, an internist, and committed her impressions of the Cajundome to paper:

Any prescriptions that had been filled [when the evacuees first arrived] were now expired and needed to be filled. FEMA had still not paid anything to the pharmacies that had filled these prescriptions, so they were not filling or renewing any prescriptions. All of the evacuees from Rita who had arrived a week earlier had been told that they would not have their prescriptions renewed until the Katrina bills were paid by FEMA … These people were in a crisis situation. Many of them were on five to six different medications for heart, thyroid, and diabetes problems and had run out of meds at least a week ago.
In addition to the health issues there is a huge population there that is addicted to pain killers and other narcotics that are now going through withdrawal. There was nothing set up for these people except a clinic they could be bused to that was only open on Mondays and Thursdays … All of these people should have been receiving counseling as they had been through trauma too unspeakable to believe.
Another medical professional stunned by the organizational chaos he found is Graham Waring, a Santa Monica-based internist who also happens to be Arnold Schwarzenegger’s personal physician. He had spoken to senior FEMA personnel before leaving for Baton Rouge. When he and a team of six other doctors and nurses arrived, however, they were told they weren’t needed. When they asked if they could at least register to practice in the disaster region, they were told: “To be quite frank, we don’t really need physicians here. We have an overabundance of them. The media has blown it out of proportion.”

Dr. Waring’s group eventually ran into a religious charity that not only provided them with the credentials FEMA was refusing to hand out but said they were actually praying for a group of doctors to show up. For a week, he and his colleagues toured many of the outlying areas not highlighted in the television and newspaper coverage and worked their hearts out. They came across untreated abscesses, patients with dangerously high blood pressure, multiple cases of dehydration, upper respiratory infections –- spread, no doubt, by the constant coughing in many shelters –- and case after case of psychological trauma.

“By the time we came to these places, people were thankful just because we were there,” Dr. Waring told me. “It made them feel someone gives a shit.”

Two members of the team also went to the River Center in downtown Baton Rouge and found a shocking scene of around 2,000 people struggling with diarrhea, vomiting, and dehydration with almost no medical supplies at all. The Red Cross, Dr. Waring said, was handing out no more than three diapers to mothers with babies and telling them that if the diapers got soiled too quickly they should wipe them off and reuse them. “That’s a great way to spread disease and get the whole place infected,” he said. “We almost got thrown out of there for helping out and distributing supplies. They told us, ‘You guys are building too much dependence in these people.’”

What do these shocking vignettes tell us about the failures of government, and what we might now be able to do to remedy them? Much of the debate so far has descended into the inevitable partisan mudslinging match, with Democrats accusing the Bush administration of bleeding FEMA and the U.S. Army Corps of Engineers dry, and the Republicans seeking to shift at least some of the blame to Democratic politicians in Louisiana.

The malaise, though, goes well beyond partisanship. It was, after all, a Democratic president who declared that the era of big government was over. This is about a generation of disastrous political ideology, in Washington and beyond, believing the answer to the inefficiencies of government was to cut and cut until there was nothing left. The result is that we now live in a crude, desperately insecure society in which everyone is essentially on his own.

“We have now a complete confirmation of the total incompetence of politicians and bureaucrats to deal with any kind of emergency,” the French-born industrial consultant Clotaire Rapaille suggested a few days ago. “They belong to a 19th-century form of organization that is very slow to react, that doesn’t know who’s giving orders to whom, that needs to watch TV to find out what is going on.”

Provocatively, Rapaille points to the 9/11 attackers for a model of more efficient organization, certainly in terms of stated goals and consequent results. “Look at what they call sleeper cells,” he says. “That’s a fantastic idea. Now we have to create a structure of volunteers, of sleeper cells, all around the country. In case of disaster, you just wake up the sleeper cell, and they’ll know what to do.”

Intriguingly, medical professionals like Dr. Waring are thinking exactly along these lines. He realized, after his experiences in the Gulf, that California is utterly unprepared for a disaster of similar proportions. And a major earthquake would give government planners even less time to prepare than a hurricane because there would be no warning.

He wants to put together a group of 50 physicians with an array of specialist skills who would train together on weekends and then meet occasionally to go through their drills. “If something happened,” Dr. Waring said, “there would be a plan that we meet at such-and-such a place. If that place was destroyed, a helicopter could drop off a pallet with supplies that were mandated beforehand so we could set up a tent and an Army hospital. With enough planning, we could handpick the doctors and get damned good people who would enjoy doing this.”

Naturally, he intends to have a word with Governor Schwarzenegger about this. Not that he’s necessarily expecting much out of Sacramento. His philosophy, post-Katrina, is that you can’t count on anything. “If you don’t do something for yourself,” he said, “it’s not going to happen.”

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