Hurricane Gustav may have treated Louisiana less harshly than Katrina, but
the lessons learned from the catastrophic 2005 storm kept Baton Rouge's
public mental health services in operation despite widespread
damage.FIG1
"In Katrina, we were providers" of care for storm victims from
New Orleans, said Jan Kasofsky, Ph.D., executive director of the region's
Capitol Area Human Services District (CAHSD). "In Gustav, we were
providers and victims."
Gustav left Louisiana's capital city struggling under a burden of
broken tree limbs, downed power lines, and wind-damaged buildings. Electric
power still hadn't been restored throughout much of the city a week after
the storm.
Baton Rouge was hit harder than New Orleans this time, at least in part
because the storm's path collided with major power lines feeding the
city.
The CAHSD took steps to ensure continuity of its services even before the
storm made landfall.
"We printed out all appointments and telephone numbers ahead of time
and called clients to tell them when and where they could be seen," said
Kasofsky. "We also contracted with Walgreens Pharmacy so we could call
in all prescriptions, which are prepaid and can be picked up at the location
closest to the patient."
Perhaps chastened by Katrina, residents of New Orleans and the Louisiana
coast headed inland ahead of Gustav as ordered, said Harold Ginzburg, M.D.,
J.D., disaster coordinator for the Louisiana Psychiatric Medical Association.
Transportation by bus or rail was provided this time for institutionalized or
incarcerated persons and for those without cars. Most evacuees had to keep
moving on to Mississippi or Texas to find places to ride out the storm,
although Baton Rouge churches did provide some space for those who
couldn't make it to out-of-state
destinations.FIG2
"Everyone was anxious until the storm passed," said Ginzburg of
his enforced stay at Jacob's Camp in Mississippi, his place of refuge
during both Katrina and Gustav. Afterward, some saw this storm as a positive,
even therapeutic experience, he said. One patient told Ginzburg of his
new-found resiliency in the face of the hurricane.
However, Ginzburg worried that lighter-than-expected damage in New Orleans
coupled with heavy traffic and eight-hour travel times during the evacuation
would dissuade residents from evacuating the next time a big hurricane
looms.
Baton Rouge, still home to thousands of people dislocated by Katrina, faced
a different set of problems with Gustav.
"There were no nonmedical shelters set up in the state," said
Kasofsky. "Along with the Office of Public Health and LSU [Louisiana
State University], we set up a medical special-needs shelter in the Pete
Maravich Center on the LSU campus."
Medical-needs shelters were set up in neighboring states too.
The CAHSD teams were responsible for all mental health support for its main
shelter and 66 other sites in the region, she said. The LSU shelter took in
330 patients, many of whom had been homebound. Medical care was provided by
Earl K. Long Hospital, and nurses were sent from the Department of Public
Health. Kasofsky's staff went on 12-hour shifts to provide
round-the-clock service and remained on that schedule for over a week.
"In a disaster, you can't stop serving clients," she said."
Patients were here asking to see their doctors."
Her team played another role as well. Critics of disaster planning in the
United States have complained in the past that mental health considerations
have been left out of the disaster-response infrastructure. The Baton Rouge
incident command team not only included a mental health liaison 24 hours a
day, but Kasofsky or a member of her staff also served rotating tours of duty
as team commanders.FIG3
About 60 patients were on oxygen when the power in the shelter went out and
the backup generator malfunctioned and died. Fortuitously, the blackout
happened just before the arrival of Gov. Bobby Jindal (R), who placed a call
to the power company, which provided a new generator. Eventually the patients
needing oxygen were transferred to a hospital for further care.
But problems at the shelter were manageable compared with the storm's
effects on the CAHSD's headquarters building and main clinic.
"The roof of our largest facility was peeled off, and the building
sustained water damage," said Kasofsky. The agency's largest adult
and child mental health facilities, its developmental disabilities services,
and all administrative offices are unusable and will be closed for a year.
The staff scrambled to find temporary and then long-term alternative office
and clinic spaces and began moving in within a week after the storm. They also
transferred $3 million worth of pharmaceuticals into a temperature-controlled
building.
The quick response by the staff had clinical benefits, said CAHSD medical
director Gerald Heintz, M.D.
"Because we made it known that we were in operation and taking
walk-ins, we prevented a lot of decompensation—and hospital beds were in
pretty short supply to begin with," said Heintz in an interview.
The experience reinforced the lessons of prior hurricanes.
"Decision makers have to be on the ground to see for themselves
what's going on," Kasofsky emphasized. "Management must be
visible as well. Let the staff trouble-shoot, give them input and feedback and
honest answers to questions. You have to be clear and give direction, but you
also have to be flexible." ▪