The Cost of the Katrina Effect

Hurricane Katrina blew the roof off Ron Smith's New Orleans house. He hitchhiked out of town, spent a night in a darkened HoJo's lobby and, later, waded through fetid waters back home. But those were the least of his problems. For two decades, Smith, 53, has battled HIV, and in the wake of the storm, with clinics flooded and physicians scattered, he missed more than a month of experimental treatments--treatments he believes were helping to counteract his body's growing resistance to standard drug therapy. He dropped 15 pounds and his healthy T-cell count plummeted. It's an ongoing struggle, says Smith, but "I refuse to give up and die."

First there was the water and winds. Now there's the health-care challenge. Even before the storm, the Southeastern states (nickname: "the stroke belt") were cursed with a toxic mix of poor health and poverty. In a survey taken of evacuees in Houston after Katrina, half said they had no health insurance; 41 percent reported suffering from chronic conditions, like heart disease, hypertension, asthma, diabetes and cancer. "We're the poster children for poor health in terms of chronic disease," says Elizabeth Fontham, dean of the School of Public Health at Louisiana State University Health Sciences Center. "Hurricane Katrina was no cure for those problems and they're likely to be exacerbated." They're also likely to linger--for months, if not years, to come.

It's not just the body that has been battered, but the mind as well. In a survey released by LSU last week, 39 percent of Louisiana residents reported feeling angry and 53 percent said they were depressed. Already, mental-health systems are stressed. In Louisiana, for example, only 28 percent of adults and 3.5 percent of children identified as having a mental illness receive care--and that was before the storm. Experts worry that the underserved will continue to struggle as otherwise healthy Gulf Coast residents succumb to the storm's psychological aftereffects, now festering like sediment in the floodwaters. Times-Picayune columnist Chris Rose, describing the collapsed roofs and the "permanent bathtub ring" around the city, put it bluntly: "We're all whacked. How could you not be?"

Rarely has a health-care system been so strained. New Orleans' big state-run hospitals, Charity and University, have been shut down since the storm. Private clinics are working with skeletal staffs. And evacuees are --swamping those facilities that are operating. Visits to outpatient clinics at Baton Rouge's Earl K. Long Medical Center have jumped 50 percent--from 8,000 patients a month to more than 12,000. Donald Smithburg, CEO of the LSU Health Care Services Division, is trying to lease new hospital space, and he has until Dec. 18 to hire back staff in New Orleans (2,600 out of 4,000 employees had to be furloughed). But just weeks before his deadline, Smithburg says he's still looking for cash. With flu season descending, he's worried about how a fractured infrastructure will care for the sick and injured. "We're a bus wreck or a plane crash away from another catastrophe," he says.

Amid the chaos, patients with chronic health problems have been scrambling to receive care. Theresa Billiot's main concern after Katrina wasn't so much the loss of her home in Port Sulphur, La.--it was how she was going to get her next chemo infusion. "I was scared to death," says Billiot, 54, who has lung cancer. Billiot's two daughters, who live in Massachusetts, managed to fly her to Boston, where she received two chemo sessions and 30 radiation treatments at Dana Farber Cancer Institute. Other evacuees have been struggling to get back on track without having good information about their medical history--how many radiations they had or what kind of drugs they were on. "They would tell the physician, 'I take a blue pill,' says Pam Dotson of the American Cancer Society. Medical data were one of the storm's great casualties. Weeks after his office was drenched in 11 feet of water, Dr. Floyd Buras, a New Orleans pediatrician, found his patients' records disintegrating in his hands. Hoping his computer records would fare better, Buras sent his disks to a company specializing in data recovery from shipwrecks. So far, no luck. "They may well be lost," he says.

Even more disturbing: some patients are unaccounted for, too. Take the HIV population in Greater New Orleans. Only half of the 1,600 patients registered with the AIDS Drug Assistance Program have been located since the storm, says Beth Scalco, Louisiana's AIDS program director. Are the rest getting their meds? Nobody knows. At New Orleans' reopened HIV Outpatient Clinic, medical director Dr. Mary Murphy is worried. "I wonder where my very sick patients are," she says. Some have landed in places where access to care is compounded by the disease's stigma. John Simms, 51, was turned away from a shelter in Baton Rouge after he disclosed that he was taking HIV medications. Others are concealing their diagnosis and perhaps going without drugs. "People could get sicker faster and may die faster," says Scalco.

Their mental health is at risk, too. Studies show that 10 to 30 percent of people who are directly exposed to dangerous or traumatic events--the destruction of a home, the death of a loved one--will develop posttraumatic stress disorder, with its intrusive flashbacks and nightmares. On the whole, human beings are extraordinarily resilient: two thirds of those who suffer PTSD symptoms early on will recover in six to nine months, says David Vlahov, of the New York Academy of Medicine, who studied the psychological aftermath of 9/11. Still, Katrina's destruction was vast, stretching across a 90,000 square miles. Whole communities were destroyed and, within them, the social networks--families and neighbors, churches and synagogues, schools and YMCAs--that help sustain people in a crisis. Relocation is a double-edged sword. First comes relief, then isolation, anxiety and feelings of abandonment. Health officials worry that some of those affected will turn to drugs and alcohol. Suicidal calls to a Louisiana help line have almost tripled since the hurricane.

Patrice Howard feels the stress. After water began seeping into her New Orleans apartment, Howard fled to the roof with her fiance, Marlon, and her two kids, Erica, 9, and Carlton, 5. The family huddled together for three days until they were rescued. Today, thanks to relatives in Cleveland, they're safe. But "even though we have a roof, food and water, now we think about what we lost," says Howard. "We were just getting ourselves together and now that life is gone." She worries most about her children. Erica refuses to talk about the storm; Carlton has trouble sleeping and has become clingy. Dana Jensen, a crisis-intervention specialist working with the children, says their reactions are not unusual. "This --family is grieving for their losses," she says.

For so many residents and evacuees, the uncertainty--Will I ever go home? Where will I live? Can I find a new job?--is overwhelming. "I'm in total limbo," says Summer Savon, a Tulane medical resident also living in Ohio. "There is real misery in seeing everyone move ahead and you're left behind." Those feelings of hopelessness and demoralization can lead to a spectrum of mental-health disorders, from anxiety and behavioral problems to depression, says Dr. Jon Shaw, a trauma specialist at the University of Miami. Fred Sautter, a clinical psychologist at the New Orleans VA hospital, was preparing to treat soldiers returning from Iraq for PTSD when the storm hit. Now, displaced from his home, with his professional and private life disrupted--he and his fiancee were supposed to be married in the city in October--he's feeling the emotional weight himself. "You reach a point where you want to reach closure so you can move on," says Sautter. "But it's impossible."

Prior research into natural disasters suggests that mental-health effects could persist long after the levees are rebuilt. In a study of Mexicans relocated after a 1999 flood, Fran Norris, a professor of psychiatry at Dartmouth Medical School, found that evacuees still suffered psychological distress two years later. "Most will recover," says Norris, "but there's usually a subset that has problems for a long time." And when Bonnie Green, a professor of psychiatry at Georgetown University Medical School, compared survivors of a dam collapse and flood in Buffalo Creek, W.Va., to a nonaffected population, she found higher rates of anxiety, depression and hostility--14 years after the event.

Nobody, however, is giving up. Government officials estimate that 500,000 people may need mental-health assistance, and this week the U.S. Department of Health and Human Services plans to announce a public-service ad campaign encouraging hurricane victims to get help. Psychologists and social workers are doing their own outreach, visiting shelters and trailer parks. Doctors and nurses are, too. The Southern University School of Nursing's Jag Mobile clinic has treated about 1,500 evacuees. And individual practitioners, many of them volunteers, are doing whatever they can to help. K. C. Arnold, a nurse practitioner who took care of diabetics at a now closed clinic, opened her own center in Mississippi last month so patients could get the medications they need. While there are frustrations--never enough funding or resources--there is also an abundance of good will. "People are committed to helping," says Dr. David Post, medical director of a public mental-health agency in Baton Rouge, "and it's getting better."

Ron Smith, for one, is optimistic. He's back in treatment and is waiting for his latest blood tests, which he hopes will show a marked improvement. Five-year-old Carlton is hopeful, too. Asked if there was anything cool about living in Cleveland, he said, "Well, I saw a rainbow after the rain. We couldn't catch it, but it was pretty." Maybe it was heading south to the gulf.