Hurricane Katrina and Disaster Medical Care
http://www.100md.com
《新英格兰医药杂志》
To the Editor: After reading the Perspective articles about Hurricane Katrina (Oct. 13 issue), I would like to offer another perspective. Although the public health work described in the first two articles was admirable,1,2 it was irrelevant to most of the people who were evacuated. Only about 50,000 went to shelters. Most of the nearly 1 million displaced people went to hotels or to the homes of family and friends. Among them were the doctors and nurses who normally served this population.
Dr. Cranmer is correct about the disconnect between the needs of the hurricane victims and the aspirations of the volunteers from elsewhere.1 The doctor she describes was a thoracic surgeon. We didn't need more thoracic surgeons or emergency-medicine physicians. What the displaced people needed from the beginning, and still need today, is access to primary care for chronic illnesses and to the medicines that keep their diabetes and chronic obstructive pulmonary disease under control. Our current medical response to disasters is designed for terrorist attacks. Our current disasters are storms, fires, and earthquakes. Medical care for chronic conditions and acute illnesses should be available to evacuees from the moment they walk into a shelter or arrive on a cousin's doorstep. The only way to provide immediate care is to use the resources that are already present and functioning. Shelter organizations like the Salvation Army and the Red Cross should enlist the services of organizations such as the American Medical Association, the American Academy of Family Physicians, and the American Hospital Association to establish a medical response as part of our disaster-relief system. We need to stop letting well-intentioned officials and volunteers shoulder aside local resources. We should coordinate the doctors and nurses who are already there to manage the response. Displaced populations in the United States need care providers who know them and their needs, speak their language, and know their culture.
Katharine C. Rathbun, M.D., M.P.H.
Ochsner Clinic Foundation
Baton Rouge, LA 70809
krathbun@ochsner.org
References
Cranmer HH. Volunteer work -- logistics first. N Engl J Med 2005;353:1541-1544.
Greenough PG, Kirsch TD. Public health response -- assessing needs. N Engl J Med 2005;353:1544-1546.
Dr. Cranmer replies: Dr. Rathbun is absolutely right. As was noted at the World Conference on Disaster Reduction in January 2005, "While the occurrence of natural events is largely beyond human control, the consequences are not."1 Throughout the world, the disasters that affect people the most are the natural ones — floods, windstorms, epidemics, and earthquakes, in that order.
Our national disaster-response plan stipulates that the affected community should be able to "survive" for at least 48 hours before help arrives. The national plan also federalizes health care personnel to help provide care. We worked with a variety of agencies that enacted this plan, including the Public Health Service, because the local capacity for public health was overwhelmed. The American Red Cross provides food, shelter, and first aid. Because there was a recognized need, we also served a public health function, providing doctors and nurses who offered care beyond first aid by supporting local capacity to address chronic care needs in the displaced population. It is true that the majority of displaced people were not in shelters, but those who were in shelters were the most vulnerable. They did not have the resources to evacuate, the network of friends and family elsewhere, or the health care they needed for such chronic conditions as hypertension, diabetes, mental illness, and addiction. We should do our best to support local capacity in disaster responses and should plan for such support before the next disaster.
Hilarie Cranmer, M.D., M.P.H.
Brigham and Women's Hospital
Boston, MA 02115
References
Darcy J. The Indian Ocean tsunami crisis: humanitarian dimensions. (Accessed January 26, 2006, at http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN019573.pdf.)
Dr. Cranmer is correct about the disconnect between the needs of the hurricane victims and the aspirations of the volunteers from elsewhere.1 The doctor she describes was a thoracic surgeon. We didn't need more thoracic surgeons or emergency-medicine physicians. What the displaced people needed from the beginning, and still need today, is access to primary care for chronic illnesses and to the medicines that keep their diabetes and chronic obstructive pulmonary disease under control. Our current medical response to disasters is designed for terrorist attacks. Our current disasters are storms, fires, and earthquakes. Medical care for chronic conditions and acute illnesses should be available to evacuees from the moment they walk into a shelter or arrive on a cousin's doorstep. The only way to provide immediate care is to use the resources that are already present and functioning. Shelter organizations like the Salvation Army and the Red Cross should enlist the services of organizations such as the American Medical Association, the American Academy of Family Physicians, and the American Hospital Association to establish a medical response as part of our disaster-relief system. We need to stop letting well-intentioned officials and volunteers shoulder aside local resources. We should coordinate the doctors and nurses who are already there to manage the response. Displaced populations in the United States need care providers who know them and their needs, speak their language, and know their culture.
Katharine C. Rathbun, M.D., M.P.H.
Ochsner Clinic Foundation
Baton Rouge, LA 70809
krathbun@ochsner.org
References
Cranmer HH. Volunteer work -- logistics first. N Engl J Med 2005;353:1541-1544.
Greenough PG, Kirsch TD. Public health response -- assessing needs. N Engl J Med 2005;353:1544-1546.
Dr. Cranmer replies: Dr. Rathbun is absolutely right. As was noted at the World Conference on Disaster Reduction in January 2005, "While the occurrence of natural events is largely beyond human control, the consequences are not."1 Throughout the world, the disasters that affect people the most are the natural ones — floods, windstorms, epidemics, and earthquakes, in that order.
Our national disaster-response plan stipulates that the affected community should be able to "survive" for at least 48 hours before help arrives. The national plan also federalizes health care personnel to help provide care. We worked with a variety of agencies that enacted this plan, including the Public Health Service, because the local capacity for public health was overwhelmed. The American Red Cross provides food, shelter, and first aid. Because there was a recognized need, we also served a public health function, providing doctors and nurses who offered care beyond first aid by supporting local capacity to address chronic care needs in the displaced population. It is true that the majority of displaced people were not in shelters, but those who were in shelters were the most vulnerable. They did not have the resources to evacuate, the network of friends and family elsewhere, or the health care they needed for such chronic conditions as hypertension, diabetes, mental illness, and addiction. We should do our best to support local capacity in disaster responses and should plan for such support before the next disaster.
Hilarie Cranmer, M.D., M.P.H.
Brigham and Women's Hospital
Boston, MA 02115
References
Darcy J. The Indian Ocean tsunami crisis: humanitarian dimensions. (Accessed January 26, 2006, at http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN019573.pdf.)