Prescription for Katrinas
Whatever human error fed the failures in our response to the devastation of Katrina, let's not allow the search for scalps to obscure the big cracks in national preparedness that emerge only in disasters of such vast magnitude. As Red Cross president during 9/11 and many hurricanes, floods, and earthquakes, I learned that each disaster offers its own lessons. One of Katrina's most shocking: Our vaunted medical superiority crumbled like the levees in her smothering wake.
No book of floods would have anticipated the 30-something fellows frolicking like golden retrievers in Katrina's sewage-filled waters, recklessly flouting medical warnings. Nor would it have foreseen storm troopers enforcing mandatory evacuation orders with rifles at the ready--this after the floodwaters receded. Or dragging a frail old lady from her dry home and carting her off in a flatbed truck in the name of that public-health menace, E. coli. That's heavy medicine, especially when bottled water, purification tablets, and--as power returns--a good boiling will do. Bacterial contamination happens all the time after floods.
If there are health risks that do justify forcing people from their homes, we'd better decide exactly what they are ahead of time. Gunpoint evacuation or quarantine might be in order for smallpox outbreaks, but for what else? And should officials have harangued the holdouts, like the French Quarter residents who were spared the floodwaters, to leave? Their determination to clean up, rebuild, and recover their beloved city is the grit America was built on. Perhaps, instead of those flatbed trucks, we should get them the means to help themselves, like heavy boots, mosquito protection, clean water, food and medicine, and needed cash.
Guerrilla warfare. Brutal surprises dimmed rescuers' efforts. New Orleans police slogged through knee-deep water to fight off armed thugs in a kind of guerrilla warfare, without vehicles, low on ammunition, and with little food, water, or communication. Most of them lost their homes, and two of their comrades committed suicide. Healthcare workers labored amid disease, desolation, and lawlessness, practicing a kind of Third World medicine, to their own and their patients' detriment.
Had we successfully evacuated the sick and frail, we would have lost far fewer lives. But civilian hospitals and nursing homes lack mass evacuation capability when roads are out. They are in the dark without military-type satellite communications and in peril without armed guards. Calls to 911 utterly depend on cell towers, phone lines, and ambulance access. Even Katrina's high demand for healthcare workers was unexpected. The federal disaster medical assistance teams are not geared for a Katrina-level crisis. Doctors and nurses everywhere stand ready to volunteer, but they need training, safe and rapid transport, medical supplies, and maintenance to become a nationally integrated mercy battalion of sorts, poised for MASH-like settings.
The most tragic surprise came with the tens of thousands of people who chose to ignore the storm warnings. Some had no transportation, or feared their homes would be looted, or mistrusted where they would be taken. Remedying transportation and security is the easy part compared with rethinking our outmoded system of sheltering. Makeshift shelters with cots lined up tighter than beds in a 1950s charity ward are entrenched in disaster response. But they just don't do it for more than a few days, as these settings inevitably deteriorate into breeding grounds for disease, depression, anger, and misery. Let's get with designing the shelter of tomorrow: rapidly assembled tents or trailers that would grant some privacy to those who sleep there, and providing all evacuees a medical clinic and pharmacy, child-care and play areas, phone and computer access, work opportunities, and a bank offering interim cash grants as needed. And yes, a kennel for pets (with appropriate rules for their care and feeding), so people don't shun evacuation to protect their cherished best friends.
Threats of major floods, earthquakes, and increasingly now acts of terrorism are with us. It takes a heap of hubris to believe that we can anticipate their many curveballs, but also great humility to continually learn and respond in the face of inevitable uncertainties. As we mourn Katrina's dead, in their name let us dedicate ourselves to a national culture of 21st-century preparedness for what is sure to haunt us again in one dreadful way or another.
This story appears in the September 26, 2005 print edition of U.S. News & World Report.
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