In a community shelter for Hurricane Katrina evacuees, an exhausted Red Cross manager slept sitting in a desk chair—worn down by two straight weeks of work. In Houston’s Astrodome crowded with evacuees, a woman shared her harrowing tale of escaping the drowned city of New Orleans. For Dean Michael J. Klag, who went to Houston September 8 to help the American Red Cross in its work sheltering over 5,000 evacuees, the images are indelible. And so are the lessons. “What this disaster did was show us the cracks in our infrastructure not only in disaster response but also in health care,” says Klag. “If people had access to health care and were receiving medical therapy, the health burden on the evacuees would be less.” As liaison between the Red Cross leadership and local, state and federal agencies, Klag, MD, MPH ’87, toured some of the 25 shelters opened by the Red Cross in Houston and Harris County, which surrounds the city and is the size of Rhode Island. “The city of Houston stepped up to the plate and provided immediate emergency shelter and coordinated care,” says Klag. “Their response was really phenomenal.” Klag began by visiting the “mega-shelters”—the Astrodome, the Reliant Center and the George R. Brown Convention Center. “In those, you had great access to health services, counseling and so on, but they lacked privacy,” he says. “The smaller shelters, which were mostly in churches, were much more family- and kid-friendly—you had access to out of doors—but the services were much harder to get. They didn’t have a clinic on the 50 yard line.” Overall, Klag was impressed with the Red Cross’s innovative efforts to provide care for the evacuees. Some of the community shelters arranged for local hospitals to send physicians and nurses to the shelter, while others transported the sick to nearby clinics. The response efforts involved a web of agencies and organizations, making swift communications and coordinated efforts difficult. Each entity had its own health surveillance and assessment forms. In mass shelters especially, it is imperative to quickly screen evacuees for health conditions. (For example, 150 people from New Orleans were known to be on directly observed therapy for tuberculosis and finding out whether they were in the shelters was a priority.) A standardized health assessment was needed. Harried shelter managers lacked training in the need for such data and initially concentrated just on maintaining the shelters. Klag helped establish a health survey system; its main goal was to detect an early outbreak of disease before evacuees left, carrying disease with them. Among his suggestions for the future are standardized processes and forms for recording health data, better health training for volunteers, and improved communication and coordination among public health and federal agencies and volunteer organizations like the Red Cross. While in Houston, Klag was assisted by Alex Vu, DO, MPH, an instructor in the Johns Hopkins School of Medicine’s Department of Emergency Medicine, and Sarah Tuneberg, a displaced MPH student from Tulane University.
— Brian W. Simpson
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