Post-Katrina Volunteers Learn To Expect the Unexpected
Volunteer psychiatrist Catherine May, M.D., flew into Gulfport, Miss., with only a Mapquest printout to guide her to the place where she would care for Hurricane Katrina's displaced victims. For Jeff Stovall, M.D., two weeks in Louisiana meant practicing psychiatry by walking around. Leslie Gise, M.D., found that improvisation and flexibility were the keys to getting medical work done.
All three were among 50 APA members who answered a call to serve in the Gulf Coast area in the four months following the devastating hurricane and flood.
An initial request to APA members on behalf of he U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) produced 56 volunteers, 28 of whom were sent to the Gulf region under the direction of SAMHSA contractor Westover Consultants Inc. For its efforts in finding the psychiatrists on such short notice, APA received $112,000, which was placed in an escrow account to reinvest in the organization's disaster response efforts, said Darrel Regier, M.D., M.P.H., executive director of the American Psychiatric Institute for Research and Education and director of APA's Division of Research.
A second round of requests produced an additional 37 volunteers, of whom 12 were deployed to the region. Many of the total number of volunteers were unable to serve because they could not rearrange their schedules on short notice, according to Edna Davis-Brown, project manager for Westover, speaking on behalf of SAMHSA.
“It was hard to find psychiatrists to send over the holidays, and it was also hard to find local people, since they were trying to restart their lives like everyone else in the area,” said Davis-Brown.
Reactions Varied by Setting
May, who is in private practice in Washington, D.C., and on the clinical staffs of George Washington and Howard University hospitals, stayed at a reform school while serving first at a tent city of evacuees and then on board an anchored cruise ship pressed into service as a shelter. The two settings could not have been more different, she said in an interview.
The people in the tents had lived in rural areas around nearby Pass Christian, Miss., “tied to the earth,” said May. Many had evacuated before the storm, and their houses had been wiped out. “Yet ask them how they're doing and they'd talk about getting by on faith, prayer, God, and family. They were tied into a support system and were better able to tap into social and spiritual resources.”
Evacuees on the ship came from more varied backgrounds, farther from their current refuge, she said. Many had ridden out the storm in attics, watching their possessions float away. On board the ship, people seemed more guarded and socially isolated, she said. People arrived at the ship with their medications but soon ran out, leaving doctors to juggle ways of substituting drugs from an inadequate supply.
Planning to assure adequate supplies of medications and licensing and insurance for out-of-state physicians ought to be addressed before future disasters strike, said May. Louisiana's temporary law allowing outside doctors to practice in the state expired at the end of the year. They were not covered by federal insurance since that applied only to unpaid volunteers, and the psychiatrists received a stipend of $200 a day.
“All of these are solvable problems,” she said. “You have to go down expecting the unexpected and just roll with it.”
At both sites, she and her colleagues had to develop case-management systems and help people reintegrate into their reconstructed communities. That was not easy, given that many local psychiatrists had not yet returned to work, patients lacked transport to get to doctors, and many had lost both their livelihoods and the health insurance that went with them.
With a delay of five or six weeks before patients could be seen at the nearest mental health center, May identified those who had to be seen soonest and arranged for the rest to get sufficient medications to tide them over the wait.
Toward the end of her two-week stay, May and fellow psychiatrist Lorna Mayo, M.D., who is researching medical quality at the Veterans Affairs Medical Center in White River Junction, Vt., went through charts on the ship looking for high-risk patients, patients with no planned followup, and patients with multiple prescriptions and left a list for the doctors who would succeed them to offer some continuity of care.
“I had an overwhelmingly positive experience despite some of the logistical and systemic difficulties,” said May. “It reaffirms my faith in the power of the human spirit to transcend adversity.”
Adaptability Is the Key
Leslie Hartley Gise, M.D., a community psychiatrist in Kula, Hawaii, and a clinical professor of psychiatry at the University of Hawaii at Manoa, worked in a shelter housing 300 people from New Orleans' Lower Ninth Ward for her two weeks, beginning September 30, 2005, one month after the hurricane. On some days she had a heavy clinical load, but at other times she, too, practiced psychiatry by walking around. People were reticent at first but soon enough told her their stories of living through the storm and flood.
Logistics were sometimes problematic, said Gise. The team was placed together in a hotel at first, but later had to split up to sites more than an hour's drive from the shelter. Orientation consisted of a brief video. She had no contact with the team that succeeded hers in the shelter and little contact with local medical or mental health professionals.
Still, adaptability was essential for accomplishing the mission, said Gise.“ You had to think on your feet when labs could not fax you back results because there were no phones or when some patients had none of their prescriptions filled while others got the same one three times over.”
Basketball + Psychiatry = Help
Stovall, who is medical director of adult outpatient services at Community Health-Link in Worcester, Mass., served as part of a 16-member team, along with two other psychiatrists and social workers, psychologists, pastoral counselors, and a nurse.
Stovall's work took him to several Red Cross shelters in the parishes north of New Orleans, caring for evacuees from the city.
“We provided daily rounds of psychiatric services plus a little general medicine,” he said, echoing the experience of other volunteers.“ On many days, I was the only physician in the shelter.”
He tried to involve himself broadly in the daily life of each shelter he visited—playing basketball with the children, helping them with homework, even serving food occasionally. As he became a familiar sight to shelter residents, they felt better about approaching him to talk about their mental conditions.
“Once they got to know me, people would talk to me about their pre-existing mental illness,” he said. “They had been afraid to say anything before for fear of being kicked out of the shelter or being denied relocation. But when I approached them in an open, confidential, and trusting way, they understood that I was a person who could help them.”
Help included identifying and assessing people with mental illness, restarting their medications, helping them sort out the next step in their lives, and trying to link them to an ongoing source of psychiatric care, if those other services were available.
“I was surprised at the level at which people were able to survive in spite of their mental illness,” he said.
The volunteer program offered lessons for everyone concerned.
“Overall, it was a successful project, but it had its challenges, and SAMHSA has learned a lot,” said Davis-Brown. “Everyone involved needs to be flexible because needs will change constantly. You have to get to the area, find out what's being done, and decide how best to support and coordinate efforts with others like state officials, the Red Cross, and FEMA.”
Even as all parties learned from their experiences, the presence of visiting psychiatrists and mental health professionals was “very helpful,” said David Edward Post, M.D., medical director of the Capital Area Human Services District in Baton Rouge.
Some volunteers were undeterred by any bumps in the road. In mid-January May and Mayo returned on their own to the Mississippi tent clinic to observe the transition from a crisis-intervention program to a sustained community setting in a local family practice. May also found that the reconstruction of lives proceeds slowly.
“In the tent city, the population has shifted a little,” she said on her return to Washington. “Those with strengths and resources are starting to be able to pull ahead, but for many of those with limited financial, personal, or spiritual resources, life remains extremely challenging.”
More information on APA's hurricane response efforts and resources is posted on APA's homepage at<www.psych.org>.▪
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Published online: 3 February 2006
Published in print: February 3, 2006
Notes
Volunteer psychiatrists find that a flexible, informal approach to storm evacuees works best.
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