Psychiatr News February 3, 2006
Volume 41, Number 3, page 1
© 2006 American Psychiatric Association
Post-Katrina Volunteers Learn To Expect the Unexpected
Aaron Levin
Volunteer psychiatrists find that a flexible, informal approach to storm
evacuees works best.
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.
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A little pharmaceutically incorrect humor lightens the décor
around the makeshift clinic on board the M.S. Holiday, a floating shelter for
storm evacuees. Courtesy of Lorna Mayo, M.D.
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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."
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Damaged roads and bridges slowed travel for medical volunteers and other
aid workers. Courtesy of Lorna Mayo, M.D.
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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>.
Related Article:
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Dual Eligibles Find Part D Rollout Problem Plagued
- Mark Moran
Psychiatr News 2006 41: 1-27.
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