Lee
Jacobs, MD
Associate Editor-In-Chief
"Those
in authority must retain the public's trust. The way to do that
is to distort nothing, to put the best face on nothing, to try
to manipulate no one."
--John
M Barry, The Great Influenza
See review Perm J 2004 Fall;8(4):84.
|
|
The
people of Kaiser Permanente (KP) continue to respond to the health
care needs of survivors of major disasters. In this issue of The
Permanente Journal (TPJ) (see page 59), we remember Katrina
one year later by taking a glimpse at the experiences of KP responders
as they cared for the evacuees in Houston and New Orleans.
Past Disaster
Responses
TPJ
has highlighted prior KP responses to disasters: natural--the
December 2003 tsunami (Fall 2005;9(4):69-82), and man-made--the
2002 anthrax poisoning (Winter 2002; 6(1):56-61). Each situation
is similar in public health challenges, yet each has its own unique
challenges.
The
response to Hurricane Katrina was no different. Though similar
to our responses in Sri Lanka and Bande Aceh, personal testimonies
demonstrate the many unique challenges the Katrina disaster presented
to the KP teams mobilized to Houston and New Orleans--the most
significant of which was poor logistical support.
Who is
in Charge?
The
accounts of the governmental confusion and difficulties in the
Katrina response were reminiscent of the anthrax letter poisoning
in the mid-Atlantic states in 2002. As an on-site infectious disease
physician during this man-made disaster, I was amazed that it
was never clear which person from which agency was in charge.
Who is the spokesperson? Who is making decisions? Who is accountable--local
or state health departments, or the CDC? As a result of this gap
in leadership, major communication lapses ensued. I recall the
KP response leaders in the command center having to watch CNN
for updates--inappropriate.
This
was vividly replayed in the Katrina response--who is really
in charge? In responding to this disaster, the multilayers
of government became more a liability than a strength.
The Lesson
from Bande Aceh, Indonesia
As
one of the responders to the tsunami disaster, I was very impressed
with the central oversight of the many international agencies.
There never was a question as to who was in charge--the Indonesian
Minister of Health. At briefing sessions coordinating the disaster
response, it was clear that the World Health Organization took
the lead in overseeing the response but all plans were contingent
on approval of the Minister of Health's office. Without this clarity,
leaders of agencies would have been in a Katrina-type mode of
uncertainty as to when and where to become involved.
Are We
Ready for a Future Influenza Pandemic?
On
the basis of observation of past US responses to disasters, there
is no doubt that the quarantine requirements of any future pandemic
will stress our public health system. Past experiences suggest
the following are essential for a successful response:
-
There must be one agency and one person who is visibly in charge,
fully accountable, and has the authority (and the will!) to
enforce essential quarantines. Why would we think we can
implement and enforce mandatory quarantines when we have proved
we are unable to enforce mandatory evacuations?
-
There must be clear communication channels from the agency in
charge to responding agencies and, just as important, to the
public.
-
We must practice--A basic requirement of emergency preparedness.
After witnessing anthrax and Katrina, I personally do not believe
that our country will be able to initiate effective quarantines
without a significant investment in drills.
Regardless,
We Are Ready to Serve!
Unfortunately
there will be future natural and man-made disasters and our preparedness
will again be tested. Whether our society is prepared or not,
one thing is certain--there will once again be a need for the
compassionate people to step forward and serve.
|
