Health Care

Trauma Certain to Trail Behind Katrina

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Physical and mental health problems are predictable in the wake of disasters on the scale of Hurricane Katrina. International disaster experts offer advice on how best to respond.


One published estimate says there was a disaster somewhere in the world on average every two weeks between 1900 and 1986. The US has had its share, but most have occurred in the developing world. NPR's Joanne Silberner talked to international disaster experts about how to handle situations like the aftermath of Hurricane Katrina.


Ron Waldman of Columbia University was the World Health Organization's disaster relief coordinator in Indonesia after last December's tsunami. He followed the Katrina relief effort through the media. He's reluctant to criticize, but he was struck by how little attention was paid to lessons learned overseas. He's seen high illness and death rates in large, poorly supplied camps in northern Iraq, in Goma, in Macedonia. It's a basic principle of resettlement: try to avoid putting large numbers of people together for any length of time. With Katrina, he saw thousands of people crowded into the New Orleans Superdome.

Mr. RON WALDMAN (Columbia University): One of the worst places for people to be in the wake of a disaster is a large stadiumlike environment. At best they can--should be used as way stations while people are being processed or sent to smaller evacuation sites.

SILBERNER: Looking forward, something he's seen in Goma, in Indonesia and the other places he's been is the importance of paying attention to the local social structure.

Mr. WALDMAN: Keeping families together, keeping even villages together or, in the case of New Orleans, neighborhoods together is a really, really important activity if one wants to make sure that recovery is going to be as quick as possible.

SILBERNER: That will reduce stress, but what about mental illness? Psychologist Thom Bornemann is director of The Carter Center for Mental Health in Atlanta. He's worked in Southeast Asia and in Cuban and Russian evacuations, and in Florida after Hurricane Andrew. Bornemann predicts a small proportion of people will get post-traumatic stress disorder, and Katrina will likely have an effect on the incidence of depression.

Mr. TOM BORNEMANN (Psychologist, The Carter Center for Mental Health): It will likely go up, probably not dramatically up, but it will go up some. I think you'll have what we used to call a reactive depression, which is something in reaction to a clear, precipitating event in the environment, but most of those folks will get better over time.

SILBERNER: The vulnerable--children, older adults, people with pre-existing mental disorders, rescue workers--will need special attention. Still, he and others with experience in disaster relief say it's important not to overmedicalize the response to trauma. Psychologist Neil Boothby of Columbia University works mostly in war situations. He says mobile trauma clinics used after 9/11 in New York City didn't make a difference.

Mr. NEIL BOOTHBY (Psychologist, Columbia University): People should feel sad after this stuff. Sadness is not a bad thing. Now if it lingers and immobilizes people, then it is a negative thing, a bad thing. But people have got to be given the time to go through the normal human reactions and feelings. It would be appropriate to have nightmares for a while.

SILBERNER: He says what's important is rebuilding the social structure.

Mr. BOOTHBY: Healing will take place as they begin to be able to help themselves and help others. I mean, the helping the others is the part. That's how you start putting communities back together.

SILBERNER: In Indonesia, in Aceh, the aid group Oxfam deliberately hired local people instead of using foreign volunteers to construct its refugee camps, giving the locals a sense of purpose and a chance to make money to support themselves. Joanne Silberner, NPR News.

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