New Orleans Returnees Face Health Concerns

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Floodwaters in New Orleans have left the city dangerously contaminated with sewage, petroleum products and toxic heavy metals. As business owners and some residents begin returning to the city, is the health crisis in the Big Easy about to get worse?

FARAI CHIDEYA, host:

From NPR News, this is NEWS & NOTES. I'm Farai Chideya.

Mayor RAY NAGIN (New Orleans, Louisiana): The city of New Orleans will start to breathe again. We will have lights. We will have commerce. We will have people getting back into their normal modes of operation and the normal rhythm of the city of New Orleans that is so unique.

CHIDEYA: That was New Orleans Mayor Ray Nagin at a press conference last week. Starting today, residents of the city's Algiers section can return to inspect their damaged homes and to start to rebuild their shattered lives. Some have already returned and more than 180,000 others have permission to return over the next two weeks, but Vice Admiral Thad Allen, who is leading the federal relief effort, cautioned that urban conditions are still unsafe, the water is undrinkable and the sewer and electrical systems still aren't fully functioning. Neither are the city's hospitals. One medical official says several hospitals are likely damaged beyond repair.

Joining us now to talk about the public health crisis in the flood zone are Dr. James Aiken, medical director for emergency preparedness for Louisiana State University's Health Sciences Center. He's with us from New Orleans. And Dr. Irwin Redlener, the director of Columbia University's National Center for Disaster Preparedness. He joins us from New York at the Mailman School of Public Health.

Thank you both so much for joining us.

Dr. IRWIN REDLENER (Columbia University's National Center for Disaster Preparedness): Hello.

Dr. JAMES AIKEN (Louisiana State University's Health Sciences Center): Hello.

CHIDEYA: So, Dr. Aiken, let me start with you. What about the call by Nagin for re-entry into the city? Is this actually the right time for that move?

Dr. AIKEN: As a health-care adviser to the city, it was my advice not to do so at this time. The health-care infrastructure in Orleans Parish at this time is still on an outpatient basis. We're still seeing patients on concrete with tents out in the open in the Convention Center. We're working as hard as we can to open up other clinic sites as well. But the hospital infrastructure in Orleans Parish has been decimated. Even if we were to stand up a number of clinics and handle the outpatient demand, we still have a critical lack of inpatient hospital beds.

Now the three hospitals in Jefferson Parish--Oschner, West Jefferson, East Jefferson--have played an enormous role in taking some of that demand from us. I can't say enough for what they've done. But we are anticipating a huge influx in the hundreds of thousands of people who will be coming back to very primitive conditions. And so as a health-care provider, I am very, very concerned that the timing of this re-entry is not in the best interest of this community.

CHIDEYA: Let me just ask you a follow-up. You are actually working on some of these makeshift hospitals and setting up new sites. What kind of injuries are you seeing so far from the people who are holdouts in the city or the people who've sort of snuck in to return?

Dr. AIKEN: Well, by numbers, it's the anticipated--stepping on glass, stepping on nails, a couple of falls--but we are also seeing some significant injuries in terms of electrocution. We had an instance the other day across the lake where a teen-ager was cutting wood and another part of the tree collapsed, fell on him, and he was significantly injured, most likely a spinal cord injury. We're also seeing again electrocutions and now we're seeing motor vehicle accidents as a result, as much as anything else, from a lack of traffic control. In most parts of the city, there's not even a basic red-green system. So in some areas, we have four-way stops, but quite frankly, traffic control is primarily based on the drivers themselves. And now we're going to have drivers who are very anxious to get back to their homes, have things on their minds, and we certainly are anticipating an increase in those type of injuries.

CHIDEYA: Dr. Redlener, let's talk a little bit about a previous experience of disaster, 9/11 in New York. What were some of the differences between a situation like 9/11 and the situation that you've got in New Orleans right now?

Dr. REDLENER: Well, there really were some extraordinary differences between the 9/11 experience and what we're experiencing throughout that 90,000-square-mile area that's been hit by the hurricane and the flooding in New Orleans. And in particular is the absence, in this case, this current case, of proximal resources to come in to the rescue. Even in 9/11, which was horrific beyond description for all the reasons that we all know, we had a flood in of resources and help from hospitals, first responders, everything you can imagine from the surrounding communities of New Jersey, Connecticut, and even the rest of New York City. So it was a much more confined area. So the problem now with such a vast area that's been affected, that the neighboring communities, even the neighboring states that you might anticipate could come in to help are themselves struggling with the consequences of the storm. So the fact that we don't have the proximal resources to help out, as we did in 9/11, is a very big difference.

And the second thing is that we didn't see in New York City after the initial explosion any secondary problems. Here, we had the storm, the hurricane, the flood, and a long-term problem with the kinds of injuries and illnesses that Dr. Aiken was just talking about. So the conditions here are extremely different, both devastating, but this one requiring a whole other level of preparedness and response.

CHIDEYA: Dr. Aiken, I was actually in New Orleans recently and saw some of the sludge, which military officials were saying is extremely toxic, in the neighborhoods. We went into the Ninth Ward, and I know that people are not going back into the Ninth Ward anytime soon. But are the toxins that are so prevalent in some of the deeply flooded areas actually spread throughout the city, and what kind of precautions are people who are returning going to have to take against that?

Dr. AIKEN: Well, I'm not sure exactly, unfortunately, what's in the water. I've not seen an official EPA or Department of Environmental Quality report on what's in the water. We know in some parishes, St. Bernard particular, that there was a significant oil spill. I will tell you from personal experience when I was evacuating the patients from Charity Hospital here that a number of us experienced rashes on areas that were exposed to the water, particularly our legs. These rashes came on very quickly. So it seemed to us it was more of a contact. I have heard reports of potential benzine in the water as well.

Dr. REDLENER: Yeah, there's also--we're hearing that there's a toxic amount of lead and maybe some other heavy metals in the water as well as very large amounts of so-called coliform bacteria like E. coli, which, of course, will be problems later on. And I also wanted to say that my National Center for Disaster Preparedness and the Children's Health Fund from up here in New York have several mobile medical units in the region. And one of the things we were seeing--and I just wanted to emphasize what Dr. Aiken was saying. We saw two days ago a young girl had fallen off a roof that she and her family were trying to repair, and she suffered a fracture in her cervical spine. So I think we're going to see an awful lot of these kinds of injuries as well as time unfolds and people try to re-establish their houses and their communities.

CHIDEYA: And Dr. Aiken, you know, we were just talking about potential toxins in the water. There's certainly petroleum. There does appear to be a certain amount of bacteria. But what about things like the fact that there is really no good drinking water system? What does that alone do to the population in terms of making sure to protect their health? A lot of people, for example, will be very careful about what they actually drink, but not as careful about what they bathe in or what they use to hose down their house.

Dr. AIKEN: That's correct. Again, we will--for those of us down here, we have not seen much in the way of illnesses that we would expect from waterborne diseases. I think most of us who've been here for a couple weeks have become very careful in how we use the water. It does seem to be safe, at least in Jefferson Parish, New Orleans, to bathe. But most of us are very careful not to either drink or even use water for brushing teeth and things like that. As people come in, though--and again, these are people that have other things on their mind--they certainly may either forget or for some reason may ingest that water. If they don't, we may then see what we have seen from the beginning, people with heat-related illnesses, dehydration, things like that, exhaustion. So the issue of not having drinkable water is a very critical issue. In addition to that is the fact that we have not completely restored our sewage system. And so this issue of contaminated water, as people influx, is going to be even greater. And it's for those reasons that a number of us have a huge concern on the timing of the re-entry here.

CHIDEYA: Dr. Redlener, Dr. Aiken, let me just end with one kind of long-term question. You first, Dr. Redlener. As these people return and try to rebuild their lives, are going to be under great stress and pressure on many different levels, what can the federal government and the city government do to make sure that their lives are safer as they return?

Dr. REDLENER: This is a very important point and we're very worried about the stress psychologically on adults but particularly children who are not going to school. Their lives are completely disrupted. And people have asked me, `What can we expect in terms of long-term psychological effects, including the so-called post-traumatic stress disorder?' And my answer is, we really don't have an idea. Typically, in a major disaster, we might see somewhere between five and 12 percent of the population still having significant symptoms a year out. We don't know what we're going to see here. I don't think there's any precedent in terms of the amount of damage and destruction and disruption to give us a good sense of what that'll ultimately be. But the answer to the question about what people need to do is a lot of community support and a lot of focus on how quickly we can get things back to normal and support people during the process of relocation or coming back to their homes to re-establish those communities.

Dr. AIKEN: I couldn't agree more. It's my opinion that illnesses from the stress that's related to what has happened here will probably be the number-one long-term chronic issue as it relates to health care. I will tell you, though, that I participate and actually am sitting at the command center for the US Public Health Service and a Greater New Orleans health care task force, and we are addressing that issue currently. The Substance Abuse and Mental Health Service Administration as well as other mental health agencies are on the ground now. And we're also using assets from the unified command that exists downtown as well to provide the support, as much as we can, to this devastated area. So, again, I consider this, in the long term, to be potentially the number-one health-care issue in the long term.

CHIDEYA: Dr. James Aiken is medical director for Emergency Preparedness for Louisiana State University's Health Sciences Center. And Dr. Irwin Redlener is the director of Columbia University's National Center for Disaster Preparedness. He joined us from New York, Dr. Aiken from New Orleans. Thank you, gentlemen, both so much.

Dr. REDLENER: You're welcome.

Dr. AIKEN: Thank you.

CHIDEYA: This is NPR News.

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