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Turning Tragedy into Triumph: Stories of Katrina Recovery and What You Can Learn from Them

By Liz Spittler

It has been three years since Hurricanes Katrina and Rita wreaked havoc on the Gulf Coast, but the most destructive natural disaster in American history still resonates among the thousands of people who lived through it. ADA members from New Orleans and the coastal areas of Louisiana, Mississippi and Alabama share stories of recovery in health care, hospital foodservice, school nutrition, dietetics education and community outreach—and explain how their experiences can help you.

When you grow up in Hurricane Alley, having an emergency plan is in your blood. Just ask Ginger Bouvier, MEd, RD, LDN, who has lived in New Orleans her entire life.

When weather reports began predicting Hurricane Katrina in late August, Bouvier evacuated to east-central Mississippi, about 250miles north of New Orleans. Three weeks later, she made her way to Metairie, La., where there were basic utilities. When she was able to re-enter New Orleans, nothing could have prepared her for what she found: her home destroyed, flooded cars, strewn debris and an eerily deserted downtown medical district. One look at the devastation left by the storms and she knew she had been lucky.

Bouvier had worked at an outpatient program or indigent individuals who are HIV positive. Run by the Louisiana State University Health Sciences Center and the Medical Center of Louisiana at New Orleans, the clinic was temporarily relocated to Baton Rouge after the storms and reopened in downtown New Orleans two months later. Unlike most clinics, its facility was intact enough to return to its original location.

“This really helped our clients find us when they returned to the city,” says Bouvier. “Every day our contact information was in a special section of the local newspaper, The Times Picayune, that listed all of the places for people to get assistance.”

Health care in New Orleans has been severely affected by the closing of multiple hospitals around the city, including Chalmette General Hospital, Memorial Hospital, the VA Medical Center in New Orleans and Charity Hospital.

Charity in particular had been a major provider of ambulatory care services, explains Bouvier, and its closing has put a strain on outpatient care in the area due to, among other factors, lack of usable space. For example, the HIV clinic now shares its pre-Katrina clinic square footage with five other ambulatory care clinics.

Other hospitals, including the VA Medical Center, have found silver-lined advantages to continuing services through clinics. After the storms, the New Orleans VA was transformed into a system of outpatient facilities serving 23 parishes in Louisiana and renamed the Southeast Louisiana Veterans Health Care System. In addition to the two pre-existing outpatient facilities in Houma and Baton Rouge, three community-based clinics were opened in surrounding areas. Initially located in tents and trailers, these clinics are now all in permanent spaces. The VA also converted part of the original downtown New Orleans Medical Center into an outpatient clinic, and plans are under way to open two more community-based outpatient clinics in St. Mary and Washington Parishes.

“The opening of the additional community-based outpatient clinics brought health services closer to veterans,” says Patricia Skinner, MS, RD, LDN, who works on special projects related to the restoration of services to veterans. “Eighty percent of patients now have primary care and mental health services within 30minutes of their home.”

Inpatient care needs in the New Orleans area have been absorbed by the hospitals that are open—including University Hospital, Tulane Medical Center, Touro Infirmary and Children’s Hospital. According to “Health Care Infrastructure in Post-Katrina New Orleans: A Status Report,” published in the August American Journal of the Medical Sciences, the ratio of hospital beds to population has returned to pre-Katrina levels. However, health-care infrastructure in the greater metropolitan area still faces challenges.

As the main state-run hospital for New Orleans and the surrounding metropolitan area, Charity was the primary source of care for the indigent population, serving 63 percent of the city’s uninsured. Although the percentage of uninsured and underinsured residents has declined by 17 percent since Katrina, lack of reimbursement has contributed to severe financial problems for many of the private hospitals in New Orleans.

The closings of area hospitals also present challenges for dietetic internship programs in New Orleans, particularly in preceptor participation. For Marsha Piacun, MBA, RD, director of the dietetic internship program at Tulane University, one solution was to find a number of preceptors who can take one or two students at a time.

“Before Katrina, we could place five or six interns at one site,” says Piacun. “But it became apparent some of the large hospitals were not reopening, and some that did reopen were not initially operating kitchens. They had food delivered from other healthcare facilities.”

Securing preceptors and managing contracts with a larger number of organizations present more work in terms of administration, “but the end result is very good. We found the interns experience more diverse environments this way,” says Piacun

Piacun became the dietetic internship director at Tulane in 2006.Having been a consultant for long-term care facilities and serving as a preceptor for 10 years, she was familiar with the program. She knew going into the position post-Katrina meant she would have her work cut out for her.

“People were afraid to apply,” says Piacun. “For the first two years [after we reopened in 2006], I was sitting at the computer e-mailing prospective students and trying to fill internships…convincing them to give us a try.” Piacun says the public perception of New Orleans played a large role in the students’ reluctance to come. “There was one intern who I really thought might not show up. She did!”

This fall, for the first time since the storms, the Tulane University internship program received more applicants than available internship opportunities.

DonnaM. Pace,MBA, LDN,RD, director of the dietetic technician program at Delgado Community College, also met the challenge of securing supervised practice.

“I had to really get on my knees and beg some of the facilities that previously did not take our students,” says Pace. “But one of the positive outcomes is we added service learning to our program. We work with a community program, usually through a nonprofit organization, and this has allowed our students to practice dietetics while at the same time provide a real service to people.”

One example is her partnership with the Rebuild Center, a program that serves as a shelter and feeding center for people without homes. In addition, the center provides a place to wash laundry and take showers, and helps people obtain identifications since many had lost birth certificates or social security cards.

Pace’s students have prepared and served meals at the shelter, the idea being that, after they graduate, they continue some kind of volunteer service.

Patricia Fitzpatrick, MA, LDN,RD, who directs the dietetic internship program at neighboring Touro Infirmary, also makes sure her interns familiarize themselves with the community.

“One of the first things I do with incoming interns is take them on a tour through the Ninth Ward, Seventh Ward, New Orleans East and St. Bernard Parish—the areas that were hit the hardest by the storms—so the students see firsthand the reality of many of our patients,” Fitzpatrick says. “This helps them understand why we focus on one or two feasible dietary recommendations for, say, a person with diabetes who is still living in a FEMA trailer and whose closest food source is a gas station down the street.”

In many cases, poor nourishment has exacerbated conditions like diabetes, obesity and cardiovascular disease, largely because many areas of the city don’t have access to grocery stores–areas also referred to as “food deserts.”

“If you are 15 to 20miles from the nearest grocery store and you don’t have a car, what are you supposed to do?” Fitzpatrick says. “That’s why those people we saw on television did not evacuate, because they didn’t have access to an automobile. Now a lot of folks who have come back [to New Orleans] still rely on public transportation.”

In fact, according to “Building Healthy Community: Expanding Access to Fresh Food Retail,” a report by the New Orleans Food Policy Advisory Committee , a 2007 survey of predominately low-income Orleans Parish residents found that only half of those surveyed own a car. Furthermore, where in 2005 there were 38 full-service supermarkets in the city, as of January 2008 there were 18—of which 14 are located in one parish.

To help bring fresh fruits and vegetables to underserved communities, Stephenie Marshall, MS,RD, LDN, regional nutrition manager for the Louisiana Office of Public Health, coordinates an outreach pilot program through the U.S. Department of Agriculture, WIC program and Crescent City Farmers’ Market. WIC participants are offered a $24 voucher to use toward fruits and vegetables at one of five farmers markets located in areas where fresh produce is typically not available.

“During our Fruit and Veggies-More Matters presentations at the clinics, chefs often deliver cooking demonstrations using produce from the farmers markets,” says Marshall. “The program allows us to show where they can get fresh produce in their communities and how to prepare it, while at the same time support local agriculture.”

Another initiative serving food deserts are the mobile pantries run by Second Harvest Food Bank of Greater New Orleans and Acadiana. Mobile pantries, or trucks filled with produce and dry goods, deliver food directly to communities that lack grocery stores or to organizations that offer food assistance in those areas.

“The mobile pantry program has been very successful,” says GNOA chief administrative officer Heather Hilliard, “and has enabled us to participate in a continuum of services brought directly to the most vulnerable populations.”

The challenge to put food on the table is not exclusive to poor urban neighborhoods. Residents in affluent suburban areas are sharing similar struggles.

“If you rented your home, your rent has probably doubled. If you own your property— regardless of whether it sustained little or even no damage from the storms—you are paying more because home and flood insurance has gone up. Way up,” says Fitzpatrick. “The result is, some people are having to choose between losing their home or scaling back on food.”

In addition to housing costs, increases in the cost of food and energy coupled with economic downturns and rebuilding from the storms have caused a dramatic increase in requests for food assistance, according to the GNOA, which collaborated with agriculture, health and social service departments at five regional universities to publish the report “After the Storm: An Overview of Food Assistance in Southern Louisiana After Hurricanes Katrina and Rita.”

“Prior to Hurricanes Katrina and Rita , we were distributing approximately 14million pounds of food per year,” says Hilliard. “In the last three years, we’ve distributed over 87million pounds. Currently, we are experiencing an 80- percent increase in need.”

While the need for food assistance continues to rise, participation in the food stamp program has decreased by at least 15 percent since Katrina. Hilliard says it is likely qualified applicants simply have been unable to register. In some areas, administrative buildings never reopened after the storms, forcing participants to travel further to register for assistance. In other cases of would-be participants, paperwork verifying food stamp qualification was lost in the storm.

For another federal program, School Lunch and Breakfast Programs, the road to recovery has been slow but sure.

“We have seen a gradual increase in participation across the state, including the areas most affected by the hurricanes,” says Judy Stracener, PhD, RD, who oversees the programs to ensure state and federal compliance. “There are still challenges, such as fewer vendors servicing those areas, but the good news is we have been able to continue providing meals to children who need them.”

In the St. Bernard Parish Public School System, food services coordinator Joni J. Blum says last year, 83 percent of her students received free or reduced lunch status—a 15 percent increase in participation levels before the storm.

“Every home in this parish of 67,000 people was damaged or destroyed,” explains Blum, “so now many students qualify for homeless status, which entitles them to free lunches.”

In November, two months after Katrina, about 300 of the 8,000 students returned to the schools, which at the time was a cluster of portable classrooms on the Chalmette High School campus. Today, eight schools are open in the St. Bernard school system and plans are to open three more in the next two years.

The Archdiocese of New Orleans school system, spanning 60miles north, 65miles south, and 30miles to the east and west of New Orleans— lost 25 schools to Katrina.

“Some of the schools reopened,” says Pat H. Farris, RD, director of school food and nutrition services, “but the enrollment is so low that we now satellite food to them from a larger cooking school.”

In addition to low student enrollment, Farris identified another challenge: staffing.

“Lack of staff has been an issue for three years,” says Farris. “In just the past few weeks, we have seen great improvement. Some of our experienced employees have returned for the first time.”

Filling positions with qualified applicants has proved to be problematic at many levels. The New Orleans Food Policy Advisory Committee identifies it as one of the main factors that prevent food retailers from opening new supermarkets. According to the American Journal of the Medical Sciences report, the largest health care work force exodus in U.S. history followed Katrina. And from clinical dietetics and foodservice to community outreach and agency administration, the demand for food and nutrition professionals is immense.

“A dietitian looking for a job in New Orleans has no problem finding one,” says Fitzpatrick. “My last class at Touro all had positions lined up a month before they graduated.” Fitzpatrick, newsletter editor for the New Orleans Dietetic Association, describes the first NODA meeting after Katrina in November.

“Nobody had a lot of time,” she says. “Many of us were still sorting through our homes—those who still had homes. We spent most of the first few meetings trying to locate people.”

By the end of 2005, NODA estimates it had lost about two-thirds of its membership to relocation. Today the district association is back up to about half its members. Stephenie Marshall, president of NODA and past president of the Louisiana Dietetic Association, is determined to continue increasing those numbers.

“Last year, the Greater New Orleans Health Service Corps offered grants for physicians and health-care practitioners to work in the areas still recovering from the storms,” says Marshall. “Unfortunately the money ran out and there wasn’t any left for allied health professionals, including RDs.”

Marshall is working on an initiative to seek dollars to be used as monetary incentives for registered dietitians to work in the greater New Orleans region.

Martina Musmeci Salles, MPH, RD, LDN, who works in home health-care services and past president of NODA, hopes the initiative will be successful. She also notes that while potential grants would be greatly helpful in rebuilding the local dietetics work force, there are other incentives for coming to New Orleans.

“I know of several RDs who came to this area to help out with clean-up and recovery on a temporary basis, “ says Salles. “Then after they left, they found they missed the closeness and resilience of the communities here, and now are looking to return permanently.”

All the ADA members who shared their experiences agreed that the people of New Orleans will never forget Katrina and its aftermath. And while there is still a long way to go, they are embracing the encouraging signs of recovery and looking toward the future.

Liz Spittler is managing editor of ADA Times.

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