Long After Katrina, One HIV Clinic Illustrates How the Impacts are Still Felt

As the rebuilding of New Orleans continues, the experience of one HIV clinic shows that the impact of Hurricane Katrina has lasted far beyond the initial death and destruction. According to an article in the Aug. 15, 2006 issue of Clinical Infectious Diseases, now available online, the experience offers lessons for other healthcare programs planning for disasters.

"Anyone watching the media had an idea of how horrific the actual hurricane was," said manuscript co-author Rebecca Clark, MD, PhD, of Louisiana State University Health Science Center, "but I don't think people understand how far-reaching the consequences of the disaster have been."

Clark and her colleagues operate an HIV outpatient program in New Orleans. After the city was evacuated for the hurricane, the program's physicians were forced to see their patients in Baton Rouge, approximately 80 miles away. Initiating clinics to see patients was challenging because the faculty and fellows who staff the clinic had been relocated to several states and telephone communication was difficult or impossible. It took two weeks for the program to locate all of its physicians.

Staff members weren't the only ones scattered by the storm. Patients had also dispersed. Many ran out of medications, which is particularly worrisome for patients on antiretroviral drugs. "Interrupting the medication allows the HIV disease to become more active," said Clark. "And we also worry that some patients might try to stretch their medication out, taking less of it or delaying their doses. These are some of the worse things that can happen because they might lead to the emergence of resistance to the medications."

It was two months after the hurricane before the HIV outpatient program was able to reopen in New Orleans. It took another month before laboratory capabilities were available, and, as recently as April, some laboratory tests were still unavailable. Instead, samples are sent 70 miles to Houma, to a reconstructed laboratory located in a former grocery store.

The authors recommend that healthcare programs prepare for disasters by taking steps to safeguard their data and their clinical samples. They suggest that programs prepare information for patients, including where to seek alternate clinical care sites and what to do if they are unable to access medication for several days. Finally, programs should cultivate alliances with hospitals and clinics in the region but outside the immediate area.

"New Orleans is still in the news somewhat, but I don't know if people realize that things are very slowly returning to normal," said Clark, who is nervous about the new hurricane season that began June 1. "Although a great deal of progress has been made, we're still not back to normal, even this long after the storm, and it'll be some time before we are back to normal."

Source: Infectious Diseases Society of America (IDSA)