Twenty Years Ago, Hurricane Katrina Transformed American Healthcare – and Direct Relief

When Janet Mentesane thinks back to the sheer scale of medical need after Hurricane Katrina, her strongest memory isn’t of providers treating physical trauma or water-borne diseases. It’s of people with diabetes, hypertension, and other chronic health issues – the non-communicable diseases that affect an estimated 1.7 billion people worldwide – evacuating without their medications.

“There was a massive amount of people who were showing up and multiple shelters that were opening up,” recalled Mentesane, who was the executive director of MLK Health, a free clinic and pharmacy in Shreveport, Louisiana, about five hours’ drive from New Orleans. (She is currently the clinic’s grants manager.) “They had no medications and no physicians…Their pharmacies were destroyed, along with the records and data.”

Mentesane’s experience reflects a larger challenge of the Hurricane Katrina response that surprised many – although not the safety net providers working on the ground.

“Primary healthcare needs, especially among low-income and chronically ill populations who couldn’t evacuate, outweighed traditional emergency care and triage for the injured,” recalled Amy Simmons, communications director at the National Association of Community Health Centers, or NACHC. “The most pressing need among Katrina survivors wasn’t treating storm-related injuries. It was medical attention for chronic health conditions that went untreated as the public health system collapsed.”

MLK Health’s providers prescribed medicine to people displaced at Shreveport shelters, a process that often required them to examine and re-diagnose patients who’d already been diagnosed with a chronic disease.

“To be on the safe side, we didn’t just dispense 90 days’ worth of pills based on what someone told us,” Mentesane explained. That kind of patient care is time-intensive and detailed, and MLK Health at that point was a tiny free clinic with a pharmacy “the size of a walk-in closet…It was difficult, let me tell you.”

Thousands of people who’d been displaced by Hurricane Katrina stayed in the area – which was then hit by Hurricane Rita, a Category 3 storm, the following month.

Mentesane remembers it as a “chaotic” time, but one that shone a spotlight on the urgent need for healthcare in southern states – and that launched a groundswell of support for community providers like MLK Health.

“Starting from Scratch”

Hurricane Katrina made landfall on Monday, August 29, 2005. The impact was cataclysmic: 1,833 people were killed by the storm in Louisiana and Mississippi. But while the death toll was horrific on its own, that number doesn’t begin to account for Katrina’s disastrous consequences for health care access, insurance coverage, community mental health, housing, food security, or many other measures of health.

Even before the disaster, Louisiana and Mississippi were ranked the two least-healthy states in the U.S., with high rates of chronic disease, food insecurity, and other issues. Health care was an unaffordable expense for many thousands of people. The storm exacerbated many of these problems: The number of operational clinics in the New Orleans area dropped from an estimated 90 to 19. NACHC reported that 11 local health center facilities were destroyed by Katrina and 80 more significantly damaged.

In part because of the lack of available primary care, NACHC explained, many people used the overstrained local hospital system to manage their health, but a Government Accountability Office survey found that New Orleans hospital capacity in February 2006 was operating at about 20% of its pre-Katrina capacity.

In addition, thousands of physicians and other providers were forced to evacuate – one study estimated as many as 6,000 doctors had been displaced from the NOLA area – and approximately 200,000 people lost employer-sponsored health insurance after Katrina and Rita, according to NACHC.

Mental health issues such as post-traumatic stress skyrocketed, with providers in the area reporting that widespread trauma persists to this day. Health issues from toxin exposure to skin conditions to substance use disorders to gastrointestinal illnesses proliferated. Children, especially those with diseases like asthma or mental health issues, were particularly severely affected by the storm.

Dr. Keith Winfrey, now chief medical officer at the New Orleans East Louisiana Community Health Center, was working as a physician at another community health center in the city of New Orleans. (NOELA had not yet been founded.) He remembers having a staff meeting the Friday before the storm made landfall, and reviewing evacuation plans with colleagues.

“We all thought we would return to work on Monday,” he said.

Instead, Dr. Winfrey’s family, which included a toddler and an infant, fled to Alexandria, Louisiana, where Dr. Winfrey worked for three years, caring for community health center patients who had been displaced by Hurricane Katrina and were struggling to get their prescriptions, re-establish care for chronic diseases, and manage anxiety and distress related to their experiences.

“Many patients didn’t have access to their medical conditions or history, but they’d tell you they needed their medications filled,” he recalled. “You were pretty much starting from scratch in terms of trying to get a good handle on their medical conditions.”

“The Right Kind of Intervention”

Dr. Winfrey returned to New Orleans in January of 2009 as a Tulane University professor of internal medicine who also provided community health care. During appointments, he was struck by the widespread post-traumatic stress his patients were experiencing. “When they would come into their appointment, everyone would pretty much have a Katrina story,” with many patients describing witnessing bodies floating down the street or being trapped on their rooftops for days, he said. “They were there for non-communicable diseases, but the trauma was so fresh.”

“I don’t think people realize how traumatic it really is,” said James Comeaux, the executive vice president of the New Orleans-based health center Access Health Louisiana, who is also a licensed clinical social worker. “You have a whole generation of people [in New Orleans] who have PTSD.”

Access Health’s providers worked “ungodly amounts of hours” in the weeks after Katrina, Comeaux recalled. Where 35,000 patients in a year might have been a typical number, they saw 35,000 in the first month after the storm hit. Many had physical trauma or needed a tetanus or hepatitis vaccination, and many others needed their prescriptions for diabetes or hypertension filled.

But it was quickly obvious to Comeaux that mental health issues – along with a broader need for maternal health care and other integrated services – were going to drive health care needs over the long term. “Finding the need is not difficult; it’s finding the right kind of intervention,” he explained.

However, the horrors of Hurricane Katrina drew public attention to the area’s urgent health needs, and the lack of affordable health care. Tulane University, like other local players, was drawing on the groundswell of support to increase community health care in the NOLA area, expanding the presence of federally qualified health centers designed to serve low-income and underinsured or uninsured patients.

One of those health centers was NOELA, where Dr. Winfrey is now chief medical officer. The FQHC was founded by the Tulane University School of Medicine in 2008.

Hurricane Katrina “led to a sort of rebirth of how primary care was delivered in New Orleans,” Dr. Winfrey explained. The push for more available and effective care also led to the use of new kinds of electronic medical records that allowed patients’ diagnoses and treatment regimens to be widely accessible rather than locally housed.

In the aftermath of Hurricane Rita, MLK Health received enough financial support to install a generator that could power their entire pharmacy, allowing them to keep medications cold – and safely dispense them – during power losses. A few years later, they were able to upgrade their pharmacy and install an electronic medical record system that allowed them to accept and fill prescriptions from outside pharmacies. “That’s been a game-changer for displaced people,” Mentesane said. By that time, MLK Health was outgrowing its original clinic building, and purchased and renovated a new facility.

“It was a combination of not only the community need, but also community support,” she recalled.

“To Be Ready”

The combined disaster also grew MLK Health’s partnership with Direct Relief. While the organization had provided support to nonprofit healthcare providers in California, most of its work was international at that point.

For Direct Relief, too, the catastrophic impact of Hurricane Katrina was a pivotal moment.

When the storm struck the Louisiana coastline, Direct Relief had recently wrapped up a successful pilot program focused on providing medication to California community health centers and clinics, free of charge. Damon Taugher, a former director of U.S. programs at Direct Relief, called NACHC to ask if similar medical support would be helpful to health facilities serving communities impacted by Katrina.

Direct Relief had responded to international disasters for decades, but its U.S. work at that time was less extensive. The organization had never responded on a large scale to a U.S. disaster. But within six months, Direct Relief had provided more than $50 million in material medical aid and cash assistance to Gulf Coast community health centers and free clinics.

“Not only was the response among the largest in Direct Relief’s history, but it shaped the organization’s next ten years,” Taugher recalled in a 10-year retrospective essay on Hurricane Katrina’s impact. “To be ready for the next disaster, Direct Relief set out to establish relationships with a nationwide network of safety net providers.”

“Direct Relief was first introduced to the nonprofit healthcare safety net in the aftermath of Hurricane Katrina, and it quickly became clear that providers at community health centers, free and charitable clinics, and charitable pharmacies were already so deeply aware of the community needs, and so ready to serve their patients in any capacity,” said Katie Lewis, Direct Relief’s regional director, U.S. Programs. “Those partnerships were a natural fit for us.”

“Willing to Step Up”

Today, Direct Relief works with more than 2,000 community health centers, free and charitable clinics and pharmacies, and other safety net providers across the U.S., and has provided more than $2.8 billion in material medical aid and $238 million in grants to U.S. healthcare providers.

Direct Relief’s network of U.S. partnerships allows the organization to provide ongoing programmatic support to safety net providers over the long term, both in the form of grant funding and through the provision of material medical aid, such as the medicines and supplies needed to manage chronic diseases like diabetes, hypertension, and chronic obstructive pulmonary disease; vaccines; reproductive health supplies; infrastructure for cold-chain medical storage; and much more.

The organization provides more support in the U.S. than in any other country, Lewis said.

“These community health centers, clinics, and pharmacies are indispensable providers in their communities,” she explained. “They are continually being asked to do more: fill healthcare gaps, reach more people in need, respond to more frequent and severe emergencies, and help the communities they serve rebuild resilience over the long term. And despite all the challenges and limitations, they are somehow always willing to step up.”

These long-term partnerships also make it possible for Direct Relief to respond quickly and effectively during emergencies such as natural disasters, when safety net providers send out mobile medical units; dispatch doctors, nurse practitioners, and emergency responders into the field to offer emergent care; provide medical care and mental health support at shelters; and reestablish continuity of care for people who have fled immediate danger, among many other lifesaving strategies.

Direct Relief has also funded resilient power projects for safety net providers in disaster-vulnerable U.S. communities from California to Louisiana to Puerto Rico through the organization’s Power for Health program; provided financial support for mobile medical units; and distributed emergency grants to search and rescue groups and community organizations responding in the aftermath of disasters.

Over the long term, too, these safety net providers will support communities still recovering years or decades later – like New Orleans, where Hurricane Katrina is still a monumental part of the area’s history, identity, and current health landscape – from a disaster.

Research increasingly shows that communities deeply affected by tropical storms will experience vastly increased morbidity and mortality for decades to come: In some cases, the excess deaths caused by a disaster can reach 300 times the original death toll in the years following.

Community health centers, free and charitable clinics and pharmacies, and other nonprofit providers work to prevent these excess deaths by connecting people to housing, reducing food insecurity, implementing new disease prevention measures and mental health monitoring, and much more.

“People Still Don’t Realize”

Today, Mentesane said, healthcare in Louisiana is a much larger network of coordinating organizations who work together during the Gulf Coast’s frequent Atlantic storms to coordinate care.

Safety net organizations are assigned roles in local and state emergency planning – MLK Health, for example, acts as a pharmacy and distributor for people displaced by disasters, conducts preparedness drills, and has its own detailed plans in place to keep tabs on patients, provide emergency care, and reopen as quickly as possible.

MLK Health receives and stages Direct Relief’s large-scale Hurricane Preparedness Packs, which contain the medications and supplies that responding organizations most frequently request in the aftermath of a tropical storm. If the storm season is uneventful, the medical support – much of it intended for patients with chronic diseases – is used as part of the health center’s ongoing community healthcare work.

Access Health also receives a Hurricane Prep Pack from Direct Relief, which Comeaux describes as a boon. “Those supplies really do change lives,” he said, recalling a child at one of the health center’s facilities who received a nebulizer from the pack when he urgently needed one. Direct Relief also provided funding to support the purchase of two mobile medical units for Access Health.

“We have benefited from that relationship in amazing ways,” Comeaux said.

After Hurricane Katrina, “the emphasis became more on continuity of care for people with chronic diseases and disabilities,” Mentesane said. “I think that a lot of people didn’t realize – I think a lot of people still don’t realize – the amount of chronic illness in Louisiana and a lot of the southern states.”

New Orleans has changed since Dr. Winfrey’s return. Where he originally cared primarily for members of the city’s lower-income Black communities, he said people from growing Latino and Vietnamese communities in the NOLA area have become a larger percentage of his patients. Chronic diseases affect each community, but “these are unique medical conditions that can be impacted by language and culture,” he said. His patients need “someone who is culturally aware and familiar with dietary practices.”

His practice has changed along with his patients, allowing him to suggest healthy substitutes for foods like white rice and tortillas, and learn more about how his patients see issues like chronic disease prevention and cancer screening.

“Each culture has their own way of viewing the importance” of health, Dr. Winfrey said.