The humanitarian crisis from Tropical Storm Harvey is likely to prove a massive public health challenge long after the waters have receded from the battered lands of Texas and Louisiana.
Tens of thousands of Texans have been evacuated to shelters with pressing medical needs caused or exacerbated by a record-breaking deluge of rain and floodwater. Volunteer physicians are treating injuries sustained during rescue operations, chronic physical ailments and mental health issues.
Contaminated floodwater can harbor bacteria and disease-bearing pathogens that cause stomach viruses, rashes and breathing problems, and crowded makeshift shelters provide a fertile atmosphere for spreading infections.
Cleanup efforts can expose workers to infections, especially those suffering from allergies or breathing conditions such as asthma. Mosquitoes breed and thrive in the fetid, standing water.
Mental health problems often surface over time in households and communities as the scale of the loss, dislocation and devastation sink in.
The Federal Emergency Management Agency estimates that 22,000 people are in 235 shelters across Texas and Louisiana. Those numbers are expected to rise as more flooding hit Gulf coastal towns Wednesday morning.
Doctors, nurses and other health care professionals are mobilizing to deal with the short- and longer-term fallout, officials said.
At the George R. Brown Convention Center in Houston, 8,000 people are taking refuge in a facility that was prepared to hold 5,000. Among the medical response teams coordinated by the Red Cross and the city of Houston, physicians from Baylor College of Medicine have joined a large number of volunteers to provide medical and mental health treatment.
“We’ve had so many physicians that have come out to help, so many residents and trainees and people who are willing to lend a hand,” said Dr. Christopher Perkins, an orthopedic surgeon with Baylor College of Medicine who spoke by phone from the convention center, where he was treating patients for orthopedic and wound care.
Doubling back
Harvey’s floodwaters started dropping across the Houston area, and the sun peeked through the clouds Wednesday in a glimmer of hope for the besieged city, The Associated Press reported. But the storm refused to move on, doubling back toward land and battering communities near the Texas-Louisiana line.
Officials say the confirmed death toll from the hurricane climbed to 31 after a woman’s body was discovered floating in Beaumont. Also, the bodies of six family members, including four children, were pulled from a van that had been swept off a Houston bridge into a bayou. Authorities were investigating at least 17 more deaths to determine whether they were storm-related.
“Unfortunately, it seems that our worst thoughts are being realized,” Harris County Sheriff Ed Gonzalez told the news service after the van was found in 10 feet of muddy water.
Harvey is certain to have massive economic, political and social aftershocks, but for health care professionals, the medical challenge has already arrived and is likely to last for years.
Patients who have been treated at the convention center include many with chronic conditions, Dr. Perkins said, such as diabetic wounds that have worsened from being submerged in floodwaters; people needing dialysis; wound care for chronic infections; and bone fractures and other trauma wounds suffered while they were being rescued or escaping the flooding.
“Obviously yesterday was trying to get supplies as much as we can. Now with the federal government with their response and some of the local pharmacies, our supplies — from wound care to medicines and antibiotics and things like that — our supplies today are much improved,” he said.
Dr. David Persse, the physician director of EMS in Houston, told CBS that the immediate challenges of physicians in the shelters concern treating people who were badly injured walking through floodwater littered with debris and filled with bacteria.
Within the shelters, promoting good hygiene is critical to preventing a bacterial outbreak, such as norovirus, a highly contagious gastrointestinal virus that causes diarrhea, nausea and stomach pain.
Dr. Persse said his staff was struggling to provide enough hand sanitizers throughout the convention center and that they were encouraging people to wash with soap and water in bathrooms, which also require multiple cleanings throughout the day.
“To get folks to focus on their person hygiene” is priority, he said and that “getting the hand sanitizer up and distributed is one of our challenges.”
In the long term, health care services in the community will be under immense strain to provide care for patients with chronic issues in addition to treating people with acute problems related to infectious diseases or injuries as result of the flooding or cleanup. This is in addition to many hospitals having damage themselves.
Ben Taub Hospital in Houston, one of the largest trauma centers, had to evacuate 60 of 350 patients in addition to being short-staffed and undersupplied, ABC News reported.
DaVita Dialysis, a national dialysis administrator, had about 150 centers in the storm path of Harvey with over 7,500 patients and 2,000 employees. About half of their 100 Houston centers are up and running.
Alicia Patterson, a spokeswoman for DaVita, said the company is helping transport patients and their employees; On Wednesday morning they had commissioned five boats to pick up providers and patients in the Houston area to bring them to clinics.
“We are doing mix of everything: Either patients get there themselves or we’re providing transportation — [whether] that’s by car, bus, boat, whatever the case may be,” she said.
Mental health challenges
At the convention center, mental health professionals are contending with treating people with chronic psychiatric disorders, caring for people with autism and dementia, and treating acute symptoms of anxiety and panic attacks.
Dr. Sophia Banu, a psychiatrist with Baylor College of Medicine, was one of the first psychiatrists to arrive to the convention center in Houston and has led the coordinating efforts of psychologists, social workers and volunteers in providing mental health services for evacuees at the shelter.
Speaking by phone from the convention center, Dr. Banu, who worked in relief efforts following 9/11 and the Nepal earthquake, said the number of volunteer psychiatrists and behavioral health residents has increased since Monday, growing from three or four people working a shift to seven people providing services in the morning and about five in the evening.
When health care providers first arrived on Monday, they were clearing out makeshift sleeping areas — some just towels on the floor. But as volunteers increased and more roads have opened, people started returning home for short breaks.
Dr. Banu said she expects they will be working out of the convention center for at least the next few days as people start to return home or have to move to other shelters or into hotels.
“Each disaster has its own challenges, and we can never really prepare,” she said.
“We are dispensing medication, making sure even if it’s not the exact medication, we are giving them the medication and making sure they come back to get their second dose, or third dose — so that they don’t go through withdrawal because a lot of [psychiatric] medications can cause withdrawal symptoms,” she said.
“We are also seeing patients who are very anxious and having panic attacks, which is a normal reaction,” Dr. Banu said, adding that they are employing breathing and relaxation exercises.
“We are also creating areas for children with autism, people with dementia, like a quieter area because it’s really, really noisy trying to create areas where they feel less stimulated and so they don’t become aggressive,” she said.
A common refrain from Texans who have either suffered from Harvey or are volunteering their efforts is an overwhelming sense of camaraderie and purpose in helping others in their time of need.
Dr. Perkins echoed this sentiment Wednesday morning.
“The biggest thing, at least in our city, it’s neighbors helping neighbors here — and physicians and nurses and other medical personnel, the response for people volunteering their time to come to different shelters and wherever there was a medical need was overwhelming,” he said.
“And that’s a good problem to have.”
• This article is based in part on wire service reports.
• Laura Kelly can be reached at lkelly@washingtontimes.com.
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