Water, shelter, food, and basic medical care--the American Red Cross has been delivering these essentials to survivors for 124 years, ever since its founding by nurse Clara Barton. But last September, Red Cross teams formally included public health expertise for the first time, when nearly 100 Harvard School of Public Health graduates signed on as volunteers in response to Hurricane Katrina.
The morning Katrina struck, HSPH Professor Jennifer Leaning and Michael VanRooyen--both emergency physicians at Brigham and Women's Hospital, in Boston--called Red Cross headquarters in Washington, DC, with a proposal. Given widespread flooding and crowding in Red Cross shelters, the risk of epidemic infectious diseases was high. Why not enlist School alumni trained in disaster response to survey the shelters, keeping tabs on disease outbreaks and collecting data to guide resource allocation in the days ahead? Their job would be to assess needs at 126 sites, educate health providers, and take a statistical snapshot of evacuees' physical health and mental health.
A call for volunteers went out by e-mail under the aegis of the Harvard Humanitarian Initiative (HHI), a new University-wide program co-directed by Leaning and VanRooyen that includes several of Boston's elite teaching hospitals as well as HSPH and Harvard's schools of medicine and government. Within three days, alumni were on the ground with a survey in hand designed by Hilarie Cranmer MPH '04, another Brigham and Women's physician.
Among them were two MPH '05 graduates of HSPH, Christian Arbelaez and Barsam Kasravi, both BWH physicians who study racial and ethnic disparities in health. Instead of cholera and dysentery, "there were cots and cots full of people with acutely exacerbated chronic illnesses," Arbelaez says, a reflection of survivors' low-rung status on the socioeconomic ladder.
Between them, the pair traveled to 15 shelters--churches, warehouses, schools--in Lafayette, Louisiana, and central and northwest parts of the state. There they met a young mother whose seven-year-old boy had asthma, but no inhaler ... an elderly woman with dementia whose name no one knew ... a lady with a history of stroke, her health endangered for want of a daily aspirin ... a man with liver failure, his abdomen bloated with fluid. Many suffered from high blood pressure and heart disease. In one large shelter, 40 percent of adults had insulin-dependent diabetes.
Says Kasravi, a family medicine physician, "Many of these disadvantaged people didn't even have a primary care doctor. Few had prescriptions, let alone medical records." Mental health was a huge issue, he adds.
Kasravi and Arbelaez call themselves "foot soldiers" for the HHI, a program dedicated to advancing research, practice, and policy in the field of humanitarian assistance. In addition to doing field work, HHI's affiliated professionals will in the future assist in tactical planning, managing the news media, and forging links with local, state, and federal public health agencies.
Through the HHI, Leaning and VanRooyen say they hope to bring a public health presence to all Red Cross operations. One goal is to build a "virtual academy of responders," says Leaning, a board member with the Red Cross's Massachusetts Bay chapter. Volunteers will be vetted for their managerial ability and expertise, she notes, then strategically matched to specific roles. A major HHI goal, VanRooyen stresses, is research--analyzing epidemiological data to aid huge numbers of people in crisis. "Research is what we do here at Harvard, and we do it better than anyone else in the world," he says.
Within 18 months, the HHI will have 300 members, Leaning predicts. "People are coming up to us and saying, 'We want to be part of this.' When the next big disaster happens somewhere in the world, we'll pull up the roster and call them."
The Harvard Humanitarian Initiative seeks to engage public health specialists with expertise in disaster response from within and outside of the University. For more information, see http://www.hsph.harvard.edu/fxbcenter/HHI_memo_for_web.htm.
Karin Kiewra is editor of the Review and associate director of Development Communications at HSPH.
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