New hurricane season sparks discussions about lessons learned

STD/HIV officials say communications were a major problem

Hurricane threats have become so common in recent years for Louisiana coastal residents that when state STD and HIV government officials closed their office doors in New Orleans on the Friday before Hurricane Katrina struck, they were convinced they would be returning on Monday morning to do business as usual.

Instead, it was weeks before some offices opened, and some state employees relocated permanently and never returned to their jobs.

There also have remained problems with collecting, storing, retrieving, and mailing laboratory specimens, locating clients of the STD program or HIV AIDS Drug Assistance Program (ADAP), and preparing for the next natural disaster.

As another hurricane season begins in June, some survivors of the New Orleans hurricane and flooding disaster of August 2005, discuss lessons learned from the last time around.

"When we left work on Friday afternoon, we didn't even know the storm was coming this way," says Lisa Longfellow, MPH, STD director for the Louisiana Office of Public Health in New Orleans. "Then on Saturday morning, we received mandatory evacuation orders, and we all took three days worth of clothes and thought we'd be back to work in the middle of the week." Longfellow was a scheduled speaker at the 2006 National STD Prevention Conference, held May 8-11 in Jacksonville, FL.

For the STD program and AIDS Drug Assistance Program, one of the biggest initial problems was employees being unable to return to the offices and retrieve files and computer data which was necessary to find clients and continue operations.

"There was a mandatory evacuation in place in New Orleans, which was not lifted until Sept. 23 or 24th, and we couldn't come into the city without police escort," says Beth Scalco, LCSW, MPA, administrative director for the Louisiana Office of Public Health HIV/AIDS program in New Orleans.

"We were able to return to our office twice to access files and servers that we had to have to restore basic functioning, but basically we couldn't get into the city," Scalco says. "Then, once the mandatory evacuation was lifted, our building still was closed."

Scalco and Longfellow share their experiences and offer this advice about recovery and preparation for a natural disaster:

• Finding a surrogate office: The Louisiana Office of Public Health's HIV/AIDS Program could not return to its office building, which is located four blocks from the Superdome, until early November 2005, more than two months after Hurricane Katrina and flooding devastated the city.

"We were very happy to be back, but the building had a great deal of damage to it, and as time went on it seemed to deteriorate," Scalco says.

With the help of the CDC, the HIV/AIDS program first found space on Oct. 3, 2005, in Kindred Hospital, where 28 employees and computers jammed into the space of four hospital rooms, Scalco says. "Up until then, we worked in Baton Rouge, Lafayette, and the North Shore of the lake to try to do as much as we could that way."

Even after employees returned to their pre-hurricane building, the stay was short. The HIV/AIDS Program was evicted from the deteriorating building in mid-February 2006, and in April, it was moved temporarily into another building, located two blocks away, Scalco says.

Although the new building is part of an emergency move, the staff hopes the office will be able to make it a permanent home, she notes.

"We're hoping this building is the one because the moving has taken a toll," Scalco says. "I have staff that are living with relatives or living in a FEMA trailer, and they don't have their homes back together, and then to have to make an office move too is a fair amount of stress."

The STD office also has been relocated from an eight-story building to a two-story building, she says.

"Before, we were on the sixth floor of an eight-story building, and we didn't have to worry about the roof leaking," Longfellow says. "No we're on the second floor of a two-story building, and we have to worry about that."

Each night, the computers have to be backed up and protected when they leave the office, she adds.

• Locating staff: The HIV/AIDS program's staffing also suffered after the hurricane. More than one-quarter of the 57 employees who worked in the week before Hurricane Katrina struck decided not to return to New Orleans or their jobs, Scalco says.

"Some people lost their homes and everything they owned, and they made an immediate decision not to come back," Scalco says. "So we had resignations immediately."

There also was some turnover among the eight employees of the STD office at the Louisiana Office of Public Health, Longfellow says. "We have people who still are not in their homes," Longfellow says. "We lost some staff because once they evacuated, they never came back and didn't have a house to return to in some cases."

Of the remaining employees, one person has to camp out in someone else's apartment; another commutes 1.5 hours to work while waiting for her home to be repaired, and yet another person has to live in a FEMA trailer, Longfellow says.

It took days or even weeks to track down staff because no one's cell phones worked in the immediate days after the storm, they say.

"The main method we had to contact people was their cell phones, and because all cell phone towers were damaged, there was no way to contact people," Longfellow says.

"Every day, I would try to call people on their cell phones, and finally I'd get through to one person, and that person would talk to another person."

The office's staff had evacuated as far away as California and Utah, she notes.

The HIV/AIDS office was similarly handicapped by the storm.

"Although we did all those wonderful things to prepare for a disaster by having a contact list, we had left the office with very little on Friday afternoon," Scalco says. "Even if we had the contact list, they were of very little value because none of the cell phones worked, and emergency contact numbers within the New Orleans area were also not working."

• Information technologies and communications problems: The unexpectedness of the storm's direct hit and the subsequent flooding undermined all disaster preparedness plans regarding communications, Scalco and Longfellow say.

The ADAP system protects all client data with security measures and computer file back-ups, but the back-up files were also located in New Orleans, so they couldn't be accessed immediately after the disaster, Scalco explains.

"In retrospect, what we've decided to do is back up even more things like fiscal information necessary to process invoices for contractors and locate these in a geographic area that's more distant," Scalco adds.

By the end of the second week post-Katrina, the HIV/AIDS program staff used conference call bridges, supplied by the National Alliance of State and Territorial AIDS Directors (NASTAD) and the Kaiser Foundation, to hold staff meetings about getting the program back together and getting clients linked to services, including their ADAP medications, Scalco says.

"It was a permanent conference call line available for our use," she explains. "So we'd tell everybody to call into this toll-free number at 11 a.m., and we'd have 60 people on the line at the same time."

The staff also used the conference line to communicate with contractors, she notes.

"Our main charge was to put the program back together and get HIV services up and running," Scalco says. "But a lot of our initial time was trying to help people who were dislocated get to new services."

Immediately after the storm subsided, Longfellow reported to the office of public health emergency operations center and was assigned to answer the volunteer phone line. She assisted in the call for volunteer nurses and physicians to work in the special needs shelters in Louisiana, and there were thousands of responses, she says.

At the same time, she was trying to locate her own staff and try to return to surveillance work.

"Our first step was to work with the management information system department to bring back computer access," Longfellow says. "As soon as they were able to they went to New Orleans and moved the computer out."

Fortunately, the computer servers were on the second floor, and the water only rose five feet high, she notes.

"So they went in with flashlights and boots and transferred and restored data from a back-up, before moving the server," Longfellow says. "Our biggest problem as far as restoring our STD surveillance system is that it's not a web-based system."

This meant that data could only be found on computers involved in the system. Whenever there is a change, software needs to be changed on all of the computers within the system, which are located throughout the state, she says.

"Another program in the Office of Public Health that had an Internet-based computer system had no problems with accessing their information," Longfellow says. "So that's one of our goals — to move toward an Internet-based system."