A mobile medical care approach targeting underserved populations in post-hurricane Katrina Mississippi

They packed what they needed for a disaster - equipment for trauma treatment and IV fluids - and headed south to Mississippi.

However, when the doctors of Operation Assist arrived on the Gulf Coast a week after Hurricane Katrina, they found themselves on a different mission.

“It wasn't so much that we were fixing broken bones or treating injuries from the flood,” recalled David Krol, M.D., chairman of the department of pediatrics at the University of Toledo College of Medicine. “What we really needed were medications for hypertension and congestive heart failure and diabetes.”

They were giving primary care treatment to storm victims.

Hurricane Katrina pummeled Mississippi and Louisiana in August 2005. An estimated 1,300 lives were lost according to government statistics. While people many evacuated, thousands remained behind — cut off from medical care.

Krol and a team consisting of two other physicians and a medical student spent time on mobile medical units that were part of Operation Assist, a project of the Children's Health Fund and the Columbia University Mailman School of Public Health. They describe what they found in the May issue of the Journal of Health Care for the Poor and Underserved .

“In the storm's aftermath, mobile medical units arrived and started work,” said Krol.

“At that point, the rain had stopped and it was ‘hot, hot, hot,'” he recalled. The units' recreational vehicles broke down, forcing medical personnel to grab supplies and set up sites to treat people.

Krol and colleagues found that 35 percent of patients “had at least one chronic disease diagnosis —such as hypertension, asthma or diabetes. Even more striking was that the older the patient, the more likely they were to have one or more chronic illnesses, and the care they sought was directly related to that chronic illness.”

“It wasn't necessarily a mistake to be prepared for trauma,” said Krol, who served as director of medical affairs and clinical evaluation for The Children's Health Fund. Still, “one has to remember that there was an epidemiology of disease prior to the storm. That doesn't get replaced by trauma.”

For the people left behind after Katrina — many of whom were poor — the obstacles to receiving health care became greater.

“You have a lot of low-income people who don't have insurance,” said Sarah Bass, assistant professor of public health at Temple University. “Needy populations often use emergency rooms for primary care.”

After a disaster like Katrina, some hospitals and health clinics are unable to function and low-income residents “don't even have access to the primary care that they fell back on,” Bass added.

While Krol does not recall any deaths in the patients seen by the mobile units, “we would find people with blood pressure out of control,” he said. “It shows how important medications are and how important access to care is.”

The researchers say that in disaster preparation, the chronic medical needs that already exist within a community should receive more attention. They conclude, “Although mobile medical units were successful in providing stopgap measures, it is clear that systemic preparedness will better serve the population as a whole.”

Krol DM, et al. A mobile medical care approach targeting underserved populations in post-hurricane Katrina Mississippi. Journal of Health Care for the Poor and Underserved 18(2), 2007.