By Moira Fordyce

Charles A. Cefalu

Charles A. Cefalu is professor of internal medicine and chief of the new Section of Geriatric Medicine at the Louisiana State University (LSU) School of Medicine in New Orleans. He is the author of numerous publications in the field of geriatric medicine and is a frequent presenter at geriatrics conferences. In this interview, he offers his perspectives as a geriatrician who experienced Hurrican Katrina, the massive storm that devastated New Orleans in August 2005.

What were some of the major challenges you encountered after Katrina?

Balancing professional versus personal losses. We had three and a half feet of water in our house from Lake Ponchartrain. Louisiana born, I have weathered many such storms, so I stayed at my house during the hurricane. My wife and two of my children evacuated to South Carolina, and one son stayed with me. We went without electricity and water for a month and lived with another family 60 miles away. Months of family stress calmed down shortly before Thanksgiving 2006, when we moved back into the second floor of our house and two FEMA trailers. It was a challenge having the family separated during and after the disaster.

During that first month, I lost my geriatric team when Charity Hospital closed. Thinking of ways to salvage the geriatrics training program, coupled with personal stresses, was difficult. Private hospitals and clinics turned us away. An LSU teaching hospital located 130 miles from New Orleans agreed to support the program temporarily, and things began to fall into place in mid-October. However, commuting that far for nine months was trying. I often thought that the two fellows transferred to this hospital would leave, and I called them many times counseling them to stay. They indeed stayed, and one eventually joined my team in October 2006 as my only additional faculty member.

What solutions did you and your team find?

Finding the teaching hospital gave me comfort that the only geriatric clinical and training program in the state might survive. This hospital absorbed the funding for two of our faculty and the two fellows. One good outcome of the disaster has been that, since I reestablished the New Orleans program, this teaching hospital has become the site of the second geriatric medicine fellowship in the state.

The American Geriatrics Society came to the rescue right away, providing $40,000 for housing and travel support for the faculty and fellows who ended up 130 miles away. In addition, a $500,000, five-year grant from the John A. Hartford Foundation gave us an emotional shot in the arm. At this point, we are applying for other grants from the state and federal government, since the New Orleans metro area has become an officially designated “Health Manpower Shortage Area.” This may give some additional financial support to rebuild the geriatrics program.

What self-care is needed to remain effective as a healthcare professional under stress during a disaster?

Staying calm and looking at the big picture, though hard, helped me weather the stress. Personally, I have to say that my faith in God pulled me together. It kept me feeling that someone up there was watching out for us and that we would be OK.

What training do you consider would be most useful to health professionals expecting to undertake disaster response with elders?

Attending disaster seminars would be terrific. Practicing disaster drills is worthwhile, as is having plans in place for several different types of disasters.

From your direct experience, what changes to the healthcare system or to public policy would improve support for elders during a disaster?

The healthcare system should oversee disaster preparedness for healthcare facilities to make sure elders are not forgotten -- as they were during Katrina. In addition, county area agencies on aging (AAA), coordinated by the state AAA, should encourage every elder to register with the specific county AAA so no one is left behind or abandoned during a disaster. This should be public law.

The state department of transportation should give elders high priority for transportation during disasters, and this agency should coordinate the effort. When there is advance warning during a disaster, healthcare facilities should be required to evacuate -- especially facilities with large numbers of seniors -- or be held in contempt of the law.

Moira Fordyce is an adjunct clinical professor at the Stanford University School of Medicine, Stanford, Calif. She is the author of Geriatric Pearls (Philadelphia: F. A. Davis, 1999).

Photo: Courtesy Charles A. Cefalu

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