After the Disaster on Nashville Medical News

After the Disaster

By: CINDY SANDERS

A photo of the Saint Thomas Campus showing Bosley Springs Road under water and the nearby unoccupied Imperial House apartment complex owned by the hospital

Public Health Concerns after the Flood

Although the waters have receded, it will take a long time for Tennessee to recover from the damage caused as raging rivers raced through neighborhoods. As those impacted by the flood try to create a new sense of normal, healthcare professionals should be aware of both the physical and behavioral health hazards that still lay ahead.

In the days following the flood, the Metro Public Health Department quickly mobilized to reach the most heavily impacted communities. Director William S. Paul, MD, MPH, said the initial concerns centered on drowning and injury. Once the immediate threats passed, the department began to take a broader view of public health needs stretching into the future. A series of information flyers on topics ranging from asbestos to tetanus are available on the website — many in both English and Spanish — at http://health.nashville.gov.

Almost immediately, a coordinated effort with the Red Cross and other relief agencies was launched to work with those who had lost homes. “A lot of people have been displaced,” pointed out Paul. “We’re trying to keep coordination with their medical home.” As the waters began to rise, many walked out without grabbing medicines. Paul said Dispensary of Hope and others in the community quickly stepped up to fill the need.

Tetanus was another concern in the early days. “We set up disaster information centers closer to the most impacted areas. During the busiest days, we had nurses there giving out tetanus shots.” He added the free shots were also available through the Department of Health’s three clinics before demand slowed. Although important for adults to receive their updated booster shot, Paul said the risk of tetanus is actually quite low. The tetanus information sheet noted, “There has never been a diagnosed case of tetanus related to floods or flood cleanup in the United States.”

Moving into the longer phase of recovery and rebuilding, Paul said mold has been an issue of concern for homeowners. “We’re doing a lot of communicating about that,” he said. “We’ve had environmental health staff going out into the heaviest affected communities.” Again, he said, there historically haven’t been large outbreaks of mold-related illness in the aftermath of a flood, although he cautioned people who are immunocompromised or allergic to mold would clearly be at higher risk for health concerns.

“If people already have respiratory illness, mold and dust can really be exacerbating. But if you don’t, most of what I’ve seen has been reassuring … it’s not a major threat,” he said.

Other potential dangers include asbestos in flood-damaged homes … particularly those built before 1980. The only way to really know if asbestos is present is to have samples tested by a certified lab. Although probably preferable to have a contractor remove asbestos-containing materials, many residents don’t have the financial luxury of hiring professionals. The asbestos guidelines on the Department of Health website lists steps to maximize protection.

An increased mosquito population and West Nile virus are two other potential public health hazards … particularly in standing water left in containers, gutters or unmaintained pools. In the first round of mosquito testing the weekend of May 9, Paul said his staff found fewer than expected mosquitoes but was continuing to monitor the situation.

The greatest concern, though, is for the mental well being of the region’s residents. Paul said it is crucial for both providers and individuals to be aware of the potential for behavioral health issues in the weeks and months ahead.

Coping with Stress

The Metro Public Health Department offers free publications and information on their website on helping children and adults cope with the stress of a natural disaster (http://health.nashville.gov). Those in crisis should call 800-273-TALK (8255) to reach a 24-hour crisis center or dial 911.

Although it’s normal to have difficulty managing feelings after a traumatic event, not doing so can prove harmful to a person’s mental and physical health. Among the tips for coping are:

Talk about it.
Spend time with friends and family.
Take care of yourself with plenty of rest, exercise and proper nutrition.
Limit exposure to images of the disaster.
Find time for activities you enjoy such as going for a walk or reading a book.
Take one thing at a time. The workload can seem unbearable so pick one urgent task and work on it. Being able to ‘check off’ tasks provides a sense of accomplishment and returns a measure of control.
Do something positive. Helping others can give you a sense of purpose in a situation that feels out of control.
Avoid drugs and excessive drinking, which might seem to temporarily remove stress but could ultimately create additional problems.

“It’s important for people to take care of themselves … spend time with family and friends … and to recognize when they need help or to recognize it in others … and to not be afraid to ask for help,” he stated.

Becky Stoll, director of crisis management strategies for Centerstone, concurred wholeheartedly. She said after the initial shock that people got very busy applying for FEMA aid, working on homes, volunteering in the community and rolling up their sleeves. With the passing of time, however, volunteers must return to jobs, repair costs begin to mount and anxiety builds.

“People’s reality before the flood is gone. They don’t have that reality anymore. It’s a new reality, and I think that is tough for people,” she said. Stoll added that people need to allow time to grieve the familiarity of their pre-flood life and recognize that anger or sadness might be part of that process.

Stoll, who worked in behavioral health in the aftermath of Katrina, expects to see an increased need for mental health providers in the coming weeks. “Behavioral health usually comes in the second wave,” she noted. “People are going to have some pretty normal reactions that don’t feel normal,” she said. “Now is the time to circle the wagons … call in social supports.”

Stoll noted there is a wealth of assistance available in the community for those in need but is aware that accessing that care might be a new experience for many. “My suspicion is that a lot of people impacted have never had to reach out for help before,” she said, adding that Centerstone and other agencies are working hard to blanket the hardest hit neighborhoods with information on behavioral health resources.

Another important outreach effort is through medical offices. Stoll encouraged physicians and nurses to ask patients if they had damage during the flood and to probe a little more to see if the patient exhibits emotional, behavioral, physical or cognitive symptoms of distress. She also pointed out the ripple effect of this type of disaster is huge as even those who didn’t lose a home or property might ultimately find themselves unemployed as a result of the flood or suffer from guilt that they were spared while a neighbor lost everything.

While the old reality is gone, Stoll said that when people call on their resiliency and work to find the good in bad situations that sometimes their new ‘normal’ is ultimately better than before. However, she cautioned, the process to get to that point is a painstaking one.