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Neuropsychiatric Implications of Disaster Relief: Notes from Camp Chaos

—From the diary (September 30 to October 15, 2005) of Dr. Michael Seyffert, child neurologist, who volunteered his services with the Medical Reserve Corps at a shelter in Baton Rouge for evacuees after the Katrina/Rita hurricane of September 2005

Twenty-one days after I filled out the paper work I was assigned to the Baton Rouge area where there were two shelters—Camp Disco and Camp Chaos—sponsored by FEMA (Federal Emergency Management Agency) Camp Chaos was an old YMCA building, and it was there in the nautilus and racquetball rooms that the Public Health Service officers and volunteers slept. The evacuees slept in cots in the gymnasium. The majority of the more difficult cases (about 90 to 100) were sent to Camp Disco and the rest stayed at Camp Chaos. The week before I arrived they received 180 individuals from other shelters in New Orleans.

Life at Camp Chaos
The apt name originated when they received so many people at the same time. Of the 13,000 evacuees from Rita, there were 800 special needs cases, mostly elderly disabled, but also people who had been on the street and had prior undiagnosed psychiatric problems. For many weeks they didn't have medical care, so when the medical care came there was such an amazing need. When I arrived on September 30th, the census at Camp Chaos was down to about 110; there were 60 special needs people ranging in age from 8 to 83 and 45 caregivers. Most of them were poor and many had chronic primary care histories: diabetes, congestive heart failure, sickle cell, end-stage renal disease, dialysis, HIV, asthma, and chronic obstructive pulmonary disease among others. Eighteen of the chronically ill patients had neuropsychiatric problems, such as schizophrenia, schizoaffective disorder, bipolar disorder, post traumatic stress disorder, ethanol abuse and withdrawal, cerebrovascular disease seizures, and pseudoseizures. Our job was two-fold: to take care of their primary care and psychiatric needs and to get housing, either in or out of state.

What were the evacuees like?
They were under incredible, almost unbearable stress. Kids and the elderly suffered the most. The first day I was there a mom had to be restrained by two nurses because she was beating her teenage daughter. The story was that her husband had recently found a new job, and left her alone to take care of the children. She was overwhelmed and an argument broke out that morning when her daughter refused to attend a local school that had just opened. The daughter, it turns out, had ADHD with co-morbid Oppositional Defiant Disorder and was not receiving treatment.

Some families I saw were separated from their larger families. We had one Hispanic family whose kids were severely ADHD and out of school. The family was split up and the father was obviously trying; he may have not have been used to taking care of his kids on an ongoing basis, and he wasn't working on his job. I was also trained as a pediatrician, and there were several children there; some with ADHD, some with asthma and ADHD.

For the geriatric patients the experience was extremely traumatic. A nearby temporary shelter was housing approximately 60 elderly patients for 7 to l0 days when they were only expected to be there for 2 to 3 days. By the time we saw them many were dehydrated, hadn't had their support equipment cleaned, their bed sores were ulcerating; none of this should have happened. Back at Camp Chaos, a new arrival was in a hypermanic bipolar state talking about suicide. "Doc, I'm at the end of my rope," said a 50-year-old man who hadn't slept in 4 days. It turns out that he had been rescued from a rooftop by the National Guard and had spent the last two weeks in four different shelters.

"Blue beams are shooting down from the sores on my legs—they hurt something awful!" reported a 51-year-old woman with schizoaffective disorder and depression. Like the gentleman before her, she had an interesting story to tell. She had been a first responder, a volunteer, like me who had worked for several months at "Ground Zero" in the aftermath of 9/11.

There were some malingerers and substance abuse cases—some people who were exploiting the situation but they were a minority. It seemed to me that newspaper and television coverage didn't accurately picture the courage and resilience of many of the hurricane victims.

Working with other services
The surrounding network of support services was overwhelmed by the number of people in need. Social services, sponsored mainly by the Public Health Service, in addition to volunteers, worked pretty smoothly with us. I thought that the emergency room workers might have some preconceived idea about what we were doing there, of how we saw our role, so we made a point of going over there. I spoke to one of the emergency room physicians to see if we could figure out a system so we could work together. Since communication was often a problem we tried to make the emergency room physicians understand that although we were not a hospital we weren't simply a shelter; our hands were tied, we weren't even allowed to put in IVs and yet we were dealing with chronically ill people. We developed a better rapport but we had very limited options in terms of how to treat. For example, I dealt with a woman with atypical chest pains; we were trying to coordinate getting her taken care of and we didn't have any equipment; we had one old EKG machine that we were able to hook up and monitor her, but the battery ran down and we called the emergency medical services. She was taken to the emergency room and she had to sit there for 6 to 8 hours and then they didn't even do basic medical tests such as serial enzymes.

I was on the front line and flying by the seat of my pants. When I wasn't sure about my medical decisions I phoned my colleagues at home. Steve Dickstein, a fellow T-32 researcher, a pediatrician and child psychiatrist generously gave of his time and experience, providing me additional reassurance. I did eventually get some help from SAMHSA (Substance Abuse Mental Health Services Agency), which is a mental health organization of NIH (National Institute of Health). We were seeing a lot of very complicated psychiatric cases so I called one of the SAMSHA representatives just to make sure and we adopted a plan. When you're on the front line trying to deal with problems it helps to have people to bat your ideas off of—it really helps. Some reps came to alleviate the burden, Janis Petzel was one of them, and between us we saw about 20 psychiatric cases, some at the shelter, some coming to the shelter. In addition, an outreach clinic mostly for children asked for our help; the need was unending, and I felt we were like the Dutch boy putting his finger in the dike to keep out the flood.

Volunteers were a great help. I particularly remember a Public Health Service officer who worked tirelessly and well beyond the call of duty although he suffered from Parkinson's disease. And I was especially amazed at the volunteer nurses who came from Indiana; if it wasn't for them we couldn't have done what we did.

Closure—October 15, 2005
The federal government wanted the shelters closed and after that time only 15,875 people remained in shelters. Upon reflecting on my experience, I realize that while it may have been frustrating, it was also very rewarding and meaningful to me personally as a physician. The stories of individual courage and resilience in the face of overwhelming catastrophe were inspirational. The impact of the increased psychosocial stress on the evacuees was exacerbated by the lack of organized assistance. The most profound and negative effects fell on the youngest and eldest of our society.

I came to realize first hand the inadequacy of the medical care available to poor people and the glaring discrepancy between the lives and expectations of the poor and those of middle class and wealthy people. The chaos and confusion pointed up the urgent need for planning for coping with a disaster.