Before Hurricane Katrina, the Mississippi State Department of Health felt that it was prepared for a hurricane. “Within a couple of days, it was glaringly obvious that we were not prepared to address many of the issues we were presented with,” said Paul Byers, acting state epidemiologist with the Mississippi State Department of Health.

The epidemiology of diseases on the Mississippi Gulf Coast resembles that of the rest of the United States. People have chronic medical problems, including diabetes, end-stage renal disease that requires dialysis, and coronary artery disease. After a disaster, people need specialized medical care, even if the capacity of primary care centers and hospitals has been drastically reduced. Furthermore, the medical care system in Mississippi has many holes. Many people in the state are not only uninsured but also have no medical home, and many places lack an adequate supply of primary care physicians.

Mississippi had several special medical needs shelters in place before Katrina, but these facilities did not meet the needs of many people after the storm. They did not have enough food, water, or medications, and many had no references to their original prescriptions, making proper medicine dosage difficult to maintain. Even where they had generators, they did not have gas to run them. The state also planned to partner with schools, community health centers, and other local institutions to provide sheltering for people with special medical needs, but the infrastructure was not in place to do that.

After the storm, the state built up its infrastructure, including a permanent special-needs shelter with trained staff and backup power and supplies, and it was better prepared when Hurricane Gustav hit in September 2008. But problems still occurred because many people who were evacuated from the Gulf Coast did not know what medications they were taking. An electronic health information exchange is needed, said Byers, so that health care providers can quickly access medications, diagnoses, special medical needs, and other information to provide the best possible care. “That takes a lot of money and a lot of effort.”

The Department of Health has the responsibility both to meet immediate medical needs in the first days to weeks after a medical or natural disaster and to meet long-term medical needs. To do so, said Byers, it needs to have partnerships with multiple entities to provide physical infrastructure and meet whatever needs exist. For example, the state now has special medical assessment teams that can be deployed to an area. A partnership with the University Medical Center in Jackson has resulted in portable facilities that can provide primary care and even surgery. Byers said that partnerships with the federal government are also necessary to access resources that transcend what is available locally.

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