Monday, August 30, 2010

Hurricane Katrina, Revisiting my Mental Health Relief Work

Five years ago, I wrote this article about my mental health relief work after Hurricane Katrina. When I reread it today, I finished with tears in my eyes. My experiences in Louisiana had a profound impact on me. One of the hardest things about relief work (after returning home) is not knowing what happened to those people with whom I interacted, especially the ones I came to deeply care about. I've never stopped praying for them and wishing them well.


As I watched the devastating effects of Hurricane Katrina on the news, and read personal horror stories posted on the internet, I knew I wanted to offer my services to the victims, using my skills in critical incident stress debriefing.

With the financial backing and emotional support from friends, family, and members of my karate studio, I left my private psychotherapy practice for two weeks to travel to Houma, Louisiana. Acquaintances in Houma (who soon became friends) provided me housing, meals, transportation, and emotional support.

Once I arrived, I was conscripted into a relief organization. The mental health director greeted me with a big hug, saying she’d been in tears that morning from the shortage of mental health workers. She assigned me to the shelters in the two gyms at Nicholls State University in Thibodaux.

Our shelter population fluctuated between 800 to 1100 people, usually hovering around 1000. They ranged from people who’d lost everything and had survived the horrors of the Superdome or had been rescued from roofs, to those whose homes were still standing, but the families had been forced to evacuate. A large percentage of the people were poor African-Americans, many of whom had never been out of New Orleans. In some cases, Thibodaux was a whole new world for them. Some found the newness frightening, and wanted to return home to their familiar surroundings, even if their familiar surroundings no longer existed. Others loved the openness and the greenery of the rural area, and made up their minds not to return.

On my first day, I began hearing people’s survival stories, or had them relayed to me by the other counselors. One woman, who’d survived the Superdome, had wrapped her clothing around her neck at night as frail protection against getting her throat cut. Others shared with me about the constant need to keep their children close to them for fear of having them kidnapped, raped, and murdered. I saw the lingering horror in their eyes and the way their hands trembled. I listened to them, asking the debriefing questions, and trying to provide counseling and support. Just taking their hands in mine and assuring them that they were safe, seemed to mean a lot to them.

And at our shelters, the residents were safe. We had a strong National Guard presence, as well as local law enforcement to provide external structure. The evacuees themselves, although stressed, were mostly polite and grateful. I never felt personally concerned for my safety. The guards, police, and sheriffs became more than just enforcers to the residents. As I watched the guards and sheriffs play with the children and joke with the adults, I realized these children would be growing up with a whole different impression of authority figures. And that many of the adults might be having their first positive, fearless interactions with law enforcement.

A lot of my time was also taken up with identifying the mentally ill patients and trying to get them medicated. Some had never been on medication. Others didn’t have their prescriptions or pill bottles, and sometimes didn’t know the names of their medication. “It was the blue pill, doc,” was the type of description they’d give. Medication is not one of my specialties, but luckily, one of my co-mental health workers was a psychiatric nurse practitioner, and it was her specialty.

The Nicholls school of nursing had been turned into a hospital. The physicians in the community had sent their samples of medications over to our “pharmacy.” Thus, we could send someone with symptoms over to the hospital and have them diagnosed and medicated. The severely mentally ill remained there. The others were released back to us, and we kept an eye on them.

Before I arrived in Louisiana, I had ideas for doing group and individual debriefings. But once there, my preexisting plans went out the window. For one thing, there was no private place to counsel anyone. The gyms were packed full of people. Even the nursing center was in a cordoned-off area in the front of the gyms. If I wanted to talk to someone, I had to ask if I could sit down on his or her bed (a cot or air mattress) or walk with him or her outside in the heat and humidity. There was very little privacy, although I found a sheltered stairway that I sometimes used.

I often found it overwhelming to deal with such a vast amount of people. We had a loudspeaker for announcements, but the words were accompanied by static and hard to understand. Plus, people didn’t always listen. If I wanted to make sure people heard an announcement, I said it over the loudspeaker, then went from bed to bed telling everyone.

I soon found my focus turning from what these people had been through to what I could do for them now, and how I could help them have a better future. In other words I changed from being a therapist to becoming a social worker. I mainly focused on two areas--school and local mental health services.

Before I traveled to Louisiana, I didn’t know the New Orleans school district was among the worst in the nation. But I soon found out. And I learned that the school district in Thibodaux was a good one. I was relieved when I discovered the wonderful pupil appraisal and counseling center in the district. The center has a large staff of psychiatrists and counselors, and all kinds of programs for the children and their parents. The pupil/counselor ratio was high enough that the evacuee children could be absorbed into the system without affecting the school district’s current population. I realized that this would be some of the good that could come from Katrina--these children would have a chance to get a superior education, one that wouldn’t have been available to them before.

I made it my goal to see that all the children were enrolled in school and had picked up their donated school uniforms and school supplies. I also spoke with some of the center’s counselors about starting a head start program for the little ones. The night before the first day of school, I was on the loud speaker several times, reminding everyone that lights out would be at 9:00, not 11:00, and that buses would be coming early for the children. Yet the children still ran around in their street clothes, obviously not ready for bed. Then I got on the loud speaker and told them to get in their pajamas, brush their teeth, and get into bed. Some did. Most didn’t.

At lights out, I went from bed to bed, chivying children into bed. Sometimes the parents were there, watching me get their children in bed, sometimes they weren’t. By this time, the families had received some money from the Red Cross or FEMA, and many had bought televisions or radios. A lot of families were watching television. I had to tell these families to turn off the televisions until their children were asleep, then they could quietly turn them back on. For the children who just wouldn’t stay in bed, I rubbed their backs until they fell asleep. But it was almost 11:00 before they were all asleep.

I worked until midnight those nights, then returned by 6:30 a.m. so I could be there before the buses arrived. I thought some children might need my help in getting ready. (They did.) I also was concerned some mothers might be upset at parting from their children. (They weren’t.) Actually, for the first time in days, quiet reigned in the gyms.

By the third school night, the bedtime routine had become easier. The parents and children had learned the rules, and also seemed to integrate the concept that having an enforced bedtime, rather then letting the children fall asleep whenever they wanted, made for an easier routine in the morning. At that point, I stopped working split shifts, instead coming in at around 3:00 pm and working until midnight. This was a relief, because the split shifts had worn me out, and I welcomed the chance to sleep in and use the mornings to recharge.

My time at the shelter was physically grueling because I was on my feet most of the time. I also walked back and forth between the two shelters. By the end of the evening, I was taking ibuprofen so I could stay on my feet. I was grateful I was, otherwise, in good physical shape.

One day, I was doing my rounds of the large gym, when I spied a tiny African-American girl, about two years old, sitting on a big bed against one of the bleacher walls. Or rather, I should say, she spied me. I was still twenty feet away from her, in a sea of other women, but when she saw me, she broke into a big grin. She held up her arms to me, her expression communicating recognition and happiness. Unable to resist the pull of her charm, I mimicked her, holding out my arms while I crossed the gym to her and scooped her up. We hugged, and she squeezed her arms and legs around me. I asked her mother if I could carry her around with me for a while, and she nodded her permission.

The little one snuggled in my arms, content, not speaking, not demanding any other kind of attention. I walked with her on my “rounds” of the gym, monitoring the population, trying to see if there were emotional problems, or any outward sign of emotional distress. I checked in at the nursing station, then, as my arms grew tired, I took my little one back and handed her, protesting, into her mother’s arms. Then I plunged back into the maelstrom of my duty.

It wasn’t until later that I had time to think about our interaction, and tune into the fact that this child had singled out an unknown woman, even though her mother and several other African-American women had been in her vicinity. I had never before interacted with this child. I didn’t remember even noticing her before. I realized that most of the relief workers and local volunteers were Caucasian. And that the child had learned positive associations with “white.” I wondered if, in the normal course of her life, this child would ever have been held by a Caucasian woman. I was struck by the realization that, as a volunteer group, we were breaking down racial barriers. By our support and service, we were showing that we care. And because of that, these children might grow up with less prejudice. And in turn, the relief workers also might be changing former preconceptions.

Mental health relief workers tend to work in periods of two weeks. As people finish up their time, others rotate in. So there’s always some “old timers” and newcomers overlapping. But I was concerned that the cycling in and out of counselors meant the evacuees didn’t have the consistent relationship with a counselor that’s often necessary for healing. In the last few days of my stay, I spoke with the director of the University’s counseling center, outlining my concerns and the needs of the evacuees. The director promised me that his student counselors would provide counseling to the evacuees on an ongoing basis.

On my one day off from the shelters, I did a consulting job for LifeEra with one of the local gas companies. Katrina had affected three of their facilities, and the company had moved over forty employees and their families to Houma, renting them apartments and furniture. A week later, with their husbands back at work, and their children enrolled in school, the wives were starting to show symptoms from their traumatic experiences.

We gathered at a restaurant where the company provided a wonderful meal. Many of the women were strangers to each other, and I hoped the meeting would bond them into a supportive network. After lunch, I had them share their experiences. The power went out, and the room grew hot. But, engrossed in each other’s stories, no one left. Before the hurricane, most of these families had evacuated. Having been through many previous hurricane warnings, the families had become blasé about them. Thus, they only packed enough clothes for two days. When the levees broke, sweeping away their homes, all they had left were the meager possessions they’d taken with them.

I’ll never forget the words of one woman, whose brief statement of pain summarized much of the women’s experiences. “For twenty years we’ve scrimped and saved to build a good life for ourselves,” she said, breaking into tears. “We had a nice house and two cars. But that’s all gone. We lost everything. Now we have to start all over.”

But there were some wonderful moments as well. One day a man came up to me saying, “I’m so happy, I just have to hug you.” He told me that the Red Cross had located his elderly mother. She was in good health at a shelter in Texas. His feet danced with excitement, and his eyes were full of tears of gratitude. He praised all the people who were reaching out to help the evacuees. As I rejoiced with him, he said something that touched me deeply. “You never really know what love is until you lose everything.”

Two weeks after I’d returned from Louisiana, I woke up from a night of dreams about the shelters. While these weren’t bad dreams, I was surprised by their intensity so long after my return.

In a strange way, I welcomed my dreams. I was back at the shelters at Nicholls, able to interact with the people I cared about, some of whom I logically knew had relocated. But we were reunited in the convoluted way of dreams, and I was comforted by being there, having power to help and change things, no longer helplessly wondering what was happening to those I’d left behind. Suddenly, I could do more than just pray for their well-being. I could interact with them.

When I awoke, I was left with an odd combination of contentment and nostalgia. My experiences in Louisiana had obviously left a deep imprint on my subconscious.