December 19, 2006
The School of Public Health blazes a trail in disaster management training.
Maureen Lichtveld had been on the job a month when Mother Nature offered rough validation of her career path. When Hurricane Katrina was knocking on the city's door, Lichtveld, chair of environmental health sciences at the Tulane University School of Public Health and Tropical Medicine and an expert in disaster management, evacuated to Atlanta and began working with the Centers for Disease Control and Prevention to develop environmental health messages for New Orleans.
There were only a handful of environmental health scientists on the ground in the city of New Orleans when the flooding stopped, says Lichtveld, not enough to gather all the samples and coordinate the return of residents. Tulane University scientists stepped into the fray, among them toxicologist LuAnn White, who has collaborated with state and local environmental health officials for the past 30 years.
For 12 weeks she and a team of state environmental health experts analyzed data from more than 1,000 soil, water and air samples and helped determine the messages that local, state and federal environmental health officials would put out about return to the city.
"LuAnn's great," says Lichtveld. "But we need about 1,000 LuAnns. Katrina has helped to show the lack of a trained workforce and the need for science to respond in an effective fashion."
This fall, Tulane launched the country's first master's of science in public health in disaster management degree program in an effort to create more LuAnns. The curriculum is deliberately broad, covering core public health, public health law, crisis communication and courses that discuss issues such as shelter, evacuation and surveillance.
Disasters come in all shapes and sizes, often presenting quite different puzzles to be solved. "Should I rebuild my house?" is a question often heard in New Orleans today. Only five years ago, "Should I microwave my mail?" was a common question asked around the country during the anthrax scare of 2001.
Earlier in 2005, when Lichtveld was interviewing for the position of chair of the environmental health sciences department, she had in her portfolio a proposal for a new disaster management degree program, to be housed in the environmental health sciences department in the Tulane University School of Public Health and Tropical Medicine.
"I knew there was a lot of disaster-related training at Tulane. I wanted to create a one-stop shop for disaster preparedness and management, to improve synergy across the programs," says Lichtveld, who has a background in public health infrastructure development. Despite the magnitude of tragedy experienced in Katrina, the Asia tsunami and the attack on the Word Trade Center, the disaster-management field is still in its infancy, says Lichtveld, who is convening an expert panel to help refine the curriculum during the first years.
"Our curriculum is also unusual because it will integrate environmental health science with population sciences, which means our graduates will know not only how to take samples of floodwater but how to put surveillance programs in place or plan to address the psychosocial needs of people affected."
Courses will be available both in New Orleans and online, building on an ongoing commitment to distance learning for working public health professionals. One of Lichtveld's long-term goals is to be able to offer the training to all state healthcare providers, essentially embedding trained responders in all communities. "This is the next step and the next generation in this kind of training activity," says Ann Anderson, longtime director of the South Central Public Health Training Center and the South Central Center for Public Health Preparedness.
Anderson, an environmental health scientist, has devoted much of the past decade to improving the training of public health professionals in Louisiana, Mississippi, Arkansas and Alabama, forming a unique quad-state partnership. Through the centers, Anderson and colleagues create training modules that are broadcast in all 50 states, with as many as 5,000 viewers registered for any given satellite module.
Anderson evacuated to a family farm in Poplarville, Miss., to wait out Hurricane Katrina, which wound up passing overhead, sweeping pines and blueberry trees down over the hills and throwing the area into a communication blackout as phones, cell phones and computers were temporarily rendered into useless hardware.
Despite the total communication system failure, public health worked, says Anderson. Evac-uation was largely successful, food and supply distribution at shelters outside New Orleans went smoothly, the feared outbreaks of disease never happened and despite the media hype, the waters that filled New Orleans proved not to be a toxic soup. "When public health works, you just don't hear about it," says Anderson, voicing a long-held frustration.
Ten days after the storm, Anderson went to Jackson, Miss., where she worked on a lessons-learned evaluation for the state health department. Which is why training is so important, says Lichtveld. The more trained professionals can get on the ground quickly, the easier it will be to dispel the unfounded, terrorizing rumors that make return and reconstruction difficult.
Lichtveld fielded many a media call about rumors of "Katrina Cough," a condition she says the data never supported. Good science is the answer, Lichtveld says. Anderson, who bulldozed what was left of two family houses in July, looks out over the shining cityscape from her 24th-story window at downtown New Orleans. Is there a better place to study disaster management? she wonders. Is there a better place to hear from those who worked the disaster and its aftermath, and learn about what worked and what didn't?
The program will have one additional faculty member: Col. Joseph Contiguglia, who retired from Keesler Air Force Base in Biloxi, Miss. During recent years, Contiguglia designed and directed the LIFESAVER exercises, coordinating the actions of hundreds of agencies and thousands of participants across the South in addressing effective management of the consequences of terrorist use of weapons of mass destruction. He also has developed terrorism response and preparedness training modules for Anderson's distance-learning program. Contiguglia occupies a unique position between two worlds -- military and medical.
As a flight surgeon for nearly 30 years, he has been actively involved in operations, planning and disaster response worldwide.
"Those experiences enable us to solidly bind realistic theory and doctrine into the practicalities of field operations, producing and executing solid plans with effective, reliable outcomes. We turn philosophy into applied science," says Contiguglia.
According to Contiguglia, the effective mitigation of disaster marries three professions: clinical medicine, public health and management.
Looking forward, he sees global changes in population distribution that will combine the challenges of natural disasters with the threats of emerging disease and the consequences of political hostility, putting those three professions to the test.
"A broad array of skills and specialties must combine and coordinate their expertise and contributions as we design, prepare, direct and serve the human environment of the future," says Contiguglia.
Disaster is best managed through a multidisciplinary team, agrees Lichtveld, who is making it a point to recruit students from first-responder professions, such as police and firefighters. "I envision a target audience that is not limited to health care, so we can make that cross-fertilization between public health and law enforcement."
One such professional is Matt Kallmyer, a public health graduate student and medical liaison for the Office of Homeland Security and Public Safety in New Orleans. A background in emergency management and training through his public health courses prepared him for his work during and after Hurricane Katrina, when he was responsible for overseeing the recovery of emergency medical services in New Orleans.
"During the early post-Katrina Emergency Operations Center briefs, my educational background in water management and treatment as well as toxicology prepared me to understand and address rising concerns relating to the potentially dangerous standing water, lack of potable water, and lack of wastewater treatment," says Kallmyer.
Without the training received in his public health courses, he says he would have been unable to ask the pertinent questions, request the appropriate assets to manage the disaster and understand the statistical data that was being provided. "My peers with disaster-management training from programs not based in public health were at a disadvantage when dealing with these pressing issues," he adds.
Today, Kallmyer has the "herculean" task of developing an emergency evacuation plan for residents with medical needs. He says he couldn't do it without the perspective that public health training brought him, to see beyond the emergency-plan needs to the needs of the greater community. His eagerness for more tools for effective disaster management is palpable. He has been in the thick of the disaster in New Orleans, an event that was a learning experience in its own right. "I look forward to being able to learn the skills that will enable me to support and manage a natural or man-made catastrophic, systemwide event," says Kallmyer.
Madeline Vann is assistant director of public relations for Tulane and a regular contributor to Tulanian.
Tulane University, New Orleans, LA 70118 504-865-5000 firstname.lastname@example.org