ACT NOW: After the Storm, Reflections on Disaster Work Post-Katrina

By Tanyaporn Wansom

It seemed like 2005 was the year of natural disasters: from the tsunami that devastated many countries in South and Southeast Asia to the earthquakes in Pakistan to our country’s own Hurricane Katrina. As health professional students, many of us likely felt that we had something special to offer and were eager to jump on the next plane to help those in need. Others might not have been so keen for adventure but were determined to do their part by soliciting donations or sending other goods to disaster areas.

Regardless of how one chooses to contribute to similar disaster situations in the future, this article directs attention to a number of issues that are important to consider when planning effective relief efforts. The following draws heavily from conversations with a fellow medical student, Catherine Jones, who led AMSA's disaster relief program after Hurricane Katrina hit her hometown of New Orleans. The first part of the article describes Catherine's experience and reflections on doing disaster work in New Orleans. The second part of the article builds on lessons learned from Catherine’s experience that may help guide future efforts of health professional students in post-disaster situations.

When Hurricane Katrina hit, Catherine was a third year MD/MPH student at Tulane University. She decided to take a year off to stay in New Orleans in order to help rebuild her community. She had no previous experience with disaster work but had been a part of a human rights delegation to Jenin in the West Bank. When asked how she decided to get involved with disaster work post-Katrina, she stated:

I didn't ever feel like it was a choice to me. New Orleans is my home and like Brother Hollywood, a young poet from New Orleans, wrote soon after the catastrophe,"New Orleans is not only where I'm from it is who I am." I don't know if I would have survived the aftermath of Katrina without being a part of the rebuilding. My own healing depended on being connected to my city and the people there.

During her year off, Catherine helped set up makeshift clinics in New Orleans before any official clinics had opened, spent time at the Common Ground Clinic which provided integrative health care to the people of Algiers, and also helped start the Latino Health Outreach Project to respond to the needs of the many Latino immigrant workers who were arriving in New Orleans to do reconstruction work. However, she also spent time mopping floors, lending people cell phones to help them contact their families, and running around the city collecting cardboard for people to sleep in. As a medical student, she noted that people had differing reactions to how she (or other medical students) could contribute:

There were other med students who didn't set foot outside the clinics, and they ended up standing around a lot because sometimes there really wasn't a lot for them to do as students; some of the doctors were clearly uncomfortable about working with medical students. Remember that you're more than a medical student, and that in a crisis situation you probably do have something important to contribute, but it might not be your medical skills. If mopping is what needs to be done, do it. Lots of times people didn't have faith in us as medical students until we'd proved that we were tenacious and willing to get our hands dirty with all types of work. We had to work to build trust; it wasn't just given to us.

On the flip side, it's important to be really clear about what your capacity is and not get yourself into situations where people think they can expect more from you than what you can deliver. It's extremely important, especially in a crisis situation, that you aren't in the middle of a situation where you're in over your head and taking responsibility for a situation that you don't know how to handle!

Catherine also expresses the need for accountability in doing work after a disaster. While many of us watched the aftermath of Katrina unfold without strong central coordination, Catherine points out that many large national organizations are ultimately not accountable to the local communities, as they leave soon after the natural disaster. She encourages people to do their homework before and after they get to the disaster site and to take local community voices into account.

Respect people's self-determination and listen to what people tell you they want and need. Respect them enough to support their efforts in those directions, even if your vision for their community may be different. (This is not about you!) Don't use a ravaged, traumatized community as the "testing ground" for a project you've always wanted to do. Don't create new projects in a community you're not a part of without the invitation of the community, and especially don't start something you can't finish.

How do you get to know a community as an outsider? Before going, try to get in touch with local community organizations or people. Alternatively, with the advent of blogs, read local accounts of what’s happening on the ground and research socially responsible organizations. While Catherine was in the unique position of being born and raised in New Orleans, she has tips for those who are in a disaster site for a week – or a month:

Get to know the community outside of your work. Be part of the community—accept invitations to people's houses; go to church if people invite you. Listen to them tell you stories of what the neighborhood was like before the storm. Remember that the work you're doing will need to be done long after you leave and that your capacity to build real relationships with real people might be more of a healing force.

Okay... you’re thinking, I’m ready to do my homework, to contribute to a socially responsible organization, to spend a month at a disaster site. Where do I start? How can I take action?

1. Be honest with yourself. What are your motivations in doing disaster work? What are you trying to get out of your weeks or months in the disaster area? Go deeper than the stock ‘I want to help people.’ Catherine states:

   I think it's important for anyone responding to a disaster to check in with themselves about their motivations for doing relief work. I think it's completely normal for there to be some component of self-interest in most service-oriented work, and that in itself is all right. There's absolutely nothing wrong with learning new things, or gaining important skills, or getting a new perspective, as a result of doing work that helps people in crisis. The important thing is to remember that ultimately, the work isn't really about you, it's about making space for the people who've been most affected (by a natural disaster, or by everyday disasters like poverty and racism) so they can shape their own responses to it.

2. Think realistically about what you can contribute. If you have only a week to spare, think about whether or not being on site is the best way for you to contribute. As a medical student, you may want to contribute your medical skills. However, there are a lot of other skills or resources that may be needed and may be helpful. Think about what resources you have (money, language skills, a large vehicle that transports people, organizational skills, etc.) and where those resources may best be used.

   People really need to be honest with themselves about the difference between going to a disaster zone and doing what they can in their home communities to raise awareness and resources. Lots of people feel the best way they can help out is by actually being in the disaster zone. If you go to a disaster zone without specific plans, someone is going to have to spend time and locate resources to accommodate you. During the first few months in New Orleans, a lot of time and energy was spent creating an infrastructure to accommodate the enormous influx of out-of-town volunteers who needed to be fed and housed and transported, and during this time our own resources in the city were really scarce. Especially, if going short-term, consider if you will probably gain more from the experience than those struck by disaster.

3. If you are committed to going to a disaster site, do your homework, not only regarding the disaster itself, but also regarding the history and people of the area. Once at the disaster site, assess the community’s needs and what you can contribute. Most importantly, be flexible! Do what needs to be done, not just what you wanted to do. Finally, reflect on the effect your work is having on yourself and those around you. Do not neglect thinking about issues like poverty, racism, and sexism.


4. If you are going to donate, make sure that your donations are socially responsible. If you are raising money from a fundraiser or want to donate individually, consider whether your money will go to ‘administrative overhead’ or to the people most affected by the disaster. Research nonprofit organizations on Give.org or Charity Navigator. These sites offer independent assessments of both domestic and global nonprofits using information provided by the nonprofits themselves. If the organization to which you wish to donate is not evaluated by these websites, you can ask the organization directly for an annual report, which breaks down sources of funding and allocation of funds. If you would like to donate goods, make sure that you are sending goods that people actually need. Catherine suggests finding an organization you would like to support, seeing if they have a wish list, and then responding to the wish list needs directly rather than sending donations ‘blindly:’

   If you're collecting donations for a disaster zone, I think it's best to focus on a specific organization that has put out a wish list. Find the things on the wish list and make sure they will get to the organization directly. If you have a bunch of something specific that you think will be useful, call the organization first before just sending it off. Sending items that have no use just adds to the workload of already overwhelmed organizations, which often don't have space for storage.

5. Finally, think about sustainability! Try to ensure that your efforts are contributing to what the community wants and needs. Remember that the work you’re doing will continue long after you leave, and that while you may be able just to pick up and return to your life back home, local folks will be dealing with the aftermath of the disaster and that their lives will have been profoundly changed because of it. New Orleans, for example, still needs a lot of work to become the vibrant city it was, and continues, to be. If you’re interested in helping out, you can check out the New Orleans Resource Guide that accompanies Rita Hamad’s article in this issue. Also, an organization that Catherine recommends is INCITE! Women's Health and Justice Initiative, a health and community organizing project by and for local women of color.

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