Post-Katrina Project Demonstrates a Rapid, Participatory Assessment of Health Care and Develops a Partnership for Post-Disaster Recovery in New Orleans

Hurricane Katrina and levee failures disrupted health care access for hundreds of thousands of Americans. While federal efforts have since improved aspects of primary care, research has documented high levels of unmet health needs in Katrina-affected communities.

Research and policy efforts that address health care concerns among vulnerable populations in post-disaster settings present important opportunities for community-directed recovery. REACH NOLA (Rapid Evaluation and Action for Community Health in New Orleans, Louisiana) partnered with New Orleans–area nongovernmental organizations and academic institutions and, one year after Katrina, engaged communities in an assessment of health priorities. Thirty nominees representing community health organizations and the general public were interviewed, and four grassroots discussion groups were held to assess perceptions of the disaster's impacts on health care access. The goals were to inform the policy process and build capacity for recovery planning. Findings were shared at a public community conference in which participants provided feedback and developed recovery-relevant action steps.

Project data revealed three main themes:

• Health care access challenges. Interviewees identified major challenges, including widespread closures of facilities, displacement of the health care workforce, and disruptions of physician-patient relationships. Access was particularly limited for uninsured residents who relied on the now-closed state hospital for care and for persons seeking specialists, such as psychiatrists or oncologists.
• Unmet needs of specific vulnerable populations. Multiple vulnerable populations faced critically limited access to necessary health care services in the year following Hurricane Katrina. They included elderly, HIV-positive, tuberculosis-positive, and mentally ill patients, as well as women seeking obstetrical services.
• Opportunities, resources, and adaptations to improve community recovery. Interviewees cited many reasons to be hopeful about the future of recovery, including visionary leadership, government transparency, and dialogue among returning citizens and policymakers. They noted promising collaborations among community groups, private-sector interests, government agencies, and academia.

This study is, to its authors' knowledge, the first community-based participatory research project to engage a diverse group of affected community members in the design and conduct of an assessment of health care needs following a major disaster, as well as in the interpretation and dissemination of the results. This assessment provided new information on community members' priorities, documented significant public health concerns relevant to disaster preparedness and community health, and produced a sustainable community-academic partnership dedicated to improving access to quality health care, with implications for future disaster preparedness policy, programs, and research. The project and subsequent developments reveal the feasibility of such a community-academic partnered approach to formulate and address disaster-recovery goals.