Three years after Hurricane Katrina laid waste to much of New Orleans, 53-year-old Mike Gootee still bears the trauma he experienced when he lost his home, his community and his livelihood.
His home, located in the Vista Park neighborhood of the city, ended up underwater when a levy broke, flooding the area with water nine feet deep.
The home had been where he had grown up, and it was where he had resided with his wife and 19-year-old son. He and his family were forced to relocate to nearby Lake Charles until the storm blew over.
"From a personal point of view, it was hard," he said. "Loss of everything -- loss of my practice, loss of my community."
Gootee is not only one of the hurricane's millions of displaced victims; he is also a licensed mental health counselor. And he says that the experience introduced him firsthand to the anxiety and anguish that comes with losing it all.
"It's a lot of 'What do you do?' 'Do you go back?'" he said. "A lot of indecision."
Now, state emergency agencies and residents alike are bracing for the possibility that the killer storm Gustav could follow Katrina's path. Brenda Roberts, a Lake Charles-based mental health counselor who survived both Hurricane Katrina and Hurricane Rita, which hit three weeks later, said lingering fears are indeed taking a toll on mental health.
"Whenever we see anything turn towards the Gulf, anxiety levels rise dramatically," she said. "People become hyper-vigilant -- everything makes them nervous, and any unresolved feelings about past trauma get stirred up.
"What they're going through right now is a reawakening of all of those feelings. Some of those who went through the storm and lost their homes are afraid of losing it again, particularly those who lost everything, are still displaced and still not able to return home."
And new research suggests that even as Gootee and his fellow New Orleans residents brace for what could be yet another encounter with a killer storm, many of the health issues of those most severely affected by Hurricane Katrina still remain three years on.
The report, published Friday morning in the journal Health Affairs, was based on surveys of 610 people who had been displaced by Katrina and were still living in trailers provided by the Federal Emergency Management Agency (FEMA). Researchers from the Johns Hopkins School of Public Health found that of these people, more than half -- 57 percent -- met the criteria for major depression. Altogether, more than 70 percent reported on or more symptoms of depression.
The lingering health effects of the storm appear to have reached beyond impacts on mental health. Eighty percent of those surveyed said at least one adult in their household had a chronic health condition, and of these, 58 percent reported that the condition was worsening. Making matters worse, nearly half of those interviewed lacked health insurance.
But lead study author Dr. Lynn Lawry said access to mental health services is a crucial step -- one without which many of those affected will not be able to achieve other important steps toward a return to a normal life.
She added that the rates of those who are unable to access needed mental health services are perhaps the highest she has seen among all of the disasters she has studied in the past.
"We are learning that ... there is not a lot that has been done to address the mental health needs of those affected," she said.
Aside from the usual effects of lingering trauma, the situation may also be part of a vicious cycle in which those who lost their homes and livelihoods in the Katrina tragedy are less likely to be able to cope effectively with their mental health issues -- making true recovery of their former lives even less likely.
"You cannot achieve this without dealing with the mental health issue," Lawry said.
According to a recent editorial Lawry wrote in the journal Disaster Medicine and Public Health Preparedness, conditions in Mississippi and Louisiana were already ripe for problems. Even before the 2005 hurricane season, Louisiana ranked dead last according to certain health and well-being indicators; Mississippi ranked 49th out of 50 states.
In the two states, approximately 1 in 5 people have no health insurance, and both states "rank in the top 5 for highest rates of HIV/AIDS, tuberculosis, sexually transmitted diseases, crude death rates, and infant mortality," Lawry noted in her editorial.
Worse, medical officials in New Orleans said the city's hospitals have yet to return to pre-Katrina capacity. Even accounting for the population decline that occurred after the storm, Dr. Russell Klein, president of the Louisiana State Medical Society, said that the number of beds available is much lower than what you would expect to find -- and lower than what is needed. Before Hurricane Katrina, there were 23 state licensed hospitals in Orleans Parish; in June of this year, only 13 were open.
But where the shortages are really being felt, Klein said, are in general medical surgery units, psychiatrists, primary care physicians, nurses, and other support staff. This translates into a sicker population that is increasingly straining emergency room capabilities. In fact, projections suggest that by next year, the five major New Orleans will be $405 million in debt.
But in some ways, Dr. Klein said, "the shortage in doctors is an easier problem to solve than the shortages in nurses and support staff." This, he said, is because it is hard to recruit people back to the city given the severe shortage of affordable rental units, the school situation, and a general lack of neighborhood amenities.
The fact that such staples have not yet been restored is a major part of the problem for displaced persons as well, Lawry said.
"One thing we know from other disasters around the world is that chronic illnesses do not get better, particularly if the public health infrastructure is destroyed, as was the case with Katrina," she said. "Three years out is a long time in this country to have not resolved some of these issues."
Much Work Left to Be Done
Lawry said that first and foremost, housing issues must be resolved -- a tall order, as more than 30,000 of the 2.5 million people displaced by Katrina still live in FEMA trailers. Health care access must also be improved.
FEMA did not return a telephone message requesting comment on the Katrina disaster and the threat from Gustav. But while the agency's handling of the emergency response from the storm three years ago is still a sore spot for many, Lawry said it is not yet time to assign blame -- particularly since mortality rates in the region have still not leveled off to pre-Katrina levels.
"Who do you blame? I don't know," she said. "You can't levy blame when you are still in the middle of a crisis. With the crude death rate still the same, I think we are still in a crisis."
Rather, she said she hopes the new research will change the way the American public perceives disaster relief.
"We can't just respond to a disaster and forget about it six weeks later when the sun is shining and everything is cleared up," she said. "You can't look at a disaster, give some money and some clothes, wipe your hands clean, and say, 'I've helped and I'm done.'
"As soon as we forget, we repeat our mistakes."
"I think it's the responsibility of our society to assist these people," she said. "I think our society is better off if we deal with these issues now instead of continuing to tell people to have a stiff upper lip and pretend everything is okay, because it's not."
Gootee said he and other Louisiana residents have not forgotten. And as they brace for what could be another killer storm, he said the mental strain could take a toll on many Katrina survivors.
"For the people who were hard hit, yes I would agree that not much has changed and it hasn't changed fast enough," Gootee noted. "It's got a long way to go, and that's part of the slow pace; it's still going on.
"It's just wearing people down. They're exhausted."
Radha Chitale and Michelle Schlief contributed to this report.