Center for Knowledge Management, Ochsner Health System, Louisiana

Ethel Ullo Madden, Director of the Center for Knowledge Management at the Ochsner Health System in New Orleans, Louisiana, reflects on her experiences during Hurricane Katrina in August 2005, which affected the hospital library.

Interview date: August 3rd, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

On August 29, 2005, Hurricane Katrina hit the Gulf Coast Area. New Orleans received the horrific winds and rains. The levee system could not contain the flood waters from Lake Pontchartrain. Consequently, the City was flooded. Thousands of people lost their homes.

(2.) How did the library respond? How did the librarian respond? Were there non-traditional (unusual) roles that the librarian performed?

Our library responded quickly. I was stationed at our Clinic in Baton Rouge where assumed the role of transportation coordinator. I helped facilitate the transportation for our Team A healthcare professionals to get out of New Orleans so that Team B could take over. I was also helping with Reference Questions while working out of Baton Rouge.

Shortly afterwards, I did open the library in New Orleans so that patients, family members, and employees had access to computers. FEMA and Red Cross Representatives also were stationed in our library to assist. Our Library Staff managed and advertised for these groups.

(3.) How has the library, or the services provided, changed as a result of these events?

This event excelled our efforts to move from print to electronic journals. We could not receive consistent mail for 9 months following the storm so we decided that print journals were a waste of our institution’s money.

(4.) What, in your opinion, are the roles for librarians and libraries in disaster planning, response and recovery efforts?

Librarians should play the role of information gatekeepers.

Librarians naturally can organize and understand the needs of their institution. In the case of a disaster, librarians should be willing to do ANYTHING – even serving food in the cafeteria.

Sumter Regional Hospital, Thompson Medical Library, Georgia

Claudia LeSueur, from the Thompson Medical Library at the Sumter Regional Hospital in Americus, Georgia, talks about a tornado that affected the hospital library in March 2007.

Interview date: July 12th, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

On March 1, 2007 at about 9:25 pm, a devastating tornado hit our community and destroyed our hospital.For photographs of the tornado damage, see: http://sumter.fastcommand.com/photo_album/detailed_image.php?id=243&pic_count=0

(2.) How did the library respond? How did the librarian respond? Were there non-traditional (unusual) roles that the librarian performed?

News about the tornado reached me about 10:30 pm. It took me one hour to drive two miles due to trees having fallen across the roads all around town. Much help was needed at the hospital and people really rallied. However, by the time I got there the patients had been moved to the OR and ER areas. Patients were being transferred to other hospitals and ambulatory patients were waiting in hallways near ER to be transported as well. I briefly visited the library when I arrived and saw a lot of devastation. Books and journals seemed safe (no windows near them) and the water that had fallen from the ceiling had not fallen in this area. About the only thing I could do at that point was help talk to people to relieve some tension. Our staff had done such an excellent job and the activity that seemed chaotic was actually very organized. It was beginning to be so crowded that they really only needed a few people so I left.I felt like just finding a place to stake a claim (geographically speaking) was very important for the library. People tend to think everything is on the internet and they might realize too late that it isn’t. Promoting awareness that you are there and have services that need to continue is a must.

When you are dealing with just plain survival the “extras” can seem small. The first place the hospital went the night of the tornado was to First Baptist Church where first aid was set up. We operated there until we got some tents from FEMA. From the tents we have moved to some FEMA/GEMA modular buildings and are just starting the building of the 70 or minus bed interim hospital. It is an unbelievable story and it goes on day after day after day. There is almost no way to describe it.

(3.) How has the library (or the services provided) changed as a result of these events?

I was able to get in the hospital after about three days to see the library and assess the damage. The text and journal collection looked safe. Water had not fallen in this area. However, my office had two large windows and water was everywhere as well as debris. My cabinets in the library were near the windows and they had a large amount of debris on them. I began looking for a temporary place and started out in a building being used by hospital administration. Then someone helped me find a larger office in a modular building owned by the hospital and across the road from the rear of the hospital. We have a company that is helping with salvage and we have a warehouse where cleaned furniture is being placed. From this warehouse I have removed bookshelves and am using them to house the journals collection.At this point we do not have an open library for people to walk in at any hour. We are members of the Mercer Medical Library (Macon, GA) GaIN (Georgia Interactive Network network and this has been an excellent resource in the past and is more so even now. Our doctors and employees have access to such databases as MD Consult. This gives 24 hours access to knowledge based literature. I am doing literature alerts and have offered a table of contents service for the journals we take. These journals are in my current “library” which is really an office in a modular building across from the hospital. An interim hospital is being built now and there will not be a place for much more than clinical service. I face about three years of keeping the library viable for the physicians and employees so I will be constantly seeking ways of reaching those in need and helping in any way I can. As the interim hospital is built I will look for ways to create awareness and offer services.

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

Clinical needs become so acute when a disaster strikes, so the librarians have to be ready to help meet information needs that arise. As people stay focused on survival and rebuilding, look for ways to helpfully respond and offer information resources. Librarians should serve on disaster and recovery committees. Awareness of the work of these committees can help you meet their information needs as well.

Southern Louisiana Area Health Education Center

Helen Caruso, a hospital librarian at the Southern Louisiana Area Health Education Center (AHEC) in Covington, Louisiana, discusses her Hurricane Katrina experience during August 2005.

Interview date: Friday June 1st, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

On August 26, 2005, I was in New Orleans, manning the National Library of Medicine exhibit at a medical job fair. The television in my room didn’t work, so I had gone to bed Friday evening without hearing the weather report. The following morning I was blissfully unaware of the approaching hurricane. After a leisurely breakfast, I arrived at the exhibit hall to find exhibitors frantically dismantling their booths. Everyone was talking about the hurricane.

I wasn’t too worried. Frankly, I thought people were over-reacting. Hurricane warnings are summer constants in southern Louisiana; most of the time they don’t become serious. Since all the exhibitors and attendees were leaving, I decided to take the exhibit materials back to Louisiana State University Health Sciences Center (LSU-HSC) before driving home across the Lake Pontchartrain Causeway. When I got to the LSU-HSC library building, the doors were locked, and I had to bang on the doors for Security to let me in. They told me that the building was closed because of the storm. It took a good deal of persuasion for me to convince Security that the exhibit belonged to LSU-HSC. Finally I was escorted upstairs and allowed to deposit the exhibit in the library.

Meanwhile, it was becoming increasingly clear that many people were taking the situation very seriously. Someone had arrived to remove laboratory animals, and a policeman informed Security that the New Orleans Police Department was taking over the parking garage. As I began driving home, the Mayor was on the radio, telling everyone to “get out” of New Orleans. I realized I was only moments ahead of a mass exodus.

I live in a rural area, and my family decided to wait out the storm there. On Sunday, the hurricane winds and rain pounded the area for hours. (1) The electricity went out and the skies darkened. It became very scary when the tall pine trees started snapping. Over 100 pine trees blocked our road. It was several days before we could leave the property. Phone lines were down, and cell phones stopped working. Electricity was not restored for three and a half weeks!

After enough of the trees were removed from the road, we managed to drive to Baton Rouge for supplies-no stores in our area were open. Cell phones worked in Baton Rouge, but there was no news about St. Tammany Parish. No one knew how far the devastation went. On our way back from Baton Rouge, we drove past Lakeview Hospital (one of the sites where I work). There were a significant number of trees down, along with signs of wind damage, but there was no evidence of flooding. I couldn’t get into the institution however as security wouldn’t let us inside.

About ten days later, I was able to go to my other site, Slidell Memorial Hospital. The storm surge had brought the lake water up to less than half a mile from the hospital. The neighborhood suffered severe wind and water damage. Huge trees lay on crushed homes and flood soaked furniture was everywhere. The hospital had remained open through the hurricane, and was accepting emergency patients. More than half of the hospital employees lost their homes or could not live in them. Those who had livable homes shared them with other staff and family. Some staff and many rescue personnel ended up staying at the hospital.

My first day back at Slidell Memorial, I couldn’t go into the library at all. I was asked to assist in setting up day care services in the hospital so employees could return to work. But I didn’t mind in the least being at work (because the hospital, unlike my home, had electricity and running water). The library is located on the first floor next to medical records and rehab. Luckily, someone from rehab had thought to put plastic on the collection before the storm hit. It was a good thing, since the roof had leaked. There were trash cans and hastily gathered containers full of water standing on the library counters and desk. A restoration company arrived to remove the humidity from the air and prevent mold from growing. They dried out the whole hospital. I was surprised at the large containers of water that was “de-humidified’ from the library.

I was allowed back at Lakeview Regional Medical Center after about two weeks. During this time I hadn’t heard from other SEL-AHEC (Southeast Louisiana Area Health Education Center) co-workers, or even my library assistant. I tried to call other library contacts, but couldn’t reach anyone. One of the first calls I received was from Greg Bodin from the National Network of Libraries of Medicine/South Central Region (NN/LM SCR) in Houston. Ethel Madden from Oschsner called the following week and related all the New Orleans news. The pair of us concluded that as far as medical library services in Southeast Louisiana-we were “it.”

Ethel and I began to coordinate our efforts toward recovery. Neither of us lost our homes (although we did host displaced family members). Since our energies weren’t consumed with simply trying to survive, we were able to work and try to help.

The harrowing after-affects of Hurricane Katrina are far from over. I recently traveled through Gulfport, Mississippi, where the Highway 90 Bay Bridge at Bay St. Louis had only just re- opened. (2) What I saw along the highway was truly devastating. It will take a long time for the gulf coast to recover. No one knows the full health effects from the aftermath. Respiratory illness and unusual rashes are common, even though epidemiologists found no lasting effect on the air quality. (3)

(1) For a chilling official report on Hurricane Katrina, see: Knabb, R.D., J.R. Rhome, and D.P. Brown. 2005. Tropical Cyclone Report: Hurricane Katrina, 23-30 August 2005. Miami: National Hurricane Center. http://www.nhc.noaa.gov/pdf/TCR-AL122005_Katrina.pdf accessed 7/6/2007.

(2) For more about the bridge, see: Nossiter, A. May 29, 2007. A Bridge Restores a Lifeline to a Battered Town. New York Times. http://www.nytimes.com/2007/05/29/us/nationalspecial/29bridge.html?ex=1338091200&en=24a98c1c1216af01&ei=5088&partner=rssnyt&emc=rss accessed 7/17/2007.

(3) This article seems to convey the ambiguity of the health situation: Wilson, Jennifer F..Health and the Environment after Hurricane Katrina. Annals of Internal Medicine 17 Jan 2006; 144(2):153-156. http://www.annals.org/cgi/content/full/144/2/153 accessed 7/6/07.

(2.) How did the library respond? How did the librarian respond? Were there non-traditional (unusual) roles that the librarian performed?

The first real day back at work (once the library was accessible again), I helped set up a daycare for the hospital employees’ children. It wasn’t a traditional library job, but it was something I could do to help the hospital The daycare was in operation until the schools started up again in October.

I worked with Ethel Madden. We talked about what was needed for the area and what we could do. We identified information access as the biggest need. Perhaps even more than health concerns, people needed telephones and an internet connection to begin reconnecting their families and restoring their homes. We appealed for assistance from the outside once people were allowed into the area to help. The South Central Region (SCR) of the NN/LM started to send out information about disaster recovery, health vulnerabilities, food storage, etc. which was then dispersed through the hospital library. I don’t know if the information was used, but it was gladly accepted by areas like the infection control, emergency room and the immunization center.

By the third week, the hospital internet was operational. I started to send hospital staff links to useful items. I also printed them out and distributed the articles. The library began offering computer access to displaced health providers and the public. Most of my actions were self-initiated or agreed upon with Ethel Madden. At first, the two of us were out of contact with the professional community. So we made the decision to go it alone. The situation was totally outside of anything that we had ever experienced, so we ended up doing many things that were out of the ordinary.

Even though the immediate financial future was uncertain, SEL-AHEC asked me to go to the SCC/MLA conference. There, I talked to other librarians and learned what they were doing. I came away with these pieces of advice for professionals in a disaster situation:

Ø Go in person to the areas where help is needed

Ø Talk to people

Ø Don’t wait for an invitation

The Medical Library Recovery Project was inspired by Ethel with input from Jenny Dagate and me, and funded by NLM and the SCR. We determined what was needed: computers, internet access and training. While we were working on the proposal, Hurricane Rita hit the region. Luckily, it didn’t affect us like Katrina did. We kept working. The proposal went to Renee Bougard and by January we were visiting the sites. We finalized the contact people and made agreements very quickly. By February, we started getting the computers. We hired a soon-to-graduate library school student to teach the classes and began the project. It continued until March 2007.

The Medical Library Recovery Project was so well received that we were invited to organize more classes. After The Medical Library Recovery Project funded a full year of high speed internet access and provided two MedlinePlus classes for The Community Resource Center at Miller Memorial Library in Hammond, they asked for more classes during 2007.

I served the North Shore and Ethel and the Ochsner staff covered the South Shore. They opened two libraries – one in the former Memorial Hospital, newly acquired by Ochsner, and one in Raceland at St. Anne’s. Some of our outreach efforts changed as we determined different needs along the way. Luckily, NN/LM SCR and NLM were very flexible, allowing leeway to revise the plans when needed.

(3.) How has the library (or the services provided) changed as a result of these events?

In general, I am more proactive. The Medical Library Recovery Project was a foot in the door for the library. It opened many places to library services that had never worked with a librarian before. The work enabled me to be more willing to approach hospital/clinic administration. And I was able to include patients and their families more in library services.

I am still working to make contacts with emergency responders. Individuals that worked for emergency agencies and groups passed through the hospital quickly. The relief workers used the computers, but that was about all the contact they had with the library. I later attended a community outreach exhibit in Hammond that included representatives from Red Cross and FEMA. I went to talk to them and handed out brochures with information about NLM’s environmental resources, MedlinePlus, and WISER.

I recently wrote another proposal (which was funded) to conduct outreach to emergency responders.

I received help from other library professionals, including my EBSCO agent Pat Pauletti. Pat provided essential aid by helping us stay connected, find missing issues (mail service was particularly bad during the aftermath). Because of Pat, my libraries are missing only a few issues.

I also received help from several libraries, including the medical library at Harvard Medical School. They had sent new, useful books for use in the emergency shelters. The leftover books made it into hospital libraries that didn’t have much funding for collections.

A hospital in Cambridge, Maryland (part of the Shore Health System) adopted Slidell Memorial Hospital. They sent truckloads of household and personal supplies and even sent people down to help out. The two institutions continue to maintain a relationship.

I spent a lot of time helping displaced health providers. Both hospitals had lots of extra people. Many displaced doctors, medical students, and nursing students needed library reference, computer access and help continuing their studies. Through The Medical Library Recovery Project, I helped put a workstation in the library as a convenient location for these individuals.

I remember a fire in 2000 at the SEL-AHEC headquarters. The library lost everything but the card catalog. At the time, it was the worst thing that could have happened to them us. Katrina was a different kind of loss entirely. The library gained much more in the long run and became more effective. It certainly doesn’t mean that Katrina was a good thing – the entire area still has devastation two years later – but I was able to help in a positive way and to increase the reach of the library. It made a difference to the kinds of services that I could provide and doors opened as a result.

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

There are three major roles that librarians can take: conducting outreach, training, and proposal writing. They can appeal for needed help through their networks and professional connections. I knows from experience that the outreach grants from NLM have made a significant difference, especially by providing opportunities to network with local health providers, hospitals and clinics, By getting to know them, I was better able to predict their needs following this disaster .

Librarians also know which information resources have accurate and reliable sources. And they know the community. As a result, they can accurately decide what is needed and provide it quickly.

In thinking ahead for another hurricane season, I advise other professionals to make sure they have accurate contact information – “real” contact information, which includes relatives and friends and cell phone numbers. The contacts should also include hospital administrators and staff. I also think it is a good idea for hospitals and organizations to set up websites hosted from an outside location and toll-free numbers to provide up to date information for employees.

Here are some pictures submitted by Helen Caruso and Kathy Duplechien, SWLAHEC Librarian, that illustrate the extent of the destruction in Slidell, Louisiana.

Destruction in Slidell, Louisiana

Destruction in Slidell, Louisiana