Lessons learned from Katrina, 9/11, SARS, and other disasters
SHUTE: Sounds like it.
Dr. Franz, tell me about how your experiences in Iraq, then, have helped you prepare for the kind of things you were trying to do for Katrina?
FRANZ: Well, I think the main lesson learned in Iraq was that the Iraqi healthcare system was mainly mandated to be a public-health-based system. There wasn't much curiosity in the minds of Iraqis that if they became ill, what their health system was. It was basically a state-mandated system.
And with all of the brokenness of that system and all of the difficulties that sometimes we might point to in terms of a government-mandated healthcare system, nevertheless there wasn't a whole lot of curiosity on any particular day how healthcare needs were going to be affected in Iraq.
My mission, as public health team leader with the Civil Affairs Battalion in Mosul, Nineveh Province, and Kurdistan, was to try to support and augment and reconstruct as necessary the healthcare system. But as large as that task would seem, I basically had one official I could go to who represented the needs of that – of the Nineveh Province, which is 5 1/2 million. There was a designated public health official. He had the mandate to come up with the plans, the missions, the decision making, and so there was a chain of command on the civilian side that we were trying to help, that we could do planning and business.
One of the difficulties – and this is nothing different in Region Four in Louisiana, where we primarily worked with Minnesota Lifeline, which is the – the headquarters was at Lafayette, or if we were in New Orleans, or if we were in Rochester, Minnesota where the Mayo Clinic is. Unfortunately, it's a fact of life – it's no criticism, but it's a fact of life that public health care services and public health infrastructure has been, to a large part, minimalized in our medical infrastructure.
In Minnesota, which statistically has the No. 1 or No. 2 public health infrastructure in the United States, I'm still not certain on any particular day what services I would get from the public health system if the traditional system, so to speak, would break down. And so I think that looking at the two experiences in Iraq, as we looked at reconstructing their healthcare system through all that they had been through, it was relatively focused on where the funding and where the help needed to go – to their public health system because that represented Iraqis.
What was difficult in this operation in Louisiana was certainly the fact that some of the – as wonderful as the healthcare facilities were and are in New Orleans, when they become affected directly by a disaster, the safety net under them in terms of a public health service, through no fault of their own, didn't exist. And our main mission, then, in Region Four, as we started our relief operations – went into Baton Rouge to speak with Dr. Aaron Brewer, who was the chief public health officer in command at the time, and she had been displaced from New Orleans – was to get from her what she felt was in the best interest of relief operations, and her suggestion to us and her mandate to us was to go to Region Four where there was a lot of displaced people and try to reconstruct and reopen public health facilities, which really had not been able to provide primary care services for over ten years. That was going to be our major mission. What it should look like at the end of our mission was that we had some viability to a public healthcare system that could start taking care of displaced people.
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