Sick people couldn’t get their medicine. There...

Sick people couldn’t get their medicine. There weren’t enough doctors and nurses to staff emergency clinics. The frail died in evacuee shelters because there was no one to care for them.

Some of the worst problems to afflict residents of the hurricane-battered Gulf Coast occurred when the public health system broke down.

Dr. Jonathan Fielding, director of public health for Los Angeles County, went to New Orleans and saw conditions firsthand, helping Louisiana officials by day and sleeping at night on dining chairs in a hotel ballroom. Upon returning to Los Angeles, he spoke to The Times.

Question: What does a community lose when disaster breaks down the public health system?

Answer: Some of the large benefits of public health are the invisible ones: the fact that the air is cleaner, the fact that the food is pure when you buy something in the supermarket. You expect the water to be potable. You expect that there is a toilet to flush and somewhere to take a shower and somewhere for the water to go, and you expect that there aren’t going to be terrible environmental toxins belching up into the air like lead or mercury. You also assume that the garbage won’t be piling up and you won’t have animals and a lot of other vectors feeding on it. These are the things you have to come back to in something like Katrina.

Q: What were your main concerns as people began to return?

A: When [New Orleans Mayor Ray] Nagin was talking about people coming back in, it raised a number of public health issues, like what was going to happen to the sewage. One of the treatment plants was under water. One option was pumping out the manholes. Or cutting pipes that [led to] the submerged sewage treatment plant and letting it go right into the river. Before the sewage treatment plants are working, those are the options you have. Or you put out porta-potties and hope people will use them....

A core public health and safety issue is the inherent habitability of the structures. You don’t want people trying to climb up stairs that collapse.

Q: Was there a threat of contagious disease?

A: One of the key issues from a public health standpoint was that some wrong information got propagated. People would have thought, listening to some media, that there were epidemics of typhoid and cholera, that the water was so toxic that you took your life in your hand if you touched it , and none of that was true. The water was filthy and it had high rates of E. coli and high rates of coliform. It wasn’t potable. But it’s not like you’re walking in sulfuric acid....

We have people all over the country in these evacuee camps, and we need to make sure we’re looking at ... communicable disease risks. For example, I think they wound up with [staph infections in some of the shelters]. You want to treat it before it becomes more serious. There are people who may have tuberculosis. New Orleans has one of the highest rates of undiagnosed HIV. You also want to make sure there’s hygiene.

Q: What do you see as the biggest long-term health issue?

A: Mental health. It’s terrible that so many people die -- but for every person who dies, there are going to be a hundred or more who are going to have some kind of issues psychologically as a result of all of this mental, and in some cases physical, trauma. So letting people know ... that if you feel guilty or angry or frustrated, if you tend to be more emotionally mobile, those are not unusual feelings. And also then finding the small percentage of these people that need direct mental health services, and getting those services up and running -- that’s really very, very important.

Q: Medical records were damaged in the flooding; will that be a significant problem?

A: If there ever were an argument for an electronic medical record that’s stored centrally, this is it. You have people who have chronic medical conditions -- it’s a broad issue in itself. But if there was a place that people could give you their PIN number and you could find, you know, “What has this diabetic been taking?” and “What are their prior problems?” Or this asthmatic, or this patient with congestive heart failure -- that would be a great boon.

In New Orleans, all the records were lost. But even in the absence of a medical record, you need to have the systems in place to help people who don’t have medication, who don’t necessarily know what their chronic diseases are. They know they were taking a bunch of pills -- especially elderly people who are confused. You have to be able to provide care not just for the emergencies but for all these people who are vulnerable.

Q: Even when doctors knew what patients needed, wasn’t it hard getting enough drugs distributed?

A: You have to have backup pharmacy supplies. You have to have a route to get things to people that are the common medications that people rely on. And that’s something that has to be part of the overall plan. Now, of course, another piece of that is you have to make sure that as many people as possible have stocked up on the right kinds of supplies -- one of the critical areas of supplies that we [recommend] is that people have several days of medication in addition to nonperishable food and water....

If people needed medication and none was available, I wouldn’t have any problem with saying we’re just going to buy whatever’s needed [at the county level]. We’re going to do whatever’s necessary to keep them alive and keep them on necessary medicine. That’s part of the public health response. But it’s really more a question of supply rather than price. How do you make sure that you have sources of supply? And have you thought of these things ahead of time?

Q: Some ill and infirm residents of New Orleans never made it out. If disaster struck here, would we see the same problem?

A: People who need help with evacuation aren’t just the ones in hospitals and nursing homes. When you have a lot of people who are very limited in their mobility, they may also be limited in their communication. One of the things that’s very important here is to try and figure out -- and I don’t know exactly how to do this -- kind of a neighborhood approach. In a number of cases you saw that somebody went next door and got the person in the wheelchair out. You need to have that sense of community and neighborhood and people caring for each other.... It reinforces for me the importance of having things almost down to the block and neighborhood level in terms of people being aware of who may need help.

Q: What’s the toughest lesson for Southern California?

A: The other issue here to which there is no answer is that you tax and overwhelm our hospital capacity.

Let’s say you had a pandemic flu. How many ventilators are there? It is unrealistic that we can plan that we’re going to have enough here. So then it’s the issue of making sure there’s mutual aid, making sure that we drill together with other counties. Even that may not be enough. We have state and we have federal resources. We need to make sure we have close cooperation.