May 9 2011
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Faces of Public Health: Donald Williamson, M.D., State Health Officer of Alabama

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Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe. Today’s profile features Donald Williamson, State Health Officer of Alabama.

Late last month violent storms hit the southern and Mid-Atlantic states, killing and injuring hundreds and leaving a wave of destruction that will take months or more to clean up. Power outages, tainted water and rubble, among other hazards, pose health risks throughout the region.

NewPublicHealth spoke with Donald Williamson, M.D., Alabama’s State Health Officer, to ask about the public health challenges and response to the disaster.

NPH: Can you tell us the current situation in your state?

Dr. Williamson: Well, it’s obviously a challenging time for thousands of Alabamians and the public health community. The tornadoes had a huge impact on our state and they came at a time when we were already facing severe economic and fiscal challenges and I think this is only going to make things worse.

NPH: How different were these storms than ones you typically see?

Dr. Williamson: What was atypical was both the number of tornadoes and the severity. I’ve lived in the south my entire life and having tornadoes in the spring is not at all unexpected. It is the time of year when we have some of our most violent weather. What was most troubling I think about this outbreak was the widespread nature of the event, the strength of the tornadoes, and the fact that some of these tornadoes were on the ground for over sixty miles. I had the opportunity earlier in the week to go and visit with some of our staff working on the response team and to see some of the damage. I’ve never seen destruction like this, both in terms of its local severity as well as the geographic dispersion.

NPH: What have you learned this time around that might better prepare you for the next disaster?

Dr. Williamson: I think you learn that there’s always a disaster that you haven’t anticipated. For us last year, it was the oil spill. Hurricanes, yes, we see those. Ice storms in the northern part of the state, we see those. Tornadoes, we see those. But an oil spill was frankly outside of our usual expected disaster response and it resulted in us having to think about things in a different way.

The same thing here is true with these recent tornadoes. I think we’ve already learned that there will be issues that come up that are going to be unique and novel to each event. For example, an issue that has really taken a lot of time over the weekend was arranging oxygen supplies for patients. Most of those individuals are on oxygen concentrators which require electricity. Because of the nature of the storm, we had large sections of our state without power and if you’re without power, you obviously don’t have a way to run an oxygen concentrator.

And we’ve learned from previous disasters that anytime people are displaced, some of them are going to have lost their access to medication. So we already had a system in place to activate a voucher system to pay for medication for people who have lost their prescription drugs. We already had drafted orders to allow pharmacies to refill medication without a prescription, based just on a medication model.

With every disaster, there is a slightly different twist. Take out of every disaster a little something new so that you use that to enhance your response for the next disaster.

NPH: I see that on your website, you have a great deal of information disaster preparation and aftermath. What are some additional cautions that you’re thinking of either adding to the website or bringing to the community?

Dr. Williamson: I think one of the things that I was struck by was that some of our assumptions about how to survive tornadoes were based on the idea that being in an interior closet in your home was the safest location--and it certainly is--but what we saw with storms of this magnitude is that being in a brick structure or in an interior closet, but above ground, was absolutely no guarantee of survival.

And another very important thing we saw was that many children showed up in the emergency room with head injuries. One of the things that we’ll probably do going forward is to begin advocating that parents have bike helmets for their children to use in such a disaster, and for adults as well. That will probably be a help in decreasing the incidents of head injuries associated with falling debris.

NPH: You’ve talked about that fact that you’re in the middle of budget cuts. Is it possible that the cost of this clean-up could impact other services?

Dr. Williamson: I think there’s no doubt that there’s a cost associated with this--and we haven’t yet received additional Federal money. A lot of this will be paid for by FEMA, but there’s still both a state and a local community cost associated with some of this. So, we’ve taken the position that we’re going to do the right things, spend the dollars we need to spend, and we’ll bill FEMA for the things we can bill FEMA and the Federal Government for. But there will still be some uncovered costs.

NPH: Such as?

Dr. Williamson: Well, for example, on those medication vouchers, or the oxygen for patients, we probably won’t recoup ten to twenty-five percent. There’s certainly the likelihood that if there is less money available, there will be things we have to look at downstream that we simply will not be able to do going forward. If you have reduced resources, then you have to adjust your program to the dollars that are available.

NPH: What are some novel services your public health department has delivered very specific to this disaster?

Dr. Williamson: One of the things that we’ve seen is that hospitals have all those patients that sustain trauma and normally, after two or three days, they would be discharged to their home. Unfortunately, many of these people no longer have a home to go to, so one of the things that we’re doing is we’ve set up medical needs shelters and we are providing much more intensive services in these than we would in a conventional shelter. I’m using our public health nurses and our staff to do these sorts of things.

Another example is that unfortunately, large numbers of first responders and volunteers doing clean-up haven’t had their tetanus shot in the last ten years. And, so in order to expedite getting these people vaccinated, we’ve sent teams out to work sites and to volunteer reception areas to offer vaccines on site instead of making folks have to come to health departments or to get vaccinated at a physician’s office Hopefully, by doing that we reduce the likelihood we’ll have health problems associated with the clean-up and also keep workers from having to leave their posts.

Previous Faces of Public Health: Danielle Varda, Assistant Professor at the School of Public Affairs, University of Colorado Denver.

Tags: Disasters, Faces of Public Health, Preparedness, State government