Recovering from Disaster: NewPublicHealth Q&A with NJ Health Commissioner Mary O’Dowd

Jul 9, 2013, 11:24 AM

file Mary O'Dowd, NJ State Health Commissioner

NewPublicHealth has been conducting a series of interviews with health directors impacted by weather disasters this year. Last month marked the official start of hurricane season in the Atlantic. We recently spoke with Mary O’Dowd, health commissioner of New Jersey, which is continuing its recovery and rebuilding after Hurricane Sandy last fall.

>>Read our interview with Oklahoma Health Commissioner Terry Cline on the tornadoes that struck Oklahoma this summer.

NewPublicHealth: How far along are you in the recovery process?

Mary O’Dowd: One of the things that we’ve learned is that recovery takes years not months when you’re dealing with a disaster of the proportion that Superstorm Sandy was for New Jersey. I would say that we’ve made significant progress. Some communities have very little signs of Sandy left, others are still working to rebuild a significant amount of their property and they’re still in the process of demolition of damaged buildings and properties. Great strides have been made, much progress has already occurred, but there still is a lot of work yet to be done.

NPH: What are some of the public health endeavors you’re still engaged in for the response?

Watch a video about the public health response to Hurricane Sandy featuringing Mary O'Dowd and other public health officials

Mary O’Dowd: We’ve gotten a lot of very positive feedback for our education activities around public health issues. For example, one of the things that we’ve been concerned about has been flooding damage of homes and property and potential mold growth as a result. We’ve done a significant amount of public awareness including radio public service announcements and a guide for home and business owners on decision making around mold remediation. And for those who need additional information, we have a partnership with the School of Public Health of New Jersey to provide free training for those doing the work themselves, as well as local public health and building code officials who are involved in the inspection and enforcement to ensure that remediation is done properly. So far, we’ve provided free training to over 400 people throughout the state and that’s an ongoing process.

Shortly after the storm and continuing since then I also conducted roundtable discussions in four of the most impacted counties — Monmouth, Ocean, Hudson and Bergen — to bring together the partners that respond to health care and public health emergencies. Having this discussion about what they each learned, what they experienced from the storm itself and our collective response, gave us some intelligence on what the state could do better in the future, as well as the individual communities local leadership and local organizations. So whether it’s the hospitals, the nursing home, the local or county Office of Emergency Management, the public health official or the EMS community, they were all working together and all learned from this experience in different ways. It was a really good opportunity to have that open, honest dialogue on how to be better prepared and improve in the future.

NPH: What has happened to people who could not return to their homes or couldn’t afford to rebuild?

Mary O’Dowd: There are still a number of individuals who continue to be displaced because their homes were so significantly damaged. From a public health perspective, we’ve tried to provide resources such as our health care directory for individuals who are now living in a new community.

In terms of homes, there are a number of programs that the administration has put forward both in concert with the federal government and independently.

  • One program allows individuals with very low income to move out of the FEMA transitional sheltering assistance housing and into more permanent housing. That has allowed them to take that next step towards their own recovery.
  • New Jersey Stronger makes $780 million in grants available to homeowners impacted by the storm. The concept is to encourage homeowners to resettle in their primary residences and reconstruct or rehabilitate or elevate their homes based on new standards.
  • The Buyout Program, coordinated with State Department of Environmental Protection and the State Office of Emergency Management along with FEMA, and allows the state to purchase homes that have been damaged by routine tidal flooding. This will allow for more green space and open space, but also allow individuals to resettle into a new location because they’ve just had so much damage, sometimes more than once.

NPH: Often after a disaster, mental health issues begin or they intensify for some people. How are you addressing that in New Jersey?

Mary O’Dowd: Very early on, the Department of Human Services, the Department of Children and Families, and the Department of Health were working collectively at the state level to identify and address the issues of emotional and mental health. There were hotlines available, and we had individuals visiting the shelters to look at how children (a vulnerable population in a shelter in particular) were being managed, and the Department of Children and Families took a leadership role in that. We have been focusing on mental health through the transition from shelters to temporary housing and even now in the general population, using case management and existing support programs. We’re also working with the health care community to ensure that health professionals are appropriately referring individuals who present with a health care problem but may have an underlying mental health, substance abuse or domestic violence issue.

And we know from academic research after previous disasters that we’re now in the second wave where we would anticipate seeing increases in domestic violence, substance abuse and mental health issues and so it remains a very high priority to make sure that we are providing resources and support.

NPH: What have you been able to share with other communities in terms of disaster preparedness given your education on the ground with Superstorm Sandy?

Mary O’Dowd: I have been working with the Association of State and Territorial Health Officers (ASTHO) to share some of the lessons in the immediate response activities, as well as the recovery. One of the big lessons learned is that recovery is much bigger and broader than you normally plan for and expect. Usually disasters are shorter and you think of recovery as getting the lights back on, making sure any evacuated facilities are back and running a normal operation. This experience is so much bigger and more dramatic that the recovery is going to be measured in years, not in days or even months.

I’ve also reached out to my counterpart, Dr. Terry Cline, in Oklahoma after the tornadoes there to let them know that we are thinking of them and to offer any type of support. One of the things that was so helpful to me was the outreach and support of my colleagues across the country knowing that there were people out there that could be supportive to me if I asked for help.

We also used federal assets for the first time such as Disaster Medical Assistance teams to support the medical needs in general population shelters, as well as medical need shelters that were stood up for the first time here in New Jersey.

We activated some requests in advance of the storm having learned how much we needed certain supports after Hurricane Irene. For Superstorm Sandy we had 135 ambulances and their teams from five different states to support our activities and that was very important that we had had those assets here before the storm because in several communities we lost equipment in the flooding so there was not only the increased need for EMS but we had less capacity.

In addition, I think that some of the other lessons learned were that the extraordinary loss of power and fuel in New Jersey as a result of the storm demanded that we think about those resources in a different way for the health care and public health system. And so we set up systems to prioritize fuel delivery to hospitals that were out of power.

NPH: What are lessons you can share with residents in advance of another disaster?

Mary O’Dowd: We found that people often didn’t bring enough supply of their medication and now we will recommend that they consider bringing a week or two worth of their prescription medications because one of the biggest needs we identified in shelters and at hospital emergency departments subsequent to the storm were people coming in just for prescription refills.

In addition we had a huge spike in injury and illness as a result of carbon monoxide poisoning because people weren’t using their generators properly. We even had a few deaths. These are things that could have been avoided. So part of our preparing for this year’s hurricane season [which runs June 1 through November 30] is that we’ve incorporated those messages into our communications to the community: make sure you’re trying out how to use those generators now in a safe way, educate yourself now on how to use them safely, and prepare an evacuation bag with sufficient supplies of medications.

Another important issue is lead exposure. In New Jersey and in many other parts of the country, we have an older housing stock and lead and other environmental hazards such as asbestos are exposed with the demolition of homes during the storm or afterwards when damaged homes are demolished. The Department of Health and DEP are working very closely to try to make sure that all that demolition is done in a safe way so that there isn’t an additional exposure to environmental hazards. In addition, we’re working with health care providers, pediatricians in particular, to remind them of the importance of screening for lead exposure and poisoning in children. There’s some research out of Louisiana that says that because of the demolition of property after Hurricane Katrina, that there was additional exposure to lead and we all know about the implications for brain development in children if there is lead exposure. We want to make sure we’re preventing exposure whenever possible and that we’re doing surveillance so that we may pick up any additional exposure that may occur and intervene quickly as possible.

NPH:  Is there any research or data being analyzed as part of determining lessons learned?

Mary O’Dowd: We are working with a number of academic institutions to evaluate some of the public health impacts of the storm, as well as building more resiliency into our communities—to identify what makes one community more resilient than another so that you know that you’re better prepared into the future for any particular event.

NPH:  How better prepared do you feel you are for the next disaster?

Mary O’Dowd: I think that there are always going to be ever changing dynamics and you have to maintain that situational awareness. Unless you experience it and go through it, it’s very hard to really appreciate how dynamic it truly is. And how long. The length of time you drill for an event, is maybe a day or two. But the stamina, the will, the thinking, the depth of what the recovery has been from Superstorm Sandy has really challenged all of us both in the health care and public health arenas to really think in a totally different way because of the dynamics of this event. I think a lot of that would be applicable to any emergency that has potential longstanding ramifications.

Even talking with my colleagues in Connecticut, subsequent to the shooting at the school there, the long-term impact of what that means to that community is something that you really need to think about in terms of years not in terms of days or weeks or months.

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This commentary originally appeared on the RWJF New Public Health blog.