Ready or not?

The somewhat less than optimal emergency management performance in the Hurrican Katrina disaster last year got the attention of state officials, at least here in the People's Republic. I attended a meeting yesterday sponsored by our state Department of Public Health, where supposedly knowledgeable persons such as YT were asked to make recommendations about emergency preparedness for so-called "Special Populations."

As far as I can decode the concept, you're considered special if you might for one reason or another present problems for the authorities which are somehow different from the problems posed by affluent, healthy, anglophone Euro-American men between the ages of 18 and 55 who are news junkies, trust authority, and always keep their Escalade's full of gas. (Only the lack of an Escalade makes me special, but I do own a functional pickup truck.) However, some populations are more special than others, and we did focus on the specialest.

Specifically, the special folks who I purport to know something about include people with limited English ability; people with serious mental disorders; people with other chronic diseases or disabilities, cognitive or physical; people with substance abuse problems; socially marginalized and very poor people including homeless people; undocumented immigrants; cultural minorities; and all the possible combinations and permutations of the above. To oversimplify a bit, the problems these special folks might pose in case of a public health emergency (e.g., contaminated water, an infectious disease epidemic, widespread radiological or chemical contamination) or natural disaster or, I suppose, war or terrorist attack, include:

1. Not getting critical information being broadcast to the public -- where to go, what to do -- because of not understanding English and/or not monitoring broadcast media;
   
2. Inability to comply with instructions due to, for example, lack of transportation (viz. New Orleans), disability, lack of other resources (e.g., money to buy emergency supplies), etc.
   
3. Unwillingness to comply for cultural reasons, mistrust of the authorities, fear of deportation or other consequences;
   
4. Difficulty in communicating with individuals directly at shelters or emergency dispensing or decontamination sites due to language, cultural or cognitive barriers;
   
5. Specific needs for medication, mental health services, or other supports which are disrupted in a disaster;
   
6. Cultural requirements, ethnic conflicts, behavioral problems or privacy needs which might arise in a shelter or evacuee situation (we aren't supposed to say refugee for some reason).

It's good that they are thinking about these problems. They all came up in New Orleans, and everybody wants to do better next time. But it turns out that while there are various specific plans and resources authorities can put in place to address some of these problems, there is one major concept that makes most of the difference.

Emergency preparedness and response are primarily the responsibility of local authorities. Counties, in those states that have strong county government, and cities in towns. In New England, we don't have much in the way of county government, so it all comes down to the towns, including very small towns. If cities and towns expect to be able to respond effectively to the needs of their special populations, they need to start talking with the people, in two-way conversations, ahead of time.

In other words, the Board of Health in East Boysenberry needs to find out who lives in or is present in the town -- be it Somalis, Hmong, Mayans, Uruguyans, Nigerians, Pakistanis, or the insular community of Believers in the Second Coming of Christ in the Person of Henrietta Glockmyer, residents of a therapeutic community, or migrant agricultural workers from Central America and Jamaica who are in town to pick the Boysenberries in October. They have to learn what languages those people speak, what channels of communication exist to reach them, what organizations exist in their communities-- whether formal community based organizations, religious congregations, sport or social clubs -- and what their resources may be, and what special needs they may have. They have to include all those people in planning, and make them part of the communal life and political process in East Boysenberry, before the excrement hits the ventilator.

Can we do that, in most of this country, especially in the current climate of nativism and cultural hegemonism? We'll see.