Friday, October 9, 2020

Hurricane season: Emotional and psychological disaster preparedness

(Note: This blog post was originally published in July 2019 as Hurricane Barry approached Louisiana. With 2020’s especially active hurricane season, we are sharing it again with updated resources and information on COVID-19 and flu season.)

By DR. JAMES E. HUSSEY | Medical Director, LDH Office of Behavioral Health

Tropical weather in the Gulf this week has us on our toes, ready to spring into action if things get nasty. While here in Louisiana we’re always ready for the possibility of high winds and torrential rains, we usually look to the practical side of things: Did we stock up on food and water? Is the generator ready to go?

Those things are undeniably important, but it’s also a good idea to be prepared mentally and emotionally. Natural events such as a storm can unfold in minutes to hours, yet the feelings and emotions they evoke can linger for weeks, months and even years after.

Psychological preparedness can help you think logically and wisely during and after disasters, helping to keep you physically safe while also weathering the emotional storm.

Disaster-related stress can affect anyone, but some people may be more vulnerable than others. They may include those with disabilities, existing mental health issues, children, the elderly and those who have been previously impacted by floods, hurricanes and other disasters.

Recognizing disaster-related stress

FEMA has some online resources aimed at coping with disaster. First, it is important to be able to recognize signs and symptoms of disaster-related stress, and to seek counseling or assistance. According to FEMA, some symptoms may include:

  • Difficulty communicating thoughts
  • Difficulty sleeping
  • Difficulty maintaining balance in their lives
  • Low threshold of frustration
  • Increased use of drugs/alcohol
  • Limited attention span
  • Poor work performance
  • Headaches/stomach problems
  • Tunnel vision/muffled hearing
  • Colds or flu-like symptoms
  • Disorientation or confusion
  • Difficulty concentrating
  • Reluctance to leave home
  • Depression, sadness
  • Feelings of hopelessness
  • Mood swings and easy bouts of crying
  • Overwhelming guilt and self-doubt

It’s OK to seek help

If disaster-related stress starts wearing you down, it’s perfectly normal and OK to ask for help. Here are some helpful resources:

  • The Keep Calm hotline, 1-866-310-7977, will connect you to trained, compassionate counselors who can offer support and who can direct you to mental health and substance abuse counseling services.
  • The Behavioral Health Recovery Outreach Line, 1-833-333-1132, offers 24/7/365 support for healthcare professionals and recovery support for those with substance use, mental health, mental illness or co-occurring disorders. Qualified support providers will connect you to trained specialists and clinicians in multiple languages.
  • The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year national hotline dedicated to providing immediate crisis counseling for those in emotional distress related to any natural or human-caused disaster.
  • The National Suicide Prevention Lifeline: 1-800-273-TALK.
  • For non-emergencies, check the Office of Behavioral Health directory for local community behavioral health services in Louisiana.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has a Disaster Kit for recovery workers, which includes wallet cards, guides for parents, caregivers, teachers and others. There is also a SAMHSA Disaster App.

Contact your primary care doctor and/or your insurance plan for referrals to behavioral health specialists.

Physical and emotional health

Hurricane season arrives amid the ongoing response to the COVID-19 pandemic and the oncoming flu season. It is just as critical to take care of your physical health as it is your emotional health. 

  • Flu and COVID-19 are respiratory diseases that share the same preventive measures: 
  • Wear a cloth mask or face covering, 
  • Wash your hands with soap and water for 20 seconds,
  • Use hand sanitizer with at least 60% alcohol if soap and water are unavailable, 
  • Cover coughs and sneezes, 
  • Avoid touching your eyes, nose or mouth with unclean hands,
  • Clean and disinfect objects and surfaces regularly,
  • Don’t go out unless necessary,
  • Keep a distance of at least 6 feet between yourself and others, and
  • Stay home if you are sick.

This year, it is more important than ever that you get your flu shot. An individual whose body is already weakened by the flu is likely to be more susceptible to COVID-19. The flu shot lessens the burden of flu illnesses, hospitalizations and deaths, so vaccinating as many people as possible decreases the likelihood of our healthcare system being overwhelmed by both flu and COVID patients.

Flu shots are available at your local clinic, your healthcare provider, most pharmacies or at one of the Department of Health’s upcoming vaccination clinics. 

If you believe you have been exposed to COVID-19, isolate yourself from other people and call your healthcare provider. 

The Louisiana Department of Health’s Fight the Flu website and COVID-19 webpage offer a wealth of guidance, resources and more information.

FEMA also recommends that you take steps to promote your own physical and emotional health and healing by healthy eating, rest, exercise, relaxation and perhaps even meditation. It is important to maintain a normal family routine as much as possible and to lean on your existing support groups of family, friends and religious institutions.

Be prepared

For many people, having a disaster supply kit stocked and a family disaster plan ready is a great comfort. When the storm comes, you’ll be ready to go. For more information, click here.

Monday, September 28, 2020

Recovery Month 2020: No longer 'loitering with the intent to recover'

By DANIEL FREEDMAN | Counselor in Training, St. Christopher’s Addiction Wellness Center of Baton Rouge

My name is Daniel Freedman, I am 28 years old and I am from Baton Rouge. I am a recovered drug addict and alcoholic, and by the grace of God and the program of Alcoholics Anonymous I have been sober since October 15, 2016.

Before that date, I spent several years in and out of recovery with varying degrees of success. As a friend said to me once, I was simply “loitering with the intent to recover” in the rooms of AA. So, what was different about the sobriety that began October 15, 2016 compared to all of the other times I tried to get sober? To get there, I have to tell you a little about how I became addicted.           

I had a normal childhood by all accounts, and I can say without hesitation that my parents did the absolute best they could for me and my older brother. My father is an alcoholic, but he remained sober for the majority of my life. He worked a normal job, had normal hobbies like gardening, and we did normal things like watch LSU football games and yell at the television. My mother is not an alcoholic or addict, and I believe she is as close to a saint as one can be. My brother is a substance abuser, but as he was six years older than me, I didn’t truly see this until I became older.

Alcohol, painkillers and more

My first experience with substances was marijuana at age 13, followed close behind by alcohol, painkillers, benzodiazepines and, honestly, whatever else I could get my hands on. I dealt with anxiety and depression as a kid, and I always had a feeling that I was somehow different from my peers. I justified this feeling as being the only Jewish boy in my school or some other perceived reason I was different. The reality is I was a young boy who had all of the early signs of alcoholism — I have often heard this referred to as the “ism.”

I was irritable and restless, and when I was first introduced to marijuana, all of those issues went away. At 16, I was introduced to Oxycontin, and I distinctly remember where I was that day because I recall lying on a bed after ingesting the pill and thinking, “This is it. I have arrived.” I wanted to feel that way forever. I knew that from that moment on, I would do anything in my power to obtain that feeling.

I can assure you the next six years were anything but fun. I slowly drank and drugged my way out of one high school and into another. I partied my way out of LSU as a freshman and continued to watch opportunities evaporate before my eyes. I was not concerned. I had one moment of insanity which resulted in me living in the Middle East for a year, thinking that Baton Rouge was my problem and I would be fine if I took a “geographical cure.” I was mistaken. I was the problem. I am the problem.

Journey to sobriety

When I got sober for the first time at age 22, I was introduced to AA and actually felt a sense of belonging for the first time in my life. Although I did not remain sober then, I never forgot that feeling and I always knew where to turn if I wanted help. When I became sober this time, the first thing I did was reach out to my AA community. They were just about the only human beings left who were answering my phone calls, and they did not hesitate to help. I was not in a position to enter addiction treatment, instead detoxing on my friend’s sofa in New Orleans. I walked into the rooms of AA still shaking from withdrawals and have not found the need to leave since.

The biggest difference in my life today is that I became desperate enough to actually work the 12 steps of AA and continue working them on a daily basis. I immersed myself in the program and found myself working with others, or practicing the 12th step, very early on in my sobriety. My sponsor at the time was hard on me, saying that if I didn’t want to die I needed to hurry up and help people. He was right.

I found a spiritual relationship with a higher power and I am comfortable calling it God, although I can’t draw you a picture and it’s likely very different than your conception. I pray on a daily basis, meditate most mornings, take daily inventory and try to be mindful of where I have been dishonest, selfish, resentful and afraid. I have made most of my amends but would be lying if I said they were all complete. I work with others as frequently as I can because I still believe that the best way for me to stay sober and alive is for me to give this away.  

In 2017, I was hired by the treatment center that I went through as a recovery advocate. In 2018, I became an addiction counselor in training and was afforded the opportunity to work with addicts and alcoholics in the same building where I was a patient. I have since moved on to another treatment center and I am currently a sophomore at Southeastern Louisiana State University where I am pursuing a degree in social work.

In my addiction, if you would have told me that I would be here today I would not have believed a word of it. If you would have asked me what I wanted out of life at that point, I think I would have sold myself short because the life I am afforded today was not one I could dream of. I have real relationships with people today who I can rely on, and they can genuinely rely on me. I have real opportunities and a genuine desire to help others.

This life is all a result of working the 12 steps of AA to the best of my ability and finding a relationship with a God of my understanding. I wouldn’t trade it for the world.

Tuesday, September 22, 2020

Recovery Month 2020: But for His grace

By LORI STONE | Peer Support Specialist, Louisiana Department of Corrections

On August 10, 1992 the courts made a decision that changed the course of my life forever. I was ordered to stop drinking and taking drugs if I ever wanted to get my three children back from state custody. Honestly, because alcohol and drugs were all I had left in my life, I was pretty reluctant.

When reality set in on that day, I asked myself, “How did I get here?” I had lost my children and my family. I was homeless, embarrassed and spiritually bankrupt. This wasn’t the way my life was supposed to end up.

Growing up, I had everything a child could dream of. I was blessed with a loving, supportive family and I lacked for nothing. I was an honor roll student who was very athletic and had a bright future ahead of me. I had choices.

Any means of escape

When I was 14 years old, I found out I was adopted as a newborn. Instead of being thankful for what I had gained, I became hateful for what I felt had been taken from me. My thoughts, feelings and behaviors changed dramatically. I felt betrayed, confused, angry and unloved, for some strange reason. The hurt was almost unbearable, and I began looking for ways to escape that pain.

At that moment, I began to break the 10 Commandments and our Family’s Golden Rules. In our family you knew what to do, how to do it, why to do it and were taught to just do it because it was said to be done, with no questions asked. There were “do’s” and “don’ts” based on right versus wrong. I began to live life acting out the “don’ts.” Even knowing I was doing wrong, I wouldn’t find out the importance of these basic rules of life until later.

I started hanging around the wrong individuals and the wrong places, and doing things I had no business doing. Those decisions led me to dropping out of school early and, eventually, starting to have children at a young age. My family stuck by me throughout everything, but with their tough love, I knew I wasn’t making the choices they wanted for me.

By the age of 25, I had been raped, discarded into a canal and left for dead. I had been incarcerated, was living on the streets and had almost lost my life during an overdose. I had to bury one of my children because of my addiction and an abusive relationship I was in. I had lost all of my self-respect and dignity as a person. I drank alcohol and did drugs to escape and survive my reality. It was the only way I knew how to cope with my life, which had become unmanageable by the time I stood in that courtroom. I realized I had finally hit bottom and began to ponder how to change. How could I turn my life around?

Learning to be a mother

I decided that I was going to get my kids back first. I didn’t know how to be a mother or a parent, because my adopted mother had raised my children. I realized I had been following the pattern of my biological mother, and I wanted to break the cycle. I hated her for not loving me. I just didn’t understand.

And, I didn’t want my kids to go through what I had gone through.

Under the direction of the courts and the Office of Community Services, I was given provisions, requirements and conditions to help turn my life around. I began to adhere. I was fortunate to get into an amazing halfway house, and I completed the program they set before me. I had to attend AA meetings, parenting classes and counseling for myself and my family. I was drug tested at their discretion and lived by their rules.

As I sobered up and began to feel again, I struggled with the emotions I had numbed for so long. However, I had also been numb and out of tune with the beauty of life and what it had to offer. I still wasn’t thoroughly convinced that I wanted to live a clean and sober life. I was fighting a process that I now realize had already begun.

I completed every class and met every goal that was put before me. Good things started to happen in my life, finally. Most importantly, I got custody of my children back. Eventually, I had a home, a family and a host of new friends. One day I looked into the mirror, and I saw Lori Ann Stone for the first time in a long time. I told her that I loved her and truly meant it.

Living by grace

From that point on, I allowed my wings to spread and I soared by living life on life’s terms. That was the point in my life that I fell in love with Jesus, and that was the best thing to ever happen to me.

I was given an opportunity to be a parent from scratch again, and I now have four wonderful children. I am a very proud grandmother of nine healthy, beautiful children. Today, I’m buying a new house and car. Currently, I’m a peer support specialist who loves to assist and empower others. I also work as a program coordinator who assists persons with disabilities and the disadvantaged in achieving their goals of being self-sufficient.

I’m a survivor — only but for the grace of God — who is taking it one day at a time. Every day, I continue “letting go and letting God.” Just for today, I will strive for progress rather than perfection in all my ways.

I grieve for the many addicts before and after me who didn’t make it, and I try to help everyone I can. I will share my experience, strength and hope, which is my greatest treasure, hoping that my past mistakes don’t become someone else’s future.

Monday, September 14, 2020

Recovery Month 2020: Recovery isn’t just possible — it’s transformational

By KATHERINE PENTON | Certified Peer Support Specialist, Florida Parishes Human Services Authority

I thought I was going to die with a needle in my arm, all alone and empty inside.

I had fully accepted this as my fate because I had tried to quit shooting heroin so many times before and nothing ever seemed to work. When in those dark and hopeless moments of despair, I would often wonder how I got there. In those moments, I could never put my finger on what led me to that place, and it seemed like I was destined to stay there.

Abstinence alone did not work for me. I almost did not make it through my addiction to be able to sit here and tell this to others. If my story can help one suffering addict or change one person’s mind about Medication-Assisted Treatment (MAT), then my pain will all be worth it.

Empty and broken

I remember a time when I was 9 years old and living in the middle of nowhere in Mississippi. I was outside, behind the trailer we had just moved into. I was looking up at the moon, feeling very empty and like something was terribly broken inside. I remember wondering if all other 9-year-olds felt the same. Now, looking back, I realize that the emptiness I would struggle to fill for most of my life started from a very early age. That 9-year-old girl had no idea what the next 25 years of life would bring, or that one day she would be taking any and every substance to try to stop that empty feeling.

A selfie of Katherine
Penton from the years
she was abusing substances

My story of the challenges I faced with addiction is not dissimilar from most other addicts. I was in and out of detox facilities and short-term treatment centers. I even had a few visits to various psychiatric units. I was miserable, hopeless and defeated by the time I was 30 years old. I somehow managed to obtain two college degrees during this time, but my goal of going to graduate school was soon forgotten.

It was difficult for my family and loved ones to understand what was happening to me. I was on the honor roll every year of high school and made straight As my first few years of college. Then, my substance abuse began. I dropped out of graduate school. I isolated myself from everyone I knew and loved. I began living on the streets. I did whatever it took to keep myself numb.

I was miserable and slowly killing myself, physically and spiritually.

Depression and anxiety are a big part of my story. Every time I would decide I was done using and either quit on my own or go to a treatment facility to get clean, once I would get through all of the physical symptoms from detoxification, my mental health challenges would rise up to meet me with a vengeance. The pain and emptiness I felt would bring me to a place of contemplating, and sometimes attempting, suicide. It became a regular occurrence and I knew to expect this every time I would quit using.

I began to associate getting clean with wanting to die, and this became torture to my soul. I was done with using and terrified of what I would become if I continued. But at the same time, I was petrified of what life would be like when I no longer had a substance to put into my body to make my mind stop racing or to make me feel normal.

My only experience with recovery was a time I managed to not use for a few months. I could not leave my house and sometimes even my room. I was overwhelmed with my emotions, and I was having constant cravings and obsessing over using.

True recovery

March 10, 2018 was the day that my recovery began. I did not know at that time that I would be sitting here today, almost 2½ years later, still clean and writing this in the hope that it might help another addict like myself. I could not have predicted that my life would be worth living and that those feelings of being empty and broken would rarely ever occur.

I found out that I was pregnant in January of that year and still could not stop using. I went to the emergency room one night after being in horrible withdrawal and reading that withdrawal could kill a fetus. The ER referred me to an outpatient clinic that had a program for pregnant women who were addicted to opiates. I was placed into the program and prescribed Suboxone as part of the MAT program.

Katherine Penton, in recovery, with her family

I still struggled in the beginning and had to go to treatment for 28 days but when I came out, something was different. I could go about my day without obsessing about using. I could talk about my trauma without being overwhelmed by the need to escape.

I realized that I felt normal for the first time ever as an adult.

I did not want to die, and I did not want to use. I no longer felt that there was a huge hole inside me that needed to be filled with something.

I began to actively participate in my recovery, going to meetings and doing individual therapy. I was able to focus on moving forward and healing from my past traumas. 

Of course, MAT did not fix everything overnight or make all my depression and anxiety go away instantly, but what it did do was allow me to feel relief and to feel balanced. I was able gain some tools and get some recovery under my belt for the first time ever. 

I no longer feel like I want to die.

I now have hope for my future. 

(Katherine Penton now works with people going through the same kinds of challenges she once tried to face alone, and she still can't stop pursuing even more education. Using medication to support her recovery changed the game for her, and has helped her to rebuild her life into something wonderful.)

Friday, September 11, 2020

LDH Staff Spotlight: Masking all y'all

Kelly Smith at her sewing machine


By MINDY FACIANE | Public Information Officer, LDH Bureau of Media and Communications 

Kelly Smith spends her days working as a transition coordinator with the Office of Behavioral Health.

In her off hours, she’s a maestro of masks.

Since March, she has sewn and donated nearly 4,700 handmade cloth masks to help slow the spread of COVID-19.

“I like sewing, and at least I’m doing something kind of useful,” Smith said.

Kelly Smith with two of her masks

That’s an understatement.

When the pandemic broke out in Louisiana in early March, the speed of the virus’s spread created a shortage of critical personal protective equipment. First responders, hospitals, nursing homes and other healthcare providers found themselves rationing, improvising or even reusing the PPE they had on hand, sometimes for days or even weeks

With supplies dwindling, hospitals began turning to commercial retailers and even made appeals to the public to make and donate cloth masks.

Soon, instructional videos and guides were on the internet showing how to make masks at home. One such video caught Smith’s attention.

“This video came up on Facebook, and I looked at it and went, ‘Oh, wow, that is so easy. I can do that,’” Smith said.

She set up her sewing machine and got to work. Her sister, Alyssa Hayes, pitched in by cutting fabric and elastic, handling shipping and maintaining the caffeine supply.

A river of handmade masks began streaming its way from Smith’s home to hospitals, the Louisiana National Guard, military deployments and other places in need.

As Smith sewed, the number of COVID-19 cases continued to rise at an alarming pace. Governor Edwards issued a Stay at Home order on March 22 aimed at flattening the curve. Although cases dropped off initially, a second wave in July prompted the Governor to issue a statewide mask mandate.

With the mandate in place, the need for face masks exploded.

Kelly Smith, right, with sister Alyssa Hayes

“I started off making masks for hospitals and stuff like that, but then pretty much everybody needed them,” Smith said. “People were selling masks on Facebook for $25 apiece. It takes a dollar of materials. It takes 15 minutes per mask. It’s not worth $25 for everybody to do that.”

Masks continued to flow from Smith’s sewing machine to hospitals and others in need. She also set out a big bin in front of her house, which she filled with masks free for the taking for anyone in need.

“People from different states started asking for masks, too,” Smith said.

Smith settled into a routine: Work from 8 a.m. until 4:30 p.m.; sew until around 10:30 p.m.; sleep until 6:30 a.m. the next day; and resume sewing until time to leave for work.

As of September 3, Smith has sewn 4,690 masks — and she’s still going strong.

Her dedication has not gone unnoticed. She said a lot of friends and complete strangers have donated bags of fabric, and some have even donated money toward buying sewing supplies.

“I’ve kept track of everything in a spreadsheet. I didn’t want to profit off anything,” she said.

All she wants is to keep on sewing, masking as many people as she can.

Sunday, September 6, 2020

Recovery Month 2020: Living a live in recovery

By BRENT AMBACHER | STR and LaSOR State Peer Recovery Support Specialist, LDH

(Note: In 2019, Brent Ambacher shared his recovery story in honor of National Recovery Month, observed every September as a time to increase awareness and understanding of mental and substance use disorders and to celebrate the people who recover. The Department of Health is reprinting his story as the state celebrates Recovery Month 2020. Learn about recovery resources in Louisiana here.)

The last time I had a drink — April 29, 2012 — I didn’t even want one. After about 10 days of AA meetings, I’d heard enough to make me decide I was done, and had given up for good (I thought) about 72 hours earlier. The problem was, after 27 years of consistent and ever-increasing drug and alcohol use, my body wasn’t down with this plan. I was unable to hold down food or water, and had started vomiting blood.

Alcohol is one of the few substances that can actually kill you if you stop abruptly. I sort of knew this. I was fully aware that I was a hopeless alcoholic who hadn’t gone a single day without drinking myself to “sleep” in probably 10 years. But I wasn’t able to connect the dots. I was told I needed to go to the emergency department, but the prospect of waiting for hours in that condition was too horrifying to contemplate.


So, instead of my usual vodka intake of more than a liter, I was sitting on my back porch, crying, sweating, shaking uncontrollably and trying to choke down a glass with a mixture of two-thirds beer and one-third honey.

I could not for the life of me understand how this was helpful, but I knew enough to know that I was in serious physical trouble and that a guy with 20 years of sobriety probably knew more than I did about quitting. The drink was his recipe. It took me two hours to get it down, but it worked. How does somebody end up the way I did — 46, jobless, divorced, broke, homeless and staying with my eldest sister?

Struggling to cope

I was a missionary kid who grew up in Hong Kong and moved back there after college. I’d been a successful photographer, journalist, advertising executive and spin doctor. I’d lived on three continents, married a beautiful, smart and talented English woman, spent nine years in London, moved to New York, traveled the world. I was SOMEBODY. But that was just on the surface.

Inside, I was desperately frightened that one of these days, everyone would figure out that I was a fake, with no talent, and that I didn’t deserve anything I had. I had also been struggling with anxiety and depression for as long as I could remember. Drugs and alcohol were my way of trying to cope with feeling like a failure and prop myself up so I could keep impressing everybody else.

I guess I thought if other people loved me enough, I’d be OK.

I wasn’t. I was a pathetic drunk and I was close to death.

Climbing back from the bottom

That was seven years — and an entire lifetime — ago. I had to start over, from the bottom. I delivered auto parts for a while, and then someone suggested I might look into becoming a Peer Recovery Support Specialist. I’d never heard of one, but I gave it a shot. Besides getting sober, it was the most important thing I’d ever done for myself.

I went to work at a treatment center and spent a little over two years helping people like me. Another person suggested I apply for a job that I never would have dared to try for, but they hired me — as the Statewide Peer for the STR Grant, here at the Louisiana Department of Health’s Office of Behavioral Health. Then they asked me if I wanted to try my hand at facilitating Peer Employment Trainings, so I said yes to that, too. I’ve learned that I don’t often know best what it is that I’m supposed to do next, but saying yes is usually the right idea.

I make about a quarter of what I used to. I don’t jet off for the weekend because I feel like it. But in return, I have so much more than money could buy me. I was able to be present and help nurse my father through the last four years of his decline from Parkinson’s and dementia, and I was at his bed when he died. I have a job where I’m allowed to be useful, and where the pain of my past can light a pathway forward for people who are looking for a way out of substance use and mental health challenges. 

And, for the last 2,600-and-something days, I haven’t needed a drink or a drug to be OK with myself. It sure seems like a good trade to me.

Friday, September 4, 2020

Sheltering in a time of COVID: Non-congregate sheltering

By DR. DAVID HOLCOMBE | Region 6 Medical Director, LDH Office of Public Health

Sheltering during a natural disaster has always been a responsibility of the State of Louisiana, in collaboration with a few other entities. General population shelters are opened by the American Red Cross and other private groups. Shelters for those without transportation (Critical Transportation Needs Shelters, or CTNS) and those for people with medical needs (Medical Special Needs Shelters, or MSNS) are provided by the State.

The Megashelter — or more properly, the State Emergency Shelter at Alexandria — was completed near LSU Alexandria in 2010, just in time for Hurricanes Gustav and Ike. At more than 200,000 square feet, this facility can hold up to 3,000 non-medical clients and up to 700 MSNS patients. This elaborate operation involves:

  • Department of Children and Family Services: shelter management
  • Office of Public Health: medical care
  • Louisiana State Police: security
  • Department of Agriculture: pet care
  • Department of Transportation: patient movement
  • Other public and private entities

The Governor of Louisiana, in collaboration with the Governor’s Office of Homeland Security and Emergency Preparedness (GOSHEP), chooses when and how the Megashelter will open. It has been activated in numerous hurricanes including Gustav, Ike, Isaac, Harvey, Barry and, most recently, Laura. It has housed thousands of evacuees over the decade of its existence.

COVID-19 posed a particular problem for the opening of any congregate (group) shelter during Hurricane Laura. This terrible pandemic struck Louisiana with full force during the spring and summer of 2020. In Louisiana alone, we have had more than 150,000 cases and around 5,000 deaths, with some of the highest per capita infection rates in the country. Positivity rates in some regions and even singular parishes exceeded 10% for weeks, indicating high community spread. These rates have only recently begun to decline.

Because over 50% of individuals with COVID have no symptoms at all, the risk of spreading this contagious disease becomes enormous, especially in large groups. To curb this, groups are restricted to 50 or fewer individuals, depending on the size of the facility and whether it is indoors or outdoors. These restrictions severely limit the number of people who can be safely transported and/or placed in any kind of shelter, especially a megashelter.

High rates of community spread and restrictions on group sizes led the State to develop a unique emphasis on non-congregate (no group) sheltering. Evacuees were directed toward reception centers where they received assistance locating available hotel rooms and vouchers to pay for them. This effectively separated family groups from one another and eliminated the need for a massive Critical Transportation Needs Shelter.

The Megashelter was made available for those with special medical needs. Beds in the MSNS were separated by a minimum of 6 feet, and masks were required of all patients and caregivers. A special sub-unit for known symptomatic COVID-19 positive patients contained separate pods where dedicated staff in more comprehensive personal protective equipment could provide care.

This solution redirected the bulk of evacuees to non-medical, non-aggregate locations such as hotels, friends or relatives rather than expose them to the dangers inherent in a group setting. Such flexibility demonstrates how policy and practice remain adaptable to new, challenging circumstances.

Although pandemics are not new, we have not experienced anything similar since the Spanish flu of 1918. Sheltering has also existed in one form or another for centuries. But the two together offer particular challenges requiring creative solutions, which have been demonstrated by the non-congregate sheltering plan developed by Louisiana’s disaster planners.

Friday, August 21, 2020

Q&A with the RMDs: Dr. Joe Kanter

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 1’s Dr. Joe Kanter, Regional Medical Director for the parishes of Jefferson, Orleans, Plaquemines and St. Bernard. He is also the Assistant State Health Officer for the Louisiana Department of Health.

Note: A different version of this post originally appeared on Pages 38-39 of the July/August 2020 Healthcare Journal of New Orleans.

The concerns of the people of this region have changed since the pandemic began. In the early days of our outbreak in Louisiana, what now seems like a distant memory, Louisiana was home to the fastest-growing COVID-19 outbreak in the world, and, by all rational expectations, was headed toward absolute disaster. Late March projections from within LDH, as well as outside experts, forecasted an early April surge of hospital-level COVID-19 patients exceeding existing acute care bed availability by approximately 2,000.

But now, as we are in Phase 2 of our reopening, people are slowly reacquainting themselves with vestiges of their pre-COVID lives. They are venturing back out, but doing so with patience and caution. For example, although they complain, people are wearing masks, not forming crowds in the French Quarter and generally keeping a safe distance from others.


If you recall back to March, April and May, we had thousands of COVID patients who required mechanical ventilation to breathe. In fact, we were projected to exceed ventilator supply by a factor of 2-3. Crisis standards of care were discussed in a manner not seen since Hurricane Katrina. Few of us have ever had ever doubted that quality acute medical care would not be available to us at all times, for any reason.

Yet we watched the experience of Northern Italy — hospitals overfull and turning away patients, long lines of ambulances queued to drop off patients like parents at elementary school — and had every reason to believe we would be there, too.

That, of course, did not happen. Immediate resources were directed toward the rapid expansion of acute care capacity, including the addition of surge capacity within existing hospitals, quick procurement of crucial supplies like mechanical ventilators, and the erection of alternative care facilities like the medical monitoring station at the Ernest N. Morial Convention Center.

This facility was a great example of our ability to be prepared. Luckily, we never had to use it to its full capacity. Today, it is much smaller, but is still serving as a place to care for patients as the need arises.


Early on, our elected leaders made difficult decisions to cancel public events, order aggressive but necessary social distancing measures, and issue calls for the public to stay at home to limit the virus’s spread. Most notably, the people of the greater New Orleans area heeded those calls.

As evidence, highway traffic data and aggregate mobile device location information pointed to widespread adherence to social distancing measures during the peak weeks of the outbreak.

By embracing these recommendations, we were able to flatten the curve and keep hospitals from becoming overwhelmed. This was remarkable, but it was far from a foregone conclusion. Now a national best-practice model, the dramatic change in trajectory in our statewide outbreak was due to data-driven public health measures, good governance, and widespread public cooperation.


Louisiana’s robust emergency preparedness infrastructure proved invaluable to our ability to monitor the outbreak and quickly respond. Significant investment and training in the years since Katrina have yielded several important changes that have enhanced our emergency readiness. These include:

  • A national best-practice hospital tracking system and registry of people who are most at risk,

  • Dedicated medical special needs sheltering plans that can be quickly adapted to a variety of emergency settings, and

  • Well-identified communication pathways between the private sector, municipal and parish governments, and state authorities.

For the pandemic, we were able to build upon this position of strength and preparedness. However, the pandemic also laid bare deep-seated racial inequities in our community.


The racial inequities throughout our region show up in the disparate prevalence of comorbid medical conditions. This results, in part, from the wide variance of social determinants of health across racial lines, and decades of severely limited access to care for marginalized communities. It remains a challenge and a partial explanation of why black Louisianans, less than one-third of Louisiana’s population, constitute nearly 50% of COVID-related deaths.

Widely unequal exposure risks tell more of the story. Black Americans are more likely to be employed in a job considered essential, are less likely to be afforded the ability to perform their job remotely, and are more likely to lack the ability to safely isolate from other family members in their own home.


We have learned from prior disasters that vulnerable people are vulnerable, and our COVID-19 experience is no different. Systemic racism in Louisiana and elsewhere certainly predates COVID-19. We have seen attention drawn to it in the widespread and spontaneous protests demanding accountability for the murder of George Floyd, and the longstanding institutional racism which has allowed for select instances of police brutality to go unaccounted for. We must recognize that poorer outcomes from COVID-19 and poorer outcomes within our societal structure are branches of the same trash tree. It is only by recognizing this as a challenge that we can work together to find solutions.


We can be proud of our COVID-19 response to date in Louisiana and still commit ourselves to working harder, working smarter and addressing longstanding long-standing problems such as racial inequities. 

Of course, we are all working on the issue to the day — such as safely getting children back in learning environments — but we must, step by step, commit ourselves to the hard work of ending the disparate treatment of our fellow citizens. Our communities and our patients demand this of us as healthcare and public health professionals, and it is our obligation to rise to the challenge.

Friday, August 14, 2020

Q&A with the RMDs: Dr. Tina Stefanski

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering many of the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 4’s Dr. Tina Stefanski, Regional Medical Director for the parishes of Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin and Vermilion.


The most common questions now are about the transition back to schools and how they will open again, safely, for teachers and students. We have been assisting public and private schools with their plans to open, reviewing our guidance with local school officials and answering their questions.

These are not just pre-opening conversations, as I fully expect to be having these discussions and addressing questions over the next several months. You have to remember: There is no playbook for this. We must be ready to deal with each new situation as it comes up. Although this will be challenging, we are committed to having schools reopen safely.

What safeguards will be put into place to limit the spread of the virus on school campuses? What is the notification process if a child or faculty does become ill? What are the triggers for quarantining students and, potentially, classes?

It is not just a school-to-parent communication. We need parents to be fully transparent and notify the school if their child is ill and if they have or may have COVID-19. This information will help us and the schools determine if there were any possible exposures in the school setting.

Earlier on, I think people did not fully understand the reasoning behind the wearing of a mask. All of that seems to be improving. It has been great to see the increase in compliance with mask wearing in our Acadiana area since the Governor’s mandate. The people of Acadiana really have responded to this preventive measure, which is encouraging.

When it comes to large gatherings, the news isn’t the same. We still see people gathering in large groups and not maintaining physical distance, especially at social events like weddings and dinner parties. We’ve had more than one report of a guest who becomes ill shortly after attending a wedding. They were contagious at the wedding and inadvertently exposed other people, who then became ill.   

Changing behavior is hard. We have a very friendly, outgoing culture here in Acadiana. The idea of social distancing is very new for all of us, but it is such a critically important piece to slowing down transmission, flattening the curve and, ultimately, saving lives.

When people test positive, feel ill or were a close contact of someone with COVID-19, they must stay home. We really need to do a better job of protecting our friends, family and community. 

A big challenge is getting the message across about the role of asymptomatic spread: people who have COVID but no symptoms, or their symptoms are very mild. They are still contagious. When people don’t feel so bad, they are often reluctant to stay home. Or, they think that their symptoms might be related to something other than COVID. With this virus, there is such a wide range of symptoms and the clinical picture is quite diverse — it really is challenging. Some people may have only a sore throat, mild headache and fatigue. Others, a cough and fever. Still others might only lose their sense of taste or smell.

When you live in a community with such a high level of viral activity — as we have now — you have to suspect COVID when you have any of these atypical symptoms. Then, stay home and monitor your symptoms. If they persist or progress, seek medical attention and testing. But, please remember to stay home while you await your test results.

While staying at home, be sure to avoid close contact with people who have high-risk conditions such as high blood pressure, heart disease, diabetes, obesity or lung problems, or those who are older than 65. Older people are more at risk of becoming severely ill or dying from infection with this virus.

It’s uplifting to hear the stories of people who have had severe cases and are fortunate enough to survive, but it’s also hard to hear of their lingering health problems.

The most upsetting thing has been the loss of life in our communities.

This is ultimately what we, as a community, need to pull together to prevent. We don’t want any other person or their family members to suffer from these sad outcomes.

On a very positive note, we have a tremendous healthcare community in Acadiana. The medical care delivered through our outpatient clinics and hospitals is top-notch. We are incredibly fortunate to the have the resources that we have here in Acadiana.

We have been busy with community-based testing. Our goal is to direct testing to the places where we are seeing higher numbers of cases, elevated positivity and hospitalizations, and to communities where access to testing may be limited. I am still concerned about the slow turnaround times, but they are improving. This is another hopeful sign.

We also remain very focused on nursing homes. As a state, we have implemented routine facility-wide testing. This helps identify cases early on and limit the spread of infection. Nursing home residents are the most vulnerable of us. We are committed to doing all that we can to protect them.

We continue to work with our public officials, medical professionals, community leaders, non-profit organizations and the general public. We are sharing information and answering questions so we all have the tools we need to protect the health of our families and communities. 

We are fortunate to have multiple, active workgroups and healthcare coalitions, well established and extremely helpful communication networks between hospitals, physicians, public health and public officials. This remains a rapidly evolving pandemic — guidance is updated, situations change — and we communicate well and often through these networks.

Friday, July 24, 2020

Q&A with the RMDs: Jeff Toms


To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. These public health leaders are in constant contact with state health officials and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 8’s Jeff Toms, Regional Administrator for the parishes of Caldwell, East Carroll, Franklin, Lincoln, Jackson, Madison, Morehouse, Ouachita, Richland, Tensas, Union and West Carroll.



People have been hearing about the importance of testing so most of the questions I have been getting are about that: Who needs to get tested? Do I need to get tested? How much does it cost to get a test? Where can I get a test? Someone I work with tested positive — what do I need to do?

Relatedly, another question is about the guidance on self-quarantining and when they can return to work after staying at home.  

I do not feel that people fully understand the importance of wearing a mask or social distancing. I hear many people say there are conflicting messages about wearing a mask and the effectiveness of masks. They say they hear different things, even from respectable organizations and trusted leaders.

This is concerning because there really needs to be a consistent message from leaders, whether in public health, business or at the local or state level — study after study shows wearing a mask, especially when done while staying 6 feet away from others and washing your hands often, works.

Personally, I am seeing a decline in both the wearing of masks and in practicing social distancing. It seems there was a drop in following these public health recommendations as restrictions were eased and people began to go out in public.

In the places where people are going more often, they do not seem to be as concerned now, compared to their behavior a month ago, about using a mask or keeping their distance from others.

People either do not know the guidelines, are forgetting to follow the guidelines or are ignoring the guidance altogether. Another challenge is businesses not having the supplies they need, such as masks and gloves, to provide to their employees and to the public. 

Businesses want to accommodate the public, but do so while maintaining social distancing in their businesses, shops and restaurants. This is a challenge as they attempt to operate successfully and safely.

This new normal is frustrating people, based on what I am seeing. The new normal varies for different people and groups. For example, families of a nursing home resident have a different normal than someone who is frustrated because they are missing going to a sporting event. Many of us get frustrated when we can’t express friendliness through a handshake or a hug. And, almost everyone is having to adjust to wearing a mask.

Even though it seems many people are frustrated, it also is encouraging seeing so many people who are doing their part to try to slow the spread of this virus. 

There are too many stories to share. I don’t do social media but my wife does — so during this time I have frequented her Facebook page to read all the encouraging stories of our health heroes in our community. At the same time, there are many, many other stories of people and families who are struggling because of the drastic changes in their lives brought on by this virus. 

I have been so encouraged by the teamwork and partnerships I have seen in this response. So many of our community partners have joined together for this effort.

These partners include the hospitals, clinics, community health centers, nursing homes, parish governments, emergency response agencies at the local and state level, local and state officials, the National Guard, area businesses and so many more who are working together in an inspiring way.

Friday, July 17, 2020

Q&A with the RMDs: Dr. Martha Whyte

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 7’s Dr. Martha Whyte, Regional Medical Director for the parishes of Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine and Webster.


The questions people are asking have to do with: “When will this be over?” They ask about the increase in the number of new cases and why we are seeing these increases. They really thought we were past this — that COVID had ended.

Then, when they hear the news about cases going up, they ask why aren’t people doing more, why aren’t they wearing a mask and why are they crowding into restaurants, stores and bars? They also want to know why so many places allow so many people in at one time. They know to avoid crowds but are looking for someone to enforce the restrictions on the number of people allowed in one place at one time.

And now with the increase in cases, people are asking where to go to get tested. All of a sudden, almost everyone wants a test.


People understand that they are supposed to be wearing a mask, but the act of wearing a mask has become very political. Many people are trying to make a statement by wearing or not wearing a mask.

The requirement to wear a mask when in public is based on recommendations from doctors and experts both in our state and around the world. It is not about politics. Experts have said over and over that wearing a mask and staying 6 feet away from others when in public are actions we can all take to stay safe and help end this pandemic.

It is crazy that some people view something as simple as wearing a mask — while there is an ongoing health risk — as a political statement. I hope that we can get to the point where we all understand that wearing a mask is a small inconvenience that we all can do. It is a selfless act that benefits our loved ones, coworkers and communities. 


I understand that people are tired and ready to get out again and interact with friends and family. However, we need to be smart, and too many people see some businesses reopening as an indication that we are free of the virus.

We need to remember that just because we succeeded in flattening the curve early on does not mean the virus went away. It is still here, it is highly contagious and it is especially dangerous for older people and people of all ages with conditions like diabetes, obesity and hypertension.

It concerns me when I see or hear of people going to crowded places and standing shoulder to shoulder. Close contact is especially dangerous. Not wearing a mask in public is dangerous. Because some of our residents did not follow these precautions, we are seeing a dramatic increase in new cases throughout the state. This is not at all surprising given what we know about how easily this virus spreads.


In our region, it remains a challenge to get people to really understand the current situation — that the virus is still around and it is still dangerous. How do we get people to act on this information and do the right thing when they are so anxious to get out of the house and resume their normal activities?

I find that older people tend to heed public health advice more so than younger people. Those who know they have health issues are cautious about when they go out and where they go. Younger people, perhaps seeing themselves as invincible, or hearing that their peers are not getting too sick, are willing to take a bigger risk.

Of course, this is not unique to COVID. It is part of the mindset of young people when it comes to many things — because they do not think they will get sick, or if they do, it will not be a big deal. The reality is that most of our recent cases are among young people. We also see some young people experiencing serious complications, and what makes that especially troubling is we really don’t know the long-term complications of the virus yet. 


One of my younger friends told me a story about going to a birthday party. When she got to the party, she saw that the place was packed. She looked for a way to judge the airflow, believing it would be safer if there was air movement. Ultimately, she left the party because she didn’t feel comfortable and decided it wasn’t worth it. She did the right thing.

Other people have told me the same thing: places jammed with people shoulder to shoulder, talking loud and laughing. Many restaurants have not removed tables or spaced them farther apart or marked off some areas to limit seating. In some places, even the staff are not all wearing masks.

Businesses are required to protect employees and staff by limiting occupancy, ensuring 6 feet of distance between parties and requiring employees and customers to wear masks, among other measures. If you are concerned or have questions about these requirements, you can 211.

From individuals to businesses to local leaders, we all have to do our part. If we can all do what is needed, we can reduce the number of cases, reduce the number of deaths and better protect everyone’s health. 


I was very saddened to hear about a couple who recently got married. No one wore a mask and the guests were all close to each other. Both the husband and wife got the virus and they had to cancel their honeymoon. That’s how they started their new life together. What should have been the best time of their lives instead started with each of them being sick.

We have all read the stories about other families where one person gets sick and dies. Too often, the person didn’t even have the risk factors. People think that because they are healthy, they won’t get sick.

My husband was sick from the virus and was in the hospital for almost two months. He was in isolation, but he could see whenever someone in the hospital died and their body was rolled out past his room. He was dismayed and saddened each time he saw this. 


Our biggest challenge is how to re-engage people, how to convince them that we’re not out of the woods. I don’t know the answer, but we are developing public service announcements using prominent voices from our communities, hoping that people will respond and wear a mask when it is being promoted by people they know or trust.

I am also concerned about our rural areas. We don’t have many cases in these less-populated areas, but we are seeing some cases. I worry that people who live farther away from one another are not as aware of the risks as they need to be.