Prepare for the worst.

THE BIGGEST THING THAT STRUCK ME WAS WHO GOT LEFT BEHIND. Before getting to New Orleans, we were pre-stationed in Houston out of the path of the hurricane. We happened to stay at the Sheraton and there we ran into a family from New Orleans. I asked the father, "Are you worried about your home?" and he said not really. They lived in the highlands, and they were going to spend the time at the Sheraton, and when things settled down they would go back. The only inconvenience his children were going to experience was staying in a hotel. When we got to New Orleans, seeing the tens of thousands of people who were so desperate and so trapped--for me to contrast those two experiences is something that I'll never forget.

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We worked the Superdome and the airport. At the airport, we were seeing chronically ill people--diabetes, heart conditions and breathing problems worsened by lack of medications and going through the disaster. We also saw a huge number of frail elderly--I'd say more than 50 percent of our patients at the airport were folks from nursing homes.

The Superdome was like being thrown into hell the whole time we were there. We were only there for 20 hours, but it was the longest 20 hours of my life. What we were seeing were the effects of heat, stress, violence and being deprived of water and food. It began as an orderly shelter operation. At the beginning, they brought in patients who were registered, checked for weapons and given food and water. As the hurricane hit, they lost power. And then when the levees broke, the entire Superdome flooded. We also got an influx of people from the area fleeing the floodwaters. What began as an orderly shelter operation then turned into chaos.

So you had somewhere between 30 thousand and 60 thousand people, about a 110-degree heat, 98 percent humidity, no air movement, overflowing toilets, no running water, and as the influx of evacuees came in they were not being registered or searched. We saw patients like one with a gunshot wound, a couple people who had been beaten up, a paraplegic woman who had been trampled, and people who had been without their meds and without food and water who were just collapsing.

The folks in the Superdome were many different ages, and they were overwhelmingly Black. We also had hundreds of nursing homes patients, and that grouping was racially mixed. I think very clearly what happened with Katrina was that the people who got left behind were the marginalized population of the larger New Orleans area. And among the non-elderly, that was overwhelmingly Black people, but what also really struck home to me was that you lose whatever privilege you might have had when you become elderly.

Medical teams are first responders in a hurricane, where we can be pre-staged. In an earthquake, it would take us 24 to 48 hours to arrive. In terms of what neighborhoods and families can expect, both at the World Trade Center and Katrina, they did not receive orderly federal assistance for days into the disaster. In the less central areas, people should expect that it will be many days before federal assistance will reach them. So the role of neighborhood organizing is extremely important.

I give talks about disaster preparedness, and the standard talk is about bolting your house to its foundation, and setting aside food and certain supplies, and I know many middle-class people go online and buy a kit that's already made and costs anywhere between $60 to a few hundred dollars. When I speak to folks who don't have those kinds of resources, there needs to be a very different message. If you can afford to put aside things, that's excellent, but I would not recommend that a poor family spend their last $60 dollars on a pre-made kit. In very poor neighborhoods, we know people don't have that capability, and they tend to feel very discouraged, as if there's nothing they could do.

Simply knowing your neighbors--who knows some first aid in your building, block or neighborhood, and who needs assistance to get out--this can save a life. Maybe you can't run out and buy those fancy kits, but simply organizing your community can improve your ability to survive.

I think in many ways more organizing and more outreach really needs to go to the poor communities, because that is where people might not have the time or the resources to figure out their family plan. The folks who are homebound or don't have a reliable car or live in more dangerous buildings, they're the ones who really need to hear the messages about things they can do, ways they can get to know their neighborhood and get help, because they will be even more on their own.

The evacuation method in the United States, where you get the notice and it's up to you to get out of town, is based on the premise that everybody has the ability to do that. When it seemed appropriate, I did ask some people why they didn't leave. A lot of people had no reliable vehicle. Is it better to get into your vehicle and get stranded and get hit by the hurricane on the side of the freeway? A lot of people felt they would be safer in their homes, and a lot of them ended up dying. If you are hand-to-mouth every month, you don't have the money to check into a motel halfway out of Louisiana. Unless they had someplace they could go like a relative's house, it's like going to nowhere. A lot of families had sick or elderly family members who wouldn't have survived the trip. A lot of families couldn't transport their whole families--maybe they had one car but too many people. I talked to many families who took the elderly and little kids and left behind people they thought were more likely to survive. Or some families decided if the whole family couldn't go, they would stay together rather than leave.

In the United States, it's the government's responsibility to get out the notice, but it's the individual's responsibility to make themselves safe. For folks who have the resources, that's fine, but for folks who don't, then what we saw in Katrina is what happens. This is the time we can push for more government responsibility, because Katrina raised the question of who has the responsibility to care for people who cannot protect themselves in disasters, and that question is on the table right now.

Barbara Morita has been part of a federal disaster medical team since 1998. She was deployed to Ground Zero of the World Trade Center and to California wildfires as well as Katrina and works on disaster planning with the city of Berkeley, California.

By Barbara Morita, as told to Tram Nguyen

RELATED ARTICLE: DISASTER PREPAREDNESS TIPS

Have a family plan.

Make sure everybody in the family knows where to meet and what to do. As part of my family plan, if I can't get there, then my husband, my sister-in-law and several neighbors are also looking out for my kids. That also applies if you have an elderly person in your home. Family plans are something that anybody can do. Stop and think about who you talk to and who you know that can help you out, and that you will also help them out.

Be familiar with the hazards in your building.

Figure out which stairways look unstable, how to get out if you're on the second floor and where the gas main is so you can turn it off. Look around your building.

Gather basic supplies.

There are some very basic supplies you should have. Most people can set aside some food and water. The water can just be in water jugs and change it every year. A crank flashlight that never runs out of batteries now costs about $10. Try to gather all of the medicines you need. With Medicaid and most HMOs, they won't give you extra supplies, but at least writing down names of your medicines will help when you get assistance later. Put all of these supplies in one place. It could be in a plastic or cardboard box, so if your house or apartment is tossed around, you can still look for that one box.

Know your child's school plan.

If you have children, know their daycare or school plan. And if they don't have a plan, then help to organize one. Also make sure that the daycare knows where you work, and that they will keep your child until you get there or know who they can release your child to.

Plan to be on your own.

The general advice is that you should plan to be on your own for the first 72 hours, but Katrina showed us that in some cases it can be much longer than that. In Mississippi, I talked to people who weeks later had not gotten electricity or water. So depending on where you live, in poor neighborhoods you do need to think of how to get by on your own for a longer time.

By Barbara Morita