Hoping for the best, preparing for disaster

This past fall, Yale’s School of Public Health introduced a new course on coping with disasters. Earthquakes, hurricanes and volcanoes are on the agenda, as well as famines, wars and epidemics. But the real focus is how to confront the ongoing threat of bioterrorism.

Since September 11, 2001, universities across the nation have been developing public health programs aimed at training students and professionals for future terror attacks and emerging health threats, including anthrax, smallpox and other methods of germ warfare.

Yale’s new course is just a first step toward plans to develop a Yale Center for Bioterrorism and Disease Outbreaks. Such a move would have been unimaginable a few years ago for lack of interest, necessity and—most important—funding. Today, however, public health is under a welcome spotlight, viewed with increasing importance as part of the Bush administration’s goals for homeland security.

Of the government’s $2.9 billion budget for fighting bioterrorism, $20 million was earmarked this year for developing a nationwide disaster response network of academic public health programs linked with state and community health agencies. Already, some 20 universities have received funds from the Centers for Disease Control and Prevention (CDC). In September, the Association of Schools of Public Health, in cooperation with the CDC, approved Yale’s application for a grant to establish a Yale Center for Public Health Preparedness, but has not yet decided whether to award nearly $1 million in funding.

Heading up the Yale initiative is Brian P. Leaderer, M.P.H. ’71, Ph.D. 75, deputy dean of the School of Public Health and vice chair of the Department of Epidemiology and Public Health. Along with other leaders in public health, Leaderer is confident the focus on bioterrorism will spill over into more resources for disaster response in general.

“Bioterrorism looms as a real potential problem,” Leaderer says. “But if you think about it, many of the competency areas in bioterrorism would apply to a large range of public health events.”

In the classroom, students taking “Public Health Management of Disasters” get a broad overview of the practical consequences of disasters at home and overseas. They also learn about the complexities of orchestrating people and agencies that are involved in disasters—the police, the military, hospitals, fire departments, federal investigators, charities, support services, religious groups, families of victims, phone companies, electric companies and the media, to name only a few.

Public health, says course co-director Linda C. Degutis, M.S.N. ’82, Ph.D. ’94, can provide leadership in disaster planning and emergency response. “Who’s where, and what’s everybody doing? Somebody’s got to know,” says Degutis, associate professor of surgery (emergency medicine) and public health. “Who are the players? What are their capabilities? What we’re trying to highlight in the course is how public health can play that coordinating role.”

Degutis, along with David C. Cone, M.D., associate professor of surgery (emergency medicine), tries to get students thinking about disaster relief from all angles. In Florida, for example, how do you handle a large elderly population in the aftermath of a hurricane? How do people dependent on Meals on Wheels get food when the roads are washed out? How do you shelter older, more fragile people in a gymnasium?

Examining the lessons of September 11, for which scientific studies of disaster management of the aftermath are only now being completed or published, Degutis and Cone rely on anecdotal accounts by disaster workers, as well as media accounts such as The New York Times’ detailed reporting on the structural collapse of the Twin Towers.

Guest speakers with nationally recognized expertise supplement lectures by core faculty. One guest, Eric K. Noji, M.D., M.P.H., is an epidemiologist with extensive field experience with disasters such as the Kobe, Japan, earthquake. Recently appointed as a special assistant for homeland security and disaster medicine to the U.S. surgeon general, Noji has been advising public health schools such as Emory’s in starting up public health preparedness centers.

“Public health is a growth industry now for several reasons,” says Noji. “Before, there was no career pathway for faculty; now there is. There was no money to support research; now there is. A lot of things which prevented programs like this are no longer the case.”

Aside from the influx of funds, the other motivation for disaster management education has been student demand. Even before Yale started thinking about a public health preparedness center, Degutis and Cone were planning a disaster course: students, jolted by September 11 and an anthrax fatality close to home in Connecticut, had asked for one.

Neha Vibhakar, 24, a second-year student in environmental health sciences, reorganized her schedule so she could take the disaster management course.

“Hopefully, we won’t have to use it,” said Vibhakar, who plans to study medicine after finishing her public health degree. “But it’s a tool that every doctor needs to have.”