Hurricane Katrina displaced many cancer patients. A disaster could have a similarly catastrophic effect in Ireland, writes Haydn Shaughnessy
Teresa Knoop wants to speak to Dr Alexander Washington, an oncologist (cancer treatment specialist). Teresa is a nurse. Rosemary is looking for him also. She's a patient. Lisa is looking for Dr Anthony and Harvey wants to find Dr Michael Broussard.
All in their different ways they are victims of Hurricane Katrina but as well as being homeless, patients like Rosemary, Harvey and Lisa are in treatment for cancer.
By displacing tens of thousands of Americans, Hurricane Katrina has interrupted the treatment plans of an incalculable number of cancer patients. Patients, nurses and doctors from across the United States have been desperately trying to make contact with each other since the end of August.
The effect could well be felt for years to come in the medical outcomes of people forced to skip a treatment, or those who have suffered too long a delay between surgery and chemotherapy or between chemotherapy and radiation treatment.
"It's a potentially fatal problem," says consultant oncologist Seamus O'Reilly, of Cork University Hospital.
"Cancer treatments are very sensitive to delay in terms of outcomes. In head and neck cancers, for example, a delay of six weeks in starting treatment increases the risk of cancer returning by three fold. A delay of more than eight weeks can halve survival rates at five years.
Gavin McGuire, head of the national office for emergency planning at the Health Service Executive, says: "Katrina, like any major emergency, absolutely holds lessons for us in Ireland.
"We don't know what those lessons are yet, and it will be some months before the preliminary debriefing takes place."
In the US, doctors were forced into action without a plan. Cancer specialists from the American Society for Clinical Oncology (ASCO) decided to act fast though, as soon as the scale of Katrina became known.
"Pretty much on the Tuesday following the hurricane, we started getting things together," says Dr Joseph Bailes of ASCO who acted as a triage assessor for refugees arriving in Houston, Texas. ASCO set up a bulletin board on the internet for doctors and patients to find each other and began liaising with other cancer agencies
"We also contacted clinics and practices across the country and asked which would be prepared to offer treatment. Pretty much all of them said yes," says Bailes.
Patients who turned up at their new practice typically did so without patient records. ASCO, The National Cancer Institutes and the charity CancerCare set about locating those records or the previous clinician to ensure patients got the right treatment at the right time - two critical care components.
Katrina has signalled a new need to plan effectively for the risk of patient displacement. Disaster plans, whether in response to natural disasters or human-inspired ones, have typically neglected our growing dependence on structured, long-term but time-critical care particularly in cancer care.
"We have better cancer survival rates but that also means patients are in treatment for longer and they are dependent on a wider range of drugs that need to be administered over a longer period of time," says Seamus O'Reilly.
The result is a greater susceptibility to any form of disruption.
In Ireland, where cancer rates are increasing by 1 per cent a year, oncology services are already operating at full capacity and beyond, which begs the question: How would the Irish medical infrastructure respond to a disaster that displaced a substantial portion of the population?
"If, for example, an accident put two or three of the Dublin hospitals out of action, patient records would be a problem," says McGuire, "although significant work is being done in that area."
Nothing seems likely to confront Ireland with a storm on the scale of Katrina. However, the Sellafield nuclear reprocessing plant, we are told, could be a real danger, and the threat from terrorism is unpredictable, while the risk from pandemic illnesses such as Sars remain an unknown, although a contagious pandemic is the most likely threat, according to HSE assessors.
"Any loss of service in cancer care or any additional sudden pressure on existing services will have an impact on outcomes," says O'Reilly, who says he is unaware of any plan to provide alternative oncology services in Cork in the event of an emergency.
The effect of any failure will not be felt immediately. "It'll be five years or even 10 years in breast cancer before we'd start to see the difference in poorer outcomes but in other cancers in two to five years, we'd certainly know about it," says O'Reilly.
Back in Houston, Bailes is confident most patients received treatment in time but the search for patients, doctors and records goes on, five weeks after Katrina and perilously close to the critical six-week barrier.
He says the lessons are already becoming clear: "Most important, electronic records are needed."
Having to recover paper records has clearly added to the logistical nightmare in the Gulf States. "And a register of practices willing to provide emergency treatment. And a system to deal with displacement."
Katrina's legacy looks set to be a long one.